Objective To observe the outcome of free TAAP flap in the reconstruction of defect after oral tumor radical resection.Methods From June,2010 to April,2015,12 patients with oral tumor underwent radical resection,including 4 cases of gingival carcinoma,3 cases of tongue carcinoma and 5 case of buccal cancer.The cause ranged from 2 to 12 months.The radical resection left defects with size ranged from 4.5 cm×3.5 cm to 6.0 cm× 4.5 cm which were reconstructed by free TAAP flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm.The length of TAAP flap was (6.5±0.6) cm.The width of flap was (4.3±0.5) cm.And the thickness of flap was (1.1±0.3)cm.The length of pedicle was(8.4±0.2) cm.All the arteries of TAAP were anastomosed with superior thyroid arteries,while the venae comitans were anastomosed with superior thyroid venae or internal jugular venae.Results The perforators existed consistently.All 12 flaps survived uneventfully.The donor sites were closed directly in all cases.All patients were followed up for 14-38 months with satisfied esthetic and functional results in reconstructed tongue.No local recurrence happened.The shoulder function was not affected.Conclusion The TAAP flap has consistent blood supply,good color match and texture,while leaving minimal morbidity at donor site,is an ideal choice for buccal tumor reconstruction.

Objective: To investigate the application of free medial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. Methods: From June 2013 to November 2015, 17 cases with tongue carcinoma underwent radical resection and tongue and mouth floor defects after surgery were reconstructed with medial thigh chimeric myocutaneous perforator flaps at the same stage. These 17 cases included tongue carcinoma on lingual margin (n=9), ventral tongue (n=7) and mouth floor (n=1). Appearance and functional results were evaluated with follow-up. Results: Medial thigh chimeric myocutaneous perforator flap was (9.0±0.3) cm in length, (4.5±0.3) cm in width , and (1.8±0.4) cm in thickness. The length of pedicle was (7.4±0.6) cm. All of the 17 flaps survived uneventfully, and the donor sites were closed directly in all cases. All patients were followed up for 10-28 months with satisfied esthetic and functional results in reconstructed tongue. Aside from linear scar in the donor sites, the functions of thighs were not affected. No local recurrence occurred. Conclusion The free medial thigh chimeric myocutaneous perforator flap is an ideal choice to reconstruct the tongue and mouth floor defect after radical resection of tongue carcinoma.

OBJECTIVETo evaluate the effect of basal serum luteinizing hormone (LH) and luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS).

METHODSA retrospective analysis was performed of 134 IVF cycles in patients with PCOS. The cycles were classified into 2 groups according to serum levels of LH and also into 2 groups according to LH/FSH ratio, namely group A1 (LH≤10 IU/L), group A2 (LH>10 IU/L), group B1 (LH/FSH ratio<2), and group B2 (LH/FSH ratio≥2). The clinical characteristics, embryological data and pregnancy outcomes were compared between the groups.

RESULTSPatients in group A2 showed significantly higher FSH, T level, and LH/FSH ratio with a greater number of oocytes retrieved than those in group A1, but the time for down-regulation, duration of stimulation, AFC, LH and LH/FSH on the first day of stimulation, embryological data and pregnancy outcomes did not differ significantly between the two groups. Compared with group B1, group B2 showed higher basal LH, E2 level on the day of HCG, more oocytes retrieved and lower dose of gonadotropins used, but the time for down-regulation, duration of stimulation, LH and LH/FSH on the first day of stimulation and pregnancy outcomes were comparable between the two groups.

CONCLUSIONA high basal LH level or a high LH/FSH ratio does not produce obvious deleterious effect on the clinical outcomes of IVF-ET in women with PCOS who take oral contraceptives for pretreatment before long GnRH-agonist protocol.

Adult ; Female ; Fertilization in Vitro ; methods ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Polycystic Ovary Syndrome ; blood ; Pregnancy ; Pregnancy Rate ; Retrospective Studies

Objective To review outcome and experience in application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment.Methods From January 2008 to February 2016,61 cases (included 58 female patients and 3 male patients) were admitted,the age ranged from 39 to 57 years old.Among these cases,37 cases received mastectomy and one-staged breast reconstructive operation and multiple chemotherapy preoperatively.The other 24 patients suffered from chest wall radiation ulcer,all occurred after mastectomy and radiotherapy,the course ranged from 12 to 56 months,all received long-time conservative therapy but the patient's condition worsened.Of those patients 8 cases suffered radioactive bone injury,involved clavicle,rib and sterum;3 cases suffered pleura injury;2 cases suffered lung injury;2 cases suffered brachial plexus injury and upper extremity lymphedema,resulted in upper extremity dysfunction.The patients were treated with pure pedicled transverse rectus abdominis musculocutaneous flap (TRAM) musculocutaneous flap in 31 cases,frec TRAM musculocutaneous flap in 3 cases,pedicled TRAM musculocutaneous flap plus superficial inferior epigastric vein anastomosis in 13 cases,and pedicled TRAM musculocutaneous flap combined with contralateral free deep inferior epigastric perforator (DIEP) flap in 14 cases.Results The area of flap for chest wall reconstruction ranged from 22 cm × 10 cm to 38 cm× 15 cm,the size of flap for breast reconstruction ranged from 16 cm × 10 cm to 22 cm× 13 cm.The donor site was closed directly in all cases.Distal part necrosis and fat liquefaction were noted in 3 cases used pure pedicled TRAM musculocutaneous flap,in 1 case the defect was closed directly after radical debridement,in other 2 cases free anterolateral thigh flap was applied after debridement.All other 58 flaps survived uneventfully.All patients were followed up for 12 -108 months with satisfied esthetic and functional results in reconstructed chest wall and breast.No local recurrence or ulcer happened.Only linear scar left in the donor sites,no hernia occurred.Conclusions Transverse rectus abdominis musculocutaneous flap is one of the first choice for breast reconstruction and chest wall radioactive ulcer.To ensure the operation success,it is efficient to apply different forms of transverse rectus abdominis musculocutaneous flap according to the flap size and blood supply.

Objective The aim of this study is to explore the hypoglycemic effect of active components of Anoectochilus roxburghii on zebrafish models. Methods Anoectochilus roxburghii components were extracted and separated into three groups: the alcohol extraction group, macromolecular polysaccharide group (≥ 5 ×103) and small molecular polysaccharide group (＜5×103). Zebrafish embryos were exposed to 2% glucose solution (2% Glu) at 24 h to imitate acute hyperglycemia phenotype, and then treated with the three Anoectochilus roxburghii components. Based on this high-glucose model, the zebrafish embryos at 72 h were collected to detect the whole tissue glucose value. Furthermore, semi-quantitative PCR and whole mount in situ hybridization were performed to detect the expression of mRNA levels of glycometabolism-related genes. Results An acute diabetic zebrafish model was induced by high glucose stress. In this model, some key factors during glycometabolism such as insulin, pck-1 and pdx-1 were significantly affected, while the alcohol extracts of Anoectochilus roxburghii obviously reversed these abnormalities induced by high glucose stress, even to normal levels. Conclusions The alcohol extracts of Anoectochilus roxburghii has obvious hypoglycemic effect on diabetic zebrafish model. Our result suggest that Anoectochilus roxburghii has a potential application in the hypoglycemic drug screening.

Objective To introduce the clinical experience of relaying anterolateral thigh (ALT)flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer.Methods From February 2014 to December 2015,16 cases with oral carcinoma underwent radical resection,leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps.The flap size ranged from 7.5 cm ×4.5 cm to 13.0 cm × 7.5 cm [the patients was 45.6 years (range 31-72 years),body mass index (BMI) range 17.5-24.3 kg/m2].Flaps'width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5％ on average (ranging from 9.8％ to 15.7％).The flap donor sites were reconstructed with relaying ALT flap at the same stage,the flap size ranged from 7.5 cm × 4.0 cm to 12.0 cm x 7.0 cm.Results The AMT and ALT perforators existed consistently in all cases of this serie.All free AMT flaps and relaying ALT flaps survived uneventfully.All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites.2-point discrimination distance of AMT flaps ranged from 7 to 14 mm,2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm,the function of thighs were not affected.Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap.

Objective: To explore the application of free profunda femoral artery pedicled gracilis chimeric myocutaneous flap in the reconstruction of defect after radical resection of buccal mucoca squamous cell carcinoma. Method: From January 2014 to May 2016, 12 cases with buccal mucoca squamous cell carcinoma underwent radical resection, leaving buccal mucoca defect which was reconstructed by free profunda femoral artery pedicled gracilis chimeric myocutaneous flap at the same stage. The buccal mucoca defect was reconstructed with skin paddle, the mouth floor cavity was filled with muscular flap. Result: The Length of free profunda femoral artery pedicled gracilis chimeric myocutaneous flap was (9.0±0.3) cm, the width of flap was (4.5±0.3) cm, the thickness of flap was (1.8±0.4) cm.The length of pedicle was (7.4±0.6) cm.All 12 chimeric perforator flaps survived uneventfully, the defects at the donor sites were closed directly in all cases. All patients were followed up for 10-28 months (14.8 on average) with satisfied esthetic and functional results in flap reconstruction. The swallowing and speech function was satisfactory. No local recurrence happened. Only linear scar was left in the donor sites, the function of thighs was not affected. Conclusions The free profunda femoral artery pedicled gracilis chimeric myocutaneous flap is an ideal choice for reconstruction of the defect after radical resection of buccal mucoca squamous cell carcinoma.

Objective: To explore the clinical application of the profunda artery perforator flap in breast reconstruction of patients with early-staged breast cancer. Methods: Six cases of early breast cancer patients received radical or modified radicaI surgery.The PAP flap was used to reconstruct breast at the same time or in the second phase.Four cases of breast cancer were in stage I and 2 cases was in stage II. Results: The length of flap was (25.2±0.2) cm, the width of flap was (6.4±0.8) cm, the thickness of flap was (2.6±0.2) cm. The length of pedicle was (7.2±0.6) cm, the outer diameter of pedicle was (1.6±0.3) mm.The average weight of flap was 345 g(ranged from 225 g to 575 g). All profunda artery perforator flaps were successful. In one flap fat necrosis occurred and healed with dressing treatment. The reconstructed breasts′ shape, texture and elasticity was good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of thighs was not affected. All 6 patients were followed up for 2-3 months (2.5 months on average) with satisfied result. No local recurrence happened. Conclusions PAP flap is suitable to reconstruct breast for breast cancer patients.

Objective: The purpose of this study is to review the single institutional experience in oncoplastic treatment of locally advanced breast cancer (LABC). Methods: This is a retrospective analysis of 246 female patients who underwent breast and chest wall reconstruction after LABC ablation in the department from August 2007 to December 2015. The mean age of the patients is 43.7 years old, range from 34 to 70 years old. The soft tissue defect size ranged from 12 cm×6 cm to 32 cm×28 cm, different flaps were chosen for reconstruction, flap size ranged from 13 cm×6 cm to 33 cm×29 cm. Simple rib defects or sternum defects occurred in 65 cases, using mesh repair and flap reconstruction; simple soft tissue defects were noted in 112 cases, pedicled flap or free flap was used; in 69 cases complicated composite chest wall defects involving multiple layers (soft tissue, ribs/sternum, and intrathoracic organs) were repaired with methylmethacrylate/polypropylene mesh sandwich prostheses. The breast and chest wall soft tissue defects were repaired with pedicled or free flap. Results: In 3 cases with pedicled rectus abdominis flap partial necrosis was noted, local flap was used after further debridement in 2 cases, in the third case with extensive defect left, free anterolateral thigh flap was transferred for reconstruction. In 2 cases with free deep inferior epigastric artery perforator flap, postoperative venous congestion occurred. The re-exploration procedure was carried out, edema was removed and the flap survived thoroughly. In 2 cases with free deep inferior epigastric artery perforator flap postoperative course margin dehiscence and chest wall basement partial necrosis was noted, free anterolateral thigh flap was transferred for reconstruction after thoroughly debridement, the wounds healed smoothly. All other wounds healed uneventfully, all flaps survived totally. The hospital stay time ranged from 12 days to 42 days, all patients received further therapy. The mean follow-up was 28.8±0.4 months, with a range from 9 to 96 months. 26 cases were lost for follow up, in the rest 220 cases, local tumor recurrence was noted in 52 cases, distant metastasis was noted in 42 cases, all other patients recovered well, the function and appearance of flaps were satisfactory, the life quality of patients improved notably. Conclusions Oncoplastic techniques are suitable and safe for LABC reconstruction, helpful for oncological local control, can improve patients life quality.

Objective:To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy.Methods:From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. The location of deep inferior epigastric artery perforator was detected by audible Doppler ultrasound blood stream detector and computed tomography angiography for designing combined tissue flap, with length of (25.32±0.27) cm, width of (13.14±0.76) cm, and thickness of (3.55±0.34) cm. The donor site of combined tissue flap was closed by suturing, and two or more tubes for negative pressure drainage were placed according to the situation of donor site and recipient site. Operation time and average placing time of negative pressure drainage tube, postoperative condition of combined tissue flap and the donor site, reconstructed breast condition, recovery of upper limb lymphedema were documented and followed up.Results:The operation time was 290-420 (396±55) min. The average retaining time of negative pressure drainage tube in breast was 5.9 d, while the average retaining time of negative pressure drainage tube in abdomen was 4.3 d. Ecchymoma occurred in DIEAP flap of one patient and in the flap donor site of another patient. Delayed healing was also seen in the rectus abdominis myocutaneous flap of a patient, which healed eventually after dressing change, and the other flaps survived well. The appearance of reconstructed breast was good with good elasticity, and no contracture or deformation occurred in the tissue flap. The upper limb lymphedema in 7 patients was alleviated in varying degrees, with 2.0-4.0 cm reduction in circumference. During follow-up of 12-24 months of 9 patients, averaged 17.5 months, with 6 patients received long term bandage pressure therapy and physical therapy to the affected limbs after operation and all patients were satisfied with appearances of the affected limbs. Neuropathic pain in affected limbs was significantly relieved in 2 patients and stopped aggravating in the other 2 patients. Only linear scar was seen in the donor site of abdomen without affecting obviously the function of abdomen.Conclusions:The PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap is an effective way for breast reconstruction and upper limb lymphedema treatment post mastectomy.