[Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities].

Objective: To investigate the clinical application effects of combination of different types of free perforator flaps in the repair of complex wounds in extremities. Methods: A retrospective observational study was conducted. From January 2018 to June 2022, 11 patients with complex wounds in extremities who met the inclusion criteria was admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 3 females, aged 28 to 55 years. The wounds in the upper extremities in 4 cases and in the lower extremities in 7 cases were repaired with different combination of free perforator flaps. After debridement, the wound area was 7.0 cm×6.0 cm-28.0 cm×12.0 cm. A combination of different types of perforator flaps were applied, including the perforator tri-leaf flap of the descending branch of the lateral femoral circumflex artery in 6 cases, the descending branch of lateral femoral circumflex artery combined with oblique branch perforating branch flap in 2 cases, the lobulated flap of the descending branch of the lateral femoral circumflex artery combined with the contralateral medial plantar artery perforator flap in 2 cases, and the bilateral perforator flap of the descending branch of lateral femoral circumflex artery combined with great toe nail flap in 1 case, with the size of a single flap ranged from 2.0 cm×2.0 cm-25.0 cm×6.0 cm. The donor site was repaired by direct suture, skin grafting, or flap transplantation. During free flap transplantation, the flap was cut and split according to the distribution of perforators, and end-to-end or end-to-side anastomosis was performed between the donor area and the recipient area. After surgery, the survival of transplanted flap in the primary recipient site, the occurrence of vascular crisis, the wound healing in the flap donor site, and the survival of transplanted skin or flap in the flap donor site were observed. During follow-up, the blood supply, appearance and texture of the transplanted flap in the primary recipient site were observed; and at the same time, the weight bearing of the plantar receiving area, the presence of sliding, ulcers, and sinus tracts of the flap, and the appearance and function of the hand were observed; the complications in the donor area were observed. Results: After surgery, one patient's transplanted flap in the primary recipient site had vascular crisis but survived after exploration+vein graft bridging; partial necrosis occurred in one lobe of anterolateral thigh lobulated flap transplanted to the primary recipient site in one patient and recovered after dressing change+skin grafting, and the different types of perforator flap transplanted to the primary recipient site in the other 9 patients all survived. After surgery, the wound with direct suture at the donor site healed well, and the skin or flap transplanted to the donor area survived well. During 3-24 months of follow-up, the blood supply, appearance, and texture of the transplanted flap at the primary recipient site were good. In two patients, the anterolateral thigh flap combined with the medial plantar flap were used to repair plantar defects. The plantar receiving area was able to bear weight, and the texture of the flaps in the recipient area was close to the normal plantar skin, without flap sliding, ulcer, or sinus tract formation. In one patient, bilateral anterolateral thigh flap combined with great toe nail flap were used to repair hand combined with soft forearm defect, and the appearance and function of hand, especially thumb were good. Only linear scar was left in the donor site without other obvious complications. Conclusions: The combination of different types of perforator flaps is a reliable clinical method to repair complex wounds in extremities with high safety, good efficacy, and less complications.

[Free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound after periorbital tumor resection and orbital enucleation].

Objective: To observe the clinical effect of free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound and after periorbital tumor resection and orbital enucleation. Methods: It was a retrospective case series study. Twelve patients with orbital tumors admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from February 2017 to April 2021 were included. There were 4 males and 8 females, aged 48 to 87 years. Nine patients had cutaneous squamous cell carcinoma, and 3 had basal cell carcinoma. All patients underwent extended resection of the tumor, resection of orbital contents and wound repair.All patients had the lesion completely removed, chimeric anterolateral thigh flap of the anterolateral femoral flap and perforator flap were transplanted to repair the wound. The donor area of the flaps was closed with tension sutures. The size of intraoperative resection lesion,intraoperative resection flap and muscle flap and the depth of the wound cavity were summarized. The postoperative flap survival, wound healing, surgical area appearance, flap color, thickness and texture, scarring and sensation in the surgical area, and tumor recurrence were observed. Results: The surgical procedures were successfully completed in all the 12 patients. The intraoperative resection lesion ranged from 7.0 cm × 5.0 cm to 15.0 cm × 8.0 cm. The depth of the wound cavity was 4.0 to 5.0 cm. The intraoperative resection flap range was 7.0 cm × 5.0 cm to 19.0 cm × 8.0 cm. The muscle flap size ranged from 4.0 cm × 3.0 cm to 5.0 cm × 4.0 cm. All flaps completely survived after surgery, and the wounds healed. The sutures at the recipient area were removed at 5 to 7 days after surgery, while the sutures at the donor area were removed at 12 to 14 days. All of the patients were followed up for 3 to 30 months. The scar at the periorbital area was concealed, and the color, thickness and texture of the flaps were similar to those of the surrounding normal skin. The scarring in the flap supply area was not hypertrophic, with localized decreased skin sensation around it. None of the patients had any tumor recurrence during the follow-up period. Conclusion: The anterolateral femoral muscle flap and perforator flap transplantation could efficiently repair the huge wound after orbital content removal, achieving satisfactory therapeutic effects.

Incidence and mortality of nasopharyngeal carcinoma: interim analysis of a cluster randomized controlled screening trial (PRO-NPC-001) in southern China.

BACKGROUND: Previous mass screening studies have shown that IgA antibodies against Epstein-Barr Virus (EBV) can facilitate early detection of nasopharyngeal carcinoma (NPC), but the impact of EBV-antibody screening for NPC-specific mortality remains unknown. PATIENTS AND METHODS: A prospective, cluster randomized, controlled trial for NPC screening (PRO-NPC-001) was conducted in 3 selected towns of Zhongshan City and 13 selected towns of Sihui City in southern China beginning in 2008. Serum samples of the screening group were tested for two previously selected anti-EBV antibodies. Subjects with serological medium risk were subsequently retested annually for 3 years, and those with serological high risk were referred to otorhinolaryngologists for diagnostic check-up. An interim analysis was carried out to evaluate the primary end points of the NPC-specific mortality and the early diagnostic rate, and the secondary end point of the NPC incidence, through linkage with the database of Zhongshan City. RESULTS: Among 70 296 total subjects, 29 413 screened participants (41.8% of the total subjects) in the screening group and 50 636 in the control group, 153 (43.3 per 100 000 person-year), 62 (55.3 per 100 000 person-year) and 99 (33.1 per 100 000 person-year) NPC cases were identified. The early diagnostic rates of NPC were significantly higher in the participants (79.0%, P < 0.0001) and the screening group (45.9%, P < 0.0001) compared with the control group (20.6%). Although no differences were found between NPC-specific mortality of the screening group and the control group [relative risk (RR)= 0.82, 95% confidence interval (CI) 0.37-1.79], lower NPC-specific mortality was noticed among participants from the screening group versus the control group (RR = 0.22, 95% CI 0.09-0.49). CONCLUSION: IgA antibodies against EBV can identify high-risk population and was effective in screening for early asymptomatic NPC. Although the mortality reduction was not significant in the primary end point, we noted encouraging evidence of a mortality reduction in screening participants in this interim analysis. CLINICAL TRIAL NUMBER: NCT00941538.

[Clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer].

Objective: To explore the clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer. Methods: From May 2012 to May 2017, 20 patients with sacral pressure ulcers (14 males and 6 females, aged 27 to 67 years) were admitted to our department. According to the consensus staging system of National Pressure Ulcer Advisory Panel in 2016, 6 cases were in 3 stages, 14 cases were in 4 stages, with the area of pressure ulcers ranging from 5.0 cm×4.0 cm to 10.0 cm×8.0 cm. After debridement and vacuum sealing drainage, the superior gluteal artery perforator island flaps were used to repair the pressure wounds, with the area of flaps ranging from 6 cm×5 cm to 13 cm×8 cm. The donor sites were sutured directly. The survival of flaps after operation, the healing of wounds, and the follow-up of patients were observed. Results: After surgery, flaps of 20 patients survived well without reoperation. The length of hospital stay of patients was 20 to 40 days, with an average of 25 days. Eighteen patients were followed up for 6 to 24 months, with an average of 12.2 months. The flaps were in good shape and elastic recovery. There were no complications such as seroma or hematoma in the donor sites. Both the patients and family members expressed satisfaction with the shape and texture of the flap and shape of hip. Conclusions: The superior gluteal artery perforator island flap is reliable in blood supply and easy to rotate. The flap can carry a little muscle to increase the anti-infective ability. Moreover, the donor site can be directly sutured with slight damage. Thus, it is one of the good methods for repairing sacral pressure ulcers.

[Effects of lappaconitine on pain and inflammatory response of severely burned rats and the mechanism].

Objective: To explore the effects of lappaconitine (LA) on pain and inflammatory response of severely burned rats and the mechanism. Methods: Forty SD rats were divided into healthy+ normal saline group, sham injury+ normal saline group, pure burn group, burn+ LA group, and healthy+ LA group according to the random number table (the same dividing method below), with 8 rats in each group. Rats in pure burn and burn+ LA groups were inflicted with about 32% total body surface area deep partial-thickness scald (hereinafter referred to as burn) on the back and right hind. Rats in sham injury+ normal saline group were sham injured. Rats in burn+ LA group were intraperitoneally injected with 1 g/L LA solution in the dosage of 4 mL/kg at 2.0 h before injury and post injury hour (PIH) 0 (immediately), 24.0, 48.0, and 72.0. Rats in healthy+ LA group were intraperitoneally injected with LA solution in the same dose at the same time points as above, and rats in healthy+ normal saline and sham injury+ normal saline groups were intraperitoneally injected with normal saline in the dose of 4 mL/kg at the same time points as above. At 1.5 h before injury and PIH 12.5, 24.5, 36.5, 48.5, and 72.5, the paw withdrawal mechanical threshold (PWMT) of injured rats was detected, and their pain behaviors were observed. The same observation and detection were conducted in rats without injury in the two groups at the same time points as above. Another 32 SD rats were divided into normal saline group, trinitrophenyl (TNP)-ATP group, minocyline group, pyridoxal-phosphate-6-azophenyl-2', 4'-disulfonic acid (PPADS) group, with 8 rats in each group, and all the rats were inflicted with the same burn injury as above. At PIH 48.0, rats in normal saline group were intrathecally injected with 10 µL normal saline; rats in TNP-ATP group were intrathecally injected with 10 µL TNP-ATP in the concentration of 30 nmol/µL; rats in minocyline group were intrathecally injected with 10 µL minocyline in the concentration of 5 g/L; rats in PPADS group were intrathecally injected with 10 µL PPADS in the concentration of 10 nmol/µL. The PWMT of rats was detected at 0.5 h before injection and 0.5 h after. At PIH 72.5, the tissue in the dorsal horn of spinal cord of rats in sham injury+ normal saline, pure burn, and burn+ LA groups was harvested to observe the co-expression of P2X(4) receptor and OX42 receptor with immunofluorescent staining and to observe the expression of P2X(4) receptor and count the positive cells with immunohistochemical staining. The venous blood was harvested for determination of serum content of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1ß) with enzyme-linked immunosorbent assay. The same observation and determination were conducted in rats without injury in the two groups at the same time point as above. Data were processed with one-way analysis of variance, analysis of variance for repeated measurement, SNK test, paired t test, and Bonferroni correction. Results: (1) There were no abnormal activity in rats of healthy+ normal saline, sham injury+ normal saline, healthy+ LA groups at all time points. Until PIH 72.5, rats in pure burn group were in poor mental state; red and swollen manifestation and blister were observed in burn wounds on the back and right hind; imbalance in gait, lick, bite, and scratch were observed occasionally. Fewer behaviors such as lick, bite, and limp were observed in rats in burn+ LA group than in pure burn group, and the red and swollen manifestation in wounds of rats in burn+ LA group dissipated faster than that in pure burn group. (2) At 1.5 h before injury, there were no significant differences in the PWMT values of rats in healthy+ normal saline, sham injury+ normal saline, pure burn, burn+ LA, and healthy+ LA groups (F=0.106, P>0.05). PWMT values of rats in pure burn group were significantly lower than those in the other 4 groups at all post injury time points (with P values below 0.05). PWMT values of rats in burn+ LA group were significantly lower than those in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups at all post injury time points (with P values below 0.05). (3) At 0.5 h before injection, PWMT values of rats in normal saline, TNP-ATP, PPADS, and minocyline groups were close, respectively 15.3±0.8, 15.1±1.0, 15.3±0.9, and 15.6±1.1 (F=0.343, P>0.05). At 0.5 h after injection, PWMT values of rats in normal saline group and PPADS group were respectively 15.2±1.2 and 14.8±1.0, which were significantly lower than 20.8±1.4 and 26.3±1.0 in TNP-ATP group and minocyline group respectively (with P values below 0.05). PWMT values of rats in normal saline and PPADS groups were similar before and after injection (with t values respectively 0.073 and -0.772, P values above 0.05), while those of rats in TNP-ATP and minocyline groups were higher after injection than before injection (with t values respectively -10.180 and -20.813, P values below 0.01). (4) At PIH 72.5, co-expression of P2X(4) receptor and OX42 receptor was observed in a few microglias of rats in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups, while co-expression of P2X(4) receptor and OX42 receptor was observed in a large number of microglias of rats in pure burn and burn+ LA groups. At PIH 72.5, more P2X(4) receptor positive cells were observed in rats in pure burn group than in the other 4 groups (with P values below 0.05), and more P2X(4) receptor positive cells were observed in rats in burn+ LA group than in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups (with P values below 0.05). (5) At PIH 72.5, the serum content of TNF-α and IL-1ß of rats in pure burn group was significantly higher than that in the other 4 groups (with P values below 0.001). The serum content of TNF-α and IL-1ß of rats in burn+ LA group was significantly lower than that in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups (with P values below 0.001). Conclusions: LA has significant analgesic effects on severely burned rats, and it can ameliorate the excessive inflammational situation. The mechanism may be related to its inhibition of expression of P2X(4) receptor in microglias in the dorsal horn of spinal cord and reduction in the release of inflammatory factors TNF-α and IL-1ß.

Joint effects between urinary selenium and polymorphisms in methylation related genes on breast cancer risk.

The aim of this study was to explore the associations of urinary selenium and polymorphisms in methylation related genes with breast cancer risk and the interactions on the risk. The present study involved in 240 female patients with incident breast cancer and 246 age-matched controls in two affiliated hospitals of Sun Yat-sen University in Guangzhou, China, from October 2009 to July 2010. DNMT1 rs2228611, MTHFR rs1801133, and MTR rs1805087 were genotyped using a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry platform. Urinary concentration of selenium was measured by inductively coupled plasma mass spectrometry. Women with urinary selenium in the second tertile had a significant reduced breast cancer risk compared to those with urinary selenium in the lowest tertile [OR (95%CI): 0.50 (0.30, 0.81)]. DNMT1 rs2228611, MTHFR rs1801133, and MTR rs1805087 were not associated with breast cancer risk. Women with the third tertile of urinary selenium had a significant reduced breast cancer risk compared to those with the lowest tertile among women only with CC genotype [OR (95%CI): 0.55 (0.30, 1.00)] but not CT/TT genotypes [OR (95%CI): 1.58 (0.73, 3.42)] of MTHFR rs1801133 (P for interaction=0.044). Our results suggested that selenium was associated with a decreased risk of breast cancer and this beneficial effect was limited to women with CC genotype of MTHFR rs1801133.

Clinical significance of CA19-9 in diagnosis of digestive tract tumors.

AIM: To evaluate the clinical value of CA19-9 in diagnosing and differentiating gastrointestinal tumors and in monitoring patients treated surgically. METHODS: Patients with gastric cancer (n = 70), colorectal cancer (n = 90), pancreatic cancer (n = 7), esophageal cancer (n = 10) and benign disorders (n = 30), and normal adults (n = 111; used as healthy controls), were studied. Fasting blood samples were obtained from each study participant. The serum CA19-9 concentration was measured with radioimmunoassay. RESULTS: The mean CA19-9 level was significantly higher in patients with gastric cancer (170.69 ± 91.45 kU/L) and patients with colorectal cancer (87.21 ± 39.55 kU/L) than in the healthy controls (11.254 ± 6.00 kU/L). Compared with the healthy controls, the CA19-9 level was also much higher in patients with pancreatic cancer (1266.58 ± 521.31 kU/L) (P < 0.01). However, the CA19-9 concentrations in patients with non-recurrent gastric cancer (12.63 ± 3.62 kU/L), colorectal cancer (14.14 ± 3.26 kU/L) and benign disorders (14.23 ± 2.60 kU/L) were statistically similar to those in the healthy controls (P > 0.05). The demarcation value of CA19-9 between negative and positive was < 31.0 kU/L. The sensitivity of CA19-9 for gastric, colorectal, pancreatic and esophageal cancers and for gastrointestinal benign disorders was 47.3%, 50.0%, 83.3%, 20.0% and 0%, respectively. The specificity of CA19-9 for digestive system malignant diseases was 100% for all.

[The polypeptides of mumps virus and their synthesis in infected chick embryo cells].

Strain ME of mumps grown in chick amniotic cavity and purified by differential centrifugation combined with sucrose gradient centrifugation. The structural polypeptides of purified virion were analyzed by SDS polyacrylamide gel electrophoresis. Eleven polypeptides were found. Their molecular weight were between 35K-72K dalton. In addition polymers of HN protein and F1 the large subunit of F protein were detected. Hela, Vero and CE cells were infected with ME strain of mumps virus. The CE cell reveals the most sensitive host cell. CE cell infected with mumps virus and labeled with [35S]-Met, SDS-PAGE and examined by autoradiography. It was found at least eight polypeptides were synthesis in host cells and their molecular weight were between 26.5K to 94K dalton. The time course of the synthesis of polypeptides in the cells were studies. Palse-Chase experiments demonstrated the posttranslational process of Fo----F.