Objective To study trabeculectomy with adjustable sutures on the ocular function score in pa-tients with angle-closure glaucoma .Methods 98 cases ( 134 eyes ) were randomly divided into the two groups , the control group(n=49 cases,66 eyes) and the observation group (n=49 cases,68 eyes).The patients in the control group were operated through trabeculectomy ,while the patients in the observation group were operated through trabe-culectomy with adjustable sutures .The occurrence of the two groups of patients intraocular pressure changes , and recovery of sight,shallow anterior chamber before and after surgery three months were observed .Postoperative 1d,3d, 1m and 3m ocular function score were compared .Results Postoperative 3 months IOP were significantly lower ( t=3.921,5.746,all P<0.01),and compared with the control group ,the observation group significantly decreased (t=2.680,P<0.05).Postoperative 3 months visual acuity significantly improved in patients (t=2.460,2.976,all P<0.05),and compared with the control group,the observation group improved more significantly (t =2.062,P <0.05).The incidence of postoperative shallow anterior chamber were 12.1% in the control group and 2.9% in the observation group Shallow anterior chamber in observation group was significantly less than that in the control group (χ2 =7.98,P<0.01).The two groups of patients after ocular surface scores were decreased in the observation group after 1d,3d,1m and 3m and ocular scores were lower than that of the control group ( t =2.1901,2.680,3.172, 3.013,all P<0.05).Conclusion Trabeculectomy with adjustable sutures can promote the recovery of angle-closure glaucoma,ocular function.

Objective To explore the relationship between long chain non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and prognosis of hepatocellular carcinoma, and to provide evidence for perioperative treatment. Methods One hundred and twenty five samples from patients with hepatocellular carcinoma treated in Tianjin Unite Medicine Center Hospital during June 2008 to June 2014 were collected in this study. The expression of MALAT1 was detected by using real-time quantitative PCR (RT-qPCR). The relationship between MALAT1 expression level and prognosis of patients with hepatectomy was analyzed. The risk factors affecting the prognosis of patients were determined. Results The expression level of MALAT1 was significantly higher in hepatocellular carcinoma samples (P<0.05). There was no relationship between the expression of MALAT1 with age, hepatitis B history, cirrhosis history, tumor size, tumor number, tumor TNM stage, vascular invasion, pathological differentiation and preoperative alpha-fetoprotein (AFP) level (P>0.05). The survival rate was calculated with Kaplan-Meier method. The overall 1-, 3-and 5-year survival rates in low level MALAT1 group were 85.9%, 55.2% and 33.8%. The overall 1-, 3- and 5-year survival rates in high level MALAT1 group were 66.0%, 34.6%and 3.9%, respectively. There was significant difference in survival rate between the two groups (P<0.01). The multivariate COX regression model analysis showed that the independent risk factors for postoperative survival rate in patients with hepatocellular carcinoma included tumor vascular invasion (RR=3.055, 95%CI:1.986-4.053, P<0.01) and over expression of MALAT1 (RR=2.918, 95%CI:1.736-3.672, P<0.01). Conclusion Long chain non-coding RNA MALAT1 is a novel tumor marker for prognosis of hepatectomy in patients with hepatocellular carcinoma, which can be used for preoperative and postoperative evaluation in patients with hepatocellular carcinoma.

ObjectiveTo study the clinical features of the bilateral frontal brain contusion with cerebral hernia center and its treatment strategies. MethodsThe clinical data of 76 patients with cerebral central hernia were restropectively analyzed. ResultsIn 76 patients,there were 53 cases survive,23 cases died.The life and survival quality of these patients were evaluated according to the Karnofsky scale systerm :46 patients underwent surgery,including 35 cases with good recovery,8 cases with long-term coma or unable to look after themselves,3 cases with death;10 cases underwent a expectant treatment,of which,6 cases with good recovery,4 cases with long-term coma or unable to look after themselves.The other 20 cases died of central brain stem failure,with a central hernia when admissioned. ConclusionPatients with bilateral frontal brain contusion were extremely complicated with central hernia,and had a suddenly deteriored condition.Close observation of changes were critical importance.The surgery should be carried out before "diencephalon period",for most recovery well after surgery.Patients with diffuse brain swelling should go under the depressioning surgery as earlier as possible.

Objective To investigate the risk factors of cerebral hemorrhage in hypertensive intracerebral hemorrhage,and to provide a reference for clinical treatment.Methods The clinical data of 118 patients with hyper-tensive cerebral hemorrhage treated in our hospital were analyzed retrospectively.The clinical data of patients was col-lected and statistical analysis was carried out,and the risk factors of edema around the hematoma were analyzed by Logistic regression analysis.Results Multivariate non conditional logistic regression analysis showed that,the course of hypertensive cerebral hemorrhage of edema around the hematoma was the risk factor,the longer the duration,the more risk of hypertensive cerebral hemorrhage edema around the hematoma enlargement.There was no significant correlation between sex,age,bleeding site,broken into ventricles and the edema around the hematoma in hypertensive intracerebral hemorrhage.Diastolic blood pressure was a risk factor for the edema around the hematoma in hypertensive cerebral hemorrhage,the diastolic blood pressure control was not good,and the swelling of the edema around the hema-toma was increasing.While the systolic blood pressure,pulse pressure difference and hypertensive cerebral hemorrhage hematoma around the hematoma showed no obvious correlation.Use of amlodipine and vascular tension angiotensin converting enzyme inhibitor in hypertensive cerebral hemorrhage were the protective factors of edema around the hematoma, early application of amlodipine,vascular and nervous angiotensin converting enzyme inhibitor to control blood pressure helped to reduce hypertensive cerebral hemorrhage edema around the hematoma volume.Conclusion Amlodipine and vascular tension angiotensin converting enzyme inhibitors help to reduce hypertensive cerebral hemorrhage edema around the hematoma volume,while long course,poor control of diastolic blood pressure can promote hypertension cerebral hemorrhage edema around the hematoma volume increase.We should pay attention to the development of hypertensive cerebral hemorrhage and the control of diastolic blood pressure,as soon as possible to stabilize the patient's condition and avoid the expansion of the volume of edema around the hematoma.

Objective:To study the use of digital subtraction angiography (DSA) guided transnasal ileus tube placement in management of abdominal compartment syndrome (ACS) after liver transplantation.Methods:From January 2015 to December 2019, a total of 30 patients who developed ACS after liver transplantation who were admitted to the Transplantation Intensive Care Unit of Tianjin First Central Hospital were retrospectively studied. According to the way of decompression, these patients were divided into the study group and the control group. Patients in the control group were treated with conventional abdominal decompression, while patients in the study group were treated with DSA guided transnasal ileus tube placement based on management principles developed in conventional abdominal decompression. Changes in intra-abdominal pressure, treatment efficacy rates and liver functions were monitored in the two groups up to 7 days after abdominal decompression.Results:There were 23 males and 7 females, aged (53.4±11.6) years. After treatment, the IAP, portal venous blood flow velocity, bile drainage volume, ALT and AST in the study group were significantly better when compared with the findings before treatment: [IAP: (7.13±3.87) vs (22.73±2.09) mmHg, portal vein blood flow velocity: (34.76±10.31) vs (21.45±6.47) cm/s, bile drainage volume: (198.43±19.94) vs (80.72±9.52) ml/d, ALT: (158.92±67.56) vs (278.73±99.17) U/L, AST: (79.36±15.63) vs (196.71±89.05) U/L], ( P<0.05). After treatment, when compared with the control group, the IAP, portal vein blood flow velocity, bile drainage and TBil in the study group were significantly better [IAP: (7.13±3.87) vs (13.47±6.19) mmHg, portal vein blood flow velocity: (34.76±10.31) vs (24.98±8.54) cm/s, bile drainage: (198.43±19.94) vs (108.73±21.30) ml/d, TBil: (258.85±91.95) vs (343.69±89.45) μmol/L], ( P<0.05). In the control group, the IAP significantly decreased on the fourth day after treatment, ( P<0.05); compared with the significant difference in the study group on the second day after treatment ( P<0.05). After 7 days of treatment, the efficacy rate of the control group was 46.7% (7/15), compared to 86.7% (13/15) in the study group. The difference between the two groups was significant (χ 2=5.400, P<0.05). Conclusion:DSA guided transnasal ileus tube placement for treatment of abdominal compartment syndrome after liver transplantation resulted in a better treatment efficacy rate than conventional treatment.

Objective To investigate the efficacy of 3D conformal radiotherapy for late-stage pancreatic cancer and determine relavent prognostic factors.Methods Fifty patients with advanced pancreatic cancer were divided into 3 groups according to treatment planning: palliative radiotherapy (group A) at 10.8-56 Gy, radiotherapy alone (group B) at 8-60.5 Gy and concurrent chemoradiother-apy (group C) at 10-64 Gy.All patients received 3D-conformal radiotherapy, and smaller multiple ports were used for palliative treatment whereas large fields including pancreatic tumors and adjacent lymph node drainage system were adopted in the beginning of radiotherapy.Concurrent chemotherapy with gemcitabine (200-600 mg/m~2) alone was used with weekly protocol.Results The duration of follow-up was 3-35 months.Forty three patients died during the follow-up for multiple metastasis, de-teriation, secondary infection and hemorrhage.Among the seven surviving patients, 3 received concur-rent radiotherapy, 3 radiotherapy alone and 1 palliative radiotherapy.Only 1 patient was alive in group A.However, the symtoms were relieved in 46% of the patients.The median survival time was 5.07 months whereas it was 4.33 months for patients received less than 45 Gy and 7.33 months for patients received 45 Gy or more.Three patients were alive in group B and the symptoms were relieved in 81% of the patients.The median survival time was 6.65 months whereas it was 4.36 months for patients received less than 45 Gy and 8.33 months for patients received 45 Gy or more.Three patients were a-live in group C and the symptoms were relieved in 89% of the patients.The median survival time was 9.89 months.One patient survived for 3 months after 8 Gy irradiation.The median survival time was 10.73 months for patients received 45 Gy or more.Conclusion 3D-conformal radiotherapy is safe and effective in treatment of advanced pancreatic cancer.The symptom relieving rate and median survival time seem to be related to patient's status, extent of disease, choice of treatment and irradiation dos-age.3D-confromal concurrent chemoradiotherapy leads to the longest survival time in some patients.

Objective:To evaluate the curative effects of 3D printed microporous titanium (tantalum) prosthesis in reconstruction of large segmental bone defects caused by lower extremity osteomyelitis.Methods:A retrospective study was conducted to analyze the clinical data of 18 patients who had been treated for large segmental bone defects caused by lower extremity osteomyelitis between January 2020 to May 2022 at Department of Orthopaedics, The 920th Hospital of Joint Logistics Support Force. There were 10 males and 8 females with an age of (45.3±14.1) years. The defects were at the left side in 13 cases and at the right side in 5 cases, at the femur in 11 cases and at the tibia in 7 cases. The duration of osteomyelitis was 1.0 (1.0, 3.5) years. The length of bone defects was 8.35 (6.50, 9.84) cm. Their bone defects were repaired by an individually 3D printed microporous titanium (tantalum) prosthesis after operative removal of osteomyelitis lesions. The wound healing was observed after surgery. The clinical efficacy was comprehensively evaluated by the Paley grading for bone defect healing, visual analog scale (VAS), lower extremity functional scale (LEFS), and imaging examination.Results:The postoperative follow-up period for the 18 patients was (12.2±0.3) months. Wound infection occurred 2 months after surgery in one patient who was treated with Ilizarov bone transfer after removal of the microporous titanium prosthesis. The remaining 17 patients had good postoperative wound healing. At the last follow-up, the 18 patients had a VAS pain score of 2.0(1.0, 4.0) points, significantly lower than the preoperative one [(6.1±2.3) points], and a LEFS score of 54.00(34.50, 69.25) points, significantly higher than the preoperative one [18.50(9.00, 26.50) points] ( P<0.05). At the last follow-up, according to the Paley grading, the bone union was rated as excellent in 16 patients, as good in 1 patient and as poor in 1 patient. The integration of femoral fractures with 3D printed microporous titanium prostheses was fine. Conclusion:In reconstruction of large segmental bone defects caused by lower extremity osteomyelitis, implantation of a 3D printed microporous titanium (tantalum) prosthesis is feasible and effective, not only reducing pain but also restoring the limb function.

Objective To analyze the risk factors for the occurrence of post transplantation diabetes mellitus (PTDM) in renal transplant recipients, establish a prediction model for PTDM and evaluate its prediction value. Methods Clinical data of 915 renal transplant recipients were retrospectively analyzed. According to the occurrence of PTDM, all recipients were divided into the PTDM group (n=78) and non-PTDM group (n=837). The main indexes of recipients were collected. The risk factors for the occurrence of PTDM in renal transplant recipients were analyzed by univariate and multivariate analysis. The prediction model for PTDM was established and its prediction value was evaluated. Results Family history of diabetes mellitus, body mass index (BMI), preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin were the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM was logit (P)=2.199×family history of diabetes (yes=1, no=0)+0.109×BMI+0.151×2 h postprandial blood glucose (mmol/L)+0.508×glycosylated hemoglobin (%)-9.123. The results of receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of these 4 predictors combined for predicting PTDM in renal transplant recipients was 0.830 [95% confidence interval (CI) 0.786-0.873], the cut-off value was 0.0608, the sensitivity was 0.821, the specificity was 0.700, and the Youden index was 0.521 (P < 0.05). Conclusions Family history of diabetes mellitus, BMI, preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin are the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM combined with4 predictors yield relatively high prediction value for PTDM.

Objective:To investigate the clinical application of continuous renal replacement therapy (CRRT) in infants with acute kidney injury (AKI) after liver transplantation.Methods:A retrospective study was conducted on infants with AKI after liver transplantation in Tianjin First Center Hospital from January 1, 2019 to June 1, 2021. Infants with AKI within 1 year after liver transplantation were divided into CRRT group and non-CRRT group according to whether CRRT was performed. The preoperative and intraoperative condition, the postoperative complications were compared, the risk factors of CRRT for AKI infants, the clinical characteristics of CRRT were analyzed, and the prognosis between CRRT group and non-CRRT group were compared.Results:① A total of 512 cases of pediatric liver transplantation were performed. A total of 189 cases (36.9%) developed AKI within 1 year after surgery, including 18 cases in CRRT group and 171 cases in non-CRRT group. ② There was no significant difference in preoperative conditions between the two groups. The duration of liver transplantation (hours: 8.8±1.5 vs. 7.5±1.3) and intraoperative blood loss [mL: 370 (220-800) vs. 310 (200-400)] in CRRT group were significantly higher than those in non-CRRT group. CRRT group had significantly higher incidence of postoperative complication [unplanned operation: 8 cases (44.4%) vs. 14 cases (8.2%), primary nonfunction: 1 case (5.6%) vs. 0 case (0%), retransplantation: 3 cases (16.7%) vs. 0 case (0%), hepatic artery thrombosis: 3 cases (16.7%) vs. 4 cases (2.3%), intestinal fistula: 2 cases (11.1%) vs. 2 cases (1.2%)] than non-CRRT group (all P < 0.05). ③ The average start time of CRRT was 10 (1-240) days. The per capita frequency of CRRT treatment was 3.3 (1.0-14.0) times. The average duration of each CRRT treatment was 10.1 (6.0-19.3) hours, the average reduction rate of serum creatinine (SCr) was 25.6% (13.5%-45.0%) after CRRT. ④ In CRRT group, 5 patients died, the 1-year and 2-year survival rates were both 72.22%. In non-CRRT group, 6 patients died, the 1-year and 2-year survival rates were 97.1% and 96.5%, respectively. There were significant differences in 1-year and 2-year survival rates between the two groups (both P < 0.01). Conclusions:The incidence of AKI after pediatric liver transplantation was high, and most infants treated with CRRT were associated with serious surgical complications. CRRT was a powerful means to remove inflammatory factors and maintain the stability of circulation and internal environment, which could improve the multi-organ dysfunction effectively.

Objective:To analyze the association of pre-transplant risk factors with diabetes mellitus after renal transplantation and examine the significance of preventing the occurrence in kidney transplantation recipients.Methods:A total of 290 kidney transplantation recipients were retrospectively reviewed at our transplantation center from August 2018 to May 2020.Diabetes mellitus after renal transplantation was employed as a primary outcome index.Multivariate Logistic regression model was utilized for constructing A (without adjusting for covariates)、B(covariates include: gender, dialysis mode, type of donation)and C(covariates include: gender, dialysis mode, type of donation, calcineurin inhibitor, antiproliferative drugs, primary disease, fasting blood glucose, 1 h postprandial blood glucose, fasting C peptide, 1 h and 2 h postprandial C peptide, fasting C-peptide index, 1 h postprandial C-peptide index, albumin, triglycerides, total cholesterol)to evaluate the relationship between diabetes mellitus after transplantation and age, body mass index, 2 h postprandial blood glucose(2 h-PG), HbA1c, and 2 h postprandial C-peptide index(2 h-CPI).Results:In model A, age [odds ratio(OR)1.1, 95% confidence interval( CI)1.0~1.1], BMI(OR 1.2, 95% CI 1.0~1.3), 2 h PG(OR 1.2, 95% CI 1.1~1.4), HbA1c(OR 2.7, 95% CI 1.5~4.9), 2 h-CPI(OR 0.7, 95% CI 0.5~1.0), model B/C had similar results with A. Age, BMI, 2 h PG and HbA1c were all risk factors for diabetes mellitus after transplantation while 2 h-CPI was a protective factor.Quartile stratification was analyzed by regression model.And trend test was significant( P<0.05). Conclusions:Age, BMI, 2 h PG, HbA1c and 2 h-CPI are correlated with diabetes mellitus after kidney transplantation.