Research progress in predicting the difficulty of surgery for middle and low rectal cancer based on pelvic measurement / 中华消化外科杂志

Total mesorectal excision (TME) has become the basic principle of surgical treat-ment for middle and low rectal cancer. Some of patients with ultra-low rectal cancer require under-going intersphincteric resection (ISR). Due to the limitation of the narrow pelvis, TME and ISR put forward higher requirements for the precise separation of the anatomical level and the protection of neurological function during the operation. At present, evaluation of the difficulty of surgery for middle and low rectal cancer is mainly based on the subjective judgment of chief surgeon, and there is no unified and objective scoring system or prediction model that can classify the difficulty of surgery for middle and low rectal cancer before surgery. The authors review relevant literatures and summarize the existing studies related to pelvic measurement for predicting the difficulty of surgery for middle and low rectal cancer, in order to provide significant guidance for the selection of surgical approach for patients with middle and low rectal cancer.

The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

The role of adipose-derived exosomes in the pathological progression of atherosclerosis / 生理学报

Atherosclerosis is a chronic inflammatory disease of vascular walls with a complex etiology. In recent years, the incidence of atherosclerosis continues to increase with obesity and diabetes as major risk factors. As an important metabolic organ in the body, adipose tissue also has a powerful endocrine function. In the case of obesity and diabetes, various cytokines and exosomes derived from adipose tissue mediate organ-organ/cell-cell crosstalk, and are involved in the occurrence and development of various diseases. As an important intercellular communicator, exosomes regulate the pathological process of various cardiovascular diseases and are closely related to atherosclerosis. In this paper, we reviewed the mechanism of adipose-derived exosomes in atherosclerosis with focus on endothelial dysfunction, inflammatory response, lipid metabolism disorder and insulin resistance, hoping to provide reference for the research, diagnosis and treatment of atherosclerosis.

A new γ-valerolactone derivative from the roots of Ardisia crispa / 药学学报

Four compounds were isolated from the 70% EtOH extract of Ardisia crispa by using various chromatographic techniques, including silica gel, ODS and semi-preparative HPLC. The structures of 1-4 were elucidated based on physicochemical properties and spectroscopic data. These compounds were defined as crispalactone A (1), (+)-pinoresinol (2), 3,5-dimethoxy-4- hydroxyphenol-1-O-β-D-glucopyranoside (3) and (+)-schizandriside (4). Compound 1 is a new γ-valerolactone derivative, and compounds 2-4 are firstly isolated from Ardisia crispa.

ACTA2 mutation is responsible for multisystemic smooth muscle dysfunction syndrome with seizures: A case report and review of literature.

BACKGROUND: ACTA2 gene is a specific gene that encodes actin α2. Multisystem smooth muscle dysfunction syndrome (MSMDS) is a multisystem disease characterized by aortic and cerebrovascular lesions caused by ACTA2 gene mutations. There have been many reports of cardiac, pulmonary and cerebrovascular lesions caused by MSMDS; however, few studies have focused on seizures caused by MSMDS. CASE SUMMARY: Our patient was a girl aged 7 years and 8 mo with recurrent cough, asthma and seizures for 7 years. She was diagnosed with severe pneumonia, congenital heart disease, cardiac insufficiency, and malnutrition in the local hospital. Cardiac ultrasonography revealed congenital heart disease, patent ductus arteriosus (with a diameter of 0.68 cm), left coronary arteriectasis, patent oval foramen (0.12 cm), tricuspid and pulmonary regurgitation, and pulmonary hypertension. Cerebral magnetic resonance imaging and magnetic resonance angiography indicated stiffness in the brain vessels, together with multiple aberrant signaling shadows in bilateral paraventricular regions. A heterozygous mutation (c.536G>A) was identified in the ACTA2 gene, resulting in generation of p.R179H. Finally, the girl was diagnosed with MSMDS combined with epilepsy. The patient had 4 episodes of seizures before treatment, and no onset of seizure was reported after oral administration of sodium valproate for 1 year. CONCLUSION: MSMDS has a variety of clinical manifestations and unique cranial imaging features. Cerebrovascular injury and white matter injury may lead to seizures. Gene detection can confirm the diagnosis and prevent missed diagnosis or misdiagnosis.

Controlling the Release of Hydrogen Peroxide from Catechol-Based Adhesive Using Silica Nanoparticle.

Catechol-based bioadhesives generate hydrogen peroxide (H2O2) as a byproduct during the curing process. H2O2 can have both beneficial and deleterious effects on biological systems depending on its concentration. To control the amount of H2O2 released from catechol-containing polyethylene glycol-based adhesive (PEG-DA), adhesive was formulated with silica nanoparticles (SiNP) prepared with increased porosity and acid treatment to increase Si-OH surface content. These SiNP demonstrated increased surface area, which promoted interaction with catechol and resulted in increased cure rate, bulk mechanical properties and adhesive properties of PEG-DA. Most importantly, SiNP demonstrated a 50% reduction in the released H2O2 while improving the cell viability and proliferation of three primary cell types, including rat dermal fibroblasts, human epidermal keratinocytes, and human tenocytes. Additionally, SiNP degraded into soluble Si, which also contributed to increased cell proliferation. Incorporation of porous and acid-treated SiNP can be a useful approach to simultaneously modulate the concentration of H2O2 while increasing the adhesive performance of catechol-based adhesives.

Containing the Spread of Coronavirus Disease 2019 (COVID-19): Meteorological Factors and Control Strategies

The novel coronavirus disease 2019 (COVID-19) has spread globally and the meteorological factors vary greatly across the world. Understanding the effect of meteorological factors and control strategies on COVID-19 transmission is critical to contain the epidemic. Using individual-level data in mainland China, Hong Kong, and Singapore, and the number of confirmed cases in other regions, we explore the effect of temperature, relative humidity, and control measures on the spread of COVID-19. We found that high temperature mitigates the transmission of the disease. High relative humidity promotes COVID-19 transmission when temperature is low, but tends to reduce transmission when temperature is high. Implementing classical control measures can dramatically slow the spread of the disease. However, due to the occurrence of pre-symptomatic infections, the effect of the measures to shorten onset-to-isolation time is markedly reduced and the importance of contact tracing and quarantine and social distancing increases. The analytic results also highlight the importance of early intervention to contain the spread of COVID-19.

Sonic hedgehog (Shh) and CC chemokine ligand 2 signaling pathways in asthma.

Asthma is a chronic inflammatory disease of the airways in which many cells are involved, including mast cells, eosinophils, T lymphocytes, and so on. During the process, many chemokines and mediators are released to engage in recruiting and activating eosinophils and other inflammatory cells. Also, some signaling pathways are involved in the pathobiology of asthma. Sonic hedgehog (Shh) is one of the members of hedgehog gene families. Shh signaling plays a critical role in the embryonic development, including the lung. Previous findings from our team reveal that Shh is involved in the asthma pathogenesis. Recombinant Shh could induce the CC chemokine ligand 2 (CCL2) overexpressing and Smo inhibitor GDC-O449 could inhibit CCL2 expression in airway epithelial cells, monocytes, or macrophages. Hence, we reviewed the effects of Shh and CCL2 signaling pathways, and the interaction between signaling pathways in asthma.

The Differential Expression Profiles of miRNA-let 7a, 7b, and 7c in Bronchoalveolar Lavage Fluid From Infants With Asthma and Airway Foreign Bodies.

The aim of this study was to investigate the expression patterns of miRNA-let 7a, 7b, and 7c in bronchoalveolar lavage fluid in infants with asthma and airway foreign bodies. Between January 2016 and February 2017, 27 infants were included and divided into observation group (infants with asthma, n = 15) and control group (infants with airway foreign bodies, n = 12). The differential expression profiles of miRNA-let 7a, 7b, and 7c were determined by reverse transcription-polymerase chain reaction in bronchoalveolar lavage fluid (BALF) from infants of the 2 groups. The BALF was collected from infants undergoing flexible bronchoscopy. MiRNA-let 7a, 7b, and 7c increased significantly in infants from observation group as compared with control group (2.72 ± 0.48 vs 1, 8.23 ± 1.64 vs 1, 3.16 ± 0.62 vs 1, respectively). The increased expression of miRNA-let 7a, 7b, and 7c were associated with the asthma of infants.

3D Channel-structured graphene as efficient electrodes for capacitive deionization.

Capacitive deionization (CDI), which is one of up-and-coming water treatment technologies, is based on ion electrostatic adsorption on electrode surface. Herein, three-dimensional channel-structured graphene (CSG), which was synthesized via exothermic reaction between liquid potassium and carbon monoxide gas, was demonstrated as an efficient electrode material for CDI. Namely, the CSG electrode exhibited a specific capacity of 207.4 F/g at 0.2 A/g in 1 M NaCl aqueous solution. In a batch-mode recycling system, the electrosorption capacity of CSG can achieve 5.70 and 9.60 mg/g at 1.5 V in 50 and 295 mg/l NaCl aqueous solutions, respectively. The excellent electrosorption capacity of CSG, especially under low saline concentration, can be attributed to the synergistic effect of its large surface area (711.9 m2/g), unique channel structure, and oxygen functional groups.

Epidemiological investigation of burn patients with Klebsiella pneumoniae infection and the analysis of risk factors for sepsis in them / 中华烧伤杂志

Objective@#To analyze the prevalence trend of Klebsiella pneumoniae (KP) infection in the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as the author′s department) from 2015 to 2017, and to screen out the independent risk factors for sepsis in burn patients with KP infection.@*Methods@#The clinical and bacteriological data of burn patients with KP infection from January 1, 2015 to December 31, 2017 were collected from the author′s department. The variation trend in infection rates of KP and carbapenems-resistant KP (CRKP) during the three years were statistically analyzed, and the data were processed with chi-square test. Clinical data were processed with binary logistic regression analysis to screen out the independent risk factors for sepsis in burn patients with KP infection.@*Results@#(1) From 2015 to 2017, 91 patients (50 males and 41 females, aged 15-90 years) with KP infection were diagnosed in the author′s department, of which 65 cases were CRKP positive, and 26 cases were carbapenems-sensitive KP positive. The KP infection rates of patients in 2015, 2016, and 2017 were 5.79% (35/605), 4.08% (23/564), and 5.54% (33/596), respectively. The CRKP infection rates of patients in 2015, 2016, and 2017 were 3.31% (20/605), 3.37% (19/564), and 4.36% (26/596), respectively. There were no statistically significant differences in KP infection rate and CRKP infection rate of patients among the three years (χ2=2.007, 1.175, P>0.05). (2) Total burn area and CRKP infection were independent risk factors for sepsis in burn patients with KP infection (odds ratios=1.03, 5.88, 95% confidence intervals=1.01-1.05, 1.08-31.94, P<0.05).@*Conclusions@#From 2015 to 2017, the infection rates of KP and CRKP in the author′s department did not increase obviously, but the proportion of CRKP infection was high. CRKP infection is one of the independent risk factors for sepsis in burn patients with KP infection. Strengthening the prevention and treatment of CRKP infection may have certain value in decreasing the incidence of burn sepsis.

Quantitative determination of nine furanocoumarins for quality evaluation of Angelica dahurica from different habitats / 中国中药杂志

A UPLC method has been developed for simultaneous determination of nine furanocoumarins of Angelica dahurics,and was used for quality evaluation of A. dahurica from different habitats. ACQUITY UPLC BEH C18 chromatographic column was employed,the separation was performed with the mobile phase consisting of acetonitrile and water,and the detection wavelength was set at254 nm. This method was used to simultaneously determine the content of xanthotoxol,oxypeucedaninhydrate,byak-angelicin,psoralen,xanthotoxin,bergapten,oxypeucedanin,imperatorin and isoimperatorin in A. dahurica from different habitats. Then,the further quality assessment of the drug was carried out by similarity evaluation,cluster analysis( CA),principal component analysis( PCA),and orthogonal partial least squares discriminant analysis( OPLS-DA). The content order of measured furanocoumarins from high to low was: oxypeucedanin>imperatorin>isoimperatorin>oxypeucedaninhydrate>bergapten>byak-angelicin>xanthotoxin>xanthotoxol>psoralen,with the mean content 2. 844,1. 277,0. 649 2,0. 216 2,0. 129 8,0. 062 68,0. 052 68,0. 019 30,0. 018 19 mg·g-1,respectively. There were difference between the batches of the drug,and the quality was influenced by smouldering sulphur based on the results of chemical pattern recognition and content determination. Finally,six active ingredients were recognized as the quality makers using OPLS-DA method. The validated UPLC fingerprint combined with chemical pattern recognition method can be used in the quality control and evaluation of A. dahurica.

Investigation on H-containing shallow trap of hydrogenated TiO2 with in situ Fourier transform infrared diffuse reflection spectroscopy.

A novel technique, high temperature high pressure in situ Fourier transform infrared diffuse reflection spectroscopy, was successfully used to investigate the formation and stability of shallow trap states in P25 TiO2 nanoparticles. Two types of shallow traps (with and without H atoms) were identified. The H-containing shallow trap can be easily generated by heating in H2 atmosphere. However, the trap is unstable in vacuum at 600 °C. In contrast, the H-free shallow trap, which can be formed by heating in vacuum, is stable even at 600 °C. The energy gaps between shallow trap states and the conduction band are 0.09 eV for H-containing shallow trap and 0.13 eV for H-free shallow trap, indicating that the H-containing shallow trap state is closer to the conduction band than that without H.

[Effect of atopy on serum glucocorticoid receptor levels in children with bronchiolitis].

OBJECTIVE: To investigate the effect of atopy on the expression of glucocorticoid receptors in children with bronchiolitis. METHODS: ELISA was used to measure the changes in the serum levels of glucocorticoid receptor α (GRα) and glucocorticoid receptor ß (GRß) in the bronchiolitis group (77 children, including 34 children with atopy) and pneumonia group (68 children). Thirty-eight children who were prepared to undergo surgeries for non-infectious diseases and had no atopy or family history of allergic diseases were enrolled as the control group. RESULTS: The bronchiolitis group and the pneumonia group had significant increases in the serum levels of GRα and GRß compared with the control group (P<0.01), and the bronchiolitis group had significant increases in these levels compared with the pneumonia group (P<0.01). Compared with the control group and the pneumonia group, the bronchiolitis group had a significant increase in the GRα/GRß ratio (P<0.01). Compared with the control group, the children with or without atopy in the bronchiolitis group had significant increases in the serum levels of GRα and GRß (P<0.01). The non-atopic children in the bronchiolitis group had a significant increase in the serum level of GRß compared with the atopic children (P<0.01). The atopic children in the bronchiolitis group had a significant increase in the GRα/GRß ratio compared with the control group and non-atopic children in the bronchiolitis group (P<0.01). CONCLUSIONS: Children with bronchiolitis have increased serum levels of GRα and GRß. The children with atopy have an increased GRα/GRß ratio, suggesting that the atopic children with bronchiolitis are highly sensitive to glucocorticoids.

Effect of atopy on serum glucocorticoid receptor levels in children with bronchiolitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of atopy on the expression of glucocorticoid receptors in children with bronchiolitis.</p><p><b>METHODS</b>ELISA was used to measure the changes in the serum levels of glucocorticoid receptor α (GRα) and glucocorticoid receptor β (GRβ) in the bronchiolitis group (77 children, including 34 children with atopy) and pneumonia group (68 children). Thirty-eight children who were prepared to undergo surgeries for non-infectious diseases and had no atopy or family history of allergic diseases were enrolled as the control group.</p><p><b>RESULTS</b>The bronchiolitis group and the pneumonia group had significant increases in the serum levels of GRα and GRβ compared with the control group (P<0.01), and the bronchiolitis group had significant increases in these levels compared with the pneumonia group (P<0.01). Compared with the control group and the pneumonia group, the bronchiolitis group had a significant increase in the GRα/GRβ ratio (P<0.01). Compared with the control group, the children with or without atopy in the bronchiolitis group had significant increases in the serum levels of GRα and GRβ (P<0.01). The non-atopic children in the bronchiolitis group had a significant increase in the serum level of GRβ compared with the atopic children (P<0.01). The atopic children in the bronchiolitis group had a significant increase in the GRα/GRβ ratio compared with the control group and non-atopic children in the bronchiolitis group (P<0.01).</p><p><b>CONCLUSIONS</b>Children with bronchiolitis have increased serum levels of GRα and GRβ. The children with atopy have an increased GRα/GRβ ratio, suggesting that the atopic children with bronchiolitis are highly sensitive to glucocorticoids.</p>

Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study.

BACKGROUND: Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE: To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS: From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS: Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION: There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS: The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.

HISTORIQUE: Les plaies fermées sous tension excessive et les anomalies cutanées qui ne peuvent pas être fermées par une intervention primaire représentent un problème quotidien pour le plasticien. OBJECTIF: Évaluer un nouveau système de soulagement des tensions (SST) pour étirer la peau et assurer la fermeture des plaies. MÉTHODOLOGIE: De septembre 2013 à mars 2014, une série consécutive de 41 patients chinois présentant 43 plaies ont été inscrits pour recevoir 50 cycles de traitement par SST. Le SST était utilisé pour deux principales applications cliniques : fermer diverses plaies chirurgicales ou traumatiques et assurer la fermeture des plaies après une suture à haute tension. Les chercheurs ont colligé l'information générale et détaillée au sujet de ce traitement et de ses complications. Les rendez-vous de suivi ont eu lieu de trois à six mois après la fermeture des plaies. RÉSULTATS: La largeur des plaies résiduelles moyennes diminuait d'environ 20 % tous les deux jours pendant les cycles de traitement par SST. L'infection était la complication la plus courante (cinq cas). Les autres complications étaient la déhiscence (deux cas) et l'ulcère de pression (un cas). Au rendez-vous de suivi six mois plus tard (21 plaies chez 20 patients), tant le processus de cicatrisation que la cicatrice étaient acceptables. EXPOSÉ: Il n'y a pas de contre-indications absolues au traitement par SST. Les auteurs ont formulé des directives pour prévenir et traiter les complications les plus courantes. CONCLUSIONS: Les résultats démontrent que le traitement par SST est une méthode simple et efficace pour assurer la fermeture primaire de plaies complexes et d'importantes anomalies de la peau et des tissus mous. Des études aléatoires plus vastes s'imposent pour approfondir l'évaluation de l'efficacité, des indications, des complications et du rapport coût-efficacité de ce traitement novateur par SST.

Experience in managing an urban massive burn incident: The Hangzhou bus attack on 5 July 2014.

BACKGROUND: On 5 July 2014, a suicide terrorist set a crowded bus on fire in Hangzhou, injuring 33 passengers. Among these, 19 adult victims with the most severe burns were triaged to our center. This is a single-center, descriptive study recording the prehospital response and in-hospital treatment of these patients. METHODS: Information on the attack, on-scene rescue, and patient triage was collected from public media, governmental, and hospital reports. Information on patient injury and our in-hospital procedures was collected from the emergency registry and patient records. RESULTS: Of the 80 passengers in the burning bus, 33 were injured. The total burn surface area (TBSA) of the 19 most severely injured patients triaged to our hospital ranged from 25% to 95% (mean 48.3 ± 2.08%). Two patients had a TBSA of >90% (92% and 95%) and eight had a TBSA of >60%. Nineteen cases of inhalation injury were diagnosed, eight of which were severe. The emergency center performed 14 bedside escharotomies, 14 central venous catheter (CVC) implantations, and one cardiopulmonary resuscitation (CPR). Approximately 131000 ml of resuscitation fluid was infused within the first 24h and 111000 ml within the second; further, 160230 ml of plasma and 4100 ml of red blood cells were infused during the antishock stage. All victims were transported to the burn ward to receive burn-centered multidisciplinary care. The respiratory team conducted 121 bronchoscopies. A total of 89 operations were performed, and the residual wound area decreased dramatically. After 124 days of extensive therapy, complete wound healing was observed and all patients entered the rehabilitation stage. CONCLUSION: Adequate preparation, including planning and disaster drills, is crucial for handling mass casualty events. Efficient and precise first rescue and triage can reduce prehospital mortality, and burn-centered multidisciplinary care and hospital-government cooperation helps reduce in-hospital mortality. Nevertheless, lessons can be drawn from this incident to be better prepared for future disasters.

Application of homemade wrist constraints for postoperative patients during anesthesia recovery period / 局解手术学杂志

Objective The purpose of this study is to evaluate the safety and effect of the homemade wrist restraint belt in postoperative patients during anesthesia recovery period.Methods Three hundred postoperative patients were randomly assigned into two groups,patients in the control group(n =150)were constrained with traditional restraint belt while patients(n =150)in the observation group were constrain-ed with homemade wrist restraint belt before recovered from general anesthesia in the post anesthesia care unit (PACU).The effectiveness of constraint,patients comfort,constraint related complications,PACU faculty responses on the satisfaction were recorded during anesthesia re-covery period.Results The complications in the observation group were lower than those in the control group (P <0.05).Compared with con-trol group,the patient satisfaction,patient comfort,PACU faculty satisfaction were significant higher in the observation group (P <0.05).Con-clusion The homemade wrist constraints could increase the patient’s safety and comfort,reduce restraint belt related complications during anesthesia recovery period.It revealed more effectiveness than the traditional restraint belt.

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.