Objective:To investigate the anatomy of the perforator flap of a perforating branch in the middle segment of ulnar artery and explore the surgical procedure and clinical effects on reconstruction of soft tissue defects in digits.Methods:From January 2021 to December 2022, an preliminary anatomical study on 8 upper limbs of 4 chilled fresh specimen of adults were carried out at the Department of Hand Surgery, Ningbo First Hospital Longshan Hospital Medical and Health Group. The anatomical study investigated the perforating branches in the middle segment of ulnar artery, and the location, quantity, outer diameter, course and distribution of the perforating branches were all recorded. SPSS 26.0 software was used for statistical process of the data, and t-test was performed according to the left and right sides. P<0.05 was considered statistically significant. Over the same period, 10 patients with soft tissue in digits defects were reconstructed with transfer of free perforator flap of the middle segment perforator of ulnar artery. All the digital injuries accompanied with various degrees of tendon or phalangeal exposure. The sizes of soft tissue defects were 1.5 cm×1.8 cm to 2.8 cm×3.5 cm. The flaps of the middle segment perforator of ulnar artery sized 1.8 cm×2.0 cm-3.0 cm×3.8 cm. Donor sites were directly sutured. Outpatient follow-up and home visit were conducted after surgery. Patients who were from other regions and not convenient to pay a visit to the hospital were reviewed through WeChat or smartphone to observe the appearance, texture, sensory recovery, and digit function. Results:There was a constant perforating branch in the middle segment of ulnar artery, at 9.89 cm±0.40 cm from the proximal end of pisiform bone, with an outer diameter of 0.71 mm±0.13 mm at the root and there was a length of 2.10 cm±0.32 cm available for vascular pedicle. There was no significant difference between the data of left and right. After surgery, 8 flaps survived smoothly with stage-I healing, and 2 flaps appeared venous occlusion on the second day after surgery and after a symptomatic treatment, the flaps survived with minor pigmentation. All 10 donor sites had stage-I healing. Follow-ups were conducted for 3-20 months, with an average of 10.5 months. The appearance, elasticity, texture, and colour of the flaps were all satisfactory. Four flaps were sutured with nerves, and the sensation recovery of these flaps achieved to S 3+ with TPD at 9-14 mm, at 11.25 mm in average. The 6 flaps without nerves suture had the sensation recovery to S 3. According to the Dargan functional evaluation criteria, the function of 6 digits were in excellent, 3 in good and 1 in poor. The Vancouver Scar Scale (VSS) was employed to evaluate the postoperative scars, and the scores were 3-6 points and at 4.08 points in average. Conclusion:Free perforator flap of the perforating branch in middle section of ulnar artery has a constant vascular pedicle, and it offers a satisfactory skin texture and appearance. It is simple to operate, does not have to sacrifice the main blood vessel, and there is a concealed donor site. It is an ideal flap for reconstruction of digital defects.

Objective:To investigate the anatomy of the perforator flap of a perforating branch in the middle segment of ulnar artery and explore the surgical procedure and clinical effects on reconstruction of soft tissue defects in digits.Methods:From January 2021 to December 2022, an preliminary anatomical study on 8 upper limbs of 4 chilled fresh specimen of adults were carried out at the Department of Hand Surgery, Ningbo First Hospital Longshan Hospital Medical and Health Group. The anatomical study investigated the perforating branches in the middle segment of ulnar artery, and the location, quantity, outer diameter, course and distribution of the perforating branches were all recorded. SPSS 26.0 software was used for statistical process of the data, and t-test was performed according to the left and right sides. P<0.05 was considered statistically significant. Over the same period, 10 patients with soft tissue in digits defects were reconstructed with transfer of free perforator flap of the middle segment perforator of ulnar artery. All the digital injuries accompanied with various degrees of tendon or phalangeal exposure. The sizes of soft tissue defects were 1.5 cm×1.8 cm to 2.8 cm×3.5 cm. The flaps of the middle segment perforator of ulnar artery sized 1.8 cm×2.0 cm-3.0 cm×3.8 cm. Donor sites were directly sutured. Outpatient follow-up and home visit were conducted after surgery. Patients who were from other regions and not convenient to pay a visit to the hospital were reviewed through WeChat or smartphone to observe the appearance, texture, sensory recovery, and digit function. Results:There was a constant perforating branch in the middle segment of ulnar artery, at 9.89 cm±0.40 cm from the proximal end of pisiform bone, with an outer diameter of 0.71 mm±0.13 mm at the root and there was a length of 2.10 cm±0.32 cm available for vascular pedicle. There was no significant difference between the data of left and right. After surgery, 8 flaps survived smoothly with stage-I healing, and 2 flaps appeared venous occlusion on the second day after surgery and after a symptomatic treatment, the flaps survived with minor pigmentation. All 10 donor sites had stage-I healing. Follow-ups were conducted for 3-20 months, with an average of 10.5 months. The appearance, elasticity, texture, and colour of the flaps were all satisfactory. Four flaps were sutured with nerves, and the sensation recovery of these flaps achieved to S 3+ with TPD at 9-14 mm, at 11.25 mm in average. The 6 flaps without nerves suture had the sensation recovery to S 3. According to the Dargan functional evaluation criteria, the function of 6 digits were in excellent, 3 in good and 1 in poor. The Vancouver Scar Scale (VSS) was employed to evaluate the postoperative scars, and the scores were 3-6 points and at 4.08 points in average. Conclusion:Free perforator flap of the perforating branch in middle section of ulnar artery has a constant vascular pedicle, and it offers a satisfactory skin texture and appearance. It is simple to operate, does not have to sacrifice the main blood vessel, and there is a concealed donor site. It is an ideal flap for reconstruction of digital defects.

Objective To investigate the preliminary value of mitral annular displacement (MAD) with two-dimensional speckle tracking in evaluating left ventricular systolic function. Methods Forty-nine patients with dilated cardiomyopathy, aged 51±14 years (DCM group), and 43 age-matched (46±14 years) normal subjects (control group) were enrolled in this study. Two-dimensional and real-time three-dimensional (RT3D) imaging were obtained all at the apical four-chamber view. The parameters of MAD and RT3D-LVEF were obtained using off-line QLAB software. Results Compared with control group, MAD reduced significantly in DCM group (P＜0.01). The parameters of MAD correlated positively with LVEF (P＜0.01). The intra- and inter-observer variabilities for measurement of MAD were low. When one point was placed at the chest wall, the ratio of long axis shortening correlated best with LVEF among all the data of MAD. Conclusion Based on two-dimensional speckle tracking imaging, MAD is a rapid and reproducible method of determining LV global systolic function, may even replace LVEF in the future.

Objective To determine the usefulness of tricuspid annular displacement(TAD),based on twodimensional speckle tracking imaging, for assessment of right ventricular(RV)systolic function.Methods Eighteen patientswith dilated cardiomyopathy and 20 age-matched healthy volunteers were in volved. Twodimensional and real-time three-dimensional(RT3D)imaging were obtained in all patients at apical four-chamber view.The parameters of TAD were derived from off-line QLAB software.RT3D-RV ejection fraction(RVEF)was calculated by using 4D RV function software.Results TAD data were acquired in all 38 cases, while RT3D-RVEF was done in 30 out of 38.The parameters of TAD correlated well with RVEF(P<0.01).The parameters of TAD in dilated cardiomyopathy group were significantly lower than the corresponding values in healthy subjects (P<0.01).The intra-and interobserver variabilities for measurement of TAD were(0.49±2.69)mm and(0.21± 0.60)mm, respectively.Conclusions TAD,based on two-dimensional speckle tracking imaging,proved to be a rapid and reproducible method in determining RV global systolic function.

OBJECTIVE:To observe the effects of borneol affecting the transdermal amount of drugs.METHODS:Drugs permeation tests were performed in a two-compartment diffusion cell through cobra skin in vitro,in rabbits and on the human skin blanching assay in vivo,respetively.RESULTS:In vitro,borneol increased the percutaneous transport of metronidazole and 5-fluorouracil.The potency of 3.0% borneol was different from that of 1.0%borneol.On the human skin beanching assay in vivo it indicated that borneol enhanced the bioavailability of percutaneous penetration of triamcinolone acetonide acetate.In rabbits,borneol increased AUCo～12h of salicylic acid in plasma.CONCLUSION:It indicated borneol is a effective percutaneous penetration enhancer.