Objective To explore the application value of three dimensional reconstruction technique in laparoscopic hepatectomy for hepatic carcinoma.Methods From September 2019 to March 2022,the clinical data of 62 patients with primary hepatic carcinoma were gathered.The enhanced CT scanning was performed before surgery.Patients with three dimensiona reconstruction technology were set as observation group(n=31).Patients who did not use three dimensiona reconstruction technology were set as the control group(n=31),and intraoperative conditions(time of operation,bleeding volume during operation)and postoperative conditions(occurrence rate of postoperative complications,postoperative length of stay)of the two groups were compared.Results 62 patients successfully completed laparoscopic hepatectomy without liver failure or death.For patients with tumors located in liver segmentⅡ and Ⅲ,there were no significant difference of operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication total rate between control group and observation group(P＞0.05).For patients with tumors located in liver segment Ⅳ-Ⅵ,operation time[(211.36±11.22)minutes vs(231.69±19.73)minutes],intraoperative blood loss[(274.29±23.84)ml vs(306.54±21.05)ml],postoperative hospital stay[(7.93±1.33)days vs(9.62±1.80)days]in observation group were lower than those in control group(P＜0.05),and there was no significant difference of postoperative complication total rate between two groups(P＞0.05).For patients with tumors located in liver segmentⅠ,Ⅶ and Ⅷ,operation time[(165.88±10.60)minutes vs(187.30±17.29)minutes],intraoperative blood loss[(271.25±12.17)ml vs(308.00±28.21)ml],postoperative hospital stay[(7.63±0.74)days vs(9.30±1.06)days]in observation group were lower than those in control group(P＜0.05),and there was no significant difference of postoperative complication total rate between two groups(P＞0.05).Conclusion The three dimensiona reconstruction technique may have prominent guiding significance for complex laparoscopic hepatectomy for hepatic carcinoma.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the long-term death of patients with ischemic stroke and its influencing factors.Methods:Based on the data of patients with ischemic stroke in the multi-center oral fibrinogen-lowering drug secondary prevention database, the follow-up patient information and the cause of death were registered through the epidemiological investigation method, and then compared with the baseline data of patients in the original database.Results:A total of 278 patients completed the follow-up, and 166 were in lumbrokinase group and 112 were in control group. There were 124 deaths (44.6%) within 10 years, of which 92 (74.2%) were vascular deaths. In the lumbrokinase group, 74 patients (44.6%) died of all causes and 55 (33.1%) died of vascular diseases; in the control group, 50 (44.6%) died of all causes and 37 (33.0%) died of vascular diseases. Cox proportional risk model analysis showed that lumbrokinase treatment had no significant effect on the 10-year survival rate of patients with ischemic stroke. The analysis of death influencing factors showed that the baseline international normalized ratio (INR) was significantly associated with the 10-year non-vascular death risk of patients (hazard ratio [ HR] 1.98, 95% confidence interval [ CI] 1.21-3.25; P=0.006). The greater the decrease of tissue plasminogen activator (tPA) within half a year, the lower the 10-year all-cause mortality risk ( HR 0.94, 95% CI 0.90-0.99; P=0.011); the greater the decrease in INR within one year , the lower the 10-year vascular death risk ( HR 0.41, 95% CI 0.17-0.96; P=0.040); the greater the decrease of D-dimer within one year , the higher the risk of the 10-year vascular death ( HR 1.37, 95% CI 1.02-1.83; P=0.034). The greater the decrease of INR in patients with ischemic stroke within one year, the higher the 10-year non-vascular death risk ( HR 2.15, 95% CI 1.29-3.59; P=0.004). Conclusions:The 10-year mortality rate of patients with ischemic stroke is higher, and about 3/4 are vascular deaths. The fibrinogen-lowering treatment in the acute stage has no significant effect on the 10-year all-cause mortality of patients with ischemic stroke. The greater the decrease of tPA in half a year, the lower the all-cause mortality; the greater the decrease of D-dimer level at baseline and within 1 year, the higher the 10-year vascular death; the greater the decrease of INR at baseline and within 1 year, the higher the 10-year non-vascular death risk.

Objective:To characterize the radial head fracture combined with capitulum cartilage injury (CCI).Methods:The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics, The Ninth People's Hospital of Wuxi from January 2011 to May 2020. They were 62 males and 48 females, aged from 17 to 74 years (average, 44.10 years). According to the finding of intraoperative exploration whether CCI was complicated or not, they were assigned into a CCI group and a CCI-free group. The diagnosis, location, size, type, operation method and postoperative recovery of CCI were observed in CCI group. The 2 groups were compared in terms of preoperative general data, range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score (MEPS).Results:CCI was complicated in 25 cases (type Ⅰ in 7 ones, type Ⅱ in 12 ones and type Ⅲ in 6 ones), involving all Mason types of radial head fracture, and located at the lateral capitellum in 13 cases, at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases. CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48% (12/25) for missed diagnosis. The preoperative flexion and extension (61.8°±13.7°) and rotation (60.0°±24.2°) in CCI group were significantly less than those in CCI-free group (77.7°±23.0° and 79.9°±21.9°) ( P<0.05); the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group ( P<0.05). There was no significant difference between the 2 groups in age, gender, combined injury, treatment of radial head fracture, follow-up time, range of forearm motion at the last follow-up or MEPS score ( P>0.05). Conclusions:CCI was complicated in 22.73%(25/110) of the radial head fractures in this cohort and found in all Mason types of radial head fracture, and mostly located at the lateral and posterolateral capitellum. CCI is likely to be missed by imaging examination. In patients with mild radial head fracture and suspected CCI, positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication. Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.

Objective:To investigate the image characteristics of woven coronary artery (WCA)on intravascular ultrasound(IVUS) and optical coherence tomography(OCT).Methods:Thirty-seven patients suspected of WCA on coronary angiography were enrolled from Teaching Hospital of Chengdu University of Traditional Chinese Medcine, Zhengzhou Cardiovascular Disease Hospital and Zhongshan Hospital of Fudan University from January 2013 to July 2020. The intraluminal imaging features of WCA were analyzed using IVUS and OCT.Results:Of the 37 patients admitted at the cardiology service, 9 patients had WCA. All the patients underwent coronary angiography, IVUS and OCT, of which 6 lesions were located on the right coronary artery, 2 lesions were located on the left anterior descending artery and 1 patient had WCA on the circumflex artery. The mean length of WCA lesions was 2.2 cm(ranged from 1.2 cm to 4.5 cm). The angiographic appearance of WCA was numerous small tortious channels origined form the main lumen. The channels appeared to be " doughnut" like pattern and they merged to normal artery again after the anomalous segment. Flow limitation was rare unless there was coronary atherosclerosis. OCT and IVUS showed multiple spiral channels in the anomalous segment, which were independent of each other and each channels had a relatively complete three-layers vascular structure.Conclusions:With typical image characteristics, IVUS and OCT are able to screen out WCA and guide the treatment decision making.

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

OBJECTIVE：To provide reference for the selection of drug treatment plan in patients with Brucellosis combined with liver dysfunction. METHODS ：Clinical pharmacists analyzed drug treatment plan in a patient with Brucellosis combined with liver dysfunction in the First Affiliated Hospital of Medical College of Shihezi University. Referring to Brucella treatment guideline . Consensus statement by the American association of clini - HbA1c cal endocrinologists and American college of endocrinology on the comprehensive type 2 diabetes management al - and domestic and foreign clinical information ，the suggesti ons were put forward according to the change of liver dysfunction. RESULTS：The patient had chronic infection and moderate liver injury. The liver dysfunction in this patient was a common complication of Brucellosis. After consultation of doctors and pharmacists ，in consideration of the abnormal liver function ， intravenous drip of levofloxacin （0.5 g，qd）was given in the patient for anti-infection treatment. After the liver function was improved，levofloxacin was stopped ，and intravenous drip of rifampin （0.6 g，qd）and oral administration of doxycycline （100 mg，bid）were given for anti-infection treatment instead ；during the treatment period ，intravenous drip of reduced glutathione （1.8 g，qd）and diammonium glycyrrhizinate （150 mg，qd）were given for anti-inflammatory and liver protecting treatment. During the treatment，the clinical pharmacists closely monitored ADR of patients ，and carried out medication education for patients to improve the compliance. 10 d after medication ，although some of the liver function indexes of the patient did not return to normal ，but Brucellosis and liver dysfunction symptoms were improved. The patient could continue to take the same dose of rifampin and doxycycline after discharge. CONCLUSIONS ：When the patients with Brucellosis have abnormal liver function ，anti-infection treatment should be the main treatment target. The clinical pharmacists should refer to the relevant guidelines and combine with the clinical practice to help doctors adjust the treatment plan ，so as to ensure the safety and effectiveness of the patients ’medication.

OBJECTIVE：To establish the HP LC fing erprints of Oxalis corniculata and to simultaneously determine the contents of isovitexin and swertisin. METHODS ：HPLC method was adopted. The determination was performed on ACE Excel- 5-C18column with mobile phase consisted of methanol- 0.1％ phosphoric acid water （gradient elution ）at the flow rate of 1 mL/min. The column temperature was 35 ℃，and detection wavelength was set at 280 nm. The sample size was 10 μL. Using isovitexin peak as reference，HPLC fingerprints of 12 batches of sample were drawn. The similarity evaluation was performed by using Similarity Evaluation System of Chromatogram Fingerprint of TCM （2012 edition）to determine common peaks. The contents of isovitexin and swertisin were determined by same method of above chromatogram. RESULTS ：There were 19 common peaks in HPLC chromatogram of 12 batches of O. corniculata ，with the similarity above 0.89. Two common peaks including isovitexin and swertisin were identified. The linear range of two components were 3.91-117.36 μg/mL（r＝0.999 4）and 9.88-118.56 μg/mL（r＝ 0.999 2），respectively. The limits of quantitation were 0.675 and 3.587 μg/mL；the limits of detection were 0.205 and 1.087 μg/mL， respectively. RSDs of precision ，stability and reproducibility tests were all lower than 2％. The recoveries were 95.46％-99.10％ （RSD＝1.23％ ，n＝6），95.34％ -101.23％（RSD＝2.74％ ，n＝6），respectively. The average contents were 0.227-1.654， 0.641-2.052 mg/g，respectively. CONCLUSIONS ：Established fingerprints can be used for the quality control of O. corniculata ； the content determination method is simple and accu rate，and can be used for simultaneous determination of two components.

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.