ObjectiveTo study the feasibility,safety and effect of laparoscopic splenectomy and selective pericardial devascularization in the treatment of portal hypertension.MethodsThis study included 7 patients diagnosed as posthepatitie cirrhosis and portal hypertension with a history of up GI bleeding receiving laparoscopic splenectomy and selective pericardial devascularization.ResultsThe operation was successful in all 7 patients without conversion to laparotomy.There were no postoperative severe complications.The average operation time was 4.2 h,mean blood loss was 430 ml.All patients recovered well,and were followed-up for 0.5 ～ 2.0 years,and there was no rebleeding in this period.ConclusionsLaparoscopic selective pericardial devascularization is feasible,safe,minimally invasive.The short to mid term result was satisfactory.

Objectives To investigate the role of laminin (LM) and fibronectin (FN) in the growth cycle of human hair follicles. Methods The expression of LM and FN was detected by streptavidin-peroxidase (SP) staining. Results In the anagen phase, LM was expressed in dermal papilla, basement membrane and outer root sheath; FN was expressed in dermal papilla, basement membrane and connective tissue sheath. In the catagen phase, LM showed a lower expression in the dermal papilla and a linear expression in the basement membrane; the expression of FN in the dermal papilla and basement membrane was less intense than that in anagen phase, but was still positive. In the telogen phase, LM was only expressed in the basement membrane while FN was negative. Conclusion The difference between LM and FN expression in hair growth cycle indicates that LM and FN may play important roles in the regulation of human hair follicle growth cycl.

Objective: To investigate the characteristics of fall injuries among primary and middle school students in Yinzhou District, Ningbo City, Zhejiang Province from 2010 to 2022, so as to provide insights into prevention and control of fall injuries among primary and middle school students. Methods: Data of 6 to 17 year-old primary and middle school students with initial diagnosis of fall injury from 2010 to 2022 were collected through Injury Subsystem of Zhejiang Provincial Chronic Disease Surveillance Information Management System. The time, place, activity and clinical characteristics of fall injury were analyzed using a descriptive method. Results: Totally 7 808 fall injury cases among primary and middle school students were reported in Yinzhou District from 2010 to 2022, accounting for 45.72% of the total injury cases in the same age. There were 5 413 boys and 2 395 girls, with a boy/girl ratio of 2.26∶1. Primary school students were the majority, accounting for 55.10%. The incidence of fall injuries among girls, junior high school students and high school students showed increasing trends from 2012 to 2022 (both P<0.05). The primary peak of fall injury was from September to November, and the secondary peak was from May to July, with 4 510 cases (57.76%). The place of fall injury development mainly included schools (2 680 cases, 34.32%), homes (2 343 cases, 30.01%) and streets/urban areas (2 247 cases, 28.78%). The activities at the time of fall injury mainly included leisure time (3 490 cases, 44.70%), sports (2 861 cases, 36.64%) and school activities (1 094 cases, 14.01%). Soft tissue injury was the main characteristics (6 224 cases, 79.71%). Lower limbs (3 101 cases, 39.72%), head (2 419 cases, 30.98%) and upper limbs (1 974 cases, 25.28%) were the main injury sites. Mild injury was predominant (5 896 cases, 75.51%). Conclusions Boys and primary school students are high-risk groups of fall injury in Yinzhou District, schools are high-risk places of fall injury. Schools should be regarded as key intervention places and health education on fall injury prevention should be strengthened.

Objective: To analyze the association between latent class of health-risk behaviors and depressive symptoms among middle school students, so as to provide the evidence for the prevention and intervention of depressive symptoms among middle school students. Methods: Students in two junior high schools, two senior high schools and one vocational high school in Yinzhou District, Ningbo City, Zhejiang Province, were selected using a stratified multi-stage cluster sampling method. Demography and health-risk behaviors were collected using questionnaire surveys, depressive symptoms were investigated using the Center for Epidemiological Studies Depression-10 Scale, and latent class analysis was conducted for health-risk behaviors. The association between different latent classes and depressive symptoms was analyzed using a multivariable logistic regression model. Results: A total of 1 247 students were surveyed, including 641 boys (51.40%) and 606 girls (48.60%). There were 452 junior high school students (36.25%), 532 high school students (42.66%) and 263 vocational high school students (21.09%). Latent class analysis showed that health-risk behaviors in students were classified into three groups, namely healthy behavior group (52.93%), poor diet group (39.94%) and high-risk behavior group (7.14%), and the detection rates of depressive symptoms were 7.12%, 18.88% and 52.81%, respectively, with a statistically significant difference between groups (P<0.05). Multivariable logistic regression analysis showed that after adjusting for age, gender, native place, only child and living on campus, the poor diet group (OR=3.107, 95%CI: 2.086-4.627) and high-risk behavior group (OR=15.401, 95%CI: 9.031-26.262) had higher risks of depressive symptoms compared with the healthy behavior group. Conclusion Having high-risk behaviors and poor diet may increase the risk of developing depressive symptoms among middle school students.

Objective To investigate the location and proliferation of human hair follicle stem cells. Methods The expression of keratin 19(K19) in the human hair follicles on the occiput was detected by immunohistochemical staining, and the positive area was located. The follicle epithelium containing the K19-positive area above the hair bulb were cultured with or without mesenchymes (dermal papilla cells, DPCs) at the air-liquid interface of the collagen gel. When the proliferating colonies formed, the distance from the colony to the bottom of hair follicles was measured and the relationship between the K19-positive position and the proliferation colonies was analyzed. The ultrastructure of the proliferation colony was observed by transmission electron microscopy. Results Two portions were found positive for K19 in the outer root sheath of the human hair follicles, the upper one being at the bulge region and the lower one at the outer root sheath above the hair bulb. The proliferating colony formed only when the epithelium of the hair follicle was co-cultured with mesenchymes cells. The statistical analysis suggested the lower portion positive for K19 and the proliferation colonies in the culture were traced to locate at the same site of the human hair follicles. Under electron microscopy, juvenile cells, mature keratinocytes and apoptotic cells were found in the proliferating colonies. Conclusions The human hair follicles may contain two distinct reservoirs for stem cells, which locate in the bulge area and in the region of the outer root sheath above the hair bulb, respectively. Mesenchymes are needed for the proliferation of stem cells. New stem cells, mature keratinocytes and apoptotic cells may be three endings of the stem cells′ proliferation.

Objective To evaluate clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug-resistant Acinetobacter baumannii (DRAB).Methods 12 patients with DRAB intracranial infection admitted in a department of neurosurgery between January 2014 and April 2015 were analyzed retrospectively,clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of DRAB intracranial infection were evaluated.Results After patients received tigecycline combined with cefoperazone/sulbactam for 12-62 days (39.5 days on average), clinical symptoms and signs (including body temperature,signs of meningeal irritation)of most patients were significantly improved compared with before treat-ment,3 cases were cured,5 were markedly effective,4 abandoned or ineffective(death).The overall effective rate was 66.67%(8/12),mortality was 33.33% (4/12);bacterial clearance rate of cerebrospinal fluid (CSF)was 83.33%(10/12).Causes of death:2 were with failure of brain stem following craniocerebral trauma,1was extensive parenchymal infection,1was recurrence of intracranial infection and formation of brain abscess after withdrawing an-timicrobial agents.No significant adverse reaction occurred during the treatment period.Conclusion On the basis of keeping CSF drainage unobstructed,long course treatment of tigecycline combined with cefoperazone/sulbactam can effectively eliminate DRAB from CSF,and has a good safety.

Objective To evaluate comprehensive therapy in the treatment of keloid effect and the patients' satisfaction.Methods From 2002 to 2015,a total of 523 patients with comprehensive treatment,according to the treatment the patients were divided into group A (surgery combined radiotherapy group) and group B (operation with corticosteroid hormone therapy group),group C (corticosteroids in combination with radiotherapy group),and the therapeutic effect of patients with satisfaction was evaluate.Results Total effective rate of three groups of patients were 85.7％,84.0％,64.9％;the efficiency in group A was higher than that of group B and group C;there was statistically significant difference between group A and C (P＜0.05),but there were no significant difference between the group A and group B (P＞0.05).All the patients were follow up for one years and the adverse reaction in the three groups was slight and happened in the 2 month after cure.And the adverse reaction was all self-cure in the final follow up.Difference was statistically significant between three groups of patients' satisfaction,group B better than in group A and group C;there was no significant difference between group A and group B (P＞0.05);the difference between group B and C group was statistically significant (P＜0.05).Conclusions Three kinds of comprehensive therapy effect are obvious,among which surgical adjuvant radiotherapy effect is best,being worth to recommend for clinical use.

Objective To explore the outcomes of open reduction and internal fixation ( ORIF ) with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal os-teoarthritis ( OA ) . Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36. 1 years ( from 19 to 54 years ) . According to the Quenu-Kuss classifica-tion, 5 patients had type-A injury, 10 type-B injury ( 4 cases of type-B1 and 6 ones of type-B2 ) , and 13 type-C injury ( 8 cases of type-C1 and 5 ones of type-C2 ) . The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society ( AOFAS ) midfoot scores and visual analog scale ( VAS ) at final follow-ups. Results The mean duration of follow-up was 29. 9 months ( from 26 to 72 months ) . AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82. 1％. The mean VAS score was 2. 8. Radiographic evidence of OA was noted in 20 patients ( 71. 4％, 20/28 ) , in 18 of whom ( 90. 0％) symp-tomatic OA was observed. There was no significant difference ( P=0. 399 ) in the incidence of symptomatic OA either between the patients with anatomic reduction ( 60. 9％, 14/23 ) and those without anatomical re-duction ( 80. 0％, 4/5 ) . Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or re-duction quality.

Objective To compare the minimally invasive sinus tarsi approach and lateral intensive L-shaped approach in the therapeutic effects concerning medial wall reduction and calcaneal alignment for cal-caneal fractures. Methods A retrospective analysis was conducted of the 52 patients with calcaneal fracture who had been treated at Department of Foot & Ankle Surgery, Guangzhou Orthopaedic Hospital from January 2010 to December 2014. They were 39 men and 13 women, 28 to 46 years of age ( average, 40.4 years ). Of them, 26 were treated via the sinus tarsi approach ( minimally invasive group ) and the other 26 via the con-ventional lateral extensile L-shaped approach ( conventional group ) . X-ray axial films of the calcaneus were taken pre-operatively and post-operatively to evaluate the medial wall reduction and calcaneal alignment. The American Orthopedic Foot Ankle Society ( AOFAS ) ankle-hindfoot scale was adopted to assess the therapeutic effects. Results The average follow-up period for this cohort was 18 months ( from 12 to 24 months). The post-operative varus angle was 7.41°± 5.17°for the minimally invasive group and 8.01°± 5.33°for the con-ventional group; the correction of varus angle was 6.60°± 6.23°for the minimally invasive group and 8.57°± 6.64°for the conventional group; the good to excellent rate of medial wall reduction was 42.3% ( 11/26 ) for the minimally invasive group and 53.8% ( 14/26 ) for the conventional group; the AOFAS score was 89.5 ± 7.0 for the minimally invasive group and 86.2 ± 8.2 for the conventional group. There were no statistically signifi-cant differences between the 2 groups in all the above comparisons ( P ＞ 0.05 ). Conclusion The mini-mally invasive sinus tarsi approach can be a fine choice for treatment of calcaneal fractures, because it leads to no differences in medial wall reduction, postoperative varus angle and postoperative correction of varus angle, compared with the conventional lateral extensile L-shaped approach.

Objective To analyze the deep venous thrombosis(DVT)after plasma infusion in a patient with congenital dysfibrinogene-mia(CD),and explore the relationship between the CD and DVT.Methods The clinical data were collected and the pedigree was investigated(3 subjects of 2 generations in total).The relevant indexes of coagulation factors of the patient and her family members were detected.The genomic DNA of peripheral blood was extracted for PCR amplification.All the exons,flanking sequences,5'and 3'untranslated regions of FGA,FGB and FGG genes of fibrinogen(Fg)of the patient were analyzed by direct sequencing.The corre-sponding mutation site was subjected to sequence in the other members of this family.The PyMol software was used to construct the pro-tein model before and after gene mutation.Results The patient was admitted to hospital for hysteromyomectomy.DVT appeared in 3 days after surgery.The prothrombin time(PT),thrombin time(TT),Fg activity(Fg∶C)and Fg antigen(Fg∶Ag)of the patient was 14.9 s,33.3 s,0.94 g/L and 2.10 g/L,respectively.The above four indicators in her mother were 14.7 s,32.8 s,0.97 g/L and 2.35 g/L,respectively.Gene sequencing revealed that both the patient and her mother had a heterozygous missense mutation c.2185G＞A(p.Glu729Lys)in exon 6 of the FGA gene.The protein model analysis demonstrated that p.Glu729Lys mutation changed the amino acid side chain and reduced the number of hydrogen bonds originally formed with Arg854.Conclusion A heterozygous missense mutation c.2185G＞A(NM_000508)in exon 6 of the FGA gene should be responsible for the low fibrinogen level in this pedigree,which might be the main reason for DVT after plasma infusion in this patient.