CT venography combined with ultrasound-guided minimally invasive treatment for recurrent varicose veins: a pilot paired-design clinical trial.

AIM: To compare 1-year outcomes of computed tomography venography (CTV) combined with ultrasound-guided minimally invasive treatment with ascending phlebography and ultrasound-guided treatment for recurrent varicose veins. MATERIALS AND METHODS: Consecutive patients with unilateral recurrent varicose veins were matched by gender, age, C classification, and degree of obesity, and randomised in a 1:1 ratio to receive either CTV (CTV group) or ascending phlebography (control group) combined with ultrasound-guided minimally invasive treatment. Patients were followed up by clinical and ultrasound examination. Follow-up was scheduled at 1 week, and 3, 6, and 12 months. The primary outcome measure was the Venous Clinical Severity Score (VCSS) at 12 months. Measures of secondary outcome included Chronic Insufficiency Venous International Questionnaire-20 (CIVIQ-20) score, recurrence of varicose vein or ulcer during 12 months, ulcer healing time, detection and location of treated veins. RESULTS: Eighty patients were enrolled. Median VCSS in the CTV group was lower than it in the control group (p=0.04) and the CIVIQ-20 score was higher than the control group (p=0.02). By 12 months, no symptomatically recurrent varicose veins or ulcers had occurred. The ulcer healing time in CTV group was shorter (p<0.01). A greater number of patients had treated veins detected using CTV than by ascending venography (p=0.01), especially among patients with recurrence reflux veins in the groin, perineum, and vulva (p<0.01). CONCLUSION: CTV combined with ultrasound may be more helpful than ascending phlebography combined with ultrasound to improve treatment efficacy for recurrent varices. These results should be verified by an future study with more patients and long-term follow-up.

[Effects of cinepazide maleate injection on blood pressure in patients with acute ischemic stroke and hypertension].

Objective: To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection. Methods: This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes. Results: This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%,P>0.05) between cinepazide maleate group and control group. Conclusion: Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

[Efficacy analysis of lidocaine plaster combined with gabapentin in the treatment of herpes zoster neuralgia].

Objective: To evaluate the efficacy and safety of lidocaine plaster combined with gabapentin in the treatment of herpes zoster neuralgia (HZN). Methods: A total of 93 patients diagnosed with HZN from June 4, 2021 to January 5, 2022 in the Department of Pain Clinic of Nanjing Drum Tower Hospital were selected, and their gender was not limited. They were divided into 3 groups by random number table method: group A (n=32) prescribed gabapentin alone, group B (n=30) lidocaine plaster alone, and group C (n=31) lidocaine plaster combined with gabapentin. After excluding patients who did not meet the criteria, there were 28 cases in group A, 28 cases in group B, and 29 cases in group C. The visual analogue scale (VAS), the short-form McGill pain questionnaire (SF-MPQ) score, and drug dosage and adverse reaction in each group at pre-treatment (T0), post-treatment in one week (T1), in two weeks (T2), in four weeks (T4), and in 12 weeks (T12) were recorded and evaluated; Pittsburgh Sleep Quality Index (PSQI) score and Medical Outcomes Study short-form 36 (SF-36) score at T0, T4, and T12 were recorded. Adverse reactions and drug dosage in each group were documented. Repeated measures ANOVA was used to compare the curative effects of the three groups at different time points before and after treatment. Results: The ages of the three groups of patients were (67.8±10.0), (60.9±11.4) and (63.5±12.5) years old respectively (P=0.318), and the proportions of men were 46.4 % (13 cases), 35.7% (10 cases) and 44.8 % (13 cases), respectively (P=0.472). After treatment, the VAS scores and SF-MPQ scores of patients in the three groups were decreased at each time point compared with those before treatment (all P<0.05), the VAS and SF-MPQ scores of patients in group C at T12 time point were 1.2±0.4 and 5.2±2.4 respectively, which were lower than those of patients in groups A and B (both P<0.05). The dosages of gabapentin and lidocaine plaster in group C were lower than those in groups A and B at each time point after treatment (all P<0.05). The PSQI scores of patients in the three groups at T4 and T12 were lower than those before treatment (all P<0.05). The PSQI scores of patients in group C at T4 and T12 were 5.7±1.2 and 4.5±1.2, which were lower than those of patients in groups A and B. (all P<0.05), The SF-36 scores of patients in three groups at T4 and T12 were higher than those before treatment (all P<0.05), and the SF-36 scores of group C at T4 and T12 were 91.7±8.5, 93.1±6.3, which were higher than that of patients in groups A and B (both P<0.05). The incidence of adverse reactions in the three groups were 35.7% (9 cases), 10.7% (3 cases), and 13.8% (4 cases) respectively (P<0.05), the adverse reactions in groups B and C were less than those in group A (P<0.05), and there was no statistical difference between groups B and C (P>0.05). Conclusion: Lidocaine plaster combined with gabapentin has better analgesic effect in the treatment of HZN, with less incidence of adverse reactions, and can reduce the dosage of systemic drugs, improve patients' sleep and quality of life, and thus could provide a safe and effective method for the treatment of HZN.

Comparison of hemagglutination inhibition and hemagglutinin pseudovirus neutralization titres in relation to protection against influenza in a mouse model.

The hemagglutination inhibition (HI) test has long been used as a standard measure of antibody response for inactivated influenza vaccines. However, the HI test has limitations, such as insensitivity when using some H3N2 virus strains and failure to detect neutralizing antibodies that target regions distant from the receptor binding site. We therefore examined a hemagglutinin pseudovirus neutralization (PVN) test as a possible supplement or alternative to the HI test. We evaluated the association of HI or PVN titres with protection against influenza infection in mice based on morbidity (where the illness was defined as 25% body weight loss). We assessed this relationship using dose-response models incorporating HI or PVN titres as a variable. The morbidity was correlated with the pre-exposure titres, and such a correlation was well described by a modified dose-response model. The mathematical modelling suggests that PVN titres consistently show a stronger association with in vivo protection as compared to HI titres in mice. Given our findings, the PVN test warrants further investigation as a tool for evaluating antibody responses to influenza vaccines containing hemagglutinin. The resulting models may also be useful for analyzing human clinical data to identify potentially protective antibody titres against influenza illness.

[Study on the etiological characteristics and prevention and control of adult community-acquired pneumonia in hospitalized patients in a hospital in Beijing from 2015 to 2019].

Objective: To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP. Methods: 1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney U test was used for continuous variables and χ2 test or Fisher's exact test was used for categorical data for statistical analysis. Results: Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% vs. 2.41%, χ²=74.712,P<0.001), Streptococcus pneumoniae (8.16% vs. 2.99%, χ²=18.156, P<0.001), rhinovirus (6.08% vs. 3.56%, χ²=5.025, P<0.025), Chlamydia pneumoniae (5.90% vs. 1.15%, χ²=26.542, P<0.001) and adenovirus (3.13% vs. 0.92%, χ²=9.547, P=0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Conclusions: Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis.

Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic-assisted mesorectal excision and intersphincteric resection respectively in different ways.

AIM: Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery. METHODS: We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection. RESULTS: For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR. CONCLUSION: It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.

Sacral nerve stimulation for bowel dysfunction following low anterior resection: a systematic review and meta-analysis.

AIM: Low anterior resection syndrome (LARS) can affect up to 70% of all patients with rectal cancer. In the last two decades, sacral nerve stimulation (SNS) has emerged as an effective treatment for faecal incontinence. There is some encouraging literature on the use of SNS in patients with LARS. The purpose of this review is to provide an up to date review on the utility of SNS on LARS. METHOD: A literature search was conducted using the MEDLINE, Embase and PubMed databases (January 1981-March 2019). Studies identified were appraised with standard selection criteria. Data points were extracted, and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: Ten studies met the inclusion criteria and were included in this study. All studies used the Cleveland Clinic Incontinence Score (CCIS), whereas the low anterior resection syndrome score (LARS score) was used in three studies. Overall median improvement in the scoring system was 67.0% (range 35.5%-88.2%) after SNS implantation. There was a significant reduction in CCIS after SNS implantation (mean difference 11.23, 95% confidence interval 9.38-13.07, Z = 11.90, P < 0.00001). The LARS score was also significantly reduced after using SNS in patients with LARS (mean difference 17.87, 95% confidence interval 10.15-25.59, Z = 4.54, P < 0.00001). CONCLUSION: Use of SNS may provide symptomatic benefits for patients with LARS refractory to medical therapy. However, the current level of evidence remains limited. A large multicentre study of SNS for LARS using the validated LARS score is warranted. In addition, the cost-effectiveness of SNS for patients with LARS needs further exploration.

[Feasibility and safety of MRgFUS ablation for uterine fibroids and adenomyosis: a preliminary study].

Objective: To investigate the feasibility and safety of magnetic resonance guided focused ultrasound surgery (MRgFUS) ablation treatment for uterine fibroids and adenomyosis. Methods: From February 2017 to July 2018, a total of 61 women in Foshan Hospital of Traditional Chinese Medicine with uterine fibroids or adenomyosis (36 cases of fibroids and 25 cases of adenomyosis) were included for treatment of MRgFUS, mean age was 27-48 (39±5) years. The treatment status, treatment effect and complications were recorded, and the differences between myoma and adenomyosis were compared. Results: Thirty-two (88.9%) patients of fibroid group and twenty-one (84.0%) patients of adenomyosis group were completed MRgFUS treatment respectively (P>0.05). The spot energy of adenomyosis group was 1 039-5 698(2 852±991) J, which was higher than 600-6 466(2 485±1 137) J of fibroid group (P<0.01). There was no significant statistical difference in mean temperature of spot and ablation time between the two groups (P>0.05).The non-perfusion volume ratio (NPVR) of the fibroid and adenomyosis group was 54%-99%(84%±15%) and 60%-98%(82%±12%) and there was no significant statistical difference (P>0.05), but the ablation efficiencies of adenomyosis group was less than fibroid group (0.8-4.3(2.1±0.9) cm(3)/min vs 1.3-7.8(3.6±1.5)cm(3)/min, P<0.01).The incidence of complications of adenomyosis group was 47.6%(10/21), it was higher than fibroid group 18.8%(6/32) (P<0.05). Conclusions: MRgFUS is a non-invasive, safe and effective treatment for both uterine fibroids and adenomyosis. Compared with uterine fibroids, MRgFUS treatment of adenomyosis has some disadvantages such as higher energy, lower ablation efficiency and more adverse reactions, and further optimization is needed.

[How to improve the prevention and treatment of ocular chemical burns in China: important elements].

Ocular chemical burns are common and serious ocular emergencies which require immediate and intensive evaluation and treatment. Loss of vision and disfigurement affect the victims, bringing great sufferings to themselves and their families. China is the biggest developing country in the world with a large number of such cases. The prevention of ocular chemical burns is emphasized in different aspects. After emergency treatment, proper care of chemical burns is started by control of inflammation with corticosteroids. Topical and systemic ascorbic acid supplement is important. Re-epithelialization is critical to stabilize the ocular surface and to prevent corneal ulceration and melting. The goal of treatment is mainly to restore the ocular structure and function. Neuroprotection is important during the treatment course for control of both glaucoma and inflammation. Prognosis depends on the degree of limbal, corneal and conjunctival involvement at the time of injury as well as the management. Medical treatments only or with combination of surgical procedures, including amniotic membrane transplantation, epithelial or limbal stem cell transplantation, tenonplasty, keratoplasty and keratoprosthesis, are according to the classification of ocular chemical burns and the phases. Further investigations should be done in the future in both prevention and management of ocular chemical burns in China. (Chin J Ophthalmol, 2018, 54: 401-405).

[Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty].

OBJECTIVE: To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes. METHODS: A series of 100 consecutive, unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed. There were 50 male patients and 50 female patients. The average patient age was 51 years, and the average body mass index was 24.69 kg/m2. The preoperative diagnosis included avascular necrosis of femoral head, hip osteoarthritis, osteoarthritis secondary to acetabular dysplasia, sequelae of hip old infection, ankylosing spondylitis, rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture. There were 7 hips which had surgical history prior to the index hip arthroplasty, including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach, 2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach, and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual). All were uncemented hips. The stems used in this study included 67 Triloc stems (DePuy company, USA), 45 Corail stems (DePuy company, USA), 2 Accolade stems (Stryker company, USA), 1 Synergy stem (Smith-Nephew company, USA) and 1 Polarstem (Smith-Nephew company, USA). RESULTS: The average follow up period was 8.5 months, the average incision scar length was 10 cm, and the average postoperative Harris score was 93.62. There was 95% postoperative leg length discrepancy within 3 mm. The average cup inclination angle was 38.7° with 94.8% in the range of 30° to 50°. The average cup anteversion angle was 14.3° with 94.2% within the target range of 5° to 25°.The were 15 (12.9%) operative complications, including two femoral perforations (changing stem from Triloc to Corail), three calcar fractures (treated with cerclage wires), four greater trochanter fractures (2 were treated wire tension band, and 2 nondisplaced fractures untreated), one deep infection (debridement and retaining of the prothesis), one superficial infection (debridement), one hematoma and three wound healing complications (debridement). All the complications were successfully treated without any sequelae at the end of the latest follow-up. There was no postoperative dislocation. There was no major nerve and vascular injuries. There were 35 cases (30.2%) reporting symptoms of lateral femoral cutaneous nerve palsy. CONCLUSION: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation, which is helpful for early rapid postoperative recovery.

[Chronic hepatitis C: from discovery to cure].

Chronic hepatitis C virus(HCV)infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. In recent years, the treatment of HCV infection has undergone a revolutionary change. Chronic HCV infection has become a curable disease. This article reviews the developmental history of antiviral therapy for hepatitis C since the discovery of HCV.

Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels.

The objective of this study was to introduce a method for repairing large soft-tissue defects on the foot. Distally based neuro-fasciocutaneous flaps with perforating vessels were designed along the saphenous and sural neurovascular axes. The cutaneous perforating branches of the major arteries of the lower extremities were used as pedicles, which provided a rotation arc for the cross-leg flap to cover the large-sized soft-tissue defects on the foot. We transferred 6 neurocutaneous vascular axial flaps, including 4 saphenous neurocutaneous axial flaps (ranging from 25 x 13 to 17 x 9 cm in area) with posterior tibial perforators as the pedicle, and 2 sural neurocutaneous axial flaps (ranging from 29 x 12 to 18 x 7 cm in area) supplied by the perforating branches of the peroneal vessels. These 6 cases of neuro-fasciocutaneous flaps survived with satisfactory cosmetic appearances and functional results on follow-up at 8 to 17 months post-surgery. Placing a distally based neuro-fasciocutaneous cross-leg flap with perforating vessels is an effective method for repairing large-sized soft-tissue defects on the foot.

China's position in negotiating the Framework Convention on Tobacco Control and the revised International Health Regulations.

This paper examines China's position in the negotiations of the Framework Convention on Tobacco Control and the revised International Health Regulations. In particular, it explores three sets of factors shaping China's attitudes and actions in the negotiations: the aspiration to be a responsible power; concerns about sovereignty; and domestic political economy. In both cases, China demonstrated strong incentives to participate in the negotiation of legally binding international rules. Still, the sovereignty issue was a major, if not the biggest, concern for China when engaging in global health rule making. The two cases also reveal domestic political economy as an important factor in shaping China's position in international health negotiations.

[Effects of modified proper digital artery island flap in repairing complex fingertip defects].

Objective: To investigate the surgical method and clinical effects of the modified proper digital artery island flap in repairing complex fingertip defects. Methods: A retrospective observational study was conducted. From January 2017 to December 2021, 15 patients (15 fingers) with complex fingertip defects, involving the pulp, nail bed, and lateral wall of the nail, who met the inclusion criteria were admitted into General Hospital of Northern Theater Command, including 11 males and 4 females, aged from 18 to 55 years. The area of the post debridement wound was from 2.5 cm×2.0 cm to 3.5 cm×3.5 cm, and all the wounds were repaired by using modified proper digital artery island flap (including 3 parts: main flap, tongue-shaped flap, and triangular flap), of which the main flap was used to cover the finger pulp defect, the tongue-shaped flap was used to cover the nail bed and the nail lateral wall defect, and the triangular flap was inserted into the edge of the finger pulp wound to cover the vessel pedicle. The range of the flap ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The wound at the donor site was repaired with full-thickness skin graft of the groin, and the donor site of the skin graft was sutured directly. After operation, the survival of the flap and skin graft as well as and the appearance of the affected finger were observed. During the follow-up, the fingertip morphology of the affected finger was observed, two-point discrimination distance of the affected finger pulp was measured, and the patients' satisfaction with the efficacy (including very satisfied, satisfied, and dissatisfied) was asked, and the affected finger function was evaluated by the total active movement (TAM) system evaluation standard recommended by American Academy for Surgery of Hand. Results: After operation, the main flaps and skin grafts in 15 patients all survived; but the incision at the edge of tongue-shaped flap in one patient healed poorly, and one patient developed venous stasis at the distal end of the tongue-shaped flap; the triangular flap at the pedicle was slightly bloated in the early postoperative period and became smooth after 2 to 3 months. Overall, two patients developed subcutaneous hematoma in their flaps. All the complications were healed by appropriate dressing change, suture removal, or compression bandaging. After operation, the appearance of the flap was full and formed a prominent fingertip shape. During the follow-up of 6 months to 5 years, the fingertips of the affected fingers were prominent and full; the two-point discrimination distance of the affected finger pulp was (8.6±1.4) mm; 8 patients were very satisfied with the efficacy, 6 patients were satisfied, and one patient was dissatisfied; the functional assessment of the affected fingers were all excellent. Conclusions: The modified proper digital artery island flap can repair complex fingertip defects involving the pulp, nail bed, and lateral wall of the nail. The operation is simple, and the shape and function of the fingertip are good after surgery.

[Curative effects of bi-pedicled deep inferior epigastric perforator flap in repairing large soft tissue defects in the lower limbs].

Objective: To investigate the curative effects of bi-pedicled deep inferior epigastric perforator (DIEP) flap in repairing large soft tissue defects in the lower limbs. Methods: A retrospective observational study was conducted. From February 2016 to June 2020, 16 patients with large soft tissue defects in the lower limbs caused by trauma or after tumor/scar resection were admitted to the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, including 9 males and 7 females, aged 25-58 years, with the area of soft tissue defects ranging from 14.0 cm×8.0 cm to 32.0 cm×18.0 cm. Using the abdomen as the donor site, the conjoined abdominal wall flap, i.e., the bi-pedicled DIEP flap (with an area ranging from 15.0 cm×9.0 cm to 32.0 cm×20.0 cm) carrying two sets of the trunk of the deep inferior epigastric artery was designed and resected to repair the wound. The donor site wound was sutured directly. The flap survival and wound healing in the donor and recipient areas were observed after operation. The curative effect was evaluated during the follow-up. At the last follow-up, the American Knee Society score and lower extremity functional scale were used to assess the functions of knee joint and lower limb, respectively. Results: The flaps of 15 patients survived after operation; the flap of one patient had partial infection at the edge after operation but healed after debridement and dressing change. The wounds in the donor and recipient areas of 16 patients all healed well. Follow-up of 16-28 months showed that the recipient area had a good shape and pliable texture, and there was no obvious swollen appearance, hyperpigmentation, or abnormal hair growth; the donor site had linear scar only, with no complications such as abdominal hernia or hyperplastic scar; the functions of knee joint and lower limb were well reconstructed, with no recurrence of tumor. At the last follow-up, among the 4 patients with knee joint injury, 3 cases were excellent and 1 case was good in the evaluation of knee joint function; among the 12 patients with lower limb injury, 9 cases were excellent and 3 cases were good in the evaluation of lower limb function. Conclusions: The donor site of bi-pedicled DIEP flap is concealed with abundant tissue and large area for resection, with which can be used to repair large soft tissue defects in the lower limbs, achieving good short-term results of appearance and function restoration.

Effect of Multicomponent Intervention on Functional Decline in Chinese Older Adults: A Multicenter Randomized Clinical Trial.

OBJECTIVES: To confirm whether multicomponent exercise following vivifrail recommendations was an effective method for improving physical ability, cognitive function, gait, balance, and muscle strength in Chinese older adults. METHODS: This was a multicenter and randomized clinical trial conducted in Jiangsu, China, from April 2021 to April 2022. Intervention lasted for 12 weeks and 104 older adults with functional declines were enrolled. All participants were randomly assigned to a control (usual care plus health education) or exercise group (usual care plus health education plus exercise). Primary outcomes were the change score of Short Physical Performance Battery (SPPB) and activities of daily living (ADL). The secondary outcomes included instrumental activities of daily living, Tinetti scores, Frailty score, short-form Mini Nutritional Assessment, Mini-Mental State Examination, Geriatric Depression Scale-15, the 12-item Short Form Survey, 4-meter gait speed test, 6-min walking distance, grip strength, and body composition analysis. RESULTS: Among the participants, the average age was 85 (82, 88) years. After 12 weeks of follow-up, the exercise group showed a significant improvement in SPPB, with a change of 2 points (95% confidence interval [0, 3.5], P<0.001) compared to control. In contrast, SPPB remained stable in the control group. Compared to the control group, ADL improved in the exercise group, as did instrumental activities of daily living, Tinetti, Frailty, Short Form Survey, 4-meter gait speed test, and 6-min walking distance. Although there was no significant difference between groups in body composition analysis after post-intervention, the exercise group still improved in soft lean mass (P=0.002), fat-free mass (P=0.002), skeletal muscle mass index (P<0.001), fat-free mass index (P=0.004), appendicular skeletal muscle mass (P<0.001), and leg muscle mass (P<0.001), while the control group had no significant increase. No difference was observed in adverse events during trial period. CONCLUSIONS: The multicomponent exercise intervention following vivifrail recommendations is an effective method for older adults with functional decline and can reverse the functional decline and improve gait, balance, and muscle strength. Additionally, the 12-week multicomponent exercise method provides guidance for Chinese medical professionals working in the field of geriatrics and is a promising method to improve physical function in the general population.