Objective: To investigate the clinical application of repairing the large-area skin defect of legs with medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap. Methods: 16 cases with a large area of soft tissue defects caused by severe trauma were included in this study. The vascular pedicles of free thoracic umbilical flap were anastomosed with the opposite posterior tibial artery and vein, and the pedicle skin tubes were made and amputated 4 weeks after surgery.Observation of postoperative flap include survival situation, shape, color, elastic, scar contracture, and dysfunction. Results: 16 cases of postoperative all flaps survived.In 1 case pain occurred 10 hours after the operation and led to arterial crisis, which was relieved with analgesia.There were no vascular crisis in other 15 eases. Followed up for 2-24 months, all the flaps survived with good color, elasticity and sensory recovery. There was no apparent stiffness in double knee and ankle joint. Conclusions For the injured limbs impossible to be repaired with local vascular pedicle, routine local transfer of skin flap or cross leg skin flap, the bridge cross anastomosis of free flap graft may be an ideal surgical treatment.

Objective: To isolate and identify the structures of triterpenoids from the extract of Acanthopanax sessiliflorus fruits. Methods:The chemical constituents were systematically isolated by column chromatography and liquid chromatography, and their struc-tures were determined by spectral data including 1 H-NMR, 13 C-NMR, HSQC and HMBC combined with ESI-MS. Results:Totally 8 trit-erpenoids compounds were isolated and identified from Acanthopanax sessiliflorus fruits, 22-α-hydroxychiisanogenin (1), chiisanogenin (2), 3-oxo-24-methylenecycloartan (3), mangiferonic acid (4), isomangiferolic acid (5), oleanolic acid (6), betulin (7) and betulin-ic acid (8). Conclusion:Compound 3, 4 and 5 are obtained from Acanthopanax genus for the first time.

Objective To investigate the clinical outcome of the feasible method of the free string type dor salis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm.Methods From May,2011 to January,2017,the anterior combined ankle flap of the ankle were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases survived.Follow-up were done from 2 months to 2 years after operation.Bone healing was achieved in all cases.Two-point discrimination recovered to 6-8mm.Total active range of motion of the fingers reached 75 ％ of the normal side.Both appearance and texture of the flaps were good.Both the appearances of the repaired palms and the functional recovery were satisfactory.The function assessment of the hand was excellent in 8 cases,good in 5 cases,fine in 2 cases and poor in 1 case.The eligible rate was 81.25 ％.Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant,which facilitate the dissection of the flaps during operation.The repairement of skin defects at two sides,both the palm and the back of hand,can be achieved via one operation.Therefore,the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.

Computer Simulation ; Models, Statistical

Objective:To investigate the predictive value of serum levels of C-C motif chemokine ligand 21 (CCL21) and C-X-C motif chemokine receptor 3 (CXCR3) for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to No.215 Hospital of Shaanxi Nuclear Industry from July 2020 to December 2023 were prospectively included. Serum CCL21 and CXCR3 test results and general clinical data at admission were collected using the hospital electronic medical record system. The independent influencing factors of SAP were identified through multivariate logistic regression analysis, and the predictive value of serum CCL21 and CXCR3 levels for SAP were analyzed by receiver operating characteristic (ROC) curves. Results:A total of 150 patients with AIS were enrolled, including 91 males (60.67%), aged 61.48±7.92 years. Among them, 41 patients (27.33%) developed SAP during hospitalization. There were significant differences in serum CCL21 and CXCR3 levels, National Institutes of Health Stroke Scale score, Glasgow Coma Scale score, invasive mechanical ventilation, length of hospital stay, and the proportion of patients with hypertension and diabetes between the SAP group and the non-SAP group (all P<0.05). Multivariate logistic regression analysis showed that serum CCL21 (odds ratio [ OR] 1.022, 95% confidence interval [ CI] 1.006-1.039; P=0.006) and CXCR3 ( OR 1.036, 95% CI 1.018-1.054; P<0.001) levels were the independent risk factors for SAP. ROC curve analysis showed that serum CCL21 and CXCR3 levels had good predictive power separately for SAP. The areas under the curve was 0.730 (95% CI 0.634-0.825) and 0.807 (95% CI 0.721-0.892), respectively. The combined prediction of the two showed an area under the curve of 0.881 (95% CI 0.819-0.943). Conclusion:The patients with AIS generally have higher levels of serum CCL21 and CXCR3. The levels of serum CCL21 and CXCR3 are closely associated with SAP, and both of them have a good predictive effect on SAP alone or in combination.