Objective:To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle.Methods:From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair.Conclusion:A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.

Humans ; China/epidemiology* ; SARS-CoV-2 ; COVID-19

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

【Objective】 To analyze ABO subtype samples from tumor patients using both blood group serology and molecular biology technology. 【Methods】 32 samples of ABO subtype, identified by routine blood group serology in the Department of Transfusion, of solid tumor patients treated in Cancer Hospital of Chinese Academy of Medical Sciences from July 2014 to December 2019 were analyzed by sequence specific primer polymerase chain reaction (PCR-SSP) and gene sequencing (PCR-SBT). 5 samples were detected by PCR-SSP, 28 PCR-SBT, 1 both PCR-SSP and PCR-SBT. The serological and genotyping results were comparatively analyzed. 【Results】 66% (21/32) of the samples in this study were confirmed as ABO subtypes or harbored mutations by genotyping assays, including 7 cases of B(A).04, 2 of B(A).02, 1 of cis AB.01, 3 of BW.12, 4 of BEL.03, 1 of AEL.02, 1 of B 974G>C, 1 of A 797insT, and 1 of A 617C>G. Among the 21 subtype samples or harbored mutations, 15 had the same blood group serology and genotyping results, and 6 had no A or B antigen detected in the serological adsorption-elution test. An additional 34% (11/32) of the samples had no variants in the gene responsible for ABO subtype detected by molecular analysis. 【Conclusion】 Molecular biology techniques can assist in the identification of difficult ABO blood types caused by weakened antigens or antibodies, and subtypes in solid tumor patients, which is an important auxiliary method for accurate identification of difficult ABO blood group.

Objective:To propose the application of recognizing bone species by touching blindly (ARBTB) and verify its application effect in human anatomy experimental courses.Methods:The study included experiment 1 and experiment 2, and the research objects were 60 students majoring in clinical medicine in Batch 2019 and 60 students majoring in preventive medicine in Batch 2018, respectively. The research objects in each experiment were randomized into mainstream teaching method group and ARBTB group, with 30 students in each group. In experiment 1, after students studying for the same hours, both of two groups carried out the same test, and then the average scores of the two groups were compared. In experiment 2, the average time spent by the two groups of students in osteology learning was compared.Results:In experiment 1, ARBTB group's average score of the test was significantly higher than that of the mainstream teaching group ( P<0.001). In experiment 2, the ARBTB group took much less time in osteology learning than the mainstream teaching group ( P<0.001). Conclusion:Compared with the mainstream teaching method, ARBTB is more effective in osteology learning, which is worth popularizing.

Objective:To investigate the protective effect of ulinastatin combined with adipose-derived stem cells (ADSCs) transplantation on renal tissue in rats with endotoxic shock.Methods:20 Sprague Dawley rats were randomly selected as normal group from 108 Sprague Dawley rats. The remaining 88 rats were treated with 2 ml lipopolysaccharide (10 mg/kg) via tail intravenous injection to establish endotoxic shock model. The established 80 model rats were randomly divided into model group, ADSCs group, ulinastatin group and combination group (ulinastatin combined with ADSCs). All the rats were treated once a day for 3 days. Three days after transplantation, the renal tissues of each group were stained with hematoxylin-eosin staining to observe the pathological changes. The distribution of CM-Dil labeled ADSCs in the kidney of rats was observed by fluorescence microscope. The levels of nitric oxide synthase (NOS), nitric oxide (NO), creatinine and urea nitrogen in rat serum were measured. The reverse transcription PCR and Western Blot were used to detect the level of Bax and Caspase-3 in rat kidney tissue. Three days after transplantation, inflammatory cell infiltration and necrosis were occasionally seen in model group. Compared with the model group, the kidney damage in the ADSCs group and the ulinastatin group was significantly reduced, and kidney damage in the combined group was the least.Results:CM-Dil-labeled positive cells were found by microscope in the ADSCs group and the combined group, while CM-Dil-labeled ADSCs were not found in the kidney tissues of the normal group, model group and ulinastatin group. Compared with the normal group, the levels of NOS, NO, creatinine and urea nitrogen in the model group were significantly increased (all P<0.05). Compared with the model group, the levels of NOS, NO, creatinine and urea nitrogen in the ADSCs group, the ulinastatin group and the combination group were significantly increased (all P<0.05), in which the combined group has a further reduction in these related protein levels than the ADSCs group and the Ulinastatin group (all P<0.05). The mRNA and protein expressions of Bax and Caspase-3 in the kidney tissues of the model group were significantly higher than those in the normal group (all P<0.05). The Bax and Caspase levels in the kidney tissues of the ADSCs group, Ulinastatin group and combination group -3 mRNA and protein expression were significantly lower than those of the model group (all P<0.05), in which the combined group has a further reduction in these related protein levels than the ADSCs group and the Ulinastatin group (all P<0.05). Conclusions:Ulinastatin combined with ADSCs transplantation has a protective effect on kidney damage caused by endotoxin shock, which may be related to alleviating renal cell injury.

Objective To investigate the effects of tea-polyphenols on diabetic nephropathy (DN) mice by regulating nuclear factor E2-related factor 2/antioxidant response element (Nrf-2/ARE) signaling pathway. Methods A total of ten male 9-week-old normal (db/m) mice were randomly and equally divided into blank control group and tea-polyphenol control group, and ten male 9-week-old homologous type 2 diabetes (db/db) mice were randomly divided into model group and tea polyphenol treatment group. The animals in the tea-polyphenol control group and the treatment group were given 50 mg/(kg·d) tea-polyphenols by oral gavage, and the animals in the blank control group and model group were given same volume of double distilled water. The administration was once a day for 8 weeks. The blood glucose and 24-hour urine protein quantization (24 h-UP) were measured and recorded at 0, 4, and 8 weeks. After 8 weeks of the treatment, the mice were sacrificed. The intraocular blood stasis samples were collected for renal function indicators (serum creatinine and urea nitrogen), and kidney tissue samples were also collected for the tests of superoxide dismutase (SOD), reactive oxygen species, and malondialdehyde. Periodic acid Schiff reaction (PAS) staining was used to observe glomerular injury and scored. Western blot was used to detect the expression of Nrf-2 and hemeoxygenase-1 (HO-1) protein. Results Compared with the blank control group, the blood glucose and 24 h-UP of the mice in the model group and the tea-polyphenol treatment group increased after 4 and 8 weeks of the treatment (all P<0.01). Compared with the blank control group, after 8 weeks of the treatment, the serum creatinine and blood urea nitrogen of the model group and the tea-polyphenol treatment group increased (all P<0.01), the content of SOD in the renal tissue decreased (all P<0.01), the content of active oxygen and malondialdehyde, the relative expression of Nrf-2 and HO-1 protein increased (all P<0.01), and the glomerular injury aggravated (all P<0.01). However, there were no significant differences in all the indexes between the tea-polyphenol control group and the blank control group (all P>0.05). Conclusions Renal tissue of DN mice will undergo significant oxidative stress injury. Tea-polyphenols may reduce the oxidative stress injury in DN mice by regulating the Nrf-2/ARE signaling pathway, and play a protective role in the kidney.

Objective: To investigate the efficacy and feasibility of laparoscopic resection for gastric gastrointestinal stromal tumor (GIST) in unfavorable location by comparing with open surgery. Methods: Clinicopathological and follow-up data of 176 patients with gastric GIST in unfavorable location admitted at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2017 were analyzed retrospectively. There were 94 males and 82 females, aging of (57.4±12.7) years (range: 20-90 years). Of the 176 patients, 64 underwent laparoscopic surgery (laparoscopic group) and 112 underwent open surgery (open group). One-to-one propensity score matching (PSM) was performed to balance the covariance between laparoscopic group and open surgery group. Before PSM, the differences between the two group in tumor size and modified National Institutes of Health risk classification were significant. After PSM, there were 63 pairs (63 cases in laparoscopic group and 63 cases in open group) and the baseline characteristics were comparable between the two groups(P>0.05). The difference of short-term outcome between the two groups were compared using t test, χ² test or Wilcoxon rank-sum test. The survival curve was established by Kaplan-Meier method and the Log-rank test was used to compare the survival of the two groups. Results: The operation time of laparoscopic group was shorter ((141.6±100.6) minutes vs. (100.4±67.7) minutes, t=2.681, P=0.008), the hospitalization cost was higher ((5.2±0.7) ten thousand yuan vs. (4.2±0.8) ten thousand yuan, t=7.357, P=0.000) than open group. The time to first flatus ((49.1±8.2) hours vs. (71.0±4.6) hours, t=-18.482, P=0.000) and preoperative hospital stay ((10.3±6.0) days vs. (14.8±7.6) days, t=-3.717, P=0.000) was shorter in laparoscopic group. With a median follow-up time of 44 months (range: 10 to 154 months), the 1-, 3-, 5-year relapse-free survival rates in the laparoscopic group and open group were 98.3%, 92.1%, 92.1% and 100%, 86.3%, 83.2%, respectively (χ²=0.696, P=0.404). The 1-, 3-, 5-year overall survival rates in the laparoscopic group and open group were 96.6%, 94.7%, 94.7% and 100%, 91.1%, 81.4%, respectively (χ²=0.366, P=0.545). Conclusions In experienced medical centers, laparoscopic resection is safe and feasible for GIST in unfavorable location. Compared to open surgery, laparoscopic resection achieves a faster postoperative recovery and a similar long-term prognosis.

Objective To develop a convolution neural network (CNN) model to classify multi?sequence MR images of the prostate. Methods ResNet18 convolution neural network (CNN) model was developed to classify multi?sequence MR images of the prostate. A deep residual network was used to improve training accuracy and test accuracy. The dataset used in this experiment included 19 146 7?sequence prostate MR images (transverse T1WI, transverse T2WI, coronal T2WI, sagittal T2WI, transverse DWI, transverse ADC, transverse PWI), from which a total of 2 800 7?sequence MR images was selected as a training set. Three hundred and eighty eight 7?sequence MR images were selected as test sets. Accuracy was used to evaluate the effectiveness of ResNet18 CNN model. Results The classification accuracy of the model for transverse DWI, sagittal T2WI, transverse ADC, transverse T1WI, and transverse T2WI was as high as 100.0% (44/44,52/52), and the accuracy for transverse PWI was also as high as 96.7% (116/120). The accuracy for coronal T2WI was 77.5% (31/40). 0.8% (1/120) of transverse PWI was incorrectly assigned to transverse T2WI, and 2.5% (3/120) incorrectly assigned to sagittal T2WI. 15.0% (6/40) of coronal T2WI was incorrectly assigned to transverse T2WI, and 7.5% (3/40) to sagittal T2WI. Conclusion The experimental results show the effectiveness of our deep learning method regarding accuracy in the prostate multi?sequence MR images detection.

Objective: To develop a convolution neural network (CNN) model to classify multi-sequence MR images of the prostate. Methods: ResNet18 convolution neural network (CNN) model was developed to classify multi-sequence MR images of the prostate. A deep residual network was used to improve training accuracy and test accuracy. The dataset used in this experiment included 19 146 7-sequence prostate MR images (transverse T₁WI, transverse T₂WI, coronal T₂WI, sagittal T₂WI, transverse DWI, transverse ADC, transverse PWI), from which a total of 2 800 7-sequence MR images was selected as a training set. Three hundred and eighty eight 7-sequence MR images were selected as test sets. Accuracy was used to evaluate the effectiveness of ResNet18 CNN model. Results: The classification accuracy of the model for transverse DWI, sagittal T₂WI, transverse ADC, transverse T₁WI, and transverse T₂WI was as high as 100.0% (44/44,52/52), and the accuracy for transverse PWI was also as high as 96.7% (116/120). The accuracy for coronal T₂WI was 77.5% (31/40). 0.8% (1/120) of transverse PWI was incorrectly assigned to transverse T₂WI, and 2.5% (3/120) incorrectly assigned to sagittal T₂WI. 15.0% (6/40) of coronal T₂WI was incorrectly assigned to transverse T₂WI, and 7.5% (3/40) to sagittal T₂WI. Conclusion The experimental results show the effectiveness of our deep learning method regarding accuracy in the prostate multi-sequence MR images detection.