Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective method for the treatment of portal hypertension complications in patients with decompensated liver cirrhosis. At present, there are many prognostic scoring tools for risk stratification of poor prognosis after TIPS. This article briefly introduces seven prognostic scoring tools commonly used for TIPS and summarizes the clinical research evidence of each scoring tool. The literature review shows that there is currently no sufficient research evidence to determine the optimal prognostic scoring tool after TIPS. Future clinical studies should comprehensively explore the advantages and disadvantages of different scoring tools in predicting short- and long-term adverse prognostic events after TIPS and develop new prognostic scoring tools in combination with new prognostic markers.

OBJECTIVE: To evaluate the correlation of magnetic resonance (MR) T₂-weighted image (T₂WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation. METHODS: Based on the presence or absence of patchy hyperintense foci on preoperative MR T₂WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups. RESULTS: A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05). CONCLUSION The signal characteristics of adenomyosis on T₂WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.
Female ; Humans ; Adenomyosis/pathology* ; Dysmenorrhea ; Cohort Studies ; Propensity Score ; High-Intensity Focused Ultrasound Ablation/methods* ; Treatment Outcome

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

Objective:To investigate the application of artificial intelligence based on the neural network radiation field in repair of soft tissue defects at lower limbs.Methods:A retrospective analysis was performed of the 23 patients who had been admitted to Department of Orthopedic Surgery, Renmin Hospital of Wuhan University from June 2020 to May 2022 for soft tissue defects at lower limbs. There were 14 males and 9 females, aged (38.6±6.7) years. Causes for soft tissue defects: traffic injury in 9 cases, benign or malignant primary soft tissue tumor in 6 cases, mechanical injury in 4 cases, crush injury in 2 cases, and chronic ulcer in 2 cases. Defect locations: the thigh in 3 cases, the lower leg in 7 cases, and the ankle and distal foot in 13 cases. The areas of soft tissue defect ranged from 6.0 cm×3.8 cm to 14.7 cm×12.8 cm. The defects were repaired and reconstructed by transplantation of an anterolateral femoral free flap in 7 cases and a pedicled flap in 16 cases with the assistance of artificial intelligence based on the neural network radiation field, a cutting-edge artificial intelligence algorithm that can quickly construct and process three-dimensional model images through volume rendering under the radiation field. The flap survival rate, aesthetic satisfaction before and after treatment, time for skin flap harvesting and transplantation, functional recovery of lower limbs and incidence of complications were recorded.Results:All the 23 patients were followed up for 32(28, 36) weeks. All the flaps were harvested smoothly and survived. The time for flap harvesting and transplantation was 65.8(50.0, 76.0) min. The aesthetic satisfaction scored (2.3±0.7) points before treatment and (8.4±1.6) points 4 weeks after treatment, showing a statistically significant difference ( P<0.05). The skin flaps healed well with no complications such as hematoma or infection in all but one patient who suffered from superficial necrosis at the distal skin flap due to venous crisis but healed with a scar. On average, the functional recovery of lower limbs scored 23.7(22.0, 25.0) points at 12 weeks after operation according to the Enneking evaluation system, and the functional recovery of lower limbs was 79% (23.7/30.0). Conclusion:Application of artificial intelligence based on the neural network radiation field can achieve ideal results in repair of soft tissue defects at lower limbs, due to its advantages of rapid and accurate surgical procedures, limited damage to the donor site, and a short learning curve.

Objective:To conduct a systematic review of clinical manifestations, treatment, and associated genotyping of Sorsby fundus dystrophy (SFD).Methods:An evidence-based medicine study. Sorsby fundus dystrophy, anti-vascular endothelial growth factor therapy, choroidal neovascularization, macular neovascularization, and TIMP3 gene were hereby used as search terms. Relevant literature was searched in CNKI, Wanfang, PubMed of the National Library of Medicine, and Embase of the Netherlands. The time span for literature searching ranged from the establishment of the database to April 2022, and two reviewers independently screened the literature and extracted relevant data, with duplicates, incomplete or irrelevant articles, and review articles excluded. SPSS26.0 software was used for analysis. The 95% confidence interval ( CI) was used as an estimate of the effect size. The clinical manifestations, treatment and related pathogenic genes of SFD were counted and recorded. Results:According to the search strategy, 157 pieces of literature were initially retrieved, and 49 eyes of 35 patients from 16 articles were finally included for analysis, among which, 17 patients were male, 13 patients were female, and 5 patients were unknown gender; 16 involved left eyes, 19 involved right eyes, and 14 involved unidentified eyes. The age of the disease onset was 42.33±2.19 years (28-59) years old. There were 19 cases with a positive family history, and the total positive rate was 54.3% (19/35, 95% CI 36%-72%). There were 31 cases of gene mutation, all of which were TIMP3. In the included literature, there were 2 and 2 cases with no mutation and unreported loci, respectively, with a total positive rate of 93.9% (31/33, 95% CI 85%-100%). Among the 31 cases with gene mutation, 22, 4, 1, and 4 cases were in the UK, Germany, Switzerland, and Chinese, respectively, and the detection rates were all 100% (22/22, 4/4, 1/1, 4/4). The clinical manifestations of SFD were mainly yellow-white deposits in the fundus and choroidal neovascularization (CNV) in the macula, thereby leading to a decrease in central vision, followed by the expansion of the deposits to the periphery, the further development of CNV, and a severe decline in vision caused by peripheral retinal and choroidal atrophy. The treatment methods for SFD include photodymatic therapy, anti-VEGF drugs, glucocorticoids, vitamin A, etc., among which, anti-VEGF drugs were considered the first-line treatment, and the combined treatment was provided with a better prognosis than a single treatment. Conclusions:Variations in the TIMP3 gene cause SFD, the fundus characteristic manifestations of which, are yellowish-white deposits and CNV, which develop from the center to the periphery, thus resulting in progressive decline of visual acuity. Current studies have shown that combined therapy presents a better prognosis than monotherapy.

Objective: To investigate family based child sexual abuse prevention education in rural areas of Luzhou, to provide guidance for child sexual abuse prevention and intervention. Methods: By stratified cluster sampling, from December 2021 to January 2022, 1 213 parents were investigated with the simplified scale of knowledge attitude practice of family sexual education. The influencing factors of family sexual education were analyzed by multiple linear regression. Results: The score of family sexual abuse prevention education in rural areas of Luzhou was (11.21 ± 3.99), and the pass rate was 51.69%. The results showed that maternal education of junior high school ( β =0.79), senior high school / technical secondary school( β =1.26) and bachelor / college degree or above( β =1.75), mothers to be the main educators ( β =1.29) were positively associated with, while being girls( β =-0.41) and left behind children ( β =-0.59) were negatively associated with family child sex abuse prevention education score( P <0.05). Children received sex education in school( β =0.81), adequate knowledge of sex education of parents ( β =1.11), positive attitudes towards sex education of parents ( β =1.51), communication with relatives and friends regarding sex education of parents ( β =1.94), parents having participated in sex education related activities( β =0.67) were positively associated with family child sex abuse prevention education score( P <0.05). Conclusion Family based child sexual abuse prevention education in rural areas of Luzhou is insufficient. Relevant departments need to set up personalized intervention measures according to the different conditions of families, carry out relative education activities, to improve the level of sex education of rural families and improve their awareness of self prevention.

Objective:To investigate the clinical effect of subcutaneous tunnel transfer of forehead thin skin flap supplied by cutaneous branch of supratrochlear artery in repairing skin defect around eyebrow.Methods:From June 2017 to June 2019, 15 patients with eyebrow skin lesion were treated with the aforementioned method at the Plastic Surgery Department of the 2nd Affiliated Hospital of Harbin Medical University. Inclusion criteria: (1)The skin defect area ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.(2)There was no redness, swelling, skin ulceration, pruritus or pain in the lesions. Based on the patient’s medical history and clinical manifestations before surgery, the lesions were preliminarily diagnosed as benign lesions, and the surrounding tissues of the lesions were good without inflammatory reaction. (3) All patients were treated with tumor resection and repair with thin flap supplied by the cutaneous branch of the supracrochlear artery. (4) Clear consciousness, no intellectual or cognitive impairment, informed consent to this study and willing to cooperate with postoperative follow-up. Patients with other serious systemic diseases were excluded. A thin frontal flap supplied by the cutaneous branch of the supratrochal artery was designed near the hairline of the forehead. The size and shape of the flap should be similar to the size of the lesion. During the operation, the frontal flap was elevated, and the subcutaneous pedicle contained the cutaneous branch of the supratrochlea artery, and the flap was transferred to repair the defect wound through the subcutaneous tunnel. After the operation, the skin flap survival was evaluated by observing the skin flap color and other indicators, and the scar was evaluated by the Vancouver Score Scale(VSS).Results:A total of 15 patients were included, including 2 males and 13 females, aged 12-44 years, and the defect range was 1.5 cm×2 cm-2 cm×3 cm. The flap survived well after operation. In 2 cases, the incision was infected after operation, and the incision healed well after receiving anti-inflammatory treatment and daily dressing change. Local epidermal necrosis occurred in 5 cases, dressing was changed on time, and blood scab was formed. After blood scab shedding, 3 cases had no obvious pigmentation, and 2 cases had mild pigmentation. After 12 months of follow-up, the VSS score was 0-4.All patients were satisfied with the postoperative effect.Conclusions:The thin frontal skin flap can be applied to repair the skin defect around the eyebrow by subcutaneous tunnel transfer. It can be completed in one stage. The scar in the donor area of the flap is hidden, and there is no deformation of the eyebrow and inner canthus, and the survival rate of the flap is high.

Objective:To investigate the clinical effect of subcutaneous tunnel transfer of forehead thin skin flap supplied by cutaneous branch of supratrochlear artery in repairing skin defect around eyebrow.Methods:From June 2017 to June 2019, 15 patients with eyebrow skin lesion were treated with the aforementioned method at the Plastic Surgery Department of the 2nd Affiliated Hospital of Harbin Medical University. Inclusion criteria: (1)The skin defect area ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.(2)There was no redness, swelling, skin ulceration, pruritus or pain in the lesions. Based on the patient’s medical history and clinical manifestations before surgery, the lesions were preliminarily diagnosed as benign lesions, and the surrounding tissues of the lesions were good without inflammatory reaction. (3) All patients were treated with tumor resection and repair with thin flap supplied by the cutaneous branch of the supracrochlear artery. (4) Clear consciousness, no intellectual or cognitive impairment, informed consent to this study and willing to cooperate with postoperative follow-up. Patients with other serious systemic diseases were excluded. A thin frontal flap supplied by the cutaneous branch of the supratrochal artery was designed near the hairline of the forehead. The size and shape of the flap should be similar to the size of the lesion. During the operation, the frontal flap was elevated, and the subcutaneous pedicle contained the cutaneous branch of the supratrochlea artery, and the flap was transferred to repair the defect wound through the subcutaneous tunnel. After the operation, the skin flap survival was evaluated by observing the skin flap color and other indicators, and the scar was evaluated by the Vancouver Score Scale(VSS).Results:A total of 15 patients were included, including 2 males and 13 females, aged 12-44 years, and the defect range was 1.5 cm×2 cm-2 cm×3 cm. The flap survived well after operation. In 2 cases, the incision was infected after operation, and the incision healed well after receiving anti-inflammatory treatment and daily dressing change. Local epidermal necrosis occurred in 5 cases, dressing was changed on time, and blood scab was formed. After blood scab shedding, 3 cases had no obvious pigmentation, and 2 cases had mild pigmentation. After 12 months of follow-up, the VSS score was 0-4.All patients were satisfied with the postoperative effect.Conclusions:The thin frontal skin flap can be applied to repair the skin defect around the eyebrow by subcutaneous tunnel transfer. It can be completed in one stage. The scar in the donor area of the flap is hidden, and there is no deformation of the eyebrow and inner canthus, and the survival rate of the flap is high.

Objective: To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of Corona Virus Disease 2019(COVID-19). Methods: In the epidemic of COVID-19 from January 21 to February 15, 2020, 128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery, The People’s Hospital of Wuhan University. They were 71 males and 57 females with an average age of 48.7 years (from 5 to 88 years).Of them, 107 cases were treated at the outpatient department and 21 hospitalized. Emergency operations were carried out for 4 cases and selective operationsfor 17 cases. COVID-19 infections were recorded in the patients and medical staff as well. Measures taken and experiences learned were summarized since the epidemicoutbreak of COVID-19. Results: Of the 107 cases treated at the outpatient department, 3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19. Of the 4 cases undergoing emergency surgery, one was suspected of having COVID-19. Of the 17 cases undergoing selective surgery, one was diagnosed definitely as COVID-19and 2 were suspected of COVID-19. Two nurses were diagnosed definitely as having mildCOVID-19.One doctor and one nurse were suspected of COVID-19. Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented,is was not ruled out that their infections might have come from communities. Conclusions It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention. In the epidemic of COVID-19, front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients. High-quality and safe medical services can be provided as long as nosocomial COVID-19infection is effectively controlled by rigid screening of patientsnewly admitted, classified management of inpatients, optimal management of inpatient wards, standard preventive measures in perioperative period, a perfect system for medical protection, and medical education for patients and their carers.

Since botulinum toxin type A was first used in medical cosmetology in the mid-1980s, it has been commonly used to treat facial and neck wrinkles. In recent years, it has been found that botulinum toxin type A also has an intervention effect on other diseases. This article reviewed the related literatures in recent years.We also summarized the mechanismof botulinum toxin type A and analyzes its application in the field of unconventional cosmetic treatment of plastic surgery, including blocking the nerves that innervate sweat glands to treat axillary odor; inhibiting the activity of the pectoralis major to increase fat graft survival rate after autologous fat breast augmentation. It has improvement effect on blood flow rate of chronic vasospasm disease of hand and flap survival rate.It can also inhibit fibroblast proliferation and change the appearance of wound; relieve pain; reduce sebaceous gland secretion and improve acne; as well as relieve body weight.