Objective To evaluate the clinical efficacy of ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.Methods Between April,2005 to August,2015,6 patients diagnosed as large skin defects in the upper extremity were treated with ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.The proximal flap blood supply was offered by the superficial circumflex iliac artery,and the distal flap blood supply was provided by the anterior fourth lumbar artery or the posterior intercostal artery.The maximal size of the flap was measured as 35.0 cm×15.0 cm,and the minimal size was 25.0 cm×9.0 cm.The donor sites of the flap were directly sutured.All cases were implemented by postoperative followup visit in hospital for observation of appearance,texture,functions and donor site of flaps.Results Postoperatively,all flaps survived.The follow-up time endured for 6 to 24 months.The flap thickness was appropriate with normal shape and soft texture.Protective sensation and perspiration function of the flap were restored.Linear scars alone were observed in the donor sites of the flap.Conclusion Ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery can extend the excision scope of the flap and provides sufficient blood supply for the flap.The flap texture is soft and can be directly sutured.This technique is an ideal option for repairing of large soft tissue defects of the upper extremity.

Objective To investigate the differences in expression of Mohawk (MKX) transcription factors and collagen of types Ⅰ and Ⅲ in anterior cruciate ligament (ACL) gratis between 2 remodeling outcomes under arthroscopy.Methods Enrolled for this study were 17 patients who had undergone arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and secondary arthroscopic exploration 48 to 131 months (average,83.1 months) after removal of tibial internal fixator at Department of Sports Medicine,The First Affiliated Hospital to Shenzhen University from March 2017 to December 2017.They were divided into a good remodeling group (11 cases) and a fair remodeling group (6 cases) according to the graft quality under arthroscopy (synovial and vascular coverage,and apparent tension,thickness and retear of the grafts).During the secondary arthroscopic procedures,biopsy of the central ACL grafts was performed.Moreover,normal ACL tissues were harvested from 8 contemporary controls of ＜ 60 years old who underwent total knee replacement.Immunohistochemical assay and quantificational real-time polymerase chain reaction were conducted to detect the expression of transcription factors and collagen of types Ⅰ and Ⅲ in all the samples.Results In the samples from good remodeling and control groups,there were abundant well-arranged collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells;in the fair remolding group,the collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells were much decreased in number and the fibers were not well arranged.The former 2 groups scored in immunohistochemical assay significantly higher than the latter one (P ＜ 0.05).qRT-PCR showed that the expression levels of MKX gene (0.44 ± 0.30),COL1A1 gene (0.52 ± 0.27) and COL3A1 gene (0.60 ± 0.22) in the fair remolding group were significantly lower than in the control group (1.00 ± 0.00,1.00 ± 0.00 and 1.00 ± 0.00) and than in the good remolding group (0.97 ± 0.67,0.99 ±0.38 and 1.00 ± 0.35) (P ＜ 0.05).Conclusion Good remodeling ACL grafts with histological maturation under arthroscopy are more similar to normal ACL than fair remodeling ACL grafts in expression of MKX transcription factors and collagen of types Ⅰ and Ⅲ.

Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.