Objective To investigate the differences in the biochemical and pathological features and therapeutic response between the elderly-onset autoimmune hepatitis (AIH) and young-onset AIH.Methods From October 2013 to November 2016,a total of 87 consecutive AIH patients diagnosed by liver biopsy were enrolled and divided into elderly-onset group (≥60 years) and the young-onset group (＜ 60 years).The biochemical and pathological features and therapeutic response of the two groups were compared.Mann Whitney test and chi square test were performed for statistical analysis.Results As AIH diagnosed,the proportion of liver cirrhosis detected by imaging examination of elderly-onset group and the young-onset group were 67.7％(21/31) and 35.7％(20/56),respectively,the former was higher than the latter,and the difference was statistically significant (X2 =8.214,P=0.004).The proportion of patients complicated with extrahepatic autoimmune diseases of the elderly-onset group was 9.7％ (3/31),which was lower than that of the young-onset group (28.6％,16/56),and the difference was statistically significant (X2 =4.173,P=0.041).The median levels of alanine aminotransferase (ALT) and albumin of the elderly-onset group were 50.0 U/L (22.0 U/L,193.0 U/L) and 34.8 g/L (31.3 g/L,40.5 g/L),which were lower than those of the young-onset group (146.0 U/L (43.8 U/L,390.5 U/L),39.4 g/L (35.8 g/L,44.6 g/L),and the differences were statistically significant (Z=-2.109,-2.092;both P＜ 0.05).Between the two groups,there was no statistically significant difference in inflammation grade,fibrosis stage,interface hepatitis,lymphoplasmacytic infiltration,positive rate of hepatocyte rosette pattern,positive rate of centrilobular necrosis and small bile duct injury (all P＞0.05).After treatment,among 17 patients of elderly-onset group,seven patients obtained biochemical remission and the median time to remission was 3.2 months;among 37 patients of young-onset group,18 patients (48.6％) obtained biochemical remission and the median time to remission was 2.3 months.There was no significant difference in the percentage of patients achieved biochemical remission and the median time between the two groups (both P＞0.05).Conclusion The percentage of complicated with extrahepatic autoimmune diseases of elderly-onset group is lower than that of young-onset group,which indicates that age-associated immune dysfunction may involve in the genesis and development of elderly-onset AIH.

Objective To explore the clinical outcome of using modified great toe wrap-around flap to reconstruct degloved thumb and fingers.Methods Eighteen patients were involved.Based on different types of injury,four procedures were carried on for reconstructing degloved thumb and fingers:①Unilateral modified great toe wrap-around flap to reconstruct 9 degloved thumbs of distal proximal level and 3 degloved fingers of proximal interphalangeal joint level.②Unilateral modified great toe wrap-around flap with second toe medial flap to reconstruct 2 total degloved fingers.③Bilateral modified great toe wrap-around flap to reconstruct 2 thumbs.④Bilateral modified great toe wrap-around flap and second toe medial flap with neurolized super thin anterolateral thigh flap to reconstruct 12 degloved fingers.This wrap-around flap carried with entire nail.A triangle flap was reserved at medial plantar of great toe.Results All free flaps were survived in one stage.Fifteen patients were followed up for 8 to 25 months.The contour of reconstructed digit was as same as contralateral digit with satisfactory motion arc and sensation.There was no extensive scar in donor toe.The width of medial plantar triangle flap increased significantly.All patients could walking,running,jumping without restricted.Conclusions With reconstructed by modified great toe wrap-around flap,degloved thumb or finger can be promised with excellent contour and function outcome.In the meantime,the loss of donor foot can be expected to minimal.This procedure is one of the best ways for reconstructing degloved thumb and finger.

To observe the effects of icariin, psoralen and oleanolic acid, the three active ingredients of Yinyanghuo (Herba Epimedii Brevicornus), Buguzhi (Fructus Psoraleae) and Nuzhenzi (Fructus Ligustri Lucidi), respectively, on gene expression profile of bone marrow stromal cells (BMSCs) from rats with corticosterone-induced osteoporosis.

Objective:To study the best opportunity for minimal invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods:Forty-one patients with hypertensive intracerebral hemorrhage were randomly divided into four groups:<6 h,6-12 h,12-18 h and 18-24 h from the onset of symptoms.The comparison among groups in outcome measures were performed,including the rebleeding rate,short-term efficacy,long-term efficacy,mortality,and excellent and good rate.Results:The incidence of complication such as rebleeding etc had no significantly difference in the four groups.The excellent and good rates of clinical outcomes at 3 months were the<6 h group>6-12 h group,and 12-18 h group>18-24 h group(P<0.05).The 18-24 h group had the highest mortality(30%,3/10).Conclusions:Within 6 h after the onset of hypertensive intracerebral hemorrhage was the best opportunity for the minimal invasive puncture.

Objective To compare the two liver volume measurements using multi-slice spiral CT (MSCT)for clinical reference.Methods Twenty-four patients with hepatic disease awaiting orthotopic liver transplantation underwent muhiphase MSCT of the upper abdomen.Liver volumes using two measurements(manual volume measurement and semi-automated volume measurement)before transplantation were compared with the actual liver volume(ALV)measured during transplantation by means of water displacement.Both measurements were timed.Correlation coefficient.one way ANOVA and Bland-Altman tests were used for statistical analysis.Results The mean liver volume estimated with the manual method and the semi-automated method were(1360±157)cm3 and(1345±152)cm3.respectively.The actual liver volume was(1307±153)cm3.There was no significant diffierence between the volumes measured using the three methods(F=0.032,P＞0.05).For all the patients,there Was significant correlation between liver volume measured by MSCT and the actual liver volume.There was a good correlation between the liver volume measured by manual method and the actual liver volume(r=0.976,P＜0.05),so did the correlation between the liver volume measured by semi-automated method and the actual liver volume (r=0.987,P＜0.05).And the semi-automated method took much shorter time[(9.2±1.8)min]compared with the manual method [(23.2±5.8)min ].Conclusion Semi-automated method provided acceptable measurements for liver volume.

Objective To systematically evaluate the effect of preoperative transarterial chemoembolization (TACE) on perioperative safety of patients with resectable hepatocellular carcinoma (HCC).Methods Literatures were researched using Chinese Journal Full-text Database,Wanfang database,VIP database,PubMed,Medline from December 1,1994 to May 30,2016 with the key words including “肝细胞癌,肝切除,术前化疗栓塞,经动脉化疗栓塞,liver cancer,hepatocellular carcinoma,liver resection,hepatectomy,transcatheter arterial chemoembolization,transarterial chemoembolization,preoperative” Manual retrieval was also conducted simultaneously.The randomized controlled trials (RCTs) about TACE on perioperative safety of patients with resectable HCC were received and enrolled.Patients undergoing surgery after preoperative TACE were allocated into the case group and patients undergoing first-stage resection were allocated into the control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as relative risk (RR) and 95％ confidence interval (CI).Measurement data were represented as standardized mean difference (SMD) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Five RCTs were enrolled in the Meta analysis,and the total sample size was 430 cases including 212 in the case group and 218 in the control group.Results of Meta analysis showed that there was no statistically significant difference in the hemihepatic resection rate between the 2 groups (RR=0.99,95％CI:0.81～ 1.20,P＞0.05).The combined resection rate of perihepatic organs in the case group was significantly higher than that in the control group (RR=3.42,95％CI:1.91-6.12,P＜0.05).Results of subgroup analysis showed that operation time and incidence of postoperative complications of patients with an average tumor diameter ＞5 cm in the case group were respectively longer and higher than these in the control group (SMD=0.31,RR=1.65,95％CI:0.06-0.57,1.01-2.69,P＜0.05).Conclusion There is no obvious effect of preoperative TACE on resectable HCC,and it can evaluated combined resection rate of perihepatic organs,operation time and incidence of postoperative complications of patients with resectable HCC and an average tumor diameter ＞ 5 cm,and also reduce the perioperative safety.

Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement (ROM) of adjacent joints by authors's method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months (average 19.7 months);all the bone defects healed,the clinical healing time was 3.0 to 7.0 months (average 4.7 months).The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months).1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded:excellent in 8 cases,good in 10 cases,and fair in 2 cases (the excellent and good rate was 90％),the ROM of the adjacent joints graded:excellent and good in 8 cases,respectively,fair and poor in 2 cases,respectively (the excellent and good rate was 80％).Conclusion Induced membrane technique has advantages of simple surgery,faster healing of bone defect,no correlation between the healing time and the length of bone defect,fewer complications,etc,but in clinical application,the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors,reduce complications and improve therapeutic effect.

Objective To study the treatment of adolescent hyperthyroidism. Methods Retrospective analysis of the clinical data of the adolescent hyperthyroidism treated by surgery was made in our hospital from January 1990 to December 1998. Results In this series, there was no death, with 3 cases transient postoperative hypocalcemia and 1 had throat spasm and physoia. All the 4 cases recovered after treatment. 78 cases(85.7%) were followed up for 0.5～9 years. Of them, all were in good condition except 2 being recurred. Conclusions Operative treatment for adolescent hyperthyroidism is a safe, quick and effictive method, but the operation indications should be good controlled.

Objective:To investigate the number of necroptotic renal tubular epithelial cells in renal tissues of patients with chronic kidney disease (CKD) and the correlation with clinicopathologic parameters, and explore its role in the progression of the excessive loss of renal tubular cells and chronic kidney injury.Methods:Renal tissue samples from 60 patients (18-65 years old) with CKD proven by kidney biopsy in the First Affiliated Hospital of Hainan Medical University from June 2017 to June 2019 were collected. According to internationally accepted K/DOQI guidelines, the patients were divided into 1-4 stages of CKD, with 15 cases in each stage. The number of necroptotic renal tubular epithelial cells in patients with different stages of CKD was detected using receptor-interacting protein 3 (RIP3) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) fluorescent staining, and the expression of RIP3 and MLKL, marker protein of necroptosis, was detected by immunohistochemistry. Pearson correlation analysis was used to analyze the correlation between the percentage of necroptotic renal tubular epithelial cells and clinicopathologic parameters. In addition, the expression of angiotensinogen Ⅱ receptor (AT2R) in renal tissue and its correlation with the percentage of necroptotic renal tubular epithelial cells were analyzed.Results:With the development of CKD, the structural destruction of renal tubules in patients with CKD was gradually aggravated, and the renal tubules in the corresponding areas were atrophied, accompanied by worsening interstitial fibrosis. The adjacent renal tubules were focally dilated and numerous protein tubules were seen in the tubules. Importantly, renal tubular injury score in second and third stage of CKD was significantly higher than that in control group (both P<0.01). TUNEL+RIP3 immunofluorescence staining results showed that the percentage of TUNEL/RIP3 double positive renal tubular epithelial cells (necroptotic renal tubular epithelial cells) in renal tubules of the second and third stage of CKD was higher (all P<0.01). Immunohistochemical results showed that RIP3, MLKL and AT2R proteins were mainly expressed in cytoplasm of renal tubular epithelial cells, and the expression of RIP3, MLKL and AT2R in renal tubular epithelial cells was higher in the second and third stage of CKD patients (all P<0.05). Pearson correlation analysis showed that the percentage of necroptotic renal tubular epithelial cells was positively correlated with blood urea nitrogen ( r=0.514, P=0.003), serum creatinine ( r=0.507, P=0.019), serum cystatin C ( r=0.571, P=0.026), serum uric acid ( r=0.592, P=0.008), renal tubules injury score ( r=0.901, P<0.001), renal interstitial fibrosis index ( r=0.700, P=0.001) and the expression of AT2R protein in renal tissue ( r=0.715, P=0.001). Conclusions:As CKD progresses, necroptosis of renal tubular epithelial cells in CKD patients occurs. The necroptotic cell death may be an important factor leading to renal tubular epithelial cell excessive death and the progression of chronic kidney injury. Furthermore, necroptosis of renal tubular epithelial cells may be related to the high expression of AT2R in kidney tissue.

Objective To assess the volumetric variation of liver and spleen in early diagnosis of liver fibrosis and cirrhosis.Methods One hundred and thirty-seven subjects underwent dynamic enhanced examination of liver and spleen using multi-slice CT(MSCT).Forty potential living liver donors were served as controls.Sixty-three histologically proved fibrotic patients were divided into slight liver fibrosis(F≤2,n=44)and advanced liver fibrosis(F≥3,n=19)according to the Ishak system.Liver cirrhosis group consisted of 34 patients diagnosed clinically and radiologically.The measurement of total liver volume(TLV),right liver lobe volume(RV),left lateral liver segment volume(LLV),left medial liver segment volume(LMV),eaudate lobe volume(CV)and spleen volume(SV)were obtained bv MSCT.The ratios of segmental liver and SV to TLV were also calculated.Results The values of liver volumes(TLV,RV and LMV)reduced gradually among control(1470.38 cm3,933.34 cm3,216.20 cm3,respectively),slight liver fibrosis(1239.99 cm3,799.74 cm3,184.69 cm3,respectively),advanced liver fibrosis(1219.76 cm3,765.22 cm3,179.44 cm3,respectively)and cirrhosis(1078.21 cm3,543.73 cm3,163.12 cm3,respectively) groups.The volume of SV and the ratios of CV/TLV and SV/TLV increased gradually among control (256.29 cm3,3.09%,17.53%),slight liver fibrosis(284.41 cm3,3.20%,22.91%),advanced liver fibrosis(343.13 cm3,3.58%,28.80%)and cirrhosis(863.38 cm3,4.16%,82.91%)groups.There was significant difference among control,liver fibrosis and cirrhosis group in TLV,RV,LMV and SV/TLV(P＜0.05),but there was no significant difference in all parameters between the slight liver fibrosis group and the advanced liver fibrosis group(P＞0.05).There was significant correlation of TLV,LMV,SV,RV,CV/TLV,SV/TLV,RV/TLV and LLV/TLV with liver cirrhosis and its staging.Conclusion Variations in liver and spleen volume,the ratios of segmental liver and SV/TLV are correlated with the extent of liver fibrosis and cirrhosis.which will be helpful in early detection of liver fibrosis and cirrhosis.