Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective: To analyze the epidemiological characteristics, etiology and hemagglutinin (HA) gene characteristics of prevalent strains in Shandong Province from 2021 to 2022. Methods: The sentinel surveillance data of influenza-like illness (ILI) were collected in Shandong Province from 2021 to 2022. ILI specimens were detected with Real-Time PCR and virus isolation to explore the distribution of influenza viruses in different months. Three virus strains of each city were selected for gene sequencing, and the HA phylogenetic analysis was carried out. Results: In the surveillance-year from 2021 to 2022, 528 263 ILI cases were totally reported in 54 sentinel hospitals for influenza surveillance in Shandong Province. ILI visiting ratio (ILI%) was 4.07%, with the largest number in 0-4 age group (45.86%). The highly frequent season for ILI was in winter and spring, with a peak in the 52nd week, 2021 (6.62%). Totally, nucleic acid was detected in 26 754 specimens, with a positive rate of 27.10%, all of which were type B Victoria influenza. The positive rate reached a peak in the 49th week, 2021 (63.78%). A total of 295 outbreaks of ILI had been reported, in which 269 were positive for influenza virus. Most of outbreaks occurred in the primary school, with a peak in December. Gene evolution analysis showed that the HA gene in Shandong possessed high homology, 98.6% to 99.5%, with the recommended vaccine strains in 2020-2023, which was divided into two branches, V1A.3a.1 and V1A.3a.2. Conclusion: In the surveillance-year of 2021-2022, influenza is prevalent in December in Shandong Province, with a single circulating strain type. The positive rate of influenza virus and outbreak are higher than those in the previous surveillance-year. The circulating strain possesses high HA gene homology with those of the WHO vaccine recommended strains. However, the overall immune barrier of influenza virus is weak.
Humans ; Influenza, Human/prevention & control* ; Phylogeny ; Influenza Vaccines ; Orthomyxoviridae ; Seasons ; China/epidemiology* ; Virus Diseases

Multi-modal therapeutics are emerging for simultaneous diagnosis and treatment of cancer. Polymeric carriers are often employed for loading multiple drugs due to their versatility and controlled release of these drugs in response to a tumor specific microenvironment. A theranostic nanomedicine was designed and prepared by complexing a small gadolinium chelate, conjugating a chemotherapeutic drug PTX through a cathepsin B-responsive linker and covalently bonding a fluorescent probe pheophorbide a (Ppa) with a branched glycopolymer. The branched prodrug-based nanosystem was degradable in the tumor microenvironment with overexpressed cathepsin B, and PTX was simultaneously released to exert its therapeutic effect. The theranostic nanomedicine, branched glycopolymer-PTX-DOTA-Gd, had an extended circulation time, enhanced accumulation in tumors, and excellent biocompatibility with significantly reduced gadolinium ion (Gd

ObjectiveThe aim of this study is to investigate the proportion of DN2 cell and the correlation between the expression of calcium ion release activated calcium ion channel（ Ca²⁺ release-activated Ca²⁺， CRAC） protein in DN2 cells and the clinical activity of lupus nephritis （LN）. MethodsFlow cytometry was used to detect the proportion of DN2 cells in healthy controls （HC， n=15）， LN （HC， n=30）， rheumatoid arthritis （RA， n=15） and primary Sjogren syndrome （pSS， n=15） patients and the expression of SOCE protein Orai1 in DN2 cells. One-way ANOVA was used to analyze the differences among the four groups. The correlation between Orai1 expression and LN disease activity was analyzed by Pearson correlation analysis. ResultsThere was a statistically significant difference in the proportion of DN2 cells in peripheral blood among the four groups （F= 9.315， P＜0.000 1）. The proportion of DN2 cells in the peripheral blood of patients with LN was significantly higher than that of HC， RA and pSS ［（2.60±2.20）% vs.（0.68±0.56）% vs.（0.69±0.45）% vs.（1.04±0.72）%］ and was correlated with 24-hour urinary protein excretion （r=0.599 9， P=0.000 5）. There was a statistically significant difference in the Orai1 expression in DN2 cells among the four groups （F= 7.935， P＜0.000 1）. The Orai1 expression in DN2 cells of LN was significantly higher than that of HC， RA and pSS （2.30±1.50 vs. 0.86±0.39 vs. 1.34±0.57 vs. 1.13±0.64）. Orai1 expression in DN2 cells was positively correlated with SLEDAI （r=0.56， P＜0.005）， blood anti-dsDNA antibody level （r=0.43， P＜0.05） and 24-hour urinary protein excretion （r=0.44， P＜0.05）， and negatively correlated with complement C3 （r=-0.39， P＜0.05）. ConclusionsThe proportion of DN2 cells and the expression of Orai1 increases in patients with LN and is correlated with disease activity. SOCE of DN2 cells may be a potential therapeutic target for LN.

ObjectiveThe aim of this study is to investigate the proportion of DN2 cell and the correlation between the expression of calcium ion release activated calcium ion channel（ Ca²⁺ release-activated Ca²⁺， CRAC） protein in DN2 cells and the clinical activity of lupus nephritis （LN）. MethodsFlow cytometry was used to detect the proportion of DN2 cells in healthy controls （HC， n=15）， LN （HC， n=30）， rheumatoid arthritis （RA， n=15） and primary Sjogren syndrome （pSS， n=15） patients and the expression of SOCE protein Orai1 in DN2 cells. One-way ANOVA was used to analyze the differences among the four groups. The correlation between Orai1 expression and LN disease activity was analyzed by Pearson correlation analysis. ResultsThere was a statistically significant difference in the proportion of DN2 cells in peripheral blood among the four groups （F= 9.315， P＜0.000 1）. The proportion of DN2 cells in the peripheral blood of patients with LN was significantly higher than that of HC， RA and pSS ［（2.60±2.20）% vs.（0.68±0.56）% vs.（0.69±0.45）% vs.（1.04±0.72）%］ and was correlated with 24-hour urinary protein excretion （r=0.599 9， P=0.000 5）. There was a statistically significant difference in the Orai1 expression in DN2 cells among the four groups （F= 7.935， P＜0.000 1）. The Orai1 expression in DN2 cells of LN was significantly higher than that of HC， RA and pSS （2.30±1.50 vs. 0.86±0.39 vs. 1.34±0.57 vs. 1.13±0.64）. Orai1 expression in DN2 cells was positively correlated with SLEDAI （r=0.56， P＜0.005）， blood anti-dsDNA antibody level （r=0.43， P＜0.05） and 24-hour urinary protein excretion （r=0.44， P＜0.05）， and negatively correlated with complement C3 （r=-0.39， P＜0.05）. ConclusionsThe proportion of DN2 cells and the expression of Orai1 increases in patients with LN and is correlated with disease activity. SOCE of DN2 cells may be a potential therapeutic target for LN.

Objective: To explore the clinical effects of the reconstruction of extensive leg defects using the free anterolateral thigh flap with the contralateral leg vessels as the recipient vessels. Methods: From January 2012 to January 2018, ten patients were treated with severe and extensive leg defects in the department of orthopedics of the First Affiliated Hospital of Nanchang University. There were 7 males and 3 females with an average age of 35, from 17 to 56. There were no main vessels for angiogenesis around the wounds in all cases. The size of defects ranged from 20 cm×13 cm to 29 cm×15 cm. The position of defects were anterior of shank in 5 cases, medial in 3 cases and medial posterior in 2 cases. The various flaps were harvested from the anterolateral thigh region of healthy leg and transferred to repair the leg defects. The healthy vessels of the contralateral leg were chosen as the recipient vessels. The musculocutaneous flap, fascia flap or perforator was removed according to the size of the defect and whether it was necessary to fill the dead space of the wound. The limbs were placed in parallel position and was fixed by external fixator. The pedicle division training was started 1 week after operation, the period of pedicle division and external fixator removing was from 21 days to 32 days. When the pedicle was divided, the vascular end of the limb and the distal end were anastomosed to re-established the continuous vessels. Results: All 10 flaps survived completely after surgery. The size of flaps ranged from 23 cm×14 cm to 32 cm×16 cm. The recipient vessels that were used included the posterior tibial vessels in 5 cases and anterior tibial vessels in the remaining 5 cases. All the vessels in flap pedicle were anastomosed to the recipient vessels in an end-to-end fashion. The anastomotic sites and vascular bundles were covered by using a local flap in 2 cases, skin tension reducer in 1 cases, and free skin graft in the remaining 7 cases. Very mild infection occurred in one case and was controlled by dress changing. A small-sized necrosis of the grafted skin occurred in another patient. All patients were followed up for 6 to 18 months with an average of 12 months. The function of the lower extremities almost recovered. All patients were happy with the final functional and aesthetic outcomes. Conclusions Although there some drawbacks of the technique, such as long-term immobilization of the lower extremities, multiple staged surgeries, for strictly selected patients, the healthy vessels of the contralateral leg could be served as recipients vessels when a free myocutaneous, fasciocutaneous, or perforator flap was used to reconstruct the extensive and severe injury of the leg, particularly in the absence of usable vessels in the ipsilateral leg.

OBJECTIVE: To explore the effect of selective lumbosacral posterior rhizotomy(SPR) on lower limb spasticity and gross motor function in patients with cerebral palsy. METHODS: From January 2018 to October 2018, 47 patients with cerebral palsy were treated with rehabilitation alone and SPR combined with rehabilitation. According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated with rehabilitation combined with SPR at lumbosacral level, and group B was treated with rehabilitation alone. There were 23 cases in group A, including 15 males and 8 females, with an average age of (7.30±3.25) years old; 24 cases in group B, 13 males and 11 females, with an average age of (7.00±3.09) years old. Forty-seven patients were assessed with modified Ashworth(MAS) and Gross Motor Function Scale(GMFM-88 items) before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups. RESULTS: All 47 patients were followed up. At 6 months after treatment, the MAS classification of the two groups was significantly improved(<0.05), and the improvement of group A was more obvious than that of group B(<0.05). Six months after treatment, the D, E and total scores of GMFM-88 between two groups were significantly improved compared with those before operation(<0.05). The improvement of D and total scores in group A was more obvious than that in group B. There was no significant difference in the improvement of area E between two groups. CONCLUSIONS Selective posterior rhizotomy combined with rehabilitation can significantly improve the spastic state and gross motor function of lower limbs in children with cerebral palsy, and can effectively promote the reconstruction and recovery of motor function of lower limbs in children with cerebral palsy.
Cerebral Palsy ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Lower Extremity ; Male ; Movement ; Muscle Spasticity ; Rhizotomy

OBJECTIVE: To study the clinical effect of calsurf, a domestic exogenous pulmonary surfactant, in the treatment of severe neonatal infectious pneumonia. METHODS: A total of 208 neonates with severe infectious pneumonia who hospitalized in 5 hospitals of China were enrolled. According to their parents' wishes on admission, these neonates were administered with conventional treatment (control group; n=81) and calsurf  treatment + conventional treatment (calsurf treatment group, n=127). The two groups were compared in terms of the degree of oxygen dependence on admission, blood gas parameters before and after treatment, lung ultrasound results, duration of mechanical ventilation, length of hospital stay, hospital costs, complications and prognosis. RESULTS: Compared with the control group on admission, the calsurf treatment group had significantly higher inhaled oxygen concentration and partial pressure of carbon dioxide and significantly lower arterial partial pressure of oxygen and oxygenation index (P<0.01). After 1 hour of treatment, both groups had significant improvements in the above indices (P<0.05), and the improvements were more significant in the calsurf treatment group (P<0.05). After 4-6 hours of calsurf administration, there was a significant reduction in the degree of pulmonary consolidation. The calsurf treatment group had significantly shorter duration of mechanical ventilation and length of hospital stay than the control group, while there was no significant difference in the incidence rate of complications between the two groups. The neonates of both groups had a good prognosis. CONCLUSIONS In neonates with severe infectious pneumonia, calsurf treatment can significantly improve oxygenation, reduce the degree of pulmonary consolidation, and shorten the duration of mechanical ventilation and length of hospital stay. Therefore, it should be considered in neonates with severe infectious pneumonia.
China ; Humans ; Infant, Newborn ; Pneumonia ; Prospective Studies ; Pulmonary Surfactants ; Respiration, Artificial

Stellera chamaejasme L. is a traditional Chinese medicine with a long history to treat stubborn skin ulcer, and it also has antiviral and antitumor effects. Neochamaejasmine B (NCB), Neochamaejasmine A (NCA) and Chamaechromone (CMC) are the major components in dried roots of Stellera chamaejasme L.. Our studies suggested that NCB, NCA and CMC are inhibitors of Organic anion transporter 1 (OAT1). OAT1 is encoded by solute carrier family 22 member 6 gene (SLC22A6) in humans and plays a critical role in the organic anion drug uptake and excretion in the kidney. Lamivudine is the typical substrate of OAT1 and is frequently used in combination with other antiviral drugs in clinical antiviral treatments. The aim of this study is to investigate the interaction and its mechanism between these bi-flavone components in Stellera chamaejasme L. and lamivudine via OAT1 both in vitro and in vivo. In vitro, the uptake studies in Madin-Darby canine kidney (MDCK) cells overexpressing OAT1 suggested that NCB inhibited the uptake of 6-CFL and lamivudine.Similar results were obtained for NCA and CMC. NCB was a noncompetitive and competitive inhibitor interaction with OAT1. IC values of NCB, NCA and CMC for inhibiting OAT1-mediated lamivudine transport were 2.46, 8.35 and 0.61 μmol·L, respectively. In vivo, the pharmacokinetic results of lamivudine in rats showed that the mean area under the plasma concentration-time curve (AUC) and maximal plasma concentration (C) of lamivudine after co-administration is increased 2.94-fold and 1.87-fold, respectively, compared to lamivudine administration alone. The results of interactions between lamivudine and these bi-flavone components in Stellera chamaejasme L. extracts via OAT1 in vivo are consistent with studies in vitro. The inhibition of OAT1-mediated uptake of lamivudine by NCB, NCA and CMC is the possible mechanism for Stellera chamaejasme L. extracts improving the oral bioavailability of lamivudine in rats.

Treatment of large bone defects caused by trauma, osteomyelitis, and tumors has been a major challenge in clinical. In the past, there have been many ways to repair and reconstruct the large bone defects. However, there is a long period of treatment, high technical requirement and complications such as ununion. After Masquelet reported the induced membrane technology in 2000, the technique was widely used in treatment of trauma, osteomyelitis, and large bone defects caused by tumors. It has been obtained good results. It has the advantages of short course, high healing rate, easy operation and easy to master. The induced membrane has unique structural characteristics and biological characteristics. There are many kinds of osteogenic factors that are included in the membrane, such as vascular endothelial growth factor, and morphogenetic protein-2, transforming growth factor-β1, etc. These osteogenic factors contribute to accelerate bone healing. With the development of induced membrane technology. The technology of Reamer Irrigator Aspirator technology, engineering tissue technology and internal fixation is used in clinic.It can provide bone source, promote bone defect reconstruction, improve long-term limb function and reduce complications.This paper retrospectively summarizes the experimental research and clinical progress of Masquelet technique in the treatment of large bone defects.