Objective:To explore the application of 3D visualisation technology combined with perforator flap transfer in reconstruction of soft tissue defects in traumatic hand and foot injury and explore the clinical outcomes.Methods:Between January 2021 and February 2023, a retrospective analysis was conducted in the Department of Emergency of the Affiliated Hospital of Jiangsu University and the Department of Sports Medical of Wuxi No. 9 People's Hospital, on the data of 12 patients (13 flaps) who received surgery of 3D visualisation technology combined with perforator flap transfer for soft tissue defects left by traumatic hand and foot injuries. The patients were 7 males and 5 females aged 45 [36.5, 55.8] years old. Nine patients had the defects in hand and 3 in foot, with 3 in the left and 9 in the right. The sizes of defects ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. The time from injury to surgery was 13.5 [8.3, 20.8] days. Preoperative CTA scans of donor and recipient sites were performed, and the imaging data were processed for 3D image reconstruction and visualisation. A total of 13 flaps were designed and harvested, including 10 free anterolateral thigh perforator flaps (ALTPFs) and 3 pedicled perforator flaps of fibular artery containing fibular nerve nutrient vessel chains. The flap sizes ranged from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Five of the donor sites were directly closed by suture and 8 by skin grafting. Monthly outpatient follow-ups were conducted for the first 3 months after surgery, and then the follow-up reviews were conducted through visits of outpatient clinic or reviewed via WeChat interviews. Information about the outcomes of the transferred flaps, complications and function recovery were recorded on all patients.Results:All 13 flaps were successfully harvested and transferred with the assistance of 3D visualisation technology. Preoperative location of perforator vessels was accurate and flap design was reasonable. The 3D visualisation provided an effective guidance for surgical manipulation. Twelve flaps survived completely after surgery. One flap that had partial necrosis healed after skin grafting. All patients were included in more than 6 months of postoperative follow-up, with a mean follow-up duration of 8.1 months±1.7 months. All flaps had good colour and texture. Four flaps that had swollen appearance received secondary thinning surgery with satisfactory outcomes. The recovery of 9 patients with hand injury was evaluated according to the Blood Circulation Elauation of Severed Finger Replantation Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association. At the final follow-up, the blood supply of flaps was excellent in 11 flaps and good in 2 flaps. Hand function was excellent in 2 hands, good in 4 hands and poor in 3 hands. Scores of American Orthopedic Foot and Ankle Societ(AOFAS) ankle-hindfoot was used for foot function evaluation and all 3 patients were in excellent. Of the postoperative complications, due to a haematoma beneath the flap, a local infection and a delayed fracture healing were occurred in 3 patients separately.Conclusion:The 3D visualisation technology assisted perforator flap transfer can achieve high-quality reconstruction of defects in hand and foot through precise preoperative flap design and simulated surgical incision, therefore it provides a better treatment outcomes for patients.

Objective:To investigate the effect of single nucleotide polymorphism (SNP) of FCN gene on the susceptibility of pre-eclampsia (PE) in Han nationality pregnant women.Methods:A total of 274 PE pregnant women (PE group) and 154 healthy pregnant women (control group) admitted to Boai Hospital of Zhongshan, Affiliated Hospital to Southern Medical University from October 2020 to October 2022 were collected. The general information, medical history, reproductive history, blood pressure, body mass index and blood biochemical indicators before delivery were compared between the two groups. Twenty-three SNP loci of FCN gene family were genotyped by time-of-flight mass spectrometry, and the serum levels of ficolins (ficolin-1, -2 and -3) were detected by enzyme-linked immunosorbent assay.Results:(1) Compared with the control group, the body mass index, mean arterial pressure, gestational age at delivery, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, direct bilirubin, albumin, and C-reactive protein in the PE group were significantly higher than those in the control group (all P<0.05). The levels of N-terminal pro-B type natriuretic peptide (NT-proBNP), placental growth factor (PlGF) and human soluble vascular endothelial growth factor receptor-1 (sFlt-1) were significantly different between the two groups (all P<0.05). (2) Among the 23 SNP loci in FCN gene family, 18 loci were in Hardy-Weinberg genetic equilibrium, including 5 loci in FCN1 gene, 10 loci in FCN2 gene, and 3 loci in FCN3 gene. Five loci that did not conform to Hardy-Weinberg genetic equilibrium were not included in the subsequent analysis. Compared with the control group, the genotype distribution of 3 loci of FCN2 gene (rs7872508, rs11103563, rs73664188) and 1 locus of FCN3 gene (rs3813800) in the PE group were significantly different (all P<0.05). After Bonferroni correction, only the genotype distribution of rs7872508 and rs73664188 in FCN2 gene were statistically different between the PE group and the control group (all P<0.05). Further analysis showed that for the rs7872508 locus of FCN2 gene, compared with GG genotype, genotype GT ( OR=3.025, 95% CI: 1.080-8.471) and TT ( OR=4.777, 95% CI: 1.758-12.979) both significantly increased the risk of PE (both P<0.05). For rs73664188 locus of FCN2 gene, compared with TT genotype, genotype TC ( OR=0.510, 95% CI: 0.334-0.778) significantly reduced the risk of PE ( P<0.05). (3) Compared with the control group, the serum levels of ficolin-1 and ficolin-2 in pregnant women in the PE group were significantly reduced (both P<0.05), while the level of ficolin-3 showed no significant change ( P=0.271). Correlation analysis showed that the serum levels of ficolin-2 in pregnant women in the PE group were significantly positively correlated with PlGF level ( r=0.321, P<0.001), and significantly negatively correlated with sFlt-1 level ( r=-0.187, P=0.002) and NT-proBNP level ( r=-0.392, P<0.001). Further analysis revealed that the serum levels of ficolin-2 in pregnant women of the PE group with GT and TT genotypes at rs7872508 locus of FCN2 gene were significantly reduced (both P<0.05), while the serum level of ficolin-2 in pregnant women of the PE group with TC genotype at the rs73664188 locus were significantly increased ( P<0.05). Conclusion:The SNP of FCN2 gene in FCN gene family might be related to the susceptibility to PE and have an effect on serum ficolin-2 level in PE pregnant women.

2-(4-Methylthiazol-5-yl) ethyl nitrate hydrochloride (W1302) is a nitro containing derivative of clomethiazole, which is a novel neuroprotective agent with both carbon monoxide (NO) donor and weak γ-aminobutyric acid type A (GABA_A) receptor allosteric regulatory excitatory effect. The current study used a rat model of transient middle cerebral arteryocclusion (tMCAO) brain injury to evaluate the therapeutic effect of W1302 on ischemic stroke and explore its potential mechanisms of action. This experiment has been reviewed and approved by the Laboratory Animal Management and Use Committee of the Institute of Materia Medica, Chinese Academy of Medical Sciences (ethical review forms No. 620, 632, 5013). The results showed that gavage administration of 1, 3, and 10 mg·kg^-1 of W1302 can significantly reduce the volume of cerebral infarction in rats with ischemia for 2 h and reperfusion for 24 h, and the therapeutic effect was better than that of 200 mg·kg^-1 of DL-3n-butylphthalide. W1302 significantly increased NO levels in blood and brain tissue. It increased cerebral blood flow and brain adenosine triphosphate (ATP) content after reperfusion, as well as, inhibited the expressions of inflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in brain tissue. The time window of W1302 was between 120-180 min after ischemia. These research results demonstrated that W1302 could increase NO release, dilate blood vessels, and increase cerebral blood flow, improve energy supply to brain tissue and increase ATP levels, and inhibit neuro-inflammation, which playing the protective roles in tMCAO stroke model rats. This provides theoretical support for the clinical application of W1302 in the treatment of ischemic stroke.

Objective To explore the effects of circ_100284 in affecting the invasion of esophageal squamous cell carcinoma(ESCC)cells and their sensitivity to 5-fluorouracil(5-FU)chemotherapy via regulating miR-217/mitogen-activated protein kinase 1(MAPK1)acting as a competing endogenous RNA(ceRNA).Methods The bioinformatics approach was used to analyze the differentially expressed circRNAs in ESCC.qRT-PCR was used to detect the expression of circ_100284 in ESCC tissues and cells.The 5-FU-resistant KYSE450 cell line(KYSE45-R)was established by increasing concentrations of 5-FU.The IC50 of 5-FU in KYSE450 and KYSE450-R cells was determined through MTT assay.qRT-PCR was used to detect the expression of circ_100284,miR-217,and MAPK1 mRNA in KYSE450 and KYSE450-R cells,while Western blotting detecting the protein expression of MAPK1.In the experiments with KYSE450-R cells,we set up the following groups:(1)blank group(without treatment),si-NC group(transfected with si-NC),si-circ_100284 group(transfected with si-circ_100284),pc-Control group(transfected with pc-Control),pc-circ_100284 group(transfected with pc-circ_100284),pc-circ_100284+mimic NC group(transfected with pc-circ_100284 and mimic NC),and pc-circ_100284+miR-217 mimic group(transfected with pc-circ_100284 and miR-217 mimic).These groups were subjected to MTT assay to detect cell viability,Transwell assay to detect cell invasion,and flow cytometry to detect cell apoptosis.(2)Blank group(without treatment),si-NC group(transfected with si-MAPK1 negative control),si-MAPK1 group(transfected with si-MAPK1),si-MAPK1+inhibitor NC group(transfected with si-MAPK1 and inhibitor NC),and si-MAPK1+miR-217 inhibitor group(transfected with si-MAPK1 and miR-217 inhibitor).We detected the mRNA and protein expression of MAPK1 using qRT-PCR and Western blotting.We evaluated cell viability using MTT assay,invasion with Transwell assay,and apoptosis by flow cytometry.circ_100284-WT or circ_100284-MUT reporter plasmids,as well as MAPK1-WT or MAPK1-MUT reporter plasmids,were co-transfected with miR-NC or miR-217 mimic into KYSE450-R cells for 48 h,and dual luciferase reporter assay was used to measure luciferase activity.Results The bioinformatics analysis revealed significant upregulation of circ_100284 in ESCC.Compared with adjacent normal tissues,the expression of circ_100284 in ESCC tissues is enhanced(P<0.05);compared with the HECC cells,the TE-11,ECA109 and KYSE450 ESCC cell lines showed enhanced expression of circ_100284(P<0.05).Compared with the KYSE450 cells,KYSE450-R cells demonstrated increased IC50 with enhanced expression of circ_100284 and MAPK1 but suppressed expression of miR-217(P<0.05).Compared with the si-NC group,the si-circ_100284 group demonstrated inhibited invasion and proliferation of cells with increased apoptosis(P<0.05).Compared with pc-Control group,the invasion and proliferation of cells in the pc-circ_100284 group are increased,and cell apoptosis is decreased(P<0.05).Over-expression of miR-217 reversed the malignant biological behavior of ESCC cells induced by pc-circ_100284(P<0.05).Compared with si-NC group,in the si-MAPK1 group,we observed decreased cell invasion and proliferation,and increased apoptosis(P<0.05),but miR-217 inhibitor reversed the effect of si-MAPK1 on the biological behavior of ESCC cells(P<0.05).The targeting relationship of circ_100284 and miR-217,miR-217 and MAPK1 is confirmed.Conclusion circ_100284 promotes ESCC cell invasion by regulating miR-217/MAPK1,inhibits the chemosensitivity of ESCC cells to 5-FU,and acts as a tumor-promoting factor in ESCC.

Humans ; Neoplasms, Second Primary/epidemiology* ; Neoplasms/epidemiology* ; Risk Factors ; Prognosis

Inhibition of human epidermal growth factor receptor 2 mediated cell signaling pathway is an important therapeutic strategy for HER2-positive cancers. Although monoclonal antibodies are currently used as marketed drugs, their large molecular weight, high cost of production and susceptibility to proteolysis could be a hurdle for long-term application. In this study, we reported a strategy for the development of artificial antibody based on

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective:To explore the selection of surgical methods for different sites of symptomatic Rathke's cleft cyst (RCC) and the clinical efficacies of these patients.Methods:Forty-seven patients with symptomatic RCC, admitted to our hospital from January 2016 to December 2019, were chosen in our study; 21 patients with intrasellar symptomatic RCC accepted surgery via unilateral nasal approach at the right side, 19 patients with intra-suprasellar symptomatic RCC accepted surgery via bilateral nasal approach, 3 patients with suprasellar symptomatic RCC accepted endonasal transsphenoidal surgery under endoscope, and 4 patients with suprasellar symptomatic RCC accepted craniotomy via pterion approach. The clinical efficacies and complications of patients accepted different surgical methods were compared. All patients were followed up for 3-36 months to observe the recurrence.Results:The postoperative symptoms of the patients were effectively improved, including headache relief ratio of 27/31, vision loss improvement ratio of 5/5, high prolactin relief ratio of 11/13, pituitary function improvement ratio of 9/18. Complications occurred in 6 patients, presenting as diabetes insipidus. Four patients recurred during follow-up.Conclusion:Intrasellar and intra-suprasellar symptomatic RCC accepted surgery via endoscopic transnasal transsphenoidal approach are safe and effective; selection of surgical methods for suprasellar symptomatic RCC should be determined according to the sizes and growth directions of cysts.

【Objective】 To investigate the predictive value of preoperative Gd- EOB- DTPA enhanced MRI in the expression of cytokeratin 19（CK19）in hepatocellular carcinoma（HCC）.【Methods】A total of 102 patients，including 94 male and 8 female，with single HCC confirmed by pathology after operation who underwent preoperative enhanced MRI were retrospectively analyzed. A total of 25 were CK19-positive HCC and 77 were CK19-negative HCC. Two radiologists evaluated MR features including tumor size，tumor margin，intratumoral vessels，signal intensity（SI）on arterial phase （AP） ，enhancement pattern ，arterial rim enhancement ，peritumoral enhancement ，internal cystic or necrotic portion，hemorrhage，intratumoral fat，tumor capsule，vascular invasion，lymph node metastasis，intratumoral septum， target sign on diffusion weighted imaging（DWI）or hepatobiliary phase（HBP），peritumor hypointensity，SI on ADC，SI on HBP ，T1 relaxation times and T1 reduction rate between pre- and post- contrast enhancement. The associations between these imaging features and CK19 expression were investigated. 【Results】SI on AP（P = 0.013），arterial rim enhancement（P = 0.018），target sign on DWI（P = 0.001）and target sign on HBP（P = 0.005）were significantly associated with CK19 expression. Delayed enhanced intratumoral septum（P = 0.042）was associated with CK19 expression between HCCs less than 5 cm. Target sign on DWI（P = 0.001，OR = 4.875，95%CI：1.838~12.927）were independent significant factors of CK19- positive HCC.【Conclusion】Preoperative enhanced MRI with Gd- EOB- DTPA is helpful to predict CK19 expression of HCC.

OBJECTIVETo assess the association between 2 single nucleotide polymorphisms (SNPs) located in exonic regions of matrix metalloproteinase-10 (MMP-10) gene and instability of carotid plaques in a Han Chinese population.

METHODSFive hundred and eighty-five patients were divided into carotid vulnerable plaque group (n=206) and stable plaque group (n=379) based on results of carotid B-mode ultrasonography. The SNPs were genotyped by real-time polymerase chain reaction using an ABI 7300 TaqMan platform.

RESULTSThe distribution of rs17435959 between the two groups was significantly different at both genotypic (GC+CC vs. GG, P=0.006, OR=2.012) and allelic levels (C vs. G, P=0.001,OR=2.160). Above differences have remained significant with binary logistic regression analysis (P=0.007, OR=2.022; P=0.002, OR=2.104). The minor allele frequency of rs17293607 was 0.56%.

CONCLUSIONAbove findings suggested that rs17435959 of the MMP-10 gene is associated with carotid vulnerable plaque in ethnic Chinese Hans. The C allele may be a susceptible predictor for carotid vulnerable plaque.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Matrix Metalloproteinase 10 ; genetics ; Middle Aged ; Plaque, Atherosclerotic ; enzymology ; genetics ; Polymorphism, Single Nucleotide