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Objective:To investigate the application of 3-D ultrasonography enabled by a wide band linear matrix array volume transducer in the localisation of perforating vessels of a free anterolateral thigh perforator flap (ALTPF) before surgery, and to guide microsurgeons in precise design and harvest of a ALTPF.Methods:From May 2020 to October 2022, a retrospective study was carried out on 35 patients who had soft tissue defects and undertaken free ALTPF surgery in Department of Foot and Ankle Surgery, Wuxi No.9 People's Hospital Affiliated to Soochow University. ALTPFs were transfered for reconstruction of soft tissue defects of foot in 25 patients and of ankle in 10 patients. The age of patients were 20 to 66 years old. The defects were 11.0 cm×8.0 cm-28.0 cm×9.0 cm in size. The sizes of ALTPFs were at 12.0 cm×9.0 cm-29.0 cm×10.0 cm. Before surgery, ultrasound scans with a wide band linear matrix array volume transducer were performed to locate the perforating vessels. The 3-D ultrasound images showing the perforating vessels of ALTPFs were acquired and the number, location and classification of the perforating vessels were saved. After the appropriate perforating vessels had been determined, ALTPFs were designed for precisely intraoperative incision. The accuracy of preoperative location of perforating vessels by the linear matrix array volume ultrasound transducer was investigated in surgery. All patients received the scheduled postoperative follow-up at outpatient clinics.Results:Of the 72 perforating vessels discovered in surgery, 70 matched with those being located by ultrasound before surgery. It was found that a total of 67 perforating vessels located before surgery by ultrasonography were consistently mapped with the perforators discovered in surgery. Of the 67 consistently mapped perforating vessels, 19 were Kimura type I, 27 of Kimura type II and 21 of Kimura type III perforators. The rate of sensitivity and positive prediction were 95.7% and 93.1%, respectively, in the preoperative localisation of perforating vessels of ALTPFs with a wide band linear matrix array volume ultrasound transducer. Twenty-five ALTPFs were harvested subfascially and 10 superfascially. Average size of ALTPFs was 17.7 cm × 8.6 cm. The perforating vessels revealed during the harvest of all ALTPFs were basically consistent with the preoperative 3-D ultrasound. All flaps survived after surgery without any incident. The postoperative follow-up lasted 8 to 20 months, with 12.7 months in average.Conclusion:The 3-D ultrasonography with a wide band linear matrix array volume ultrasound transducer can accurately locate the perforating vessels of ALTPF before surgery. This technique has many advantages in the design and harvest of super-thin ALTPFs.
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OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
الموضوعات
Male , Female , Humans , Thigh/surgery , Plastic Surgery Procedures , Prospective Studies , Skin Transplantation , Free Tissue Flaps , Burns , Soft Tissue Injuries/surgery , Ultrasonography, Doppler, Color , Crush Injuries/surgery , Perforator Flap , Treatment Outcomeالملخص
Objective:To investigate the clinical effect of minimally invasive-locking block modified Krackow (MI-LBMK) and open giftbox technique in the treatment of Achilles tendon rupture.Methods:Fifty-six patients with Achilles tendon rupture from January 2016 to December 2018 were collected, including 54 males and 2 females, aged 40.7±9.4 years (range 26 to 65 years). The MI group (30 patients) used two minimally invasive incisions without exposing the rupture site, and the LBMK technique was used to repair the Achilles tendon. The open group (26 patients) used a posteromedial longitudinal incision and the giftbox technique was used to repair the rupture tendon. The Achilles tendon was repaired with 6-strand sutures in both groups. Early rehabilitation programs were adopted for postoperative rehabilitation, and regular follow-up (6 weeks, 3, 6, 12 and 24 months after operation) was performed to record the Achilles tendon resting angle (ATRA), American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Achilles tendon total rupture score (ATRS). The rupture gap and cross-sectional area (CSA) were measured by MRI at 6 weeks and 3 months after surgery.Results:A total of 30 patients in the MI group and 26 in the open group were enrolled. The differences between the two groups in age, body mass index, interval from injury to operation, and tendon rupture site were not statistically significant ( P>0.05). All patients were followed up to 24 months after surgery. There were no wound complications in MI group, and 2 cases of superficial infection and 1 case of wound skin necrosis occurred in open group. There was no re-rupture in both groups. The relative ATRA of MI group was -6.32°±0.99°, -3.90°±1.05°, -2.38°±0.84°, -0.25°±1.37° at 3, 6, 12 and 24 months after operation, respectively. The relative ATRA of open group was -7.88°±3.71°, -6.16°±1.10°, -4.53°±0.95°, -3.01°±0.95° at 3, 6, 12 and 24 months after operation, respectively. The differences between the two groups were statistically significant ( P<0.05). The ATRS of minimally invasive group at 6 months and 12 months were 72.70±7.41 and 92.97±3.35 respectively, and the ATRS of open group at 6 months and 12 months were 68.08±6.64 and 90.85±4.27 respectively, and the differences were statistically significant ( P<0.05). The AOFAS of minimally invasive group at 6 months and 12 months were 88.60±2.76 and 93.83±1.98 respectively, and the AOFAS of open group at 6 months and 12 months were 85.77±3.20 and 92.08±2.64 respectively, and the differences were statistically significant ( P<0.05). The difference in the gap between the tendon rupture ends measured by MRI sagittal plane T2WI between the two groups was not statistically significant ( P>0.05). The cross-sectional area of Achilles tendon in the MI group was higher than that of the open group at 12 weeks ( P<0.05). Conclusion:The MI-LBMK technique may protect the peritendon tissue and has fewer complications, and can enable the patient to return to daily life faster, with lower postoperative Achilles tendon elongation and better recovery of Achilles tendon function.
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Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.
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Objective:To investigate the clinical effect of free anterolateral thigh flap(ALTF) combined with medial plantar flap(MPF) transfer in repairing forefoot and mid-foot degloving injury.Methods:From May, 2016 to November, 2019, 6 patients with forefoot and mid-foot degloving injuries underwent reconstructions using free ALTF combined with MPF. The study included 4 males and 2 females patients with an average of 43 (range, 35-55) years. The size of soft tissue defects was 15 cm×12 cm-19 cm×14 cm. The dimension of the MPF was 8 cm×5 cm-10 cm× 6 cm, and that of ALTF was 16 cm×7 cm-20 cm×8 cm. The ALTF was used to cover the dorsal and lateral foot, the flap artery was anastomosed to the dorsalis pedis artery. The MPF was used to repair the weight-bearing area of the forefoot, the flap artery was anastomosed to the medial plantar artery in recipient site. All patients entered follow-up by outpatient clinic or Wechat for 9-18(mean, 14) months, and the appearance of flap and limb function were recorded.Results:The MPF and ALTF survived uneventfully in all 6 patients, and the wound in donor and recipient areas healed in one stage. At the last follow-up, the flaps had satisfactory contour, the texture of the flaps was soft, the protective sensation was recovered, and the appearance and function of the foot recovered satisfactorily. The Maryland score of reconstructed foot function was considered excellent (90-100) in 4 cases and good (75-89) in 2 cases. The average Maryland score was 91.2.Conclusion:ALTF combined with MPF generated good effect and satisfactory function in repairing forefoot and mid-foot degloving injury.
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Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.
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Objective:To compare the application and results in repairing wounds on shank and medial malleolus by perforator pedicled middle and lower third of posterior tibial flap, saphenous neurovascular flap and posterior tibial artery perforator plus saphenous neurovascular (double blood supply) flap.Methods:Clinical data of 60 patients with wounds on shank and medial malleolus and treated between August, 2015 and December, 2018 were analyzed. Among the patients, 25 were treated with perforator pedicled middle and lower third of posterior tibial flaps, 15 with saphenous neurovascular flaps, and 20 with double blood supply flaps. The data of surgery, survival of the flaps, texture and swelling of the flaps, patient satisfaction and scores set by American Orthopaedic Foot and Ankle Society(AOFAS) were collected. Statistic analysis was carried out to compare observations among the 3 groups.Results:Postoperative followed-up was 6 to 24(average 13.4) months. One flap suffered insufficient blood supply in the group of perforator pedicled middle and lower third of posterior tibial flaps, 2 flaps suffersd necrosis and skin graft was carried out in reverse saphenous nerve neurocutaneous flaps group. In double blood supply flaps group, 2 flaps appeared purple after surgery, and improved after removing the pedicle sutuer, and flaps became swelling and received secondary repair. All AOFAS scores (93.8, 93.3 and 92.8, respectively) and patient satisfaction were high in all 3 groups.Conclusion:All 3 types of flap are able to be used in repairing the soft tissue defect on shank and medial malleolus. The inclusive of saphenous nerve should be determined in intraoperation according to the presence and size of the perforator. If artery perforation is reliable, the use of posterior tibial artery perforator flap in wound repairing will deliver satisfactory outcomes in terms of blood supply and appearance of the flap. For the wider area of wound, a flap with double blood supply is preferred.
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Objective:To investigate the clinical effectiveness of peroneal artery perforator flap with anterior tibial artery perforator in repair of the soft tissue defect of dorsum of forefoot and midfoot.Methods:From February, 2015 to July, 2019, peroneal artery perforator flaps with anterior tibial artery perforator were used to repair dorsal foot soft tissue defect in 42 patients. There were 25 males and 17 females, with an averge age of 62(44-73) years. The size of soft tissue defect ranged from 7 cm×4 cm to 18 cm×5 cm. The recipient sites on forefoot and midfoot were repaired by peroneal artery perforator flaps with anterior tibial artery from the anterolateral aspect of shank. The donor sites were resurfaced with full-thickness skin graft. All patients were followed-up at the outpatient clinic or through WeChat for 3-12 months. The appearance of the flaps and limb recovery were recorded.Results:All flaps survived successfully. The donor sites and recipient sites were well healed. At the last follow-up, the texture and aesthetic of flaps were good, and the appearance and function of the foot were satisfactory.Conclusion:The peroneal artery perforator flaps with anterior tibial artery double blood supply and can be designed to repair large and distanced soft tissue defect of forefoot and midfoot.
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Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P > 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8%),minor complications (57.6%) and overall complications (83.1%) than the induced membrane technique group (11.2 ± 2.8 months,16.7%,26.7% and 30.0%,respectively) (P < O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P < 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.
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Objective The aim of this study was to investigate the relative expression of zinc finger protein ZNF436 in hu-man gastric cancer cells and tissues and its mechanism of ZNF436 on migration and invasion of gastric cancer MKN -28 cells. Methods RT-qPCR and immunohistochemistry were used to determine the expression of ZNF436 at the levels of mRNA and pro-tein in human gastric cancer cells,gastric cancer and matched paracancerous tissues,and normal human gastric tissues. ZNF436 ex-pression and prognostics were analyzed through online data. The ZNF436 -siRNA ( experimental group) and NC -siRNA( control group)plasmids were transfected into MKN028 cells. RT-qPCR was used to confirm the knockout efficiency of ZNF436 after trans-fection for 48 hours. The transwell assay was used to analyze the effect of ZNF436 on cell migration and invasion after knockout ZNF436. The effect of ZNF436 on cell metastasis was verified by nude mice metastasis experiments. The effect of ZNF436 on WNT/β-catenin signaling pathway was verified by immunoblotting. Results Compared with normal gastric epithelial cells,ZNF436 was highly expressed in human gastric cancer cells(P<0. 001). ZNF436 was highly expressed in gastric cancer tissues compared with ad-jacent normal tissues and normal human gastric tissues(P<0. 001). The expression of ZNF436 was associated with the prognosis of gastric cancer from online data(P=0. 0028);the high expression of ZNF436 gene,the worse prognosis of patients(P<0. 001);When compared with the control group,the migration and invasion ability in the experimental group was significantly inhibited(P<0. 001);the size and volume of metastasis in nude mice in the experimental group were significantly lower than those in the experimental group ( P<0. 001). After the low expression of ZNF436,the WNT/β-catenin signaling pathway and its downstream cytokines were signifi-cantly inhibited. Conclusion ZNF436 is up-regulated as a potential oncogene in human gastric cancer and participates in the pro-gression of gastric cancer by promoting WNT/β-catenin signaling pathway.
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Objective To use SVV as a standard and observe the availability of IDVG in assess-ing volume status of perioperative esophageal cancer patients.Methods Thirty patients undergoing selective esophageal cancer surgery were enrolled.The values of SVV were obtained from Vigileo sys-tem after tracheal intubation.Baseline blood glucose was measured through radial artery,and then 5 g glucose (50% glucose solution 10 ml)was injected through right jugular vein in 30 s.Blood glucose levels in 1,3,5,60 mins after the injection were assassed via radial artery blood samples and IDVG3 (3 min post injection of glucose)was further calculated.The correlation between SVV and IDVG3 was studied using Pearson correlation analysis.Results There's no difference in blood glucose level CT0 and CT60 [(5.60±0.74)mmol/L vs (5.77 ± 0.76 )mmol/L].There was a negative correlation be-tween SVV and IDVG 3 mins after glucose injection (r =-0.79,P <0.001).Conclusion IDVG of 3 min post injection of glucose can predict fluid volume state in patients with esophageal cancer.
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Objective: To explore the antagonistic effect of quercetin on fine particulate matter (PM2.5)-induced embryonic developmental toxicity in vitro.Methods: PM2.5 was collected on glass fiber filters by PM2.5 samplers during the heating period of Dec.2015 to Mar.2016 in an area of Haidian District, Beijing City.The sampled filters were cut into 1 cm×3 cm pieces followed by sonication.The PM2.5 suspension was filtered into a 10 cm glass dish through 8 layers of sterile carbasus and stored at-80 ℃ until freeze drying.Frozen PM2.5 suspension was dried by vacuum freeze-drying.In vitro post-implantation whole embryo culture was used in this study.Pregnant rats with 9.5 gestation days (GD) were killed by cervical dislocation and the uteri were removed into sterile Hank's solution.The embryos with intact yolk sacs and ecto placental cones were induced by PM2.5, and then subjected to intervention of quercetin at the doses of 0.1 μmol/L, 0.5 μmol/L, 1.0 μmol/L and 5.0 μmol/L, respectively.At the end of the 48 h culture period, the cultures were terminated, and all embryos were removed from the culture bottles and placed in prewarmed Hank's solution for evaluation.Morphological evaluation of the embryos was conducted under a stereomicroscope using the morphologic scoring system by Brown and Fabro.The mitochondrial reactive oxygen species (ROS) level was detected by FACSCalibur flow cyto-metry using MitoSOXTM Red staining.Results: An obvious antagonistic effect was achieved through querce-tin at the dose of 1.0 μmol/L, which could result in an increase of visceral yolk sac (VYS) diameter, crown-rump length and head length, somite number, and the differentiation of visceral yolk sac vascular vessels.The scores of allantois, flexion, heart, hind brain, midbrain, forebrain, auditory system, visual system, olfactory system, branchialarch, maxillary process, forelimb bud and hindlimb bud also revealed a significant increase and the relative mitochondrial ROS level of embryonic cells was significantly decreased when compared with PM2.5 group.Although quercetin at the doses of 0.1 μmol/L, 0.5 μmol/L, 5.0 μmol/L also exhibited protective effects against PM2.5-induced embryonic developmental toxicity, the protective effect was weaker when compared with the dose of 1.0 μmol/L.Conclusion: Quercetin at proper dose may be of great benefit for the development of embryos exposed to PM2.5 in the uterus of the rats.Quercetin provides an effective strategy for the prevention of PM2.5-induced embryonic developmental toxicity.Clearance of mitochondrial ROS may be one of its mechanisms.
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Objective@#To summarize 7 adjacent V-Y advanced perforator flaps for defects at donor sites leaving by six commonly-used flaps.@*Methods@#From May 2007 to Jan. 2014, 66 cases with hands and feet skin defects, tendon and bone exposure were treated with reverse island flap(15 cases), thumb dorsal artery island flaps (9 cases), dorsal metacarpal artery island flaps (9 cases), abdominal pedicle flaps (9 cases), free anterolateral thigh flaps (15 cases), sural nerve retrograde island flaps (9 cases). The defects at donor sites were covered by adjacent V-Y advanced perforator flaps, including dorsal metacarpal perforator flap, snuffbox perforator flap, dorsal carpal perforator flap, deep iliac circumflex artery musculocutaneous perforating branches flap, outer knee perforator flap, medial thigh perforator flap, proximal posterior tibial artery.@*Results@#All the six common flaps survived with average healing period of 15 days. Only one adjacent V-Y advanced outer knee perforator flap underwent partial necrosis at the proximal flap end which healed after dressing. All the other V-Y advanced flaps survived. The patients were followed up for 5-24 months (8 on average) with satisfactory flap texture and color both at reconstructed area and donor sites. The adjacent joints had normal movement function.@*Conclusions@#Adjacent V-Y advanced perforator flap is an important method for closure of defects at donor sites. It has the advantages of no sacrifice of main artery, satisfactory result and easy performance.
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Gut microbiota provide enzymes and additional biochemical metabolic pathways for the host, which together with the host genome and the external environment, influence the body function. The composition of gut microbiota in infant is closely related to health in later life. However, it is influenced by many factors, including delivery mode, feeding pattern, prenatal diet, pregnancy psychology and antepartum antibiotic treatment. Vaginal delivery and breastfeeding is beneficial for shaping gut microbiota, while cesarean section and formula feeding would reduce the amount of gut dominant bacteria. In addition, inappropriate diet during pregnancy, prenatal stress and antepartum antibiotic treatment alters bacterial colonization of the gut in infant.
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Objective To investigate therapeutic effect of the low dose clomiphene treatment of idiopathic oligoasthenospermia and effect on sperm epididymal protein level 4.Methods183 cases of idiopathic oligoasthenospermia were divided into three groups, vitamin group of 61 patients were given vitamin E,clomiphene group(61 cases)treated with low dose clomiphene, combined group of 61 patients were given low dose clomiphene and vitamin E, lasted for 12 weeks.Semen volume, sperm density, sperm motility, sperm survival rate and sperm reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), human epididymis protein 4 (HE4), follicle stimulating hormone, luteinizing hormone, testosterone concentration were observed before and after treatment.After treatment, the patients were followed up for 1 year, the observation of the natural pregnancy rate after treatment.ResultsSperm density, sperm survival rate and sperm and a A+B grade sperm in the clomiphene group were significantly higher comparedwith the vitamin group (P< 0.05), sperm density, sperm survival rate and sperm and a A+B grade sperm in the combined group were significantly increasedcompared with clomiphene group and vitamin group (P< 0.05),levels of HE4 after treatment was significantly lower compared with before treatment (P< 0.05), And the difference between the three groups were statistically significant (P< 0.05).Follicle stimulating hormone, luteinizing hormone, testosterone in clomiphene group and combined group after treatment, were significantly increased compared with before treatment (P< 0.05), and the combined group had no statistically difference compared with clomiphene group.The pregnancy rate in 1 year of vitamin group, clomiphene group and combined group were 24.59%, 42.62% and 62.29% (P< 0.05).ConclusionClomiphene treatment of idiopathic asthenospermia is better than vitamin E, the combination of the two has a synergistic effect.
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Objective:To evaluate the immunomodulating effect of oyster peptide on immunosup-pressed mice.Methods:ICR mice injected with cyclophosphamide (CTX)were adopted as the module group,with mice without treatment as the control group,and different dosages of oyster peptide (0.5 g/kg,1 .0 g/kg,and 2.0 g/kg)were given to the low,middle,and high groups for 1 5 days.The body weight,spleen,and thymus weight of the mice,structures under the microscope of the immune organs, numbers of white blood cells,ratios of T lymphocyte subsets,immune cytokines and numbers of nuclear cells,and DNA content in bone marrow were all assessed.Results:Compared with the control group, the structures of thymus and spleen of the mice in the CTX group appeared obscure and shrunk when ob-served under microscope,the number of their white blood cells declined (P =0.04),the proportion of their CD3 +T cells in peripheral blood declined (P =0.003),the proportion of their CD8 +T cells in pe-ripheral blood declined (P =0.002),the concentration of their IL-5 in peripheral blood significantly in-creased (P <0.01 ),the concentration of their nucleated cells and DNA density in bone marrow de-creased (P =0.04,P <0.01 ).Oyster could improve the structures of thymus and spleen of the immuno-suppressed mice.Compared with the CTX group,the number of white blood cells in 2.0 g/kg group in-creased (P =0.003),the proportion of CD3 +T cells in peripheral blood in 1 .0 g/kg group (P =0.04) and 2.0 g/kg group (P =0.02)increased,the proportion of CD8 +T cells in peripheral blood in 2.0 g/kg group increased (P =0.002),the concentration of IL-5 in peripheral blood in all the oyster treated groups increased (P <0.01 in 0.5 g/kg,1 .0 g/kg,and 2.0 g/kg groups),the concentration of IL-1 7 in peripheral blood in 2.0 g/kg group decreased (P =0.03),the concentration of nucleated cells in bone marrow of all the oyster treated groups increased (0.5 g/kg vs.CTX,P =0.04;1 .0 g/kg vs. CTX,P =0.02;2.0 g/kg vs.CTX P =0.01 ),the DNA content in bone marrow of all the oyster treated groups increased (P <0.01 in the 0.5 g/kg,1 .0 g/kg,and 2.0 g/kg groups).Conclusion:Oyster peptide could improve the structures of immune organs of the CTX-induced immunosuppressed mice,re-cover the imbalances of T lymphocyte subsets,improve the immune cytokines and increase numbers of nucleated cells and DNA content in bone marrow,thus improving the immunologic function.
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Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application.Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect of hands in 18 patients,in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases,anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases,anterosuperior malleolus flap-dorsal pedal trilobate flap in 2 cases;Anterosuperior malleolus retrograde island (bone) flap was used in recovering pedal soft tissue in 22 patients,the flap pedicled from stem of anterior tibial artery in 16 cases,dorsal pedal flap-anterosuperior malleolus flap in 2 cases,the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases,the bone flap combined with the distal of tibia in 2 cases.Results In the 18 cases of hands,17 cases survived,and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair.Twenty cases of anterosuperior malleolus retrograde island (bone) flap survived,and the other 2 cases needed secondary skin-grafting to repair the necrosis edge of flaps because of venous limited.After a follow-up from 3 to 6 months,30 cases showed the satisfied postoperative outlook,with the good healing of the donor sites.Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap,20 cases locate in the medial of anterior tibial muscle,16 cases locate between the anterior tibial muscle and extensor hallucis longus,4 cases locate between extensor hallucis longus and extensor digitorum longus.Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of operations、preventing cutaneous branches,but also improving the success rate of surgery.
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Background and purpose:Perioperative hypothermia will affect the prognosis of cancer patients. Amino acid infusion can increase the core temperature by endogenous thermogenesis. And the forced-air warming system has gained high acceptance as a measure for rewarming. This study aimed to find out whether amino acid infusion was effective to treat postoperative hypothermia and how well the treatment effect was when compared with the forced-air warming system.Methods:Fifty-seven ASAⅠ orⅡ patients aged 18-60 years undergoing elective esophageal or gastric cancer operation under epidural-general anesthesia and whose core temperature were below 36℃. When admitted to the recovery room wererandomly divided into 3 groups (n=19): GroupⅠ received intravenous infusion of mixed amino acid at a rate of 2 mL·kg-1·h-1 (A); GroupⅡ received a forced-air system (B); groupⅢreceived no therapy (C). Rectal temperature and thermal comfort were recorded per 5 min during the ifrst 1 h and oral temperature and thermal comfort were recorded at the 2, 6 and 24 h. ABG was recorded when patients were admitted to the recovery room and at the ifrst hour.Results:At the ifrst hour, the rectal temperature and thermal comfort of groups A and B were higher when compared with group C (P0.05). At the second and sixthhour, the temperature and thermal comfort of group A were higher when compared with group B and C (P0.05). At the 24th hour, there were no statistically signiifcant differences in the temperature and thermal comfort among the three groups (P>0.05). Conclusion:The rewarming effect of infusion of mixed amino acid is better than that of the forced-air warming system. It is the more effective and convenient method to rewarm the postoperative hypothermia.
الملخص
Objective:To study the effect of quercetin given during pregnancy and lactation period of obese rats on weight and expression of insulin-like growth factors-1 ( IGF-1 ) mRNA of the offspring . Methods:In the study , 8 healthy weaning female SD rats were randomly selected to feed the basal diet and as blank control group , and the others were fed with high-fat diet.When the average weight of the high-fat diet rats was 20% as many as the average weight of the control group , we believed the model succeeded .Then the female SD rats were mated and the pregnant rats were randomly divided into 5 groups , 8 rats in each .They were fed with high fat diet during pregnancy and lactation , and the obese pregnant rats were respectively irrigated with 0 mg/kg body weight ( high-fat control ) , 50 mg/kg body weight,100 mg/kg body weight , and 200 mg/kg body weight quercetin .The blank control group was fed with basic diet throughout the experimental period .The birth weight , the weights during the development of d7, d21, d56, and d98, and the expressions of IGF-1 mRNA in livers tissue of the F1 generation were measured.Results:The average birth weight of the F1 generation of high fat diet (HFD) group was sig-nificantly higher than that of the blank control group .Decreased offspring birth weight was observed with the intervention of quercetin , which effect remained to the delectation .The quercetin also reduced the ex-pression of IGF-1 mRNA in livers of the F1 generation , and this effect remained to the adulthood .The 200 mg/kg body weight quercetin was most significantly effective .Conclusion:The averaged birth weight of the F1 generation of obese pregnant rats was significantly increased , and quercetin could effectively in-hibit the expression of IGF-1 mRNA in livers of F1 generation to decrease cell proliferation and cell differentiation.
الملخص
<p><b>OBJECTIVE</b>To investigate the therapeutic effect of V-Y advanced flap pedicled with posterior perforator from medial malleolus for small skin defect at achilles tendon region.</p><p><b>METHODS</b>From Mar. 2011 to Sep. 2012, 7 cases with small skin defect at achilles tendon region were treated by V-Y advanced flap pedicled with posterior perforator from medial malleolus. The flaps was 6.0 cm x 3.0 cm-9.0 cm x 4.5 cm in size. The defects at the donor sites were closed directly.</p><p><b>RESULTS</b>All flaps survived completely. 7 cases were followed up for 6-8 months after operation. The flaps had good texture and color match. The function of ankle was normal. All patients were satisfied with postoperative function and shape.</p><p><b>CONCLUSION</b>It is an ideal reconstruction method for skin defect at achilles tendon region with V-Y advanced flap pedicled with posterior perforator from medial malleolus. It is easily performed with low risk and short recovery time.</p>