Objective:To explore the feasibility for reconstruction of soft tissue defects in limbs and trunk with perforator pedicled kite flap, and to summarise its clinical efficacy.Methods:A retrospective study was conducted on 14 patients with soft tissue defects and admitted to the Department of Hand Microsurgery of Xiangya Hospital, Central South University from January 2016 to September 2023. Among the 14 patients (6 males and 8 females), 7 had defects in calf, 2 in sacrococcygeal area, 2 in the back and 3 in forearm. All of the defects were reconstructed with the perforator pedicled kite flaps, of which 6 flaps had the pedicles of single perforator, 3 of 2 perforators, 4 of 3 perforators and 1 of 5 perforators. Single V-Y advancement flaps were used for defect reconstruction in 8 patients, and double V-Y advancement flaps were used in 6 patients. The size of the defects ranged from 2.2 cm×1.8 cm to 8.0 cm×16.0 cm, and the size of the flaps ranged from 3.0 cm×5.5 cm to 9.0 cm×23.0 cm. All donor sites were closed directly. Postoperative follow-up was conducted at outpatient clinic, by telephone reviews and WeChat after surgery, to observe the flap survival and postoperative complications.Results:All flaps survived completely. All the flaps and donor sites healed primarily. The postoperative follow-up lasted for 3 to 36 (mean, 14.5) months. Thirteen flaps presented with soft texture, good appearance, with similar texture to the surrounding skin and without obvious swelling. The patients were satisfied with the aesthetic outcomes. One patient had a local ulcer with exudation at the recipient site and the ulcer healed after removal of the steel plate and thoroughly debridement.Conclusion:With a perforator pedicled kite flap, vascular anastomosis or sacrifice of a second donor site can be avoided. A perforator pedicled kite flap can be applied to many recipient sites, with a simple surgical procedure and a good postoperative appearance. It is an ideal flap for reconstruction of small to medium-sized soft tissue defects in trunk and limbs. More studies are required to evaluate the feasibility of the flap to be applied in local hospitals.

The nucleus accumbens (NAc) plays an important role in various emotional and motivational behaviors that rely on heightened wakefulness. However, the neural mechanisms underlying the relationship between arousal and emotion regulation in NAc remain unclear. Here, we investigated the roles of a specific subset of inhibitory corticotropin-releasing hormone neurons in the NAc (NAc^CRH) in regulating arousal and emotional behaviors in mice. We found an increased activity of NAc^CRH neurons during wakefulness and rewarding stimulation. Activation of NAc^CRH neurons converts NREM or REM sleep to wakefulness, while inhibition of these neurons attenuates wakefulness. Remarkably, activation of NAc^CRH neurons induces a place preference response (PPR) and decreased basal anxiety level, whereas their inactivation induces a place aversion response and anxious state. NAc^CRH neurons are identified as the major NAc projection neurons to the bed nucleus of the stria terminalis (BNST). Furthermore, activation of the NAc^CRH-BNST pathway similarly induced wakefulness and positive emotional behaviors. Taken together, we identified a basal forebrain CRH pathway that promotes the arousal associated with positive affective states.
Animals ; Septal Nuclei/metabolism* ; Nucleus Accumbens/physiology* ; Corticotropin-Releasing Hormone/metabolism* ; Wakefulness/physiology* ; Neurons/metabolism* ; Male ; Mice ; Mice, Inbred C57BL ; Neural Pathways/physiology* ; Anxiety/physiopathology* ; Reward

Objective To study the safety and efficacy of intraoperative implanting slow-released 5-Fu after hepatectomy in patients with hepatocellular carcinoma (HCC). Methods 59 HCC patients undergoing hepatectomy from January 2008 to January 2009 were divided into two groups:to receive slowrelaesed 5-Fu in treatment group and nothing in control group.Postoperatively no patients in both group took chemotherapy.The serous value of WBC,ALT,AST,TBIL and AFP were measured in all cases on 1 day before and 3 weeks after the operation.During the first six months,AFP was measured and imaging studies were done one month after discharge,and every 3 months since then.CT-guided biopsy was used to confirm the recurrence of HCC. Disease-free survival rate and overall survival rate in two groups calculated respectively 6-,12-,18- and 24-months after the operation. Results The serous value of WBC,ALT,AST,TBIL was not different between treatment group and control group 3 weeks after the operation (separately t =0.801,- 0.854,- 1.948,- 0.503,all P ＞ 0.05).AFP was (361.58 ± 431.06) μg/L,( 17.02 ± 15.55 ) μg/L,(43.61 ± 58.03 ) μg/L in treatment group and (495.50 ± 441.63 ) μg/L,(26.82 ±60.46) μg/L,(127.48 ±229.79) μg/L in control group preoperatively,3 weeks and 6 months after the operation.AFP was lower in treatment group than that in control group ( t =- 2.065,P ＜ 0.05 ).The disease-free survival rate in treatment group was 95.8％,91.7％,79.2％,75.0％ at 6-,12-,18- and 24-months after the operation,in control group it was 94.3％,71.4％,60.0％,48.6％ ( x2 =4.035,P ＜0.05).The overall survival rate was respectively 100％,95.8％,91.7％,83.3％ in treatment group and was 100％,94.3％,77.1％,60.0％ in control group( x2 =3.931,P ＜0.05).Conclusions Intraoperativeimplanting slow-released 5-Fu during the hepatectomy was safe and effective method to reduce the recurrence rate of hepatocellular carcinoma and prolongs postoperative disease free and overall survival in HCC patients undergoing hepatectomy.