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Objective To investigate the application value of tenofovir alafenamide fumarate (TAF) in patients with first-time hepatitis B virus-related decompensated cirrhosis (HBV-DC) and its impact on renal function and lipid metabolism. Methods A total of 57 patients with first-time HBV-DC who were hospitalized and received TAF antiviral therapy in The Affiliated Hospital of Xuzhou Medical University from January 1, 2020 to December 31, 2022 were enrolled, and all of them received TAF antiviral therapy. Related data were collected at baseline and at weeks 12, 24, and 48 of treatment, including virological and serological indicators, liver and renal function, serum phosphorus, and blood lipids. The paired t-test or single group repeated measures ANOVA were used for comparison of normally distributed continuous data, the Friedman test was used for comparison of non-normally distributed continuous data, and the chi-square test or the Fisher’s exact test were used for categorical data. Results A total of 52 patients completed the 48 weeks of follow-up. After 12, 24, and 48 weeks of treatment, the patients achieving HBV DNA seroconversion accounted for 38.5%, 63.5%, and 84.6%, respectively; the alanine aminotransferase normalization rate were 71.2%, 82.7%, and 82.7%, respectively; the proportion of the patients with Child-Pugh class A disease increased to 55.8%, 73.1%, and 92.3%, respectively. Within the 48 weeks of treatment, there were significant increases in the levels of cystatin C (X²=35.163, P<0.001) and serum phosphorus (F=8.600, P<0.001) and low-density lipoprotein cholesterol (X²=10.064, P=0.018) . The ratio of total cholesterol/high-density lipoprotein cholesterol decreased continuously from 3.61 (2.61～5.84) to 3.27 (2.70～4.36) (X²=5.000, P=0.172) . Conclusion TAF can rapidly inhibit HBV replication and significantly improve liver function in HBV-DC patients, with no significant impact on renal function. However, blood lipid should be closely monitored. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy and safety of neoadjuvant treatment regimens for early resectable non-small cell lung cancer. Methods PubMed, Embase, MEDLINE,Cochrane Library and other databases were searched to include clinical trials related to neoadjuvant therapy. Data such as pathological complete response, event-free survival, and incidence of adverse events of various treatment regimens were extracted, and network meta-analysis was performed using R4. 3. 2 software. Results A total of 10 randomized controlled trials involving 3 650 patients and five neoadjuvant treatment regimens were included. Neoadjuvant chemoinunotherapy significantly improved pathological complete response and event-free survival compared to neoadjuvant chemotherapy alone（relative risk/hazard ratio=7. 18,0. 60; 95% CI 2. 96-18. 60,0. 37-0. 97). There was no significant difference in the incidence of Grade 3 or higher adverse events among the treatment regimens（P＞0. 05). Conclusion For patients with early resectable non-small cell lung cancer, neoadjuvant immunotherapy combined with chemotherapy can enhance pathological remission and survival benefits. However, the addition of adjuvant immunotherapy following neoadjuvant treatment does not show a significant difference in survival benefits. [ABSTRACT FROM AUTHOR]

Objective To compare and analyze the clinical efficacy of femoral neck dynamic cross nail system (FNS) and traditional three cannulated screws in the treatment of femoral neck fracture. Methods A total of 50 patients with femoral neck fracture admitted to our hospital from April 2020 to August 2021 were selected and divided into group A (treated with FNS) and group B (treated with traditional three hollow screws) according to different treatment methods, with 25 cases in each group. The operation time, garden alignment index reduction, intraoperative fluoroscopy times, femoral neck shortening, femoral head necrosis, healing time and postoperative Harris score were recorded and compared between the two groups. The patients in the two groups were followed up for more than 12 months. The patients in group A were followed up for (22. 1±6. 5) months, and the patients in group B were followed up for (23. 5±5. 3) months. Results The incisions of the two groups healed by first intention. The intraoperative fluoroscopy times, Harris score at 12 months after operation and femoral neck shortening in group A were significantly better than those in group B, and the differences were statistically significant (P＜0. 05). Most of the femoral neck fractures in the two groups healed well, and there was no significant difference in healing time between the two groups (P＞0. 05). Conclusion Both FNS and hollow screw are effective methods for the treatment of femoral neck fracture. Compared with hollow screw fixation, FNS fixation can effectively reduce the incidence of femoral neck shortening. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation between the diagnosis, treatment, progression and prognosis of chronic myeloid leukemia (CML) in chronic phase (CML-CP) patients with additional chromosomal abnormalities (ACAs) at the initial diagnosis. Methods The clinical data of 92 patients with newly diagnosed CML-CP admitted to the hospital from January 1, 2016 to December 31, 2022 were retrospectively analyzed. The clinical and genetic characteristics were analyzed. Kaplan Meier method was used to analyze the differences in survival distribution of CML-CP patients with or without ACAs, and to explore the correlation between CML-CP patients with ACAs and disease diagnosis, treatment, and prognosis. Results BCR-ABL1 fusion gene was detected in the initial bone marrow images of 92 CML-CP patients (100% positive rate), with 82 cases (89. 13%) in the pure t (9; 22) group and 10 cases (10. 87%) in the ACAs group. The survival time of CML-CP patients was 78. 49-87. 64 months, with a median of 83. 06 months. Compared with simple t (9; 22), the onset age and overall survival time of ACAs patients were lower, and they had a higher risk of infection, and the differences were statistically significant (P＜0. 05). ACAs were independent risk factors for poor prognosis in CML-CP patients. Conclusion ACAs may be one of the factors leading to the progression and poor prognosis of CML. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical efficacy and safety of 3D printing guided percutaneous microballoon compression (PMC) and conventional PMC in the treatment of primary trigeminal neuralgia (PTN). Methods A total of 80 patients with PTN treated in the Department of Neurosurgery, Langfang Municipal People's Hospital from January 2020 to December 2022 were selected as the study objects. All patients were divided into observation group and control group with 40 cases in each group using random number table method. The control group received conventional PMC treatment, and the observation group received 3D printing guide positioning PMC treatment. The general situation of operation, immediate postoperative efficacy, pain visual analogue scale (VAS) score at different time points before and after operation, recurrence 12 months after operation and postoperative complications were compared between two groups. Results The success rate of first puncture in observation group was 97.50%, which was significantly higher than that in control group (27.50%, P<0.05). The puncture success time, total operation time, hospitalization time and hospitalization cost in observation group were significantly better than those in control group (P<0.05). The total effective rate was 97.50% in the observation group and 95.00% in the control group, the difference was not statistically significant (P>0.05). Comparison of VAS scores between two groups before surgery, 1 and 2 weeks after surgery (P>0.05) showed that the VAS score of the observation group at 4 weeks after surgery was significantly lower than that of the control group(P<0.05). At 12 months after operation, the recurrence rate of observation group was 5.00%, which was significantly lower than that of control group (20.00%) (P<0.05). The incidence of facial numbness, masseteric muscle weakness and herpes labialis in observation group was compared with that in control group, the difference was not statistically significant(P>0.05). Conclusions PMC with 3D printed guide plate can significantly improve the success rate of the first puncture, shorten the puncture time and the total operation time, and the immediate and long-term effect after operation are very significant. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C virus (HCV) infection can lead to liver cirrhosis, and complications after liver cirrhosis, including hepatocellular carcinoma (HCC), are the leading causes of death in patients with chronic liver diseases. Antiviral therapy can help to realize sustained virologic response, improve hepatitis and liver fibrosis, and delay disease progression. The safety and efficacy of direct-acting antivirals (DAAs) have been confirmed in patients with HCV-related liver cirrhosis, and whether DAAs can improve the complications and prognosis of patients with liver cirrhosis has gradually become a research hotspot. Related data are mainly reported by foreign scholars, and since DAAs have not been marketed in China for a long time, there is still a lack of mid-and long-term data. This article reviews the latest studies on the application of DAAs in patients with HCV-related liver cirrhosis and the impact of DAAs on clinical prognosis. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the efficacy and safety of mesenchymal stem cells (MSC) in the treatment of acute-on-chronic liver failure (ACLF). Methods This study was conducted according to PRISMA guidelines, with the PROSPERO registration number of CRD42024517851. PubMed, Embase, Wanfang Data, VIP, CNKI, CBM, and the Cochrane Library were searched for randomized controlled trials (RCT) and cohort studies on MSC in the treatment of ACLF published up to November 1, 2023, and the articles were screened according to inclusion and exclusion criteria. After data extraction and quality assessment, RevMan 5.3 software was used to perform the Meta-analysis. Results A total of 11 articles involving 803 subjects were included in this meta-analysis. The results showed that for the patients with ACLF, MSC could improve 8-week survival rate (odds ratio [OR] =2.71, 95% confidence interval [CI]: 1.58—4.67, P=0.000 3), 12-week survival rate (OR=2.24, 95%CI: 1.36—3.69, P=0.001), 24-week survival rate (OR=2.09, 95%CI: 1.37—3.17, P=0.000 6), and 48-week survival rate (OR= 2.09, 95%CI: 1.29—3.40, P=0.003) and reduce 12-week Model for End-Stage Liver Disease (MELD) score (mean difference [MD] =−3.27, 95%CI: −6.07 to −0.48, P=0.02) and 24-week MELD score (MD=−2.24, 95%CI: −3.16 to −1.33, P<0.000 01); it could also reduce the level of total bilirubin after 4 weeks of treatment (MD=−36.86, 95%CI: −48.72 to −25.01, P<0.000 01) and increase 4-week albumin level (MD=2.11, 95%CI: 0.62—3.61, P=0.006) and 24-week albumin level (MD=3.54, 95%CI: 2.06—5.02, P<0.000 01). Adverse events were evaluated in 6 studies, with no serious adverse events. Conclusion MSC have a good safety in treatment and can improve the survival rate of patients and enhance liver function to some extent, and therefore, it holds promise for clinical application. [ABSTRACT FROM AUTHOR]

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Objective To investigate the effect of Lianzhu Xiaoke Prescription on glucose and lipid metabolism and micro-inflammation state in patients with newly diagnosed type 2 diabetes mellitus (T2DM) of dampness-heat binding and blood stasis syndrome. Methods A total of 80 patients with newly diagnosed T2DM who were admitted to the outpatient or inpatient department of endocrinology in the hospital from March 2020 to February 2022 were randomly divided into observation group and control group Using the random number table method, with 40 cases in each group. The control group was treated with metformin orally, and the observation group was treated with Lianzhu Xiaoke Prescription. The course of treatment was eight weeks. The clinical efficacy, TCM syndrome scores. glucose and lipid metabolism indexes (fasting blood glucose, two hours postprandial blood glucose, homeostasis model insulin resistance index, triglyceride, low density lipoprotein cholesterol,etc.), micro-inflammatory indexes (interleukin-6, C-reactive protein, tumor necrosis factor-a, homocysteine.etc.) were compared between the two groups, and the occurrence of adverse events during the course of treatment was recorded. During the study, four patients in the observation group fell off and 36 patients were finally included. In the control group, three cases were lost and 37 cases were finally admitted. Results The total effective rate of the observation group was significantly higher than that of the control group [94.44% (34/36) vs. 78.38% (29/37)], and the TCM syndrome score was significantly lower than that of the control group after the treatment, and the differences were statistically significant (P<0.05). Compared with before treatment, the levels of fasting blood glucose, two hours postprandial blood glucose.triglyceride, low density lipoprotein cholesterol, homeostasis model insulin resistance index, interleukin-6, C-reactive protein, tumor necrosis factor-a and homocysteine in the two groups were significantly decreased after treatment, and the decrease of each index in the observation group was significantly better than that in the control group, the differences were statistically significant (P<0.05). No adverse events occurred in the two groups during the study. Conclusion Lianzhu Xiaoke Prescription can improve the clinical symptoms ms of patients with newly diagnosed T2DM, inhibit the release of inflammatory cytokines, restore the function of glucose and lipid metabolism, and improve the clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of ultrasonic debridement combined with photon therapy in the treatment of chronic wounds. Methods A prospective randomized controlled study was conducted on 40 patients with chronic wounds who were treated in the wound care elinic of Dahua Hospital of Xuhui District Shanghai from October 2021 to December 2022. They were divided into control group and study group by random number table method with 20 cases in each group. In the control group there were eight males and 12 females with an average age of (62±17) years and 24 wounds. There were nine males and 11 females in the study group with an average age of (65±12) years and 26 wounds. The control group was treated with mechanical debridement, that is, using a scalpel, vascular clamp.and a spoon to remove necrotic tissue and remove unhealthy granulation tissue. On the basis of mechanical debridement, the study group used ultrasonic debridement machine to debrid the wound and then gave photon therapy. According to the wound condition. the patients in the two groups were debrided with the above method every day for the first three days after the first debridement and then changed to dressing change once every two to three days according to the wound condition. The wound healing rate at seven, 14.21,28 and 60 days after the first debridement, the positive rate of wound bacterial culture after the first debridement, the pain score at the time of debridement and after debridement the frequency and cost of dressing change after the first debridement were compared between the two groups. Results The wound healing rate of the study group was significantly higher than that of the control group at seven-14-21-28 and 60 days after the first debridement and the positive rate of wound bacterial statistical significance (P<0.05). There was no significant difference in pain scores between the two groups before debridement (P>0.05). The pain scores during and after debridement in the study group were significantly lower than those in the control group and the number of dressing changes was significantly lower than that in the control group, the differences were statistically significant (P<0.05). There was no significant difference in the total cost of dressing change between the two groups (P>0.05). Conclusion Ultrasonic debridement combined with photon therapy is more effective than traditional surgical debridement in the treatment of chronic wounds. The wound healing time is short, the pain is light the infection control effect is good. and the frequency of dressing change can be reduced thereby reducing the cost of dressing change. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and efficacy of tyrosine kinase inhibitors combined with immune checkpoint inhibitors in the treatment of patients with Child-Pugh class B unresectable hepatocellular carcinoma (uHCC). Methods A total of 96 patients with Child-Pugh class B uHCC who were admitted to Beijing Ditan Hospital, Capital Medical University, from December 31, 2020 to March 30, 2023 were enrolled as subjects, among whom 63 patients receiving lenvatinib combined with programmed death-1 (PD-1) inhibitor were enrolled as L group and 33 patients receiving sorafenib combined with PD-1inhibitor were enrolled as S group. The primary endpoint was objective response rate (ORR), and secondary endpoints included time to progression (TTP), overall survival (OS), toxicity, drug withdrawal rate, and dose adjustment rate. The The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups；the chi-square test was used for comparison of categorical data between two groups. Survival curves were plotted, and the Kaplan-Meier method was used to calculate the survival rate of patients in both groups, while the Log-rank test was used for comparison between the two groups. The Cox regression model was used to calculate hazard ratio (HR) and its 95% confidence interval (CI) and perform the multivariate analysis of influencing factors for prognosis. Results Among the 96 patients with uHCC, 55 (57.3%) had Child-Pugh class B (7 points) uHCC and 41 (42.7%) had Child-Pugh class B (8—9 points) uHCC. The L group had a significantly higher ORR than the S group (46.0% vs 15.2%, P=0.003), and there were no significant differences between the L group and the S group in median TTP (6.6 months vs 3.5 months, P=0.48) or OS (13.8 months vs 13.2 months, P=0.95). There was no significant difference in median TTP between the patients with Child-Pugh class B (7 points) uHCC and those with Child-Pugh class B (8—9 points) uHCC (6.6 months vs 4.8 months, P=0.35), while there was a significant difference in OS between these two groups of patients (14.5 months vs 8.8 months, P=0.045). The multivariate analysis showed that ORR was a protective factor for both TTP (HR=0.18, 95%CI：0.09 — 0.36, P<0.001) and OS (HR=0.20, 95%CI：0.09 — 0.43, P<0.001). There were no significant differences between the L group and the S group in the overall incidence rate of adverse reactions (98.4% vs 97.0%) and the incidence rate of grade≥3 adverse reactions (68.3% vs 63.6%), and there were also no significant differences between the two groups in dose adjustment rate (84.8% vs 70.2%) and drug withdrawal rate (56.1% vs 72.7%). Conclusion Compared with the regimen of sorafenib combined with PD-1 inhibitor, the regimen of lenvatinib combined with PD-1 inhibitor can improve the ORR of patients with Child-Pugh class B uHCC, with similar prognosis and safety profile between the two groups. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy and safety of detrusor and external urethral sphincter injections of botulinum toxin A in children with detrusor overactivity and impaired contractility (DOIC). Methods From May 2022 to June 2023, a total of 25 DOIC children received injections of botulinum toxin A in detrusor and external urethral sphincter. There were 18 boys and 7 girls with a mean age of (11.0±3.8) year. Three-day voiding diaries, quality of life questionnaires and incontinence-specific quality of life (I-QOL) assessments and overactive bladder symptom score (OABSS) were completed at baseline and Month 1/6. Also video-urodynamic examination at baseline and Month 1 and free uroflowmetry and residual urine measurement at baseline and Month 6 were performed. And the occurrences of adverse events were recorded. Results At baseline, mean urinary incontinence episode and daily voiding frequency were (6.9±1.5) and (10.8±1.7), quality of life questionnaire (8.8±0.7), OABSS (10.5±1.8), I-QOL score (43.6±4.6), mean voiding volume (127.4±37.9) ml, functional bladder capacity (FBC) (160.7±29.4) ml, maximum flow rate (MFR) (9.7±3.3) ml/s, mean daily frequency of catheterization (8.0±0.5), postvoid residual (PVR) (190.6±99.2) ml and bladder emptying efficiency (32.8±4.9)% in children undergoing intermittent catheterization (IC). At Month 1/6 post-injection, mean urinary incontinence episode and daily voiding frequency decreased to (3.5±1.3), (4.9±1.4) and (7.6±1.1), (8.5±1.4); quality of life questionnaire declined to (5.8±0.9), (7.1±0.8); OABSS score dropped to (8.5±1.0), (9.0±1.3); mean daily frequency of catheterization dipped to (6.4±0.7), (7.3±0.8), PVR decreased to (91.3±36.7), (121.9±42.7) ml; I-QOL score jumped to (59.7±5.8), (50.1±4.7); mean voiding volume increased to (164.9±31.1), (146.0±24.5) ml; FBC rose to (198.3±27.5), (176.2±24.3) ml; MFR spiked to (13.8±3.1), (11.0±2.5) ml/s; bladder emptying efficiency increased to (62.0±6.4), (47.8±6.7)%; Furthermore, the results of video-urodynamic examinations were compared between Month 1 and baseline. Maximum cystometric bladder capacity (MCC)(230.2±36.0 vs. 198.2±46.1 ml) and bladder compliance (BC)(18.6±5.1 vs.14.4±6.6 ml/cmH2O) increased. In addition, maximal detrusor pressure (64.4±6.0 vs.80.0±5.1 cmH2O) and frequency of DO during bladder filling period (2.8±1.3 vs.4.4±1.7), maximum urethral pressure (MUP)(72.0±5.5 vs.78.5±8.2 cmH2O) and maximum urethral closure pressure (MUCP)(59.1±5.2 vs.64.1±7.2 cmH2O) all decreased. Among 4 children of vesicoureteral reflux (VUR) at baseline, there were resolution ( n=2) and improvement ( n=2) at Month 1; 5/11 children of detrusor external sphincter dyssynergia (DESD) at baseline resolved at Month 1; 2/7 children of detrusor bladder neck dyssynergia (DBND) at baseline resolved at Month 1.Furthermore, as compared with Month 1, mean urinary incontinence episode (4.9±1.4 vs. 3.5±1.3) and daily voiding frequency (8.5±1.4 vs. 7.6±1.1), quality of life questionnaire (7.1±0.8 vs. 5.8±0.9), mean daily frequency of catheterization (7.3±0.8 vs. 6.4±0.7) and PVR (121.9±42.7 vs. 91.3±36.7 ml) increased while mean voiding volume (146.0±24.5 vs.164.9±31.1 ml), FBC (176.2±24.3 vs.198.3±27.5 ml), MFR (8.5±1.0 vs. 10.5±1.8 ml/s), I-QOL score (8.5±1.0 vs 10.5±1.8) and bladder emptying efficiency (47.8±6.7% vs. 62.0±6.4%) declined at Month 6 (all P<0.05). During follow-ups, there were transient gross in-catheter hematuria ( n=7) and urinary tract infection ( n=2). No other adverse events occurred. Conclusions Injections of botulinum toxin A in detrusor and external urethral sphincter is an effective, mini-invasive and safe treatment for DOIC children. It may effectively improve the symptoms of abnormal urination and lower the risks of upper urinary tract injury. Moreover, quality of life improves after injections. Efficacy remains for at least 6 months. [ABSTRACT FROM AUTHOR]

Objective To evaluate the medium-term outcomes of resecting distal 3 cm of rectal pouch in children with congenital anorectal malformations (ARMs). Methods From January 2010 to December 2018, the relevant clinical data were retrospectively reviewed for 171 children with high-and-intermediate ARMs undergoing laparoscopic-assisted anorectoplasty. Based upon whether or not distal 3 cm rectal pouch was resected, they were divided into two groups of resection ( n=120) and control ( n=51).Baseline characteristics of two groups were matched with a ratio of 1∶1 using propensity score matching. No statistically significant difference existed in preoperative clinical data. Forty-six cases were included for each group and medium-term outcomes were compared between two groups. Results After propensity score matching, no statistically significant differences existed in operative duration, postoperative hospitalization stay or postoperative complication rate between resection and control groups ( P>0.05). However, postoperative rectal retraction ( n=1) and megarectosigmoid ( n=1) during follow-ups in control group. The median follow-up period for both groups was 5.5 years and defecation function was evaluated by Krickenbeck scores. No significant inter-group difference existed in voluntary bowel movement or stool soiling. However, resection group exhibited a significantly a lower constipation rate than control group (47.0% vs.69.6%, P=0.014). Conclusions The constipation rate in ARM with distal 3cm resection is significantly lower without any increment of soiling. Excessive preservation of rectal pouch is one of the contributing factors to postoperative constipation in ARM children. It may be associated with residual fibrosis of rectal pouch. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of superficial temporal artery dressing for Moyamoya disease(MMD) in children. Methods From January 2020 to August 2022, the clinical data were retrospectively reviewed for 18 hospitalized MMD children at Affiliated Children's Hospital of Shandong University. Clinical efficacies were evaluated by success rate, postoperative complication rate, improvements of clinical symptoms and changes of imaging features. Results A total of 28 operations were completed successfully. During hospitalization, there was no occurrence of such serious complications as cerebral hemorrhage, cerebral infarction or seizure. However, one child of motor aphasia failed to open mouth. One case of had brief slurred speech after an initial operation and developed transient facial tics after contralateral operation. And another child developed transient weakness of right upper arm due to emotional agitation. Cranial MRA after Month 3 hinted at neovascularization. Cerebral perfusion significantly improved. During a follow-up period of(3-31) month, mRS grade was 0 ( n=13), 1 ( n=3), 2 ( n=1) and 4 ( n=1). Conclusions For MMD in children, superficial temporal artery patching offers a high success rate, few complications, obvious symptomatic improvements and a definite efficacy. [ABSTRACT FROM AUTHOR]

Objective In clinical practices, intradermic continuous suture (ICS) is one of the most frequently applied. However, it is prone to scar hyperplasia due to insufficient tension reduction. Widely used in plastic surgery, modified fully buried vertical mattress suture (MFBVMS) has a good tension reducing effect. The goal of this study was to compare the effect of MFBVMS versus ICS on wound healing and scar prevention in pediatric surgery. Methods From January 2022 to August 2022, 70 children were randomized by envelope method into two groups of study (MFBVMS, n=35) and control (ICS, n=35). During a follow-up period of 6 months. suturing time, scar width, Vancouver scar scale (VSS) score at Month 1/6 post-operation and the incidence of wound adverse events were compared between two groups. Results Suturing time was longer in study group than that in control group [(16.66±6.35) vs. (7.20±3.48) min, P<0.001, t=-7.729]. At Month 6 post-operation, scar width was narrower in study group than that in control group [(1.13±0.53) vs. (2.49±1.03) mm, P<0.001, t=6.920]; VSS score was lower in study group than that in control group [(3.69±1.13) vs. (5.49±1.25), P<0.001, t=6.352]. No incision adverse reactions occurred in study group and it was lower than 11.43% in control group ( P<0.05, χ²=4.242). Incision healing time was shorter in study group than that in control group [(6.77±0.55) vs. (7.83±2.47), P<0.05, t=2.475]. Conclusions Application of MFBVMS may significantly minimize scar formation and improve the quality of incision healing in pediatric surgery. [ABSTRACT FROM AUTHOR]

Objective To observe the efficacies of local flap for tissue defect after facial nevus excision in children. Methods From January 2018 to January 2022, retrospective analysis was performed for 246 children with facial nevus. Clinical features, lesion location/size, essential points of flap design and postoperative appearance improvements were recorded. Results All cases achieved primary healing and skin flap survived well. During a follow-up period of (9-36) months, there were satisfactory appearances without no obvious scar. Scar cosmesis assessment and rating (SCAR) score was (3.49±1.58) and the satisfaction of surgical efficacy reached 95.5%. Conclusions Using appropriate local flaps for repairing skin defect is effective in minimizing scar after facial nevus excision in children. [ABSTRACT FROM AUTHOR]

Objective To explore a simple and mini-invasive surgical approach for femoral neck fracture in children. Methods From February 2017 to January 2023, retrospective review was performed for the relevant clinical data of 13 children with femoral neck fractures undergoing incisional reduction, compression screw or Kirschner pin fixation at Chongqing Children's Hospital and Dongguan Children's Hospital. There were a total of 14 sides. One epileptic child had bilateral femoral neck fractures occurring sequentially 6 months apart. There were 10 boy and 3 girls with a mean age of 6.5(3.2-8.2) year. Delbet type was Ⅰ ( n=2), Ⅱ ( n=9, 10 sides) and Ⅲ ( n=2). All cases exhibited significant fracture displacement or angular deformity pre-operation. Operation was performed under general anesthesia. After location was located under a C-arm, target location was marked and direct anterior approach (DAA) adopted. After incising skin and subcutaneous fat, proximal lateral side of rectus femoris muscle was bluntly dissected and proximal end of muscle retracted medially, exposing anterior part of hip joint capsule. For type Ⅰ/Ⅱ fracture, joint capsule was opened and assisted traction plus reduction were performed under a direct vision. Then after inserting guide wires and confirming a correct position, two hollow compression screws with a diameter of 4.0 mm were used for fixation. For type Ⅰ fractures, 3-4 Kirschner needle with a diameter of 2.0 mm was utilized for fixation. After surgery, they were immobilized with a hip brace or cast for 6 weeks and then removed. At Month 3 post-operation, weight-bearing activities at affected side were avoided and monthly follow-ups conducted. At Month 6 post-operation, internal fixation was removed and MRI performed for eliminating the possibility of avascular necrosis of femoral head. Collect information on incision length, operative time, intraoperative bleeding, reduction and complications in all patients. Results The incision length ranged from 3.0 to 3.5 cm with a mean length of 3.2 cm. No muscle tissue was incised intraoperatively. Average operative duration was 36(33-42) min. Intraoperative hemorrhage had a mean volume of 12.3(12-20) mL. Postoperative radiography confirmed anatomical realignment in all cases. Internal fixation was removed at a mean time of 6.8(6-12) month. One child of type Ⅰ fracture resulting in ischemic necrosis of the femoral head was identified through MRI after Kirschner's pin removal. Conclusions DAA is suitable for treating pediatric femoral neck fractures. This approach may provide a distinct exposure of fracture site, cause mini-trauma and does not disrupt the integrity of anterior muscles. Allowing for fast postoperative functional recovery, it has a low incidence of complications, making it a simple and feasible surgical approach for femoral neck fractures. [ABSTRACT FROM AUTHOR]

Objective To explore the preliminary therapeutic efficacy of nephron sparing surgery (NSS) for unilateral Wilms tumor after neoadjuvant chemotherapy. Methods From January 2014 to December 2020, retrospective analysis was conducted for the relevant clinical data of 7 children hospitalized with unilateral Wilms tumor (uWT) receiving neoadjuvant chemotherapy and undergoing NSS. Clinical parameters of tumor recurrence, renal function, and survival rate were recorded. And treatment outcomes were compared with matched cases of radical nephrectomy (RN) during the same period. Results There were 4 boys and 3 girls with an onset age of (38.86±18.23)(16-55) month. There was no tumor-related syndrome or hemihypertrophy. Renal tumor was located at pole ( n=1) and center ( n=6). After neoadjuvant chemotherapy, tumor shrank by (66.4%±18.6%)(53.3%-93.9%). One child with a pole renal tumor underwent partial nephrectomy (PN) while the remainders tumor enucleation (TE). Postoperative pathological examination indicated that microscopic tumor margins were positive ( n=2). According to SIOP staging, the stages were Ⅱ( n=4) and Ⅲ( n=3). During a follow-up period of (38.42±10.17)(27-64) month, no case became lost or died. There were tumor-free survival ( n=6) and 1 tumor-bearing survival ( n=1). Two cases had tumor recurrence after NSS surgery. No statistically significant difference existed in recurrence rate (28.6%) and 5-year survival rate (100%) after NSS as compared with recurrence rate (13.3%) and 5-year survival rate (86.9%) of RN in the same period. Conclusions For uWT, proper preoperative evaluations and neoadjuvant chemotherapy may boost the proportion of NSS surgery and achieve similar therapeutic outcomes as RN. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and safety of first-line transcatheter arterial chemoembolization (TACE) combined with targeted therapy and immunotherapy in the treatment of patients with stage Ⅱb/Ⅲa hepatocellular carcinoma (HCC) based on China Liver Cancer Staging (CNLC) . Methods A total of 198 patients who received first-line TACE combined with targeted therapy and immunotherapy or received TACE alone from January 2015 to December 2022 in the First Affiliated Hospital of Soochow University were enrolled in this study, and after propensity score matching, there were 50 patients in combination group and 50 patients in TACE group. The Kaplan-Meier method was used to calculate median overall survival (mOS) and median progression-free survival (mPFS) . Modified Response Evaluation Criteria in Solid Tumors was used to evaluate objective response rate (ORR) and disease control rate (DCR), and Common Terminology Criteria for Adverse Events v5.0 was used to evaluate adverse events. The chi-square test was used for comparison of categorical data between two groups； the t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate survival time and calculate 95% confidence interval (CI), and the Log-rank test was used for comparison of mOS and mPFS between two groups. Results The combination group had an mOS of 30.1 months (95%CI：21.9—38.3), and the TACE group had an mOS of 14.5 months (95%CI：11.0 —18.0), with a significant difference between the two groups (χ² =17.8, P<0.001); the combination group had an mPFS of 10.3 months (95%CI：8.8—11.8), and the TACE group had an mPFS of 7.1 months (95%CI：5.8 — 8.4), with a significant difference between the two groups (χ² =10.4, P<0.001) . There were significant differences between the combination group and the TACE group in ORR (84% vs 58%, P<0.05) and DCR (94% vs 80%, P<0.05) . There was no significant difference between the combination group and the TACE group in the incidence rate of adverse events (24% vs 16%, P=0.317), and no adverse event-related deaths were observed in either group. Conclusion Compared with TACE alone, TACE combined with targeted therapy and immunotherapy has a better efficacy in the treatment of patients with CNLC stage Ⅱb/Ⅲa HCC, without increasing the incidence rate of severe adverse events. [ABSTRACT FROM AUTHOR]

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Objective To systematically evaluate the curative effect of Helicobacter pylori (Hp) eradication therapy on idiopathic thrombocytopenic purpura (ITP) in children. Methods The randomized controlled trials of the curative effect of Hp eradication therapy on ITP in children were searched by computer in PubMed, Embase, Cochrane database of randomized controlled trials and Wanfang medical database. The retrieval time was from the establishment of the databases to August 2022. Statistical analyses were performed by using RevMan5.4 software and Stata12.0 software. Results A total of seven randomized controlled trials regarding 315 pediatric patients were included in this study. Compared with immunotherapy alone, Hp eradication therapy combined with immunotherapy could obviously improve the overall remission rate and complete remission rate, and reduce the recurrence rate after treatment (odds ratio=2.87,3.27,0.24,95% confidence interval: 1.60-5.13,2.01-5.32,0.11-0.53,P=0.000 40,＜0.000 01,0.000 30. Conclusion Hp eradication therapy has a beneficial effect on the clinical remission and relapse prevention of ITP in children. However, considering the limited quality of current research evidence, further large-scale and high-quality studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective To compare and analyze the knee function and clinical prognosis of symptomatic discoid lateral meniscus (DLM) and non-DLM treated with arthroscopically in adolescent patients. Methods A total of 47 adolescent patients treated with arthroscopy in our hospital from 2015 to 2021 were retrospectively analyzed and divided into the DLM group (20 cases) and the non-DLM group (27 cases) according to whether they had DLM.The clinical features, type of surgery, and scores of the International Knee Documentation Committee (IKDC) and Physical Activity Questionnaire (PAQ) at six months, one year, and two years after surgery were compared between the two groups. Results The age and body mass index of the DLM group were lower than those of the non-DML group, and the differences were statistically significant (P＜0.05). IKDC and PAQ scores of patients in two groups were significantly improved six months after surgery, one year and two years after surgery, with statistical significance (P＜0.05), but there was no statistical significance in IKDC and PAQ scores between two groups at each time point (P＞0.05). There were no significant differences in IKDC and PAQ scores among patients with different gender, age and type of surgery (P＞0.05). Conclusion Arthroscopic surgery can effectively improve the knee function of DLM and non-DLM patients, but gender, type of surgery, age do not affect the knee function and physical recovery [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis (CASBP) . Methods This prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the MannWhitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Results All patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group (88.0% vs 60.0%， χ2 =5.094，P=0.024) ， while there was no significant difference in the cure rate on day 5 between the two groups (80.0% vs 56.6%， χ2 =3.309，P=0.069) . As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group (88.9% vs 60.0%，χ2 =4.341，P=0.037) ， while there was no significant difference in the cure rate on day 5 between the two groups (83.3% vs 56.0%，χ2 =2.425，P=0.119) . There was no significant difference in 30-day mortality rate between the two groups (8.0% vs 20.0%，χ2 =0.664，P=0.415) . For all patients， there was a significant association between response of initial treatment and cure on day 5（odds ratio ［OR］=9.643，95% confidence interval ［CI］：2.292—40.564) and between cure on day 5 and 30-day mortality (OR=0.138，95%CI：0.023—0.813) . Conclusion This predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP. [ABSTRACT FROM AUTHOR]

Objective To explore the therapeutic efficacy of frontal orbital advancement on improving social-emotional abnormalities and frontal lobe volume in children with metopic synostosis (MS). Methods From January 2017 to October 2021, retrospective review was performed for the relevant clinical data of 15 infants of premature closure of frontal suture managed with frontal orbital advancement.At the timepoints of pre-operation, 1-year post-operation and during a final postoperative follow-up period of (52±19) month, Social-Emotional Assessment (ASQ: SE) was utilized for assessing social-emotional well-being.And cranial magnetic resonance imaging (MRI) along with 3D Slicer 5.4.0 software was employed for calculating frontal lobe volume, brain volume and frontal angle. Results Frontal orbital advancement was performed.Preoperative measurements of frontal lobe volume were 106.58(103.38, 112.35)cm³, brain volume 528.65(496.57, 563.36)cm³, frontal angle 91.3(89.6, 93.3)ånd frontal lobe/brain volume 20(20, 20)%.At 1-year post-operation, frontal lobe volume was 149.64(145.64, 168.85)cm³, brain volume 623.71(587.77, 651.87)cm³, frontal angle 109.5(106.4, 114.6)ånd frontal lobe/brain volume 24(20, 30)%.At the final follow-up, frontal lobe volume was 217.18(208.44, 238.42)cm³, brain volume 870.62(786.21, 961.88)cm³, frontal angle 116.4(113.4, 120.7)° and frontal lobe/brain volume 25(20, 30)% with statistical significance (P < 0.05).At 1-year post-operation, proportion of frontal lobe growth was significant higher than brain growth [32(30, 30)% vs.15(10, 20)%, P < 0.05].At the final follow-up, proportion of frontal lobe growth was significant higher than brain growth [51(50, 50)% vs. 39(30, 40)%, P < 0.05].Preoperative social-emotional scores of 85(85, 95) were significantly higher than normal threshold.However, at 1-year post-operation, social-emotional scores 50(50, 55) dropped markedly.At the final follow-up, all social-emotional scores 35(30, 40) declined below a threshold and normalized. Conclusions For MS children, frontal orbital advancement may significantly boost frontal volume and effectively improve adverse social-emotional outcomes. [ABSTRACT FROM AUTHOR]

Objective To explore the application value of transcranialcerebral vessel Doppler (TVD) ultrasonography in the diagnoses and postoperative evaluations of type Ⅰ Chiari malformation in children. Methods From March 2018 to December 2021, the relevant clinical data were retrospectively reviewed for 27 children with type Ⅰ Chiari malformation. Based upon age, they were assigned into two groups of preschool (aged 1-6 year, n=15) and school-age (aged 7-16 year, n=12). TVD was detected at pre-operation, 24 h post-operation and 1 month post-operation. Posterior cerebral artery (PCA), bilateral vertebral artery (VA) and basilar artery (BA) in posterior cranial fossa were selected as target vessels. Peak systolic velocity (PSV), end-diastolic velocity (EVD) and pulsative index (PI) of the corresponding target vessels were monitored. Hemodynamic profiles of posterior cranial fossa were compared in different age groups at pre-operation versus post-operation. The accuracy of diagnosis was compared with magnetic resonance imaging (MRI) at pre-operation and the consistency of efficacy compared with Tator evaluation post-operation. Results PSV of bilateral PCA post-operation spiked in preschool group as compared with that pre-operation [left (44.25±13.06) vs. (66.76±14.45) cm/s, t=5.148, P=0.023; right (45.12±13.41) cm/s vs. (65.33±10.12) cm/s, t=5.389, P=0.021) and PI declined [left (1.18±0.42) vs. (0.91±0.18), t=4.545, P=0.033; right (1.24±0.48) vs. (0.92±0.13), t=4.776, P=0.028), bilateral VA PSV [left (43.50±11.99) vs. (70.94±7.56) cm/s, t=7.042, P=0.008; right (44.56±8.45) vs. (68.82±9.02) cm/s, t=6.833, P=0.009], preoperative EVD rose [left (19.01±9.22) vs. (27.18±8.53) cm/s, t=4.587, P=0.032; right (18.28±5.77) vs. (28.32±7.26) cm/s, t=4.683, P=0.030]and preoperative bilateral PI dropped [left (1.12±0.45) vs. (0.86±0.19), t=4.712, P=0.029; right (1.31±0.46) vs. (0.84±0.31) cm/s, t=5.277, P=0.022], BA PSV [(48.75±16.57) vs. (69.17±11.86) cm/s, t=5.413, P=0.019], preoperative EVD increased [(27.73±7.34) vs. (27.18±8.53) cm/s, t=4.738, P=0.027) and preoperative PI decreased [(1.13±0.55) vs. (0.90±0.28), t=4.721, P=0.030]; PSV of bilateral VA after surgery in school-age group was higher than that pre-operation [left (48.16±18.47) vs. (53.77±24.73)cm/s, t=4.187, P=0.045; right [(45.72±18.53) vs. (56.31±19.82) cm/s, t=3.872, P=0.036)], BA PSV [(48.50±11.44) vs. (58.17±18.86) cm/s, t=5.108, P=0.024], preoperative EVD increased [(18.63±9.91) vs. (23.19±10.63) cm/s, t=4.763, P=0.029]and preoperative PI declined [(1.06±0.42) vs. (0.92±0.25), t=4.572, P=0.032]. Preoperative TVD detection rate of 27 cases was lower than that of MRI (χ²=5.511, P=0.019). At 1 month after Tator efficacy evaluation, there were improvements (n=19, 70.4%) and non-improvements (n=8, 29.6%). TVD ultrasonic monitoring parameters improved (n=22, 81.5%) and stagnated (n=5, 18.5%). There was consistency between TVD ultrasound and Tator efficacy evaluation [χ²=0.911, P=0.340]. Conclusions MRI is a gold diagnostic standard for Chiari type Ⅰ malformation in children. However, TVD ultrasound has some accuracy and auxiliary effects. It can effectively depict the hemodynamic changes of posterior fossa artery and indirectly and non-invasively assess intracranial pressures. Thus it enables clinicians to make a timely diagnosis, offer a proper treatment and make an accurate assessment of outcomes. [ABSTRACT FROM AUTHOR]

儿童继发性枕叶癫痫常伴有脑组织结构异常, 经癫痫术前评估后, 一般采用切除或离断致癫相关脑组织的治疗方法。近年来, 随着立体脑电图(stereo electroencephalogram, SEEG)植入技术在国内的开展, 通过收集患儿癫痫发作症状学资料、视频脑电图和影像学资料, 经分析讨论后植入SEEG监测, 明确致癫灶及放电传播网络, 进而在SEEG引导下行射频热凝(radiofrequency thermocoagulation, RF-TC)治疗, 可获得满意疗效。本文报道1例儿童继发性枕叶癫痫的微创诊治经验。 [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of arthroscopy for habitual patellar dislocation (HPD) in children. Methods From July 2015 to July 2021, retrospective review was conducted for 20 HPD children. There were 8 boys and 12 girls with an age range of (5.8-15) year. According to different surgical approaches, they were assigned into two groups of arthroscopy (n=9 with 10 knees) and open (n=11 with 12 knees). Lateral release, medial contraction and patellar ligament semitendinous transfer were performed. Two groups were compared in terms of basic clinical profiles, imaging examinations and Lysholm score of knee. Results During an average follow-up period of 24(18-36) month, there was no wound infection or other complications. Redislocation (n=1) occurred in open group. Two groups were similar in basic profiles (P>0.05). Operative duration of arthroscopy and open groups was [95.5(94.3, 97.8) vs. 99.0(95.0, 111.3) min], blood loss [(23.00±5.89) vs.(50.83±8.21) ml], incision length [(6.60±0.70) vs.(13.50±2.39) cm], length of hospital stay [7.0(7.0, 9.0) vs.9.0(7.0, 10.0) day], time to full weight bearing [(8.70±0.95) vs.(10.58±2.02) week], normal knee activity [(65.50±6.43) vs.(75.83.00±11.25) day]and postoperative Lysholm score of knee [95.00(92.75, 95.25) vs.90.00(86.25, 94.25)]. And there were significant inter-group statistical differences (P < 0.05). No significant difference existed in patellofemoral fitting angle [(-8.2±1.75) vs.(-8.5±2.32) degree]or lateral patellofemoral angle [(6.80±1.87) vs.(7.17±1.64) degree]. Conclusions For HPD, arthroscopic lateral release, medial contraction and patellar ligament semitendinous transfer is superior to traditional incision. It offers a smaller incision, shorter operative duration, minimal intraoperative hemorrhage, shorter hospitalization stay and faster recovery of knee function. There is no redislocation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the healing index and complications of proximal tibial lengthening in children with congenital pseudarthrosis of the tibia (CPT). Methods From February 2012 to December 2019, retrospective analysis was conducted for clinical data of 57 CPT children undergoing proximal tibial extension using Ilizarov external fixation device. The average follow-up period was 72.9 months. According to the average value of healing index, group A had a healing index < 57.1 cm/d and group B a healing index of >57.1 cm/d. At Month 1 post-operation, radiographic examination was performed for evaluating the quality of callus with Li classification. Postoperative complications of tibial lengthening were recorded. Results The average healing index was 57.1 d/cm. The average operative age was 80 months in group A with an average follow-up period of 75.5 months and an average extension length of 5.9 cm. And 81% of them obtained decent callus morphology and quality after 1-month extension with a healing index of 39.1 d/cm. The average operative age was 100.9 months in group B with an average follow-up time period of 69.6 months. The average extension length was 4.9 cm. And 56% of them obtained decent callus morphology after 1-month extension with a healing index of 80.1 d/cm. There were early fibular healing during tibial lengthening (n=3), needle infection (n=5), ankle joint stiffness (n=3), 20 degree deformity of ankle metatarsal flexion (n=1), extended segment angulation deformity (n=4) and limited movement of knee joint (n=8). Conclusions The average healing index of CPT children is 57.1 d/cm during tibial lengthening. There are such complications as early fibular healing and angled extension segments. During lengthening, close attention should be paid to the morphology of callus. [ABSTRACT FROM AUTHOR]

Objective To explore the early efficacy and surgical essentials of closed reduction intramedullary nail fixation assisted by Steinmann pin for adolescent femoral shaft fractures. Methods From June 2018 to September 2021, the relevant clinical data were retrospectively reviewed for 31 adolescents undergoing intramedullary nail fixation for femoral shaft fractures via a lateral recumbent position with Steinmann pin. There were 18 boys and 13 girls with an average age of (13.5±2.1) year, an average weight of (60.2±6.5)kg and an average time from injury to surgery of (4.4±1.8)day. The affected side was left (n=20) and right (n=11). Statistical analysis was performed for surgical duration, hospitalization stay, hemorrhagic volume, lower extremity length at the last follow-up, articulotrochanteric distance (ATD), widest femoral neck diameter (FND) and neck shaft angle. Results Closed repositioning of femoral intramedullary nail fixation was assisted by a lateral recumbent Steinman pin. Average operative duration was (67.9±20.4) min and average volume of intraoperative hemorrhage (124.4±34.8)mL. At the last follow-up, hip function was evaluated according to the Harris function score. The excellent rate was up to 100%. The average follow-up period was (22.8±5.2)(15-37) month. At the last follow-up, length of lower extremities and healthy side, ATD, FND, cervical stem angle and hip function score were (84.2±5.1) cm, (84.1±5.2) cm; (30.3±1.4)°, (31.1±1.3)°;(27.7±1.9)°, (27.4±1.4)°;(132.0±2.9)°, (131.7±2.7)°;(95.7±2.0) points, (96.1±1.4) points respectively at affected and healthy sides. There were no statistically significant differences (P>0.05). At the last follow-up, there was no occurrence of infection, ischemic necrosis of femoral head, proximal femoral deformity, delayed healing, non-healing of fracture, functional impairment, re-fracture or loosening of internal fixation. Conclusions Treating adolescent femoral shaft fractures with closed reduction intramedullary nail fixation assisted by a lateral recumbent Steinman pin may achieve an excellent reduction with a definite therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical features and surgical approaches of unilateral coronal craniostenosis in infants. Methods From March 2019 to March 2023, the relevant clinical data were retrospectively reviewed for 27 infants aged over 3 months with unilateral coronary craniostenosis at Hunan Children's Hospital.There were varying degrees of anterior plagiocephaly in skull appearance.A definite diagnosis was made by plain cranial/facial computed tomography (CT) plus three-dimensional reconstruction.Bone flap was designed by three-dimensional printing.Surgical protocols were formulated by the characteristics, degree and age of cranial deformity.Healthy side was utilized as a mirror image for orbital remodeling at affected side.And formed orbital bone flap was employed as a baseline for fitting frontal bone flap into a "new frontal part".Anterior oblique deformity improved with the changes of cranial volume. Results The follow-up period was 28.8(3-48) month.Bilateral forehead and bilateral orbit were located in the same coronal plane.Development of anterior plagiocephaly and frontal lobe at affected side improved markedly as compared with pre-operation.None of them was re-operated. Conclusions In infants aged over 3 months with unilateral coronal craniostenosis, skull remodeling is efficacious using affected orbit with healthy side as a mirror image and frontal bone flap with orbital bone flap as a baseline into a "new forehead". [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy of traditional ligation of patent ductus arteriosus (PDA) through left posterolateral incision, video-assisted thoracoscopic closure of PDA and modified ligation of PDA through axillary small incision. Methods From February 2018 to December 2020, clinical data were retrospectively reviewed for 119 PDA children. According to different surgical approaches, they were divided into three groups of A, B and C. Group A underwent traditional ligation of PDA through left posterolateral incision, group B video-assisted thoracoscopic closure of PDA and group C modified axillary small incision ligation of PDA. Operative duration, volume of blood loss, incision length, postoperative closed chest drainage volume, ICU retention time, closed chest drainage removal time, postoperative hospitalization stay and incidence of complications were recorded. Results There were 16 boys and 25 girls in group A, 19 boys and 18 girls in group B and 17 boys and 24 girls in group C. Among groups A, B and C, no statistical differences existed in operative duration (112.20±26.41, 104.51±18.59, 114.39±33.28 min) or complications (9, 10, 2)(P>0.05): volume of blood loss (18.12±13.69, 11.73±9.15, 10.68±7.08 ml), incision length (8.98±0.94, 4.05±0.48, 2.38±0.31 cm), volume of closed chest drainage (109.76±37.18, 69.05±23.95), removal time of closed chest drainage (4.66±2.67、3.24±0.93 day). No closed chest irrigation in group c. Tracheal intubation time (7.68±1.77, 6.81±2.38, 5.66±1.51 h), ICU retention time (42.78±21.62, 39.94±14.48, 29.39±12.94 h), postoperative hospitalization stay (6.17±1.80, 5.54±1.92, 4.56±0.92 day), FLACC score (facial expression, legs, activity, cry & consolability) T1 (6.63±0.70, 5.97±0.93, 4.73±1.03), T2 (5.66±0.83, 5.19±0.81, 3.20±0.98), T3 (5.07±0.75, 4.51±0.84, 2.83±1.09). Group B was less than group A and group C less than group B. The differences were statistically significant (P < 0.05). Conclusions Small axillary incision ligation of PDA is preferred due to minimal trauma, quicker recovery, excellent cosmetics and fewer complications. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical efficacy and complications of β receptor blockers for infantile hemangioma (IH) and observe the effect on growth and development during treatment. Methods From January 2017 to may 2022, 33 IH children were recruited. They were randomized into two groups of propranolol (n=22) and atenolol (n=11) according to parental wishes. No significant inter-group differences existed in age, gender, location or type (P>0.05). The former group received an oral dose of non-selective propranolol 1.5-2 mg·kg-1·d-1. And the latter group was prescribed with atenolol at 0.5 mg·kg-1·d-1 in the first week and then 1 mg·kg-1·d-1. During monthly follow-ups, the changes of clinical manifestations such as tumor color, size, texture and the complications were recorded. Color Doppler ultrasound was performed for measuring tumor volume and evaluating growth and development. Results There was nostatistically significant difference in the age, gender, Location, and type of initial diagnosis between the two groups of chidren(P > 0.05). The effective rate of both groups was 100%. No statistically significant reduction occurred in tumor volume in neither groups at Month 1, 5-6 and 10-12 post-treatment (P>0.05). Adverse reactions of drug dosing occurred in propranolol group (5/22, 22.7%) with respiratory symptoms, fretting or sleep disorder and atenolol group(2/11, 18.2%)with fretting or sleep disorder. No other serious adverse reactions occurred. No abnormality was found in physical development of neither groups during follow-ups. The developmental quotient of two groups did not differ significantly at Month 1/3/6/9 post-dosing (P>0.05). Conclusions The efficacies and complications of propranolol and atenolol are comparable for infantile hemangioma. No significant inter-group difference exists in growth and development during treatment. Regarding the impact of respiratory tract, atenolol may replace propranolol for infantile hemangiomas. [ABSTRACT FROM AUTHOR]

Objective To compare the perioperative risk factors and postoperative efficacy of πcraniectomy plus orthopedic helmet versus cranial vault remodeling for non-syndromic premature sagittal suture and examine the advantages and disadvantages of two treatments to provide references for formulating individualized treatment plans for infantile non-syndromic sagittal premature closure. Methods From May 2018 to May 2023, retrospective review was conducted for hospitalized infants with non-syndromic sagittal premature closure.Perioperative data, perioperative cephalic index and intracranial volume were statistically examined.T test was utilized for normal distribution data and Mann-Whitney test for non-normal distribution data.P < 0.05 implied statistically significant inter-group difference. Results There were 11 children (8 boys, 3 girls) in π craniectomy plus orthopedic helmet group.Cranial vault remodeling group included 6 children (4 boys, 2 girls).No significant inter-group difference existed in pericephalic index or preoperative intracranial volume (P>0.05).Preoperative cephalic index [(0.72±0.06) vs.(0.67±0.04)], postoperative cephalic index [(0.77±0.06) vs.(0.73±0.01)]and preoperative intracranial volume [(753.54±94.25) vs.(812.02±79.89) ml].However, differences of statistical significance existed in age [(8.23±2.10) vs.(14.57±5.54) month], operation duration[(2.24±0.22) vs.(5.00±0.52) h], intraoperative volume of blood loss [(70.0(57.5, 122.5) vs.120.0(100.0, 127.5) mL], hospitalization expense [31355.0(27595.0, 37554.0) vs.116414.5(98185.3, 124383.5) yuan]and postoperative follow-up intracranial volume [(823.72±93.94) vs.956.54±149.31) mL](P < 0.05). Conclusions Both πcraniectomy plus orthopedic helmet and cranial vault remodeling may improve intracranial volume and cephalic index of infants with non-syndromic premature sagittal suture.However, π craniectomy plus orthopedic helmet offers the advantages of shorter operative duration, less intraoperative volume of hemorrhage and lower hospitalization expense.Cranial vault remodeling is reserved for postoperative expansion of intracranial volume. [ABSTRACT FROM AUTHOR]

Objective　To investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. Methods　This study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. Results　Eight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］= − 1.75， 95% confidence interval ［CI］： −2.33 to −1.16， P<0.05）， postoperative diameter of the portal vein （SMD=−0.87， 95%CI： −1.64 to −0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level（ SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. Conclusion　Compared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fractures of the distal radius and the base of the styloid process of the ulna are common in clinical practice. Because of the double destruction of the fracture and the surrounding ligaments and cartilage, the distal radioulnar joint is unstable. In the past, insufficient attention was paid to the fracture of the base of the styloid process of the ulna, which often led to complications such as wrist joint pain and limited range of motion after surgery, and the treatment plan was controversial. OBJECTIVE: To investigate the effect of internal fixation on the function of the wrist joint with fracture of ulnar styloid process base in distal radius fracture. METHODS: Clinical data of 40 patients with traumatic distal radius fractures accompanied by ulnar styloid process base fractures treated with concurrent surgical treatment in Dongying People’s Hospital from June 2018 to December 2020 were retrospectively analyzed. All distal radius fractures were operated by open reduction and internal fixation. According to whether the fracture of the base of ulnar styloid process was treated surgically or not, the patients were divided into the internal fixation group and control group, with 20 cases in each group. The measured data of X-ray films were collected before and 6 and 12 months after operation, and the ulnar inclination, palmar tilt and radial height of the two groups were compared. The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were recorded 1 year after operation. The effect was evaluated with the Gartland-Werley scoring standard. RESULTS AND CONCLUSION: At the follow-up after operation, palmar tilt, ulnar inclination and radial height of the wrist joint of the two groups were all better than those before operation (P < 0.05), but the difference was not statistically significant between the two groups (P > 0.05). The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were better in the internal fixation group than those in the control group 1 year after operation (P < 0.05). The excellent and good rate of the internal fixation group (90%) 1 year after the operation was significantly higher than that of the control group (55%) (P < 0.05). These findings conclude that one-stage internal fixation of ulnar styloid process base fracture during the operation of distal radius fracture is conducive to further recovery of wrist function. [ABSTRACT FROM AUTHOR]

Objective To compare the early efficacy and safety of Da Vinci robot-assisted Kasai versus traditional open surgery for biliary atresia (BA). Methods From January 2021 to June 2022, retrospective analysis was performed for 9 children undergoing robotic portoenterostomy (RP) and another 21 children open portoenterostomy (OP) within the same period. General profiles, perioperative biochemical parameters, postoperative complications and hospitalization stay were compared. Results In RP group, there were 8 boys and 1 girl with a body weight of 5.4(5.0-6.5) kg and an average age of 65(56-90) day; In OP group, 13 boys and 8 girls with a body weight of 4.9 (4.5-5.8) kg and an average age of 59(49, 85) day. No significant differences existed among the above parameters (P>0.05). In RP and OP groups, preoperative total bilirubin [179.6(116.2-224.5) mmol/L vs. 170.3(129.6-208.2) mmol/L], postoperative total bilirubin [115.0(69.3-143.4) mmol/L vs. 120.3(88.5-160.7) mmol/L], preoperative direct bilirubin[83.4(79.0-155.7) mmol/L vs. 97.6(82.5-147.4) mmol/L], postoperative direct bilirubin [71.6(47.6-100.2) mmol/L vs. 82.1(64.3-117.5) mmol/L], preoperative alanine aminotransferase [175(114-234) U/L vs. 147(94-218) U/L], postoperative alanine aminotransferase [144(119-310) U/L vs. 183(150-253) U/L], preoperative aspartate aminotransferase [212(164-164) U/L vs. 129 (96-157) U/L] and postoperative aspartate aminotransferase [167(90-191) U/L vs. 120 (80-155) U/L]. There were no differences of statistical significance (P>0.05). Compared with those before operation, the biochemical indexes of children in all groups after operation were decreased except for the increase of alanine aminotransferase after operation in OP group, with statistical significance (P < 0.05). Postoperative hospitalization stay [15(12.5-21.5) day vs. 15(12-17.5) day], postoperative complication rate (2/9 vs. 3/21), cholangitis rate (7/9 vs. 15/21) and jaundice clearance (3/9 vs. 12/21) showed no inter-group differences of statistical significance (P>0.05). Conclusions Early curative efficacy of Da Vinci robotic surgery and open surgery is comparable for BA. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical characteristics, diagnoses and treatments of subacute osteomyelitis of epiphyseal plate caused by Fusobacterium nucleatum infection in children. Methods Clinical data were retrospectively reviewed for a child with subacute osteomyelitis of distal femoral epiphysis caused by F. nucleatum infection admitted on July 9, 2023. The relevant literature items of F. nucleatum-induced osteomyelitis in children were retrieved from the databases of PubMed, Wanfang Medical Network and CNKI from 1970 to 2023. Clinical manifestations, diagnoses, treatments and outcomes were analyzed. Results A 50-month-old boy with osteomyelitis of right distal femoral metaphysis was hospitalized. The pathogenic anaerobic Gram-negative bacillus was confirmed as G-proteobacterium by intraoperative tissue microbiome analysis using next generation sequencing (NGS). After 11-day treatment of clindamycin, local lesion debridement, bone augmentation with clindamycin-impregnated synthetic bone graft and cartilage repair of femoral condyle joint were performed. During 10-week follow-ups, the symptoms of right femur disappeared and knee joint function normalized. A search of domestic and foreign databases revealed that only 10 cases have been reported and there was no domestic report. Among 10 reported children with G-proteobacterium osteomyelitis, diagnosis was confirmed by tissue culture (n=9) and polymerase chain reaction (PCR, n=1). The interventions included lesion drainage (n=7), medication alone (n=3) and dosing of sensitive antibiotics (n=11). Follow-up showed disappearance of symptoms and near-normal motor function. Conclusions G-proteobacterium may cause osteomyelitis in children. There are common signs of fever and local pain. Imaging studies reveal bone destruction and abnormal signals in bone marrow and surrounding tissues. Anaerobic culture and NGS are important diagnostic tools for confirming G-proteobacterium infection-related osteomyelitis. Local debridement and dosing of sensitive antibiotics are efficacious. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and risk factors of urethral fistula with tubularized incised plate urethroplasty (TIPU). Methods From December 2018 to January 2020, 126 children with hypospadias undergoing primary TIPU were consecutively recruited. General demographics and intraoperative data were recorded. Electronic surgical records were reviewed and telephone follow-ups conducted, including types and occurrence time of complications. Univariate analysis was conducted for potential risk factors of urethral fistula. Variables with statistical significance were selected for Logistic multivariate analysis. Results During a mean follow-up period of 20.2 mouths, 2 cases were lost. Median age was 24 months. The position of urethral opening accounted for 58.1% of anterior type, 29.8% of intermediate type and 12.1% of posterior type respectively. The preoperative proportion of mild/moderate/severe penile curvature was 29.8%, 54.8% and 15.3% respectively. Penile curvature was corrected by penile degloving and dorsal plication. And 59.5% of children with mild penile curvature and 33.8% of moderate penile curvature were corrected only by degloving while all cases of severe penile curvature managed by dorsal plication. The overall complication rate of TIP surgery was 26.6%, including urethral stricture (n=10, 8.1%), urethral fistula (n=23, 18.5%), penile fistula (n=17, 13.7%) and penile head fissure (n=6, 4.8%). In univariate analysis, age, surgeon experiences or new urethra coverage had no correlation with postoperative urethral fistula. Urethral fistula was significantly higher in smaller glans, posterior hypospadias, severer penile curvature after degloving and chordee requiring dorsal plication. In multivariate analysis, glans width < 14 mm were independent risk factors for postoperative urethral fistula with TIP. Conclusions TIPU has a satisfactory efficacy for anterior/mediate hypospadias. The incidence of urethral fistula for posterior hypospadias is high with a poor efficacy. Children with smaller glans or severer penile curvature after degloving have a higher incidence of urethral fistula and glans width < 14 mm are independent risk factors for postoperative urethral fistula after TIPU. As compared to covering foreskin vascular pedicle, TIP surgery using Buck's fascia coverage has a lower incidence of urethral fistula. However, the incidence of urethral stricture is higher. The indications of TIP surgery should be strictly controlled for lowering the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical efficacies and outcomes of pediatric living donor liver transplantation (LDLT). Methods From September 2021 to February 2023, retrospective analysis was performed for the relevant clinical data of 11 children undergoing LDLT at First Affiliated Hospital of Xinjiang Medical University. Primary diseases included biliary atresia (n=2), portal vein cavernous degeneration (n=2), hepatolenticular degeneration (n=3), tyrosinemia type Ⅰ (n=1), congenital liver fibrosis (n=2) and Budd-Chiari syndrome (n=1). Postoperative interventions included anti-infection, liver protection, bile promotion, anticoagulation and immunosuppression. The immunosuppressive protocols were a triple regimen of tacrolimus, mycophenolate mofetil and methylprednisolone (n=8) and a dual regimen of tacrolimus and methylprednisolone (n=3). Results Mean operative duration was (11. 85±1. 85) h, mean graft-to-recipient weight ratio (GRWR) (2. 20±2. 03) %, mean cold ischemic time (75. 91±20. 87) min, mean warm ischemic time (2. 63±2. 30) min, mean anhepatic period (60. 55±18. 86) min and mean intraoperative volume of hemorrhagic loss (770. 91±541. 12) mL. End-to-end biliary anastomosis (n=4) and bile-intestinal anastomosis (n=7) were performed. There were no vascular or biliary postoperative complications. However, there were thrombocytopenia (n=1), lung infection (n=1), lymphatic leakage (n=2), seizure (n=1) and hypertension with irritability (n=1). All of them were cured and discharged after symptomatic measures. No postoperative complications occurred in donors. Conclusions LDLT is an effective treatment for end-stage liver disease and some genetically metabolic liver diseases in children. Indications for LDLT should be strictly tailored for different primary diseases. And perioperative managements are individualized for optimizing long-term survivals and quality-of-life. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy and safety of associating liver partition and portal vein ligation during two-stage hepatectomy (ALPPS) for massive hepatoblastoma. Methods The relevant clinical data were reviewed retrospectively for 4 children with hepatoblastoma undergoing ALPPS between July 2016 and February 2020. Results There were 1 boy and 3 girls with an average age of 39. 5 months). ALPPS was successful. Mean future liver remnant of total liver volume (FLR/TLV) pre-intervention was (12-35. 1)% and (16. 3-85. 2)% before stage Ⅱ resection. The average operation duration and blood loss for stages Ⅰ and Ⅱ were 286 min, 150 mL and 127 min, 112 mL respectively. No postoperative mortality occurred. One child underwent laparotomy and hepatic duct jejunum Roux-Y anastomosis due to obstructive jaundice after stage Ⅱ resection. During a postoperative follow-up period of (4-14) months, there were tumor-free survival (n=2), lung metastasis during chemotherapy after ALPPS (n=1) and right bone Ewing's sarcoma (n=1). Conclusions ALPPS is both efficacious and safe for children with massive hepatoblastoma having insufficient residual liver volume for complete resection. However, more confirmative data should be required and clinical indications of ALPPS further verified in future studies. [ABSTRACT FROM AUTHOR]

Objective To summarize the surgical experiences of the first-ever global case of robotic hepatectomy (RH) in a child with hepatoblastoma (HB) without the first hepatic portal control. Methods A 14-month-old HB boy reviewed retrospectively. Located in right hepatic lobe S5/S6, tumor had a dimension of 9. 0×6. 9×6 cm. RH was performed with Da Vinci system. Trocar positioning, operative skills and perioperative managements of pediatric robotic hepatectomy were recorded. Results Without the first hepatic control (Pringle), hepatic vessels were ligated by an ultrasonic knife with a Hemo-lock. Tumors (S5, S6, partial S7 & gallbladder) were completely removed with four robotic arms and one auxiliary hole. Operative duration was 120 min and volume of blood loss 50 ml. There were no such postoperative complications as bile leakage, hemorrhage or infection. Postoperative pathology hinted at HB. Discharge index was attained at Day 7 post-RH. C5V chemotherapeutic regimen (cisplatin + 5-fluorouracil + vincristine) was offered at Day 14. AFP was 36. 88, 8. 90 and 6. 61 ng/ml at Month 1, Day 53 and Month 3 post-RH. No new lesions were detected by ultrasonography. Conclusions RH is both safe and feasible for infantile HB without the first hepatic control (Pringle). Currently there are few related reports of RH in children. It is imperative to continue expanding cases and accumulating experiences. [ABSTRACT FROM AUTHOR]

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目的 观察鼻内镜辅助眶壁整复术对不同部位眶壁骨折的修复及治疗效果。方法 选取眶壁骨折整复 手术患者 60 例, 其中眶内壁、眶下壁和眶尖各 20 例, 患者均采用鼻内镜辅助眶壁整复术治疗。术后 3 d 观察眼球运 动受限、复视、眼球突出度以及视力改善情况; 对照术前、术后 3 个月骨折部位CT检查, 评价眶腔骨架修复效果; 记 录手术部位有无感染及置入物是否移位等并发症情况。结果 60 例患者, 修复治疗后眼球运动受限完全消失, 眼 球运动受限治愈率为 100%; 复视治愈 51 例、好转 7 例, 无效1例, 治愈率为 85.00%; 患者术后均无眼球内陷, 两侧眼 球突出度差值均低于 2 mm。60 例患者整复重建手术后视力均较治疗前明显改善, 视力差异有统计学意义 (P< 0. 05)。术后 3 个月 CT 检查显示患者眶腔骨架完全修复 51 例, 完全修复率为 85.00%。患者置入物均未发生移位, 术后切口未发生感染, 均正常愈合。结论　鼻内镜辅助眶壁整复术对眶内壁、眶下壁以及眶尖等不同部位眶壁骨折 患者的眼球运动受限、复视、眼球内陷以及视力损害均有良好治疗效果。 [ABSTRACT FROM AUTHOR]

Objective To systematically review the efficacy of Jiaji points injection in the treatment of postherpetic neuralgia (PHN) . Methods Chinese and English literature databases were systematically searched, and after a series of steps such as screening, extraction, and evaluation, the system review was completed. The search date is as of April 10, 2023. Results A total of 11 articles were included, with 852 patients, including 429 cases in the treatment group (Jiaji points injection alone or in combination) and 423 cases in the control group (oral Western medicine treatment) . The total effective rate of patients in the treatment group was significantly higher than that in the control group, and the pain relief was significantly better than that in the control group. The differences were statistically significant (RR=1. 24, MD=-2. 39, 95%CI:1. 17-1. 32, -3. 09--1. 70, P＜0. 000 01, I²=64%, 98%);There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (RR=0. 45, 95%CI:0. 17-1. 23, P=0. 120 00, I²=36%). Conclusion Jiaji points injection alone or in combination has a certain therapeutic effect on PHN, but more high-quality randomized double-blind controlled trials are needed to further confirm the efficacy of Jiaji points injection in the treatment of PHN. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy and safety of ultrasound endoscopic treatment of infected pancreatic necrosis (IPN). Methods The technical success rate, clinical success rate, complication rate, unplanned re-endoscopic operation rate and recurrence rate of 36 patients with IPN treated by endoscopy-guided puncture and drainage in this unit from November 2018 to November 2021, and how to reduce the postoperative complication rate was discussed. One patient was lost to follow-up, and the patient did not return to the hospital for further treatment or follow-up after discharge. Results The technical success rate of 36 patients with IPN treated by endoscopic stent drainage was 100. 0% (36/36). One case failed in treatment, and finally got better after percutaneous drainage. The clinical success rate was 97. 1% (34/35), the operation rate of unplanned reoperation was 25. 7% (9/35), and the recurrence rate was 5. 7% (2/35). Postoperative infection occurred in 9 patients, and incomplete intestinal obstruction occurred in one patient. The incidence of complications was 27. 8% (10/36), and there were no postoperative bleeding, perforation and death. Conclusion Ultrasound endoscopy-guided stent drainage is a safe and effective endoscopic treatment for IPN, which is worth further popularization and application. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death, and surgical resection remains an important method for radical treatment, but it is urgently needed to solve the problem of high postoperative recurrence rate. Neoadjuvant therapy can reduce the high recurrence rate after surgery, and there are little benefits from neoadjuvant therapy for HCC due to a lack of effective treatment methods in the past. At present, combination therapy based on immune checkpoint inhibitors has a relatively high response rate and has thus changed the treatment landscape for patients with advanced HCC. This urges investigators to reexamine the neoadjuvant treatment strategies for HCC, and it is expected that neoadjuvant therapy can provide new opportunities, reduce the postoperative recurrence rate, and improve the survival rate after treatment. This article discusses the current status and prospects of neoadjuvant therapy for HCC and related hot topics, so as to provide more ideas for exploring neoadjuvant therapy for HCC. [ABSTRACT FROM AUTHOR]

Objective To investigate the survival and adverse reactions of patients with unresectable cholangiocarcinoma after stereotactic body radiation therapy (SBRT). Methods A total of 27 patients with unresectable solitary cholangiocarcinoma without metastasis who underwent SBRT in The Fifth Medical Center of Chinese PLA General Hospital from February 2012 to July 2020 were enrolled. The prescribed dose to planning target volume was 42-60 Gy in 5-8 fractions, with 5-11 Gy/fraction. Among these patients, five patients were also treated with chemotherapy and transcatheter arterial chemoembolization. The 6-, 12-, 18-, and 24-month overall survival (OS) rates, progression-free survival (PFS) rates, and local control (LC) rates were used as the assessment indices for treatment outcome；Common Terminology Criteria for Adverse Events v. 4.03 was used to evaluate adverse reactions； the Kaplan-Meier method was used to calculate OS, PFS, and LC rates. Results The median follow-up time was 17 months. For all 27 patients, the 6-, 12-, 18-, and 24-month OS rates were 100%, 88%, 57.5%, and 47.9%, respectively； the 6-, 12-, 18-, and 24-month PFS rates were 74.1%, 58.6%, 47.9%, and 35.9%, respectively； the 6-, 12-, 18-, and 24-month LC rates were 96.3%, 91.9%, 84.8%, and 76.4%, respectively. No grade 3 or above toxic reactions were observed. Five patients were diagnosed with radiation-induced liver injury, but there was no death due to radiation-induced liver injury. Conclusion SBRT is safe and effective in the treatment of unresectable cholangiocarcinoma, with relatively high survival rate, PFS rate, and LC rate and low toxicity, and therefore, SBRT can be used as an alternative treatment method for patients with cholangiocarcinoma who are not candidates for surgery. [ABSTRACT FROM AUTHOR]

目的　探讨伊立替康联合紫杉醇治疗铂类耐药型进展期胃癌患者的临床疗效。方法　选取铂类耐药型 进展期胃癌患者94例，采用随机数字表法分为对照组和观察组各47例。对照组伊立替康联合氟尿嘧啶治疗，观察 组伊立替康联合紫杉醇治疗，3周为1个周期，共治疗3个周期。治疗期间对照组1例病死、1例主动退出研究，观察 组 2 例病死，最终两组各有 45 例患者完成本次研究。治疗前及治疗 3 个周期检测两组患者血清糖类抗原 724 (CA724)、糖类抗原125(CA125)、糖类抗原199(CA199)肿瘤标志物水平，观察两组近期临床疗效、不良反应发生情 况；治疗结束后对患者进行为期1年的跟踪随访，以肿瘤复发或病死作为随访终点事件，比较两组随访期间肿瘤复 发率和生存率。结果　与治疗前比较，两组治疗 3 个周期后血清 CA724、CA125、CA199 水平均降低(P 均<0. 05)。 治疗 3个周期比较，两组血清 CA724、CA125、CA199水平以及疾病总缓解率差异无统计学意义(P均>0. 05)。治疗 期间，观察组白细胞减少、血小板减少及血红蛋白减少程度较对照组减轻(P<0. 05)。随访1年，观察组生存率高于 对照组(P<0. 05)。结论　伊立替康联合紫杉醇治疗铂类耐药型进展期胃癌可获得与传统治疗方案同等的近期临 床疗效，而且可降低患者血液系统不良反应分级，提高患者生存率。 [ABSTRACT FROM AUTHOR]

Objective To systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta－analysis. Methods This study was conducted based on PRISMA guidelines, with a PROSPERO registration number of CRD42023406221. Chinese databases including CNKI, Wanfang Data, and VIP and foreign language databases such as PubMed, Embase, the Cochrane Library, and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones. Dichotomous variables were assessed by odds ratio (OR) and 95% confidence interval (CI), while continuous variables were assessed by weighted mean difference (WMD) and 95%CI, and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity. The Begg test and Egger test were used to evaluate publication bias. Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis. Results A total of 26 retrospective studies from China were included in this study, with 2 238 patients in total. The meta－analysis showed that compared with traditional laparotomy for the treatment of bile duct stones, laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation (WMD＝－1.26, 95%CI: - 1.36 to －1.16, P<0.001), length of hospital stay (WMD＝ －1.93, 95%CI: - 2.64 to －1.12, P <0.001), and time to bowel function recovery (WMD＝－1.52, 95%CI: - 1.68 to －1.35, P<0.001), significantly less intraoperative blood loss (WMD＝－1.79, 95%CI: - 1.93 to －1.66, P<0.001), a significantly lower rate of intraoperative residual stone (OR＝0.15, 95%CI：0.11－0.20, P<0.001), and significantly fewer complications (OR＝0.17, 95%CI：0.13－0.23, P<0.001). Conclusion Compared with traditional laparotomy, laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of ultrasound-guided hydrostatic reduction (UGHR) versus fluoroscopy-guided air reduction (FGAR) for primary intussusception in children. Methods A single-center retrospective analysis was performed for 949 children with primary intussusception from July 2019 to December 2020. According to the reduction approaches, they were assigned into two groups of UGHR (n=471) and FGAR (n=478). Gender, age, onset time, reduction success rate, perforation rate, recurrence rate and reduction time of two groups were compared. Results No significant inter-group differences existed in gender, age or onset time (P>0. 05). Reduction success rate of UGHR group was higher than that of FGAR group (98. 3% vs. 93. 9%)(P<0. 05). In children with onset time <48 h, reduction success rate of UGHR group was higher than that of FGAR group (98. 0% vs. 93. 3%)(P<0. 05). In children aged <1 year, reduction success rate was significantly higher in UGHR group than that in FGAR group (96. 7% vs. 82. 9%)(P<0. 05). ConclusionIn children with onset time <48 h and age <1 year, the efficacy of UGHR is better than that of FGAR. Thus UGHR is a preferred treatment for intussusception. [ABSTRACT FROM AUTHOR]