27 cases with acute severe cholangitis were treate d in our department last year． Among them, 3 cases died． Death rate is 11.l %． The patients records about the age, disease cause and operative treatment were analyzed． Results showed: It is the key of acute severe Cholangitis treatment to break virulent circulation which is made by bile duct obstruction as soon as possible． Resisting shock treatment ought to be carried out at the same time when preoperative preparation is done． Shock resist isnt standard whether we shall perform the operation． At one time, protecting organ function and postoperative complications preventing and treatment ought to insist．

Objective To detect serum level of thrombospondin-1 (TSP-1) in rheumatoid arthritis (RA) patients,and analyze the correlation between serum TSP-1 level and disease activity in elderly versus young and middle aged RA patients in order to provide the basis for diagnosis and evaluation of RA.Methods Peripheral blood was collected from 98 RA patients (including 33 elderly,65 young and middle-aged RA patients) and 58 healthy controls.Serum TSP-1 levels were detected by enzyme linked immunosorbent assay (ELISA).Difference in TSP-1 level between RA patients and healthy controls was analyzed.Correlations of TSP-1 level with disease activity parameters of number of tender joints and swelling joints,disease activity score (DAS28 score) and erythrocyte sedimentation rate (ESR),levels of C-reactive protein (CRP),rheumatoid factor (RF),immunoglobin G (IgG),immunoglobin A (IgA) and immunoglobin M (IgM) were analyzed in elderly versus young and middle-aged RA patients.Spearman's and Pearson's correlation analysis were performed.Results TSP-1 level was significantly higher in RA patients than in healthy controls (P＜0.01).TSP-1 level was correlated with number of swelling joints and DAS28 score in RA patients (r=0.246 and 0.241,both P＜0.05).In elderly RA patients,TSP-1 level was correlated with number of swelling joints (r=0.377,P＜0.05),meanwhile significantly positive correlations of TSP-1 level with DAS28 score and rheumatoid factor level were observed in young and middle-aged RA patients (r =0.243 and 0.326,both P＜ 0.05).Conclusions TSP-1 may play roles in the development of RA and its determination may benefit evaluating disease activity.In elderly RA patients,TSP-1 level may reflect severity of rheumatoid arthritis and may be a novel biomarker to the evaluation of disease severity.

Objective To study the association between the plasma homocysteine level and coronary artery disease(CAD), and the methylenetetrahydrofolate reductase (MTHFR) A1298C polymorphism, the methionine synthase (MS) A2756G polymorphism and their associations to the plasma homocysteine level and CAD in the elderly . Methods One hundred and twenty-nine elderly patients with CAD documented by coronary angiogram and 48 elderly patients with normal coronary angiographic results were included in this study. Plasma homocysteine level were measured by fluorescence polarization immunoassay (FPIA) method and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to analyse the MTHFR A1298C and MS A2756G genotypes. Results The plasma homocysteine level was significantly higher in CAD group than that in the control group〔(16.2?8.6) ?mol/L vs (12.7?5.0) ?mol/L,P0.05);the prevalence of MTHFR 1298CC homozygous in the CAD patients was significantly less than that in the control group (3.1% vs 14.6%, P

Objective To discuss clinical curative effects of using Forehead skin expansion combine with auricular cartilage for repairing nose alar full-thickness defects.Methods From August 2010 to August 2010,36 patients with nose alar full-thickness defects in the second affiliated hospital of kunmin medical university,The defect range exceed 1.5 cm× 1.2 cm.50-80 ml expander was implanted in forehead and injected saline water to expand in order to acquire extra skin.We Turn around the skin of defect as the lining of nose,harvest ipsilateral auricular cartilage for nose ala framework,Expanded forehead pedicle flap was transferred to cover framework.The donor area was sutured directly.The pedicle of flap was cut and trimmed after 2 months.Results Follow-up time of 3-18 months after the operation,All flaps are survive,nose alar defects are repaired successfully.Some cases were performed second surgery,postoperative,nose alar color,thickness,nostril size and shape the same with the contralateral side.Donor site healed with linear scar.Conclusions This method could be easy to obtain excess skin,for repairing large sides nose alar full-thickness defect.Frontal scar is not obvious,It is a practical.

Objective To study the relationship between postoperative recurrence time and relat-ed clinical factors in patients with breast cancer. Methods The clinical data of 170 patients with recur-rent breast cancer were analyzed retrospectively. The recurrence time and the related influencing factors were analyzed using Kaplan-Meier test. Results The one-way analysis of variance showed that endocrine therapy,estrogen receptor and progesterone receptor(ERPR)status,Ki-67 and lymph node metastasis were related to the recurrence time(P < 0. 05). Pearson correlation analysis showed that age,neutrophil-to-lym-phocyte ratio(NLR)and platelet-to-lymphocyte(PLR)were related to the recurrence time(P < 0. 05). Fi-nally,Cox multivariate analysis showed that endocrine therapy,lymph node metastasis and Ki-67 were in-dependent prognostic factors of relapse(P < 0. 05). Conclusion To develop personalized follow-up and adjuvant treatment strategy according to the characteristics of patients may prevent breast cancer from re-currence.

In October 2016, a male patient attacked by a black bear was treated in the Department of Plastic Surgery, the Second Affiliated Hospital of Kunming Medical University.The patient had facial skin and soft tissue defects, and zygomatic arch and buccal damage. The patient received three operations, including debridement, scapular free skin flap transplantation, and reconstruction of zygomatic arch. The facial appearance recovered well after 6-months follow-up.

Objective: To explore the effects of anteriolateral thigh perforator flap and fascia lata transplantation in combination with computed tomography angiography (CTA) on repair of electrical burn wounds of head with skull exposure and necrosis. Methods: Seven patients with head electrical burns accompanied by skull exposure and necrosis were admitted to our burn center from March 2016 to December 2017. Head CTA was performed before the operation. The diameters of the facial artery and vein or the superficial temporal artery and vein were measured, and their locations were marked on the body surface. Preoperative CTA for flap donor sites in lower extremities were also performed to track the descending branch of the lateral circumflex femoral artery with the similar diameter as the recipient vessels on the head, and their locations were marked on the body surface. Routine wound debridement and skull drilling were performed successively. The size of the wounds after debridement ranged from 12 cm×8 cm to 20 cm×12 cm, and the areas of skull exposure ranged from 8 cm×6 cm to 15 cm×10 cm. Anteriolateral thigh perforator flaps with areas from 13 cm×9 cm to 21 cm×13 cm containing 5-10 cm long vascular pedicles were designed and dissected accordingly. The fascia lata under the flap with area from 5 cm×2 cm to 10 cm×3 cm was dissected according to the length of vascular pedicle. The fascia lata was transplanted to cover the exposed skull, and the anteriolateral thigh perforator flap was transplanted afterwards. The descending branch of the lateral circumflex femoral artery and its accompanying vein of the flap were anastomosed with superficial temporal artery and vein or facial artery and vein before the suture of flap. The flap donor sites were covered by intermediate split-thickness skin graft collected from contralateral thigh or abdomen. Results: The descending branch of the lateral circumflex femoral artery and its accompanying vein were anastomosed with superficial temporal artery and vein in six patients, while those with facial artery and vein in one patient. All the flaps survived after the operation, and no vascular crisis was observed. Wound healing was satisfactory. One patient was lost to follow up. Six patients were followed up for 6 to 10 months. The patients were bald in the head operation area with acceptable appearance. No psychiatric symptom such as headache or epileptic seizure was reported. The flap donor sites were normal in appearance. The muscle strength of the lower extremities all reached grade V. The sensation and movement of the lower extremities were normal. Conclusions Anterolateral thigh perforator flap with fascia lata transplantation can effectively repair electrical burn wounds of head with skull exposure and necrosis. The fascia lata can be used to protect the vascular pedicle of flaps, which is beneficial to the survival of the flap. Preoperative head and lower extremities CTA can provide reference for intraoperative vascular exploration in donor site and recipient area, so as to shorten operation time.

Objective:To observe the efficacy of free transplantation of latissimus dorsi musculocutaneous flap and anterolateral femoral skin flap in repairing the wound after the resection of the scalp squamous cell carcinoma, and to explore the indications of these two skin flaps.Methods:The clinical data of patients with scalp squamous cell carcinoma admitted to the Plastic Surgery Department of the Second Affiliated Hospital of Kunming Medical University from June 2013 to May 2019 were analyzed retrospectively. All patients showed no cancer metastasis examined with CT. None of the patients had systemic diseases such as hypertension, diabetes, vascular disease. The wounds were repaired with free transplantation of latissimus dorsi myocutaneous flaps and anterolateral thigh flaps after extensive tumor resection. The intraoperative vascular variation, the diameter of the anastomosed blood vessel, the length of the vascular pedicle, the flap size, the time of harvesting the flap, the time for anastomosis, the operation time, and the incidences of complications at the donor site and recipient site were measured or recorded in both groups.Results:A total of 21 cases were included, including 14 males and 7 females, aged from 12 to 61 years. Eleven cases were repaired with the latissimus dorsi musculocutaneous flap, and 10 cases with the anterolateral thigh flap. All the 21 flaps survived during the 1 to 2 years follow-up. No vascular variation was found in the latissimus dorsi myocutaneous flap group, whereas 2 cases of vascular variation were found in the anterolateral thigh flap. In the latissimus dorsi myocutaneous flap group, the anastomotic vessel diameter was (2.14±0.09) mm for the artery and (2.49±0.10) mm for the vein. The vascular pedicle length was (6.14±0.28) cm, and the size of the flap was (135.0±20.8) cm 2, the harvesting time was (114.8±3.0) min, the vascular anastomosis time was (20.8±0.8) min, and the operation time was (6.5±0.2) h. In the anterolateral thigh flap group, the anastomotic vessel diameter was (2.15±0.14) mm for the artery and (2.45±0.15) mm for the vein. The vascular pedicle length was (6.80±0.31) cm, and the size of the flap was (159.9±16.4) cm 2, the harvesting time was (119.8±3.6) min, the vascular anastomosis time was (21.5±0.9) min, and the operation time was (6.9±0.2) h. There was no significant difference between the two kinds of flaps in the above parameter. The incidence of total complications at the donor site was higher in the latissimus dorsi myocutaneous flap group (7 cases) than that in the anterolateral thigh flap group (4 cases). The incidence of overall complications at the recipient was lower in the latissimus dorsi myocutaneous flap group (1 case) than that in the anterolateral thigh flap group (2 cases). Conclusions:Both the latissimus dorsi myocutaneous flap and the anterolateral femoral skin flap can achieve good results in repairing the wound after the resection of the scalp squamous cell carcinoma. The latissimus dorsi myocutaneous flap has a constant blood supply, and the operative technique is relatively easy and with low risk, which is more suitable for novices. The anterolateral thigh flap is thin and with fewer complications at the donor site. It is easy to be accepted by patients and can be performed in the supine position, which is more suitable for elderly patients.

Objective To investigate the clinical effect of free pre-expanded scapular skin flap for repairing of large size facial and cervical scar .Methods 15 patients suffering from post-burn facial and cervical scar contractures were treated in the Department of Plastic Surgery of Second Affiliated Hospital of Kunming Medical University.The reconstruction was performed in two operative stages .First, the skin incision were made paralleling with the descending branches of the circumflex scapular artery near posterior axillary line and the scapular skin flap was elevated .A 300 to 400 ml kidney -shaped expander was implanted under scapular region skin .The expansion began 1 week post-operatively.After the expander was fully expanded and could supply sufficient flap , the facial and cervical scar was resected and the contracture was released .The pre-expanded scapular flap was harvested and transferred to repair the defects.Then the facial vascular anastomosis with circumflex scapular vascular was performed .The expander was removed and the wound was closed directly .Results The expansion time ranged from 2 to 4 months with the average time of 2.8 months.The flap size ranged from 14 cm ×7 cm to 25 cm ×14 cm. All flaps survived post-operatively and wounds at donor sites healed primarily .The face and neck have good appearance .Conclusions Pre-expanded scapular skin flap is suitable for repairing of larger face and neck scar with good color and thickness match .Expanded skin flap can provide large size flap , leaving less morbidity at the donor sites .

Objective:To observe the efficacy of free transplantation of latissimus dorsi musculocutaneous flap and anterolateral femoral skin flap in repairing the wound after the resection of the scalp squamous cell carcinoma, and to explore the indications of these two skin flaps.Methods:The clinical data of patients with scalp squamous cell carcinoma admitted to the Plastic Surgery Department of the Second Affiliated Hospital of Kunming Medical University from June 2013 to May 2019 were analyzed retrospectively. All patients showed no cancer metastasis examined with CT. None of the patients had systemic diseases such as hypertension, diabetes, vascular disease. The wounds were repaired with free transplantation of latissimus dorsi myocutaneous flaps and anterolateral thigh flaps after extensive tumor resection. The intraoperative vascular variation, the diameter of the anastomosed blood vessel, the length of the vascular pedicle, the flap size, the time of harvesting the flap, the time for anastomosis, the operation time, and the incidences of complications at the donor site and recipient site were measured or recorded in both groups.Results:A total of 21 cases were included, including 14 males and 7 females, aged from 12 to 61 years. Eleven cases were repaired with the latissimus dorsi musculocutaneous flap, and 10 cases with the anterolateral thigh flap. All the 21 flaps survived during the 1 to 2 years follow-up. No vascular variation was found in the latissimus dorsi myocutaneous flap group, whereas 2 cases of vascular variation were found in the anterolateral thigh flap. In the latissimus dorsi myocutaneous flap group, the anastomotic vessel diameter was (2.14±0.09) mm for the artery and (2.49±0.10) mm for the vein. The vascular pedicle length was (6.14±0.28) cm, and the size of the flap was (135.0±20.8) cm 2, the harvesting time was (114.8±3.0) min, the vascular anastomosis time was (20.8±0.8) min, and the operation time was (6.5±0.2) h. In the anterolateral thigh flap group, the anastomotic vessel diameter was (2.15±0.14) mm for the artery and (2.45±0.15) mm for the vein. The vascular pedicle length was (6.80±0.31) cm, and the size of the flap was (159.9±16.4) cm 2, the harvesting time was (119.8±3.6) min, the vascular anastomosis time was (21.5±0.9) min, and the operation time was (6.9±0.2) h. There was no significant difference between the two kinds of flaps in the above parameter. The incidence of total complications at the donor site was higher in the latissimus dorsi myocutaneous flap group (7 cases) than that in the anterolateral thigh flap group (4 cases). The incidence of overall complications at the recipient was lower in the latissimus dorsi myocutaneous flap group (1 case) than that in the anterolateral thigh flap group (2 cases). Conclusions:Both the latissimus dorsi myocutaneous flap and the anterolateral femoral skin flap can achieve good results in repairing the wound after the resection of the scalp squamous cell carcinoma. The latissimus dorsi myocutaneous flap has a constant blood supply, and the operative technique is relatively easy and with low risk, which is more suitable for novices. The anterolateral thigh flap is thin and with fewer complications at the donor site. It is easy to be accepted by patients and can be performed in the supine position, which is more suitable for elderly patients.