Objective To measure the volume of olfaction-related cortex in olfactory dysfunction patients after upper respiratory tract infections via MRI,and to analyze the differences in the volume of olfaction-related cortex.Methods Fifteen olfactory dysfunction patients after upper respiratory tract infections (patient group) and fifteen age-and gender-matched normal volunteers (control group) were enrolled in this study to undergo 1.5 Tesla MR scanning.The volumes of olfaction-related cortex,including entorhinal cortex (EC),perirhinal cortex (PRC) and insular cortex (IC),were drawn and computed with Dr.View software.Olfactory function test was performed with the Sniffin' Sticks method which consisted of three tests:odor threshold (THR),odor discrimination (DIS),odor identification (ID),and their sum score (TDI).Statistical differences in the volumetric measures of bilateral EC,PRC,and IC between patient and control group were analyzed by analysis of covariance (ANCOVA) with age and intracranial volume (ICV) as covariates.Statistical differences in the olfactory function between patient and control group were analyzed by ANCOVA with age as a covariate.Results (1) The EC volume of patient group in the left and right side were (1.5 ± 0.3),(1.6 ± 0.1) cm3,while the control group were (1.7 ± 0.2),(1.8 ± 0.3) cm3 ; The PRC volume of patient group in the left and right side were (1.9 ± 0.4),(1.9 ± 0.3) cm3,and the control group were (2.5 ± 0.8),(2.3 ± 0.7) cm3 ; The IC volume of patient group in the left and right side were (5.2 ± 0.4),(5.8 ± 0.5) cm3,and the control group were (5.8 ± 0.8),(6.7 ± 0.2) cm3.EC,PRC and IC volumes of patient group and control group were measured and the results showed that the olfaction-related cortex volume was decreased in patient group showing significant statistical difference (F =4.913,4.793,7.832,5.574,9.842,7.221,P ＜ 0.05).(2) Olfactory function test of patient group and control group was performed and the results showed that the scores of patient group were lower than that of control group,and the differences were significant (F =54.508,118.774,93.039,53.692,74.139,53.626,91.842,91.696,P ＜ 0.01).Conclusions It is feasible to measure the volumes of olfaction-related cortex with MRI,and the volumes of EC,PRC and IC decreased in olfactory dysfunction patients after upper respiratory tract infections compared with normal people.

Objective To understand the current state of research and clinical application of α-asarone injection.Method Literature search was conducted and the pharmacology, toxicology, preparation, clinical application and adverse reactions of α-asarone were reviewed.Results α-asarone injection has strong relieving effects on cough and asthma, but the quality of production is varying, adverse reactions are often reported, and the toxicological effects need to be further investigated.Conclusions α-asarone injection has a certain clinical effect, but the reports of related adverse reactions are gradually increased.Its toxicity remains to be further studied, and the product quality standard system and instructions need also to be further improved.

Objective:To explore the clinical efficacy and feasibility of applying a medial plantar vein flap to repair the great toenail flap donor site.Methods:A retrospective analysis was performed on the clinical data of patients who underwent great toenail flap or partial great toenail flap transplantation for finger reconstruction from January 2020 to June 2021 in Longgang Orthopedic Hospital of Shenzhen. During the operation, the donor site of the great toenail flap was repaired with medial plantar venous flaps, and the donor site of the medial plantar venous flaps was repaired with a free full-thickness skin graft. The survival of the flap was observed and the appearance, sensation, and complications of the flap were followed up. The foot function was evaluated by the Maryland foot function evaluation standard.Results:A total of 6 cases were enrolled, including 5 males and 1 female with an average of 22 years, ranged from 14-28 years old. The wound area of the great toenail flap was 2.2 cm×3.7 cm-5.5 cm×7.0 cm, and the skin flap was 2.5 cm×3.8 cm-5.5 cm×7.1 cm. All flaps survived. 2 cases developed tension blisters. All patients were followed up for 3-18 months, with an average of 9 months. And all flaps had no swollen appearance, good color, texture, and no ulcers or pain. Two-point discrimination was 7-10 mm, and the second/third donor area was concealed. According to the Maryland foot function evaluation standard, all 6 cases were rated as excellent.Conclusion:The application of the medial plantar vein flap to repair the donor area of the great toenail flap is an effective repair method. The donor area is concealed, the flap is not bloated, the texture is good, the survival rate is high, and the sensation recovered satisfactory.

Objective:To explore the clinical effect of medial plantar venous flow-through flap combined with vein transplantation to repair incomplete finger amputation with circularity soft tissue defect.Methods:A retrospective analysis was performed on the clinical data of patients with incomplete finger amputation injury with circularity soft tissue defect treated by medial plantar venous flow-through flap combined with vein transplantation from January 2016 to October 2020 in Longgang Orthopedic Hospital of Shenzhen. According to the length of the arterial and venous defects of the injured finger and the area of the circular wound, a venous flap (including 2-3 veins )was designed and harvested in the medial plantar. And then two superficial veins were harvested from the donor site to repair the dominant digital artery and distal digital vein of the severed finger. One vein in the flap was bridged to repair the non-dominant digital artery of the severed finger, and the other 1-2 veins were anastomosed with the subcutaneous vein of the proximal wound. The recipient site was closed. The donor site was repaired with full-thickness skin grafting. The appearance, two-point discrimination of the flap, as well as the shape, two-point discrimination, and the extension and flexion of the finger were followed up after the operation. The evaluation was performed by the trial standard for the replantation function of amputated fingers of the Chinese Medical Association Hand Surgery Branch.Results:In this study, a total of 11 patients with thermal crush injury were enrolled, including 7 males and 4 females, aged 16-46 years old. Cyclic skin and soft tissue defect was 1.4 cm×4.5 cm - 3.2 cm×5.4 cm in size after debridement, the arterial defect was 1.6-3.5 cm in length, and the venous defect was 1.7-3.3 cm in length. The flap was 1.6 cm×4.6 cm-3.3 cm×5.5 cm in size, and the harvested vein was 1.7-3.5 cm in length. All severed fingers and flaps survived. Eleven cases were followed up 11-18 months. The appearance of flap was not swollen, and the color and texture were close to the surrounding skin. The two-point discrimination was 7-11 mm. The shape of the finger was good, the two-point discrimination was 5-8 mm, and the extension and flexion activity of the finger was good. Ultimately, the hand function of 10 cases could be rated as excellent, and 1 case could be rated as good. There was slight pigmentation in the donor area, but no ulceration or pain, and no obvious abnormality in wearing shoes, walking, or running.Conclusions:The medial plantar venous flow-through flap combined with vascular transplantation is an ideal repair method to repair incomplete finger amputation with circularity soft tissue defect. It can not only reliably rebuild the blood supply of the distal finger, but also repair the annular defect of the proximal finger. The impact on the donor site is slight.

Objective:To explore the clinical efficacy and feasibility of applying a medial plantar vein flap to repair the great toenail flap donor site.Methods:A retrospective analysis was performed on the clinical data of patients who underwent great toenail flap or partial great toenail flap transplantation for finger reconstruction from January 2020 to June 2021 in Longgang Orthopedic Hospital of Shenzhen. During the operation, the donor site of the great toenail flap was repaired with medial plantar venous flaps, and the donor site of the medial plantar venous flaps was repaired with a free full-thickness skin graft. The survival of the flap was observed and the appearance, sensation, and complications of the flap were followed up. The foot function was evaluated by the Maryland foot function evaluation standard.Results:A total of 6 cases were enrolled, including 5 males and 1 female with an average of 22 years, ranged from 14-28 years old. The wound area of the great toenail flap was 2.2 cm×3.7 cm-5.5 cm×7.0 cm, and the skin flap was 2.5 cm×3.8 cm-5.5 cm×7.1 cm. All flaps survived. 2 cases developed tension blisters. All patients were followed up for 3-18 months, with an average of 9 months. And all flaps had no swollen appearance, good color, texture, and no ulcers or pain. Two-point discrimination was 7-10 mm, and the second/third donor area was concealed. According to the Maryland foot function evaluation standard, all 6 cases were rated as excellent.Conclusion:The application of the medial plantar vein flap to repair the donor area of the great toenail flap is an effective repair method. The donor area is concealed, the flap is not bloated, the texture is good, the survival rate is high, and the sensation recovered satisfactory.

Objective:To explore the clinical effect of medial plantar venous flow-through flap combined with vein transplantation to repair incomplete finger amputation with circularity soft tissue defect.Methods:A retrospective analysis was performed on the clinical data of patients with incomplete finger amputation injury with circularity soft tissue defect treated by medial plantar venous flow-through flap combined with vein transplantation from January 2016 to October 2020 in Longgang Orthopedic Hospital of Shenzhen. According to the length of the arterial and venous defects of the injured finger and the area of the circular wound, a venous flap (including 2-3 veins )was designed and harvested in the medial plantar. And then two superficial veins were harvested from the donor site to repair the dominant digital artery and distal digital vein of the severed finger. One vein in the flap was bridged to repair the non-dominant digital artery of the severed finger, and the other 1-2 veins were anastomosed with the subcutaneous vein of the proximal wound. The recipient site was closed. The donor site was repaired with full-thickness skin grafting. The appearance, two-point discrimination of the flap, as well as the shape, two-point discrimination, and the extension and flexion of the finger were followed up after the operation. The evaluation was performed by the trial standard for the replantation function of amputated fingers of the Chinese Medical Association Hand Surgery Branch.Results:In this study, a total of 11 patients with thermal crush injury were enrolled, including 7 males and 4 females, aged 16-46 years old. Cyclic skin and soft tissue defect was 1.4 cm×4.5 cm - 3.2 cm×5.4 cm in size after debridement, the arterial defect was 1.6-3.5 cm in length, and the venous defect was 1.7-3.3 cm in length. The flap was 1.6 cm×4.6 cm-3.3 cm×5.5 cm in size, and the harvested vein was 1.7-3.5 cm in length. All severed fingers and flaps survived. Eleven cases were followed up 11-18 months. The appearance of flap was not swollen, and the color and texture were close to the surrounding skin. The two-point discrimination was 7-11 mm. The shape of the finger was good, the two-point discrimination was 5-8 mm, and the extension and flexion activity of the finger was good. Ultimately, the hand function of 10 cases could be rated as excellent, and 1 case could be rated as good. There was slight pigmentation in the donor area, but no ulceration or pain, and no obvious abnormality in wearing shoes, walking, or running.Conclusions:The medial plantar venous flow-through flap combined with vascular transplantation is an ideal repair method to repair incomplete finger amputation with circularity soft tissue defect. It can not only reliably rebuild the blood supply of the distal finger, but also repair the annular defect of the proximal finger. The impact on the donor site is slight.

Objective:To compare and analyze the clinical characteristics between acute fatty liver of pregnancy (AFLP) and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.Methods:This is a retrospective cohort study. The clinical data of 13 cases with AFLP and 34 cases with HELLP syndrome were collected from three tertiary referral centers in Yunnan (the First Affiliated Hospital of Kunming Medical University, the Second Affiliated Hospital of Kunming Medical University, and Yan'an Hospital of Kunming City) from January 2016 to December 2021. The patients were diagnosed to AFLP and HELLP syndrome according to the Swansea criteria and the Tennessee classification system. The general characteristics, clinical features, laboratory results within 24 hours after admission, complications, maternal and neonatal outcomes were compared to analysis the differences between the two groups.Results:① Maternal characteristics: compared with HELLP syndrome group, AFLP group had lower body mass index (BMI) and blood pressure at admission (both P < 0.01). ②Clinical features: the most common symptoms in AFLP patients were skin jaundice, abdominal pain, nausea and vomiting, edema. The main manifestations of patients with HELLP syndrome were albuminuria, hypertension, edema, headache. Some patients had multiple symptoms concurrently. ③ Laboratory results: compared with HELLP syndrome group, the levels of platelet count (PLT), total bilirubin (TBil), direct bilirubin (DBil), γ-glutamyl transferase (γ-GGT), alkaline phosphatase (ALP), total bile acid (TBA), serum creatinine (SCr) and international standardized ratio (INR) in AFLP group were significantly increased within 24 hours after admission [PLT (×10 9/L): 107.69±51.13 vs.76.71±43.25, TBil (μmol/L): 121.60 (83.20, 170.00) vs.15.25 (7.22, 29.05), DBil (μmol/L): 86.50 (58.60, 104.00) vs. 4.30 (2.22, 10.10), γ-GGT (U/L): 87.00 (37.00, 127.00) vs. 41.00 (19.00, 64.42), ALP (U/L): 199.10 (109.00, 349.20) vs. 125.50 (90.50, 155.25), TBA (μmol/L): 51.50 (16.20, 117.40) vs. 4.15 (2.02, 6.95), SCr (μmol/L): 155.80 (129.00, 237.00) vs. 79.00 (65.43, 113.70), INR: 1.28 (1.17, 1.63) vs. 0.94 (0.88, 1.08), all P < 0.05], prothrombin time (PT) was significantly prolonged [seconds: 16.10 (14.50, 19.20) vs. 12.40 (11.43, 13.40), P < 0.05]. The level of blood glucose (GLU), fibrinogen (FIB) and the activity of antithrombin Ⅲ (ATⅢ) decreased significantly [GLU (mmol/L): 5.18±1.33 vs. 6.33±1.19, FIB (g/L): 1.96±1.46 vs. 3.81±1.58, ATⅢ (%): 40.61±25.84 vs. 66.39±24.11, all P < 0.05]; ④ Complications: compared with HELLP syndrome group, the incidence of patients with hypoglycemia [30.77% (4/13) vs. 0% (0/34)], acute liver failure [53.85% (7/13) vs. 5.88% (2/34)], acute renal insufficiency [69.23% (9/13) vs. 8.82% (3/34)], coagulopathy [76.92% (10/13) vs. 38.24% (13/34)], disseminated intravascular coagulation (DIC) [53.85% (7/13) vs. 5.88% (2/34)], and multiple organ dysfunction syndrome (MODS) [53.85% (7/13) vs. 5.88% (2/34)] were significantly higher in AFLP group (all P < 0.05). ⑤ Maternal and neonatal outcome: all patients delivered after admission. The total length of hospital and intensive care unit stay were significantly longer in the AFLP group than in the HELLP syndrome group [days: 17.00 (11.00, 25.00) vs. 9.00 (7.00, 12.00), 12.00 (4.00, 22.00) vs. 3.91 (0, 7.00), both P < 0.01]. Two AFLP patients died, including one due to intracranial venous thrombosis and one due to multiple organ failure and cardiopulmonary arrest. There were no deaths in the HELLP syndrome group. Conclusions:There are significant differences in maternal characteristics, laboratory results and complications between AFLP and HELLP syndrome. TBil, γ-GGT, SCr, FIB, INR and ATⅢ activity may help to distinguish the two diseases.

Objective: To analyze the phenotype and genotype of a Chinese pedigree with inherited dysfibrinogenaemia and investigate the molecular mechanism of the disease. Methods: Venous blood samples were collected from all family members, and routine coagulation tests were conducted. Functional fibrinogen in venous blood samples was measured by Clauss method, and the antigen level of fibrinogen in plasma was measured by immunoturbidimetry assay. All the exons and exon-intron boundaries of the three fibrinogen genes were analyzed by direct sequencing. Fibrinogen electrophoresis, fibrinogen clottability measurement, fibrin polymerisation measurement and electron microscopy scanning were also used to investigate the molecular characteristics and pathogenesis. Results: The proband had normal activated partial thromboplastin time, prothrombin time and plasma fibrinogen antigen, but prolonged thrombin time, prolonged reptilase time and reduced fibrinogen activity level, which were also found in his father. The sequencing results of the proband revealed heterozygous A1211G in the exon 2 of FGA gene originating from his father, which caused Arg19Gly missense mutation. The western-blot results showed that no abnormal bands of plasma fibrinogen were found in the proband and his father. Both thrombin-induced fibrin polymerisation and reptilase induced fibrin polymerisation were significantly impaired compared to normal control. Fibrinogen clottability measurement showed that only about 20.8% molecules of plasma fibrinogen in the proband were involved in the clot formation. Scanning electron microscopy revealed that the proband′s average fibre diameters were found to be significantly thicker than that of the control(P＜0.001), and the density was smaller than that of normal control. Conclusion The Arg19Gly mutation should be responsible for the proband′s dysfibrinogenaemia and the relevant clinical symptoms.