Background The residual astigmatism following Toric intraocular lens (IOL) rotation have received much attention.However,the variation of the optical performance and the wavefront abrrveation with Toric IOL rotation are unclear.Objective The aim of this study was to evaluate the optical performance,wavefront abrrveation and residual diopter spherical and cylinder lens with Toric IOL rotation.Methods T3,T4 and T5 Toric IOLs of +22.0 D were placed in Hwey-Lan Liou model eye respectively,with the posterior surface flat on the X axis and steep on the Y axis.Corneal astigmatism model was established by mimicing the model eye with Toric IOL using Zemax optical software.Then the Toric IOLs were rotated 5° to 10° individually under the 4 mm pupil diameter and 550 nm monochromatic light,and the image performance and wavefront abrrveation were recorded with all conditions,including modulation transfer function (MTF),out-of-focus aberration,astigmatism aberration,coma,trefoil aberration and spherical aberration.The refractive error of spherical power and cylinder power were calculated.Results Corneal astigmatism was fully corrected when Toric IOLs in the middle,and the MTF curves were near in T3,T4,T5 Toric IOLs.The image performance was worse under the high spatial frequency with the increase of rotation degrees of Toric IOLs,showing the gradually low of MTF curves,especially T5 Toric IOL.No obvious changes was seen in coma,trefoil aberration and spherical aberration after rotation of Toric IOLs,while out-of-focus aberration,astigmatism aberration were obviously increased.In addition,residual astigmatism and spherical error increase with the rotation of Toric IOLs.Conclusions Toricl IOL rotation leads to increase of astigmatism and spherical refractive error but not high order aberration.

Objective To explore the clinical manifestation, diagnosis and prognosis of Leigh syndrome in children. Method Clinical data from 4 cases of Leigh syndrome conifrmed by genetic testing were retrospectively analyzed. The related literature were reviewed. Results In 4 cases, 3 were boys and one was a girl, 3 cases were onset in infant and one case was in school age. The main manifestations were mental retardation, low muscle tone, convulsions, feeding dififculties, drooping eyelids, extraocular muscle paralysis and nystagmus, irritation, activity intolerance etc. The brain magnetic resonance imaging (MRI) revealed symmetry long T1, T2 abnormal signal in brainstem, bilateral globus pallidus, thalamus, cerebellar dentate nuclei, and periaqueductal, 3 cases involved midbrain, one case involved thalamus, and one case involved cerebellar dentate nuclei;2 cases had encephalatrophy. Electromyography was normal in all cases. The levels of lactate in blood and cerebrospinal lfuid were increased. Mitochondrial DNA (mtDNA) detection found the mutation of mtDNA 8993 T>G in one case, and the mutation of mtDNA 9176 T>C in another 3 cases. The case onset in school age died of respiratory failure one month later, and another 3 cases were still in follow up, there were mental retardation, but no signiifcant setback. Conclusion The clinical manifestations of Leigh syndrome in children are diverse. The diagnosis is based on the typical clinical manifestations and MRI, blood and/or cerebrospinal lfuid lactate levels. The genetic testing is the golden standard for diagnosis.

Objective To localise and evaluate the precise position of the shank perforators preoperatively with the CTA and hand-held color Doppler (HHD),then evaluate the clinical efficacy of the method.Methods From April,2013 to June,2017,designed 36 propeller perforator flaps in 36 patients by following methods.Firstly,the CTA test was performed to calculate the parameters of perforator vessel positioning.Secondly,a HHD was typically used to verify the location of perforators found on preoperative CTA.At last,according to the "like with like" principle,the propeller perforator flaps were accurately designed.The regular followed-up was performed.Results All patients were followed-up for 3-24 months after operation.Thirty-six propeller perforator flaps survived,and 3 cases among them showed partial epidermal necrosis and healed after skin grafting.Donor sites were closed primarily in 24 cases,and skin grafting were performed in 12 cases.The skin graft sites survived without necrosis,and the average time of cutting flaps was 45 min.Conclusion By the methods of mapping the perforator propeller flaps with CTA and HHD,the perforator vessel can be positioned more accurately and quickly.The operation time was shortened,and the clinical efficiency can be achieved with the good clinical application values.

Survival and migration of transplanted neural stem cells (NSCs) are prerequisites for therapeutic benefits in spinal cord injury. We have shown that survival of NSC grafts declines after transplantation into the injured spinal cord, and that combining treadmill training (TMT) enhances NSC survival via insulin-like growth factor-1 (IGF-1). Here, we aimed to obtain genetic evidence that IGF-1 signaling in the transplanted NSCs determines the beneficial effects of TMT. We transplanted NSCs heterozygous (+/−) for Igf1r, the gene encoding IGF-1 receptor, into the mouse spinal cord after injury, with or without combining TMT. We analyzed the influence of genotype and TMT on locomotor recovery and survival and migration of NSC grafts. In vitro experiments were performed to examine the potential roles of IGF-1 signaling in the migratory ability of NSCs. Mice receiving +/− NSC grafts showed impaired locomotor recovery compared with those receiving wild-type (+/+) NSCs. Locomotor improvement by TMT was more pronounced with +/+ grafts. Deficiency of one allele of Igf1r significantly reduced survival and migration of the transplanted NSCs. Although TMT did not significantly influence NSC survival, it substantially enhanced the extent of migration for only +/+ NSCs. Cultured neurospheres exhibited dynamic motility with cytoplasmic protrusions, which was regulated by IGF-1 signaling. IGF-1 signaling in transplanted NSCs may be essential in regulating their survival and migration. Furthermore, TMT may promote NSC graft-mediated locomotor recovery via activation of IGF-1 signaling in transplanted NSCs. Dynamic NSC motility via IGF-1 signaling may be the cellular basis for the TMT-induced enhancement of migration.
Alleles ; Animals ; Cytoplasm ; Genotype ; In Vitro Techniques ; Insulin-Like Growth Factor I ; Mice ; Neural Stem Cells* ; Receptor, IGF Type 1 ; Spinal Cord Injuries ; Spinal Cord* ; Transplants*

Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.

Objective To explore how to overcome the difficulties during two paddle anterolateral thigh flap harvest. Methods From January, 2009 to December, 2015, the harvest of two paddle anterolateral thigh flap was encountered difficulties during surgery in 8 cases, which were 7 males and 1 female. The age was ranged from 16 to 48 years old, with averaged of 32.8. Six patients presented with one defect, and 2 patients presented with two defects. The skin defects ranged from 60-247 cm2. The number of the flap perforator, vascular source, flap pattern and out-comes was recorded. All patiants were followed-up at regular intervals. Results All of 8 flaps were converted suc-cessfully during surgery. Only 1 perforator was found in 4 cases. The flap was converted to sigle perforator flap. The dornor site was covered by skin graft. Two perforators from different origins were found in 2 cases, and the flap was converted to sequential chimeric flap. Two perforators from descending branch and transverse branch respectively were found in 1 case, and the flap was converted to combined anterolateral thigh and tensor fascia lata flap. Only 1 perfora-tor was found in 1 case, which the distal defect was small sized, the flap was converted to deepithelialized two paddle flap. The flap ranged from 78-288 cm2. Venous compromise was happened in 1 case, and the flap survived after reex-ploration surgery. Local infection was found in 2 cases, and cured with wound dressing. Other flaps were survived un-eventfully. At donor site, 1 case wound dehiscence and 1 case local infection, both of which underwent debridement and healed. All patiants were followed-up for 7-21(mean, 11.5)months. The flaps had satisfactory appearance and soft texture. Conclusion When it is difficult to harvest two paddle anterolateral thigh flap during surgery, the flap need to be converted rationally based on the characteristics of the defect, the number of the flap perforator, and the vascular origins.

Objective:To investigate the efficacy of induced membrane technique combined with anterolateral thigh flap transfer in treating composite foot defect.Methods:A retrospective case series study was performed for 7 patients with composite foot defect treated at 920th Hospital of Joint Logistic Support Force of PLA from February 2014 to December 2018. There were 5 males and 2 females, with the age of 20-73 years [(38.9±16.3)years]. The composite defect located at the forefoot in 5 patients, midfoot in 1, and hindfoot in 1. There were 9 metatarsal bone defects, 1 medial cuneiform bone defect, and 1 calcaneus bone defect. The size of soft tissue defect varied from 6 cm×5 cm to 70 cm×35 cm. At stage I, the anterolateral thigh flap transfer and vancomycin loaded cement implantation were performed. The flap survival and complications were recorded. At stage II, the cement was removed and autogenous bone was grafted into the induced membrane. The duration of two-stage operation, bone union time, and complications were recorded. The postoperative function was assessed using Maryland foot score system before operation and at the last follow-up and postoperative compications were documented.Results:All patients were followed up for 22-54 months [(33.8±9.7)months]. At stage I, flaps survived in all patients, and bulking of the flap was seen in 3 patients. One patient with calcaneus bone defect had repeated infection after operation, and received debridement. At stage II, 6 patients received bone grafting surgery. The duration of two-stage operation was 2-4 months [(2.8±0.9)months]. The bone union time was 3 and 7 months [(4.7±1.2)months]. At the last follow-up, the Maryland foot function score was 63-92 points [(82.1±8.7)points], significantly different from 0 point before operation ( P<0.01). The results were excellent in 1 patient, good in 5, and fair in 1. Except for one nonunion of metatarsal bone, all the other 8 sites were with bone union uneventfully. Conclusion:The induced membrane technique combined with anterolateral thigh flap transfer is an effective protocol for composite foot defect, which can well repair soft tissue and bone defect, and restore walking.

Objective:To estimate the preliminary result of circumflex scapular perforator propeller flap in reconstruction of axillary scar contractures.Methods:From January 2016 to June 2021, circumflex scapular perforator propeller flaps were used in 7 cases for reconstruction of soft tissue defect after axillary scar contractures. Patients were 5 males and 2 females. Age ranged from 23 to 38 years old, mean age of 27.7 years old. According to Kurtzman and Stern classification of axillary scar contractures, there were 1 case with type 1a, 1 with type 1b, 2 with type 2, and 3 with type 3. The preoperative range of motion of the shoulder joint were 40°-85°, with an average of 63.7°. All the patients were underwent scar release and circumflex scapular perforator propeller flap transfer. All flaps were transferred as the manner of perforator propeller flap. All the donor sites were closed directly. The defects after releasing ranged from 5.0 cm×7.0 cm to 11.0 cm×9.0 cm, and the flaps ranged from 16.0 cm×7.0 cm to 24.0 cm×9.0 cm. Flap survival, complications of donor site and recipient site were recorded after surgery. The range of motion of the shoulder joint, donor and recipient sites were reviewed in outpatient clinic.Results:All flaps survived uneventfully after surgery, besides 1 case complicated with distal venous congestion. The follow-up time ranged from 6 to 23 months, with an average of 12 months. The texture and contour of the flaps were good in all. At last follow-up, the range of motion of the shoulder joints were 90°-120°, with an average of 107°. Mild scar hyperplasia occurred in 2 cases.Conclusion:The circumflex scapular perforator propeller flap is an effective protocol in reconstruction of axillary scar contractures.

Objective:To investigate the preliminary clinical effect of posterior interosseous artery propeller flap in the repair of dorsal of wrist and hand wounds.Methods:From March, 2015 to December, 2019, 9 cases of dorsal of wrist and hand wounds were repaired with posterior interosseous artery propeller flap, including 6 cases of dorsal hand defect and 3 cases of dorsal wrist defect. Defect area: 6 cm × 4 cm-3 cm × 3 cm; There were 3 cases of metacarpal fracture, 1 case of phalangeal fracture and 1 case of tendon rupture. According to the size and shape of the wound, the posterior interosseous artery propeller flap was designed to transfer and repair the soft tissue defect wound. The size of the flap: 20 cm × 5 cm-12 cm × 3 cm, the size of posterior interosseous artery propeller flap was recorded and the surgical characteristics were summarized; The survival of the flap, donor and recipient complications were observed and followed-up.Results:All flaps were cut smoothly and the donor areas were sutured directly. The flap survived completely in 8 cases and partial necrosis in 1 case; One case complicated with wound infection. The follow-up ranged from 6 to 31 months, with an average of 14 months. The texture and shape of the flap were good; The last DASH score was 3-18, with an average of 9.3; There were 2 cases of mild scar hyperplasia in the donor area and 1 case of mild scar hyperplasia at the edge of the flap.Conclusion:Posterior interosseous artery propeller flap may be an effective method to repair small and medium-sized wounds of dorsal of wrist and hand.

Objective To investigate the effect and characteristics of anterolateral thigh flap in repair of extremity wound in children.Methods A retrospective case series study was conducted to analyze the clinical data of 69 patients with limb soft tissue defects admitted to Kunming General Hospital of PLA from January 2008 to December 2016.There were 57 boys and 12 girls,aged 2-15 years (mean,6.7 years).There were 56 cases of lower extremity wounds and 13 cases of upper limb wounds.The wound areas ranged from 3 cm ×4 cm to 14 cm × 15 cm,with an average of 52.4 cm2.All wounds were repaired with the anterolateral thigh flap.The type of flap,number of perforators,type of perforation,closure of donor site,healing of the flap,complications,and reoperation were recorded.Results Seventy anterolateral thigh flaps were harvested in 69 children,including 42 musculocutaneous flaps and 28 perforator flaps.Intraoperative visualization identified 76 perforators,including 14 septocutaneous and 62 musculocutaneous perforators.The donor site was closed primarily in 52 cases,and a split-thickness skin graft was required in 18 cases.After operation,vascular crisis occurred in four cases.After exploration,one flap survived,and partial necrosis was found in three flaps.Except for one flap with total necrosis because of infection,the rest of the flaps survived.Other postoperative complications included flap edge necrosis in six cases,local infection in six,and wound dehiscence in three.The follow-up ranged from 6 to 33 months,averaged 14.9 months.Hypertrophic scar occurred at donor site in 27 children.The number of reoperation was 46,including 23 debulking procedures,seven skin grafts,four debridements,and 12 others.Conclusions The anterolateral thigh flap is a safe,reliable option for reconstruction of soft tissue defects in extremities of children.The anterolateral thigh musculocutaneous flap is used commonly in children.However,hypertrophic scar at donor site occurs more often after flap surgery,with high rate of reoperations.