Objective To investigate the effect and mechanism of exogenous leptin on liver injury in severe acute pancreatitis rat .Methods Thirty male SD rats were randomly divided into the sham operation group ,SAP group and leptin intervention group . The SAP rat models was established by retrograde injection of 3 .5% sodium taurocholate into the biliopancreatic duct .The leptin intervention group was intraperitoneally injected with leptin 20 μg/kg .The rats in each group were sacrificed at 12 h after model‐ing .The pancreas and liver tissues were taken for HE staining and detecting the nuclear factor kappa B (NF‐κB) .The cell apoptosis in situ labeling method was adopted for detecting the liver tissue cell apoptosis index .ALT ,AST and AMY were detected . Results Compared with the sham operation group ,the liver tissue pathology score in SAP group and leptin intervention group were significantly increased(P<0 .05) .The liver tissue pathology scores in the leptin intervention group were lower than those in the SAP group(P<0 .05) .The NF‐κB expression of liver tissue in the SAP group and leptin intervention group was obviously increased compared with the sham operation group ,the expression in the leptin intervention group was decreased compared with the SAP group (P<0 .05) .The liver cell apoptosis index in the leptin intervention group and SAP group was significantly higher than that in the sham operation group (P<0 .05) ,and which leptin intervention group was decreased compared with the SAP group (P<0 .05) . The results of ALT ,AST and AMY in the SAP group and leptin intervention group were increased significantly compared with the sham operation group(P<0 .05) ,while which in the leptin intervention group was decreased compared with the SAP group (P<0 .05) .Conclusion The exogenous leptin may play the protective effect on SAP complicating liver damage by lowering the liver tis‐sue NF‐κB expression and reducing the liver cell apoptosis index .

Treatment of calcaneal fractures has always been the focus of many clinical researchers.The goals of traditional surgical treatment are not only to restore the integrity of calcaneal articular surface but also to reconstruct the anatomy of the calcaneus.More importantly,we need to reduce postoperative soft tissue swelling and incidence of postoperative complications.In recent years,scholars have reported satisfactory clinical efficacy and prognosis resulting from a sinus tarsal approach for treatment of calcaneal fractures.This paper reviews the latest research progress concerning the sinus tarsal approach for treatment of calcaneal fractures at home and abroad,intending to provide helpful information for the clinical surgeons.

Objective To investigate the feasibility of measuring femoral neck torsion angle and anteversion angle by laser projection method .Methods The femoral neck torsion angle and anteversion were observed and described .An angle measuring device was designed and produced .With the device , the femoral torsion angle and anteversion angle were measured by laser projection method two times .Statistical analysis was performed on the measured value , and sides difference .Results The differences between femoral neck torsion angle and anteversion angle were observed .There was no significant difference ( P >0.05, power =100%) between the two measurements by laser projection method . Measurements of the femoral anteversion were 13.58 °±6.55 °on the left side , and 12.15 °±5.83 °on the right side . Measurements of the femoral neck torsion angle were 18.50 °±7.38 °on the left and 19.08 °±8.59 °on the right .There was no significant difference between left and right side ( P >0.05 ) .Conclusion The laser projection method is the effective method in measuring femoral neck torsion angle and anteversion angle , and has excellent repeatability .

BACKGROUND:Early-onset scoliosis is a kind of disease that seriously affects the growth of children’s spine and development of cardiorespiratory function. The treatment of the disease has always been the focus of many clinical researchers.OBJECTIVE:To analyze the therapy for early-onset scoliosis and explore the spinal fusion, spinal non-fusion, conventional growth rod technology and magnetic control ed growth rod technology of early-onset scoliosis. METHODS:We retrieved PubMed, CENTRAL, EMbase, the ISI Web of Knowledge Databases, VIP, CNKI, CBM and Wanfang Database for related studies published from inception of the database to March 2016. The key words were“scoliosis, growing rod, complications”. The included 54 studies were analyzed and discussed. RESULTS AND CONCLUSION:For these children of early-onset scoliosis, we should not only maintain the correction of spine deformities, but also protect the ability of spine growth, keeping the normal cardiopulmonary function. In addition to conventional (non-surgical) treatment, there are surgical treatment (such as spinal fusion and growing rod technique) and magnetical y control ed growing rod, a new technology for the treatment of early-onset scoliosis. A comprehensive understanding of the effect of surgical treatment on the spine growth and cardiopulmonary function of children with early-onset scoliosis wil help to prevent the occurrence of related complications, so as to obtain a better therapeutic effect.

OBJECTIVETo clarify the nature of a DMD splice acceptor mutation c.2381-3T>C.

METHODSGenomic DNA was extracted from 5 members of a family affected with DMD. For an obligatory carrier, after excluding gross deletion and duplication of the DMD gene with multiplex ligation-dependent probe amplification (MLPA) method, all coding and splice site sequences of the DMD gene were analyzed with Next Generation Sequencing followed by confirmation with targeted Sanger sequencing. Mutations of the carrier were detected in other 4 members. For the splice site mutation, mini-gene was constructed and expressed in vitro to detect the number of transcript and cDNA sequence.

RESULTSA known nonsense mutation (c.8038C>T, p.Arg2680Ter) was identified in the carrier, her sister and the mother. The rest 4 members, except for the mother from the first generation, have all carried the c.2381-3T>C mutation. The latter has been described as a splice site mutation to cause DMD. One of 135 male adults without DMD was also detected to have carried the c.2381-3T>C mutation. No additional transcript was produced by the mini-genes containing c.2381-3T>C mutation.

CONCLUSIONThe c.8038C>T（p.Arg2680Ter）mutation of DMD gene probably underlies the disease in this family. The presence of the c.2381-3T>C mutation in a asymptomatic male and a non-DMD male control, together with the normal in vitro expression of the mini-gene carrying the c.2381-3T>C, strongly suggested that the c.2381-3T>C mutation collected in the Human Gene Mutation Database is a rare SNP without significant pathogenicity.

Sarcopenia and physical deconditioning are common complications in patients with liver cancer,which are frequently caused by insufficient physical activity and poor nutritional status,resulting in physical frailty and a significant impact on the patient's physical fitness.Notably,sarcopenia,frailty,and poor cardiopulmonary endurance have all been linked to higher mortality rates among patients with liver cancer.Exercise intervention significantly improves various health parameters in liver cancer patients,including metabolic syndrome,muscle wasting,cardiorespiratory endurance,health-related quality of life,and reduction in hepatic venous pressure gradient.However,the link between physical exercise and liver cancer is commonly overlooked.In this article,we will examine the impact of exercise on liver cancer and present the most recent evidence on the best types of exercise for various stages of liver cancer.This article also summarizes and discusses the molecular mechanisms that control metabolism and systemic immune function in tumors.In brief,physical exercise should be considered an important intervention in the prevention and treatment of liver cancer and its complications.

This article reported a case of hypertrophic pyloric stenosis after neonatal esophageal atresia repair. The mother of the child did not have regular prenatal care. The child was born at a gestational age of 40 weeks and 2 days of gestation, with polyhydramnios at birth, and was diagnosed with esophageal atresia and cleft palate after birth and underwent thoracoscopic esophageal-esophageal end-to-end anastomosis and esophageal-tracheal fistula ligation and was given nasogastric feeding after surgery. At four months of age, the child vomited a lot of coffee-like material after nasogastric feeding, and the ultrasonographic and upper gastroenterography findings suggested hypertrophic pyloric stenosis, which was treated surgically with good results. This case suggests that hypertrophic pyloric stenosis should be considered in children with unexplained non-bilious vomiting/feeding difficulties after esophageal atresia repair. After definitive diagnosis, laparoscopic pyloromyotomy is feasible.

Objective To investigate a new strategy of bone marrow transplantation (BMT) for donor-specific tolerance induction after heart transplantation. Methods Donor bone marrow cells (BMCs)were harvested simultaneously with donor cardiac graft using modified perfusion method (PM) ,then stored in a -80 ℃ refrigerator after filtration and centrifugation. Whole BMCs (IBM-BMT) (monocytes 1.2 ×107/kg,CD34+ cells 2.38× 105/kg) in host iliac bones were injected into the bone marrow cavity 40 days after heart transplantation. Preconditoning regimens that consisted of fludarabine, antithymoctye globin and total lymphoid irradiation were performed 3 days before BMT. Tacrolimus (Tac) was administrated intravenously after BMT or orally in conjunction with mycophenolate mofetil (MMF) 3 weeks later.Cyclosporine and MMF were orally administrated 6 weeks later. Donor chimerism was detected using short tandem repeats-polymerase chain reaction in monocytes from peripheral blood at the 2nd,4th, 8th or 12th week after BMT or BMCs at the 4th, 8th or 12th week after BMT. Intramyocardium electrocardiography examination or endomyocardial biopsy was performed weekly or monthly respectively. Mixed lymphocyte reactions (MLR) were performed 3 months after BMT. Results Donor chimerism in monocytes in peripheral blood or BMCs in iliac bones measured at the 1 st,2nd and 3rd month after BMT was 26.3%, 19.1%,4.8% ,and 46.3%, 24.4%, 7.6%, respectively. After 3-month follow-up, there was no rejection confirmed by endomyocardial biopsy or intramyocardium electrocardiography. Echocardiography revealed that the diastolic and systolic function of the cardiac graft was maintained well 3 months after BMT. MLR revealed donor-specific hyporesponsiveness while immunocompetence was preserved to third-party antigens. Conclusion These findings indicate that the two-stage BMT strategy is a safe and feasible method for the induction of donor-specific tolerance via stable mixed chimerism and needs to be further confirmed after a long-term observation.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.