Objective To explore the effect of using pedicle skin flaps for treatment of skin and soft tissue defects.Methods From January 2004 to September 2010,87 patients with skin and soft tissue injury which had been treated by using pedicle skin flaps without vessel anastomosis were retrospectively analyzed,including 61 males and 26 females with an average age of 40 years (range,14-61).The pedicle skin flaps selected were known vessel skin flaps or unknown vessel random skin flaps.The reconstruction treatment increased multiple selections of skin flaps for patients.Skin and soft tissue defects were located at the hand in 21 cases,at the lower extremities in 66.The kinds of skin flaps included adjacent transposition flaps in 50 cases,distal skin flaps in 37.The areas of the skin flaps were 2.0 cm×1.5 cm-18 cm×12 cm.Donor sites were as follows:lower leg in 61 cases,abdomen in 18,and hand in 8.Results Three patients appeared skin flaps hematoma after operation,which were removed immediately with no effect on flaps survival.Pedicle skin flap was compressed due to unstable fixation in 1 case,which made distal flap tissue necrosis approximately 2 cm in width.After dressing change for 6 weeks,the flaps got survival.Thirty seven patients underwent the second stage operation for breaking the perdicle 3 weeks after the first operation.All 87 patients were obtained follow-up for an average of 13 months (range,3-60).The total of 90.80％ patients treated with pedicle skin flaps were satisfied with the results.Conclusion Pedicle skin flap surgery can be performed more easily with less limitations of surgical designs.The survival rate of the flap is high,and the treatment of pedicle skin flaps could be well applied for soft tissue defects.

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE MRA) in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ (923/945) in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows:proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC(area under ROC curve) of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

Objective To analyze and evaluate changes of the brain gray matter in patients with Parkinson's disease (PD).Methods 46 patients with PD and 19 normal control(NC) subjects(matched to the patients in age and gender) were selected in this study.46 cases of PD were divided into early PD group(ePD,25 cases) and middle-advanced PD group(maPD,21 cases) by improved Hoehn-Yahr(H-Y) stages.All the subjects underwent 3.0T MR scanning,and data of high resolution T1-weighted imageing (T1WI) were acquired.Gray matter volume differences between PD group and NC group,or ePD group and maPD group were assessed by voxel-based morphometry (VBM) combined diffeomorphic anatomical registration through exponentiated lie (DARTEL) method.Results The gray matter volume of the bilateral frontal lobes, temporal lobes, insular lobes, cingulum gyrus, hippocampus, fusiform gyrus, cerebellum and right cuneus lobe and precuneus lobe in the PD group was smaller than that in the NC group.The gray matter volume of the bilateral frontal lobes, temporal lobes,insular lobes,cingulum gyrus,rectus gyrus,lingualis gyrus,fusiform gyrus,hippocampus,amygdaloid and cerebellum in the maPD group was smaller than that in the ePD group.Conclusion VBM reveals a widespread volume reduction of the gray matter in PD patients,and detectes a correlation with disease duration and severity.These changes located in special distribution may be in line with the pathology of PD.

Objective To evaluate the feasibility and diagnostic accuracy of CE-MRA with low dose contrast agent by comparison with DSA in diabetic patients with peripheral arterial diseases. Methods ( 1 )Study in vitro: test tubes containing Gd-DTPA of different concentrations were scanned, and the relationship between signal intensities and concentrations of GD-DTPA was analyzed. DSA and CE-MRA with selected concentrations of Gd-DTPA were performed on stenotic vascular models to estimate the proper low dose of GD-DTPA for clinical applications. (2) Clinical applications: 78 diabetic patients with peripheral arterial diseases were scanned from the abdomen and pelvis station to the calf-foot station in a 3 T MR system with standard bolus chase 3D CE-MRA sequence after injection of 13 ml GD-DTPA . The image quality,diagnostic rate of stenosis of arteries in calf and degree of venous contamination were evaluated with Fisher's exact test. DSA images of 220 vascular segments in 22 patients ( 10 segments per patient) were acquired as the gold standard and compared with CE-MRA by using Kappa test. Results The MR signal intensities were proportional to the concentrations of contrast agent in present study, and all stenotic segments of vascular model were displayed by CE-MRA with GD-DTPA at lower concentration of 1.5 mmol/L. As for MRA images of 78 diabetic patients with low dose Gd-DTPA, about 97.4% (76/78) showed diagnostic image quality for pelvic and thigh stations. But the MRA images of lower extremities were interfered by the venous contamination significantly (P ＜ 0.01 ). Compared with DSA for 22 patients, the diagnostic sensitivity, specificity and agreement coefficient (Kappa value) of MRA were 96. 0% ( 168/175), 73.3%(33/45), and 0.72 (P＜0.01), respectively. Conclusion Using 3.0 T MR scanner, high quality CE-MRA of lower limb arteries can be obtained for clinical applications with contrast agent dose as low as 13 ml,which has comparable diagnostic sensitivity and specificity with DSA. But the limitation of venous contamination in MRA image should be resolved in further studies.

Objective:To evaluate the efficacy and safety of adalimumab in the treatment of severe plaque psoriasis.Methods:From June 2018 to April 2019, 20 patients with severe plaque psoriasis were collected from Department of Dermatology, Henan Provincial People′s Hospital. After initial subcutaneous injection of adalimumab at a dose of 80 mg, these patients were subcutaneously injected with adalimumab at a dose of 40 mg at weeks 1, 3, 5, 7, 9 and 11. At weeks 4, 8 and 12, psoriasis area and severity index (PASI) was recorded, and changes in skin lesions were observed by reflectance confocal microscopy (RCM) . Adverse reactions were monitored during treatment.Results:At week 4, 12 patients achieved a 50% reduction in PASI (PASI50) ; at week 8, 14 achieved PASI75; at week 12, 20 patients achieved PASI75, of which 5 achieved PASI90 and 2 achieved PASI100. As RCM showed, the melanin content in the basal layer of skin lesions was lower compared with that of perilesional normal skin before treatment, gradually increased within 4 weeks, and nearly returned to normal at week 12. No infections, tumors or other related adverse reactions occurred in the 20 patients.Conclusion:Subcutaneous injection of adalimumab every other week is markedly effective in the treatment of severe psoriasis, with few related adverse reactions.

Objective To identify mutations in keratin genes (KRT1 and KRT10) in a pair of twins with bullous congenital ichthyosiform erythroderma (BCIE),and to explore the relationship between the causative genes and phenotypes.Methods Clinical data were collected from a pair of twins with BCIE and their family members.Peripheral blood samples were obtained from the twins,their old brother and parents,and DNA was extracted from these blood samples.Polymerase chain reaction (PCR)was performed to amplify all the coding exons and their flanking sequences of the KRT1 and KRT10 genes,and 100 unrelated healthy persons served as controls.Results The 11-year-old male proband presented with recurrent blisters,hypertrophy and desquamation all over the body for 11 years.His twin brother had similar skin lesions.Skin examination of the proband showed diffuse erythema covered with thick scaly crusts on the trunk and extremities.Blisters,bullae and erosions due to ruptured blisters were observed locally with tenderness on palpation.There were obvious hyperkeratotic and hard lesions on the big joints of the extremities.Diffuse hyperkeratosis could be seen on the palms and soles.A mutation c.591 + 1G ＞ A was identified at position 1 in intron 1 of the KRT1 gene in the twins,but not in the 3 healthy family members or the 100 unrelated healthy controls.Conclusion The mutation c.591 + 1G ＞ A at position 1 in intron 1 of the KRT1 gene may contribute to the clinical phenotype of the twins with BCIE.

Objective:To report 7 cases of vitiligo caused by eyebrow tattooing.Methods:Seven cases of vitiligo caused by eyebrow tattooing were collected from Department of Dermatology, Henan Provincial People′s Hospital from December 2017 to May 2019, and their clinical features were retrospectively analyzed.Results:One month to 1 year after eyebrow tattooing, several eyebrows became white in the 7 patients. In the early stage, only several eyebrows became white, and the surrounding skin was normal, but white patches with unclear boundaries gradually appeared around the eyebrows in the later stage. Reflectance confocal scanning microscopy of skin lesions on the eyebrow showed depigmentation in the basal layer and around hair follicles, and highly refractive amorphous substances (colorants) in the superficial and middle dermis. The 7 patients all showed negative patch test reactions to eyebrow colorants but positive reactions to sodium dodecyl sulfate.Conclusion:No depigmentation was observed on the eyebrow skin in the early stage of vitiligo caused by eyebrow tattooing, and reflectance confocal scanning microscopy of eyebrow lesions may be beneficial in reducing its misdiagnosis.

Objective    To summarize the clinical experience of surgical resection of synchronous multiple ground-glass nodules (SMGN), and explore the individualized diagnosis and treatment strategy of SMGN. Methods    Clinical data of 84 patients with SMGN who underwent thoracic surgery in Anhui Chest Hospital from July 2016 to August 2018 were analyzed retrospectively, including 18 males (21.4%) and 66 females (78.6%), aged 32-80 (55.6±10.3) years. The results of operation and the information of GGNs were analyzed. Results    Except for 1 patient who was converted to thoracotomy due to extensive dense adhesion of thoracic, other patients underwent video-assisted thoracoscopic surgery successfully. All patients recuperated successfully after operation, without severe perioperative complications or death. Finally, 79 patients were diagnosed as malignant tumors (94.0%), and 5 patients of benign lesions (6.0%). A total of 240 GGNs were removed, among which there were 168 pGGNs, including 68 benign lesions (40.5%) and 100 malignant tumors (59.5%), and 72 mGGNs, including 2 benign nodules (2.8%) and 70 malignant tumors (97.2%). Nodules diameter (P<0.001), consolidation/maximum diameter of nodule ratio (P<0.001), vacuole sign (P<0.001), air bronchograms sign (P=0.001), spine-like process (P=0.001), pleural indentation sign (P<0.001), lobulation sign (P<0.001), and vascular convergence (P=0.002) were correlated with malignant tumor. Conclusion    Analysis of the imaging features of GGNs by thin-section CT scan and three-dimensional reconstruction is of great value in predicting the benign and malignant nodules, which can guide the surgical decision-making and preoperative planning. Through reasonable preoperative planning and following certain principles, simultaneous surgical treatment for SMGN is safe and feasible.