Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

In October 2023, a patient with locally advanced breast cancer was treated in the Department of Reconstructive Microsurgery, Xuzhou Renci Hospital. Radical mastectomy for breast cancer was performed, and the huge soft tissue defect (40.0 cm×22.0 cm) was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap (TRAMF) combined with a free deep inferior epigastric artery perforator flap (DIEPF) and a free anterolateral thigh perforator flap (ALTPF). The size of the lower abdominal flap was 28.0 cm×11.0 cm, and the size of ALTPF was 30.0 cm×11.0 cm. All flaps survived well with soft texture. Scores of Karnofsky Performance Status (KPS) and Visual Analogue Scale (VAS) were significantly improved at 1 month after the surgery. The patient refused chemotherapy, radiotherapy and other comprehensive treatments at the time. A local cancer recurrence in chest wall was found at 9 months after surgery, the patient was currently under chemotherapy and other comprehensive therapies.

In October 2023, a patient with locally advanced breast cancer was treated in the Department of Reconstructive Microsurgery, Xuzhou Renci Hospital. Radical mastectomy for breast cancer was performed, and the huge soft tissue defect (40.0 cm×22.0 cm) was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap (TRAMF) combined with a free deep inferior epigastric artery perforator flap (DIEPF) and a free anterolateral thigh perforator flap (ALTPF). The size of the lower abdominal flap was 28.0 cm×11.0 cm, and the size of ALTPF was 30.0 cm×11.0 cm. All flaps survived well with soft texture. Scores of Karnofsky Performance Status (KPS) and Visual Analogue Scale (VAS) were significantly improved at 1 month after the surgery. The patient refused chemotherapy, radiotherapy and other comprehensive treatments at the time. A local cancer recurrence in chest wall was found at 9 months after surgery, the patient was currently under chemotherapy and other comprehensive therapies.

Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

OBJECTIVE To establish the HPLC fingerprint of Jianpi huayu decoction， and to determine the contents of 8 components. METHODS Thermo Hypersil Gold C18 column was used with mobile phase consisted of methanol-0.05% phosphoric acid aqueous solution （gradient elution） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃， the injection volume was 5 μL. The detection wavelength of matrine was 211 nm， and the other components’ detection wavelength was 283 nm. The similarity evaluation of HPLC fingerprints for 10 batches of Jianpi huayu decoction was performed by using the Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine （2012 edition）. The contents of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine in the samples were determined by HPLC. RESULTS HPLC fingerprint of Jianpi huayu decoction was established. A total of 27 common peaks were identified， and 8 components were identified. The similarity between 10 batches of samples and the control map ranged from 0.942-0.999. RSDs of precision， repeatability and stability tests were less than 3% （n＝6）. The average recoveries of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine were 99.48%， 101.32%， 101.18%， 100.79%， 101.12%， 99.19%， 99.81% and 102.46%， respectively； RSDs were 1.34%， 0.93%， 1.90%， 1.84%， 0.54%， 1.53%， 1.33% and 1.01%， respectively （n＝6）. The contents were 0.021-0.061， 0.025-0.034， 0.116-0.295， 0.006- 0.062， 0.014-0.053， 0.017-0.026， 0.014-0.027 and 14.05-24.11 mg/g， respectively. CONCLUSIONS The established fingerprint and content determination method can provide a reference for the quality control and subsequent preparation development for Jianpi huayu decoction.

Objective:To investigate the effect of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus.Methods:Clinical data of patients with post-traumatic lower extremity shortening and talipes equinovarus treated by the Ilizarov technique in the Department of Orthopaedics of Xuzhou Renci Hospital from January 2013 to April 2020 were retrospectively analyzed. The annular external fixator was installed on the affected limb according to the Ilizarov principle of external fixation. 3 days after the operation, the internal and lateral screw rods were adjusted at the speed of 2 mm/d to gradually correct the talipes equinovarus. 7 days after surgery, the lower leg was lengthened at a speed of 1 mm/d. After the foot was corrected, the foot external fixator was continued to be worn for 4 to 6 weeks, and then the fixator was removed and the foot was immobilized with a brace for 6 to 8 weeks. The lower leg fixator was removed after the lower extremity length was restored and the bone mineralization at the extension site was good. The length of both lower extremities, angle of talonavicular joint, angle of plantar flexion and dorsal extension of the ankle, and range of motion of ankle were compared before surgery and at the last follow-up. At the last follow-up, the affected feet were scored and rated using the International Clubfoot Study Group (ICFSG) scoring system, which was divided into four grades: excellent, good, medium, and poor. SPSS 25.0 software was used for statistical analysis, and each measurement index and ICFSG score were expressed in Mean±SD. Paired t-test was used to compare the preoperative and last follow-up data, and P<0.05 was considered statistically significant. Results:A total of 31 patients were enrolled, including 17 males and 14 females. The age was 15-18 years old, with an average of 16.5 years old. There were 16 cases on the right side and 15 cases on the left side. The lower extremity shortening was 45-75 mm, with an average of 65 mm. The fixation time of the external fixator was 4.5-6 months after surgery, with an average of 5 months, and the follow-up time was 22-28 months, with an average of 25.5 months. The length of the affected lower extremity recovered, the shape was basically satisfactory, and the plantar gait was restored. At the last follow-up, compared with the preoperative period, the anteroposterior talocalcaneal angle of the foot (23.0°±2.1° vs. 8.5°±2.6°), from lateral talocalcaneal angle the foot (27.0°±4.3° vs. 11.2°±4.4°), ankle plantar flexion angle (24.5°±6.8° vs. 51.1°±6.5°), ankle dorsiflexion angle (5.8°±3.5° vs. -46.8°±7.0°) and ankle range of motion (30.3°±8.2° vs. 4.2°±1.6°) were statistically significant ( P <0.01). ICFSG score: The points at the last follow-up (8.0 ± 4.2) were significantly lower than that before the operation (41.9 ± 5.3) ( P<0.01), of which 18 were excellent, 9 were good, and 4 were medium. Two cases had recurrent deformities in the later stage, and the results were satisfactory after the fusion of the talonavicular joint and calcaneocuboid joint and the anteposition of the posterior tibial tendon in the second stage. There were 4 cases of toe contracture deformity, which did not recur after the release of the flexor digitorum longus tendon at the toe. Anterior ankle impingement was observed in 5 cases and improved after the arthroscopic osteophyte removal. After the lower extremity extension was in place, the external fixator was replaced by the intramedullary nail for walking in 6 patients. The infection of the nail path occurred in 7 cases, which improved after replacement of fixing pins and dressing change of the nail path. Conclusion:The application of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus has the advantages of small trauma and dynamic control of deformity correction, which can achieve good result.

Objective:To investigate the effect of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus.Methods:Clinical data of patients with post-traumatic lower extremity shortening and talipes equinovarus treated by the Ilizarov technique in the Department of Orthopaedics of Xuzhou Renci Hospital from January 2013 to April 2020 were retrospectively analyzed. The annular external fixator was installed on the affected limb according to the Ilizarov principle of external fixation. 3 days after the operation, the internal and lateral screw rods were adjusted at the speed of 2 mm/d to gradually correct the talipes equinovarus. 7 days after surgery, the lower leg was lengthened at a speed of 1 mm/d. After the foot was corrected, the foot external fixator was continued to be worn for 4 to 6 weeks, and then the fixator was removed and the foot was immobilized with a brace for 6 to 8 weeks. The lower leg fixator was removed after the lower extremity length was restored and the bone mineralization at the extension site was good. The length of both lower extremities, angle of talonavicular joint, angle of plantar flexion and dorsal extension of the ankle, and range of motion of ankle were compared before surgery and at the last follow-up. At the last follow-up, the affected feet were scored and rated using the International Clubfoot Study Group (ICFSG) scoring system, which was divided into four grades: excellent, good, medium, and poor. SPSS 25.0 software was used for statistical analysis, and each measurement index and ICFSG score were expressed in Mean±SD. Paired t-test was used to compare the preoperative and last follow-up data, and P<0.05 was considered statistically significant. Results:A total of 31 patients were enrolled, including 17 males and 14 females. The age was 15-18 years old, with an average of 16.5 years old. There were 16 cases on the right side and 15 cases on the left side. The lower extremity shortening was 45-75 mm, with an average of 65 mm. The fixation time of the external fixator was 4.5-6 months after surgery, with an average of 5 months, and the follow-up time was 22-28 months, with an average of 25.5 months. The length of the affected lower extremity recovered, the shape was basically satisfactory, and the plantar gait was restored. At the last follow-up, compared with the preoperative period, the anteroposterior talocalcaneal angle of the foot (23.0°±2.1° vs. 8.5°±2.6°), from lateral talocalcaneal angle the foot (27.0°±4.3° vs. 11.2°±4.4°), ankle plantar flexion angle (24.5°±6.8° vs. 51.1°±6.5°), ankle dorsiflexion angle (5.8°±3.5° vs. -46.8°±7.0°) and ankle range of motion (30.3°±8.2° vs. 4.2°±1.6°) were statistically significant ( P <0.01). ICFSG score: The points at the last follow-up (8.0 ± 4.2) were significantly lower than that before the operation (41.9 ± 5.3) ( P<0.01), of which 18 were excellent, 9 were good, and 4 were medium. Two cases had recurrent deformities in the later stage, and the results were satisfactory after the fusion of the talonavicular joint and calcaneocuboid joint and the anteposition of the posterior tibial tendon in the second stage. There were 4 cases of toe contracture deformity, which did not recur after the release of the flexor digitorum longus tendon at the toe. Anterior ankle impingement was observed in 5 cases and improved after the arthroscopic osteophyte removal. After the lower extremity extension was in place, the external fixator was replaced by the intramedullary nail for walking in 6 patients. The infection of the nail path occurred in 7 cases, which improved after replacement of fixing pins and dressing change of the nail path. Conclusion:The application of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus has the advantages of small trauma and dynamic control of deformity correction, which can achieve good result.

Objective To observe the clinical effect of Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets in treating post-stroke cognitive impairment(PSCI).Methods 110 patients who met the diagnostic criteria of PSCI in the outpatient department were included.According to the random number table method,the patients were divided into trial group and control group,with 55 cases in each group.Patients in control group were treated with routine western medicine,including the treatment of Donepezil Hydrochloride Tablets and secondary prevention of stroke such as lowering blood pressure,lowering blood lipid,lowering blood glucose and anti-platelet aggregation.The trial group was treated with Yi'naokang Capsules on the basis of the treatment in control group,and both groups were treated for 6 months.Before and after 6 months of treatment,the cognitive function of patients was evaluated by the Montreal Cognitive Assessment(MoCA)scale.The activity of daily living(ADL)scale was used to evaluate the ability of daily living,and the severity of cerebral white matter lesions was evaluated by Fazekas scale,and the adverse reactions were also observed.Results After 6 months of treatment,the total score of the MoCA,the scores of visual space and executive function,attention,delayed recall and the ADL of the two groups were all improved(P＜0.05),and the improvement degree of the trial group was better than that of the control group(P＜0.05).The Fazekas score of the trial group after treatment was no significant difference when compared with that before treatment(P＞0.05),but it increased in the control group after treatment(P＜0.05),and the effect of delaying white matter lesion in the trial group was better than that in the control group(P＜0.05).Conclusion Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets are superior to Donepezil alone in the treatment of PSCI,which can safely and effectively improve the cognitive function and daily living ability of patients,as well as prolong the progress of white matter lesions.

Objective:To investigate the effect of minimally invasive treatment of mild to moderate hallux valgus using frequency conversion waterflood ultrasound extracapsular osteotomy.Methods:The data of patients with mild to moderate hallux valgus who were treated with frequency conversion waterflood ultrasound extracapsular osteotomy at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from August 2017 to August 2020 were retrospectively analyzed. During the operation, the metatarsal bone was truncated outside the capsule of the medial joint of the first metatarsal head with frequency conversion waterflood ultrasound osteotomy to correct the hallux valgus deformity. The changes of hallux valgus angle (HVA), the first and second intermetatarsal angle (IMA), the distal articular surface angle of the first metatarsal bone (DMAA) and the range of motion(ROM) of the first metatarsophalangeal joint were compared before operation and at the last follow-up. The American Foot and Ankle Society (AOFAS) forefoot scoring system was used to evaluate the clinical effect. Measurement data with normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 32 patients (53 feet) were enrolled, including 6 males and 26 females; 28 left feet and 25 right feet; age (34.5±7.8) years old. All patients were followed up for (13.0±5.9) months. All osteotomy sites healed without metastatic metatarsalgia, infection and deformity recurrence. At the last follow-up, HVA, IMA, and DMAA were all improved compared with those before surgery [(11.25±1.59) ° vs. (33.45±4.45) °; (6.83±0.95) ° vs. (14.96±2.10) °; (6.26±1.92) ° vs. (23.64±4.72) °; all P<0.01], AOFAS forefoot score was significantly higher than that before operation (90.96±2.92 vs. 59.22±5.63, P<0.01). There was no significant difference in the ROM of the first metatarsophalangeal joint before and after operation ( P>0.05). Conclusions:The application of frequency conversion waterflood ultrasonic bone cutter combined with extracapsular osteotomy for minimally invasive treatment of mild to moderate hallux valgus has the advantages of small damage, inconspicuous scars, and reliable correction. It can be popularized in clinical practice.

Objective:To investigate the effect of minimally invasive treatment of mild to moderate hallux valgus using frequency conversion waterflood ultrasound extracapsular osteotomy.Methods:The data of patients with mild to moderate hallux valgus who were treated with frequency conversion waterflood ultrasound extracapsular osteotomy at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from August 2017 to August 2020 were retrospectively analyzed. During the operation, the metatarsal bone was truncated outside the capsule of the medial joint of the first metatarsal head with frequency conversion waterflood ultrasound osteotomy to correct the hallux valgus deformity. The changes of hallux valgus angle (HVA), the first and second intermetatarsal angle (IMA), the distal articular surface angle of the first metatarsal bone (DMAA) and the range of motion(ROM) of the first metatarsophalangeal joint were compared before operation and at the last follow-up. The American Foot and Ankle Society (AOFAS) forefoot scoring system was used to evaluate the clinical effect. Measurement data with normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 32 patients (53 feet) were enrolled, including 6 males and 26 females; 28 left feet and 25 right feet; age (34.5±7.8) years old. All patients were followed up for (13.0±5.9) months. All osteotomy sites healed without metastatic metatarsalgia, infection and deformity recurrence. At the last follow-up, HVA, IMA, and DMAA were all improved compared with those before surgery [(11.25±1.59) ° vs. (33.45±4.45) °; (6.83±0.95) ° vs. (14.96±2.10) °; (6.26±1.92) ° vs. (23.64±4.72) °; all P<0.01], AOFAS forefoot score was significantly higher than that before operation (90.96±2.92 vs. 59.22±5.63, P<0.01). There was no significant difference in the ROM of the first metatarsophalangeal joint before and after operation ( P>0.05). Conclusions:The application of frequency conversion waterflood ultrasonic bone cutter combined with extracapsular osteotomy for minimally invasive treatment of mild to moderate hallux valgus has the advantages of small damage, inconspicuous scars, and reliable correction. It can be popularized in clinical practice.