Hepatic ischemia-reperfusion injury （HIRI） is an inevitable major complication during surgical procedures such as liver transplantation and partial hepatectomy， and its prevention and treatment are hotspots and difficulties in clinical practice. This article reviews the mechanism of injury caused by energy metabolism disorders during liver ischemia-reperfusion and related treatment strategies and summarizes the current advances in metabolism-related therapies， in order to provide new ideas for further clarifying the onset mechanism of HIRI and exploring effective clinical prevention and treatment strategies for HIRI.

Objective:To study the feasibility and efficacy of pericranial flaps for the repairs of large anterior skull base defects.Methods:The average length of the pericranial flaps needed for skull base repair was determined with computed tomography measurements in 20 adults and anatomical dissections in 5 cadaver specimen. A series of patients who underwent endoscopic skull base surgeries and subsequent reconstructions with pericranial flaps at the Department of Otolaryngology Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital from 2016 to 2022 were retrospectively reviewed. There were 19 males and 6 females, aged from 11 to 59 years, including 13 cases of cerebrospinal fluid (CSF) rhinorrhea (12 traumatic) and 12 cases of sinonasal skull base tumors. Descriptive statistical methods were used.Results:The mean areas of anterior skull base, sellar, and clival defects were 16.13, 14.03 and 13.12 cm 2, respectively, and the mean pericranial flap lengths were (18.77±3.44)mm, (133.99±5.08)mm, (181.76±6.31)mm, respectively. Among sinonasal skull base neoplasms, the pathologies included olfactory neuroblastoma ( n=6), squamous cell carcinoma ( n=3), chondrosarcoma ( n=1), osteosarcoma ( n=1), and invasive schwannoma ( n=1), in whom 8 patients underwent adjuvant radiotherapy after surgery. One patient (7.7%) had acoustic neuroma-related CSF leak before radiotherapy. All 25 patients successfully underwent skull base reconstruction without complications such as CSF leak, intracranial infection, forehead wrinkles disappearance, or scalp necrosis. All flaps survived well with no CSF leaks within the follow-up period of 2-4 years. Conclusion:Pericranial flap is a safe choice for large anterior skull base defects following resection of sinonasal skull base neoplasms and complex traumatic CSF leaks when endonasal flaps are not available.

Objective To investigate the imaging findings of craniocervical adenoid cystic carcinoma(ACC)with invading adjacent tissues,neural foramen and tube.Methods The CT and MR imaging features of 33 cases of craniocervical ACC with invading adja-cent tissues,neural foramen and tube of the basis cranii were analyzed retrospectively and compared with surgical and pathological results.Results Among 33 cases of ACC,17 cases were located in the nasal cavity,sinuses and nasopharynx(including 3 cases of recur-rence after surgery),8 cases in salivary gland,5 cases in lacrimal gland and lacrimal sac,and 3 cases in external auditory canal.Tumors invaded and destroyed adjacent muscle bundles,spaces,nasal cavity,sinuses,and bone walls in 16 cases,invaded pterygopala-tine fossa in 9 cases,pterygoid canal in 7 cases,foramen rotundum in 6 cases,foramen ovale in 5 cases,nasolacrimal duct in 3 cases,foramina stylomastoideum in 2 cases and external auditory canal in 3 cases(a total of 35 foramen and tubes).When the tumor inva-ded the adjacent muscle bundles,spaces,nasal cavity,sinuses and basis cranii,CT or MR showed the thickening of the surrounding tissues,with the density/signal abnormalities and obvious enhancement.When the tumor invaded the adjacent bone,cartilage,neural foramen and tube,CT displayed the thickening,thinning,or loss of the bone wall,as well as the enlargement of neural foramen and tube,wall thickening,and bone destruction.Conclusion CT and MR can show the imaging features of multiple small vesicles and ethmoid structures in the craniocervical ACC,as well as the invasion of adjacent tissues and the destruction of basis cranii,maxillofa-cial nerve foramen and tube,which are of great significance for the imaging diagnosis and surgical treatment of craniocervical ACC.

Objective To investigate the correlation between atherogenic index of plasma (AIP) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP) and the value of AIP combined with Bedside Index for Severity in Acute Pancreatitis (BISAP) score in the early prediction of severe HTG-AP (sHTG-AP). Methods A retrospective analysis was performed for the clinical data of 170 patients with HTG-AP who were hospitalized in The General Hospital of Central Theater Command from January 2017 to December 2021, and according to related guidelines, they were divided into the sHTG-AP group with 28 patients and non-sHTG-AP group with 142 patients. Peripheral blood samples were collected from all patients within 24 hours after admission, and the two groups were compared in terms of sex, age, laboratory test results, AIP, BISAP score, and modified CT severity index (MCTSI) score. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of continuous data between groups. The Spearman rank correlation test was used to investigate the correlation between each factor and the severity of HTG-AP, and the binary logistic regression analysis were used to investigate the independent risk factors for sHTG-AP. The receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy of each indicator. Results There were significant differences between the two groups in the medical history of diabetes, lymphocyte count, albumin, Ca 2+ , triglyceride, high-density lipoprotein cholesterol, AIP, BISAP score, MCTSI score, length of hospital stay, and hospital costs (all P < 0.05). The sHTG-AP group had a longer length of hospital stay, higher hospital costs, and a higher AIP value. AIP (odds ratio [ OR ]=1.244, 95% confidence interval [ CI ]: 1.062-1.458, P =0.007), BISAP score ( OR =5.525, 95% CI : 1.646-18.543, P =0.006), and MCTSI score ( OR =2.029, 95% CI : 1.245-3.305, P =0.004) were risk factors for sHTG-AP. AIP, BISAP score, and MCTSI score were positively correlated with the severity of HTG-AP ( r =0.291, 0.631, and 0.649, all P < 0.001), and AIP was positively correlated with BISAP score and MCTSI score ( r =0.190 and 0.215, both P < 0.05). AIP had an optimal cut-off value of 1.095 in predicting sHTG-AP, and AIP, BISAP score, and AIP combined with BISAP score had an area under the ROC curve of 0.759, 0.887, 0.925, respectively, a sensitivity of 0.821, 0.857, and 0.786, respectively, and a specificity of 0.627, 0.817, and 0.937, respectively (all P < 0.001). Conclusion AIP is a risk factor for sHTG-AP and is correlated with disease severity, and AIP combined with BISAP score has a relatively high value in the early prediction of sHTG-AP.

Hyaluronic acid (HA) injections have already been one of most popular cosmetic procedures for around 18 years. However, blindness is one of the most serious complications caused by HA injections. There is still no consensus on the treatment for vision recovery. The efficacy and safety of different delivery administration of hyaluronidase such as retrobulbar injection and endovascular intervention are still controversial so far. Based on current status, prevention is prior to treatment, which is widely recognized in the world. The pathogenic mechanism of blindness induced by filler injection is still not clear, and there exist several theories including the artery embolism, ischaemia, artery spasm and venous involvement, which are all related to the ophthalmic artery and its branches. Therefore, acquiring anatomic knowledge and the relevant parameters will help us prevent to damage the ophthalmic artery and its branches during HA injections. The mechanism, treatment progress and prognosis of blindness caused by HA injections in recent years were analyzed and summarized in this article. We hope it will help the clinician to improve the relevant knowledge about vision loss caused by HA injection, as well as to promote the safety of filler injection.

Hyaluronic acid (HA) injections have already been one of most popular cosmetic procedures for around 18 years. However, blindness is one of the most serious complications caused by HA injections. There is still no consensus on the treatment for vision recovery. The efficacy and safety of different delivery administration of hyaluronidase such as retrobulbar injection and endovascular intervention are still controversial so far. Based on current status, prevention is prior to treatment, which is widely recognized in the world. The pathogenic mechanism of blindness induced by filler injection is still not clear, and there exist several theories including the artery embolism, ischaemia, artery spasm and venous involvement, which are all related to the ophthalmic artery and its branches. Therefore, acquiring anatomic knowledge and the relevant parameters will help us prevent to damage the ophthalmic artery and its branches during HA injections. The mechanism, treatment progress and prognosis of blindness caused by HA injections in recent years were analyzed and summarized in this article. We hope it will help the clinician to improve the relevant knowledge about vision loss caused by HA injection, as well as to promote the safety of filler injection.

Objective:To investigate the safety and outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma (HCC).Methods:The clinical data of HCC patients who underwent hepatectomy at the University of Hongkong-Shenzhen Hospital from April 2014 to December 2020 were retrospectively analyzed. Of 57 HCC patients who were enrolled, there were 43 males and 14 females, aged (51±14) years old. According to the surgical method, the patients were divided into two groups: patients with pre-operative residual liver volume/standard liver volume <30% who underwent ALPPS procedure by anterior approach formed the study group ( n=20), and patients who underwent right hepatectomy with residual liver volume/standard liver volume ≥35% formed the control group ( n=37). Clinicopathological data and prognosis were reviewed and compared between the two groups. The patients were followed up via outpatient service and telephone. Results:There were more patients with well-moderately differentiated HCC in the study group than in the control group, and the difference was statistically significant ( P<0.05). All patients in the study group successfully completed two-step hepatectomy. Compared with the control group, the operative duration [644(535, 780) vs. 352 (269, 401) min], intraoperative blood loss [1 650 (1 338, 2 200) vs. 650 (500, 925) ml], and proportion of patients requiring blood transfusion (60.0% vs. 29.7%) were increased in the study group. The difference was statistically significant ( P<0.05). There was no significant difference in the incidence of grade III or higher complications between the study group and the control group [30.0% (6/20) vs. 18.9% (7/37), χ 2=0.91, P=0.341]. The 1-, 2- and 3-year overall survival rates were 90.0%, 63.8% and 46.4% respectively, and the corresponding tumor-free survival rates were 53.3%, 35.6%, and 35.6% respectively for the study group. The 1-, 2-, and 3-year overall survival rates were 71.4%, 63.4%, 51.7%, and tumor-free survival rates were 39.0%, 18.5%, 9.3% in the control group respectively. There was no significant difference in the postoperative survival rate and tumor-free survival rate between the two groups ( P>0.05). Conclusion:ALPPS was safe and feasible for treatment of right hepatocellular carcinoma with insufficient residual liver volume, and its survival outcomes was similar with one-stage right hepatectomy for HCC patients.

Objective:To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery.Methods:A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People′s Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy.Results:The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases.Conclusions:For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

Objective:To evaluate the general anesthesia on efficiency and safety of the photodynamic therapy (PDT) on patients with port wine stain (PWS).Method:A retrospective analysis was conducted on the data of patients who underwent PDT and were divided into groups either with or without general anesthesia relatively. The lesion color was expressed in terms of the Commission Internationale de l’Eclairage (CIE) L *a *b * color system, where L value corresponds to the lightness, a value to the red-green coordinate and b value to the yellow-blue coordinate. Paired t-test was used to evaluate the difference of L value, a value and b value before and after treatment respectively. Student t-test was carried out between the two groups on ΔL, Δa and Δb to illustrate the efficiency of general anesthesia in PDT. Pain scores were used to evaluate the pain degree after PDT treatment, and Mann-Whitney U test was carried out to compare the pain scores between the patients with and without general anesthesia. The adverse effects (including blister, scab and scar) were evaluated as well. The adverse effects rate was compared using Chi-square test. Results:A total of 62 cases (134 treatments) were reviewed, including 6 cases with general anesthesia in every treatment (general anesthesia group), 9 cases with general anesthesia or not (patial anesthesia group), and 47 cases with no anesthesia in their PDT treatments (non-anesthesia group). For patients with general anesthesia, a value decreased by 5.63±2.51, having statistical difference ( P=0.007), and for those without general anesthesia, L value increased by 3.39±5.16 ( P=0.035), a value decreased by 2.12±3.28 ( P=0.039), and b value increased by 3.05±3.92 ( P =0.016). Comparing between the two groups, |Δa| was much higher (5.63±2.51 vs. 2.12±3.28, P=0.047) in patients with general anesthesia, which indicated a better regression in red. Pain score evaluation showed no difference [7(6, 7) vs. 7(6, 8), P=0.653] between the two groups in the pain degree after treatment. Percentage of scab in the general anesthesia cases was 66.7%(18/27), while 51.4%(55/107) in the non-anesthesia cases, with no significant difference ( P=0.064). No blister case was reported in the general anesthesia cases, while only 5 cases were observed in 107 non-anesthesia cases (4.7%). The difference wasn’t significant ( P=0.252). No scar was reported in all the enrolled patients. Conclusions:General anesthesia can improve the red regression of PWS lesions in photodynamic therapy, but post-treatment pain and the rate of adverse effect can not be improved by general anesthesia.

Objective:To evaluate the general anesthesia on efficiency and safety of the photodynamic therapy (PDT) on patients with port wine stain (PWS).Method:A retrospective analysis was conducted on the data of patients who underwent PDT and were divided into groups either with or without general anesthesia relatively. The lesion color was expressed in terms of the Commission Internationale de l’Eclairage (CIE) L *a *b * color system, where L value corresponds to the lightness, a value to the red-green coordinate and b value to the yellow-blue coordinate. Paired t-test was used to evaluate the difference of L value, a value and b value before and after treatment respectively. Student t-test was carried out between the two groups on ΔL, Δa and Δb to illustrate the efficiency of general anesthesia in PDT. Pain scores were used to evaluate the pain degree after PDT treatment, and Mann-Whitney U test was carried out to compare the pain scores between the patients with and without general anesthesia. The adverse effects (including blister, scab and scar) were evaluated as well. The adverse effects rate was compared using Chi-square test. Results:A total of 62 cases (134 treatments) were reviewed, including 6 cases with general anesthesia in every treatment (general anesthesia group), 9 cases with general anesthesia or not (patial anesthesia group), and 47 cases with no anesthesia in their PDT treatments (non-anesthesia group). For patients with general anesthesia, a value decreased by 5.63±2.51, having statistical difference ( P=0.007), and for those without general anesthesia, L value increased by 3.39±5.16 ( P=0.035), a value decreased by 2.12±3.28 ( P=0.039), and b value increased by 3.05±3.92 ( P =0.016). Comparing between the two groups, |Δa| was much higher (5.63±2.51 vs. 2.12±3.28, P=0.047) in patients with general anesthesia, which indicated a better regression in red. Pain score evaluation showed no difference [7(6, 7) vs. 7(6, 8), P=0.653] between the two groups in the pain degree after treatment. Percentage of scab in the general anesthesia cases was 66.7%(18/27), while 51.4%(55/107) in the non-anesthesia cases, with no significant difference ( P=0.064). No blister case was reported in the general anesthesia cases, while only 5 cases were observed in 107 non-anesthesia cases (4.7%). The difference wasn’t significant ( P=0.252). No scar was reported in all the enrolled patients. Conclusions:General anesthesia can improve the red regression of PWS lesions in photodynamic therapy, but post-treatment pain and the rate of adverse effect can not be improved by general anesthesia.