In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.

Objective: To investigate the spatial distribution characteristics and correlation between the prevalence of dental fluorosis and the chemical elemental composition of drinking water sources in coal-fired fluorosis areas. Methods: Based on the survey data on the prevalence of dental fluorosis at CDC in Guizhou Province in 2022, 274 original surface drinking water sources were collected in typical coal-fired fluorosis areas, and fluoride (F), calcium (Ca), magnesium (Mg), aluminum (Al), titanium (Ti), chromium (Cr), manganese (Mn), iron (Fe), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), cadmium (Cd), barium (Ba), lead (Pb) 17 elements; apply Moran's I index, Getis-Ord Gi* hotspot analysis of the global spatial autocorrelation of chemical elements in drinking water and the degree of aggregation of each element on the local area, and correlation analysis with the prevalence of dental fluorosis in the region. Results: Except for Cu, Zn, and Cd, global spatial autocorrelation Moran's I was negative, and all other elements were positive. F, Ca, Al, Ti, As, Mo, Cd, and Cu elements showed high values of aggregation in the southeastern low-altitude area; Mg, Ba, Pb, Cr, Mn, and Fe elements were mainly aggregated in the central altitude terrain transition area, Zn and Se elements in water sources are significantly positively correlated with the prevalence of dental fluorosis (P<0.05). In contrast, F, Mg, Al, Ti, As, Mo, Cd, Ba, and Pb elements negatively correlate (P<0.05). Elements in the central region were high-high aggregation, as a hot spot aggregation area with high disease incidence, while F, Al, Mn, Mo, Cd, and Ba elements in the western region were low-low aggregation, as a cold spot aggregation area with a low incidence of fluorosis. Conclusions: The risk of population fluoride exposure in surface drinking water sources is shallow. However, the chemical element content of drinking water sources in coal-fired polluted endemic fluorosis areas has prominent spatial geographical distribution characteristics. There is a significant spatial aggregation effect with the prevalence of dental fluorosis, which may play a synergistic or antagonistic effect on the occurrence and prevalence of dental fluorosis.
Humans ; Drinking Water ; Prevalence ; Coal ; Fluorides/adverse effects* ; Cadmium ; Fluorosis, Dental/epidemiology* ; Lead ; Selenium ; Arsenic

Objective : To investigate the sex difference of the effects of chronic pregnancy stress on depression-like behavior in offspring adolescent mice and whether the amygdala is involved in mediating depression-like behavior and its possible mechanism． Methods : Male and female of C57BL /6J mice were put in cage together．Pregnant mice were randomly divided into normal control group ( CON group) and chronic pregnancy stress group ( CPS group) ．The day of delivery was recorded as post-natal day(PND0) ．The offspring of different groups were divided into Female group and Male groupaccording to sex，respectively．From PND35，the depressive-like behavior of off- spring was monitored in different groups．Morphological structure of basolateral amygdala (BLA) cone neurone was observed by Golgi-Cox staining，and apoptosis of BLA neurone was detected by TUNEL．Serum corticotrophin-relea- sing hormone ( CRH) was detected by ELISA．The level of protein associated with amygdala mammalian target of rapamycin (mTOR) and phosphorylated mammalian target of rapamycin ［p-mTOR ( Ser2448) ］was detected by Western blot. Results : Depression-like behavior was appeared in different sexual offspring by chronic pregnancy stress，and there was an interaction between chronic pregnancy stress and gender．In the forced swimming test，the immobility time of offspring in the CPS group prominently increased(Female: P＜0. 05，Male: P＜0. 001) ．Interest- ingly，compared with female offspring ，despairing behavior of male offspring was much more clearly observed in CPS group(P＜0. 05) ．Compared with offspring of CON group，the rate of sucrose preference was significantly re- duced in the female offspring of CPS group(P＜0. 05) ，while no obvious difference was observed in the male off- spring．Compared with the CON group，the density of neuronal dendrite branches in the BLA of offspring mice in the CPS group decreased(Female: P＜0. 01，Male : P＜0. 01) and the degree of neuronal apoptosis increased( Fe- male: P＜0. 001，Male : P ＜0. 001) ，the expression level of p-mTOR in amygdala of offspring mice in CPS group significantly decreased(Female: P＜0. 001，Male: P＜0. 001) ．Chronic pregnancy stress increased the serum CRH level of offspring mice(P＜0. 001) ，and the gender had significant influence on serum CRH level，the serum CRH level of female in CPS group was higher than that of male(P＜0. 05) ． Conclusion Chronic pregnancy stress leads to depression-like behavior in offspring adolescent mice，and the depression-like behavior has gender differences. In addition，chronic pregnancy stress leads to dendrite atrophy and apoptosis of BLA neurons in offspring mice，and the mechanism may be that the activation of mTOR in the amygdala of offspring mice is inhibited．CRH may be in- volved in mediating sex differences in depression-like behavior and BLA neuron damage in offspring induced by chronic pregnancy stress.

BACKGROUND:A new-type nano-bionic anti-adhesion hernia mesh was developed in our previous research.OBJECTIVE:To investigate the mechanical properties and cytocompatibility of the new-type nano-bionic anti-adhesion hernia mesh.METHODS:The tensile strength of the compound hernia mesh was detected using a textile detector.Mouse fibroblasts (L929) were cultured with the compound hernia mesh,and cell structures on the mesh surface were observed under electron microscope at 1,3,5 days after culture.In addition,L929 cells were co-cultured with compound hernia mesh,polypropylene patch,and polyester patch,respectively.Cells cultured alone were used as negative controls.After 1,3,5 days of culture,MTS array was used to detect cell proliferation and evaluate cytotoxicity;after 3 days of culture,western blot was used to detect the content of type Ⅰ and Ⅲ collagens.RESULTS AND CONCLUSION:The average tensile strength of the compound hernia mesh was 31.2 N The number of fibroblasts on the nanofibrous layer of the compound hernia mesh increased as long as cultured.The cells spread along the nanofibers and pseudopodia extended from the cells formed polygon and fusiform structures,with a good cross-linking with the mesh.A complete cell layer covered all pores of the nanofibers at 5 days.The cytotoxicity of the nanofibrous layer of the compound hernia mesh was graded 0,and the cytotoxicity was graded 1 of polypropylene and polyester patches.All the three kinds of patches fulfilled the implantation requirements,and the compound hernia mesh had better biological properties.No significant differences were found among groups in the contents of type Ⅰ and Ⅲ collagens at 3 days of culture.To conclude,the new-type nano-bionic anti-adhesion hernia mesh has good mechanical properties and cytocompatibility.

Adult ; Hemoglobinuria, Paroxysmal ; complications ; pathology ; Humans ; Male ; Moyamoya Disease ; diagnosis ; etiology ; pathology ; Young Adult

BACKGROUNDIt remains controversial whether patients with Stage II colorectal cancer would benefit from adjuvant chemotherapy after radical resection. The aim of this study was to establish two mathematical models to identify the suitable patients for adjuvant chemotherapy.

METHODSThe current study comprised of two steps. In the first step, 353 patients with Stage II colorectal cancer who underwent surgical procedures at the Third Affiliated Hospital of Sun Yat-sen University between June 2006 and December 2015 were entered and followed up for 6-120 months. Their clinical data were collected and enrolled into the database. We established two mathematical models by univariate and multivariate Cox regression analysis to identify the target patients; in the second step, 230 patients under the same standard between January 2012 and December 2016 were entered and followed up for 3-62 months to verify the two models' validation.

RESULTSIn the first step, totally 340 surgical patients with Stage II colorectal cancer were finally enrolled in this study. Statistical analysis showed that tumor differentiation (TD) (P < 0.001), lymphovascular invasion (LVI) (P < 0.001), uncertain or positive margins (UPM) (P < 0.001), and fewer lymph nodes (LNs) (<12) retrieved (P < 0.001) were correlated with the overall survival (OS) and disease free survival (DFS). We obtained two models: (1) OS risk score = 1.116 × TD + 2.202 × LVI + 3.676 × UPM + 1.438 × LN - 0.493; (2) DFS risk score = 0.789 × TD + 2.074 × LVI + 3.183 × UPM + 1.329 × LN - 0.432. According to the models and cutoff points [(0.07, 1.33) and (-0.04, 1.30), respectively], patients can be divided into three groups: low-risk, moderate-risk, and high-risk. Moreover, the high-risk group patients could benefit from adjuvant chemotherapy. In the second step, totally 221 patients were finally used to verify the models' validation. The results proved that the models were accurate and feasible (P< 0.05).

CONCLUSIONSAccording to the predictive models, patients with Stage II colorectal cancer in the high-risk group are strongly recommended for adjuvant chemotherapy, thus facilitating the individualized and precise treatment.

Background: Right upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most vari-able anatomical structures, but no studies have analyzed its effects on postoperative recovery. This study compared the conventional surgical approach, VAB (dissecting pulmonary vessels first, followed by the bronchus), and the alter-native surgical approach, aBVA (dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients. Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into aBVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop-erative outcomes. Results: Three hundred one patients were selected (109 in the aBVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the aBVA cohort than in the VAB cohort (164 vs. 221 min, P < 0.001), and less blood loss occurred in the aBVA cohort (92 vs. 141 mL, P < 0.001). The rate of conversion to thoracotomy was lower in the aBVA cohort than in the VAB cohort (0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the aBVA cohort than in the VAB cohort (3.6 vs. 4.5 days, P = 0.001). The rates of postoperative complica-tions were comparable (P = 0.629). The median overall survival was not arrived in both cohorts (P > 0.05). The median disease-free survival was comparable for all patients in the two cohorts (not arrived vs. 41.97 months) and for patients with disease recurrences (13.25 vs. 9.44 months) (both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences (6.4% vs. 7.8%), distant metastases (10.1% vs. 8.3%), and both (1.8% vs. 1.6%) (all P > 0.05). Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the aBVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.

Antineoplastic Agents ; adverse effects ; Arterial Occlusive Diseases ; chemically induced ; Breast Neoplasms ; drug therapy ; Carotid Artery Diseases ; chemically induced ; Carotid Artery, Internal ; Female ; Humans ; Middle Aged ; Nitriles ; adverse effects ; Postmenopause ; Triazoles ; adverse effects