Objective To compare the clinical efficacy of three different therapies,including transjugular intrahepatic portosystemic shunt(TIPS)treatment,endoscopic treatment and medication treatment,combined with transhepatic arterial chemoembolization(TACE)in treating primary liver cancer complicated by portal hypertension and upper gastrointestinal bleeding.Methods A total of 105 patients with primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,who were admitted to the No.980 Hospital of PLA Joint Logistics Support Forces of China to receive treatment between January 2014 and June 2020,were enrolled in this study.According to the therapeutic scheme,the patients were divided into TIPS+TACE group(TIPS group,n=25),endoscopy+TACE group(endoscopy group,n=30),and medication+TACE group(medication group,n=50).The clinical efficacy,recurrence rate of bleeding,incidence of hepatic encephalopathy,and survival rate were compared between each other among the three groups.Results The differences in the postoperative 6-month,12-month and 24-month recurrence rates of bleeding between each other among the three groups were statistically significant(all P＜0.05).In TIPS group,the portal vein pressure decreased from preoperative(38.47±9.35)mmHg(1 mmHg=0.133 kPa)to postoperative(25.24±5.68)mmHg,the difference was statistically significant(P＜0.05).After treatment,the hemoglobin level in the three groups showed varying degrees of elevation,which in the TIPS group and endoscopy group were better than that in the medication group,the differences were statistically significant(P＜0.05).In all three groups,the differences in the recurrence rate of bleeding between postoperative 6-month value,12-month value and 24-month value were statistically significant(all P＜0.05).The postoperative 6-month,12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the TIPS group were lower than those in the endoscopy group,and the differences were statistically significant(P＜0.05).The postoperative 12-month and 24-month recurrence rates of bleeding in the endoscopy group were lower than those in the medication group(P＜0.05),and the difference in the postoperative 6-month recurrence rate of bleeding between the two groups was not statistically significant(P＞0.05).The postoperative 6-month and 12-month incidences of hepatic encephalopathy in the TIPS group were higher than those in the endoscopy group and the medication group,the differences were statistically significant(P＜0.05),while the differences in the postoperative 6-month and 12-month incidences of hepatic encephalopathy between the endoscopy group and the medication group were not statistically significant(P＞0.05),and the differences in the postoperative 24-month incidence of hepatic encephalopathy between each other among the three groups were not statistically significant(P＞0.05).No statistically significant difference in the 6-month mortality existed between TIPS group and endoscopy group(P＞0.05),and the 6-month mortality of both TIPS group and endoscopy group was remarkably lower than that of the medication group(P＜0.05).The postoperative 12-month mortality and 24-month mortality in TIPS group were lower than those in the endoscopy group and the medication group,and the differences were statistically significant(P＜0.05),but the differences in the postoperative 12-month mortality and 24-month mortality between the endoscopy group and the medication group were not statistically significant(P＞0.05).Conclusion For primary liver cancer associated with portal hypertension and upper gastrointestinal bleeding,TIPS combined with TACE can effectively control tumor progression and prolong survival.(J Intervent Radiol,2024,32:33-37)

Objective:To investigate the effects and mechanism of baicalin on the wound healing of full-thickness skin defects in diabetic mice.Methods:This study was an experimental research. Mononuclear cells were isolated from five male C57BL/6J mice aged 8-12 weeks and induced to differentiate into macrophages for conducting the subsequent experiments. According to the random number table (the same grouping method below), macrophages in a high-glucose environment were divided into 0 μmol/L baicalin group (no baicalin was added), 5 μmol/L baicalin group, 15 μmol/L baicalin group, 25 μmol/L baicalin group, 50 μmol/L baicalin group, and 75 μmol/L baicalin group treated with the corresponding final molarity of baicalin and 1 μg/mL endotoxin/lipopolysaccharide (LPS). After treatment for 48 hours, the cell proliferation activity was detected using a microplate reader. Macrophages in a high-glucose environment were divided into LPS group treated with 1 μg/mL LPS and LPS+baicalin group treated with 50 μmol/L baicalin+1 μg/mL LPS. After treatment for 48 hours, the percentage of double-positive cells for inducible nitric oxide synthase (iNOS) and CD80, as well as that for arginase 1 (Arg1) and CD206 among the cells, were detected using immunofluorescence method, the secretion levels of interleukin 1β (IL-1β), IL-6, IL-23, IL-10, insulin-like growth factor (IGF), and transforming growth factor β 1 (TGF-β 1) by the cells were detected using enzyme-linked immunosorbent assay, the expression of reactive oxygen species in the cells was detected using a fluorescent probe method, the protein expression of nuclear factor κB in the cells were detected using Western blotting, and the expression of nuclear factor 2 in the cells was observed using immunofluorescence method. The number of cell experimental samples was 3. Twenty-four 8-week-old male db/db mice were selected. After preparing full-thickness skin defect wounds on their backs, they were divided into baicalin group and normal saline group (with 12 mice in each group). On the third day after injury, 50 μmol/L baicalin and normal saline were injected into the wounds of mice, respectively. The wound healing situation was observed and the percentage of the residual wound area was calculated on the 4 th, 8 th, and 12 th day after injury. The wound tissue was sampled on the 8 th day after injury, hematoxylin-eosin staining was performed to observe the epithelial regeneration and inflammatory cell infiltration, the protein expression of CD31 was detected by Western blotting, and the expression of reactive oxygen species was detected by a microplate reader. The number of animal experimental samples was 6. Results:After treatment for 48 hours, only the proliferation activity of macrophages in 50 μmol/L baicalin group was significantly higher than that in 0 μmol/L baicalin group ( P<0.05). After treatment for 48 hours, the percentage of double-positive cells for iNOS and CD80 among the macrophages in LPS+baicalin group was (21.0±2.4)%, which was significantly lower than (66.6±4.5)% in LPS group ( t=15.63, P<0.05); the percentage of double-positive cells for Arg1 and CD206 among the macrophages in LPS+baicalin group was (59.1±2.1)%, which was significantly higher than (18.6±1.7)% in LPS group ( t=25.38, P<0.05); compared with those in LPS group, the secretion levels of IL-1β, IL-6, and IL-23 by the macrophages in LPS+baicalin group were significantly decreased (with t values of 14.26, 15.95, and 12.23, respectively, P<0.05), while the secretion levels of IL-10, IGF, and TGF-β 1 were significantly increased (with t values of 8.49, 11.98, and 13.84, respectively, P<0.05); the expression of reactive oxygen species in the macrophages in LPS+baicalin group was significantly lower than that in LPS group ( t=5.54, P<0.05); compared with those in LPS group, the protein expression of nuclear factor κB in the nucleus of the macrophages in LPS+baicalin group was significantly decreased ( t=36.22, P<0.05), while that in the cytoplasm was significantly increased ( t=14.47, P<0.05), and the expression of nuclear factor 2 in the nucleus was increased. On the 4 th and 8 th day after injury, the wound area of mice in baicalin group was significantly smaller than that in normal saline group, and the wounds of mice in baicalin group completely healed on the 12 th day after injury. On the 4 th, 8 th, and 12 th day after injury, the residual wound area percentage of mice in baicalin group was significantly lower than that in normal saline group (with t values of 13.29, 10.08, and 11.72, respectively, P<0.05). On the 8 th day after injury, compared with those in normal saline group, the wound tissue of mice in baicalin group showed significant re-epithelization, the infiltration of inflammatory cells was reduced, the expression of CD31 protein was significantly increased ( t=17.23, P<0.05), and the expression of reactive oxygen species was significantly reduced ( t=5.78, P<0.05). Conclusions:Baicalin alleviates the inflammatory response of macrophages by lowering the level of reactive oxygen species in cells and promoting the polarization of macrophages to the M2 type, thereby facilitating the healing of full-thickness skin defect wounds in diabetic mice.

Background/Aims: The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation. Methods: Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles. Results: FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012). Conclusions FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.Methods:Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ2 test was used for group comparison. P<0.05 indicated the difference with statistical significance. Results:A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred. Conclusion:Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Objective:To investigate the efficacy and safety of geritinib in the treatment of acute myeloid leukemia (AML) with FLT3 mutation.Methods:The clinical data of 5 AML patients with FLT3 mutation who were diagnosed in the University of Hong Kong-Shenzhen Hospital, Shenzhen People's Hospital, Shenzhen Second People's Hospital, Shenzhen University General Hospital from March 2020 to April 2021 were retrospectively analyzed. Relapsed patients concurrently received two- or three-drug chemotherapy combined with geritinib. Blood routine was checked once a week; liver function and renal function were checked once every 2 weeks during treatment. Bone marrow puncture was performed once every 1 to 3 months to monitor the bone marrow morphology, minimal residual disease (MRD) and FLT3 mutation expression levels. The efficacy, side effects, overall survival of these patients were analyzed after treatment with geritinib.Results:The white blood cell was increased in all the 5 patients at the initial diagnosis. FLT3 mutations analysis showed FLT3-internal tandem duplication (ITD) (3 cases) and FLT-3 tyrosine-kinase domain (TKD) (2 cases). Among 5 patients, 1 patient was relapse-free with maintenance therapy of oral geritinib after hematological stem cell transplantation (HSCT) for 60 days; among other 4 relapsed and refractory patients, 1 female patient after pregnancy relapsed after transplantation and then achieved complete remission followed by the maintenance therapy with geritinib after oral geritinib, 1 16-year-old patient achieved treatment outcome close to the complete remission after treatment with geritinib, 1 patient achieved complete remission after treatment with geritinib, and then underwent haplo-HSCT followed by the maintenance therapy with geritinib and the other 1 relapsed patient achieved complete remission after treatment with geritinib. After transplantation, 3 patients receiving maintenance treatment of geritinib did not relapse. The main side effects included anemia, decreased neutrophil count, rash, and increased aminotransferase. The median follow-up time of 5 patients was 15 months (6-20 months). All 5 cases survived until the last follow-up in November 2021 and 4 patients were disease-free.Conclusions:Relapsed and refractory AML patients with FLT3 mutation can achieve complete remission after treatment with geritinib and get a chance for transplantation. Geritinib may reduce the risk of recurrence after transplantation and improve survival rate. No serious side effects occur in geritinib treatment.

The glymphatic system, as "waste" clearance pathway in the brain, plays a critical role in maintaining the homeostasis of the brain cell microenvironment. It has been found that changes in the glymphatic system are common in many neurological diseases. MRI is currently the only technology that can achieve human glymphatic imaging, and has the advantages of high soft tissue resolution and sensitivity to tracers. Quantitative MRI can objectively evaluate the changes of inflow and outflow of glymphatic system. Therefore, in this review, we introduce the application of quantitative MRI technology in the glymphatic system in detail, aiming to provide help for the diagnosis and treatment of diseases related to glymphatic system.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Objective:To summarize and discuss the surgical effect in otoplasty of prominent ear using cartilage folding with unilateral cartilage incision.Methods:Data of patients with prominent ear who were treated in the Department of Vascular and Plastic Surgery of Guangdong Provincial People’s Hospital and the Department of Plastic Surgery of Sun Yat-sen Memorial Hospital from May 2018 to April 2022 were retrospectively analyzed. All patients underwent otoplasty using cartilage folding with unilateral cartilage incision. During the operation, a unilateral cartilage incision was made along the lateral bottom of intended antihelix, cartilage dissection and scoring were made, and the cartilage was folded and sutured to form the antihelix. The patients were followed up postoperatively for auricular shape, wound healing and other complications.Results:A total of 18 patients with prominent ear (22 ears) were included, consisting of 12 males (15 ears) and 6 females (7 ears), aged from 18 to 51 years(average of 25.8 years). There were 9 cases on the left, 5 cases on the right and 4 cases on both sides. Four patients had pain in the operation area within 2 days postoperatively which could be relieved by analgesics. The patients were followed up for 1-24 months, with an average follow-up of 13.6 months. Twenty-two prominent ears were corrected. Scaphoconchal angle and cranioauricular angle of the prominent ears were significantly reduced, and the shape of the antihelix was smooth after the operation. All patients were satisfied with the results. There were no other complications after the operation, such as deformity relapse, infection, unhealing, auricular cartilage deformation and hypertrophic scar.Conclusions:Otoplasty of prominent ear using cartilage folding with unilateral cartilage incision is a simple, stable and satisfactory surgical method for the treatment of prominent ear.