Objective To compare and analyze the advantages and disadvantages of the forearm skin flap and the lateral femoral skin flap in the repair of oral and maxillofacial defects.Methods Of the 34 patients of oral and maxillofacial tumor resection received postopera-tive reconstruction of maxillofacial defects treatment,18 patients repaired by forearm flap( forearm flap group) ,16 patients repaired by antero-lateral thigh flap ( anterolateral thigh flap group) .The clinical effect and the restoration of two groups after surgery were compared.Results The survival rate of disposable surgical flap in forearm flap group was 94.44%,the survival rate of the anterolateral thigh flap group was 87.50%.The difference between two groups was not statistically significant (P>0.05).The difference of swallowing function in 3 months after surgery between two groups was not statistically significant (P>0.05).The difference of survival quality score between the two groups was not statistically significant (P >0.05) in 6 months after surgery.The scar proliferation rate (27.78%), pigment deposition rate (88.89%), temporary sexual dysfunction rate(66.67%),a permanent disability rate (27.78%) of forearm flap group were significantly higher than those of the femoral anterolateral flap group patients (P<0.05).Conclusion The forearm skin flap and the lateral femoral skin flap have a good clincal effect on the repair of oral and maxillofacial defects,and the incidence of complications of the femoral anterior lateral femoral flap is lower.

Objective To explore the effect of latissimus dorsi musculocutaneous flap for repairing severe soft tissue defect of the elbow.Methods Seventeen patients with severe soft tissue defect of the elbow were repaired by latissimus dorsi musculocutaneous flap.Ten patients were performed transfer of skin flap for functional reconstruction,9 patients reconstructed elbow flexion,and 1 patient reconstructed elbow extension.Seven patients' tissue defect were repaired by cover type musculocutaneous flap,and the areas of these flaps ranged from 6 cm × 10 cm-12 cm × 27 cm.Results All the musculocutaneous flaps kept alive.After an average postoperative follow-up for 12-40(22.0 ± 9.6) months,the color and luster of the flaps were satisfying.There were no scar contracture of the flap and no bulkiness of the elbow.Ten patients performed transfer of skin flap for functional reconstruction,and the range of motion was 100°-140° of flexion and-20°-0° of extension.Muscle power was M3-M5.Hand function was near normal.Conclusion Latissimus dorsi musculocutaneous flap is an ideal surgical method to repair the severe soft tissue defect of the elbow.

Objective To explore the effect of great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap. Methods Fifty-two patients with skin and soft tissue lost on ankle received neoplasty using distally crural saphenous neurocutaneous pedicled skin flap. The patients were divided into two groups: the patients in interruption group (25 patients) were treated with great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap, the patients in conventional group (27 cases) were treated without saphenous vein interruption. Results Primary healing: 15 patients (55.56%, 15/27) in conventional group, 21 patients (84.00%,21/25) in interruption group. With effusion: 17 patients (62.96%,17/27) in conventional group, 7 patients(28.00%,7/25) in interruption group. With venous crisis: 10 patients (37.04%,10/27) in conventional group, 2 patients (8.00%,2/25) in interruption group. There was statistical significance between two groups on the above 3 indexes (P <0.05). With infection: 7 patients (25.93%,7/27) in conventional group; 4 patients(16.00%,4/25) in interruption group. There was no statistical significance between two groups (P>0.05). Conclusions Great saphenous vein interruption could relieve swelling, reduce effusion and have higher primary healing rate in neoplasty using distally crural saphenous neurocutaneous pedicled skin flap compared with the conventional method, which greatly reduce the pain and medical expenses of the patients.

Objective To explore the common bleeding location, disease features, and the management strategies of intractable aged epistaxis. Methods 134 serious epistaxis patients were examined step by step according to nasal anatomic structure and treated by a stepwise way under endoscopy. Results The bleeding location of the intractable aged epistaxis were found as follows:2 cases (1. 49%) in anterosu-perior area, 44 cases (32. 84%) in anteroinferior area, 18 cases (13. 43%) in posterosuperior area, 22 cases (16. 42%) in posteroinferi-or area, 3 cases (2. 24%) in nasopharynx, and the bleeding site of the other 45 cases (33. 58%) were not found. All the patients were healed. The final treatment way were:46 cases (34. 33%) with pharmacotherapy or cauterization (grade Ⅰ~Ⅲ), 88 cases (65. 67%) with anterior nasal packing (grade Ⅳ), 9 cases (6. 72%) with posterior packing(gradeⅤ),1 case (0. 75%) with selective angiographic embolization (grade Ⅵ). There were 82 cases (61. 19%) succeed with the initial hemostasis methods while 52 cases (38. 81%) succeed with the upgrade therapy. Both hemostasis methods and upgrade therapy had statistical significance in different nasal position groups ( hemo-stasis methods:χ2 =16. 35,P=0. 00; upgrade therapy: χ2 =16. 35,P=0. 00). Conclusion Compartmental examination and classified treatment steps by using endoscope may locate and stop nose bleeding promptly while decrease patients' pain and medical cost.

Objective: To investigate the recurrence of pulmonary tuberculosis patients 5 years after successful treatment in Hengyang City, Hunan Province, and to analyze its influencing factors. Methods: The data of pulmonary tuberculosis patients who were successfully treated in Hengyang City in 2014 were collected through the tuberculosis management information system. The recurrence of pulmonary tuberculosis was defined as the endpoint, and all patients were observed for five consecutive years. Factors affecting recurrence of pulmonary tuberculosis were identified using Kaplan-Meier estimates, log-rank test and multivariable Cox proportional hazards regression analysis. Results: A total of 6 626 patients with successfully treated pulmonary tuberculosis were included, including 4 961 males and 1 665 females, with a median age of 54 years. There were 536 cases with recurrence of pulmonary tuberculosis within five years, with a 8.09% cumulative proportion of recurrence and annual recurrence rate of 1.75 per 100 person-years. Multivariable Cox proportional hazards regression analysis showed that men ( HR=1.592, 95%CI: 1.256-2.019 ), age of 40 years and greater ( age of 40 to 59 years, HR=7.025, 95%CI: 1.739-28.377; age of 60 years and greater, HR=8.175, 95%CI: 2.024-33.023), farmers ( HR=1.379, 95%CI: 1.070-1.778 ), retreatment ( HR=6.398, 95%CI: 5.163-7.929 ) and positive etiology ( HR=1.255, 95%CI: 1.042-1.511 ) were risk factors for five-year recurrence of pulmonary tuberculosis among successfully-treated patients. Conclusions High recurrence rate is found among pulmonary tuberculosis patients within five years after successful treatment in Hengyang City. There is a high risk of pulmonary tuberculosis recurrence among male, etiologically positive, retreated farmers at ages of 40 years and older, and targeted interventions are recommended.

Purpose: This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. Materials and Methods: Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. Results: With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

As an emerging discipline that combines traditional diagnostic methods with modern scientific technology,micro syndrome differentiation has good prospects for development,but there are some controversies in the research process.Based on ancient and modern literature,this article reviewed the origin and flow of research on micro syndrome differentiation,and summarized the problems to be improved in the process of research on micro syndrome differentiation from three aspects:application of disease type,guiding ideology and micro indicators.Based on this,the article further expounded the new thinking on"near-micro"syndrome differentiation from three aspects:connotation,scope of application,and links to traditional identification and micro-identification,and pointed out that the modern medical detection basis should be incorporated into the field of TCM syndrome differentiation,and at the same time,it should be based on the overall thinking mode of TCM,which would provide a new idea for the development of modern TCM diagnosis technology.

Objective: To investigate the effect of silencing the endoplasmic reticulum stress-related protein calnexin on the proliferation, invasion, and migration of tongue squamous cell carcinoma cells. Methods : Calnexin siRNA was transfected into SCC-9 and SCC-25 tongue squamous cell carcinoma cells, and the expression of calnexin was detected by qRT-PCR. The silencing effect of calnexin siRNA was further verified by Western blotting. CCK-8 assay was applied to detect the effect of silencing calnexin on the proliferation of tongue squamous cell carcinoma cells; Transwell assay was used to detect the effect of silencing calnexin on the invasion and migration of tongue squamous cell carcinoma cells. Results : qRT-PCR showed that calnexin siRNA could effectively downregulate the expression of calnexin. Western blot analysis further confirmed the silencing effect of calnexin siRNA on calnexin. The CCK-8 assay showed that silencing calnexin expression on the 4th and 5th days could inhibit the proliferation of tongue squamous cell carcinoma cells, and the difference was statistically significant (P < 0.01). The Transwell assay showed that knockdown of calnexin could inhibit the invasion and migration of tongue squamous cell carcinoma cells (P < 0.001). Conclusion Knockdown of calnexin can inhibit the proliferation, invasion, and migration of tongue squamous cell carcinoma cells.