Practice and reflection of day surgery in a tertiary hospital in Tianjin / 现代医院

Objective To analyze the implementation of day surgery in a public hospital in Tianjin,and to provide refer-ence for the quantity and quality of day surgery.Methods The implementation of day surgery in a public hospital in Tianjin from 2020 to 2022 was analyzed.Results From 2020-2022,the main types of daytime operations were secondary(43 kinds)and ter-tiary operations(28 kinds).In terms of the implementation of professional disciplines,anorectal surgery,urology surgery and orthopedics carried out the largest number of operations,among which anorectal surgery accounted for 70.76％(2 285/3 229).Conclusion It is necessary to further improve the development of professional disciplines,the management system of day surger-y,and the guarantee of medical services,strengthen the construction of weak links in the management path of day surgery and im-prove the coverage and accessibility of day service.

Inheritance and innovation: pursue the best in discipline development of microsurgery / 中华显微外科杂志

Microsurgery is not only a technology, but also a science. Microsurgery was enlisted as a tier-three discipline in the Classification of National Clinical Medicine Disciplines (Discipline code 320.2715) in 1992. In the new era, the discipline development of microsurgery should be inherited, innovated, realistic and pragmatic, and it also relies on the other surgical specialties to expand the applications of microsurgery. Microsurgery technology should firmly adhere to its core competitiveness and hold high the banner of microsurgical characteristics by offering the best possible serves to all the clinical surgical disciplines; Pay equal attention to medicine, teaching and scientific researches; Unite, collaborate and strengthen academic exchanges at home and abroad; Focus on talent training (i.e. exports of great country, leading figures, etc.) and support the development of private hospitals specialised in microsurgery. The supportive roles of the Chinese Journal of Microsurgery shall be further enforced to facilitate the discipline development of microsurgery and promoting high-quality development of microsurgery.

Inherit, innovate and correctly position the clinical application of microsurgery technology: Celebrate the 60th anniversary of successful replantation of severed limbs in China / 中华显微外科杂志

In 1963, the successful replantation of severed limbs in China was firstly reported in the world, and it opened a new era of microsurgery. In the past 60 years, Chinese microsurgery scholars had created numerous world firsts. Microsurgery is an advantage and characteristic clinical subject in China. We should continue to innovate and correctly position the clinical application of microsurgery technology, constantly expand the business space, serve the grass-roots level, educate new people, develop technologies and techniques, improve skills, strengthen communication.

From in-situ suture to microvascular anastomosis / 中华显微外科杂志

In 1959, Douglas reported successful survival of in-situ suturing composite graft of completely amputated fingertips. In the early 1960s, Jacobson and Buncke respectively performed experimental microvascular anastomosis in vessel diameters of 1.4 mm and 0.8 mm, and achieved replantation of amputated finger in monkey. In 1962, Kleinert successfully replanted incompletely amputated thumbs through microvascular anastomoses. In 1965, Tamai achieved replantation of completely amputated thumbs using microsurgery techniques. In 1967, Chen Zhongwei published the first report in English on successful replantation of severed digits in 20 cases. In October 1972, O'Brien reported Chinese limb (digit) replantation techniques and experiences after his visit to China. In November 1972, an exchange meeting on replantation of amputated limb was held in Guangzhou, China, where a total of 398 complete severed digits of 260 patients, with 179 successful replantation(44.9%) were reported. In May 1973, a delegation of North American limb replantation surgeons visited China and later published a report about the visit. Since then the techniques and principles of limb (digit) replantation applied by the Chinese surgeons were recognised by international peers. In January 1974, a Chinese delegation of representatives in microsurgery led by Chen Zhongwei visited the United States and delivered a presentation as the pioneer of limb (digit) replantation. It further expanded the influence of Chinese limb (digit) replantation on the international community.

Tissue distribution and analysis of human umbilical cord mesenchymal stem cells in NOG mice following single intravenous injection / 中国实验动物学报

Objective To establish a quantitative polymerase chain reaction(PCR)method for the analysis of human-derived SRY DNA in mouse tissues,and to study the tissue distribution of human umbilical cord mesenchymal stem cells(HUCMSCs)in immunodeficient NOG mice after a single intravenous injection.Methods We established a quantitative PCR method for the analysis of human SRY DNA in mouse tissues,and validated the standard curve,linear range,accuracy,precision,and stability.Thirty-six NOG mice(18 male,18 female)were administered 3.5×107 HUCMSCs/kg by single intravenous injection.Six mice were then anesthetized and dissected after blood collection(EDTA anticoagulation)at 6,12,24,and 72 h,and at 1 and 2 weeks,respectively.DNA was extracted from lung,kidney,heart,liver,brain,spinal cord,stomach,small intestine,fat,skin,spleen,testis,uterus,and ovary tissues,and the distribution of HUCMSCs in each tissue was determined by the validated quantitative PCR method for detecting the human-derived SRY gene in mouse tissues.In addition,18 NOG mice(9 male,9 female)were divided into control(n = 6)and treatment groups(n = 12)injected intravenously with 0.9%sodium chloride and 3.5×107 cells/kg,respectively.Acute toxic reactions were observed during the administration period,and four animals were dissected at 72 h and at 2 and 4 weeks after administration to observe the gross organs.Mitochondrial protein expression was detected in paraffin sections of lung tissues by immunohistochemistry to analyze the colonization of HUCMSCs in lung tissues.Results The established RT-qPCR method for human-derived SRY DNA in mouse tissues met the validation criteria for each index.After a single intravenous injection in NOG mice,HUCMSCs were mainly distributed in the lungs and blood within 1 week after administration,with higher concentrations in lung tissues than in blood.The concentrations of HUCMSCs in lung tissue and blood remained relatively stable within 6～24 h and 6～72 h,respectively,and then decreased over time.The distribution of HUCMSCs in other tissues was not measured at all sampling points.The colonization result showed that HUCMSCs were detected in lungs 72 h after intravenous injection,but not at 2 and 4 weeks.No obvious acute toxicity was observed in NOG mice after single intravenous administration of HUCMSCs.Conclusions The above method for analyzing the distribution of HUCMSCs in mouse tissue is reliable and feasible.HUCMSCs were mainly distributed in lung and blood in NOG mice within 1 week after a single intravenous injection,and mainly colonized lung tissue at 72 h.A single intravenous administration of HUCMSCs has a good safety profile.

Preoperative risk factors for early extremity blood supply after repair of major arterial injury / 中华创伤骨科杂志

Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.

Inheritance and innovation: maintain academic communications in microsurgery under the normalized prevention and control of COVID-19 pandemics / 中华显微外科杂志

Chinese Journal of Microsurgery, based on the premise of doing well in the prevention and control of COVID-19 pandemics, shall keep on driving on the inheritance and innovation, carry forward the spirit of microsurgery, give full play to the advantages of microsurgery technology and improve the level of surgical repair and reconstruction, as well as try new ways for academic communications and give full play to the roles of an academic platform for a professional magazine; Clinical Orthopaedic Microsurgery(internal communication), the internal journal of editorial office, is the "showcase in China" to highlight and disseminate the achievements in microsurgery, focus on the support for the Chinese young microsurgeons who work in the front-line of medical services, provide a platform effectively for the young microsurgeons in China to actively participate in the Sino-English literary exchange, and truly "publish the papers on the land of our motherland".

The progress of surgical treatment of Alzheimer’s disease / 中华显微外科杂志

Alzheimer’s disease (AD) is a progressive neurological disease. Its main clinical features include progressive memory loss, cognitive dysfunction, behavioral disorders and decreased ability of daily living. Its etiology is complex, and there is no effective treatment at present. There are many ways to delay or prevent the disease and improve its symptoms, including some drugs to improve neurological symptoms, activity, diet, cognitive training, and so on. In addition, some scholars have tried to treat AD by surgical methods. This article reviews the surgical methods for the treatment of AD.

The process in research of anatomy of brain lymphatic system and the relationship between it and Alzheimer's disease / 中华显微外科杂志

Conventional wisdom holds that the central nervous system (CNS) does not have lymphatic vessels or lymphatic circulation, and it lacks lymphatic pathways to clear brain metabolites. However, with the development of study in intracranial clearance, it has been discovered that there are lymphatic systems in CNS, including glymphatic pathway and it meningeal lymphatic vessels. It further reveals the exchange system between cerebrospinal fluid (CSF) and interstitial fluid (ISF). It also closely relates to the development of neurodegenerative diseases, age-related changes of brain, traumatic brain injury, circulatory diseases and tumors. In the past 10 years, the research in CNS has been a hot spot in life sciences. This article aims to explain the research progress from the aspects of the discovery of glymphatic system, anatomical structure and function, and relationship with Alzheimer's disease (AD).

Advances in super-microsurgery vascular anastomoses training model / 中华显微外科杂志

The current mainstream training models for vascular suturing in microsurgery include the invitro chicken wings, legs, and experimental mouse in vivo. With the development of super-microsurgery, it needs to complete super-microsurgery training in a vessel less than 0.8 mm, especially less than 0.3 mm. These training models gradually don't meet the needs. The perfusion specimens of in vitro vessels have several limitations, while vessel models in vivo are faced with the problems of difficulty in obtaining and high logistical support. Vessel model used chickabiddy in vivo is expected to establish a relatively economical, low-risk, high-efficiency, training repeatable and good for scientific research training model in super-microsurgery. Its vessel branches can meet the requirements for vessel diameter less than 0.8 mm. It can be used in continuous training by clinicians and can also meet the pathophysiology and hemodynamic research needs in super-microsurgery field. However, it is necessary to establish a stable vessel model and its evaluated system, as well as an intraoperative anesthesia method for the chickabiddy vessel in vivo model.

Literature research on the history of microsurgery in China: A difficult start (1960-1973) / 中华显微外科杂志

Objective:To sort out the history of microsurgery in China from 1960 to 1973 based on the literatures in chronological order.Methods:Chinese and English scientific journals and academic monographs published in public and in house were searched, and the words "microsurgery" and "microsurgery related" literatures in both Chinese and English were carefully read and analysed. The dates of operation, communication and report were recorded and confirmed.Results:Microsurgery in China started in early 1963, thanks to the report of the world's first successful severed limb replantation in Shanghai Sixth Hospital. In the following 3 years, many teams carried out experimental researches on microvascular technology and explored the replantation of severed fingers. In 1964, the world's first severed leg replantation. In 1966, the world's first toe transfer was operated to reconstruct the thumb, and the world's first batch of completely severed fingers were successfully replanted by microvascular suture. In 1972, it was reported, at the Guangzhou Conference on Replantation of Severed Limbs, that a 44.9% of survival rate had been achieved over 260 cases and the term "microsurgery" was used for the first time in the conference. In March, 1973, the second free inguinal flap transfer in the world was completed. In May, 1973, an American Replantation Mission visited China. It opened a precedent for academic exchange in microsurgery between China and foreign countries. With 10 years of clinical practices, the original and advanced Chinese limb (finger) replantation technology and principle had been recognised by the international peers.Conclusion:The research on the history of Chinese microsurgery has confirmed that the development of Chinese microsurgery was basically synchronised with the world, but with a difficult start in 1960-1973.

Insisting on inheritance, encouraging innovation and building a new platform for academic communication / 中华显微外科杂志

In order to further popularization and promotion of microsurgery, Chinese Journal of Microsurgery, insisting on inheritance and encouraging innovation, has built a new academic communication platform——Chinese Microsurgery Inheritance and Innovation Forum. Basing on this platform, we focus on creating a new brand for micro-surgery academic communication, devote to cultivate a core of young-and-middle-aged microsurgeons working on the front line and look for potential talents to strengthen the team and benefit patients, participate in academic communications actively at home and abroad and reinforce international cooperation, and make unremitting efforts to establish an international magazine with Chinese characteristics. Still, we are striving to make Chinese microsurgery sustainably develop, move toward the world and integrate into the world academic family.

Analysis of early complications of free gracilis muscle transfer in reconstruction of brachial plexus injury / 中华显微外科杂志

Objective:To explore the causes and preventive measures of early complications after free gracilis muscle transfer in reconstruction of brachial plexus injury, and to improve the postoperative function of the transferred gracilis muscle.Methods:Patients were recruited from August, 2005 to December, 2016. All 111 patients of brachial plexus injury underwent reconstructive surgery using 122 free gracilis flaps. Early postoperative complications, including recipient site, donor site and systemic complications, were closely observed and recorded. Outcome measurements included incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion and salvage rate. The postoperative strength of gracilis was evaluated according to the BMRC score. The data were statistically analyzed. The difference was statistically significant if P<0.05. Results:The survival rate of 122 free gracilis transfers was 98.4% (120/122). Early complications occurred in 32 cases (including 2 complications in 6 patients) : 27 cases with recipient site complications (84.4%), 4 with donor site complications and 7 with systemic complications. Among the 32 cases of complications, 17 flap compromises caused by vascular obstruction and 15 of them were salvaged completely after exploration. Flap crisis was the main issue that affected the postoperative function of gracilis muscle, and 58.8% (10/17) of patients with vascular crisis showed muscle strength above M 3 after surgery. The main causes of vascular crisis were venous tortuosity and venous thrombosis, which had nothing to do with operation time and intraoperative blood loss. Conclusion:Flap crisis is the main factor affecting the postoperative function of gracilis. The rate of flap salvage can be tremendously increased by early detection, re-exploration and effective management of the flap crisis.

Limb salvage for Gustilo III C open fracture of left humerus with limb ischemia and wound infection by microsurgery: A case report / 中华显微外科杂志

Report a case sustained Gustilo type III C open fracture of the left humerus with brachial artery injury who has limb ischemia and wound infection after operation in June, 2014. To salvage the limb, performed cross limb vessel transfer to restore blood supply at one-stage. After multiple debridement, Flow-through flap transfer was performed for definitive reconstruction of the arterial injury and repair the wound in secondary stage. In the 3rd stage, cutting the pedicle of transposition vessels. Follow-up at 1 year after surgery, the patient's left upper limb had survived with limited movement and confirmed Flow-through the vessel reconstruction using CTA.

Inheritance, innovation, unity, cooperation and internationalization——New mission of Chinese Journal of Microsurgery in 2020 / 中华显微外科杂志

In and from year 2020, we will work on an enthusiastic initiative: to make the Chinese Journal of Microsurgery a world leading sci-tech journal by executing our new mission "inheritance, innovation, unity, cooperation and internationalization" . Two special columns will be created: World Masters in Microsurgery and Pioneers of Microsurgery in China. We will start to compile a bilingual Bibliographic Index of Literatures in Microsurgery in China (Chinese and English), and publish a commemorative album which includes all the successive members of the editorial boards of the Chinese Journal of Microsurgery. A new academic and communicational forum will be established through a series of academic seminars held by the Chinese Journal of Microsurgery. In addition, we will start professional training programs for the surgeons and junior surgeons who work in the first-line of care in microsurgery, assist and enable them to participate international academic events and build/establish cooperation with their international counterparts. In line with international standards, we will apply bilingual titles and abstracts of articles in both Chinese and English, and add English interpretations/translations to all the references listed in Chinese. We will continue to keep our best work to make our journal being listed by the Medline hence to fulfil international involvement.

Analysis of role change and function of microsurgery staff in fighting against COVID-19 / 中华显微外科杂志

The outbreak of COVID-19 around the world has made more than two millions of confirmed patients and serious shortages of healthcare resources and medical staff in many countries. In the battle of fighting COVID-19 in Wuhan, many microsurgery staff across China were sent to Wuhan and put on duty in the treatment of COVID-19 patients. The purpose of this article is to review the personal experiences of microsurgery staff in fighting against COVID-19 as well as to analyse how to act professionally when facing the challenges and change of roles and meanwhile having to give full play to the professional advantages subject to make contributions to the battle of COVID-19. A reference is hereby provided for the microsurgery staff in dealing with a sudden and major epidemic outbreak in the future.

Research progress of groin flap / 中华显微外科杂志

In the development of flap surgery, the groin flap was one of the earliest flaps used in repair of soft tissue defect. However, due to its unstable anatomical position and many variations, small vessels and great difficulty in vascular anastomosis, the application of this flap reduced gradually. With the development of microsurgical techniques and the increasing demand of patients for aesthetics in donor site, the groin flap has been still widely used in the repair of soft tissue defect in limb maxillofacial region, and perineal partsin in recent 10 years, due to its advantages of concealed donor site and large area of flap. This article review the historical development of the groin flap, summarize the clinical application of perforator flap, and special types of groin flaps in repair of soft tissue defect in extremities. Hoping to further promote the application and development of groin flap in soft tissue repair.

Repair of skeletal muscle defects by skeletal muscle acellular matrix hydrogel combined with skeletal muscle stem cells in rats / 中华显微外科杂志

Objective:To explore the therapeutic outcome of rat skeletal muscle extracellular matrix(ECM) hydrogels blended with skeletal muscle stem cells for skeletal muscle defects in a rat model.Methods:From May, 2018 to January, 2020, 5 methods were employed to obtain ECM from rat skeletal muscle. The resulting ECM was evaluated using haematoxylin and eosin (HE) staning and 4-6-diamidino-2-phenylindole (DAPI) staining. The components and structure of hydrogel were assessed by Masson staining and scanning electron microscopy (SEM). Skeletal muscle stem cells were then blended in the hydrogel and MTT was used to observe the growth of cells. Rat skeletal muscle defect models were established and HE staining was used to examine the growth of injured skeletal muscle in each group. Expression of Pax7 and MyoD were detected by immunofluorescence in each group. The function of skeletomuscular tissue was evaluated by electrical stimulation in each group. T test and ONE-WAY analysis of variance were used for data analysis.Results:In this study, a method that caused little damage to skeletal muscle structure and completely removed the cell components was found. This method was employed in the preparation of hydrogel. Masson staining and SEM showed that hydrogel retained the basic structure and some biological factors of skeletal muscle. MTT test showed that hydrogel promoted the proliferation of skeletal muscle stem cells. The experiments in rat skeletal muscle defect models showed that the group treated with stem cells [Specific force was (9.00±2.10) N/cm 2 achieved better outcomes than the other groups (4.06±1.12) N/cm 2 and (5.00±1.60) N/cm 2 in unrepaired group and hyclrogel group, respectively] ( P<0.05) . Conclusion:The results indicated that ECM hydrogel has a good biocompatibility. Furthermore, it was observed that rat skeletal muscle ECM hydrogels blended with skeletal muscle stem cells promoted the repair of muscle defect in a rat model, which would offer a promising strategy for functional muscle repair.

A preliminary study on B-mode ultrasonic evaluation of muscle recovery after functional gracilis muscle transplantation / 中华显微外科杂志

Objective To investigate the value of the B-mode ultrasound method for muscle recovery after transplantation.Methods From January,2009 to January,2014,35 patients of functioning free gracilis muscle transplantation for brachial plexus injury were involved.Using B-mode ultrasound to determine the cross-sectional area (CSA) of transplanted gracilismuscle at rest and contraction state.The contraction ratio (CR) and the muscle bulk ratio (MBR) was calculated based on the CSA.Then the CR and MBR were analysised statistically with manual muscle strength and joint range of motion (ROM) to investigate the correlation.Results The followed-up time was 8-24 months,averaged of 22.4 months.The CR of the transplated muscle was (1.23±0.15),which was significantly correlated with muscle strength and joint ROM (P＜0.01,r=0.872,r=0.847,respectively).CR of transplanted muscle with or larger than M4 was greater than that of less than M4 [CR were (1.35±0.10),(1.09±0.06),respectively],and the difference was statistically significant (P＜0.05).The MBR was greater than 1 in 17 cases,and less than 1 in 18 cases.There was no significant correlation between MBR and muscle strength and ROM (P＞0.05).There was no statistically significant difference in muscle strength and ROM between patients with MBR greater than 1 and those with MBR less than 1 (P=0.054,P=0.284,respectively).Conclusion The transplanted muscle recovery can be quantitatively reflected by the CR.CR enlargement of the transplanted gracilis muscle indicated a better recovery of muscle contraction function.MBR is not suitable for evaluating function recovery of transplanted muscles.

Construction of Chinese peripheral nerve society and progress in repair and reconstruction of peripheral nerve injury / 中国修复重建外科杂志

The peripheral nerve group of the reparative and reconstructive surgery committee (branch of Chinese association of rehabilitation medicine) was established in 1995. Major research progress has been made in the repair, regeneration, and reconstruction of peripheral nerve injury. Professor GU Yudong initiated the contralateral cervical7 root (CC7) transfer for the treatment of total brachial plexus root injury in 1986. Now this method has been applied safely and effectively for 30 years with profound progress and refinement. In addition, the repair and reconstruction of peripheral nerve injury had achieved great development such as the treatment of spastic paralysis of upper limb, CC7 transfer using a modified prespinal route, the reconstruction of bladder function after spinal cord injury, the development of acellular allograft nerve, the small gap suture technique, the functioning free gracilis muscle transplantation, and contralateral S 1 transfer which have been widely used in clinical application with good outcomes. With the progress of the biological manufacturing of peripheral nerve bio-materials and the remodeling of central nervous system after brachial plexus injury, a novel peripheral neuroscience research field was growing up. It is still a challenge for surgeons and scholars in this field to insist on the popularization and improvement of peripheral nerve repair and reconstruction by microsurgical technique, and to make efforts to transform the results of peripheral nerve research into clinical practice.