Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective To discuss the accuracy and effectiveness of digital subtraction angiography(DSA)in determining the cause of limb ischemia after extra corporeal membrane oxygenation(ECMO.Methods The clinical data of 3 child patients,who developed 4 times of acute limb ischemia during perioperative period of ECMO at the Affiliated Children's Hospital of Zhengzhou University of China from July to October of 2023,were retrospectively analyzed.In all the child patients,emergency angiography was carried out to quickly identify the cause,then,appropriate treatment plan was adopted to open the blood vessels of the right lower limb.Results After the child patients entered the operating room and received DSA examination,the causes of the limb ischemia were quickly identified.After treatment,the blood supply to the lower limbs was restored.Except for one child who experienced irreversible necrosis of the distal limb due to repeated ischemia-reperfusion injury and required amputation,the other two child patients recovered well.Conclusion It is of great significance to perform DSA examination as soon as possible when the child patients develop limb ischemic manifestations after ECMO so as to quickly identify the cause,promptly restore blood supply to ischemic limbs and increase limb preservation rate,besides,DSA examination can also be used as a preventive measure for child patients after ECMO.

Objective To explore the safety and efficacy of semiconductor laser combined with sclerotherapy in the treatment of venous malformations(VM)in child patients.Methods The clinical data of 68 child patients with VM,who were admitted to the Affiliated Children's Hospital of Zhengzhou University of China from April 2023 to April 2024,were retrospectively analyzed.The child patients were divided into semiconductor laser combined with sclerotherapy group(laser+sclerotherapy group)and simple sclerotherapy group(sclerotherapy group),with 34 child patients in each group.The reduction rate of lesion size and the incidence of complications were compared between the two groups.Results The total effective rate and significant effective rate in the laser+sclerotherapy group were 100％ and 79.41％(27/34)respectively,which were higher than 82.35％(28/34)and 29.41％(10/34)respectively in the sclerotherapy group.The incidences of blister and pigmentation complications in the laser+sclerotherapy group were 11.76％(4/34)and 14.71％(5/34)respectively,which were lower than 41.18％(14/34)and 38.24％(13/34)respectively in the sclerotherapy group,and the differences between the two groups were statistically significant(all P＜0.05).Conclusion In treating child patients with VM,the combination use of semiconductor laser and sclerotherapy has higher clinical safety and effectiveness.

Objective To discuss the application value of intracavitary semiconductor laser therapy in improving facial appearance for child patients with facial venous malformations(VM)after receiving sclerotherapy.Methods The clinical data of 12 child patients with facial VM after receiving sclerotherapy,for whom the improvement of their facial appearance was difficult and who were admitted to the Affiliated Children's Hospital of Zhengzhou University of China from February 2023 to February 2024,were retrospectively analyzed.Intracavitary semiconductor laser treatment was adopted in all the 12 child patients.All the child patients were followed up to check the degree of appearance improvement and lesion volume reduction,and the curative effect was evaluated.Results Three months after intracavitary semiconductor laser treatment,obvious improvement of facial appearance was obtained in all the 12 child patients.The mean postoperative PAC-QOL psychological discomfort score was(10.4±3.9)points,when compared with the preoperative(23.7±4.3)points the difference was statistically significant(P＜0.05).MRI examination showed that after treatment no obvious improvement of the lesion was seen in 0 case,moderate improvement in one case,significant improvement in 4 cases,and cure in 7 cases.Conclusion Intracavitary semiconductor laser therapy has significant therapeutic effect in improving facial appearance for child patients with facial VM after receiving sclerotherapy,for whom the improvement of their facial appearance is difficult,therefore,this therapy has high clinical application value.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective To discuss the clinical efficacy of absolute ethanol and foam hardening agent in the treatment of large venous malformations(VM)in child patients.Methods The clinical data of a total of 60 child patients with solitary large VM were retrospectively analyzed.The child patients were divided into group A(n=30)and group B(n=30).Patients in group A received absolute ethanol injection followed by foam hardening agent injection,while patients in group B received foam hardening agent injection followed by absolute ethanol injection.The clinical efficacy,complications,mean number of injections and mean dosage of absolute ethanol were compared between the two groups.Results The total effective rate in both group A and group B was 100%.The markedly effective rate in group A and group B was 63.33%(19/30)and 90%(27/30)respectively,and the difference was statistically significant(P＜0.05).In group A and group B,the mean dosage of absolute ethanol was(10.30±3.19)mL and(6.73±2.06)mL respectively,the mean number of injection was(3.57±1.01)times and(2.63±0.61)times respectively,and the differences in the above two indexes were statistically significant(both P＜0.05).No serious complications occurred in either group.The incidence of blisters in group A and group B was 30%(9/30)and 6.67%(2/30)respectively,and the difference was statistically significant(P＜0.05).Conclusion For large VM in child patients,combination use of absolute ethanol and foam hardening agent can improve the curative efficacy,reduce the dosage of absolute ethanol,and lower the incidence of complications.In addition,the therapeutic mode of foam hardening agent injection followed by absolute ethanol injection can achieve better efficacy.(J Intervent Radiol,2024,32:28-32)

Objective:To develop an improved wireless intelligent capsule cystoscope (WCE)for dynamic detection of bladder mucosa in a pig model.Methods:The WCE was introduced into a healthy experimental pig that under general anesthesia via urethra by applying an improved device. Multi-angle images of the bladder mucosa were then obtained by controlling the position of capsule cystoscope with an external magnetic field system. The shutter speed of the WCE was 2.5 fps and was automatically converted to 1.5 fps 30 minutes after initiation. The Vue software was utilized to download the shoot pictures which were former received by a computer via wireless transmission. The pig was roused and sent to the pigpen, without limitations in moving. The improved WCE was connected with a 2 cm thread. 12 hours later, the dilated sheath was inserted again, and the capsule was removed by a foreign body forceps under observation of a ureteroscopy.Results:The WCE was successfully placed and removed from the pig's bladder with the application of the improved devices. Over 20 thousand images that with 60K pixels of bladder mucosa were captured by the WCE at various angles within 12 hours, which revealed the process of urine filling and excreting in a time-dependent way. No notable adverse effects (bleeding, urinary tract injury, etc) were noted during the process of cystoscope placement, image acquisition, transmission, and removal.Conclusion:This study developed a novel WCE that could dynamically, intelligently and accurately monitor all aspects of the pig bladder mucosa, and has preferable application prospect.

Autoimmune hepatitis (AIH) affects all age group and occurs mainly in women. Pyroptosis is a novel programmed cell death featured with cell bursting and release of proinflammatory cytokines. A deeper understanding of AIH pathogenesis will contribute to novel therapy for AIH patients. Here, we aimed to investigate the role of IL-17 in immune-mediated liver injury.The levels of cytokines were measured by ELISA, and mRNA levels of STAT3 and IFN gammainducible protein 16 (IFI16) were detected by PCR. Expressions of STAT3, IFI16, gasdermin D and cleaved caspase-1 were measured by western-blotting. Immunohistochemical staining and transmission electron microscopy were applied to evaluate liver histopathological changes of the treated mice. Our results showed that the levels of IFI16 was increased in hepatocytes treated with IL-17 protein, and further elevated after STAT3-overexpressed (STAT3-OE) lentivirus treatment. The levels of IFI16 were reduced in hepatocytes treated with IL-17 neutralizing Ab (nAb), but were significantly increased after STAT3-OE treatment. Pyroptosis was observed in hepatocytes treated with IL-17 protein, and further cell damage was observed after STAT3-OE lentivirus treatment. Liver damage was alleviated in mice treated with IL-17 nAb, however sever damage was experienced after STAT3-OE lentivirus treatment. A binding interaction between IFI16 and STAT3 was detected in IL-17 treated hepatocytes. Glutathione transaminase activity was enhanced in concanavalin A-induced AIH mice compared to the control group (p<0.01). IL-17 plays an important role in activating STAT3 and up-regulating IFI16, which may promote the pyroptosis in AIH-related liver injury through STAT3-IFI16 axis.

Objective To study the validity period of sterilized medical supplies packed by non-woven fabric or disposable paper-plastic packages and placed in different battle positions and storage conditions during long-distance navigation.Methods After autoclaving,the non-woven fabrics and paper-plastic packages stored in different battle positions on ships with different batches were tested for sterility,the validity period of the two packaging methods was determined,and the data were analysed.Results On the 150th day after sterilization,bacteria began to grow on the medical supplies packed by both packages in the machine room and engine room.On the 165th day after sterilization,bacteria began to grow on the non-woven packaging items in the dental room.On the 180th day after sterilization,bacteria began to grow on the paper plastic packaging items in the clinic(reception room).On the 180th day after sterilization,the medical supplies packed by both packages in the operation room had no bacteria growth.There was no significant difference in the validity period of sterilized medical supplies between disposable paper-plastic and non-woven packages in the same battle position(P>0.05).There was no significant difference in the validity period of sterilized medical supplies between medical clinic,dental room,and operation room(P>0.05),but there were significant differences between machine room,engine room,and operation room(P<0.05).Conclusion The term of validity of medical supplies packaged with disposable paper-plastic and non-woven fabric packages sterilized by autoclaving is both within 135 days,and there is no significant difference in the validity period date between the two packaging methods.

Objective:To identify the pathogenic gene and inheritance pattern in a pedigree of congenital iris coloboma with congenital cataract.Methods:The method of pedigree investigation was adopted.A pedigree of congenital iris coloboma with congenital cataract was collected by Yunnan Disabled Rehabilitation Center and the 2nd Afliated Hospital of Kunming Medical University in February 2020.Ophthalmic examinations were carried out on the female proband, her parents, her children and her husband, and the clinical diagnosis was made.Genomic DNA was extracted from peripheral blood samples collected from the family members.The suspected pathogenic gene in the proband and her husband was screened by whole exome sequencing and was identified by bioinformatics analysis.The amino acid conservation was analyzed by UGENE software.The impact of the mutation on protein translation was predicted using MutationTaster software.The pathogenicity of the mutation was assessed according to the American College of Medical Genetics (ACMG) Standards and Guidelines.Pathogenic gene and mutations were verified by Sanger sequencing.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the 2nd Afliated Hospital of Kunming Medical University (No.PJ-2020-61).Written informed consent was obtained from each subject or custodian.Results:The proband showed large iris defects in both eyes with only a small amount of observable iris tissue in the periphery, lens cortical opacity and posterior capsule opacification, accompanied by nystagmus.A novel heterozygous frameshift variation c. 415dupA (p.R139fs) was located in exon 8 of PAX6 gene, and the variation was conservative across multiple species.The variation was in the highly conserved region of PAX6 gene and caused the dysfunction of PAX6 protein.The variation was graded as PVS1+ PM2+ PP1, a pathogenic variation, based on ACMG guidelines.The pedigree was consistent with co-segregation, indicating that the novel variation was pathogenic.The proband and her children were diagnosed, but her parents were phenotypically normal, in accordance with autosomal dominant inheritance. Conclusions:The novel frameshift variation c.415dupA (p.R139fs) on the exon 8 of PAX6 gene is responsible for congenital iris coloboma with congenital cataract in the pedigree.This is the first report of this novel variation in PAX6 gene.