Esophagogastric variceal bleeding is a common complication and the leading cause of death in advanced liver cirrhosis， and endoscopic variceal ligation （EVL） and endoscopic cyanoacrylate injection （ECI） are commonly used treatment strategies. Thrombocytopenia is one of the most common hematological complications in liver cirrhosis， and patients with severe thrombocytopenia have the potential risk of bleeding， which may affect treatment decision-making by clinicians and endoscopists. This article reviews the evolution of guidelines and clinical research advances regarding EVL/ECI in China and globally， in order to provide a basis for decision making among clinicians.

AIM: To report three cases of viral keratitis caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).METHODS: Slit lamp, intraocular pressure, corneal fluorescence staining, anterior segment photography, in vivo confocal microscopy(IVCM), and routine fundus screening were performed in the three confirmed patients. Treatment involved Ganciclovir, artificial tears and glucocorticoid eye drops.RESULTS: Three patients with SARS-CoV-2 keratitis(SCK)recovered well after standard treatment.CONCLUSION: SARS-CoV-2 keratitis typically presents as corneal subepithelial infiltration and can result in a decrease in corneal subepithelial nerve fiber density and an increase in dendritic cells(DC). Antiviral therapy in combination with glucocorticoid has proven to be effective.

Objective To investigate the clinical features in children with invasive pneumococcal disease (IPD) and early warning indicators of severe case.Methods The case data of 101 children inpatients with IPD isolated Streptococcus pneumoniae (Sp) at least once blood culture in this hospital from January 2007 to De-cember 2021 were collected retrospectively.The children patients were divided into the pediatric intensive care unit (PICU) group (35 cases) and general ward group (66 cases) according to whether or not entering PICU during hospitalization.The general clinical data,infection types and results of drug sensitivity test and bacteri-al strain serotype identification were compared between the two groups and analyzed.Results Compared with the general ward group,the male proportion,proportions of complicating nervous system disease and iron-defi-ciency anemia,winter incidence rate,disturbance of consciousness,convulsion,dyspnea,heart rate increase,oc-currence rate of vomiting and diarrhea,proportion of peripheral blood neutrophilic granulocytes,C reactive protein (CRP),lactic dehydrogenase (LDH) level,Hb<90 g/L,LDH>700 U/L,creatine kinase isoenzyme-MB (CK-MB) abnomality,proportions of bacterial meningitis,sepsis and severe pneumonia in the PICU group were higher,the proportion of 3-97 percentile of body weight,bronchopneumonia and no-focus blood stream infection were lower,WBC,Hb and albumin level were lower,and the differences were statistically significant (P<0.05).Eleven kinds of serotypes were identified in this study,ranking the top five in order were 6B,14,19F,23F and 19A.Pneumococcal 13-valent conjugate vaccine (PCV13) could cover 96.9％ of the IPD sero-types.The multivariate logistic regression analysis showed that consciousness disturbance,convulsion,per-centage of neutrophils increase,Hb<90 g/L,LDH>700 U/L and CK-MB abnormality indicated the condition of IPD children patients was critical,which was the early-warning indicator of entering PICU (P<0.05).Con-clusion Severe IPD lacks the early specific early-warning indicator,and the cover rate of PCV13 is high.

Objective To compare the effect of internal iliac artery block using balloon of different properties in cesarean section for delivery female patients with pernicious placenta previa(PPP).Methods The clinical data of 82 delivery female patients with PPP were retrospectively analyzed.The patients were divided into observation group(n=40)and control group(n=42).The patients of the observation group received compliant Fogarty balloon block of bilateral internal iliac arteries,while the patients of the control group received non-compliant balloon block of bilateral internal iliac arteries.The preoperative and postoperative systolic blood pressure and heart rate,X-ray fluoroscopy time,fetal body surface radiation dose,time spent for cesarean section,intraoperative blood loss amount and blood transfusion quantity,uterine artery embolization rate,hysterectomy rate,1-,5-,and 10-minute neonatal Apgar scores,postoperative hospital stay,and surgery-related complications were compared between the two groups.Results In all patients of both groups,the uterus was successfully preserved and the bilateral internal iliac artery balloon obstruction-assisted cesarean section was successfully accomplished.After the balloon catheter was withdrawn,uterine artery embolization was carried out in some patients,and no patient received ovarian artery embolization and hysterectomy.No statistically significant differences in preoperative,postoperative systolic blood pressure and heart rate existed between the two groups,but in both groups the postoperative systolic blood pressure and heart rate were lower than their preoperative values(all P＜0.05).No statistically significant differences in X-ray fluoroscopy time,fetal body surface radiation dose,uterine artery embolization rate,hysterectomy rate,1-,5-,and 10-minute neonatal Apgar scores,and postoperative hospital stay existed between the two groups.In the observation group the time spent for cesarean section,intraoperative blood loss amount and blood transfusion quantity were lower than those in the control group(all P＜0.05).The difference in the incidence of balloon obstruction-related complications between the two groups was not statistically significant.Conclusion In cesarean section for delivery female patients with PPP,balloon block of bilateral internal iliac,regardless of using compliant Fogarty balloon catheter or non-compliant balloon catheter,is clinically safe and effective.However,the use of compliant Fogarty balloon catheter is superior to the use of non-compliant balloon catheter in reducing the cesarean section operative time,intraoperative blood loss amount,and intraoperative blood transfusion quantity.

Objective:To explore the effect of pentraxin 3 (PTX3) on memory improvement and Aβ expression in Alzheimer's disease (AD) model mice.Methods:(1) Ten 5-month-old 5×FAD mice were randomly divided into PTX3 group and model group ( n=5); 5 C57BL/6 wild-type mice at the same age were selected as control group; mice in the PTX3 group and control group were stereotactically injected 4 μL 0.5 g/L PTX3 or same dose of phosphate buffered saline (PBS); Morris water maze test was used to detect the learning and memory abilities, Y maze test was used to detect the short-term memory, and ELISA was used to obsevre the contents of Aβ 40 and Aβ 42 in the brain hemisphere. (2) Twenty-five 3-month-old 5×FAD mice were randomly divided into model group, 2 μg/kg PTX3 group, 4 μg/kg PTX3 group, 8 μg/kg PTX3 group, and 16 μg/kg PTX3 group ( n=5); 5 C57BL/6 wild-type mice at the same age were selected as control group; mice in the PTX3 groups were intranasally injected 2, 4, 8, and 16 μg/kg PTX3, respectively; those in the model group and control group were intranasally injected same dose of PBS; injection was given once every 96 h for a total of 7 times. Morris water maze test was used to detect the learning and memory abilities, Y maze test was used to detect the short-term memory, and ELISA was used to obsevre the contents of Aβ 40 and Aβ 42 in the hippocampus. Results:(1) Compared with the model group, the PTX3 group had significantly shorter platform latency, higher percentage of exploration time and higher percentage of spontaneous alternations ( P<0.05). Compared with those in model group ([63.38±21.42] pg/mL, [29.77±6.11] pg/mL), the concentrations of Aβ 40 and Aβ 42 in the brain tissues of PTX3 group ([15.87±2.11] pg/mL, [16.55±1.95] pg/mL) were statistically lower ( P<0.05). (2) Compared with the model group, the 16 μg/kg PTX3 group had significantly shorter escape latency and higher percentage of exploration time ( P<0.05); compared with the model group, the 2 μg/kg PTX3 group and 16 μg/kg PTX3 group had significantly higher percentage of spontaneous alternations ( P<0.05). The contents of Aβ 40 and Aβ 42 in the hippocampus of 8 μg/kg PTX3 group and 16 μg/kg PTX3 group were statistically lower compared with those in the model group ( P<0.05). Conclusion:PTX3 may attenuate cognitive deficits and decrease Aβ expression in the brain or hippocampus tissues of 5×FAD mice with AD.

Objective:To evaluate the safety and effectiveness of dual-plane breast augmentation via endoscopic assisted axillary approach.Methods:A retrospective analysis was conducted on 215 female patients who underwent dual-plane breast augmentation via endoscopic assisted axillary approach from March 2019 to March 2021 (15 cases at Longhua Maternal and Child Health Hospital and 200 cases at Chongqing Huamei Hospital). The patient′s age was 22-45 (32.32±5.67) years. 42 cases underwent dual-plane breast augmentation via endoscopic assisted axillary approach, by using a combination of blunt and sharp methods to separate the cavity; while 173 cases used sharp methods to separate cavities. The complications related to breast augmentation were evaluated during a follow-up period of 6 to 18 months.Results:None of the 215 patients experienced wound infection, postoperative hematoma formation, or skin burns. The long-term complications included 1 case (0.46%) of grade Ⅰ capsule contracture, 1 case (0.46%) of grade Ⅲ capsule contracture, and 12 cases (5.58%) of nipple areola sensory impairment or reduction. A patient with grade Ⅲ capsule contracture underwent right capsulotomy and replacement of the prosthesis.Conclusions:The endoscope-assisted transaxillary dual-plane breast augmentation surgery has higher safety and satisfactory, worthy of clinical promotion and application.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Objective:To explore values and differences of multi-modality image registration and normalization methods in 18F-AV45 PET quantitative analysis of Alzheimer′s disease (AD). Methods:Twenty AD patients (10 males, 10 females; age (77.0±5.8) years) and 20 normal controls (NC; 8 males, 12 females; age (75.2±4.8) years) from the AD neuroimaging initiative (ADNI) open database of the National Institute on Aging were analyzed. β-amyloid (Aβ) deposition (positive/negative) was assessed by visual analysis. The SUV ratio (SUVr) in each brain region and individual average SUVr were calculated using template normalization method (M1), normalization after registration with 18F-FDG PET or MRI image (M2 or M3) respectively with the cerebellum as the reference area. The intra-class correlation coefficient (ICC) was used to complete the reliability between methods, and independent-sample t test and one-way repeated measures analysis of variance were used to compare the differences of quantitative indexes between different groups and different methods. ROC curve analysis was used to compare the diagnostic efficacy in distinguishing AD and NC, Aβ positive and negative cases. Results:There were 15 and 6 patients with positive Aβ deposition in AD group and in NC group respectively by visual analysis. The SUVrs of three methods were with good consistency (ICC=0.82, P<0.001), and the differences among individual average SUVrs (1.29±0.17, 1.36±0.23, 1.45±0.24) were significant ( F=68.78, P<0.001). There were significant differences between AD group (1.39±0.17, 1.48±0.24, 1.58±0.25) and NC group (1.20±0.10, 1.24±0.15, 1.33±0.16; t values: 3.55-4.33, all P<0.05), Aβ positive group (1.39±0.16, 1.50±0.21, 1.59±0.23) and negative group (1.19±0.11, 1.21±0.14, 1.31±0.15; t values: 4.58, 5.11, 4.41, all P<0.001), and the individual average SUVr of M3 was higher (both P<0.001). The AUCs of distinguishing Aβ positive and negative deposition of M1-M3 were 0.86, 0.88, 0.84 and the thresholds of SUVrs were 1.29, 1.37, 1.52, respectively. Conclusion:The three multi-modality registration and normalization methods are reliable methods for quantitation of 18F-AV45 PET imaging with certain differences, and should be selected carefully based on data conditions in practice.

The promise of regeneration therapy for restoration of damaged myocardium after cardiac ischemic injury relies on targeted delivery of proliferative molecules into cardiomyocytes whose healing benefits are still limited owing to severe immune microenvironment due to local high concentration of proinflammatory cytokines. Optimal therapeutic strategies are therefore in urgent need to both modulate local immunity and deliver proliferative molecules. Here, we addressed this unmet need by developing neutrophil-mimic nanoparticles NM@miR, fabricated by coating hybrid neutrophil membranes with artificial lipids onto mesoporous silica nanoparticles (MSNs) loaded with microRNA-10b. The hybrid membrane could endow nanoparticles with strong capacity to migrate into inflammatory sites and neutralize proinflammatory cytokines and increase the delivery efficiency of microRNA-10b into adult mammalian cardiomyocytes (CMs) by fusing with cell membranes and leading to the release of MSNs-miR into cytosol. Upon NM@miR administration, this nanoparticle could home to the injured myocardium, restore the local immunity, and efficiently deliver microRNA-10b to cardiomyocytes, which could reduce the activation of Hippo-YAP pathway mediated by excessive cytokines and exert the best proliferative effect of miR-10b. This combination therapy could finally improve cardiac function and mitigate ventricular remodeling. Consequently, this work offers a combination strategy of immunity modulation and proliferative molecule delivery to boost cardiac regeneration after injury.

Objective:To explore the clinical application of portable head and neck magnetic resonance imaging (MRI) device in neurosurgery.Methods:A total of 213 patients with brain diseases who were scanned by portable head and neck MRI device in Center of Neurosurgery, Zhujiang Hospital, Southern Medical University from June to September 2022 were selected. The portable head and neck MRI images and 3.0T conventional MRI images of 10 randomly selected patients were compared; the differences in signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of different sequences were analyzed. Thirty-one patients accepted tracheal intubation/tracheotomy, or ventilator-assisted breathing were selected as special patient group, and another 30 patients were as general patient group; the differences in comprehensive diagnostic scores of portable head and neck MRI images were compared. Noise intensity differences in different sequences between 3.0T conventional MRI and portable head and neck MRI were statistically compared. Twenty hospitalized volunteers with normal hearing in our center from July to August 2022 were selected, conventional 3.0T MRI and portable head and neck MRI were performed successively, and the noise intensity of different sequences in them was evaluated by using a 5-point system.Results:Compared with those in 3.0T conventional MRI images, the SNR and CNR of T1WI, T2WI, and Liquid attenuated reverse recovery sequence (FLAIR) sequences in portable head and neck MRI images were significantly lower ( P<0.05). No significant difference was noted in the comprehensive diagnostic scores of portable head and neck MRI images between special patients and general patients ( P>0.05). Compared with that in the 3.0T conventional MRI, the noise intensity of different sequences in portable head and neck MRI was significantly reduced ( P<0.05). These volunteers had significantly reduced noise intensity scores of different sequences in portable head and neck MRI compared with that in conventional 3.0T MRI ( P<0.05). Conclusion:Portable head and neck MRI device is easy to use, enjoying high safety, imaging quality and suitability, which meets the clinical needs for neurosurgery patients.