Bacillus velezensis K-9 as a Potential Biocontrol Agent for Managing Potato Scab.

Crop pathogen infections can lead to substantial economic losses, but biocontrol, an environmentally friendly approach, can be used to control infections. For the biological management of potato scab disease, we assessed the potential use of Bacillus velezensis as a biocontrol agent. B. velezensis K-9 inhibited up to 44.90% of the infection caused by Streptomyces scabies, the causative agent of potato scab. Treatment of the S. scabies-infected potato plants with B. velezensis K-9 resulted in a significant reduction in the depth of the disease lesions compared with the untreated infected potato plants. In a radish seedling test, the B. velezensis K-9 culture and cell-free filtrate significantly reduced (P < 0.05) potato scab disease symptoms, suggesting that the strain K-9 was able to reduce S. scabies pathogenesis on potatoes. In a field test, the disease and scab indexes for B. velezensis K-9 against potato scab were significantly different from the control. In 2021, the potato yield for the B. velezensis K-9-treated plants was 12.44% higher than that for the control plants. In 2022, the potato yield following B. velezensis K-9 treatment increased by 12.65% compared with the control. In conclusion, B. velezensis K-9 prevented potato scab and increased potato yield. Thus, B. velezensis K-9 substantially reduced the occurrence of potato scab and could be used as a potential biocontrol agent for the management of potato scab.

Relationship Between Intimal Thickness on Ultrasonography and Long-Term Patency of Arteriovenous Fistula Restenosis After Cutting Balloon Versus High Pressure Balloon Angioplasty.

BACKGROUND: To investigate the relationship between intimal thickness on ultrasonography and long-term patency of arteriovenous fistula restenosis after cutting balloon and high pressure balloon angioplasty. METHODS: We retrospectively compared the outcomes between cutting balloon angioplasty and high pressure balloon angioplasty in 149 patients with hemodialysis access restenosis. The relationship of intimal thickness and primary assisted patency of hemodialysis access on ultrasonography was investigated as the primary outcome, using Kaplan-Meier survival analysis and Cox proportional hazards model. The second outcomes included residual diameter, blood flow, and venous pressure of hemodialysis access before and after angiography and balloon diameter and inflation pressure. RESULTS: Primary assisted patency in cutting balloon angioplasty was 90.6%, which was significantly (P = 0.001) more than that of 37.9% in high pressure balloon angioplasty during the 20-month follow-up period. Cox proportional hazards model screened significant factors including procedure type (high pressure or cutting, P = 0.004), inflation pressure (P = 0.013), preoperative intimal thickness (P = 0.009), and difference of intimal thickness (P = 0.029). Finally, procedure type (P = 0.012) and preoperative intimal thickness (P = 0.033) were identified for predicting primary assisted patency by multivariate Cox proportional hazards model. CONCLUSIONS: Compared to high pressure balloon angioplasty for treating patients with hemodialysis access restenosis, cutting balloon angioplasty had a better primary assisted patency. The increase of intimal thickness on ultrasonography after angiography was inversely correlated with primary assisted patency.

Effect of BBM gene on callus growth and ginsenoside content in Panax quinquefolius / 中国中药杂志

Baby Boom(BBM) gene is a key regulatory factor in embryonic development and regeneration, cell proliferation, callus growth, and differentiation promotion. Since the genetic transformation system of Panax quinquefolius is unstable with low efficiency and long period, this study attempted to transfer BBM gene of Zea mays to P. quinquefolius callus by gene gunship to investigate its effect on the callus growth and ginsenoside content, laying a foundation for establishing efficient genetic transformation system of P. quinquefolius. Four transgenic callus of P. quinquefolius with different transformation events were obtained by screening for glufosinate ammonium resistance and molecular identification by PCR. The growth state and growth rate of wild-type and transgenic callus were compared in the same growth period. The content of ginsenoside in transgenic callus was determined by ultra-high performance liquid chromatography-triple quadrupole mass spectrometry(UPLC-MS/MS). The results showed that transgenic callus growth rate was significantly higher than that of wild-type callus. In addition, the content of ginsenoside Rb_1, Rg_1, Ro, and Re was significantly higher than that in wild-type callus. The paper preliminarily proved the function of BBM gene in promoting growth rate and increasing ginsenoside content, which provided a scientific basis to establish a stable and efficient genetic transformation system for Panax plants in the future.

Clinical characteristics and virus identification of 4 cases of monkeypox confirmed in Zhejiang province / 中华临床感染病杂志

Objective:To analyze the clinical characteristics of monkeypox patients.Methods:The clinical data and laboratory findings of 4 patients with monkeypox patients diagnosed at Yiwu Central Hospital in July 2023 were analyzed. Herpes fluid and skin tissue samples were collected, the viruses were isolation and cultured in African green monkey kidney cells (Vero) and identified with whole gene sequencing.Results:All four patients were male, aged 24-35 years. All patients had male-to-male behavior within 21 days before onset of the disease. Among them, one patient has AIDS and one patient has syphilis. Four patients presented with perineal skin lesions with itching, and 3 patients were found to have enlarged lymph nodes upon admission. Laboratory testing: lymphocyte abnormality (4.57×10 9/L) in 1 case; increased procalcitonin (0.25 ng/mL) in 1 case; elevated IL-10 levels ( 7.11 ng/L and 9.42 ng/L) in 2 cases; increased IL-6 (66 ng/L) and IL-4 (3.24 ng/L) in 1 case, respectively. One case had abnormal myocardial zymogram with a elevated lactate dehydrogenase level of 313 U/L. The monkeypox virus was isolated from lesion tissue and herpes fluid, and the whole gene sequencing identified it as the B. 1.3 subtype of the IIb evolutionary branch, exhibiting typical pathological effects on Vero cells. Conclusion:The clinical manifestations of the 4 monkeypox patients confirmed in Zhejiang province are mild, patients had a definitive history of male-to-male sexual behavior and the virus strains belong to the B. 1.3 lineage of the IIb evolutionary branch.

Prognostic Value of Hematological Indicators in Children and Adolescents with Nasopharyngeal Carcinoma / 肿瘤防治研究

Objective To explore the prognostic value of pretreatment hematological indicators in children and adolescents with nasopharyngeal carcinoma. Methods We performed a retrospective analysis on the medical records of 79 children and adolescents (≤20 years old) with nasopharyngeal carcinoma. Before treatment, all patients underwent hematological tests, and patients received intensity-modulated radiotherapy alone or intensity-modulated radiotherapy combined with chemotherapy, targeted, and other comprehensive treatment modes. The follow-up endpoints were overall survival (OS) and progression-free survival (PFS). Results Age≤14 years, no concurrent chemotherapy, pretreatment hematological indicators (high NLR, high PLR, high LDH, and high LAR) were associated with poor OS and PFS in children and adolescents with nasopharyngeal carcinoma (all P < 0.05). No concurrent chemotherapy and high LAR before treatment were independent adverse prognostic factors for OS in children and adolescents with nasopharyngeal carcinoma. Conclusion High NLR, high PLR, high LDH, and high LAR of pretreatment hematological indicators are associated with poor OS and PFS. Meanwhile, high LAR before treatment is an independent adverse prognostic factor for OS in children and adolescents with nasopharyngeal carcinoma.

Isolation and identification of an endophytic bacteria Bacillus sp. K-9 exhibiting biocontrol activity against potato common scab.

Potato scab is an important soil-borne disease that can significantly reduce the quality and economic value of potatoes. The purpose of this study was to isolate, screen and identify endophytic bacteria that have antagonistic and control effects on potato scab disease, and to determine the control effect and yield traits of the selected strains on potato scab disease in field conditions. A bacterial strain K-9 was isolated from the junction between scab spot and healthy epidermis of potato tuber. The K-9 strain was identified as Bacillus sp. through morphological, physiological and biochemical characterization, and 16S rDNA and gyrB gene sequence analysis. The diameter of the inhibition zone of strain K-9 against Streptomyces scabies on the YME plate was 3.82 cm. The K-9 strain could inhibit eight types of crop pathogens, with the highest inhibition rate (70.39%) against another soil-borne potato disease (potato black scurf). In the field test, the control effect of K-9 strain against potato scab was not significantly different from that of mixed bacteria or chemical agents, but the disease index and the scab index in the K-9 treatment were significantly lower than in the control. The potato yield in the K-9 treatment was 12.44% higher than the control. In summary, the K-9 strain can prevent not only potato scab, but also increase potato yield. Therefore, the endophytic bacterial K-9 strain may be a potential biological control agent.

Effects of nitrogen and phosphorus addition on growth and leaf nitrogen metabolism of alfalfa in alkaline soil in Yinchuan Plain of Hetao Basin.

Alkaline soil is widely distributed in China. Its rational utilization is an effective measure to solve land shortage and improve the environment. Alfalfa is characterized by strong salt and alkali tolerance and high yield and protein content. Nitrogen (N) and phosphorus (P) are the main nutrients for plant growth, and N metabolism is one of the primary forms of plant metabolism, which plays a vital role in quality and yield formation. The exploration of the effect of N and P on N metabolism and alfalfa growth will provide a theoretical basis for scientific fertilization for alfalfa in the alkaline soil of the Yinchuan Plain of the Hetao Basin. Therefore, a 2-year experiment of N and P addition was conducted. Six treatments were set up with a randomized block design, including without N (WN), medium N (MN), high N (HN), without P (WP), medium P (MP), and high P (HP). It was found that the MN and MP treatments increased plant height, stem diameter, stem/leaf, dry/fresh, and dry matter of alfalfa. The HN and HP treatments inhibited alfalfa biomass formation. The MN and MP treatments increased key products and enzymes of leaf N metabolism of alfalfa and promoted activities of leaf nitrate reductase (NR), glutamine synthase (GS), glutamate synthase (GOGAT), glutamic-oxalacetic transaminase (GOT), and glutamic-pyruvate transaminase (GPT), and inhibited activities of leaf protease of alfalfa. The MN and MP treatments increased contents of leaf N, P, ammonium nitrogen (NH4 +-N), nitrate nitrogen (NO3 --N), total chlorophyll, and protein and reduced leaf chlorophyll a/b and amino acid, results after HN and HP treatments were opposite. The correlation among leaf P, N, NO3 --N, amino acid, and protein reached significant levels (P < 0.01). It is suggested that MN and MP treatments can improve the yield and quality of alfalfa by increasing key products and enzymes of N metabolism and can be adopted to promote alfalfa production in the alkaline soil of the Yinchuan Plain of the Hetao Basin.

Digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap / 中华显微外科杂志

Objective:To investigate the clinical value of digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap.Methods:From January 2015 to February 2021, 9 patients with soft tissue defects in hand were repaired with anterior tibial artery perforator flap assisted by digital technology in flap design, including 6 males and 3 females aged from 19 to 63 years with a mean age of 33 years. The size of defects varied from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm, with exposed bones or tendons. Preoperative CTA scan of lower limb was performed and three-dimensional image was reconstructed with Mimics 20.0. The anterior tibial artery perforator flap was designed according to the shape and size of the defect, then the resection of flap was digitally simulated. The flap based on the digital design was harvested and the defect was repaired in the operation. The size of flap was 2.5 cm×2.0 cm~4.5 cm×3.5 cm. Outpatient clinic follow-up was performed to evaluate the survival of flaps. Disability of Arm, Shoulder and Hand(DASH) was used for function evaluation.Results:All flaps were harvested successfully and all donor sites were closed directly. After surgery, 8 flaps survived completely. One flap developed venous occlusion that showed partial necrosis of the flap, and it was rescued after exploration and re-anastomosis. The follow-up period ranged from 6 to 21 months, with an average of 13 months. The DASH scores of the affected limb were 2 to 15 points at the last follow-up, with an average of 6.4 points. Mild scar hyperplasia occurred at donor site in 1 case without sensory abnormality.Conclusion:The digital technology is able to accurately locate the perforators by allowing an individualised design of the anterior tibial artery perforator flap. The flap is suitable for repair of small and medium-sized soft tissue defect in hand, and the digital technology has certain value in clinical application.

Flap combined with 3D printed microporous tianium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect / 中华显微外科杂志

Objective:To investigate the effect of flap combined with 3D printed microporous titanium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect.Methods:From January 2019 to December 2020, 2 patients with large soft tissue defects on dorsal foot together with large metatarsal bone defect and 4 patients with soft tissue defects of calf with large tibial bone defect were treated. The areas of soft tissue defect were 5.0 cm×8.0 cm-15.0 cm×10.0 cm. The length of the bone defect were 3.8 cm to 7.0 cm, 5.75 cm in average. In the first stage, metatarsal bone defect or tibial bone defect was filled with vancomycin blended bone cement, meanwhile, soft tissue defect was repaired with anterolateral femoral flap(ALTF) with vascular anastomosis in 2 cases of feet, and local fascia flap was trans-positioned in 4 cases of lower extremity defects. The sizes of repairing flap were 6.0 cm×8.5 cm-16.0 cm×11.0 cm. Two to 7 months after the initial surgery, the customer designed microporous titanium prostheses were used(5 cases with microporous titanium and 1 with microporous tantalum) to repair the bone defects. The wound healing, the integration of metatarsal and tibial fractures with 3D printed microporous titanium(tantalum) prostheses, and the walking condition were observed after surgery. The follow-up lasted from 6 to 25 months, with an average of 12.7 months.Results:The wound healing in 5 patients was good. The patients stood on the foot in 2 months after surgery, started to walk with the assistance of crutch in 3 months after surgery, and took walk without assistance in 5-6 months after surgery. Good osseous integration were achieved. One diabetic patient had infection of foot wound 3 months after surgery. After removal of microporous titanium prosthesis and replacement of vancomycin blended interstitial substance of bone cement, the wound healed and the patient resumed walking.Conclusion:It is an effective method to encourage the patients to take early ambulation after the surgery for lower extremity soft tissue defect with large bone defect that was repaired by a flap and 3D printed microporous titanium(tantalum)prosthesis. Further observations are required to investigate the long-term efficacy, and the reduction of prosthesis infection rate requires further exploration.

Clinical information analysis of 10 533 patients of chronic pancreatitis-summary of clinical treatment in Changhai Hospital over 28 years / 中华胰腺病杂志

Objective:To summarize the experience of treatment for chronic pancreatitis by analyzing the clinical information of 10 533 patients with chronic pancreatitis admitted to First Affiliated Hospital of Naval Medical University (Changhai Hospital) in the past 28 years.Methods:Clinical data including the age, sex, place of birth, admission time, admission age, admission department, discharge time, hospitalization times and treatment methods of chronic pancreatitis patients admitted to Changhai Hospital from January 1995 to February 2022 were analyzed retrospectively. The changes of chronic pancreatitis patients′ admission, demographic characteristics and treatment mode were summarized.Results:A total of 10 533 patients were analyzed, including 7 443 males (70.66%) and 3 090 females (29.34%), and male to female ratio was 2.41∶1. The average age of admission was (45.7±15.0) years. In terms of geographical distribution, East China was the largest, followed by North China and Northwest China. 10 533 patients were admitted for 19 920 times, and there were 18 156 times (91.14%) in gastroenterology department and 1 452 times (7.29%) in general surgery department. Patients in gastroenterology department were admitted for (1.88±1.45) times and the average length of hospitalization was (10.33±5.63) days. A total of 14 134 endoscopic retrograde cholangiopancreatography [(1.45±1.41) times per patient] were performed among 8 022 patients, and 13 882 pancreatic extracorporeal shock wave lithotripsy [(2.22±0.36) times per patient] were performed among 6 629 patients. In general surgery department, patients were admitted for (1.03±0.16) times and the average length of hospitalization was (14.90±9.00) days. 1 242 patients underwent surgical treatment. The ratio of endoscopic therapy to surgery increased from 0.12∶1 in 1995 to 15.72∶1 in 2021.Conclusions:The study shows that chronic pancreatitis was more common in middle-aged males in China, and the treatment modes of chronic pancreatitis in Changhai Hospital had changed from surgery to endoscopic therapy.

Value of Stroop test in the diagnosis of minimal hepatic encephalopathy / 临床肝胆病杂志

Objective To investigate the value of Stroop test, a neuropsychological test, in the diagnosis of minimal hepatic encephalopathy (MHE). Methods A total of 96 patients with liver cirrhosis who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, from August 2020 to March 2021 were enrolled, and the number connection test-A (NCT-A), digit symbol test (DST), animal naming test (ANT), and Stroop test were performed for all patients. Test results were recorded and related clinical data were collected. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was used to investigate the value of Stroop test in the diagnosis of MHE, and the Pearson correlation coefficient was used to analyze the correlation of the results of Stroop test with those of NCT-A, DST, and ANT. Results For the 96 patients with liver cirrhosis, the prevalence rate of MHE was 30.21% (29/96). The Off+On time of Stroop test had a cut-off value of 212.49 s in the diagnosis of MHE, with an area under the ROC curve of 0.845, a sensitivity of 93.10%, and a specificity of 64.20%. The Pearson correlation analysis showed that the On+Off time and On time of Stroop test were moderately correlated with NCT-A( r =0.580 and 0.590, both P < 0.01), the Off time of Stroop test was strongly correlated with NCT-A( r =0.620, P < 0.01), and the On+Off time, On time, and Off time of Stroop test were strongly correlated with DST( r =-0.650, -0.650, and -0.630, all P < 0.01). Conclusion In the diagnosis of MHE, Stroop test is a highly sensitive method with easy-to-read results and a high diagnostic value and does not require professional equipment.

Progress in the diagnosis of minimal hepatic encephalopathy / 中华肝脏病杂志

Hepatic encephalopathy (HE) is a common serious complication of liver cirrhosis, with sudden onset, indicating a poor prognosis in patients with chronic liver disease. Minimal hepatic encephalopathy (MHE) is an early stage of HE with no apparent symptoms, but it shows abnormal results in neuropsychological and/or neurophysiological tests. MHE affects patients' quality of life, employability, driving ability, and has a high risk of developing overt hepatic encephalopathy (OHE). This article aims to explore various diagnostic methods, strengthen the routine work of clinicians in diagnosis and treatment, and develop an effective MHE screening protocol.

Intraoperative IPC combined with 3M warming instrument to prevent lower extremity deep venous thrombosis in patients undergoing proximal femoral anti rotation intramedullary nailing / 中国骨伤

OBJECTIVE@#To explore the effect of intermittent pneumatic compression(IPC) combined with 3M thermometer on the prevention of deep venous thrombosis(DVT) in patients with femoral intertrochanteric fracture.@*METHODS@#From March 2016 to August 2019, 127 patients with femoral intertrochanteric fractures who underwent proximal femoral nail antirotation(PFNA) were retrospectively analyzed. They were divided into two groups according to different methods of thrombus prevention and treatment. Among them, 63 patients in group A did not use IPC and 3M thermometer;64 cases in group B were treated with IPC combined with 3M thermometer. Color Doppler ultrasound was used to dynamically monitor the DVT and changes of lower limbs during perioperative period. The venous thrombosis of lower limbs was monitored at 0, 24, 72 h and > 72 h after operation(recheck every 3 days until discharge).@*RESULTS@#Occurrence of DVT of lower limbs after PFNA operation in two groups:there were 5 cases (7.8%) in group B and 20 cases (31.7%) in group A, there was significant difference between two groups (P=0.001). There was no significant difference in lower limb DVT between two groups at 0, 72 and > 72 h after operation(P>0.05), but the formation rate of group A was significantly higher than that of group B at 24 h after operation (P=0.049). There was no significant difference in DVT formation between group A and group B(P>0.05). However, the formation of DVT in group A was significantly higher than that in group B(P=0.012).@*CONCLUSION@#Intraoperative IPC combined with 3M thermostat can effectively prevent DVT of lower limbs in patients undergoing PFNA surgery.

Thumb soft tissue defect repaired with posterior tibial artery septal perforator flap of calf with precise localization and matching: A case report / 中华显微外科杂志

A patient suffered a sustained soft tissue necrosis and infection at the radial interphalangeal joint of left thumb after laser nevus removal. He was treated in the Department of Orthopaedics, No. 920 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army in February 2020. CTA combined with digital technology of Mimics software was used to accurately locate the perforator of posterior tibial artery septal perforator flap at the appropriate part of the calf and the super flap (1.20 cm×0.80 cm×0.46 cm) for the repair was designed. After 1 year of follow-up, the left thumb flap had no swelling with a satisfactory texture and appearance. The sensory recovered to S 3, and the left thumb movement was completely normal. Only a linear scar remained at the donor site of the calf.

In vitro and in vivo immunoregulatory activity of sulfated fucan from the sea cucumber A. leucoprocta.

The in vitro and in vivo immunoregulatory activity of a water-soluble sulfated fucan AL1-1 from the sea cucumber A. leucoprocta was elucidated. In vitro experiments showed that AL1-1 up-regulated immunostimulatory activities in RAW264.7 cells and that it could successfully promote ROS production and phagocytic activity, increase secretion levels of iNOS, and induce the production of considerable amounts of cytokines (TNF-α, IL-6, IL-1ß and IL-12). We found that toll-like receptor 4 (TLR4) was mainly involved in AL1-1 mediated macrophage activation. AL1-1's in vivo immunomodulatory activity on cyclophosphamide (CY)-treated mice was investigated and it was shown that it could strongly enhance Sig A levels, promote the total antioxidant capacity (T-AOC), and reduce malondialdehyde (MDA) level in the intestine. It could also increase activities of superoxidase dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-PX). These results demonstrate that AL1-1 has a significant effect on enhancing in vivo and in vitro immune response.

Screening of mRNA expression differences of PI3K/Akt/eNOS in the aortic tissue of rats exposed to sodium fluoride based on mRNA sequencing / 中华地方病学杂志

Objective:To explore the effect of fluoride exposure on the gene expression of phosphatidylinositol-3-kinase/protein kinase B/endothelial nitric oxide synthase (PI3K/Akt/eNOS) in rat aortic tissue, and to provide a theoretical basis for studying the mechanism of cardiovascular injury caused by endemic fluorosis.Methods:A total of 40 male Wistar rats were divided into 4 groups (10 rats in each group) via the random number table method according to body weight (80 - 100 g), namely control group (drinking distilled water), low-dose, medium-dose and high-dose groups [drinking distilled water containing 50, 100 and 150 mg/L sodium fluoride (NaF), respectively]. The rats were free to drink and eat. After feeding for 90 days, rats were sacrificed and the aortic tissue was taken. Three aortic tissue samples from the control group and the high-dose group were taken for mRNA sequencing, the differential genes were screened, and the differential genes were analyzed by GO function enrichment analysis and KEGG function enrichment analysis. At the same time, the mRNA expression levels of PI3K, Akt and eNOS in the aortic tissue of rats in each group were determined by real-time fluorescence quantitative PCR.Results:Compared with control group, there were 756 differential genes in high-dose group, including 654 up-regulated genes and 102 down-regulated genes. These differential genes were mainly related to biological processes such as muscle contraction, muscle regulation, muscle tissue development, striated muscle cell development, muscle cell differentiation, blood circulation regulation and striated muscle tissue development. They were mainly enriched in cyclic guanosine phosphate (cGMP-PKG) signaling pathway, relaxin signaling pathway and PI3K/Akt signaling pathway, etc. Compared with control group, the mRNA expression levels of PI3K and eNOS in aortic tissue of rats in low-dose, medium-dose and high-dose groups were significantly reduced ( P < 0.05); the mRNA expression level of Akt in low-dose group was significantly increased ( P < 0.05). Conclusion:Fluoride exposure has certain effects on the function and gene expression of rat aortic tissue, and PI3K/Akt/eNOS signaling pathway may play an important role in the process of fluoride induced aortic tissue injury in rats.

Protection of Addition and Subtraction Therapy of Ditantang Combined with Taohong Siwutang to Brain Nerve of Patients with Cerebral Infarction and （Syndrome of Phlegm and Blood Stasis Blocking Collaterals） During Early Recovery / 中国实验方剂学杂志

Objective:To discuss clinical effect of addition and subtraction therapy of Ditantang combined with Taohong Siwutang to cerebral infarction and syndrome of phlegm and blood stasis blocking collaterals during early recovery， and to study protection to brain nerve. Method:One hundred and fifty-two patients were randomly divided into control group （76 cases） and observation group （76 cases） by random number table， 71 patients in control group completed the therapy （5 patients were falling off， missing visit or eliminated）， and 70 patients in observation group completed the therapy. Both groups' patients got comprehensive rehabilitation measures. Patients in control group got Zhongfeng Huichun pills， 1.5 g/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Ditantang combined with Taohong Siwutang in the morning and at night， 1 dose/day. The treatment was continued for 12 weeks. Before and after treatment， scores of degree of neurological deficit， Barthel （BI） index， Fugl-Meyer scale （FMA）， modified Rankin scale （MRS） and syndrome of phlegm and blood stasis blocking collaterals were graded. And levels of malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， superoxide dismutase （SOD）， advanced oxidation protein products （AOPP）， vascular endothelial growth factor （VEGF）， brain-derived neurotrophic factor （BDNF） and neuron specific enolase （NSE）. And cerebral hemodynamics were detected， and peak flow velocity （VS）， vascular resistance index （RI）， pulsatility index （PI） and cerebrovascular reserve function （CVR） were recorded. Safety was evaluated. Result:After the 6th week and 12th week of treatment， scores of degree of neurological deficit， BI， FMA， MRS， syndrome of phlegm and blood stasis blocking collaterals， AOPP， MDA， NSE， RI and PI were lower than those in control group （P<0.01）， levels of SOD， GSH-Px， BDNF， VEGF， Vs and CVR were higher than those in control group （P<0.01）. The clinical effect was better than which in control group （Z=2.109， P<0.05）. Besides， there was no adverse reaction caused by Ditantang combined with Taohong Siwutang. Conclusion:Ditantang combined with Taohong Siwutang can ameliarate the hemodynamics， reduce the lipid peroxidation damage， regulate the neurovascular repair factor， so it can promote the repair of nerve tissue and function， clinically reduce the degree of nerve function defect， improve the ability of daily life and exercise when it used to cerebral infarction and syndrome of phlegm and blood stasis blocking collaterals during early recovery， and it is good for clinical effect and safe using.

Repair of defects in dorsal of wrist and hand with posterior interosseous artery propeller flap: a report of 9 cases / 中华显微外科杂志

Objective:To investigate the preliminary clinical effect of posterior interosseous artery propeller flap in the repair of dorsal of wrist and hand wounds.Methods:From March, 2015 to December, 2019, 9 cases of dorsal of wrist and hand wounds were repaired with posterior interosseous artery propeller flap, including 6 cases of dorsal hand defect and 3 cases of dorsal wrist defect. Defect area: 6 cm × 4 cm-3 cm × 3 cm; There were 3 cases of metacarpal fracture, 1 case of phalangeal fracture and 1 case of tendon rupture. According to the size and shape of the wound, the posterior interosseous artery propeller flap was designed to transfer and repair the soft tissue defect wound. The size of the flap: 20 cm × 5 cm-12 cm × 3 cm, the size of posterior interosseous artery propeller flap was recorded and the surgical characteristics were summarized; The survival of the flap, donor and recipient complications were observed and followed-up.Results:All flaps were cut smoothly and the donor areas were sutured directly. The flap survived completely in 8 cases and partial necrosis in 1 case; One case complicated with wound infection. The follow-up ranged from 6 to 31 months, with an average of 14 months. The texture and shape of the flap were good; The last DASH score was 3-18, with an average of 9.3; There were 2 cases of mild scar hyperplasia in the donor area and 1 case of mild scar hyperplasia at the edge of the flap.Conclusion:Posterior interosseous artery propeller flap may be an effective method to repair small and medium-sized wounds of dorsal of wrist and hand.

Choices for treatment of pressure sores in different parts of buttocks / 中华显微外科杂志

Objective:To explore the treatment of pressure sores in different parts of the buttocks.Methods:From May, 2005 to March, 2020, 170 (157 patients) pressure sores in different parts of buttocks were treated. Eighty-two pressure sores located at sacrococcyx, 52 at ischial tuberosity, 24 at greater trochanter (without hip joint exposure) and 12 at femoral greater trochanter with exposure of the hip joint. Flaps were used to repair the pressure sores. ①Seventy-one sacrococcygeal pressure sores were repaired by the gluteal epithelial neurovascular flap; ②10 (10 patients) sacrococcygeal and 42 (36 patients) sciatic tubercle pressure sores were repaired by the posterior femoral neurovascular flap; ③24(24 patients) femoral trochanter pressure sores and 1(1 patient) sacrococcygeal pressure sore were repaired by the tensor fascia lata myocutaneous flap; ④2 (2 patients) sciatic tubercle pressure sores were repaired by the gracilis myocutaneous flap; ⑤12 (10 patients) femoral trochanter pressure sores were with hip joint exposure treated with hip joint amputation; ⑥8 (8 patients) pressure sores at ischial tuberosity were treated with VSD. The pressure sores were measured at 5.0 cm×8.0 cm-15.0 cm×30.0 cm, and the flaps were sized 10.0 cm×12.0 cm-17.0 cm×32.0 cm. The follow-up was conducted in 2 methods: visit of outpatient clinic by patients and WeChat distanced interview by medical staff.Results:The gluteal epithelial neurovascular flaps, tensor fasciae lata flaps, gracilis myocutaneous flaps and posterior femoral neurovascular flaps all survived; 4 of 10 posterior femoral neurovascular flaps had partial necrosis and healed after dressing change. A total of 139 patients were treated by flap repair, of which 136 pressure sores healed, except 1 sacrococcygeal pressure sore and 1 femoral greater trochanter pressure sore did not heal because the patient was in old age, long-term hypoproteinaemia and anaemia, and 1 ischial tubercle pressure sore failed to heal due to osteomyelitis osteomyelitis. Ten pressure sores at femoral greater trochanter decubitus with hip joint exposure treated by hip joint amputation and 8 pressure sores at ischial tubercle decubitus treated by simple insertion of VSD were all healed. The follow-up period was 0.5-15.0 years, 7.5 years in average. The results of follow-up showed that pressure sores healed without recurrence in 154 patients, but failed to heal in 3 patients.Conclusion:The gluteal epithelial neurotrophic vascular flap has reliable blood supply and is simple to harvest, and it is a good flap to repair sacrococcygeal pressure sores. The tensor fascia lata myocutaneous flap has reliable blood supply and is simple to harvest, hence it is a good flap to repair greater trochanteric pressure sores. Transposition of the posterior femoral cutaneous nerve nutrient vessel flap or the V-Y advancement flap is simple and effective in repair of the sciatic tuberosity pressure sores. However, it is not recommended to apply the transposition of posterior femoral cutaneous nerve nutrient vessel flap in repair of the sacrococcygobtaineal pressure sore, because it would cause a necrosis at the distal part of the flap. When a greater trochanteric pressure sore coexists with an expose of hip joint, the hip joint can be dissected. For the pressure sore at ischial tuberosity, and if there is a small wound with a large internal cavity, it can be treated with simple insertion of VSD.

Efficacy of CT angiography combined with three-dimensional modeling-assisted design of superficial peroneal artery perforator flap for reconstruction of traumatic hand wound / 中华创伤杂志

Objective:To investigate the effectiveness of CT angiography (CTA) combined with three-dimensional modeling-assisted design of superficial peroneal artery perforator flap for reconstruction of traumatic hand wound.Methods:A retrospective case series study was conducted to analyze the clinical data of 15 patients with hand injury admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2016 to December 2019. There were 11 males and 4 females, aged 19-51 years [(27.8±8.1)years]. All patients had soft tissue defect of the hand with exposed bone or tendon, and the defect area ranged from 2.0 cm×1.0 cm to 6.0 cm×4.0 cm. All patients underwent CTA of the abdominal aorta to dorsalis pedis artery before surgery. The three-dimensional models of bones, blood vessels, skin and other tissues were reconstructed by Mimics 20.0 software. The location, diameter and length of the superficial peroneal artery perforator vessels were accurately measured, and the perforator flap was designed according to the shape and size of the defect, then the resection of flap was simulated. During the operation, the superficial peroneal artery perforator flap was removed and transplanted to repair the defect according to the design. The location, diameter and length of perforator vessels were measured intraoperatively and compared with the preoperative modeling measurement. The operation time and intraoperative blood loss were recorded. The survival of the flap and healing of the donor site were observed after operation. The function of the affected limb was evaluated according to the upper limb function evaluation standard of Chinese Medical Association before and 3 months after surgery. The appearance, sensation and motion of the donor site were observed 3 months after surgery.Results:The origin and course of superficial peroneal artery perforator vessels could be clarified preoperatively based on the three-dimensional model. There was no significant difference in the location, diameter and length of perforator vessels between the pre- and intra-operative measurements ( P>0.05). All patients were followed up for 6-20 months [(12.2±3.8)months]. The operation duration was 50-125 minutes [(91.2±10.4)minutes], with blood loss of 150-450 ml [(364.1±44.7)ml]. The partial epidermal necrosis occurred in 2 patients after surgery, which gradually healed after dressing change, and other flaps survived smoothly. All donor sites could be sutured directly, and all incisions healed by first intention. According to the upper limb function evaluation standard of the Chinese Medical Association, the affected limb scored (76.4±9.7)points 3 months after surgery, higher than the preoperative score of (48.2±10.1)points ( P<0.05). The results were excellent in 8 patients, good in 6 and fair in 1, with the excellent and good rate of 93%. All patients had slight scar growth in donor sites and showed no obvious abnormalities in the sensation of foot dorsum and donor sites, with normal walking gait. Conclusion:CT angiography combined with three-dimensional modeling can accurately locate the perforating vessels, realize the individualized and precise design of the superficial peroneal artery perforator flap, and assist in the rapid and accurate flap resection, and hence promote wound healing and functional recovery of the hand.