Hereditary carotid body tumor (HCBT) is a rare neuroendocrine tumor mainly caused by germline mutations of the SDHx gene. Its multifocality, familial aggregation, and potential malignant risk pose unique challenges to diagnosis and treatment. This review systematically expounds the molecular mechanism of HCBT, pointing out that SDHx mutations drive tumorigenesis through the “pseudo-hypoxia” pathway and are regulated by epigenetic and somatic mutations. In terms of diagnosis, we emphasize the crucial role of ⁶⁸Ga-DOTATATE PET/CT and SDHB immunohistochemistry and advocate for multigene panel sequencing for patients with high-risk characteristics (such as early-onset, multifocal, family history or malignant signs) to clarify the genetic background. On the basis of existing evidence, we recommend conducting baseline biochemical tests for all newly diagnosed patients and actively suggest genetic screening for high-risk individuals such as those who are young, have multifocal tumors, or have a family history. In terms of treatment, surgery is the main treatment method for HCBT. Nevertheless, individualized strategies still need to be formulated based on tumor classification and patient’s overall condition and genetic background. Comprehensive management measures such as targeted therapy, radionuclide therapy, and standardized family management are crucial for improving the prognosis of patients.

Objective: To introduce the design of modified Reading man flap, and observe the clinical effect of modified flap for repairing digit and toe wounds. Methods: From July 2014 to September 2017, dorsal skin defects on 37 digits and 18 toes were repaired with our modified Reading man flaps. The revised design was characterized with enlargement the major flap and extending the minor flap proximally, and all donor site defect were sutured primarily through the major flap recover the defect and the minor flap repair the subsequent donor defect. Results: All the detects in 55 patients were repaired by the modified Reading man flaps with direct donor sites closure. With average of 11.5 months (9.5-25.7 months) follow-up, all flaps survived with satisfactory texture and appearance, the bulky deformity and scar contracture did not occur. Partial necrosis of tip in the minor flaps occurred in 2 toes and healed by wound dressing. The function of the toe joints was good and the walking gait was normal. Partially impaired PIP joint function with limited flexion occurred in 2 cases. Based on the TAM evaluation criteria, the results were excellent in 28 digits, good in 7 digits, and the overall satisfactory rate was 94.6%. Conclusions The modified Reading man flap can get good clinical effects for treatment of the digit and toe dorsal skin defect with the advantages of simple procedure, easy transfer and direct closure of donor sites. Flaps appearance and joints function can get good result postoperatively.

Objective To explore the relationship between individual difference in heparin sensitivity and postoperative bleeding,and lay the foundation for individualized heparin anticoagulant strategy. Methods A total of 120 patients undergoing cardiopulmonary bypass were enrolled in this study. Activated clotting time(ACT)of whole blood was established,and 2.5 mg/kg first heparin was given to the sternum.The value of ACT was measured after five minutes.The patients were divided into 3 groups according to the results of the first measured heparin.If the ACT value did not meet the transfer requirements,heparin 0.5 mg/kg was added,and the amount of bleeding was recorded. The general information of patients,blood transfusion and drainage and other information 24 hours postoperatively were recorded. Results Drainage volume 24 hours after the operation in 3 groups was statistically significant(P < 0.05). Drainage volume 24 hours after the operation in group with ACT>750 s and group with ACT<480 s was significantly higher than that in group with ACT ranging from 480 s to 750 s but the difference be-tween the group with ACT < 480 s and the group with ACT > 750 s was not statistically significant(P > 0.05). Conclusions Heparin sensitivity is associated with postoperative bleeding in patients with cardiopulmonary by-pass surgery,and patients with ACT ranging from 480 s to750 s have the lowest amount of bleeding.