Objective To explore a new microsurgical method for reconstruction of finger pulp defect.Methods From May 2008 to May 2009,10 male patients with finger pulp defect were treated in our hospital,aged from 18 to 38 years (average,26 years).The index finger was involved in 6 patients,the middle finger in 3 patients and the ring finger in 1 patient.All finger pulp defects were caused by machine injury.The defect sizes ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.Six patients suffered from single skin defect,and 4 patinets suffered from skin defect combined with nail bed laceration and distal phalangeal fractures.All patients were performed emergency operations.The defects were reconstructed by using arterialized venous flap with microsurgical suture of the dorsal branch of the proper digital nerve.The fractures were fixed by Kirschner wires.The donor area was covered with skin grafts.Results All flaps survived completely.The fractures healed 8 to 10 weeks postoperatively.All patients were followed up for 4 to 6 months,all flaps presented satisfactory appearance,normal texture,with no pigmentation at the last followup.The static 2-point discrimination of the flaps ranged from 8 to 12mm.All injured fingers obtained good recovery of flexion and extension of the distal interphalangeal joints.The nails of the fingers with laceration of nail bed grew smoothly.The nail bed with laceration grew smoothly,and some new nails could be seen.The skin grafts applied to the donor area survived completely.Conclusion The arterialized venous flap with suture of the dorsal branch of the proper digital nerve is a good method for reconstruction of finger pulp defect,which had the following advantages:slight donor injury,low anesthesia risk,simple operative technique,and satisfactory postoperative function and appearance.

Objective To evaluate the clinical efficacy of monosegmental pedicle instrumentation in management of thoracolumbar burst fractures. Methods A total of 67 patients with traumatic thora-columbar burst fractures (type A3.1 and A3.2) were treated with monosegmental pedicle instrumentation in our department from October 2003 to February 2008. Imageologic effect was observed by measuring sagittal index and wedge index via X-ray and clinical outcomes evaluated by using low back outcome score. Results All operations were performed successfully, with average operation duration of 93 mi-nutes and average intraoperative blood loss of 157 ml. Of all, 65 patients were followed up for 4-27 months (average 19.8 months), which showed that all the patients achieved bony fusion, with no implant failure except for one with screw loosening. The sagittal index and wedge index were 13.06°and 42.9% preoperatively and 4.47° and 21.78% postoperatively, with statistical difference (P <0.01). The final follow-up showed no significant correction loss except for two patients (P < 0.05). The low back outcome scores of all patients at follow-up were improved significantly (P < 0.05). Conclusions Monoseg-mental pedicle instrumentation has advantages of minimal invasion, short operative duration, less blood loss and less vertebral motion segment loss and hence is an effective and reliable operative technique for thoracolumbar burst fractures.

BACKGROUND:Hydroxyapatite (HA) artificial bone,as bone grafting substitute,would not cause inflammatory reaction or immunological rejection and possesses good biocompatibility after transplantation into human body.It is a novel implant material with bone conduction ability.OBJECTIVE:To investigate the efficacy of HA artificial bone in bilateral open-door posterior cervical expansive laminoplasty and to make a comparison with autogenous bone.DESIGN,TIME AND SETFING:A retrospective case analysis was performed at the Department of Spine Surgery,Hungpuyuan Branch,the First Affiliated Hospital of Sun Yat-sen University from March 2001 to December 2008.PARTICIPANTS:Seventy patients with cervical spondylosis complicated by compression in 3 or more segments or by cervical stenosis and additional fifteen patients with cervical stenosis complicated by cervical trauma were included in this study.METHODS:A bilateral open-door posterior cervical expansive laminoplasty was performed,in which,23 patients received autogenous bone transplantation (autogenous bone group) and 62 patients underwent HA artificial bone transplantation (HA group).MAIN OUTCOME MEASURES:① Japanese Orthopaedic Association (JOA) score pdor to and after surgery,surgery time,and intraoperative bleeding.② HA artificial bone-host biocompatibility.RESULTS:All eighty-five patients were followed up for more than 3 months.There was no significant difference in JOA scores no matter prior to or after surgery between the autogenous bone and HA groups (P＞0.05).The surgery time averaged 85.2 minutes (range 65-110 minutes) in the HA group and averaged 116.4 minutes (range 75-150 minutes) in the autogenous bone group.The intraoperative bleeding averaged 210 mL (range 130-400 mL) in the HA group and averaged 260 mL (range 170-500 mL) in the autogenous bone group.There were no material-host response and other severe complications found in each group,except HA artificial bone fragmentation in 3 patients from the HA group.CONCLUSION:HA artificial bone yields good efficacy and causes fewer complications in bilateral open-door posterior cervical expansive laminoplasty;in addition,it requires less time for surgery and causes less bleeding.

A 26?year?old male patient presented with facial depigmented patches for 10 years, some of which turned to blue?grey 7 years prior to the presentation. Before the white patches turned blue?gray, the patient developed contact dermatitis due to topical application of self?made drugs. Skin examination showed blue?gray hyperpigmentation on the left upper lip and in the temporal region, with white hairs in the hyperpigmented lesions on the left upper lip. Dermoscopy revealed irregularly shaped, light to dark blue?gray patches on the left upper lip, which were intermingled with white patches in some regions, and white hair stubs were observed in the white patches. Histopathological examination of temporal lesions showed decreased melanocytes in some regions in the epidermis, pigmentation in both basal and suprabasal layers, perivascular infiltration of a small number of chronic inflammatory cells and melanophages in the superficial dermis, and melanophage infiltration around sweat ducts. Finally, the patient was diagnosed with blue vitiligo. He refused to receive any treatments, and follow?up was under way.

Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ± 5.6 per-year in group I, 10.8 ± 3.9 per-year in group II, and 9.8 ± 4.2 per-year in group III. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1-7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.

Objective:To analyze the molecular characteristics of Echovirus 11 (Echo11) strains isolated in Xiangyang, Hubei Province from 2016 to 2017 based on the sequences of VP1 gene.Methods:Rectal and throat swab specimens were collected from children with hand, foot and mouth disease (HFMD) in Xiangyang from 2016 to 2017. Echo11 strains were detected by real-time reverse transcriptase PCR (RT-PCR) and isolated after cultured in human rhabdosarcoma (RD) cells. The VP1 regions of Echo11 strains isolated from RD cells and the whole genomes of three representative Echo11 strains were amplified by conventional RT-PCR and the sequences were analyzed. DNAStar7.0 (MegAlign) and MEGA6.0 (Data) were used to analyze the homology and mutation sites in nucleotide and amino acid sequences. Neighbor-joining method was used to construct phylogenetic trees. Recombination analysis was performed with SimPlot software (BootScanning).Results:A total of 11 Echo11 strains were isolated from 3 494 HFMD cases, accounting for 0.31%. They were highly homologous in the VP1 gene. These strains shared 98.4%-100.0% homology in nucleotide sequences and 98.3%-100.0% homology in amino acid sequences. The homology between the 11 Echo11 strains and the prototype strain (Echo11/Gregory, X80059) was 73.9%-74.8% in nucleotide sequences and 87.7%-88.7% in amino acid sequences. All of the Echo11 strains circulating in Xiangyang were classified into lineage D, having a similarity to the strains circulating in some regions of mainland China since 2013. In multiple regions of the genome, the Echo11 strains isolated in Xiangyang were highly similar to the Henan Echo1 strains in 2010 and the Hubei Echo6 strains in 2015, suggesting there was recombination within the genome of Echo11 strains in Xiangyang.Conclusions:The Echo11 strains circulating in Xiangyang from 2016 to 2017 belonged to lineage D and were recombinant strains.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

OBJECTIVE: To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer. METHODS: This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541). INCLUSION CRITERIA: (1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent. EXCLUSION CRITERIA: (1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon. RESULTS: The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P<0.001]. There was no stent migration in either group. Three patients had perforation in the elective surgery group; one patient had perforation and one had obstruction in the neoadjuvant chemotherapy group; and all these patients received emergent surgery. Adverse reactions of neodajuvant chemotherapy were mainly degree 1 and 2 except one patient with degree 3 diarrhea. Patients in neoadjuvant chemotherapy group had significantly lower rate of stoma [4.8%(1/21) vs. 34.1%(14/41), χ²=6.538, P=0.011], higher rate of laparoscopic surgery [71.4%(15/21) vs. 36.6%(15/41), χ²=6.751, P=0.009], shorter mean operative time (147 minutes vs. 178 minutes, t=-3.255, P=0.002), less mean intraoperative blood loss (47 ml vs. 127 ml, t=-4.129, P<0.001), lower degree of surgical difficulty(3.3 vs. 5.6, t=-5.091, P<0.001), shorter mean postoperative exhausting time (56.2 hours vs. 69.0 hours, t=-2.891, P=0.006), and shorter mean postoperative hospital stay (8.5 days vs. 13.5 days, t=-2.246, P=0.028) as compared with patients in the elective surgery group. Surgical site infection rate and anastomotic leakage rate did not differ significantly between two groups(all P>0.05). CONCLUSION Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.
Aged ; Colorectal Neoplasms ; surgery ; therapy ; Female ; Humans ; Intestinal Obstruction ; Male ; Middle Aged ; Neoadjuvant Therapy ; Prospective Studies ; Stents ; Treatment Outcome