[Comparison among different flushing media for intracoronary imaging with optical coherence tomography].

Objective: To explore the effects and safety of saline mixed 1∶1 with contrast medium (mixed medium) and pure heparinized saline as alternative media for optimal Optical Coherence Tomography (OCT) guided percutaneous coronary intervention (PCI). Methods: This single-center, prospective cohort study enrolled patients who underwent PCI with OCT guidance for chronic stable angina or acute coronary syndrome at the Department of Cardiology, the Second Hospital of Jilin University from October 2021 to August 2022. The target vessels were examined using OCT with three different flushing media at the same anatomical positions: contrast agent, mixed medium, and pure heparinized saline. An independent observer analyzed all imaging results and evaluated the lumen imaging quality, using the proportion of the clear imaging field (CIF%) as a quantitative measure for analysis. The average luminal diameter was compared among different flushing media. The study also assessed the image quality of the luminal anatomical structures, lesion pathologies, and stents. Results: A total of 105 patients were enrolled in the study, including 110 target vessels. The age of the enrolled patients was (60.5±8.4) years, with 60 male patients (57.1%). OCT examinations were successfully completed using all three media, and no related complications were observed in any groups. The three flushing media presented with the same image quality in terms of depicting the lumen anatomical structures, lesion characteristics, and stent-related features. The mixed medium group achieved a comparable CIF% to the contrast group with both right and left coronary arteries (right coronary 100.0% (100.0%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05; left coronary 100.0% (95.9%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05). While the saline group reached a comparable CIF% to the contrast group with right coronary arteries (100.0% (97.6%, 100.0%) vs. 100.0% (95.9%, 100.0%), P>0.05) but showed a significantly lower CIF% with left coronary arteries (84.9% (75.9%, 93.4%) vs. 100.0% (100.0%, 100.0%), P<0.05). For the average diameter of the coronary lumen, there was no statistically significant difference between the mixed medium group and the saline group compared to the contrast group with both right and left coronary arteries (P>0.05). Conclusions: A 1∶1 heparinized saline and contrast mixture can serve as a substitute flushing medium for OCT examination during PCI procedure. Pure saline can also yield good results in OCT examination of the right coronary artery, and both alternatives are safe for use as flushing medium in OCT imaging.

Vitamin D levels in the assessment of Crohn's disease activity and their relation to nutritional status and inflammation.

BACKGROUND: Crohn's disease (CD) is frequently associated with malnutrition, inflammation and a deficiency of vitamin D (VD) with the relationships between these symptoms being poorly defined. VD is a modulator of the immune system and is associated with the onset of CD and disease activity. The level of serum VD may have potential in the assessment of CD activity. This study aimed to evaluate the relationships between VD, nutritional status and inflammation, and to identify more accurate VD thresholds. METHODS: The study included 76 outpatients with CD diagnosed between October 2018 and October 2020 and 76 healthy volunteers. Levels of serum 25(OH)D and nutritional indicators, as well as biochemical and disease activity assessments, were conducted. RESULTS: Patients with CD and healthy participants were found to differ significantly in their 25(OH)D levels as well in levels of nutritional and inflammatory indicators. The optimal VD cut-off value was found to be 46.81 nmol/L for CD development and 35.32 nmol/L for disease activity. Levels of 25(OH)D were correlated with both nutritional status and inflammation. CONCLUSIONS: The VD level is likely to be a useful additional tool in the evaluation of CD patients and predicting the disease activity and clinical response. The VD level may relate both to the nutritional status and levels of inflammation in CD patients, and disease progression.

Surgical treatment of peri-implantitis with or without adjunctive graft material: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis was performed to compare the clinical effect of surgical treatment of peri-implantitis alone or in combination with graft material. Literature searches were conducted up to June 20, 2020. Randomized controlled trials (RCTs) comparing the clinical effects of open flap debridement (OFD) alone and OFD with adjunctive graft materials for the treatment of peri-implantitis were included. Probing depth (PD) changes and marginal bone level (MBL) changes were assessed and expressed as the standardized mean difference (SMD) with 95% confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted. The search yielded 7419 articles, five of which were analysed quantitatively. The adjunctive use of graft materials in OFD did not provide additional PD improvements (SMD 0.46, 95% CI -0.13 to 1.05; P = 0.13), but did yield additional MBL improvements (SMD 1.04, 95% CI 0.71-1.37; P < 0.01). The degradability of the material, number of implants included per patient, and risk of bias did not have significant effects on the results, but the origin of the material may affect the PD improvements. Based on the available evidence, the adjunctive use of graft materials in the surgical treatment of peri-implantitis can significantly improve MBL changes but not PD changes.

Spin-textures of medium-body boson systems with trapped spin-f cold atoms.

The spin-textures of bound medium-body systems with spin-[Formula: see text] atoms ([Formula: see text]) have been studied. The Hamiltonian is assumed to be dominated by the two-body interaction favoring parallel spins. The system with particle number [Formula: see text] and [Formula: see text] is first chosen, and the Hamiltonian is exactly diagonalized by using Fock-states as basis-states, thereby all the eigenenergies and eigenstates are obtained and a detailed analysis is made. Then the cases with [Formula: see text] and [Formula: see text] are further studied. Since the total spin S is conserved, the eigenstates having the same S form an S-group. Let the lowest (highest) energy state of an S-group be called a bottom-state (top-state). We found that all the bottom-states are bipartite product states with constituent states describing fully polarized subsystems containing [Formula: see text] and [Formula: see text] ([Formula: see text]) particles, respectively. For two bottom-states different in [Formula: see text], the one with a larger [Formula: see text] is higher. For two having the same [Formula: see text], the one with a smaller S is higher. Whereas all the top-states are found to be essentially a product state of the pairs, in each pair the two spins are coupled to [Formula: see text] if the strength of the [Formula: see text]-channel is more repulsive than the others. For the states belonging to an S-group, the higher one would contain more pieces. As the energy goes up, larger pieces (those containing more than two particles) will disappear.

[Assessment of lymphocytic function in vitro stimulated by specific tumor polypeptide combined with dendritic cells].

OBJECTIVE: To assess the activation function of specific tumor polypeptide for dendritic cell vaccine on lymphocytes proliferation, production of cytokines and killing activity in vitro by using dendritic cells as antigen presenting vector. METHODS: Peripheral blood dendritic cells (DC) and cytokine-induced killer (CIK) were isolated and cultured by adherent culture method; CCK-8 method was used to assess the proliferation function of lymphocytes and the killing function of lymphocytes to tumor cells; enzyme-linked immunospot assay method was used to evaluate the secretion function of cytokines. The experiment was divided into tumor polypeptide group (peptide with DC-CIK), DC-CIK group and CIK group. RESULTS: With presence of interleukin-2 (IL-2) in the culture system, the lymphocyte proliferation of the three groups was obvious. The absorbance at 450 nm of tumor polypeptide group was significantly higher than that of CIK group at the time points day 4 and day 6 (day 4: Z=-3.79, P < 0.001; day 6: Z =-2.95, P < 0.01). The absorbance at 450 nm of group tumor polypeptide was significantly higher than that of DC-CIK group on day 4 (Z=-2.02, P < 0.05). Without IL-2 in the culture system, lymphocytes proliferated slowly in all the three groups, and there was no significant difference in 450 nm absorbance at each time point. The levels of IL-4 (Z=-2.61, P < 0.01), granulocyte-macrophage colony-stimulation factor (GM-CSF, Z=-3.85, P < 0.001), interferon- γ (IFN- γ, Z=-3.56, P < 0.001) and tumor necrosis factor-α (TNF-ɑ, Z=-3.40, P < 0.001) of tumor polypeptide group were higher than those of CIK group. There was no significant difference in the production of cytokines except IL-4 (Z=-2.15, P < 0.05) when tumor polypeptide group was compared with DC-CIK group. The production of IFN-γ (Z=-2.44, P < 0.05), TNF-ɑ (Z=-2.26, P < 0.05) and GM-CSF (Z=-3.73, P < 0.001) in DC-CIK group were higher than those of CIK group. Although there was no significant difference in killing activity between tumor polypeptide group, DC-CIK group and CIK group at hour 18 and hour 24, and the killing activity of tumor polypeptide group was higher than that of the other two groups. CONCLUSION: Tumor peptide combined with dendritic cells can improve the proliferation activity of CIK cells in vitro, and increase the secretion of several cytokines.

[Efficacy of extracorporeal membrane oxygenation in patients with complex high risk coronary artery disease undergoing percutaneous coronary intervention].

Objective: To explore the safety and efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in complex high-risk and indicated patients (CHIP). Methods: This is a single-center retrospective study. Patients who underwent percutaneous coronary intervention (PCI) supported by VA-ECMO in the Second Hospital of Jilin University from June 2018 to January 2020 were enrolled. General clinical data, laboratory examination results, PCI and ECMO process, postoperative complications and prognosis were collected through the electronic medical record system. The endpoint of the study was major adverse cardiovascular events (MACE), defined as complex events including cardiac death, recurrent myocardial infarction, heart failure and malignant arrhythmia. All patients were followed up for 12 months after discharge. Kaplan-Meier method was used for survival analysis. Results: A total of 31 patients, aged (64.6±10.1) years, including 19 males were included. All patients were treated with VA-ECMO before PCI. The ProGlide vascular suture device was embedded by local anesthesia to quickly establish circulation. There were 9 (29.0%) patients with ST-segment elevation myocardial infarction, 10 (32.3%) patients with non-ST-segment elevation myocardial infarction and 12 (38.7%) patients with unstable angina. The number of stents implanted during the operation were 2.8±1.8. The VA-ECMO weaning time was 24.0 (2.0, 88.5) hours. Compared with the results of pre-operation, the patient's postoperative left ventricular ejection fraction was significantly improved (49% (42%, 55%) vs. 43% (35%, 52%), P<0.01], hemoglobin and platelet count levels decreased, the level of creatinine and urea nitrogen was increased (P<0.05). Within 24 hours after operation, hemoglobin decreased>20 g/L was observed in 18 cases (58.1%), puncture site bleeding was found in 2 cases (6.5%), pseudoaneurysm occurred in 1 case (3.2%) and postoperative cerebral infarction occurred in 1 case (3.2%). There were no deaths during the operation, 2 patients died during hospitalization. All discharged patients were followed up for 12 months. The incidence of MACE was 13.8% (4/29). During the follow-up period, 2 patients died. One patient was hospitalized with recurrent myocardial infarction and one patient with heart failure. Survival analysis was performed 12 months after intervention and the cumulative survival rate was 80.0%. Conclusion: The application of VA-ECMO in CHIP interventional therapy is safe, effective and feasible.

Classification and treatment strategies for condylar fractures in children.

In this study, we aimed to describe a classification method (position and displacement (PD) classification) and the corresponding treatment strategies for condylar fractures in children, based on the anatomical position and displacement of the fractures. Moreover, we aimed to explore the effect of the treatment strategies for condylar fractures in children. Such fractures were classified into the following three types by PD classification: condylar head fracture (type A), mildly displaced condylar neck and base fracture (type B), and severely displaced condylar neck and base fracture (type C). According to this classification, we proposed the corresponding treatment strategy of closed treatment for types A and B fractures and open treatment for type C fractures. Eighty-four patients who had 123 condylar fractures (type A = 97, type B = 16, type C = 10) were included in this study. Type A fractures showed the restoration of normal function with favourable remodelling in the condyles. Types B and C fractures had good function and symmetry in the condylar angle and height of the condylar neck. The PD classification and corresponding treatment strategies may serve as a better option for the clinical treatment of condylar fractures in children.

Tumor promoting effects of exosomal microRNA-210 derived from lung cancer cells on lung cancer through the RUNX3/PI3K/AKT signaling pathway axis.

Exosomes are involved in a range of processes in lung cancer such as cell proliferation, metastasis, and angiogenesis. Tumor-derived exosomes participate in the formation and progression of lung cancer by delivering functional biomolecules, including microRNAs (miRNA). The purpose of the present study was to determine the role of lung cancer cell-derived exosomal miR-210 in the proliferation and invasion of lung cancer cells and its underlying mechanism. Initially, exosomes were isolated from A549 cells and characterized by transmission electron microscopy and assessment of exosomal marker expression. RT-qPCR determined that miR-210 expression was elevated in exosomes as well as lung cancer cells. As reflected by dual-luciferase reporter assay, miR-210 negatively regulated RUNX3 expression. Following loss- and gain- function assay, it was found that miR-210 inhibition suppressed biological properties of A549 and H460 cells, which could be reversed by the silencing of RUNX3. miR-210 elevation induced the p-PI3K/PI3K and p-AKT/AKT levels, suggesting the activation of PI3K/AKT signaling pathway. Collectively, exosomal miR-210 targeted and negatively regulated RUNX3 expression to promote malignant properties of lung cancer cells by potentiating PI3K/AKT signaling pathway.

[Expert consensus on the treatment of oral and maxillofacial space infections].

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Correlation between serum microRNA-136 levels and RAAS biochemical markers in patients with essential hypertension.

OBJECTIVE: The aim of this study was to investigate the correlation between microRNA-136 levels and biochemical markers of renin-angiotensin-aldosterone system (RAAS) in patients with essential hypertension (EH). PATIENTS AND METHODS: The subjects were divided into EH group (n=110) and healthy control group (n=110). MicroRNA-136 expression, angiotensin-converting enzyme (ACE) activity, and expression of renin (RA) and angiotensin II (Ang II), and aldosterone (ALD) in peripheral blood serum were examined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR), equine glycylglycine glycine method, magnetic particle chemistry, and radioimmunoassay, respectively. In addition, the correlation between microRNA-136 and RAAS biochemical markers was estimated by Pearson linear regression. Meanwhile, ROC curve analysis was carried out to evaluate the potential of microRNA-136 for the diagnosis of EH. Follow-up data were recorded for assessing the influence of microRNA-136 on the prognosis in patients with EH. RESULTS: It was found that microRNA-136 expression was remarkably elevated in peripheral blood serum of patients with EH, and the expression levels of biochemical markers of RASS, such as ACE, RA, Ang II, and ALD were also found higher than those in healthy controls. Meanwhile, a significant positive correlation was confirmed between microRNA-136 level and ACE activity, RA, Ang II, as well as ALD levels in patients with EH. In addition, the area under the ROC curve (AUC) was calculated as 0.8662, with a sensitivity of 82.73% and a specificity of 80.91%. After two-months medication intervention, patients with EH expressing a high level of microRNA-136 had better therapeutic efficacy than those with a low level. CONCLUSIONS: In peripheral blood serum, microRNA-136 expression was dramatically negatively correlated with biochemical markers of RASS. High level of microRNA-136 predicts a good prognosis in patients with EH following medication. Therefore, microRNA-136 can be used as a potential biomarker for the diagnosis of EH.

[Genetic analysis of mitochondrial pcox1 and ribosomal 18S rRNA genes in Eurytrema pancreaticum isolates from goats in Huaihua City, Hunan Province].

OBJECTIVE: To investigate the genetic variation of Eurytrema pancreaticum isolated from goats in Huaihua City, Hunan Province. METHODS: The partial sequence of mitochondrial cytochrome I (pcox1) and ribosomal 18S rRNA genes were amplified using a PCR assay in E. pancreaticum isolates from goats in Huaihua City, Hunan Province, and the PCR amplification products were sequenced. Then, the gene sequences were subjected to genetic variation and phylogenetic analyses. RESULTS: The sequences of the pcox1 and 18S rRNA genes were 430 bp and 1 857 bp in length in 18 E. pancreaticum isolates from goats in Huaihua City, Hunan Province, and there were 14 and 35 variation sites in pcox1 and 18S rRNA gene sequences, with intra-species genetic variations of 0 to 1.4% and 0 to 0.8%, respectively. The sequences of pcox1 and 18S rRNA genes had 99.0% to 99.8% and 99.5% to 99.8% homologies with those from E. pancreaticum Chinese strain recorded in the GenBank database. Consistent phylogenetic analysis results were found based on pcox1 and 18S rRNA genes. The 18 E. pancreaticum isolates from goats in Huaihua City were clustered into a clade with the known E. pancreaticum isolates registered in GenBank, and the clade with these 18 E. pancreaticum isolates was close to the clades with Eurytrema species and far from the clades with other trematodes. CONCLUSIONS: The E. pancreaticum isolates from goats have a low genetic variation in Huaihua City, Hunan Province. Mitochondrial pcox1 and ribosomal 18S rRNA genes may serve as molecular markers for the studies on the genetic variation in goat-derived E. pancreaticum.

[Effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis].

Objective: To explore the effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis. Methods: From March 2014 to December 2018, 6 patients with skin and soft tissue defects in perineal region caused by necrotizing fasciitis were admitted to Department of Burns of Hanzhong Central Hospital (hereinafter referred to as our hospital). Two female patients had labia major defects and 4 male patients had scrotum defects, with age of 43-68 years. The areas of skin and soft tissue defects after debridement were 4%-8% total body surface area. The wounds in non-joint and non-functional area were repaired with free split-thickness skin grafts from medial femoral region, and the residual wounds areas in perineal region after repair were 10 cm×4 cm-22 cm×10 cm, which were repaired with pedicled anterolateral thigh flaps, with area of 12 cm×5 cm-24 cm×12 cm. The secondary wounds in the donor sites were sutured directly or repaired with free split-thickness skin grafts from medial thigh on the same or opposite side of the wounds. The bacterial culture result of wound exudate, drug sensitivity test result, and blood bacterial culture result on admission were recorded. The postoperative flap survival was observed. The length of hospital stay, debridement times, and antibiotics use time were recorded. The flap swelling condition was observed to evaluate whether flap thinning operation was necessary, the sensory recovery of the flap and hip joint activity were evaluated, and the scrotum function of male patients was evaluated by urologist in our hospital during follow-up. Results: The bacterial culture results of wound exudate in 5 patients on admission showed Escherichia coli with 4 of them having the same bacteria and the other one having methicillin-resistant Staphylococcus aureus detected in their blood samples. All the flaps survived in 6 patients after the operation, with total length of hospital stay of (22±5) d, debridement of 3-5 times, and antibiotics use time of (13±3) d. During follow-up of 3 to 6 months after the operation, the flaps were slightly bloated in 2 patients, and the flap thinning operation was performed 6 months after wound repair. The sensory function recovered to normal in 2 flaps of patients with anterolateral femoral cutaneous nerve, and the superficial sensory function in the other flaps of patients recovered in different degrees.The hip joint activity was close to normal in all the patients, and the scrotum function was normal in 4 male patients. Conclusions: The pedicled anterolateral thigh flap showed good effects in repairing skin and soft tissue defects on perineal region caused by necrotizing fasciitis, with good appearance and function after operation, and the method is simple, safe, and easy to apply.

Circ-RPL15/miR-146b-3p/VEGFA feedback loop is responsible for triggering proliferation and migration in glioma.

OBJECTIVE: This study aims to elucidate the role of circ-RPL15 in the progression of glioma. PATIENTS AND METHODS: Circ-RPL15 levels in glioma tissues and normal brain tissues were detected. Subcellular distribution of circ-RPL15 was examined. The binding between miR-146b-3p and circ-RPL15 was verified by Luciferase assay. Potential targets of miR-146b-3p were further determined. The influences of the circ-RPL15/miR-146b-3p/VEGFA feedback loop on proliferative and migratory abilities in T98G and U251 cells were detected by cell counting kit-8 (CCK-8) and transwell assay, respectively. RESULTS: Circ-RPL15 and VEGFA were upregulated in glioma tissues than normal ones, whereas miR-146b-3p was downregulated. Circ-RPL15 was mainly distributed in the cytoplasm. The interaction in the circ-RPL15/miR-146b-3p/VEGFA feedback loop was indicated by Luciferase assay, and it markedly promoted proliferative and migratory abilities in glioma. CONCLUSIONS: Circ-RPL15 triggers proliferative and migratory potentials in glioma by competitively binding miR-146b-3p and thus upregulates VEGFA.

Circ-100338 induces angiogenesis after myocardial ischemia-reperfusion injury by sponging miR-200a-3p.

OBJECTIVE: To investigate the effect of circular RNA circ-100338 on angiogenesis of human umbilical vein endothelial cells (HUVEC) cells after hypoxia/reoxygenation (H/R) and its molecular mechanism. MATERIALS AND METHODS: We evaluated the role of circ-100338 in coronary artery endothelial cells using human coronary endothelial cells (HCAEC). Then, we verified the function of circ-100338 in HUVEC cells through cell counting kit-8 (CCK8), scratch test, Tube forming experiment, 5-Ethynyl-2'-deoxyuridine (EdU) staining. Dual-Luciferase reporter gene experiment and RNA Pull-Down experiments were used to detect the binding effect of circ-100338 and miR-200a-3p, miR-200a-3p and FUS. RESULTS: QRT-PCR results showed that the expression of circ-100338 decreased in HCAEC after H/R treatment. Overexpression of circ-100338 promotes angiogenesis. The Dual-Luciferase reporter gene assay and RNA pull-down assay consistently indicated the specific binding effect between circ-100338 and miR-200a-3p, miR-200a-3p and FUS, and circ-100338 promoted the angiogenesis phenotype in HUVEC cells. CONCLUSIONS: CircRNA-100338 may inhibit the function of miRNA-200a-3p by combining with miRNA-200a-3p, and then miRNA-200a-3p plays a role in regulating FUS, thereby regulating the state of angiogenesis.

[Practice guideline for patients with ankylosing spondylitis/spondyloarthritis].

In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.

[Clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap].

Objective: To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap. Methods: From March 2014 to March 2017, 6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit, including 5 males and 1 female, aged 27-65 years, 1 case of electric injury, 2 cases of coal burn, 3 cases of traffic injury, 2 cases involving upper limb, and 4 cases involving lower limb. After debridement, the wound area ranged from 26 cm×8 cm to 36 cm×15 cm, and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm. The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap. The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm. The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap. The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded, and the recovery of donor and recipient areas and the occurrence of complications were followed up. Results: Three patients were treated with simple vascular supercharging technique during flap transplantation, and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation. All the flaps survived well in 6 patients without vascular crisis. Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees. Except for 1 case of upper limb flap, the other flaps had no obvious swelling and needed no second thinning. There were only depressed scars in the donor sites, and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts. No short-term or long-term complications were found. Conclusions: The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation, which is worth popularizing.

The influence of different resuscitation solution on lactic acid accumulation after hemorrhagic shock: a network meta-analysis.

OBJECTIVE: To compare the effect of various fluid resuscitation procedures after hemorrhagic shock on the lactic acid accumulation by network meta-analysis. MATERIALS AND METHODS: A number of articles were obtained by searching the databases. Randomized control trials (RCT) were selected by two literature quality assessors; the extracted experimental data were then summarized to compare and analyze the effect of various kinds of infusion procedures at different time points on the concentration of lactic acid in the internal environment of rat models. RESULTS: 9 articles containing 25 independent reports were enrolled. Results revealed that the accumulation of lactic acid generated in the resuscitation using hydroxyethyl starch solution or gelofusine was significantly different from the one using Ringer solution, hypertonic saline or normal salt solution (p<0.05). Compared to the colloidal, the aqueous solution of pyruvate showed a slightly weaker effect in reducing the accumulation of lactic acid. The accumulation of lactic acid is severely affected by hypertonic saline, Ringer lactate solution, and balanced salt solution, i.e., the concentration of lactic acid is increasing with an augment of concentration or prolongation of treatment time. CONCLUSIONS: In terms of the management of lactic acid accumulation after hemorrhagic shock, the effect of colloidal solution was remarkably better than a crystalloid solution, and hypertonic saline and normal salt solution were not recommended as preferable drugs in the treatment of hemorrhagic shock.