Objective:To investigate the clinical application and effect of the self-designed pedicled perforator flap combined with vacuum sealing drainage (VSD) for the repair of gluteal pressure ulcers.Methods:A retrospective study was performed on 15 patients with gluteal pressure ulcers who were treated with self-designed pedicled perforator flaps combined with VSD in Linyi People's Hospital from January 2020 to April 2023. The cohort included 9 males and 6 females, with ages ranging from 41 to 73 (57±16) years, and the duration of the disease ranged from 12 to 39 days. Following debridement surgery in conjunction with VSD treatment, the wounds were repaired with self-designed pedicled perforator flaps. In cases with larger donor areas, relay flaps were utilized. All wounds were closed in the first stage with VSD drainage for one week. Postoperative assessments focused on flap survival, wound healing, and patient follow-up.Results:Three cases were mixed pressure ulcers, 12 cases were ulcerative pressure ulcers, and the area of the base of the wound ranged from 3 cm × 5 cm to 10 cm × 15 cm. Among the cohort, 14 patients demonstrated favorable outcomes regarding flap survival and incision healing while one paraplegic patient experienced bleeding, subcutaneous congestion and poor incision healing after operation due to severe wound infection and poor fundamentals, and was discharged from the hospital after 10 days of healing post-operation with the flap clearing and repairing. The duration of the operation was (123±10) min, and the intraoperative blood loss was (87±5) ml. A total of 13 cases were followed up for 3 to 24 months with satisfactory results. The flaps demonstrated optimal hematologic performance, satisfactory appearance and texture, and no recurrence of ulcers.Conclusion:The combination of self-designed pedicled perforator flap with VSD is an effective method for repairing gluteal pressure ulcers with less intraoperative bleeding and shorter operative time.

Objective:To investigate the clinical application and effect of the self-designed pedicled perforator flap combined with vacuum sealing drainage (VSD) for the repair of gluteal pressure ulcers.Methods:A retrospective study was performed on 15 patients with gluteal pressure ulcers who were treated with self-designed pedicled perforator flaps combined with VSD in Linyi People's Hospital from January 2020 to April 2023. The cohort included 9 males and 6 females, with ages ranging from 41 to 73 (57±16) years, and the duration of the disease ranged from 12 to 39 days. Following debridement surgery in conjunction with VSD treatment, the wounds were repaired with self-designed pedicled perforator flaps. In cases with larger donor areas, relay flaps were utilized. All wounds were closed in the first stage with VSD drainage for one week. Postoperative assessments focused on flap survival, wound healing, and patient follow-up.Results:Three cases were mixed pressure ulcers, 12 cases were ulcerative pressure ulcers, and the area of the base of the wound ranged from 3 cm × 5 cm to 10 cm × 15 cm. Among the cohort, 14 patients demonstrated favorable outcomes regarding flap survival and incision healing while one paraplegic patient experienced bleeding, subcutaneous congestion and poor incision healing after operation due to severe wound infection and poor fundamentals, and was discharged from the hospital after 10 days of healing post-operation with the flap clearing and repairing. The duration of the operation was (123±10) min, and the intraoperative blood loss was (87±5) ml. A total of 13 cases were followed up for 3 to 24 months with satisfactory results. The flaps demonstrated optimal hematologic performance, satisfactory appearance and texture, and no recurrence of ulcers.Conclusion:The combination of self-designed pedicled perforator flap with VSD is an effective method for repairing gluteal pressure ulcers with less intraoperative bleeding and shorter operative time.

Keloid is a common skin disease, and the mechanism of its occurrence is not fully understood. There is evidence to show that multiple factors such as genetics, race, age, gender, hormones, infection, immunity, and oxidative stress, etc. may be related to the occurrence of keloids. Metabolic remodeling and protein acylation modification, as two important biological processes, play important roles in various skin related diseases. Based on this, this article reviews the roles of metabolic remodeling and protein acylation modification in keloids and the interrelationship between the two biological processes, and explores the application prospects of targeting the two biological processes in the prevention and treatment of keloids.

Objective To investigate the effect of ε-polylysine to prevent ventilator-associated pneumonia ( VAP) for children with mechanical ventilation in Pediatric Intensive Care Unit ( PICU ) and to provide evidence-based procedure for clinical VAP prevention.Methods A total of ninety children with mechanical ventilation in PICU from January to September in 2012 were randomly divided into three groups averagely:experimental group A and B (3 timesε-polylysine intervention daily as group A,2 timesε-polylysine intervention daily as group B) and control group ( non-ε-polylysine-intervention as group C) .All cases had been numbered by time sequence.ε-polylysine was sprayed to Y-interface.The incidences of VAP were targeted monitored, and sampling bacteria on lower respiratory tract and various parts of ventilator tubing ( thread-inlet end and outlet end interface, condensate of inlet and outlet section, Y-type interface, wet tank) had been isolated, cultured and counted.Results The rates of VAP were 10%, 30%and 70%respectively in group A, B and C (χ2 =24.115;P<0.01), while the time of mechanical ventilation in three groups were (4.2 ±0.4), (5.2 ±0.7) and (7.1 ±0.3)h (F=260.953;P<0.01).In the fourth day and seventh day, we compared the numbers of bacteria in children′s respiration and tube for air admission, tube for air outlet and Y-type interface indicated statistical significance (χ2 =12.115-34.658,P<0.01).On the fourth day and fifth to eighth day, we compared children patients′bacteria amount in condensate water for ventilator′s air inlet and outlet in three groups, it showed that they had statistical significance (χ2 =12.604 -47.624;P <0.01). Conclusions The use of 28 μg/ml ε-polylysine 3 times daily can effectively control bacterial colonization in ventilator tubing, cut off infection from exogenous route, reduce the incidence of VAP, shorten mechanical ventilation time and improve the prognosis, and make more important guiding significance on clinical nursing.

Objective Brain -derived neurophic factor ( BDNF) has played an important role in the repair of cauda equina Injury.The aim of this article was to observe the influences of Miao medicine Sheng Xian Decoction on structural change and BDNF protein expression in the sacral spinal cord of rats with cauda equina injury . Methods The rat model of cauda equina injury was es-tablished by using nerve clamping .Rats were randomly divided into the following groups:normal group , control group , Miao medicine group and mecobalamin group , 15 rats in each group .According to the death time after modeling , the rats in each group were subdivi-ded into 1d group, 7d group and 14d group, 5 in each subgroup.The nerve function recovery of rats in every group was observed through Basso , Beattie & Bresnahan locomotor rating score ( BBB score ) .The structural change of sacral spinal cord was observed(11.40 ±1.14) and the mecobalamin group (11.40 ±0.89) (P>0.05).On the 7th, 14th day after modeling, the scores of the Miao medicine group (17.0 ±1.00, 19.60 ±0.55) and the mecobalamin group (16.2 ±0.84, 18.80 ±0.84) were much higher than the control group (14.00 ±0.70, 16.40 ±0.55) (P<0.05).There was no significant difference between the Miao medicine group and the mecobalamin group (P>0.05).The scores of the control group , the Miao medicine group and the mecobalamin group showed an increasing tendency with time, and the difference of scores among the groups are of statistical significance (P<0.05).HE staining:Compared with the normal group , the spinal cord structure of the control group was damaged and glial cell proliferation increased signif -icantly.Compared with the control group , rats in the Miao medicine group and the mecobalamin group were lightly damaged in spinal cord and got improvement in the glial cell proliferation as well as an increase in the number of normal neurons .Immunohistochemistry staining:On the 1st day after modeling, the MOD values of the control group (0.152 ±0.007) , the Miao medicine group (0.156 ± 0.008) and the mecobalamin group (0.162 ±0.008) were much higher than that of the normal group (0.130 ±0.006), and the difference was of significant difference (P<0.05).Moreover,the MOD value of the mecobalamin group was much higher than those of the control group and the Miao medicine group , which was of significant difference (P<0.05); there was no statistical significance between the control group and the Miao medicine group (P>0.05).On the 7th and 14th day after modeling, the MOD values of the Miao medicine group (0.205 ±0.009, 0.183 ±0.008) and the mecobalamin group (0.217 ±0.033, 0.187 ±0.007) were much higher than that of the control group (0.181 ±0.007, 0.161 ±0.014), which was of significant difference (P<0.05).There was no statistical significance between the values of Miao medicine group and the mecobalamin group (P>0.05).The MOD values of the control group , the Miao medicine group and the mecobalamin group showed a tendency of increase followed by decrease with time .The MOD values of 3 subgroups in the Miao medicine group and the mecobalamin group had no statistical significance (P>0.05).The MOD value of 14d subgroup was much lower than 7d subgroup in the control group (P<0.05), however, compared with 1d subgroup in the control group, there was no significant difference (P>0.05).There was no significant difference among the MOD value of 3 subgroups in the normal group (0.130 ±0.006, 0.130 ±0.006, 0.130 ±0.008) (P>0.05). Conclusion Miao medicine Sheng Xian Decoction can promote neuron survival and improve nerve functions through increasing the BDNF expression in the sacral spinal cord of rats with cauda equina injury .

Objectiye To investigate the relationship between dementia degree of multi - infarct dementia(MID)and CT findiugs. MethodThe volume and location of focal lesion as well as the presence of cerebral atrophy in 44 MID patents with mild dementia, 40 MID patients withmoderate dementia, 38 MID patients with severe dementia were compared. Result The volume of focal lesion correlated with dementia degreeof MID. The bigger the volume was, the heavier the dementia was. The cerebral atropohy was heavier in patients with severe dementia than thatin patients with other dementia. Dementia degree of MID should no correlation with the location of focal lesion. Conclusion The volume andcerebral atrophy were important the factor for determing dementia degree of MID.