Objective To explore the curative effect of oral cancer radical surgery plus free anterolateral thigh flap repair and analyze the influence factors of skin flap necrosis.Methods The data of 98 patients who underwent oral cancer radical surgery with concurrent free anterolateral thigh flap repair in our hospital from January 2010 to June 2015 were retrospectively analyzed.The complete survival rate of skin flaps and incidence of complications in all patients were statistically analyzed.The age,diabetes,infection in implanted skin flap area,smoking and mental status,etc.of patients with survived or necrotic skin flaps were compared between patients with survival flaps and patients with flap necrosis,and multivariate Logistic regression analysis was performed.Results Among the 98 cases,86 cases of flaps survived completely and the survival rate was 87.8%.Fifteen cases with the skin flap necrosis,the incidence of complications was 15.3%,including 7 cases of surgi-cal site infection and 5 cases of skin flap necrosis with massive hemorrhage.The donor site incisions of all patients were primary healing and the patients were satisfied with the postoperative appearance.Among the patients with flap necrosis,the incidence rates of ≥60 years old,with diabetes,infection in flap implanted area,smoking and poor mental state (41.7%,41.7%,58.3%,75.0%,83.3%)were higher than those corresponding proportions in the patients with with survival flaps(P <0.05).Multivariate Logistic regression analysis showed that age,diabe-tes,infection in implanted skin flap area,smoking and poor mental status were the influencing factors for flap necrosis.Conclusion Oral cancer radical surgery with concurrent free anterolateral thigh flap repair has good curative effects.The age,combined with diabetes,smoking,infec-tion in flap implanted area and poor mental state are the risk factors for flap necrosis in patients with oral cancer after flap repair,which should be given intervention to improve the survival rate of skin flap in clinic.

Aim To reveal the mechanism of cross-species ischemic heart failure from the perspective of spatial and gene co-expression networks.Methods GSE210374 and GSE57338 high-throughput sequencing datas were re-trieved from the national center for biotechnology information gene expression database(NCBI-GEO),and R language soft-ware packages was used to analyze and screen differentially expressed genes(DEG)in different myocardial regions of myo-cardial infarction rats,as well as DEG of myocardial samples from patients with ischemic heart failure and healthy controls,and the regional expression of common genes was analyzed.Weighted gene co-expression network analysis(WGCNA)was used to screen the genes related to myocardial infarction and to carry out enrichment analysis,protein-protein interac-tion network(PPI)was constructed to screen core genes(HG).Results A total of 4 835 differentially expressed genes were screened out in myocardial infarction rats and normal controls,and 51 differentially expressed genes were screened out in ischemic heart failure patients and normal control samples,which revealed representative gene sets in the left ventricular myocardial infarction area(I area),border area(BZ area),and remote area(R area)after myocardial in-farction.Spatial expression analysis revealed that there were 20 co-expressed genes in each myocardial region,16 of which were expressed in all three regions,the number of genes specifically expressed in I,BZ and R regions were 2,0 and 2,respectively.Enrichment analysis showed that the functions of co-expressed genes were different in different region.The I and BZ regions were related to collagen fiber assembly,stress-induced cardiomyocyte hypertrophy,down-regulation of c-Jun amino terminal kinase(JNK signal)and cell proliferation,and complement signaling pathways;The I and R regions were enriched in the binding of Wnt and collagen;As a non-ischemic distal R region,the co-expressed genes were signifi-cantly enriched in the extracellular matrix for functions such as compressive resistance,cytolysis and inhibition of T cell proliferation.Furthermore,it was worth noting that the products of co-expressed genes in the three regions were mostly lo-cated in the extracellular space and extracellular matrix,suggesting that there may be active cellular secretion and interac-tion regulation.Further PPI analysis suggested that asporin(ASPN),osteoglycin(OGN)and collagentype ⅩⅥ alpha chain(COL14A1)gene might be the core genes of the mechanism mentioned above.Conclusions The common mechanism of ischemic heart failure in rats and human involves multiple signaling pathways such as complement and coagu-lation cascade signaling and Wnt;which may be closely related to cell apoptosis mediated by extracellular matrix and exo-somes;ASPN,OGN,and COL14A1 may be the core genes.This work is expected to provide spatial and pathway refer-ence for the selection of intervention targets and pathway in the transformation research related to ischemic heart failure.