Objective:To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns.Methods:A retrospective observational study was conducted. From May 2016 to September 2022, 17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 13 males and 4 females, aged 23 to 55 years, with 3 patients having degree Ⅱ cervical contracture, 14 patients having degree Ⅲ cervical contracture, and 12 patients having facial scar contracture deformity. In the first stage, 34 rectangular skin and soft tissue expanders (hereinafter referred to as expanders) with rated capacity of 100-600 mL were inserted into the face, chest, shoulder, and abdomen, and then the normal saline was injected for expansion. In the second stage, the scar tissue was removed and the contracture was released to correct the deformity. Two expanded facial flaps were transplanted in local fashion, 17 expanded flaps were transplanted in pedicled fashion, and 15 expanded flaps were freely transplanted to repair the secondary wounds after release, with artery pressurization was performed in 7 flaps. Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation. The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm. The wounds of 31 flap donor sites were closed by direct suture, and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation. The skin condition of inserted place, expansion time, and total amount of normal saline injection of expanders, complications of skin and soft tissue expansion surgery, and survival of flap after the second stage surgery were observed and recorded. The long-term face and neck reconstruction effect and recovery of flap donor area were followed up. At the last follow-up, the 5-level Likert scale was used to evaluate the efficacy satisfaction of patients.Results:Of the 34 expander inserted places in 17 patients, 22 places were superficial scar skin after deep partial-thickness burns, 8 places were superficial scar skin after multiple skin donations, and 4 places were normal skin. After 4 to 15 months of expansion, the total normal saline injection volume was 238 to 2 000 mL, with no complications occurred. After the second stage surgery, the distal part of 2 pedicled flaps was partially necrotic, and the necrotic wounds were healed after flap dressing and free transplantation of contralateral expanded triangular flaps, respectively; the other flaps survived completely. During 6 to 18 months of follow-up, except for 2 expanded paraumbilical flaps and 1 expanded groin flap, which were bloated and improved by flap thinning, the appearance and texture of the other flaps were good, and all the flap donor sites recovered well. At the last follow-up, the face and neck scar contracture deformities were significantly improved in all patients, and the satisfaction of curative effect of patient was very satisfactory in 8 patients and relatively satisfactory in 9 patients.Conclusions:The expanded flaps of chest, abdomen, and other parts, combined with local advance, pedicled, and free transplantation, can effectively reconstruct scar contracture deformities in the face and neck after extensive burns, restore the function of operative area and improve the appearance simultaneously, with high degree of patient satisfaction, which is worthy of promotion in clinic.

Objective : To analyze the status of glucose metabolism in obese children． Methods : 266 cases of obese children were included in the study，fasting plasma glucose ( FPG) ，fasting insulin ( FINS) ，glycosylated hemoglobin ( HbA1c) were measured ，Oral glucose tolerance test ( OGTT) and insulin release test ( IRT) were carried out，insulin resistance index ( HOMA-IR) ，quantified insulin sensitivity index ( QUICKI) and peak insu- lin /fasting insulin (Ip / I0 ) were calculated．Two hundred non-obese healthy children were used as control group， and glucose metabolism indexes were compared between the two groups． Glucose metabolism indexes and the incidence of insulin resistance (IR) were compared in children with different degrees of obesity ．Prediabetes risk factors and body mass index(BMI) correlation were analyzed in obese children. Results : The proportion of predia- betes and type 2 diabetes mellitus in obese children was 18. 0% (48 /266) ．FINS，HOMA-IR and HbA1c in obesi- ty group were higher than those in the control group，but QUICKI was lower than that in the control group (P < 0. 05) ．There was no significant difference in FPG between the two groups (P = 0. 423) ．FINS and HOMA-IR of severe obesity group were higher than those of mild to moderate obesity group，Ip / I0 was lower than that of mild to moderate obesity group (P＜0. 05) ，and there was no significant difference in FPG，QUICKI，HbA1c and 2hPG of severe obesity group．There was no significant difference in IR incidence between mild to moderate obesity group and severe obesity group (P = 0. 163) ．Logistic regression indicated that BMI and acanthosis nigricans was great influential on prediabetes with no statistical significance(P＞0. 05) ．Correlation analysis showed that BMI had no correlation with FPG (P = 0. 160) ，but was positively correlated with FINS，HOMA-IR , 2hPG and HbA1c (P < 0. 05) ，and negatively correlated with QUICKI and Ip / I0 (P＜0. 05) ． Conclusion Abnormal glucose metabolism is available in nearly 20% of obese children．The prevalence of insulin resistance in obese children is not affected by the degree of obesity.

OBJECTIVE: To explore the disease spectrum for abnormal 3-hydroxyisovalerylcarnitine (C5OH) metabolism identified through newborn screening and clinical diagnosis patients and the key points for differential diagnosis so as to raise the awareness of pediatricians for such diseases. METHODS: Clinical data of 85 neonates with abnormal C5OH metabolism identified from February 2004 to January 2022 at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were collected. Their clinical manifestations and results of tandem mass spectrometry (MS/MS), gas chromatography mass spectrometry (GC-MS) and genetic testing were retrospectively analyzed. RESULTS: Among the 85 cases, 46 (54.1%) were identified by neonate screening, whilst 39 (45.9%) were clinically diagnosed patients. Five diseases were diagnosed, including 28 cases with multiple carboxylase deficiency (MCD, 32.9%), 29 cases with 3-methylcrotonyl-coenzymeAcarboxylasedeficiency (MCCD, 34.1%), 4 cases with 3-methylglutaconic acid (3-MGA, 4.7%), 7 cases with 3-hydroxy-3-methylglutaric acid (3-HMG, 8.2%), and 17 cases with beta-ketothiolase deficiency (BKD, 20.0%). The disorders were characterized by sudden onset, anorexia, vomiting, diarrhea, abnormal breathing, consciousness disorder, spasm and developmental delay. CONCLUSION Among newborns with abnormal C5OH metabolism, MCCD is the most common disorder, which was followed by BKD and MCD. For patients with abnormal C5OH metabolism, MCD is the most common, followed by BKD and 3-HMG. C5OH related diseases have great heterogeneity. Combination of blood acylcarnitine levels, urinary organic acid levels and genetic testing based on clinical characteristics can help to attain the diagnosis.
Humans ; Infant, Newborn ; China ; Neonatal Screening ; Retrospective Studies ; Tandem Mass Spectrometry/methods*

【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.

Objective: : This study aimed to investigate the changes and significance of microRNA155 levels in serum of patients with cerebral small vessel disease (CSVD). Methods: : Thirty patients with CSVD who met the inclusion criteria were selected and divided into eight patients with lacunar infarction (LI) group and 22 patients with multiple lacunar infarction (MLI) combined with white matter lesions (WML) group according to the results of head magnetic resonance imaging (MRI). Thirty samples from healthy volunteers without abnormalities after head MRI examination were selected as the control group. The levels of serum microRNA155 in each group were determined by real-time polymerase chain reaction, and the correlation between microRNA155 in the serum of patients with CSVD and the increase of imaging lesions was analyzed by Spearman correlation analysis. Results: : Compared with the control group, the serum microRNA155 level in the LI group, MLI combined with WML group increased, the difference was statistically significant (p<0.05); serum microRNA155 level was positively correlated with the increase of imaging lesions (p<0.05). Conclusion : The change of serum microRNA155 level in patients with CSVD may be one of its self-protection mechanisms, and the intensity of this self-protection mechanism is positively correlated with the number of CSVD lesions.

Objective To investigate the difference between Han nationality residents and the Hani nationality residents in southern Yunnan about the effects of stroke risk factors on cerebral vascular hemodynamic indicators.Methods In the cohort crowds,Hani nationality outpatient patients were selected as the Hani nationality group,the Han nationality outpatient patients with the same gender and similar age were randomly selected as the Han nationality group with the ratio of nearly 1 ∶ 3.The risk factors of stroke and the differences of the hemodynamic indicators were compared between the two groups.Results The dyslipidemia proportion of the Hani nationality group was lower than that of the Han nationality group [48 cases (11.5 ％) vs.257 cases (17.5 ％),x2 =8.867,P =0.003],and the drinking proportion of the Hani nationality group was higher than that of the Han nationality group [79 cases (18.9％) vs.214 cases(14.6％),x2 =4.498,P =0.034],the other risk factors exposure rates had no statistically significant differences between the two groups (all P ＞ 0.05).The ratio of numbers of cerebral vascular hemodynamic indicators below 75 points(optimum truncation points) in the Hani nationality group and the Han nationality group were 30.3％ and 31.9％,respectively,the proportion of the two groups of integral value distribution had statistically significant difference (x2 =12.614,P ＜ 0.01);Vmean (left:t =0.632,P =0.527;right:t =0.642,P =0.532),Vmin (left:t =-0.349,P =0.727;right:t =-0.540,P =0.589),Wv(left:t =0.297,P =0.767;right:t =1.119,P =0.263),Zcv(left:t =0.297,P =0.767;right:t =1.247,P =0.213),Rv(left:t =0.837,P =0.403;right:t =1.222,P =0.222),DR(left:t =0.720,P =0.482;right:t =0.396,P =0.692),Cp(left:t =0.614,P =0.539;right:t =1.486,P =0.138) and other indicators of the two groups had no statistically significant differences.Conclusion The Hani nationality residents'stroke risk factors and CVHI integral distribution in different age groups are different from Han people in southern Yunnan.

Objective To investigate the exposure to stroke risk factors, the proportion of high?risk individuals, and the relationship between risk factor exposure and impaired cerebrovascular hemodynamics in patients at Pu'er People's Hospital. Methods Between April 2014 and June 2017, this study enrolled inpatients and outpatients of the neurology department of Pu'er People's Hospital who underwent cerebrovascular hemodynamic examinations to evaluate stroke risk. A total of 30 103 (12 793 males and 17 310 females) participants aged 22 to 99 (53.3±14.5) years were included. The distribution of exposure rates for stroke risk factors and proportion of high?risk individuals were determined according to age and sex. The relationships between integral scores of cerebrovascular hemodynamics and exposure to risk factors were also analyzed. Results Exposure rates for risk factors of hypertension, dyslipidemia, diabetes, heart disease, stroke family history, cigarette smoking, alcohol drinking, and overweight or obesity in males were 36.6%, 11.4%, 8.8%, 5.9%, 7.0%, 41.6%, 37.8%, and 51.4%, respectively. The exposure rates in females were 31.2%, 11.3%, 7.6%, 5.5%, 6.8%, 0.7%, 1.6%, and 48.8%, respectively. Differences between age groups for all risk factors were significant (P<0.01). Exposure rates for hypertension, diabetes, cigarette smoking, alcohol drinking, and overweight or obesity in males were significantly higher than in females (P<0.01). High?risk males and females accounted for 41.8% and 35.6% (χ2=119.82, P<0.01) and the rates in both groups increased significantly with age (χ2=1 838.2, 2 881.5, P<0.01). Risk factors including age, hypertension, dyslipidemia, diabetes, heart disease, stroke family history, alcohol drinking, and body mass index were independent predictors of increased individual risk of stroke. Conclusions Exposure levels for stroke risk factors and the proportion of individuals at high risk of stroke were relatively high in the hospital population. Cerebrovascular dysfunction is closely related to exposure to common risk factors for stroke.

Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received multi-interventional modes mainly with mechanical thrombectomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics (gender,age,and underlying diseases),timing of treatment (time from ictus to puncture,time from puncture to recanalization), multi-interventional mode therapies (intra-arterial thrombolysis,thrombectomy,balloon dilation,and stenting, etc. ),and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale (mTICI)grade was used to evaluate revascularization. The National Institute of Health Stroke Scale (NIHSS)score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale (mRS)was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications (mainly symptomatic intracranial hemorrhage)and mortality. The patients were divided into either a good prognosis group (n = 34;mRS≤2)or a poor prognosis group (n =22;mRS≥3)according to the prognosis at 3 months after procedure. They were analyzed with univariate analysis. The factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results (1)The recanalization rate in 56 patients was 78. 6%(n = 44),in which basilar artery was the highest,reaching 93. 8% (15 / 16),middle cerebral artery was 87. 0% (20 / 23). The NIHSS score at 24 hours was 10 ± 7,it was lower than 16 ± 6 on admission. There was significant difference (t =6. 401,P <0. 01). At 3 months,34 patients (60. 7%)had good prognosis,4 (7. 1%)died,and 8 (14. 3%) had symptomatic intracranial hemorrhage. (2)Multiple factor analysis showed that the high level of recanalization was a protective factor for good prognosis (OR,0. 465,95% CI 0. 267 -0. 809,P =0. 007). Diabetes was an independent risk factor for poor prognosis (OR,5. 535,95% CI 1. 101 -27. 835, P = 0. 038). Conclusion Acute large artery occlusive cerebral infarction treated with the intra-arterial multi-interventional modes may quickly and effectively restore intracranial blood flow. It has the characteris-tics of high recanalization rate and good prognosis,and the higher the level of recanalization,the better the prognosis. Diabetes is an independent risk factor for poor prognosis.

Objective To investigate the correlation between different blood pressure levels and carotid atherosclerotic plaque formation.Methods The population participated in stroke screening were selected from September 2012 to January 2013 in Dongying,Shandong province.The subjects met the diagnostic criteria of ideal blood pressure (systolic blood pressure [SBP] ＜ 120 mm Hg and diastolic blood pressure [DBP] ＜80 mm Hg,1 mm Hg =0.133 kPa),normotensive (SBP 120-129 mm Hg and/or DBP 80-84 mm Hg),and high-normal blood pressure (SBP 130-139 mm Hgand/or DBP 85-89 mm Hg)were selected.The questionnaires,physical examinations,blood biochemical tests,and neck vascular ultrasound examination were performed.The detection rates of carotid plaque among the normotensive,high-normal blood pressure and ideal blood pressure groups were compared.Multivariatelogistic regression analysis was used to identify the independent risk factors for carotid plaque.Results The proportions of men and diabetes,as well as the levels of body mass index (BMI) and fasting blood glucose (FBG) of the normotensive and high-normal blood pressure groups were significantly higher than those of the ideal blood pressure group (all P ＜0.05).The detection rates of carotid plaque of the normotensive,high-normal blood pressure and ideal blood pressure groups were 12.41％,38.14％ and 49.45％,respectively.The proportions of men and age,as well as the levels of SBP,FBG,and homocysteine (Hcy) of the carotid plaque formation group were significant higher than those of the non-carotid plaque formation group (all P ＜0.05).Multivariable logistic regression showed that age,SBP,FBG,and Hcy were the independent risk factors for carotid atherosclerotic plaque formation,while female gender was an independent protective factor.After adjusting the risk factors such as age,FBG,and Hcy,etc,the risk of plaque formation of the high-normal blood pressure group was significantly higher than that of the ideal blood pressure group (odds ratio 1.354,95％ confidence interval 1.028-1.783; P =0.031),while there was no significant difference between the normotensive group and the ideal blood pressure group.Conclusions High-normal blood pressure was significantly associated with the increased risk of carotid plaque formation,which was an independent risk factor for carotid plaque formation.

Objective To investigate the effect of thrombospondin 1(TSP-1) on the cell proliferation of cultured rat pulmonary artery smooth cell (PASMCs) in vitro .Methods Rat PASMCs were cultured in vitro ,and treated with different concentrations (10-12 、10-11 、10-10 mol/L) of TSP-1 for 12 ,24 ,48 h .The cell proliferation was quantified by MTT assay .The cell cycle of PASMCs was measured by flow cytometric(FCM) analysis .Results MTT assay showed that TSP-1 promoted the proliferation of PASMCs significantly ,and the effect was concentration-dependent and time-dependent .FCM analysis indicated that TSP-1 increased the percentage of S phase .The percentage of S phase of PASMCs were increased after treated with thrombospondin-1 for 12 h , slight down after 24 h ,while reached a maximal level at 48 h .Conclusion The TSP-1 promotes rat PASMCs proliferation in a con-centration-dependent and time-dependent manner .