Objective:To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation (OLT).Methods:The retrospective cohort study was conducted. The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected. Of the 35 donors, there were 31 males and 4 females, aged (48±9)years. Of the 35 recipients, there were 25 males and 10 females, aged (47±9)years. Of the 35 recipients, 16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group, and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data of skewed distribution were represented as M(range). Count data were descried as absolute numbers, and comparison between groups was analyzed using the Fisher exact probability. Results:(1) Surgical situations. The anhepatic phase time and arterial blood Ca 2+ concentration within 5 minutes after reperfusion of the recipients were (52±12)minutes and (0.99±0.10)mmol/L in the portal vein group, versus (64±12)minutes and (1.05±0.07)mmol/L in the albumin group, showing significant differences in the above indicators between the two groups ( t=2.94, 2.22, P<0.05). The mean arterial pressure, arterial blood K +concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were (70±24)mmHg (1 mmHg=0.133 kPa), (4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group, versus (71±28)mmHg, (4.6±1.1)mmol/L and 7.30±0.07 in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.14, 0.30, 1.22, P>0.05). (2) Post-operative situations. Cases with post-reperfusion syndrome (PRS), cases with severe PRS of cardiac arrest, cases with primary graft nonfunction of the recipients were 6, 0, 2 in the portal vein group, versus 8, 1, 1 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). Total bilirubin on postoperative day 7 of the recipients was (90±52)μmol/L in the portal vein group, versus (166±112)μmol/L in the albumin group, showing a significant difference between the two groups ( t=2.66, P<0.05). International normalized ratio on postoperative day 7, the highest alanine aminotransferase and aspartate aminotransferase within 7 days after operation of the recipients were 2.1±2.0, (1 952±2 813)IU/L and (3 944±6 673)IU/L in the portal vein group, versus 1.8±0.6, (1 023±1 014) IU/L and (2 005±2 910)IU/L in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.66, 1.23, 1.08, P>0.05). Recipients with hepatic artery complication and biliary complication were 1 and 2 in the portal vein group, versus 0 and 4 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). There were 3 cases and 2 cases died during the perioperative period in the portal vein group and the albumin group, respectively. (3) Follow-up. Of the 35 recipients, 30 recipients were followed up for 534(range, 28?776)days after operation. During the follow-up, there were 3 patients with postoperative complications in the portal vein group including 2 cases died and 1 case recovered after sympto-matic treatment. There were 5 patients with postoperative complications in the albumin group including 1 case died and 4 cases recovered after symptomatic treatment. Up to the follow-up date, 11 patients in the portal vein group and 16 patients in the albumin group were in good condition. Conclusion:Rinse of the donor liver with autologous portal venous blood during liver transplantation can shorten the time of anhepatic phase, without increasing the occurrence of post-reperfusion syndrome, ischemia re-perfusion injury and biliary tract complications.

Objective:To investigate the clinical efficacy of avatrombopag combined with recombinant human thrombopoietin (rhTPO) versus avatrombopag in the treatment of severe thrombocytopenia associated with chronic liver disease.Methods:The retrospective cohort study was conducted. The clinical data of 56 patients with severe thrombocytopenia associated with chronic liver disease who were admitted to the First Affiliated Hospital of University of Science and Technology of China from May 2020 to October 2021 were collected. There were 36 males and 20 females, aged from 33 to 74 years, with a median age of 54 years. Of 56 patients, 21 cases undergoing treatment of avatrombopag combined with rhTPO were allocated into the combined treatment group and 35 cases undergoing treatment of avatrombopag were allocated into the monotherapy group. Observation indicators: (1) changes of platelet after treatment; (2) adverse drug reaction. Follow-up was conducted using outpatient examination and telephone interview to detect changes of platelet and effects of treatment within 2 weeks after treatment. The follow-up was up to October 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and compari-son between groups was analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed using the repeated ANOVA. Results:(1) Changes of platelet after treatment. The platelet level within 1 to 5 days and 6 to 10 days after treatment in the combined treatment group were (35±19)×10 9/L and (73±41)×10 9/L, respectively. The above indicators of the monotherapy group were (40±30)×10 9/L and (70±51)×10 9/L, respectively. There was no significant difference in change trends of platelet before and after treatment between the two groups ( Fgroup=0.30, P>0.05). There was a significant difference in platelet count before and after treatment between the two groups ( Ftime=59.96, P<0.05). There was no interaction effect in change trends of platelet between the two groups ( Finteraction=0.40, P>0.05). The effective rates were 66.67%(14/21) in the combination therapy group and 54.29%(19/35) in the monotherapy group. There was no significant difference in the effective rate between the two groups ( χ2=0.83, P>0.05). (2) Adverse drug reaction. Cases with headache, dizziness, blood transfusion reaction, hematuria, proteinuria, fever, abdominal pain, diarrhea, dyspepsia, fatigue, nausea or peripheral tissue edema were 2, 4, 1, 2, 2, 7, 10, 6, 8, 14, 12, 5 in the combined treatment group, versus 5, 8, 1, 3, 5, 7, 19, 11,20, 19, 14, 5 in the monotherapy group, respectively. There was no significant difference in cases with headache, dizziness, blood transfusion reaction, hematuria, proteinuria between the two groups ( P>0.05), and there was no significant difference in cases with fever, abdominal pain, diarrhea, dyspepsia, fatigue, nausea, peripheral tissue edema between the two groups ( χ2=1.24, 0.23, 0.05, 1.91, 0.83, 2.04, 0.81, P>0.05). Conclusion:Both of avatrombopag combined with rhTPO and monotherapy of avatrom-bopag can be used to promote the platelet level in patients with severe thrombocytopenia associated with chronic liver disease, and avatrombopag combined with rhTPO does not provide better clinical benefits compared with monotherapy avatrombopag.

Hepatocellular adenoma is a rare type of benign tumor in the liver. It has high risk of rupture and low risk of malignant transform. Recently the incidence of hepatocellular adenoma malignant transforming has been increasing. The malignant progress of hepatocellular adenoma develop to hepatocellular carcinoma has the transition state. This course not only relyes on the CTNNB1 gene exon 3 mutations, but also depends on TERT gene promoter mutation. This article will elaborate the hepatocellular adenoma malignant transforming in molecule mechanism, pathological diagnosis and therapies.

Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius.Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics,Shandong Provincial Hospital.There were 13 males and 8 females,aged from 34 to 63 years (average,46.9 years).According to the preoperative definite diagnoses by the X-ray and CT images,there were 14 metacarpal compression fractures and 7 dorsal compression fractures.The palmar approach was used in 13 cases,the dorsal approach in 7 and the combined approach in one.Autogenous iliac bone grafting was performed for all the cases.Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist,and postoperative complications as well,were observed and recorded.Results This cohort was followed up for 8 to 14 months (average,9.2 months).All their postoperative wounds healed by the first intention.Their Cooney functional scores of the wrist were,respectively,58.5 ± 4.2 and 84.0 ± 3.1 points preoperatively and at the final follow-up,and their corresponding VAS scores 7.6 ± 0.9 and 3.4 ± 1.3 points,showing significant differences between preoperation and the final follow-up (P ＜ 0.05).Carpal arthritis was observed in one case.Conclusion For old die-punch fractures of the distal radius,surgical treatment can obviously reduce pain,improve function of the wrist and enhance the quality of life of the patients.

Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children.Methods From May 2014 to June 2015,7 children with skin defects around the Achilles tendon were admitted to our trauma center.The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm.The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case.The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement.In the one case with the Achilles tendon partly disrupted,the contaminated tendon ends were excised before wound closure.The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap.Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change.The follow-up periods ranged from 8 to 12 months (average,11.5 months).The scar around the flap was remarkable in 2 cases,but the flaps in the other cases appeared normal in terms of color and texture.The ankle function was satisfactorily normal in all the cases.Conclusion Our self-designed rectangle advancement flaps provide a simple,safe and reliable way to repair skin defects around the Achilles tendon in children.

Objective To compare the therapeutic results between low-molecular-weight heparin therapy and combined therapy of low-molecular-weight heparin and Shuxuetong for deep venous thrombosis (DVT) after lower extremity fracture.Methods Forty-two patients with DVT from 1,037 patients with lower extremity fracture treated from December 2010 through November 2012 were included in the study.There were 31 males and 11 females,aged from 26 to 82 years (mean,63 years).The patients were assigned to administration of 4,250 IU low-molecular-weight heparin subcutaneously,twice daily (Group A,n =19)and 4,250 IU low-molecular-weight heparin subcutaneously,twice daily plus shuxuetong to 6 ml intravenously,once daily (Group B,n =23) according to the random number table.A period of treatment was a week.Color Doppler sonography was performed to detect DVT.Results Longest course of treatment was 3 weeks.In Group A,the results were recanalization in 2 patients with mean time of 2.50 weeks,significantly effective in 3 patients with mean time of 2.67 weeks,effective in 7 patients with mean time of 3 weeks,and invalid or worse in 7 patients with mean time of 3 weeks.Whereas in Group B,the results were recanalization in 7 patients with mean time of 1.86 weeks,significantly effective in 12 patients with mean time of 1.83 weeks,effective in 3 patients with mean time of 3 weeks,and invalid or worse in 1 patient with mean time of 3 weeks (P ＜ 0.05).Conclusion Low-molecular-weight heparin plus Shuxuetong is effective in treatment of DVT after lower extremity fracture and hence can be as an option in clinical application.

Objective To determine the curative effect of stabilizing unstable pelvic ring fracture using the anterior subcutaneous internal fixator (INFIX).Methods From July 2013 to June 2014,15 cases who suffered from anterior pelvic ring fracture were treated with the device.There were 11 males and 4 females,with mean age of 38.5 years (range,23-65 years).Eight cases sustained fracture in traffic accidents,4 in high falls,and 3 in crush injury.According to the Young-Burgess and AO/OTA classification systems,type APC2 or 61-B1 was noted in one case,LC1 or 61-B2.1 in 4 cases,LC2 or 61-B2.2/61-B2.3 in 6 cases,and VS or 61-C1/61-C2 in 4 cases.Basic method in anterior ring fixation was one pedicle screw was respectively inserted into the area between the anterior superior iliac spine and anterior inferior iliac spine of both sides.The precontoured rod was then tunneled subcutaneously from one screw to the other.For the stable posterior injury in pelvic ring fracture,the anterior pelvic ring was stabilized only using the technique.For the unstable posterior injury in pelvic ring fracture,the anterior and posterior ring were both fixed using the technique.During follow-up visits,patients' tolerance to the device,wound infection,myositis ossificans,internal fixation lessening,and lateral femoral cutaneous nerve injury were evaluated.Results Follow-up ranged from 6-12 months (mean,7.5 months).The device was well tolerated by the patients for comfort.None had surgical site infection and internal fixation loosening.Injuries healed without loss of reduction at the 3-month follow-up.Injury of the lateral femoral cutaneous nerve at the both side was reported in 4 cases and at one side in 2 cases,but all restored 3 month after operation.Conclusion The reported technique is minimally invasive with few complications and reliable results,hinting an ideal method to stabilize the anterior pelvic ring fracture.

ObjectiveTo compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. MethodsA prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined.ResultsA total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. ConclusionsE. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.

BACKGROUND: Treatment for acetabular fracture becomes a hot point in orthopaedic trauma, but ignorance of rehabilitative treatment that effect therapeutic efficacy is to be seen repeatedly. Normative rehabilitation therapy is one indispensable procedure of acetabular fracture treatment.OBJECTIVE: To investigate the effect of early rehabilitation on the hip joint function in patients with comminuted posterior wall fractures of the acetabulum after internal fixation.METHODS: Forty patients of comminuted posterior wall fractures of the acetabulum at the Department of Orthopedics, Third Hospital of Hebei Medical University, were selected, including 36 males and 4 females, aged 23-61 years, mean aged 35.3 years. All patients were randomly divided into rehabilitation and control group, with 20 patients in each group. All the patients were fixed with reconstruction plate, the patients in the rehabilitation group received early standard rehabilitation exercises intervention and those in control group received usual care. The clinical result was evaluated with the scores of Merle d'Aubigne and Postel.RESULTS AND CONCLUSION: The scores of Merle d'Aubigne and Postel of the rehabilitation group were (13.10±2.05),(14.50±1.32), and (15.80±1.36) points at months 3, 6, and 12 after operation, which were greater than those of the control group (11.20±2.80), (13.00±2.10), and (14.25±1.74) points, respectively (P<0.05). The early rehabilitation exercises may improve the hip joint function for patients of the comminuted posterior wall fractures of the acetabulum after surgery.

As an essential part of all kinds of medical relations,the physician-patient relationship should be developed following the unceasing progress of medical modes.Patients were provided with the respect for their legal rights,dignity,freedom and personality with humanistic treatment and nursing care.With ethical and moral principles,such as patient first principle,body and mind unified principle,confidentiality principle,impartial treatment principle,optimization principle,medical informed consent principle,coordination principle and the principle of striving for perfection,patients' psychological state was taken into full consideration during perioperative period.Humanistic care is embodied by humanistic treatment and nursing care during perioperative period,and patients are provided with sympathy,encouragement and psychotherapy.The physician-patient relationship is improved and a harmonious medical atmosphere enhanced through humanistic caring.