Individualized design program of multiple flaps for adapting different zones to repair large irregular wounds in children.

Objective: Management of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method based on the principle of adapting different recipient zones to overcome the intractable wounds, simplifying and programing the design process of targeted flaps for covering large irregular soft-tissue defects. Patients and methods: From January 2009 to December 2020, 31 children (9 girls and 22 boys) aged 3-16 years (mean 9.8 years) underwent multiple modular flaps with edge to edge splicing reconstruction of the lower extremities. All the wounds were large with non-adjacent defects and with or without a dead space. Several variants of flaps were harvested according to the needs and reconstruction requirements of patients. Results: A total of 71 flaps were harvested from 31 patients and all flaps donor sites received primary closure. Nine patients underwent split-thickness skin grafting, and three cases of flaps survived from vascular crisis by rebuilding the vessels and the rest accepting LD flap transplants. And five partial necrosis of the distal epidermis flaps recovered using skin grafting and dressing change. No major complication was encountered in other patients and donor sites, except one heel ulcer. During the follow-up (ranging from 16 to 38 months, mean 27.7 months), aesthetic and functional results of reconstructed limbs were satisfactory in all patients. Conclusions: The Individualized design program of multiple flaps for adapting different recipient zones is an alternative for repairing large irregular soft-tissue defects in children, beneficial for plastic and reconstructive surgeons to simplify and program the process of designing and perform multiple flaps to achieve this goal. Level of evidence: III, Retrospective.

Knowledge mapping and emerging trends of ferroptosis in ischemia reperfusion injury research: A bibliometric analysis (2013-2022).

Objective: Ischemia/reperfusion (I/R) injury is an inevitable dilemma when previously ischemic multiple organs and tissues are returned to a state of blood flow, with confirming a critical role of ferroptosis in molecular, pathway mechanisms, subcellular structure. Discovering the potential relationship may provide useful approaches for the clinical treatment and prognosis of the pathophysiological status of IRI. Therefore, a comprehensive visualization and scientometric analysis were conducted to systematically summarize and discuss the "ferroptosis in ischemia reperfusion injury" research to demonstrate directions for scholars in this field. Methods: We retrieved all publications focusing on I/R injury and ferroptosis from the Web of Science Core Collection (WoSCC), published from 2013 to October 2022. Next, scientometric analysis of different items was performed using various bibliometrics softwares to explore the annual trends, countries/regions, institutions, journals, authors and their multi-dimensional relationship pointing to current hotspots and future advancement in this field. Results: We included a total of 421 English articles in set timespan. The number of publications increased steadily annually. China produced the highest number of publications, followed by the United States. Most publications were from Central South University, followed by Sichuan University and Wuhan University. The most authoritative academic journal was Oxidative Medicine and Cellular Longevity. Cell occupied the first rank of co-cited journal list. Andreas Linkermann and Scott J Dixon may have the highest influence in this intersected field with the highest number of citations and co-cited references respectively. The essential biological reactions such as oxidative stress response, lipid peroxidation metabolism, anti-inflammmatory and pro-inflammatory procedure, and related molecular pathways were knowledge base and current hotspots. Molecules pathways exploration, effective inhibition of I/R injury and promising strategy of improving allografts may become future trends and focuses. Conclusions: Research on ferroptosis in I/R injury had aroused great interest recently. This first bibliometric study comprehensively analyzed the research landscape of ferroptosis and I/R injury, and also provided a reliable reference for related scholars to facilitate further advancement in this field.

The application of infrared thermography technology in flap: A perspective from bibliometric and visual analysis.

The application of infrared thermography technology (IRT) in flap has become a major focus of research, as it provides a non-invasive, real-time, and quantitative approach for monitoring flap perfusion. In this regard, we conducted a comprehensive visualization and scientometric analysis to systematically summarize and discuss the current state of research in this field. We systematically reviewed publications on the application of IRT in flap procedures from 1999 to 2022, using the Web of Science Core Collection (WoSCC). Through scientometric analysis, we examined annual trends, affiliations, countries, journals, authors, and their relationships, providing insights into current hotspots and future developments in this area. We analysed 522 English studies and found a steady increase in annual publications. The United States and Germany had the highest publication rates, with Beth Israel Deaconess Medical Center and Shanghai Jiaotong University being leading institutions. Notably, Lee BT and Alex Keller emerged as influential authors in this field. Compared to existing techniques, infrared-based technology offers significant advantages for non-invasive monitoring of flap perfusion, including simplicity of operation and objective results. Future trends should focus on interdisciplinary collaborations to develop new infrared devices and achieve intelligent image processing, enabling broader application in various clinical scenarios. This bibliometric study summarizes the progress and landscape of research on 'the Application of infrared thermography technology in flap' over the past two decades, providing valuable insights and serving as a reliable reference to drive further advancements and spark researchers' interest in this field.

Itaconic acid induces angiogenesis and suppresses apoptosis via Nrf2/autophagy to prolong the survival of multi-territory perforator flaps.

Background: Perforator flaps are widely used in hand microsurgery to reconstruct and repair soft tissue injuries. However, ischemia and subsequent ischemia-reperfusion injury may cause distal necrosis of the flap. Itaconic acid (IA) is a modulator of macrophage function, which exerts anti-inflammatory effects in macrophage activation. Methods: The necrotic area of the flap was detected by measuring the flap temperature with an infrared thermometer. Flap cell apoptosis was detected by TUNEL staining and Western blot analysis of the apoptosis-associated proteins Bcl-2 and Bax. HE staining was used to detect angiogenesis of the skin flaps. CD31 was detected to identify positive vascular expression, and the survival of choke vessels in different areas of the skin flap was assessed by arteriography. In addition, Western blot was performed to quantify the expressions of VEGF, Nrf2, LC3II, SQSTM1, and CTSD. Results: Itaconic acid raises VEGF protein levels in skin flaps and the number of CD31-positive vessels. The skin flaps in the IA treatment group exhibited higher neovascularization and less necrosis than those in the control group. The results of TUNEL staining and Western blot revealed that Itaconic acid attenuated apoptosis in the ischemic area of flap. The combination of itaconic acid and Nrf2 inhibitor ML385 reversed this beneficial effect. The results revealed that itaconic acid attenuated apoptosis, enhanced angiogenesis, and enhanced autophagy. Conclusion: In summary, our findings indicate that itaconic acid might be an effective treatment to reduce flap necrosis. Additionally, this study identified a novel mechanism for the effects of itaconic acid on flap survival.

Carnosol Alleviates Collagen-Induced Arthritis by Inhibiting Th17-Mediated Immunity and Favoring Suppressive Activity of Regulatory T Cells.

Current approaches are incurable for rheumatoid arthritis (RA). Regulatory T (Treg) cells and T helper cells (Th1 and Th17) are crucial in controlling the process of RA, which is characterized by inflammatory cell infiltration and bone destruction. Carnosol is an orthodiphenolic diterpene that has been extensively applied in traditional medicine for the treatment of multiple autoimmune and inflammatory diseases. Herein, we indicate that administration of carnosol dramatically alleviated the severity of collagen-induced arthritis (CIA) model with a decreased clinical score and inflammation reduction. Cellular mechanistically, carnosol inhibits the Th17 cell differentiation and maintains Treg cell suppressive function in vitro and in vivo. Meanwhile, it also restrains Treg cells from transdifferentiation into Th17 cells under inflammatory milieu. Furthermore, carnosol modulates the function of Th17 and Treg cells possibly via limiting IL-6R (CD126) expression. Collectively, our results suggest that carnosol can alleviate the severity of CIA via hiding Th17 cell differentiation and maintain the stability of Treg cells. Administration of carnosol can be applied as a potential therapy for patients with RA.

The research landscape on vascularized composite allografts: a bibliometric analysis (2002-2021).

OBJECTIVE: Vascularized composite allografts (VCAs) refer to the transplantation of multiple types of tissues during plastic and reconstructive surgery. Several publications have emerged in the field of VCA. However, there are no bibliometric studies on this topic. The aim was to multidimensionally analyze the knowledge base and hotspots in this subject. METHODS: We retrieved all publications related to VCA from the Web of Science Core Collection (WoSCC), published from 2002 to 2021. Next, scientometric analysis of different items was performed using various bibliometrics software to explore knowledge base, research hotspots, and advancement trends in this field. RESULTS: We included a total of 3,190 English articles from 2002 to 2021. The number of publications increased steadily annually. The United States produced the highest number of publications, followed by China. Most publications were from Harvard University, followed by Johns Hopkins University. The most authoritative academic journal was Plastic and Reconstructive Surgery. Transplantation occupied the first rank of co-cited journal list. Maria Z Siemionow may have the highest influence in the VCA field with the highest number of citations (n = 88) and co-cited references (n = 1252). Clinical studies on different allografts, immunosuppression, and tissue engineering were both the knowledge base and recent topics in VCA research. CONCLUSIONS: The first bibliometric study comprehensively summarized the trends and development of VCA research with steady growth over the past two decades. Currently, the most active topics are the clinical application of multiple allografts, immunosuppression strategies/therapies, and translation of tissue engineering to clinical practice.

The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review.

BACKGROUND: Vascular malformations are common but complicated types of disease in infants, with unclear causes and lack of effective prevention. The symptoms usually do not disappear and tend to progress without medical intervention. It is extremely necessary to choose correct treatment options for different types of vascular malformations. A large number of studies have confirmed that sclerotherapy has a tendency to become the first-line treatment in near future, but it is also associated with mild or severe complications. Furthermore, to our knowledge, the serious adverse event of progressive limb necrosis has not been systematically analyzed and reported in the literature. CASE PRESENTATION: Three cases (two females and one male) were presented who were all diagnosed as vascular malformations and were treated by several sessions of interventional sclerotherapy. Their previous medical records showed the use of several sclerosants in different sessions including Polidocanol and Bleomycin. The sign of limb necrosis did not occur during the first sclerotherapy, but after the second and third sessions. Furthermore, the short-term symptomatic treatment could improve the necrosis syndrome, but could not change the outcome of amputation. CONCLUSION: Sclerotherapy undoubtedly tends to be the first-line treatment in near future, but the adverse reactions still remain major challenges. Awareness of progressive limb necrosis after sclerotherapy and timely management by experts in centers of experience of this complication can avoid amputation.

Successful management of a rare radius schwannoma mimicking malignant bone tumors: A case report and literature review.

Background: Schwannomas are benign tumors originating from Schwann cells, frequently occurring in the spinal cord and peripheral nerves. Intraosseous schwannomas, a rare subset, account for approximately 0.2% of schwannomas. Intraosseous schwannomas commonly impinge the mandible, followed by the sacrum and the spine. By far, only three cases of radius intraosseous schwannomas have been reported in PubMed. The tumor was treated differently in all three cases, resulting in different outcomes. Case presentation: A 29-year-old male construction engineer who complained of a painless mass on the radial aspect of the right forearm was diagnosed with an intraosseous schwannoma of the radius based on radiography, three-dimensional computed tomography reconstruction, magnetic resonance imaging, pathological examination, and immunohistochemistry. A different surgical approach was employed to reconstruct the radial graft defect using bone microrepair techniques, resulting in more reliable bone healing and early functional recovery. Meanwhile, no clinical and radiographic findings suggestive of recurrence were observed at the 12-month follow-up. Conclusion: Vascularized bone flap transplantation combined with three-dimensional imaging reconstruction planning might yield better results for repairing small segmental bone defects of the radius caused by intraosseous schwannomas.

Radiosensitization of Nasopharyngeal Carcinoma by Graphene Oxide Nanosheets to Reduce Bcl-2 Level.

There are many treatments for nasopharyngeal carcinoma (NPC), but none of them are very effective. Radiotherapy is used extensively in NPC treatment, but radioresistance is a major problem. Graphene oxide (GO) has been previously studied in cancer treatment, and this study is aimed to explore its role in radiosensitization of NPC. Therefore, graphene oxide nanosheets were prepared, and the relationship between GO and radioresistance was explored. The GO nanosheets were synthesized by a modified Hummers' method. The morphologies of the GO nanosheets were characterized by field-emission environmental scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The morphological changes and radiosensitivity of C666-1 and HK-1 cells with or without the GO nanosheets were observed by an inverted fluorescence microscopy and laser scanning confocal microscopy (LSCM). Colony formation assay and Western Blot were applied for analysis of NPC radiosensitivity. The as-synthesized GO nanosheets have lateral dimensions (sizes ∼1 µm) and exhibit a thin wrinkled two-dimensional lamellar structure with slight folds and crimped edges (thickness values ∼1 nm). C666-1 cells with the GO was significantly changed the morphology of cells postirradiation. The full field of view visualized by a microscope showed the shadow of dead cells or cell debris. The synthesized graphene oxide nanosheets inhibited cell proliferation, promoted cell apoptosis, and inhibited the expression of Bcl-2 in C666-1 and HK-1 cells but increased the level of Bax. The GO nanosheets could affect the cell apoptosis and reduce the pro-survival protein Bcl-2 related to the intrinsic mitochondrial pathway. The GO nanosheets could enhance radiosensitivity, which might be a radioactive material in NPC cells.

Prevalence and the factors associated with malnutrition risk in elderly Chinese inpatients.

BACKGROUND: Malnutrition is an under recognized, but common issue in elderly patients. This study aimed to investigate the prevalence of poor nutritional status and identify comprehensive geriatric assessment-based clinical factors associated with increased malnutrition risk to assessing malnutrition risk in hospitalized elderly patients in China. METHODS: A total of 365 elderly hospitalized patients (178 women, 76.37 ± 7.74 years) undertook a comprehensive geriatric assessment (CGA), and have their nutritional status assessed using the short-form mini-nutritional assessment. RESULTS: Among 365 patients, 32 (8.77%) were malnourished and 112 (30.68%) were at risk of malnutrition. A logistic regression analysis showed that age (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.13-2.23), alcohol consumption (OR, 2.04; 95% CI, 1.19-3.48), presence or history of cancer or heart failure (OR, 3.48 and 2.86; 95% CI, 1.49-8.13 and 1.12-7.27), depression (OR, 2.86; 95% CI, 1.97-4.17), body mass index (OR, 5.62; 95% CI, 3.62-8.71), being dependent in activity of daily living (OR, 3.81; 95% CI, 2.61-5.57), a lower score in instrumental activities of daily living (OR, 3.01; 95% CI, 2.09-4.33), recent fall(s) (OR, 2.22; 95% CI, 1.37-2.91), cognitive impairment (OR, 1.81; 95% CI, 1.30-2.53), insomnia (OR, 1.49; 95% CI, 1.07-2.06), hemoglobin and albumin level (OR, 1.72 and 2.86; 95% CI, 1.17-2.50 and 1.53-5.36) were independent correlates of malnutrition in older patients. CONCLUSION: Our study demonstrated that age, alcohol consumption, chronic diseases (cancer and heart failure), depression, body mass index, function status, recent fall(s), cognitive impairment, insomnia, and low hemoglobin and albumin levels were independently associated with malnutrition in these patients. Comprehensive geriatric assessment can provide detailed information of older patients and can be a useful tool for assessing malnutrition risk-associated factors.

Identification of comprehensive geriatric assessment-based risk factors for insomnia in elderly Chinese hospitalized patients.

OBJECTIVE: Insomnia is a common problem in older persons and is associated with poor prognosis from a functional or clinical perspective. The purpose of this study was to investigate the prevalence of insomnia and identify comprehensive geriatric assessment (CGA) based clinical factors associated with insomnia in elderly hospitalized patients. METHODS: Standardized face-to-face interviews were conducted and CGA data were collected from 356 Chinese hospitalized patients aged 60 years or older. Insomnia was defined as self-reported sleep poor quality according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-Ⅴ). Multivariate logistic regression analysis was applied to assess the association between patient clinical factors together with domains within the CGA and insomnia. RESULTS: Among the 365 patients, insomnia was found in 48.31% of the participants. Difficulty in initiating sleep (DIS), early morning awakening (EMA), difficulty in maintaining sleep (DMS), and snoring were found in 33.99%, 9.55%, 13.48%, and 1.69% of patients, respectively. Significant associations were found between insomnia and several covariates: female gender (P = 0.034), depression (P = 0.001), activities of daily living (ADL) (P = 0.034), instrumental activities of daily living (IADL; P = 0.009), falling (P = 0.003), chronic pain (P = 0.001), and poor nutritional status (P = 0.038). According to the results of the adjustment multivariate logistic regression analysis, female sex (odds ratio [OR] = 2.057, confidence interval [CI] = 1.179-3.588, P = 0.011), depression (OR = 1.889, CI = 1.080-3.304, P = 0.026), and chronic pain (OR = 1.779, CI = 1.103-2.868, P = 0.018) were significant independently predictors associated with insomnia. CONCLUSIONS: Our study revealed that female sex, depression, and chronic pain were independently predictors of insomnia in hospitalized patients. Early identification of elderly patients with these risk factors using the CGA may improve the quality of life and treatment outcomes.