Objective To demonstrate the clinical outcome of bilateral gluteus maximus musculocutaneous flap in conjunction with continuous postoperative negative pressure wound therapy in reconstruction of sacral soft tissue defects.Methods From January, 2008 to April, 2013, 18 patients (8 males and 10 females, aged from 34 to 78 years old) with full-thickness sacral soft tissue defects were treated.The size of the defects after initial debridement ranged from 3.0 cm × 2.0 cm to 18.0 cm × 14.0 cm, with the exposure of sacrum or ligament.Bilateral gluteus maximus musculocutaneous flap were applied in all the patients.Two drainage tubes were placed on each side of the flaps during the surgery and suck for 10 to 12 consecutive days after the operation.Results The size of the harvested flaps ranged from 12.0 cm × 8.0 cm to 18.0 cm × 12.0 cm, and all the donor sites of the flaps were closed with primary suture.Thirty-five flaps in 17 patients survived without any complication.Partial necrosis of one flap was found in 1 patient and managed successfully with conservative dressing change.Fourteen patients were followed-up ranged from 8 months to 2.5 years (mean follow-up was 18 months).Color and texture of the flaps were satisfactory and no recurrence of sacral defect was noted.Conclusion Bilateral gluteus maximus musculocutaneous flap in conjunction with continuous postoperative negative pressure wound therapy may serve as a useful option for fullthickness sacral soft tissue defects.

Objective To study doctor-nurse associated pain intervention effect on postoperative patient-controlled analgesia of patients with lower limb fractures and their negative emotions.Methods One hundred and twenty patients with lower limb fractures who used the postoperative fentanyl patient-controlled analgesia method in the author's hospital from June 2015 to June 2016 were selected with a convenience sampling method. The patients from June 2015 to December 2015 were included into the control group (n=60). The patients from January 2016 to June 2016 were included into the observation group (n=60). The patients in the control group were cared with the postoperative routine nursing. The patients in the observation group were cared with the postoperative doctor-nurse associated pain nursing intervention. The visual analogue pain (VAS) and the Ramasy sedation score of patients in the two groups who were at admission,6 h,24 h,48 h and 72 h after surgery,discharged from hospital were evaluated and compared. The negative emotions of patients in the two groups one day before operation and three days after operation were evaluated with the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS). The complications during patient-controlled analgesia in the two groups were recorded.Results The VAS score and the Ramasy sedation score of patients were significantly different at different time points(Ftime=145.263,132.561;P<0.05). The VAS score and the Ramasy sedation score of patients were significantly different between the two groups(Fgroup=122.451,98.126;P<0.05). There was a significant effect between time and group (Finteraction=102.454,118.259;P<0.05). The SAS score and the SDS score were significantly lower in the observation group compared to the control group (P<0.05). The incidence of nausea and vomiting,the incidence of dizziness and the amount of sufentanil after surgery in the observation group were significantly lower than those in the control group (P<0.05). The satisfaction score of the patients in the observation group was higher compared to the control group (P<0.05). Conclusions The doctor-nurse associated pain intervention can improve postoperative anxiety and depression of patients with lower limb fractures,reduce the postoperative pain,contribute to the postoperative sedation, reduce the dose of postoperative anesthesia medication and complications,enhance patient-controlled analgesia pump effects and patients' satisfaction.

Objective:To explore the expressions of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) and clinicopathological characteristics in post-transplant lymphoproliferative disorder (PTLD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children, with the aim of clarifying whether checkpoint inhibition of PD-1/PD-L1 inhibitors may serve as a therapy option.Methods:The clinical data of 13 cases of PTLD after allo-HSCT pathologically confirmed in Shenzhen Children′s Hospital from January 1, 2012 to December 30, 2019 were retrospectively analyzed.The detection was performed by immunohistochemical staining by MaxVision? method, Epstein-Barr virus(EBV) in situ hybridization and lymphoma gene rearrangement.The relationship between the expression of PD-1 and PD-L1 and the clinicopathological characteristics of PTLD were analyzed.Results:The expression of PD-1 was not correlated with gender, age, primary diseases, histopathological types, transplantation mode and the expression of EBV in situ hybridization (all P>0.05). The expression of PD-L1 was correlated with histopathological types ( P<0.05). Furthermore, the expression rate of PD-L1 on severe β-thalassemia was significantly higher than that of severe aplastic anemia [90.0%(9/10 cases) vs. 66.7%(2/3 cases)] and monomorphic PTLD was higher than that of polymorphic PTLD [100.0%(2/2 cases) vs. 83.3%(5/6 cases)]. Moreover, the positive PTLD in EBV was higher than the negative PTLD in EBV [90.9%(10/11 cases) vs. 50.0%(1/2 cases)]. The positive rates of PD-1 and PD-L1 in 13 cases with PTLD were 46.2%(6/13 cases) and 61.5%(8/13 cases) in tumor cells, 92.3% (12/13 cases) and 76.9% (10/13 cases) in microenvironmental cells, and 84.6%(11/13 cases) in EBV, respectively. Conclusions:PD-L1 has a higher positive rate in tumor cells with monomorphic PTLD; and routine staining for PD-1 and PD-L1 can be performed in all types of PTLD when standard immunotherapy and chemotherapy are ineffective.

The vast majority of the published papers dealing with the treatment of wounds in the past few decades reported that extracorporeal shock wave therapy (ESWT) used in wound repair is easy in manipulation, noninvasive, safe, effective, and well tolerated by patients. However, little is known about the mechanism of ESWT in wound healing to date. In this article, we reviewed the literature to identify the potential cellular and molecular mechanisms of ESWT in the process of wound healing, and the results of the literature showed that the mechanism of ESWT in promoting wound healing is the result of heterogeneous biological effects.
High-Energy Shock Waves ; therapeutic use ; Humans ; Skin ; Soft Tissue Injuries ; therapy ; Ultrasonic Therapy ; methods ; trends ; Wound Healing ; physiology