BACKGROUND:Posterior antebrachial skin is beneficial for repairing injury of dorsum,however,the systematic anatomic characteristics of distally based compound flap pedicled with nutrient vessels need to be further studied.OBJECTIVE:To investigate the anatomic characteristics of distally based flap pedicled with nutrient vessels of the posterior antebrachial cutaneous nerve and compound flap.DESIGN:Single sample observation.SETTING:Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS:The experiment was carried out at the laboratory for Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from October to December 2004.A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS:All 30 adults upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna and radius.The following microdissection was emphasized:The origins,branches,distribution and anastomosis of nutrient vessels of the posterior antebrachial cutaneous nerve;The blood supply relationship of nutrient vessels of posterior antebrachial cutaneous nerve and vicinal bone and skin.MAIN OUTCOME MEASURES:The ordgins and branches of nutrient vessels of posterior antebrachial cutaneous nerve,and whose blood supply relationship with vicinal bone and skin.RESULTS:The origin of nutrient vessels of posterior antebrachial cutaneous nerve were as follows:Proximal part:2-6cutaneous perforators of radial collateral artery,with an outer diameter of (0.6±0.3) mm;Distal part:3-5 cutaneous perforators of dorsal carpal branch of anterior interosseous artery,with an outer diameter of (0.8±0.2) mm;Others:6-9cutaneous perforators of posterior nterosseous artery,with an outer diameter of (0.7±0.3) mm.Posterior interosseous artery sent out 6-8 muscle- periosteum branches with an outer diameter of (0.3-1.0) mm,which distribute on ulnar periosteum;Radial bone-skin perforators of posterior interosseous artery anastomosed with periosteal vessels of mid-inferior bare area of radial bone.All above mentioned cutaneous perforators gave off cutaneous branches,fascia branches,periosteal branches and nerve-nutrient vascular branches,all of which formed a vascular chain of cutaneous nervous stem and vascular networks of deep fascia,superficial fascia and periosteum.CONCLUSION:The nutrient vessels of posterior antebrachial cutaneous nerve have the same origins as the vicinal bone-skin nutrient vessels,and the rotation point of its distally based pedicled flap and compound flap can reach the plane of wrist joint,which may be helpful to design a kind of more convenient and simplified flap to repair the distal tissue defects of the hand.

BACKGROUND: Flap pedicled with nutritional vessels of the cutaneous antebrachial medialis nerve is beneficial for repairing injury of dorsum of hand; but it needs the support from systemic anatomic research on distally based compound flap.OBJECTIVE: To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve -basilic vein.DESIGN: Single sample observation.SETTING: Research Center for Clinical Anatomy, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the laboratory for Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March to August 2003. A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. Each cadaver was injected with a mixture of red gelatin to show the branches, distributions and anastomosis of the lesser vessels on the stained small arteries of the finger tips.METHODS: All 30 adult upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna: ①The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of medial antebrachial cutaneous nerve-basilic vein, and whose blood supply relationship with ulnar periosteal vessels. ②The superficial and deep communicating branches of basilic vein.MAIN OUTCOME MEASURES: ①The origins, branches, distribution and anastomosis of nutrient vessels of medial antebrachial cutaneous nerve, and whose blood supply relationship with vicinal bone and skin. ② The superficial and deep communicating branches of basilic vein.RESULTS: ①The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were 5-9 cutaneous branches of ulnar artery with an outer diameter of (0.7±0.3)mm. The ascending and descending branches of wrist superior branches sent out several cutaneous branches nourishing basilic vein, with an outer diameter of (0.6±0.3) mm. Between the position of (6.0-16.0) cm superior to ulnar malleolus, anterior interosseous artery sent out 2-3 perforating bone-skin branches, with an outer diameter of (0.7±0.2) mm; Posterior interosseous artery sent out 1-3 bone-skin perforating branches, with an outer diameter of (0.6±0.3) mm. Both of them were distributed on periosteum and skin of the corresponding area. All above-mentioned cutaneous perforators gave off cutaneous branches, fascia branches, periosteal branches and nutrient vascular branches of cutaneous nerve-superficial vein, and a vessel chain of cutaneous nerve-basilic vein and vascular networks of deep fascia, superficial fascia and periosteum formed. ②Ulnar artery had two accompanying veins, one was grossus, and the other thin. The two veins accompanied along two sides of artery, and the accompanying vein of arterial cutaneous branches infused. Superior wrist cutaneous branches of ulnar artery had two accompanying veins. One pumped into ulnar branch of ulnar vein, and the other one passed through deep fascia, then entered subcutaneous tissue, and straightly pumped into basilic vein. The injected position was (2.3±0.8) cm superior to ulnar malleolus, with an outer diameter of (2.8±0.5) mm.CONCLUSION: The nutrient vessels of medial antebrachial cutaneous nerve-basilic vein and the nutrient vessels of bone and skin are homologous. The rotation point of their distally based pedicled flap and compound flap can reach the plane of wrist joint, which can be applied to repair the distal tissue defects of the hand.

BACKGROUND: Flap pedicled with nutritional vessels of the lateral antebrachial cutaneous nerve is beneficial for repairing injury of dorsum; however, lacks of system researches of the lateral antebrachial cutaneous nerve compound flap.OBJECTIVE: To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the lateral antebrachial cutaneous nerve - cephalic vein.DESIGN: A single sample observation.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January to May in 2004.A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: The radial styloid process was taken as the mark for the microanatomical observation of the follows: ① the origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of lateral antebrachial cutaneous nerve-cephalic vein; ② the relationship of nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and radius periosteal vessels; ③ the superficial-deep communicating branches of cephalic vein.MAIN OUTCOME MEASURES: ① The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of lateral antebrachial cutaneous nerve-cephalic vein; ② The relationship of nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and radius periosteal vessels.RESULTS: ① The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were: 6 to 11 cutaneous branches of radial artery with an outer diameter of (0.7±0.3) mm, 2 to 6 cutaneous branches of superficial palmar branch, with an outer diameter of (0.5±0.3) mm, 1 to 2 cutaneous branches of recurrent branch nourishing the radial styloid process with an outer diameter of (0.8±0.1) mm, 1 to 2 cutaneous branches nourishing tabatiere anatomique with an outer diameter of (0.6±0.2) mm. 8.0 to 15.0 cm superior to the radial styloid process, there were 1 to 3 spatium intermuscular osteocutaneous perforators of radial artery with an outer diameter of (1.1 ±0.2) mm, and periosteal branches distributed in the denudate area of the middle-inferior radial bone with its cutaneous branches (0.8±0.2) mm in diameter. Above perforators gave rise to cutaneous branches, fascia branches,periosteal branches and nutrient vessels of nerve to superficial vein to form a vessel chain of cutaneous nerve-cephalic vein and vascular networks of deep fascia, superficial fascia and periosteum.CONCLUSION: The nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and the nutrient vessels of muscle, bone and skin are homologous. The compound flap of lateral antebrachial cutaneous nerve-cephalic vein pedicled with the cutaneous branches of radial artery can be applied to repair the distal tissue defects of the hand by rotating the flap on the plane of wrist joint.

Objective To investigate the classification and treatment of displaced intra articular fractures of the calcaneus. Methods Twelve displaced intra articular fractures of the calcaneus in 8 patients were included in this study. Classification of calcaneus fractures was done according to Sanders' computed tomographic classification system. There were 2 cases of type Ⅱfractures, 4 type Ⅲfractures and 6 type Ⅳfractures. The open reduction and internal fixation (ORIF) and bone grafting were performed using a standard extended lateral approach, and the fractures were fixed with small fragment AO bridge plates with autogenous bone grafting. Average follow up was 28.6 months (range 24 to 33 months). The Creighton Nebraska Health Foundation Assessment Score System for fractures of the calcaneus was used for evaluation. Results The average score was 89.7 for type Ⅱ, 86.5 for type Ⅲ, and 73.5 for type Ⅳfractures. There was statistically significant superiority in treatment by ORIF compared with nonoperative methods (P0.05); whereas in type Ⅳfractures, the differences were significant between with and without bone grafting (P

Objective To discuss diagnostic classification and emergency treatment protocols for complex pelvic fractures. Methods The first aid management of 23 cases of major pelvic fractures were analyzed retrospectively. Results 22 of the patients survived, but one died of hemorrhagic shock.Conclusions Correct classification of severe pelvic fractures is of guidance value to the first aid management. Cooperation among multiple departments, comprehensive application of various surgical methods, early stabilization of hemodynamics, rapid repair of injured organs, stabilization of pelvic ring with external fixator are effective techniques to enhance the survival rate of patients with severe pelvic fractures.

Objective To evaluate the diagnostic accuracy of half-Fourier single-shot TSE MR cholangiopancreatography (HASTE-MRCP) of 0.5 T MR scanner, and to assess its imaging advantage and clinical value by comparing with 3D-TSE-MRCP MIP. Methods All 95 patients were examined by HASTE-MRCP and 3D-TSE-MRCP with respiratory-triggering (Philips 0.5 T T5-NT). The results, including anatomies and diseases, were evaluated after operation. Results By HASTE-MRCP, common bile ducts, 1-3 branches of hepatic ducts, gallbladder, and pancreatic ducts were demonstrated in 100.0%, 94.7%, 74.1%, and 63.2% of the cases. Stones, malignant diseases, and postoperative stenosis were revealed in 100.0% of the cases. Compared with 3D-TSE-MRCP, the demonstrating rates of 4-5 hepatic ducts,neck of the gallbladders,and calculi,especially mud calculi, were higher in HASTE-MRCP, and there was significant difference between the two ways. Stones displayed as low signal in the bile ducts. Block obstruction and mass contour were revealed in malignant diseases. Conclusion Comparing with 3D TSE-MRCP, HASTE-MRCP was better and faster, especially in serious patients or in cases with small and mud calculus.

Objective:To investigate the incidence, drug sensitivity and drug resistance characteristies, and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis (PDAP), aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP. Methods:Clinical data of PDAP patients admitted to the Second Hospital of Jilin University, the First Hospital of Jilin University-the Eastern Division, Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1, 2013 and December 31, 2019 were retrospectively collected. The results of etiology, drug sensitivity and drug resistance of staphylococcal PDAP patients were collected. According to the pathogenic bacteria, patients were divided into staphylococcus aureus group ( n=48) and coagulase-negative staphylococcus group ( n=232). According to the results of methicillin resistance, patients were divided into drug-resistant group ( n=71) and drug-sensitive group ( n=30). The prognosis of antibiotic therapy in each group were compared. Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP. The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trend χ2 test. Results:A total of 1 085 cases of PDAP occurred in 625 patients were screened, and 280 cases of staphylococcal PDAP were finally included. The incidences of staphylococcal PDAP, staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year, 0.010 times per patient year and 0.053 times per patient year respectively. In addition, the incidence of PDAP caused by staphylococcus, staphylococcus aureus and coagulase-negative staphylococcus decreased year by year (all P<0.05). With the change of years, the sensitivity rate of staphylococcus to rifampicin increased, while the sensitivity rate of staphylococcus to moxifloxacin decreased (both P<0.05). The drug resistance rate of staphylococcus to levofloxacin increased ( P<0.05). The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group, and the recurrence rate was higher than that in coagulase-negative staphylococcus group (all P<0.05). The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group ( P<0.05). Conclusions:The incidence of staphylococcal PDAP decreases year by year, and the drug sensitivity characteristics of staphylococcus also change. The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.

Objective: To discuss the use of butterfly costal cartilage as columella strut graft. Methods: On the costal cartilage that being cut, butterfly graft was designed length of 2.8 cm, upper and lower end thickness of 5 mm, middle part thickness of 1.5 mm. The lower end was designed with a groove about 1 cm in length, the width of the lower end of the butterfly graft was determined according to the degree of retraction at the caudal end of the septum, then insert to the nasal crest. The posterior end of two lamella grafts was sutured and fixed with the middle part of the nasal columnar strut graft. Results: From November 2016 to March 2018, about 150 patients underwent rhinoplasty with this method, follow-up was 3 to 12 months. Two cases had mild nasal tip deviation one month after surgery and were adjusted with auricular cartilage three months later. Three patients had mild postoperative hyporotation and adjustment three months postoperatively, residual had good shape. Conclusions The stability and controllability of the sphenoid columella strut graft are good, out of shape not easily, It is a worthy clinical method.

Objective: To study the efficacy and safety of Cefpodoxime proxetil granules in the treatment of acute bronchitis in children. Methods: One hundred and sixty children of the First People′s Hospital of Nanning from June to December 2018 with acute bronchitis were randomly divided into cefpodoxime group and cefaclor group, with 80 cases in each group.All patients received routine treatment.On this basis, 80 patients in the cefpodoxime group received oral Cefpodoxime proxetil granules 5 mg/kg (not more than 100 mg/time), twice a day; 80 patients in the cefaclor group received oral Cefaclor.The granules were 10 mg/kg (not more than 250 mg/time), 3 times a day, and the course of treatment was 5 days.The clinical efficacy and adverse reactions were observed. Results: The cure rate and effective rate of Cefpodoxime group were 91.3% (73/80 cases) and 95.0% (76/80 cases), respectively, while the cure rate and effective rate of Cefaclor group were 66.3%(53/80 cases) and 81.3%(65/80 cases), respectively, and the differences between the 2 groups were statistically significant (χ²=14.94, 7.23, all P<0.05). Sixty-three strains of pathogenic bacteria and 66 strains of pathogenic bacteria were obtained in Cefpodoxine group and Cefaclor group, respectively, and the detection rates of bacteria in the 2 groups were 78.75% and 82.50%, respectively.There was no significant diffe-rence in the number of bacterial strains and strains detected in each group (χ²=0.36, P>0.05), but the total bacterial clearance rate in Cefpodoxine group was 88.9%(56/63 cases) while the bacterial Clearance rate in Cefaclor group was 74.2%(49/66 cases), and the difference between the 2 groups was statistically significant (χ²=4.57, P<0.05). In particular, the bacterial clearance rate in Cefpodoxine group to Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae were significantly higher than those in Cefaclor group, while the bacterial Clearance rate of Proteus and Escherichia coli were lower than those in Cefaclor group.The incidence of adverse reactions in Cefpodoxine group and Cefaclor group were 5.0% and 3.8%, respectively, with no significant difference (P>0.05). Conclusions The clinical effect of Cefpodoxime pro-xetil granules in treating children with acute bronchitis is more significant than that of Cefaclor.It has high safety and no serious side effect.