Adult ; Bone Neoplasms ; Humans ; Male ; Nose Neoplasms ; Osteoblastoma ; Skull Base Neoplasms

Objective To introduce the surgical method of reverse radial side of dorsal artery the fascial pedicle island bone flap for the treatment of thumb composite tissue defects,and to evaluate its short term clinical outcome.Methods From May 2010 to March 2012,9 cases with composite tissue defects at thumb were treated with reverse radial side of dorsal artery the fascial pedicle island bone flap,including 5 males and 4 female with an average age of 38 years (range,13-68).All injuries were caused by planer.The time of injury to operation was 3-8 hours,all patients showed in both thumb root plane beyond volar or dorsal,skin and soft tissue defect accompanied by distal phalanx defect.Skin and soft tissue of thumb defect size was 1.0 cm ×1.8 cm to 2.0 cm × 2.2 cm.Preoperative hands anteroposterior and lateral X-ray were routine taken.Imaging findings were associated with the thumb base beyond the distal phalanx fractures,bone defect length was 0.4-0.7 cm.We cut thumb radial side of the dorsal artery fascia flap during surgery operation according to the thumb side wound defect case.The size of the bone flap was 0.2 cm× 0.6 cm to 0.4 cm × 0.8 cm,properly inserting intramedullary distal phalanx fixed base,9-0 line will flap inside the dorsal nerve and a nerve suture flap reconstruction feeling.Results All bone flaps were survived completely,no case occur venous disorders,flap blood circulation was stable,donor skin graft was survival in stage Ⅰ.This group of patients incision were healing 2 weeks after surgery.All the patients were followed up as scheduled,and the follow-up time was 6-12 months.All flaps survived,and the colors,texture,contour of the flaps were good.The two-points discrimination distance was 7.0-10.0 mm on the flap,Thumb distal phalanx healing time was 1.0-1.5 months.Bone absorption was not observed in graft.The thumb function was assessed as excellent in 7 fingers,good in 2 fingers,no complication occurred in donor site.Conclusion The main artery and nerve will not be sacrifice,when the bone flap is used.There are blood into the backbone of the first metacarpal nearly 1/3 of the bone to reconstruct thumb bone defect,the operative procedures is available and easy to be performed,which is a new method for the treatment of thumb composite tissue defects.

Objective To investigate the infection sites,the offending species,diagnosis and prognosis of deep fungal infections (DFI) in patients with systemic lupus erythcmatosus (SLE).Methods Fifty-one patients with fungal infections in 1466 SLE patients admitted to Peking Union Medical College (PUMC) Hospital from 2000 to 2006 were reviewed retrospectively.Results Candida albicans was ranked the first pathogen,followed by ncoformans and Aspergillus species.The infection sites were lungs,cerebral meninges and blood in the order of prevalence.The overall mortality was 20%(10/51).Aspergillasis carried the highest mortality which couht be as high as 80%.Hypoproteinemia,multiple focus of fungal infections,Aspergillasis and fungemia might he the independent risk factor for mortality.Conclusion Candida albicans is the most frequent species of fungal infections in SLE patients.Iungs are the most prevalent location of infection.Earlier diagnosis is important.Special attention should be paid to aspergillasis.

Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu-sioned slightly;defects were associated with exposed bone or tendon, exposed blood vessels. Of the 13 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves-sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cm×2.0 cm to 9.0 cm×5.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cm×3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated andcat eardeformity. Flaps were soft, no bloated appearance;color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small;skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10° to 25°, plantar flexion 15° to 45°. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret-rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.

Objective To investigate the effect of vascular tortuosity and bending radius on the new type knitting stents (LVIS stent ) releasing on the cavernous sinus segment of internal carotid artery. Methods From December 2015 to January 2016,31 consecutive patients with wide-neckedaneurysm treated with LVIS stents and the proximal end of the stent released in the cavernous segment at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled. According to whether the stents completely adhered to the walls or not after the first release,they were divided into two groups:a satisfactorily release group (n =23 )or an unsatisfactorily release group (n =8 ). The differences of vascular tortuosity and bending radius of the 2 groups were compared.Results Thevascular tortuosities of the satisfactorily release group and the unsatisfactorily release group were 118° ± 23° and 147° ± 19° respectively. There was significant difference (P=0. 028). The vascular bending radii were 3. 4 ± 0. 7 mm and 2. 8 ± 0. 7 mm respectively. There was significant difference (P=0. 042). The mean vascular tortuosity was larger and the mean vascular bending radius was smaller in the unsatisfactorily release group. Conclusions The greater the vascular tortuosity,the smaller the vascular bending radius may be connected with the unsatisfactorily release in the LVIS stent. The evaluation of vascular tortuosity is conductive to the guidance of the stent release technique before stent implantation.

OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with posterior perforator from medial malleolus for small skin defect at achilles tendon region.

METHODSFrom Mar. 2011 to Sep. 2012, 7 cases with small skin defect at achilles tendon region were treated by V-Y advanced flap pedicled with posterior perforator from medial malleolus. The flaps was 6.0 cm x 3.0 cm-9.0 cm x 4.5 cm in size. The defects at the donor sites were closed directly.

RESULTSAll flaps survived completely. 7 cases were followed up for 6-8 months after operation. The flaps had good texture and color match. The function of ankle was normal. All patients were satisfied with postoperative function and shape.

CONCLUSIONIt is an ideal reconstruction method for skin defect at achilles tendon region with V-Y advanced flap pedicled with posterior perforator from medial malleolus. It is easily performed with low risk and short recovery time.

Achilles Tendon ; injuries ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Treatment Outcome ; Young Adult

Abstract: Objective　To understand the kdr (knockdown resistance, kdr) gene mutation of the voltage-gated sodium channel (VGSC) of Anopheles sinensis in Yunnan Province. Methods　From 2018 to 2019, mosquitoes were collected in Luoping County, Suijiang County, Tengchong City, Yingjiang County, Yuanjiang County and Mengla County in Yunnan Province. The collected mosquitoes were morphologically identified as Anopheles sinensis and genomic DNA was extracted by kits. The DNA templates were sequenced after PCR amplification and the sequencing results were identify as Anopheles sinensis by homology alignment in NCBI. After the ⅡS5 and ⅡS6 fragments of the sodium channels in Anopheles sinensis were amplified and sequenced, the sequencing results were multiple aligned by DNAMAN software, and the mutations were analyzed one by one with BioEdit software to determine the kdr allele types and genotypes, and the frequencies were calculated. Results This survey amplified 287 sequences, and the sequence maps showed that 1014 loci had three alleles, including wild type TTG/L (89.20%), mutant type TTT/F (9.76%) and TCG/S (1.04%). Five genotypes: homozygous wildtype L/L (85.02%), homozygous mutant F/F (6.27%) and S/S (0.35%), heterozygous mutant L/F (6.97%) and L/S (1.39%). The wild type allele TTG/L was the main allele in six sampling sites except Suijiang County. The frequency of wild type allele in Tengchong City was the highest (100.00%). That is, no mutation was detected, while the rest of counties occurred different degrees of mutation at 1014 loci. The frequency of mutant allele in Suijiang County was the highest, reaching 55.68%. Luoping County, Mengla County and Suijiang County had two mutant types. Yingjiang County and Yuanjiang County had one heterozygous mutant L/F. Conclusion　Wild type L1014 (TTG/L) is still dominant in most areas of Yunnan Province. The kdr mutation type is mainly L1014F, followed by L1014S, and the mutation frequency is lower than that in central provinces of China.

With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program (ASP) at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children's, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses (DDDs) per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient cases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days (P<0.001). The percentage of antibiotic use in outpatient prescriptions (range: 24.12%-18.71%, P=0.109) and inpatient cases (64.85%-60.10%, P=0.006) also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

BACKGROUNDPharmacological therapy has been considered as the first-line treatment for patients with uncomplicated benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the efficacy and safety of tamsulosin compared with a placebo for treating BPH.

METHODSThe randomized placebo-controlled trials (RCT) of tamsulosin for the treatment of BPH from all over the world were searched. PubMed, Ovid, ScienceDirect, EBSCO, CBM, and CNKI were searched, as well as a manual search of four Chinese journals: Chinese Journal of Andrology, National Journal of Andrology, Chinese Journal of Urology, and Journal of Clinical Urology was also performed. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinions were settled by discussion. Meta-analysis was processed by Rev Man 5.0 software, fail-safe number was performed by SAS8.0 software.

RESULTSSeven RCTs involving 2455 men met the inclusion criteria. The basic characteristics of patients were comparable in all the studies. Comparing three common criteria: international prostate symptom score (IPSS)/Boyarsky symptom score, maximum flow rate (MFR), quality of life (QOL), tamsulosin was better than placebo at improving IPSS and MFR, with no significant difference in the QOL. Adverse events of tamsulosin also showed no significant difference from the placebo group (Z=1.62, P=0.10, OR=1.22, 95% CI 0.96-1.54).

CONCLUSIONSTamsulosin is better than placebo at improving IPSS and MFR. Adverse events of tamsuloisn show no significant difference compared with placebo. More high quality trials with larger samples and longer follow-up are proposed.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Humans ; Male ; Prostatic Hyperplasia ; drug therapy ; Randomized Controlled Trials as Topic ; Sulfonamides ; adverse effects ; therapeutic use

OBJECTIVETo discuss the therapeutic effect of thenar perforator flaps for the narrow cicatricial contracture at thumb and the first web.

METHODSFrom Aug. 2010 to Jan. 2012, 9 cases with narrow cicatricial contracture at thumb and the first web, were treated. The defect size after releasing the contracture ranged from 8 mm x 20 mm to 15 cm x 30 mm. The bilateral thenar perforator flaps beside the wound were designed which size was 10 mm x 25 mm to 15 mm x 35 mm. The wounds at donor sites were closed directly.

RESULTSAll the 9 flaps survived completely with primary healing. The patients were followed up for 6-18 months. The flaps had soft texture and good appearance. The shape of flaps and function of the fingers were satisfied after 6-18 months of follow-up. There was no scar contracture at incisions in thenar. The thumb motion was really normal. The abduction of first web was 70 degrees - 90 degrees degrees.

CONCLUSIONSThe thenar perforator flaps is one of the ideal methods for the treatment of narrow cicatricial contracture at thumb and the first web. The main artery is not sacrified.

Arteries ; Cicatrix ; surgery ; Contracture ; surgery ; Fingers ; Humans ; Perforator Flap ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Thumb ; surgery ; Wound Healing