Objective To compare the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LS + ED) versus open splenectomy and esophagogastric devascularization (OS + ED) in treating portal hypertension using Meta-analysis.Methods Controlled trials comparing LS + ED and OS + ED in treating portal hypertension were electronically searched from Wan Fang Data Knowledge Service Platform,Medalink,CNKI,PubMed,Elsevier,SpringerLink and CBM disc.The most recent search was conducted in April 2015.All the relevant data and references were retrieved and screened.RevMan 5.2 was used for data analysis.Results Eventually,7 randomized controlled trials (RCTs) or high-quality case-controlled studies involving 468 patients were included into this study.Meta-analysis showed LS reduced blood loss [WMD =214.67,95％ CI 198.74-230.60,P ＜ 0.01],shortened flatus time [WMD =17.72,95％ CI 12.39-23.04,P ＜ 0.01] and postoperative hospital stay [WMD =3.75,95％ CI 3.28-4.23,P ＜ 0.01],while the duration of surgery was shorter in OS (P ＞ 0.05).However,OS was comparable with LS in complication rates.Conclusions Comparing with OS,LS had the advantages of reducing intraoperative blood loss and shortening recovery time after operation.In patients with cirrhosis,portal hypertension and esophageal varices,laparoscopic splenectomy was safe and effective.

Objective To evaluate laparoscopic radical resection of liver hydatid cyst as compared with conventional open surgery.Methods From May 2006 to January 2013 clinical data of 41 patients undergoing laparoscopic radical resection of hepatic hydatid cyst were compared with those 112 cases treated by open surgery.Operation time,blood loss,conversion rate,length of hospitalization and recurrence rate were compared and analyzed.Results There was not statistical significant difference in operative time and blood loss between the two groups (t =1.97,P ＞ 0.05) (t =2.00,P ＞ 0.05).Five laparoscopic patients were converted to open surgery,conversion rate was 12.2 ％ (5/41),three due to inadequate exposure,and two for intraoperative bleeding.Postoperative hospital stay was significantly shorter in laparoscopic group than that in conventional group.The overall morbidity was 4.9％ (2/41) in laparoscopic and 16.0％ (18/112) in conventional group with statistical significance(x2 =3.92,P ＜ 0.05).Recurrence rate and mortality was 0 in both groups.Conclusions Laparoscopic radical resection of hydatid cyst is safe and effective in carefully selected patients and provides short hospital stay,good cosmetic result,fast recovery and fewer complications.

Objective To systematically evaluate the storage effect and transplant outcomes of University of Wisconsin (UW) preservation solution and histidine-tryptophan-ketoglutarate (HTK) preservation solution on liver allografts.Methods Literatures were researched using PubMed,Embase (1980-),Ovid Medline (1948-),The Cochrane Library,Wanfang database,VIP database from the database establishement to October 2015 with the key words including organ preservation,storage solutions,Histidine-tryptophan-ketoglutarate or HTK,custodial,bretschneider,University of Wisconsin,UW solution,viaspan,cardiosol,belzer solution,hepatic transplantation,liver transplantation,viscera transplantation,liver grafts,hepatic grafts,liver allografts,hepatic allografts,器官移植,器官保存液,UW,HTK,肝移植and比较.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients using UW and HTK preservation solutions were respectively allocated into the UW group and HTK group.Count data were represented as the odds ratio (OR) and measurement data were represented as the standardized mean difference (SMD) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven literatures were retrieved,and the total sample size were 34 475 patients including 25 248 in the UW group and 9 227 in the HTK group.The results of Meta analysis showed that there were no statistically significant differences in the primary transplants nonfunction,retransplant rate and 1-year grafts overall survival rate between the 2 groups (OR =1.18,0.84,0.97,1.02,95％ CI:0.55-2.57,0.47-1.50,0.66-1.42,0.66-1.58,P ＞0.05).There were also no statistically significant differences in the levels of alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil) at postoperative day 1 between the 2 groups (SMD =-0.19,-O.30,0.30,95％ CI:-0.62-0.23,-0.70-0.10,-0.01-0.61,P ＞0.05).There were no statistically significant differences in the postoperative prothrombin time(PT) and alkaline phosphatase(ALP) between the 2 groups (P ＞0.05) and in the incidence of postoperative biliary complications between the 2 groups (OR =1.49,95％ CI:0.97-2.30,P ＞ 0.05).Conclusion There is similar storage effect between UW and HTK preservation solutions on liver allografts,and no difference in the transplant outcomes.

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.

To investigate the safety and efficacy of capsular tension ring ( CTR ) insertion combined with phacoemulsification and intraocular lens ( lOL ) implantation in patient with pseudoexfoliation syndrome after anti-glaucoma surgery.
●METHODS: A retrospective study was conducted of 10 eyes from 10 cataract patients with pseudoexfoliation syndrome following trabeculectomy surgery, and who underwent CTR insertion combined with phacoemulsification and lOL implantation between January, 2012 and June, 2013. All cases had nuclear cataracts ( nuclear hardness Ⅱ 1 eye, nuclear hardnessⅢ 4 eyes, nuclear hardness Ⅳ 5 eyes). One case with Ⅳ nuclear hardness cataract had iridodonesis and lens subluxation. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, lOL position, and postoperative intraocular pressure ( lOP) were assessed. Follow-ups ranged from 3 to 14mo. The t test was used to analyze the variables studied.
●RESULTS: All patients had a successful CTR insertion combined with phacoemulsification and lOL implantation. A modified CTR insertion was performed in one case, the others underwent a standard CTR insertion. The best corrected visual acuity ( BCVA) was≥0. 5 in 3 eyes and 0. 3-<0. 5 in 2 eyes. However, BCVA was ≤0. 1 in 5 eyes. No decentration and dislocation of lOL was found during follow - up. Optic atrophy of different level could be found in all cases. The mean lOP was 16. 78±2. 48mmHg before surgery. And the average lOP is 16. 01±2. 33mmHg at 3mo postoperative (t= 1. 9955, P>0. 05). The most common intrao- and post-operative complications were corneal edema, small pupil, residual cortex, spontaneous zonular dialysis.
● CONCLUSlON: Suitable CTR insertion in appropriate occasion may be beneficial to patients with pseudoexfoliation syndrome after trabeculectomy during cataract surgery. lt prevents the lOL decentration and decrease the surgical complication. Less complication occurs at the early stage.

The occurrence and development of hepatic ischemia-reperfusion injury (HIR) has important clinical significance,while interleukin-6 (IL-6) is closely related to HIR and it plays an important role in the signaling pathway between downstream signal transducer and activator of transcription 3 (STAT3).IL-6 has been considered to be a typical proinflammatory cytokine.Activation of the gpl30 homodimer by IL-6 leads to the initiation of Janus kinase (JAK)-STAT path-way that is often constitutively switched on in inflammatory diseases.However,a plethora of studies in the last decade showed that only signaling via the soluble IL-6R (trans-signaling) accounts for the deleterious effects of IL-6,whereas the signaling via the membrane-bound receptor (classic signaling) is essential for the regenerative and anti-inflammatory effects of IL-6.In this paper,the latest progresses in the research field of the IL-6/STAT3 signaling pathway in HIR is discussed.

OBJECTIVE:To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis. METHODS:By searching PubMed,Cochrane Library,EMbase,CNKI,WanFang and VIP databases,18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria.Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data.The incidences of vertebral fracture,non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed. RESULTS:A total of 18 randomized controlled studies were included,of which 10 were of medium and high quality and 8 were of low quality.Meta-analysis results showed that the fracture incidence in the teriparatide group[risk ratio(RR)=0.56,95%confidence interval(CI):0.48-0.66,P＜0.000 01]was lower than that in the bisphosphonate group,and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis(RR=0.50,95%CI:0.35-0.69,P＜0.000 1)and other bisphosphonates(RR=0.58,95%CI:0.49-0.70,P＜0.000 01).During the follow-up over 18 months,teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis(RR=0.56,95%CI:0.48-0.69,P＜0.000 01).In addition,we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures(RR=0.48,95%CI:0.37-0.62,P＜0.000 01)and non-vertebral fractures(RR=0.63,95%CI:0.51-0.78,P＜0.000 1)in postmenopausal women with osteoporosis.Teriparatide was superior to bisphosphonates in increasing lumbar bone density[odds ratio=4.16,95%CI:2.96-5.36,P＜0.000 1)and femoral neck bone density(odds ratio=1.02,95%CI:0.04-2.01,P=0.04).There was no significant difference in adverse reactions between teriparatide and bisphosphonates(RR=0.95,95%CI:0.85,1.06,P=0.37). CONCLUSION:Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis,but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar.Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term(＜18 months)or long-term(≥18 months)use.

BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.

BACKGROUND:Studies have shown that good bone cement distribution during percutaneous vertebroplasty reduces postoperative secondary vertebral fractures and helps improve prognosis.However,how to get a good distribution of bone cement is a problem for spine surgeons. OBJECTIVE:To analyze the correlation of bone cement distribution with surgical and adjacent vertebral refractures after percutaneous vertebroplasty. METHODS:A total of 193 patients with thoracolumbar compression fracture(≤2 fractured vertebrae)admitted to Xinjiang Uygur Autonomous Region Orthopedic Hospital from January 2018 to December 2022 were selected.They underwent percutaneous vertebroplasty via unilateral approach and were followed up after surgery.They were divided into fracture group(n=30)and non-fracture group(n=163)based on whether the surgical and adjacent vertebral fractures were observed during the follow-up period(more than 6 months).The basic data of the two groups were analyzed by univariate analysis.Statistically significant factors were replaced with binary logistic regression model to explore the correlation with recompression fracture of surgical and adjacent vertebrae after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference between the two groups in gender,body mass index,menopause age of female patients,bone cement dose,previous history,smoking history,drinking history,operation segment,operation time,and hospital stay(P>0.05).There were significant differences in age,bone mineral density T value,bone cement leakage,and bone cement distribution between the two groups(P<0.05).(2)Binary logistic regression analysis showed that age(95%CI:1.016-1.167,P=0.016),bone cement leakage(95%CI:0.080-0.582,P=0.002),bone mineral density T value(95%CI:1.214-22.602,P=0.026),and bone cement distribution(P=0.007)were risk factors for recurrent fractures after percutaneous vertebroplasty and adjacent vertebroplasty.Patients with type I bone cement distribution(which did not touch the upper and lower endplates of the vertebral body)had a higher risk of recurrent fractures of surgical and adjacent vertebrae after percutaneous vertebroplasty.(3)The results of this study show that refracture of surgical and adjacent vertebrae is caused by the interaction of various risk factors.Age,bone cement leakage,T value of bone mineral density and bone cement distribution are independent risk factors for surgical and adjacent vertebral refracture.Refracture of surgical and adjacent vertebrae can easily occur when bone cement is distributed type I.