Objective To evaluate the outcome of the procedure of using the free flap vascularized by the dorsal artery of big toe to treat finger skin defect.Methods From August 2010 to April 2013,21 cases of finger shin defect were treated with the free flap vascularized by the dorsal artery of big toe in which emergency surgeries were conducted in 9 cases and sub emergency surgeries were conducted in 12 cases.The age of the 21 patients was 21 to 48 years old and 15 of them were males and 6 were females.Thumb was involved in 6 patients and index finger was involved in 15 patients.The skin defect occurred at dorsal in 7 patients and palm in 14 patients.The area of the flaps ranged from 2.2 cm × 1.6 cm to 4.0 cm × 3.2 cm.Observed the restoration of the affected fingers' appearance and function,investigated the clinical results and concluded the indication and advantages and disadvantages of this procedure by following up.Results All of the 21 flaps survived at the last office visit.The follow-up period ranged from 3 to 18 months.The shapes and the fingerprints of the flaps were satisfied.The color and texture of the flaps were similar to those of the finger skin.The 2 points discriminations of the flaps was 6-8 mm.No function deficits were found in the donor feet.Conclusion This free flap is satisfied in the shape,easy to harvested and the blood supply was constant in its location,and recommend it in treating the small of middle area skin defect in the finger.

Objective To compare the number of lymph node dissected by intraoperative lymphatic mapping guided D2 gastrectomy and that by standard D2 gastrectomy plus lymphadenectomy in patients of advanced gastric cancer. Methods In this study 20 advanced gastric cancer cases received intraoperative peritumor injection of carbon nanoparticles suspension ( group 1 ) and D2 lymphadenectomy was guided by the black-stained lymph nodes. 21 cases undergoing standard D2 lymphadenectomy served as controls (group 2). The number of lymph nodes removed and the condition of lymphatic metastasis in two groups, blackstained lymph nodes in group 1, and postoperative complications were compared. Results The average lymph nodes dissected in group 1 (35. 1 ± 13.4) were higher than in control group (26.2 ±7.8). The differences were statistically significant (t =2. 126, P =0. 034). The number of removed N2 and N3 lymph nodes in group 1 were more than that in control group. The total black-stained ration of lymph nodes was 52. 7% in group 1. The positive rate of lymph nodes was higher in black-stained lymph nodes (27.6%) than in unstained lymph nodes ( 10. 8% ) in group 1 and in control group ( 16. 9% ). The differences were also statistically significant ( x2 = 6. 034, P = 0. 016; x2 = 5. 142, P = 0. 023 ). Postoperative afferent loop obstruction developed in one case in group 1. Conclusions Lymphatic mapping guided D2 radical gastrectomy plus lymphadenectomy increases the number of lymph nodes dessected and improves the efficiency of positive lymph nodes excision for patients of advanced gastric cancer.

Objective To discuss the significance of the retrograde urethrography in diagnosis and treatment of urethraltrauma. Methods 78 cases with urethraltrauma treated by the retrograde urethrography were retrospectively analyzed. Results The location and extent of urethral injury was determined according to the place and speed of contrast medium overflow and the diffuse range. Among 78 cases ,29 cases were bulbar urethral trauma and other 49 cases were membranous urethral trauma.Conclusion Retrograde urethrography is simple, practical and easy to operate for determining the injured part of urethra and the extent of damage of urethraltrauma, and was instructional for the choice of operation method and incision.

Objective To analyze the efficacy and safety of HAA induction regimen consisted of homoharringtonine (HHT),cytarabine (Ara-C) and aclacinomycin (ACM) in naive and refractory relapsed acute myeloid leukemia.Methods Data from 66 acute myeloid leukemia (AML) cases hospitalized and treated with HAA induction regimen was analyzed retrospectively.Results 45 of the 66 cases suffered from naive AML,and 21 were refractory relapsed.HAA efficacy in naive AML was evaluated in 41 cases with 36 in complete remission (CR) and 1 in partial remission (PR).The efficiency of HAA induction regimen was 90.2 ％ (37/41)in naive AML group and 42.9 ％ (9/21) in refractory relapsed group,respectively.There were no differences (P ＞ 0.05) when considering patient' s gender,age,disease subtype and white blood cell count at onset.14 patients in CR with naive AML were followed-up for a median time of 9 months (2-17 months),and 5 cases relapsed (35.7 ％) in a range of 2-8 months.The median myelosuppression period was 14 days (3-23 days).Nausea and vomiting [20 ％ (13/66)] were the major side effects of HAA regimen,and the other side effects were abdominal pain and diarrhea [9 ％ (6/66).After chemotherapy,53 ％ (35/66) of the cases experienced infection/fever due to neutropenia.Other severe non-hematological side effects did not occur.Conclusion HAA regimen may be an ideal choice for the induction chemotherapy of naive and relapsed refractory AML.

Objective To study the value of the technique of "Push-pull traction-relax homingrepeatedly confirmed" in the prevention of bile duct injury in LC. Methods From March 2001-August 2009, we applied this technique in 4800 cases of LC. The technique of "Push-pull traction" showed the structures of in the Calot's triangle. The technique of "relax homing" was to restore the cystic duct,hepatic duct and common bile duct to their original anatomical positions. The technique of "repeatedly confirmed" repeatedly identified the positions of the cystic duct, the common hepatic duct and the common bile duct. Results There was no bile duct injury. Conversion to open surgery happened in 118patients due to difficulties in identifying the Calot's triangle structures, bile duct stones, gallbladder cancer, and gallbladder-duodenal fistula. Conclusions The "Push-pull traction-relax homing-repeatedly confirmed" technique could effectively prevent bile duct injury in LC. The method is simple, easy to master and worthy of promotion.

Objective:To explore the role of an exosomal long non-coding RNA zinc finger E-box-bingding homeobox 1 antisense 1(ZEB1-AS1) from adipose-derived MSC(adMSC) and its action mechanism in DN.Methods:DN rat model and high glucose(HG)-induced glomerular mesangial cell(GMCs) model treated with exosomal ZEB1-AS1 from adMSC were used for biochemical analysis and inflammation/oxidative stress assessment. The binding relationships among ZEB1-AS1, microRNA(miR)-142-5p, and phosphatase and tensin homolog deleted on chromosome 10(PTEN) were confirmed by dual luciferase reporter assay. Western blotting was used for the measurement of PTEN protein level.Results:adMSC-secreted exosomal ZEB1-AS1 reduced the levels of blood glucose, serum creatinine, 24 h urinary protein, kidney weight, fibrosis, and inflammatory cell infiltrations in DN rats. Meanwhile, both in DN rats and HG-induced GMCs, the levels of tumor necrosis factor(TNF)-α, interleukin(IL)-6, and IL-1β were inhibited, but glutathione peroxidase(GPx), superoxide dismutase(SOD), catalase(CAT), and glutathione(GSH) were promoted by exosomal ZEB1-AS1 treatment. Additionally, miR-142-5p was identified to bind to ZEB1-AS1, while miR-142-5p further targeted PTEN. miR-142-5p overexpression or PTEN silencing reversed the inhibiting effects of exosomal ZEB1-AS1 on inflammatory cytokine levels and the promoting effects on the concentrations of antioxidant enzymes.Conclusion:Exosomal ZEB1-AS1 from adMSC prevents DN progression by controlling inflammation and oxidative stress via the miR-142-5p/PTEN pathway, suggesting that ZEB1-AS1 may serve as a potential and effective therapeutic target for treating DN.

Objective:To investigate the effects of daurinsoline (DS) on L-type calcium channel Cav1.2 expressed in HEK293 cells.Methods:Cav1.2 was transferred into HEK293 cells using Lipofectamine 2000, and the effects of DS on Cav1.2 currents (ICav1.2) were analyzed by whole-cell patch clamp techniques. Results:DS at 1,3 and 10 μmol·L-1could inhibit the ICav1.2in HEK293 cells in a dose-dependent manner. The inhibitory rate was(14.68 ± 4.02) %,(32.37 ± 6.63) % and(59.63 ± 5.23) %,respectively. The inhibitory rate of DS at 3 μmol·L-1was 40 % of that of 3 μmol·L-1isradipine(a L-type calcium channel blocker). Conclusion:DS can inhibit the ICav1.2in HEK293 cells in a dose-dependent manner and the inhibition of DS is weaker than that of isradipine.

Objective Discuss the clinical efficacy by using two kinds of mini perforator free flap for digital injuries reconstruction. Methods From August, 2014 to February, 2017, 45 patients were managed randomly with either radial artery superficial palmar branch(RASPB)perforator free flap or digital artery(DA)perforator free flap for digital skin defects reconstruction, and they were therefore divided into two groups according to the flap type. There were 24 patients in RASPB group, with an average wound dimensions ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm, and an average harvested flap size ranged from 2.0 cm×1.7 cm to 4.2 cm×2.6 cm. Another 21 patients were in DA group, with an average wound dimensions ranged from 2.0 cm×1.5 cm to 3.8 cm×3.0 cm, and an average harvested flap size ranged from 2.2 cm×1.6 cm to 3.9 cm×3.2 cm. The survival rate, sensory function, donor site complications, hand function recovery and aesthetic outcomes of two groups were compared by the SPSS22.0 statistical software after surgery. Results The mean follow up period was 15 months. All flaps were primary survived without vascular crisis. The flaps were soft in texture,trimness in appearance and none of them overtop the normal skin for more than 0.5 cm. Both groups had a favorable sensory recovery.All cases recovery to S3+or better.In Group RASPB,the mean two point discrimination(2 PD)was 7.85±1.15 mm(ranged from 7.0 mm to 9.0 mm). And it was 6.02±0.94 mm(ranged from 6.0 mm to 8.0 mm)in DA group. The difference between two groups was statistically significant(P <0.05). Then we synthetically analyzed flap texture and sensory function,and calculated the qualified ratio of each group.There was no significant difference between two groups(P > 0.05). The degree of scar contracture demonstrated donor site compli cations in RASPB group was lesser than that in DA group(P<0.05).The range of motion of interphalangeal joint was used to reflect the hand function. And we calculated the ratio of repaired and contralateral sites. The difference of the mean ratio between two groups was not statistically significant(P>0.05). Conclusion On account of the characteristics of invariant anatomy position, sufficient blood supply, favorable aesthetic outcome and minimal donor site mobility, both RASPB perforator flap and DA perforator flap were optimal for digital skin defects reconstruction.Besides,incorporated with nerve and tendon,the RASPB perforator flap can also be used for complex tissue transplantation,and the surgery field was only on the arm.While the DA perforator free flap had an advantage of better sensory recovery and appearance.

Objective To investigate the therapeutic effect of different combination regimens on patients with high-frequency sudden sensorineural hearing loss(SSNHL). Methods 82 patients with high-frequency SSNHL from December 2013 to May 2017 were enrolled. The control group was treated with hormone,lidocaine, and genetein combination therapy,while the observation group received systemic hormones,and local hormones combined with hyperbaric oxygen therapy,the average frequency of pure tone valve improvement,complications and adverse reactions in two groups were compared.Results After the treatment,the average pure tone of the two groups was significantly improved than pretherapy(tcontrol group = 10.28,P = 0.00;tobservation group = 11.06, P=0.00),but there was no significant difference in hearing improvement between the two groups(t=0.680,P=0.698),the total effective rate in the control group was 63.41%,in which the observation group was 68.29%,the difference was not statistically significant(χ2=0.230,P=0.816),but the cure rate was 26.83% in the observa-tion group which was higher than that in the control group(7.32%)(χ2=2.05,P=0.040).There was no signifi-cant difference in improvement of complication(tinnitus and ear nausea)between the two groups(χ2Tinnitus =0.000,P=1.000;χ2Aurussion=0.000,P=1.000),and there was no obvious adverse reaction in both groups. Conclusions Treatment of high-frequency SSNHL,hormone and hyperbaric oxygen therapy is good and safe, which can effectively improve the patient′s complication(tinnitus and ear nausea).

Objective:To investigate the curative effect of transfer of free anteriolateral thigh flap (ALTF) with partial iliotibial tract on reconstruction of composite tissue defects in dorsal wrist/hand.Methods:Ten patients who were admitted in the Department of Hand Surgery of Yongkang Orthopaedic Hospital from March 2018 to August 2022 were entered in the study due to extensive composite tissue defects in dorsal wrists and hands. The patients were 24-48 (37 in average) years old. All patients had tendon defects in 3 or more digits with 35 digits in total. The length of the tendon defects were 5.0-11.0 cm in various digits. The soft tissue defects ranged from 6.0 cm×8.0 cm to 11.0 cm×21.0 cm in size. Six patients had defects accompanied with metacarpal and phalangeal bone fracture and joint capsule. In emergency surgery, all patients received thorough debridement and VSD coverage after internal fixation for combined fractures. At 3-5 days after the primary surgery, free ALTF transfer with partial iliotibial tract was employed to reconstruct the defects on dorsal wrists and hands and the digit extension function. The size of flap was 6.0 cm×9.0 cm-9.0 cm×17.0 cm, and the rest of defect wound was covered by skin graft. All the donor sites were sutured directly, except 1 that received abdominal skin graft. Patients had the follow-ups in outpatient clinics, or via telephone or Wechat, to observe the sensation and appearance of the flap, and the healing of the donor site. The recovery of the extension function of the hand was evaluated according to the totle active motion (TAM) system.Results:All flaps survived except one that had vascular compromise after the surgery and it survived after two explorations and a vascular transfer. Postoperative follow-ups lasted for 6 to 24 months, with 13 months in average. At the last follow-up, a all the flaps were found soft in texture and slightly swollen in appearance. There was no obvious pigmentation or rupture of skin and extensor tendon. Sensory recovery achieved to S 2 in 7 patients and S 3 in 3 patients. The hand function was evaluated according to TAM system and rated as excellent for 3 digits, good for 18 digits, fair for 9 digits and poor for 5 digits. There were linear scars in the donor sites. Conclusion:Free ALTF transfer with partial iliotibial tract in the reconstruction of composite tissue defect of dorsal wrists and hands can not only reconstruct the wound surface, but also the extension of digits, which cuts short the course of treatment.