Objective:To investigate the predictors of rebleeding three months after treatment of esophageal and gastric variceal bleeding (EGVB) in patients with hepatitis B cirrhosis and the effects of different treatments on rebleeding.Methods:From January 2018 to January 2020, the hepatitis B cirrhosis patients with first onset of EGVB in the First Hospital of Lanzhou University were enrolled and followed up for three months. The development of rebleeding, information about portal vein flow velocity and model for end-stage liver disease (MELD) scores after treatment of first bleeding were collected. The statistical analysis was conducted by chi-square test and binary logistic regression analysis. The efficacy for predictors of rebleeding was evaluated by using area under the receiver operating characteristic curve.Results:Among the 33 patients with the first EGVB, the rebleeding rate during three months follow-up was 42% (14 cases), including one patient (1/8) who underwent transjugular intrahepatic portosystemic shunt, 10 patients (10/19) were treated with therapeutic endoscopy, and three patients (3/6) were treated with vasoactive drugs. No statistically significant difference in rebleeding rates was found among the three treatment groups ( χ2=3.853, P=0.175). Portal vein flow velocity after treatment for the first onset of EGVB (odds ratio ( OR)=0.21, 95% confidence interval ( CI) 0.05 to 0.93, P=0.039) and MELD score ( OR=1.53, 95% CI 1.02 to 2.30, P=0.040) were independent predictors for the occurrence of rebleeding events during three months. When the portal vein flow velocity after treatment for the first bleeding was 19 cm/s, the area under the receiver operating characteristic curve for prediction of the occurrence of rebleeding during three months was 0.86, with the sensitivity of 92% and the specificity of 61%. Conclusion:Among the patients with hepatitis B cirrhosis and the first onset of EGVB, different treatments may have little relationship with three-month rebleeding, while portal vein flow velocity ≤19 cm/s is the main predictor for rebleeding within three months.

Objective To explore the effect of the use of flap transplantation combined with Masquelet tech-nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March,2013 to March,2016,13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm,while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection:3 cases of Staphylococcus aureus(including 1 MRSA),2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi-otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled.After 8-12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic-impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat-ment exclusive of the case with MRSA.As the condition of the patient with MRSA relapse,we changed to convention-al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique. All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4-6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently.

Coronary Angiography ; Fractional Flow Reserve, Myocardial ; physiology ; Humans ; Renal Artery Obstruction ; physiopathology