BACKGROUND:Postoperative results with Meek skin grafting in some patients with extremely severe burns have not been satisfactory,with problems of delayed healing or skin graft failure. There have been fewer studies on the treatment of patients with failed Meek skin grafting due to insufficient skin source. This study aimed to explore a treatment method for such patients. OBJECTIVE:To observe the curative effect of stamp-shaped skin allograft in the treatment of severe burns after Meek skin graft failure. METHODS:Twenty-three patients with extremely severe burns who were admitted at Department of Burns and Skin Surgery,the First Affiliated Hospital of the Air Force Medical University from August 2013 to August 2023 with poor healing after Meek skin grafting were enrolled and divided into allogeneic skin treatment group and dressing change group according to different treatment methods. There were 10 cases in the allograft group and 13 cases in the dressing change group. Preoperative hemoglobin,platelet count,albumin count,white blood cell count,neutrophil count,procalcitonin count,and positive rate of microbial culture before secondary Meek skin grafting were compared between two groups. Survival rate of skin grafts before and after the second operation were compared. The number of operations,incidence of sepsis,and wound scars at 3 months and 6 months after operation were retrospectively analyzed. RESULTS AND CONCLUSION:The preoperative hemoglobin,platelet count and albumin count in the allogeneic skin treatment group were significantly higher than those in the dressing change group (Z=-3.172,P=0.002;Z=-3.010,P=0.003;Z=-2.761,P=0.006). There was no significant difference in the preoperative white blood cell count and neutrophil count between the two groups before secondary Meek skin grafting (Z=1.148,P=0.251;Z=0.373,P=0.709),but the serum procalcitonin count in the allogeneic skin treatment group prior to the second operation was significantly lower than that in the dressing change group (Z=2.955,P=0.002). Burn patients in the dressing change group exhibited a higher microbial culture rate than those in the allogeneic skin treatment group (x2=6.303,P=0.029). The survival rate of skin grafts before the second operation in the allogeneic skin treatment group[(74.8±13.3)％]was significantly higher than that in the dressing change group[(58.4±14.2)％;t=2.85,P=0.01). The survival rate of skin grafts after the second stage operation in the allogeneic skin treatment group[(84.0±11.5)％]was significantly higher than that in the dressing change group[(67.6±20.7)％;t=2.24,P=0.03). The frequency of postoperative surgery in the allogeneic skin treatment group was less than that in the dressing change group (Z=2.27,P=0.02). The incidence of sepsis in the dressing change group was significantly higher than that in the allogeneic skin treatment group (x2=5.490,P=0.03). There was no significant difference in the Vancouver Scar Scale scores of the scars between the two groups at 3 and 6 months after operation (t=0.96,1.138,P>0.05). To conclude,stamp-shaped skin allograft has good curative effect in the treatment of wounds with poor healing of skin after Meek micro-transplantation. The utilization rate of skin in the later stage is significantly increased,which reduces the probability of wound infection and solves the problem of insufficient skin source.

Objectives:This study aims to investigate the association between Chinese visceral adiposity index(CVAI)and the risk of cardiovascular disease(CVD),and explore the sex differences.Methods:Participants were screened from the three sub-cohorts of Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project,baseline information on body measure and biochemistry examinations were collected from 1998,2000-2001,and 2007-2008,separately.Participants were followed up to 2015.Cohort-stratified Cox proportional risk models were used to analyze the relationship between CVAI,both in continuous(per standard deviation increase)and categorical(quartiles,with Q1 as reference)scales,and CVD risk in the total population,men and women.The multiplicative interaction between sex and CVAI on CVD risk were calculated.Restricted cubic spline regression was employed to investigate the dose-response relationship.Results:A total of 98 464 participants without CVD at baseline were included.During the 723 508 person-years of follow-up,3 605 CVD events were recorded.After multivariate adjustment,the HRs(95％CIs)of CVD were 1.25(1.20-1.29),1.09(1.04-1.15),and 1.54(1.46-1.64)for per standard deviation increment in CVAI in the general population,men and women,respectively.Besides,compared with Q1 group,the HRs(95％CIs)in Q4 group were 1.87(1.67-2.10),1.33(1.14-1.54)and 3.84(3.09-4.78),correspondingly,and the effect of CVAI on the risk of CVD was significantly higher in women than in men(Pinteraction<0.05).Additionally,there was a positive dose-response relationship between CVAI and the risk of CVD.Conclusions:Elevated CVAI is an independent risk factor for CVD,especially in women.

BACKGROUND:Postoperative results with Meek skin grafting in some patients with extremely severe burns have not been satisfactory,with problems of delayed healing or skin graft failure. There have been fewer studies on the treatment of patients with failed Meek skin grafting due to insufficient skin source. This study aimed to explore a treatment method for such patients. OBJECTIVE:To observe the curative effect of stamp-shaped skin allograft in the treatment of severe burns after Meek skin graft failure. METHODS:Twenty-three patients with extremely severe burns who were admitted at Department of Burns and Skin Surgery,the First Affiliated Hospital of the Air Force Medical University from August 2013 to August 2023 with poor healing after Meek skin grafting were enrolled and divided into allogeneic skin treatment group and dressing change group according to different treatment methods. There were 10 cases in the allograft group and 13 cases in the dressing change group. Preoperative hemoglobin,platelet count,albumin count,white blood cell count,neutrophil count,procalcitonin count,and positive rate of microbial culture before secondary Meek skin grafting were compared between two groups. Survival rate of skin grafts before and after the second operation were compared. The number of operations,incidence of sepsis,and wound scars at 3 months and 6 months after operation were retrospectively analyzed. RESULTS AND CONCLUSION:The preoperative hemoglobin,platelet count and albumin count in the allogeneic skin treatment group were significantly higher than those in the dressing change group (Z=-3.172,P=0.002;Z=-3.010,P=0.003;Z=-2.761,P=0.006). There was no significant difference in the preoperative white blood cell count and neutrophil count between the two groups before secondary Meek skin grafting (Z=1.148,P=0.251;Z=0.373,P=0.709),but the serum procalcitonin count in the allogeneic skin treatment group prior to the second operation was significantly lower than that in the dressing change group (Z=2.955,P=0.002). Burn patients in the dressing change group exhibited a higher microbial culture rate than those in the allogeneic skin treatment group (x2=6.303,P=0.029). The survival rate of skin grafts before the second operation in the allogeneic skin treatment group[(74.8±13.3)％]was significantly higher than that in the dressing change group[(58.4±14.2)％;t=2.85,P=0.01). The survival rate of skin grafts after the second stage operation in the allogeneic skin treatment group[(84.0±11.5)％]was significantly higher than that in the dressing change group[(67.6±20.7)％;t=2.24,P=0.03). The frequency of postoperative surgery in the allogeneic skin treatment group was less than that in the dressing change group (Z=2.27,P=0.02). The incidence of sepsis in the dressing change group was significantly higher than that in the allogeneic skin treatment group (x2=5.490,P=0.03). There was no significant difference in the Vancouver Scar Scale scores of the scars between the two groups at 3 and 6 months after operation (t=0.96,1.138,P>0.05). To conclude,stamp-shaped skin allograft has good curative effect in the treatment of wounds with poor healing of skin after Meek micro-transplantation. The utilization rate of skin in the later stage is significantly increased,which reduces the probability of wound infection and solves the problem of insufficient skin source.

Objectives:This study aims to investigate the association between Chinese visceral adiposity index(CVAI)and the risk of cardiovascular disease(CVD),and explore the sex differences.Methods:Participants were screened from the three sub-cohorts of Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project,baseline information on body measure and biochemistry examinations were collected from 1998,2000-2001,and 2007-2008,separately.Participants were followed up to 2015.Cohort-stratified Cox proportional risk models were used to analyze the relationship between CVAI,both in continuous(per standard deviation increase)and categorical(quartiles,with Q1 as reference)scales,and CVD risk in the total population,men and women.The multiplicative interaction between sex and CVAI on CVD risk were calculated.Restricted cubic spline regression was employed to investigate the dose-response relationship.Results:A total of 98 464 participants without CVD at baseline were included.During the 723 508 person-years of follow-up,3 605 CVD events were recorded.After multivariate adjustment,the HRs(95％CIs)of CVD were 1.25(1.20-1.29),1.09(1.04-1.15),and 1.54(1.46-1.64)for per standard deviation increment in CVAI in the general population,men and women,respectively.Besides,compared with Q1 group,the HRs(95％CIs)in Q4 group were 1.87(1.67-2.10),1.33(1.14-1.54)and 3.84(3.09-4.78),correspondingly,and the effect of CVAI on the risk of CVD was significantly higher in women than in men(Pinteraction<0.05).Additionally,there was a positive dose-response relationship between CVAI and the risk of CVD.Conclusions:Elevated CVAI is an independent risk factor for CVD,especially in women.

Objective:To explore the clinical effect of composite skin transplantation combined with systemic rehabilitation in the treatment of extensive scar contracture deformity around the popliteal fossa in children after burns.Methods:A retrospective observational research method was adopted. Seventeen children with extensive scar contracture deformities around the popliteal fossa after burns who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Military Medical University from March 2018 to April 2022 were selected. Among them, there were 10 males and 7 females, aged 2-11 years, with scar contracture deformities lasting from 10 months to 9 years, all located around the popliteal fossa, 10 cases of right popliteal fossa, 5 cases of left popliteal fossa, 2 cases of bilateral popliteal fossa, scars around the popliteal fossa result in a knee joint extension angle of only 95° to 115°. The scar contracture during surgery was thoroughly released, joint mobility was restored, so as to form a secondary wound range of 10 cm×8 cm-20 cm×13 cm. In stage Ⅰ, after completely releasing the scar contracture, the wound was covered with negative pressure closure drainage (VSD) for 2-3 days. In stage Ⅱ, a large autologous blade thick scalp and allogeneic decellularized dermal matrix composite graft was performed to repair the wound around the popliteal fossa. After 8-10 days of surgery, the dressing was changed to check the survival of the skin graft. One week after the skin graft survived, a 12 month orderly knee joint function training was conducted under the guidance of a rehabilitation therapist. Postoperative sequential treatment with a combination of strong pulsed light and ultra pulsed carbon dioxide lattice laser for 5-7 courses of significant scar hyperplasia in the skin graft area and edges.Results:15 cases of pediatric patients had good skin graft survival; One patient developed a wound due to partial displacement of the transplanted autologous scalp, and one patient developed a plasma swelling under the limb graft, which was drained through an opening. Two patients underwent dressing changes for 3 weeks before the wound healed. After follow-up for 6 to 36 months, the elasticity and appearance of the skin graft were similar to those of a medium thickness skin graft. Children with knee joint contracture were able to fully extend to 180°, and knee joint function was significantly improved. There was no scar formation or hair loss in the donor skin area.Conclusions:The combination of composite skin transplantation and systematic rehabilitation has a good effect on the treatment of extensive scar contracture around the popliteal fossa in children after burns, avoiding the problem of scars left in the donor area due to autologous skin grafting.

Objective:To investigate the role and mechanism of long non-coding RNA (lncRNA) gastric cancer associated transcript 3 (GACAT3) in glioma radioresistance.Methods:Real-time reverse transcription PCR (RT-qPCR) was used to detect the expression of lncRNA GACAT3 and miR-497 in human astrocyte NHA cells and glioma cells U251. NC-siRNA and GACAT3-siRNA were transfected into U251 cells, and the cells were treated with X-ray irradiation. Colony formation assay was used to detect the survival fraction of U251 cells. The apoptosis of U251 cells was detected by flow cytometry. Western blot was used to detect the expression of cysteine containing aspartate specific protease 3 (Caspase-3) in U251 cells. Bioinformatics software and dual luciferase reporter gene assay were used to predict and verify the targeting relationship between lncRNA GACAT3 and miR-497, and between miR-497 and Yes-associated protein 1 (YAP1), respectively. NC mimic, miR-497 mimic, GACAT3-siRNA and NC inhibitor, GACAT3-siRNA and miR-497 inhibitor were co-transfected into U251 cells. Colony formation assay, flow cytometry and Western blot were adopted to evaluate the effect of miR-497 overexpression and lncRNA GACAT3 on the radiosensitivity of U251 cells by regulating miR-497.Results:Compared with NHA cells, the expression of lncRNA GACAT3 in U251 cells was significantly up-regulated, and the expression of miR-497 in U251 cells was significantly down-regulated (both P<0.05). After knockdown of GACAT3, the survival fraction of irradiated U251 cells was significantly decreased, while the apoptosis rate and Caspase-3 protein expression were significantly increased (all P<0.05). lncRNA GACAT3 targeted and negatively regulated the expression of miR-497. Overexpression of miR-497 significantly reduced the survival fraction of U251 cells after irradiation, and increased the apoptosis rate and Caspase-3 protein expression. Inhibition of miR-497 significantly reversed the promoting effect of lncRNA GACAT3 knockdown on the radiosensitivity of U251 cells. miR-497 targeted and negatively regulated the expression of YAP1. Conclusion:Knockdown of lncRNA GACAT3 can enhance the radiosensitivity of glioma cells by regulating the miR-497/YAP1 axis.

Objective To evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. Methods The clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. Results A total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). Conclusion Staged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.

Objective:To compare the antiosteoporosis effect of conventional treatment and conventional treatment combined with Denosumab after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 211 patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from September 2020 to September 2022. All the patients were female, aged 56-90 years [(71.4±8.1)years]. The bone mineral density T-score of the lumbar spine was (-2.6±1.0)SD before operation. Fracture segments included T 1-T 9 in 45 patients, T 10-L 2 in 146, and L 3-L 5 in 69. Of all, 174 patients were treated with single-segment surgery, 25 with two-segment surgery and 12 with surgery involving three or more segments. According to the wishes of the patients, 107 patients were treated with daily oral administration of calcium and active Vitamin D after PKP (conventional treatment group) and 104 patients with Denosumab combined with the conventional treatment after PKP (Denosumab therapy group). The bone mineral density T-scores of the lumbar spine of the two groups were compared before surgery and at the last follow-up. The visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery, at 3 days, 6 months after surgery, and at the last follow-up were evaluated and the refracture rate after surgery was detected. Possible adverse effects after medication during anti-osteoporosis treatment were observed in two the groups. Results:All the patients were followed up for 12-24 months [(13.5±2.0)months]. Before surgery, the bone mineral density T-score of the lumbar spine was (-2.7±1.1)SD in the Denosumab therapy group and (-2.5±0.8)SD in the conventional treatment group ( P>0.05). At the last follow-up, the bone mineral density T-score of the lumbar spine was (-2.1±1.1)SD in the Denosumab therapy group, significantly higher than (-2.5±0.9)SD in the conventional treatment group ( P<0.05). In the Denosumab therapy group, the bone mineral density T-score of the lumbar spine at the last follow-up was significantly increased compared to that before surgery ( P<0.01), while there was no significant difference in the conventional treatment group ( P<0.05). Before surgery and at 3 days after surgery, the VAS scores and ODI values were (8.5±0.9)points, (2.8±0.8)points, 48.7±4.8 and 25.6±4.0 in the Denosumab therapy group, which was not statistically different from those in the conventional treatment group [(8.5±1.3)points and (2.8±0.9)points, 47.9±7.0 and 25.9±3.7] ( P>0.05). At 6 months after surgery and at the last follow-up, the VAS scores and ODI values were (2.2±0.8)points, (1.7±0.8)points, 24.2±3.6 and 23.2±4.1 in the Denosumab therapy group, significantly lower than those of the conventional treatment group [(2.8±0.9)points, (2.8±1.1)points, 26.4±3.2 and 27.3±4.0] ( P<0.01). The VAS scores at each time point after surgery in both groups decreased significantly compared with those before surgery ( P<0.05). The VAS scores continued to decrease after surgery in the Denosumab therapy group ( P<0.05), while no significant difference was found among those at different time points in the conventional treatment group ( P>0.05). The ODI values at each time point after surgery in both groups significantly decreased compared to those before surgery ( P<0.05). The ODI values continued to decrease after surgery in the Denosumab therapy group ( P<0.05), while in the conventional treatment group, no significant difference was found between those at 6 months after surgery and those at 3 days after surgery ( P>0.05) and they were improved at the last follow-up compared with those at 3 days after surgery ( P<0.05). The refracture rate after surgery was 6.7% (7/104) in the Denosumab therapy group, significantly lower than 16.8% (18/107) in the conventional treatment group ( P<0.05). No serious complications were observed during the antiosteoporosis period in either group. Conclusion:Compared with daily oral administration of Calcium and active Vitamin D after PKP, the conventional treatment combined with Denosumab after PKP can effectively increase the bone density, relieve pain continuously, improve functional restoration, and reduce the risk of refracture in OVCF patients.

Objective:To investigate the clinical characteristics and prognostic factors of primary urethral cancer.Methods:The clinical data of 35 patients with primary urethral cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to April 2022 were retrospectively analyzed. There were 12 males (34.3%) and 23 females (65.7%). The average age was 61.1 ± 13.0 years old. The clinical symptoms included 13 cases of urethral obstruction (37.1%), 7 cases of hematuria (20.0%), 6 cases of urethral bleeding (17.1%), 5 cases of urinary tract irritation (14.3%), 1 case of Urinary incontinence (2.9%), 1 case of low back pain (2.9%), 1 case of scrotal ulcer (2.9%), and 1 case (2.9%) by self examination. All patients underwent cystourethroscopy and tissue biopsy. The biopsy pathology showed 16 cases of urothelial carcinoma, 7 cases of squamous carcinoma, 4 cases of adenocarcinoma, 3 cases of malignant melanoma, 1 case of urothelial carcinoma with squamous carcinoma, 1 case of Signet ring cell carcinoma, 1 case of sarcomatoid carcinoma, 1 case of embryonic Rhabdomyosarcoma, and 1 case of epithelioid angiosarcoma. The tumors were located in the proximal urethra in 13 cases (37.1%) and in the distal urethra in 22 cases (62.9%). There were 14 cases (40.0%) with a maximum diameter of less than 3 cm, 16 cases (45.7%) with a diameter of ≥ 3 cm, and 5 cases (14.3%) with mucosal abnormalities. There were 12 cases of T 1 stage, 9 cases of T 2 stage, 7 cases of T 3 stage, and 7 cases of T 4 stage in tumor staging. Imaging evaluation of lymph nodes showed 25 cases of N 0 stage, 2 cases of N 1 stage, and 8 cases of N 2 stage; A total of 11 cases of lymph node biopsy were performed (including 8 cases of intraoperative lymph node dissection and 3 cases of preoperative lymph node biopsy), of which 6 cases had lymph node metastasis, and 1 case was initially diagnosed with distant metastasis. Thirty-one cases underwent surgical treatment, of which 16 cases underwent radical urethrectomy, and 8 cases underwent intraoperative pelvic and bilateral inguinal lymph node dissection, 8 cases underwent resection of urethral tumors, and 7 cases underwent transurethral resection of tumors. Four cases did not undergo surgical treatment, while 1 case had epithelioid angiosarcoma and received radiotherapy combined with chemotherapy, 2 cases received chemotherapy with GC (Gemcitabine+ cisplatin) regimen, and 1 case received immunotherapy with immune checkpoint inhibitors. The risk factors that affected patient prognosis were analyzed. Results:All 35 cases in this group were followed up, with a median follow-up time of 22 (2, 122) months. Seventeen cases survived, 18 cases died, and the overall median survival duration was 23 (13 to not reached) months. The overall 5-year survival rate was 45%. The results of univariate analysis showed that clinical T-stage ( P=0.019), maximum tumor diameter ( P=0.016), and tumor location ( P=0.006) were independent risk factors affecting patient prognosis. Result of multivariate analysis showed that the maximum diameter of the tumor ≥ 3 cm ( HR=2.673, P=0.029) and the proximal location of the tumor ( HR=3.064, P=0.023) were independent risk factors affecting patient survival. Gender, age, treatment method, lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, clinical manifestations, pathological type, clinical N staging, and pathological N staging had no significant impact on patient survival rate ( P>0.05). Single factor analysis was conducted on female patients separately, and only tumor location was found to be a prognostic factor ( χ2=17.246, P<0.01). Conclusions:Primary urethral cancer is a rare disease with various symptoms and poor prognosis. The maximum diameter of the tumor ≥3 cm and the tumor located at the proximal end of the urethra are clinical risk factors affecting the prognosis of patients with primary urethral cancer.

Objective:To investigate the effects of anterolateral thigh chimeric perforator flap in repairing complex wounds of foot and ankle.Methods:A retrospective observational study was conducted. From May 2018 to June 2022, 23 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University to repair complex wounds of foot and ankle with anterolateral thigh chimeric perforator flaps, including 15 males and 8 females, aged from 20 to 66 years. The wounds were all accompanied by bone exposure and defects, and were complicated with varying degrees of infection. All patients underwent debridement and continuous vacuum sealing drainage treatment for 1 week in stage Ⅰ, with the skin and soft tissue defect area after debridement being 10 cm×5 cm to 22 cm×7 cm. In stage Ⅱ, the anterolateral thigh chimeric perforator flap was used to cover the defective wound, of which the muscle flap was used to fill the deep invalid cavity of the ankle joint or cover bone and internal fixation exposures, and the skin flap was used to cover the superficial wound, with the area of the skin flap ranging from 11 cm×6 cm to 23 cm×8 cm, and the area of the muscle flap ranging from 4.0 cm×2.5 cm to 8.0 cm×5.0 cm. The survival of the flap was observed after operation. During follow-up, the color, texture, appearance, and complications of the flap were observed, the function of ankle joint and its range of dorsiflexion motion and plantar flexion motion were measured, and the scar hyperplasia and muscular hernia in donor area were observed.Results:Ecchymosis and epidermal necrosis occurred at the tip of the flap in 1 patient on 5 days after operation and healed after dressing change for 1 week; the other flaps of patients survived successfully. After 6 to 40 months of follow-up, the color, texture, and shape of flaps were good, but 1 patient was not satisfied with the shape of the flap because of flap swelling; the ankle joint movement was basically normal, the dorsiflexion motion was 15-30°, and the plantar flexion motion was 20-45°; the scar hyperplasia in the donor area of the flap was not obvious, and no muscular hernia occurred.Conclusions:The anterolateral thigh chimeric perforator flap can effectively fill the deep invalid cavity of ankle joint and cover the superficial wound at the same time, with minimal damage to the donor site. So it is an ideal flap for repairing the complex wounds of foot and ankle.