Objective To investigate risk factors for neonatal clavicular fracture,to provide a reference for clinical treatment.Methods A retrospective analysis was performed towards 3 025 live births,47 cases had neonatal clavicular fracture.The birth weight,mode of delivery,maternal age,parity,gestational age,clavicle second stage of labor,the fundus height plus abdominal circumference,cord around neck,and other fracture potential risk factors were analyzed through univariate and multivariate analysis,and the risk factors were summarized.Results 3 025 cases of live births,of which 47 cases had neonatal clavicular fracture,clavicle fracture rate was 1.55%;univariate results sug-gested that the mode of delivery,birth weight,the second stage of labor,maternal age,gestational age,nuchal cord,ma-ternal weight's clinical data index had statistically significant differences between the fracture group and non -fracture group (χ2 =37.514,34.997,28.647,19.847,18.847,16.694,all P <0.05 );multivariate analysis showed that mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index were a newborn children collarbone fracture independent risk factors.Conclusion Mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index are independent risk factors for neonatal clavicu-lar fracture,obstetric should continue to improve midwifery skills,to develop prevention strategies to reduce the inci-dence of neonatal clavicular fracture.

Objective To review our single institutional 10-year experience in complex chest wall reconstruction and identify a working algorithm based on our retrospective analysis.Methods A retrospective analysis of 87 patients who underwent chest wallreconstruction in our department from January 2005 to December 2015.Fifty female patients and 37 male patients who underwent the above procedure were reviewed retrospectively.The median age of the patients is 52.3 years (24-75years).Histologic diagnosis including squamous-cell carcinoma (n =10),soft tissue sarcoma(n =22),chondrosarcomas(n =13) and metastasis from breast cancer(n =42).Type of skeletal defect including partial ribs/sternum defects in 19 cases,soft tissue defects alone in 33 cases,complicated composite chest wall defects involving multiple layers(soft tissue,ribs/sternum,and intrathoracic organs) in 35 cases.Sole methylmethacrylate/polypropylene mesh was used for small sized rib defects in 26cases.Methylmethacrylate/polypropylene mesh sandwich prostheses was used in 28 cases with extensive skeletal reconstruction after partial sternectomy and rib resection.The chest wall defects were repaired with pedicled internal mammary artery perforator flap(3 cases),pedicled deep superior epigastric artery perforator flap(4 cases),pedicled pectoralis major flap(8 cases),free anterolateral thigh perforator flap(9 cases),free deep inferior epigastric artery perforator flap(17 cases),pedicled lateral thoracic flap(5 cases),pedicled latissimus dorsi flap(17 cases),pedicled rectus abdominis flap(15 cases),free deep inferior epigastric artery perforator flap combined with pedicled rectus abdominis flap (4 cases),pedicled bipaddled latissimus dorsi flap(5 cases).11 cases with extensive full-thickness defects of the chest wall,the skeletal reconstruction was achieved with prosthetic sandwich and then covered with the omental flap,further free flaps were harvested for skin and soft tissue repairing.Results 1 case with pedicled rectus abdominis flap partial necrosis was noted,free anterolateral thigh flap was used for repairmen after further revision.1 case with edicled bipaddled latissimus dorsi flap,necrosis of the distal 1/4 part of one paddle was noted,healed with dressing therapy,no secondary skin grafting was required.Postoperative venous congestion occurred in 2 cases with deep inferior epigastric artery flap transplantation,in which both skin flaps exhibited venous crisis within 24 h after surgery.The reexploration procedures were successful in both cases and the flaps survived totally.All other flaps survived.The mean follow-up was 31 months,ranged from 9 to 72 months.No tumour extirpation was noted,functional and appearance results were satisfied.Conclusion According to the size and location of chest wall defect,different pedicled and free flaps should be chosen to achieve optimal outcome.Free flaps are efficient for large complex chest defects reconstruction.

Objective:To explore the association between chest high resolution CT (HRCT) scoring and prognostic factors of interstitial lung disease (ILD) in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM).Methods:The patients with DM admitted to Kailuan General Hospital between January 2017 and December 2019 were included into the study including 13 patients with positiveanti-MDA5 antibody (7 survivors, 6 deaths) and 18 patients with anti-synthase (ARS)-antibody positive. All patients underwent chest HRCT prior to treatment. The consolidation, ground-glass opacity (GGO) and fibrosis were scored to assess HRCT findings. The clinical manifestations were compared between the two groups. Cox regression analysis adjusted for age and sex was used to determine the prognostic factors for anti-MDA5 antibody-related ILD.Results:Compared with ARS patients, glutamyl transferase (GGT) and ferritin levels were significantly higher in MDA5-ILD patients [70.0(37.0, 122.5) vs 21.0(16.5, 33.5), Z=-3.37, P=0.001; 977.0(502.5, 1 366.0) vs 307.1(72.3, 546.9) , Z=-3.44, P=0.001]. The cumulative survival rate was significantly lower in patients with positive anti-MDA5 antibody than in those with positive anti-ARS antibody (100% vs 70%, P=0.001). The DM complicated with acute/subacute interstitial pneumonia (A/SIP) were found to significantly relate to death. There were no significant differences in chest HRCT scoringbetween the survivors and the deceased patients [ HR=1.08, 95% CI(0.95, 1.23), P=0.229; HR=0.97, 95% CI(0.72, 1.30), P=0.814]. Conclusion:Anti-MDA5 antibody is an important index for early diagnosis of DM complicated with acute/subacute interstitial pneumonia (A/SIP). The chest HRCT scoreis is not associated with the prognosis of anti-MDA5 antibody-related ILD patients.

Objective:To investigate the expression and role of the tumor necrosis factor-α (TNF-α) induced protein 8 like-1 (TIPE1) in acute kidney injury (AKI) induced by cisplatin in animal model and cells.Methods:Twelve male C57BL/6 mice aged 6-8 weeks were randomly divided into the control group and the model group. Mice in the model group received a single intraperitoneal injection of 20 mg/kg of cisplatin (20 mg/kg saline in the control group). All mice were euthanized after 5 days. Meanwhile, serum and kidney samples were collected. The levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were detected by biochemical kits. Renal histopathological changes in mice were observed by HE staining. The expression of TIPE1 in kidney was examined using immunohistochemistry. qRT-PCR was used for testing the relative expression of TIPE1 mRNA in mice kidney. Western blotting was used for testing TIPE1 and NGAL protein relative expression in mice kidney. Human kidney proximal tubular cells (HK-2) were stimulated with 20 μmol/L cisplatin for 0, 6, 12 and 24 h to establish cisplatin-induced AKI cell model. The expressions of TIPE1 mRNA and protein were detected by qRT-PCR and Western blotting in HK-2 cells. The expression of TIPE1 gene in HK-2 cells was silenced by lentivirus containing TIPE1 siRNA sequence. Then, TIPE1 stable knockout HK-2 cell strains were treated with 20 μmol/L of cisplatin for 24 hours. The protein expression of tubular damage marker neutrophil gelatinase-associated lipocalin (NGAL), microtubule-associated protein 1 light chain 3 (LC3) and Beclin1 in HK-2 cells were detected by Western blotting. Results:Compared with the control group, the expressions of TIPE1 mRNA and protein were up-regulated and NGAL protein expression was increased significantly in renal tissue of the model group (all P<0.05). The expressions of TIPE1 mRNA and protein were remarkably increased with the prolongation of cisplatin treatment in HK-2 cells (both P<0.05). Compared with the scramble siRNA group, the protein expressions of NGAL, LC3-Ⅱ and Beclin1 were increased significantly in the TIPE1 siRNA group after lentivirus interfered with the expression of TIPE1 gene in HK-2 cells (all P<0.05). Conclusions:The mRNA and protein expressions of TIPE1 are increased in acute kidney injury models. Gene silencing of TIPE1 can promote the expressions of early renal tubular damage marker and autophagy-related proteins, which indicates the excessive autophagy aggravates renal tubular injury. It is suggested that TIPE1 may be involved in the pathogenesis of acute kidney injury.

Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two-point discrimination distances of the sites repaired with relaying ALT perforator flaps were ranged from 7 to 12 mm. The function of thigh was not obviously affected, and patients could walk normally and do related daily activities. Conclusions Reconstruction of defect after oral tumor radical resection with free AMT perforator flap can achieve good outcome, and wound in the donor site of free AMT perforator flap repaired with relaying ALT perforator flap can achieve good appearance and function recovery.

Objective: To investigate the application of free anteromedial thigh (AMT) perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. Methods: From September 2010 to January 2015, 57 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by AMT perforator flaps at the same stage.These 57 eases included tongue carcinoma at lingual margin (n=36), at ventral tongue (n=15) and at mouth floor (n=6). Results: The size of AMT perforator flap ranged from 5.5 cm×4.0 cm to 7.5 cm×5.5 cm, the thickness of flap ranged from 1.0-1.7 cm.The length of pedicle from descending branch of lateral circumferential femoral artery is (8.2±0.6) cm, found in 28 cases.The length of pedicle from profunda femoral artery is (8.5±0.4) cm, found in 17 cases.The length of pedicle from femoral artery is (8.1±0.7) cm, found in 12 cases.All 57 perforator flaps survived uneventfully, the defects at donor site were closed directly in all cases. All patients were followed up for 12-24 months with satisfactory esthetic and functional results in reconstructed tongue. No local recurrence happened. Only linear scar left in the donor sites, the function of thighs were not affected. Conclusions The free AMT perforator flap is an ideal choice for reconstruction of the tongue and mouth floor defect after radical resection of tongue carcinoma.

Objective To investigate the expression and potential diagnostic value of six-transmembrane epithelial antigen of prostate 1(STEAP1)in bladder transitional cell carcinoma.Methods 52 patients with transitional cell carcinoma of the bladder who underwent surgical treatment at the 940th Hospital of Joint Lo-gistics Support Force of the Chinese People's Liberation Army from June 2021 to December 2022 were select-ed as the observation group.In addition,52 patients with benign tumors of the bladder who matched basic clin-ical data such as age,gender,and disease incidence were selected as the control group.The relative expression levels of STEAP1 and STEAP1 mRNA in bladder tumor tissues of patients in the two groups were deter-mined by enzyme-linked immunosorbent assay and real-time fluorescence quantitative PCR,and the relative expression levels of STEAP1 and STEAP1 mRNA in bladder tumor tissues of patients with different patho-logical parameters were compared.Spearman correlation analysis and binary Logistic regression analysis were used to screen the risk factors for the occurrence and clinical stage of bladder transitional cell carcinoma.Re-ceiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnos-tic and predictive value of each indicator for bladder transitional cell carcinoma.Results The relative expres-sion levels of STEAP1 and STEAP1 mRNA in bladder tumor tissues in observation group were significantly higher than those in control group,with statistical significance(P＜0.05).The relative expression levels of STEAP1 and STEAP1 mRNA in bladder tumor tissues of patients with middle and advanced bladder transi-tional cell carcinoma were significantly higher than those of patients with early bladder transitional cell carci-noma,with statistical significance(P＜0.05).Binary Logistic regression analysis showed that the relative ex-pression level of STEAP1 and STEAP1 mRNA in bladder tumor tissues of patients were independent risk fac-tors for the development of bladder transitional cell carcinoma and middle and advanced bladder transitional cell carcinoma(P＜0.05).ROC curve analysis showed that the AUC of STEAP1 and STEAP1 mRNA inde-pendently predicting the occurrence of bladder transitional cell carcinoma was 0.841(95％CI:0.760-0.922,P＜0.001)and 0.936(95％CI:0.893-0.980,P＜0.001),respectively,both of which had high predictive ef-ficacy.Conclusion The relative expression levels of STEAP1 and STEAP1 mRNA in bladder tumor tissues of patients are positively correlated with the occurrence of bladder transitional cell carcinoma and the middle and advanced bladder transitional cell carcinoma,suggesting that STEAP1 can be used as a potential marker for di-agnosis and prediction of the occurrence and development of bladder transitional cell carcinoma.

OBJECTIVETo analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues.

METHODSA total of 850 cases with head and neck tumors who underwent free flap reconstruction from October 2010 to April 2014 were studied retrospectively. The risks for vascular crisis and necrosis were analyzed with one-factor analysis and multivariate analysis.

RESULTSThe total success rate of 95.1% (808/850) for the free flap reconstruction was obtained. Twelve flaps due to poor blood supply indicated during operation were replaced by other free flaps. Among 73 flaps with vascular crisis, 31 flaps were salvaged by surgical exploration and subcutaneous injection of low molecular heparin calcium. Obesity, smoking, preoperative radiotherapy and surgeon's experience, rather than age, hypertension and diabetes, were the risk factors of skin flap necrosis. Two-vein anastomosis had a higher success rate than one-vein anastomosis.

CONCLUSIONSThe necrosis rate of free flaps can be reduced by the choice of suitable flaps, subtly preparation of flaps, carefully vascular anastomosis, and prompt perioperative managements. The two-vein anastomosis is recommended. Diabetes, hypertension and elderly patients are not the contraindications for free flap reconstruction.

Aged ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; surgery ; Heparin ; Humans ; Necrosis ; etiology ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; Retrospective Studies ; Risk Factors ; Surgical Flaps