Objective:To explore the feasibility and clinical effectiveness of preoperative positioning grid combined with CTA assisted design of anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects around foot and ankle.Methods:From May 2018 to December 2021, a total of 18 cases with soft tissue defects around foot and ankle were admitted to the Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Ningbo University. The patients were 11 males and 7 females, aged from 32 to 78 years old, with an average age of 57.5 years old. Among them, 10 had chronic ulcer wounds, 6 had traumatic wounds, and 2 had postoperative wounds after malignant tumor resection. The sizes of soft tissue defect ranged from 6.0 cm×8.0 cm to 9.0 cm×13.0 cm, and the flap sizes ranged from 8.0 cm×10.0 cm to 11.0 cm×15.0 cm. Preoperative positioning grid combined with CTA three-dimensional reconstruction were used to mark the exit point of the perforator vessels in digital format, in order to restore the course of vessels and calculate the length of the vascular pedicles. ALTPFs were accurately designed based on the digitally reconstructed images, and then the ALTPFs were used to repair the soft tissue defects around the ankle. The flap donor sites were directly closed in stage Ⅰ. After the operation, all the patients were included in scheduled follow-ups at the outpatient department to observe the appearance of the recipient flaps and donor sites. The functional evaluation of the affected feet were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results:All 18 flaps survived, and the wounds in both the recipient and donor sites healed in stageⅠ. Postoperative follow-up for the 18 patients were 5 to 36 months, with an average of 13 months. At the last follow-up, the appearances of the flaps were good without swelling, the donor sites had good recovery, and there was no obvious scar hypertrophy. The function evaluation of the affected feet were found at excellent in 10 cases, good in 6 cases, and fair in 2 cases.Conclusion:Preoperative position grid combined with CTA three-dimensional reconstruction can digitally mark the exit points and running courses of the perforator vessels. It is an effective method for accurate position of perforator vessels before surgery. It can effectively reduce the operation time, lower the surgical risks, and achieve a high survival rate of the flap, thus holding considerable clinical value.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Forty patients with Hashimoto thyroiditis ( HT) and 20 healthy subjects with matched age-and sex-features ( NC) were selected. The patients with HT were further divided into normal thyroid function ( HT-A) and hypothyroidism ( HT-B) groups. Real-time PCR was performed to evaluate the expressions of Notch1, Dll4, and retinoid-related orphan receptor ( ROR )-γt mRNA. Flow-cytometry was used to detect the percentage of Th17 cells. Thyroid function, thyroid peroxidase antibody ( TPOAb) , and thyroglobulin antibody ( TgAb) were detected by electrochemiluminescence immunoassaies. The results showed that the Notch1, Dll4, ROR-γt mRNA levels and Th17 cell percentage were significantly increased in HT group compared with NC group (all P<0.01), especially in HT-B group. In HT patients, Notch1 and Dll4 mRNA expression levels were positively correlated with Th17 cell percentage and its transcription factor ROR-γt ( all P<0.01) . Besides, there were significantly positive correlations of Notch1 and Dll4 mRNA expressions with TPOAb and TgAb titers (P<0.05 or P<0.01). These results suggest that Notch1-Dll4 signaling pathway might be involved in the pathogenesis of thyroid-specific autoimmune damage by regulating Th17 cells in HT patients.

Objective: To investigate the association between macrophage migration inhibitory factor (MIF) -173G/C gene polymorphism and the susceptibility to immune-related diseases in Chinese Han population. Methods: Databases of Wanfang, China National Knowledge Infrastructure (CNKI), PubMed, Excerpta Medica dataBASE (EMbase) and Web of Science (WOS) were comprehensively searched for pertinent articles published in Chinese and English. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used as effect size measures. Publication bias was examined by Brgge′s funnel plots and Egger′s test. Revman 5.3 and STATA 12.0 software were used for statistical analysis. Results: Nine articles were included in this meta-analysis and the studied immune-related diseases included UC (ulcerative colitis), CD (Crohn′s disease), RA (rheumatoid arthritis), PS (psoriasis), asthma, BD (Behçet′s disease), VKH (Vogt-Koyanagi-Harada syndrome), AOSD (adult-onset Still′s disease) and AD (atopic dermatitis). The overall result of the meta-analysis showed that the MIF 173G/C gene polymorphism could increase the susceptibility to immune-related diseases in Chinese Han people (recessive genetic model: OR=1.92, 95%CI: 1.44-2.58; dominant genetic model: OR=1.44, 95%CI: 1.28-1.61; allele model: OR=1.34, 95%CI: 1.22-1.34; homozygote model: OR=1.98, 95%CI: 1.51-2.60; heterozygote model: OR=1.24, 95%CI: 1.11-1.40; all P<0.01). In addition, a subgroup analysis of the North and South of China showed that except for the heterozygote model in the North group, the recessive model (OR=2.03, 95%CI: 1.24-3.31), dominant genetic model (OR=1.51, 95%CI: 1.24-1.83), allele model (OR=1.37, 95%CI: 1.22-1.54) and homozygote model (OR=2.08, 95%CI: 1.31-2.30) all had statistical significance. All of the five models in the South group showed statistical significance (recessive model: OR=1.88, 95%CI: 1.31-2.69; dominant genetic model: OR=1.40, 95%CI: 1.22-1.61; allele model: OR=1.29, 95%CI: 1.10-1.52; homozygote model: OR=1.93, 95%CI: 1.38-2.71; heterozygote model: OR=1.19, 95%CI: 1.08-1.31; all P<0.05). Conclusion The polymorphism of MIF -173G/C gene may be a susceptible gene to immune-related diseases in Chinese Han people.

BACKGROUND: The aim of this study was to analyze the incidence of lower limb deep venous thrombosis (DVT) and the corresponding coagulation status in severe patients after thoracic surgery. METHODS: Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016 and June 2018 were analysed retrospectively. Their general information, disease species, surgical treatment, and coagulation index were reviewed. RESULTS: Fifty patients were finally included. There were 34 male and 16 female, aging from 22 to 80 years. The incidence of DVT was 22.0%, all of them were isolated calf DVT. The incidence was 29.4% in male patients, while 6.3% in female; 23.5% in malignant diseases and 18.6% in benign. All coagulation index presented no statistical difference between patients with and without DVT, except activated partial thromboplastin time (APTT). CONCLUSIONS Even on the basis of adequate mechanical prophylaxis, lower limb DVT is common in severe patients after thoracic surgery. Meanwhile, male patients and malignant diseases are more suscepted.
Adult ; Aged ; Aged, 80 and over ; Blood Coagulation ; Female ; Humans ; Incidence ; Lower Extremity ; blood supply ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Surgical Procedures ; adverse effects ; Venous Thrombosis ; etiology ; physiopathology ; Young Adult

Objective To analyze the clinical characteristics of liver injury related to edaravone in treating patients with acute ischemic stroke (AIS). Methods Among the AIS patients treated with edaravone in Vascular Surgery ICU of Xuanwu Hospital Capital Medical University from January 2014 to October 2017,9 patients were diagnosed as having liver injury associated with edaravone by active monitoring. The total number of patients treated with edaravone at the same period in Vascular Surgery ICU were obtained from the hospital information system and the incidence of liver injury associated with edaravone was calculated. The clinical data of the 9 patients were collected and analyzed retrospectively. Results The incidence of liver injury associated with edaravone was 8.7% (9/103 ). The 9 patients included 6 males and 3 females. The age of the patients was 52-83 years and their average age was (65 ± 6)years. The time for the occurrence of liver injury was 3-9 days and the average time was (6 ± 2)days. The main manifestations of liver injury were increase of alanine aminotransferase (9 cases),aspartic aminotransferase (7 cases),alkaline phosphatase (4 cases),total bilirubin (2 cases),and accompanied by rash in 1 case. Using RUCAM scale,7 patients were classified as ＂highly probable＂ and 2 patients were classified as＂probable＂. Using ＂Grade of DILI severity＂＂ standard,all the 9 patients were diagnosed as ＂mild liver injury＂. After 4-13 days of edaravone withdrawal,8 patients had normal liver function and 1 case improved. Conclusions Edaravone might cause liver injury,mainly manifesting liver dysfunction. The degree of liver injury was mild,and the prognosis was good after timely intervention.

Objective To analyze the clinical characteristics of liver injury related to edaravone in treating patients with acute ischemic stroke (AIS). Methods Among the AIS patients treated with edaravone in Vascular Surgery ICU of Xuanwu Hospital Capital Medical University from January 2014 to October 2017,9 patients were diagnosed as having liver injury associated with edaravone by active monitoring. The total number of patients treated with edaravone at the same period in Vascular Surgery ICU were obtained from the hospital information system and the incidence of liver injury associated with edaravone was calculated. The clinical data of the 9 patients were collected and analyzed retrospectively. Results The incidence of liver injury associated with edaravone was 8.7% (9/103 ). The 9 patients included 6 males and 3 females. The age of the patients was 52-83 years and their average age was (65 ± 6)years. The time for the occurrence of liver injury was 3-9 days and the average time was (6 ± 2)days. The main manifestations of liver injury were increase of alanine aminotransferase (9 cases),aspartic aminotransferase (7 cases),alkaline phosphatase (4 cases),total bilirubin (2 cases),and accompanied by rash in 1 case. Using RUCAM scale,7 patients were classified as ＂highly probable＂ and 2 patients were classified as＂probable＂. Using ＂Grade of DILI severity＂＂ standard,all the 9 patients were diagnosed as ＂mild liver injury＂. After 4-13 days of edaravone withdrawal,8 patients had normal liver function and 1 case improved. Conclusions Edaravone might cause liver injury,mainly manifesting liver dysfunction. The degree of liver injury was mild,and the prognosis was good after timely intervention.

Objective To observe the efficacy and safety of recombinant tissue type plasminogen activa-tor (rt-PA)for the treatment of the patients with wake-up ischemic stroke (WUS)under the guidance of multimode CT. Methods Eighteen patients with WUS (a thrombolytic group)suitable for intravenous thrombolysis after multimode CT imaging screen at the Department of Neurology,Shiyan Hospital of Integrated Traditional and Western Medicine,Hubei Province from October 2012 to October 2014 were enrolled retrospectively. Twenty patients with WUS (a control group)who underwent multimode CT imaging screen were suitable for intravenous thrombolysis,but because of exceeding time window or rejecting thrombolysis and other reasons without having intravenous thrombolysis from February 2012 to February 2014 were enrolled retrospectively. The control group was treated with conventional therapy and the thrombolytic group was treated with rt-PA (0. 9 mg/kg)intravenous thrombolytic therapy. The indicators including fibrinogen (Fib),coagulation function (prothrombin time [PT ]),activated partial thromboplastin time (APTT ), platelet (PLT ),high-sensitivity C-reactive protein (hs-CRP ),National Institute of Health Stroke Scale (NIHSS )scores,and activities of daily living scores (Barthel index)at before treatment and 24 h,7 and 14 days after treatment were observed respectively. The adverse events and complications were documented and compared with the control group. Results There were no significant differences in Fib,PT,APTT, PLT,hs-CRP,NIHSS score and Barthel index before treatment between the thrombolytic group and the con-trol group (all P>0. 05);at day 7 and 14 after treatment in the thrombolytic group,compared with before treatment,Fib (14 d after treatment),PLT,and hs-CRP were decreased,PT and APTT were prolonged,the NIHSS scores were decreased,and Barthel indexes were increased. There were significant differences (all P<0. 05). At day 14 after treatment,there were significant differences in Fib,PT,APTT,hs-CRP,NIHSS scores,and Barthel indexes (Fib:3. 25 ± 0. 38 g/L vs. 3. 55 ± 0. 28 g/L;PT:15. 7 ± 3. 2 s vs. 12. 9 ± 2. 5 s;APTT:42. 7 ± 3. 5 s vs. 38. 7 ± 2. 6 s;PLT:[189 ± 26]× 109/L vs. [201 ± 23]× 109/L;hs-CRP:5. 7 ± 0. 6 mg/L vs. 11. 3 ± 2. 2 mg/L;NIHSS scores:5. 6 ± 2. 4 vs. 9. 2 ± 4. 5;and Barthel indexes:68 ± 15 vs. 47 ± 5)between the two groups (all P <0. 05). Except 1 patient occurred symptomatic intracerebral hemorrhage after thrombolysis,no other serious complications were observed in the thrombolytic group. One patient in the control group had stress gastric ulcer and bleeding,no symptomatic intracerebral hemorrhage occurred. Conclusion Multimode CT guidance can be used as a reliable imaging evidence for patients with WUS expanding intravenous thrombolytic time window. Under the multimode CT guidance, using rt-PA for intravenous thrombolytic therapy has a certain efficacy.

OBJECTIVE: To investigate the clinical features, therapeutic methods and therapeutic efficacy of imflammatory myofibroblastic tumor(IMT)of the nasal cavity and paranasal sinuses. METHOD: Clinical data of 14 cases diagnosed as IMT by pathology were retrospectively analyzed. There were 8 males and 6 females,age ranging from 18 to 77 years. 12 cases of them were treated by surgery while 2 cases received postoperative radiotherapy. RESULT: All cases were operated. All the patients were followed up for a period of 1 to 7 years after operation and two cases were proved low grade IMT pathologically. Eight cases survived with no recurrence until the last follow-up and 6 cases relapsed, of which 4 cases died and 2 were alive with tumor. CONCLUSION IMT of the nasal cavity and paranasal sinuses is very rare. The diagonosis of IMT is based on pathology and immunohistochemistry. Proper diagnosis is essential to avoid mutilating and disfiguring surgical procedures. Radical excision is still the first choice of treatment for IMT of the nasal cavity and paranasal sinuses. Chemotherapy and radiotherapy may not be helpful to prevent recurrence after operation. Due to high recurrence rate, long-term follow up is necessary after operation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Neoplasm Recurrence, Local ; Neoplasms, Muscle Tissue ; pathology ; radiotherapy ; surgery ; Paranasal Sinus Neoplasms ; pathology ; radiotherapy ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Young Adult

OBJECTIVE: To investigate the clinopathological characteristics, differential diagnosis, therapy and prognosis of sinonasal mucosal malignant melanoma. METHOD: Clinopathological data of 18 cases which were diagnosed by pathology and immmunohistochemistry were analyzed retrospectively. All cases were proved by pathology and immmunohistochemistry. All cases were performed operations. 5 underwent single surgery. 4 underwent surgery plus adjuvant radiotherapy. 4 underwent surgery plus adjuvant radiotherapy chemotherapy. 5 underwent surgery plus adjuvant chemoradiation. RESULT: All cases were followed up for a period of 1 to 7 years after operation. Twelve patients died of tumor until the last follow-up, meanwhile 6 patients stayed alive. In Six cases recurrence occurred. In five casescervical lymph node metastasis occurred, of which 3 cases received neck dissection and 2 cases received chemotherapy and radiotherapy due to no surgical indications. In three cases distant metastasis oc- curred. CONCLUSION Sinonasal mucosal malignant melanoma is rare and highly heterogenous. Current diagnosis depends on clinical characteristics and immunohistochemical examination. It still should be differentially diagnosed from other tumors. CT and MRI image examination can provide some helpful information to understand the extent and nature of lesions. The treatment of nasal endoscopic or the surgery under endoscopy has become to be a safe, viable and reasonable alternative to open resection. Appropriate indication must be carefully selected for these lesions.
Chemotherapy, Adjuvant ; Endoscopy ; Humans ; Lymphatic Metastasis ; Melanoma ; drug therapy ; pathology ; surgery ; Mucous Membrane ; Neck Dissection ; Neoplasm Recurrence, Local ; Nose Neoplasms ; Paranasal Sinus Neoplasms ; drug therapy ; pathology ; surgery ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies