Objective:Reports about impact of lumbar posterolateral fusion on adjacent segment degeneration concentrated on biomechanics and imageology,lack experimental study. This study observes the impact of posterolateral arthrodesis on the adjacent intervertebral disc. To observe the impact of posterolateral arthrodesis on the adjacent intervertebral disc. Methods:Rabbit models of posterolateral arthrodesis were established and the transverse processes of the fourth,fifth and sixth lumbar vertebrae were exposed. Stainless-steel wire0.8 mm in diameter was used to interconnect the three transverse processes in a figure of 8. Methylmethacrylate was then applied to encircle the transverse processes and the wire. Changes in the adjacent disc were observed by light microscopy 3 and 6 months after the operation. Results:Disc degeneration was found at L3-4 at 3 months postoperatively,and further degeneration was noted at this level at 6 months. Conclusion:Posterolateral fusion may accelerate the degeneration of the adjacent intervertebral disc.

Objective To study on the influence of comprehensive nursing intervention on extremities function and quality of life (QOL) in community patients with convalescent stroke.Methods A total of 200 community patients with convalescent stroke were selected and randomized into the experimental group and the control group,100 cases each.Patients in the control group were given conventional treatment and following.While patients in the experimental group were given comprehensive nursing intervention besides the treatment mentioned above.Then the therapeutic effects were evaluated by filling out brief Fugl-Meyer assessment(FMA) scale and ADL rating scale(FIM).Life satisfaction index A(LSIA) and quality of life index (QLI) were selected to evaluate QOL.Results After treatment,the scores of LSIA and QLI of the control group showed no difference,but these scores of the experimental group were significantly improved,and was better than those of the control group.In addition,both FMA and FIM in these two groups improved obviously compared to those before treatment and the effect of the experimental group was superior to that of the control group.Conclusions The comprehensive nursing intervention can significantly improve extremities function and ADL and QOL of community patients with convalescent stroke.It is economical,simple and suitable to community families with any education background.

Objective To explore the effect of research practical teaching mode on the critical thinking ability and innovation ability of nursing in the course of community nursing teaching.Methods The research practical teaching was provided for 90 nursing students.They were investigated with the WatsonGlaser Critical Thinking Appraisal (WGCTA) and the test of self innovation level scale before and after teaching.Results After the teaching,the total score of critical thinking and the score of innovation ability among nursing students were significantly improved.the recognition hypothesis,deduction, explanation,evaluation discussed dimensions were statistically significant,but before and after teaching reasoningdimensions showed no significant difference.Conclusions Research practical teaching mode can improve critical thinking ability and innovation ability of nursing students in the course of community nursing teaching.

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.

Maple syrup disease (MSUD) is a rare autosomal recessive disorder caused primarily by mutations of branched-chain keto acid dehydrogenase complex (BCKDC). BCKDC includes at least four pathogenic genes of BCKDHA, BCKDHB, DLD and DBT. The clinical manifestations of MSUD are complex, and the main symptoms at the early stage include difficulty in feeding, drowsiness, change in muscle tone and special urine flavor of maple syrup. As the disease progresses, convulsion, hypoglycemia, coma and systemic failure may occur. MSUD is easily missed or misdiagnosed during the neonatal period. This paper provides a review for recent progress made in research on MSUD including etiology, physiopathology, clinical manifestation, auxiliary examination and treatment, with a particular emphasis on genetic testing and treatment.
3-Methyl-2-Oxobutanoate Dehydrogenase (Lipoamide) ; genetics ; Humans ; Maple Syrup Urine Disease ; diagnosis ; genetics ; therapy ; Mutation

Oral medicine and deep brain stimulation are two main treatments for Parkinson′s disease (PD). But their long-term efficacies are decreasing, which limit the choice of patients in advanced stage. As a special way of sensory intervention, rhythmic cueing can improve gait parameters, reduce freezing of gait severity and improve gait-related mobility by activating the motor pathway directly, repairing internal clock, promoting internal dopamine release and improving cognitive function to maintain gait stability. Rhythmic auditory and visual cueing has a potential in PD treatment.

Objective:To introduce the concept and procedure of CTA guided precision flap surgery and report the preliminary clinical application.Methods:The theory of CTA guided precision flap surgery is: based on CTA high-throughput data, comprehensively evaluate the wound and potential donor sites, and select the best plan for wound repair. This article reviews 177 patients treated under the guidance of CTA guided precision flap surgery from August 2014 to December 2018. Among them, 131 were males and 46 were females; they were 7-72 years old, with an average age of 39.5 years. The tissue defects were: 74 cases of foot and ankle, 64 cases of wrist, 15 cases of calf, 11 cases of forearm and upper arm, 7 cases of thigh and perineum, 5 cases of face and neck, and 1 case of abdomen. The size of the defect was 2 cm×1 cm to 65 cm×50 cm. The recipient and donor sites were assessed based on CTA guided precision flap surgery, then choose the optimal flap to repair the defect. The flap types, outcomes and complications were recorded. The visual analogue scale (VAS), British Medical Research Council sensory rating scale, and revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association was used to assess clinical results.Results:All flaps were uneventfully harvested as planned according to the CTA guided precision flap surgery concept.A total number of 181 flaps were harvested, including 125 free flaps and 56 pedicled flaps. The flap area rangedfrom 4 cm×3 cm to 40 cm×8 cm. After surgery, 165 cases were survival completely, 7 cases were total necrosis, 9 cases were partial necrosis. A total of 174 cases of flaps survived. The mean follow-up was 9.2 months (range, 6-60 months). After surgery 53 flaps were bulky, and 7 cases with other complications.At the last follow-up, only 6 patients had mild pain, the VAS score was 1-3. The sensation of the flaps recovered partially. According to the British Medical Research Council sensory rating scale: 68 cases were grade S2 and 106 cases were grade S3. According to the revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association, 171 cases were excellent and 3 cases were good.Conclusion:The concept of precision flap surgery based on CTA can effectively guide flap surgery and achieve precise wound repair.

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.

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 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.