Objective:To evaluate the clinical efficacy of autologous bone marrow nucleated cell transplantation on ovarian dysfunction-related diseases.Methods:From September 2020 to August 2021, we conducted a before-after study in Shanghai Institute of Planned Parenthood Research Hospital and Shanghai New Hongqiao International Medical Center. A total of 28 patients with premature ovarian insufficiency, perimenopausal syndrome or repeated assisted reproduction failure were treated with ultrasound-guided autologous bone marrow nucleated cell transplantation into the ovaries. Clinical efficacy was evaluated by comparing the patients' self-reported symptoms, endometrial thickness, bilateral ovarian volume, the number of bilateral ovarian follicles, the maximum diameter of bilateral ovarian follicles, and the level of plasma estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, prolactin, and testosterone.Results:After autologous bone marrow nucleated cell transplantation, the number of bilateral ovarian follicles and the maximum diameter of bilateral ovarian follicles statistically significantly increased by an average of 1.26±2.12 ( P=0.005) and (5.40±8.92) mm ( P=0.006), respectively. Endometrial thickness and bilateral ovarian volume increased after treatment although without statistically significance (all P>0.05). However, the ovarian volume, the number of follicles, and the maximum diameter of follicles with greater changes between the left and right sides of the treatment, were found to statistically significantly increase after treatment ( P=0.007, P<0.001, P=0.002). Besides, the levels of FSH, LH, progesterone, and prolactin decreased with no statistical significance (all P>0.05). The stratified analysis of disease types found that endometrial thickness, the number of bilateral ovarian follicles, and the maximum diameter of bilateral ovarian follicles after treatment tended to increase, but only the number of bilateral follicles and the maximum diameter of bilateral ovarian follicles in patients with perimenopausal syndrome showed statistical significance ( P=0.008, P=0.047). Conclusion:The present study suggested that autologous bone marrow nuclear cell therapy could improve ovarian function to some extent, and is expected to be a new treatment method for patients with premature ovarian insufficiency, perimenopausal syndrome, and repeated assisted reproduction failure. However, further studies with larger sample sizes are needed to corroborate the findings.

Objective:To evaluate the clinical efficacy of autologous bone marrow nucleated cell transplantation on ovarian dysfunction-related diseases.Methods:From September 2020 to August 2021, we conducted a before-after study in Shanghai Institute of Planned Parenthood Research Hospital and Shanghai New Hongqiao International Medical Center. A total of 28 patients with premature ovarian insufficiency, perimenopausal syndrome or repeated assisted reproduction failure were treated with ultrasound-guided autologous bone marrow nucleated cell transplantation into the ovaries. Clinical efficacy was evaluated by comparing the patients' self-reported symptoms, endometrial thickness, bilateral ovarian volume, the number of bilateral ovarian follicles, the maximum diameter of bilateral ovarian follicles, and the level of plasma estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, prolactin, and testosterone.Results:After autologous bone marrow nucleated cell transplantation, the number of bilateral ovarian follicles and the maximum diameter of bilateral ovarian follicles statistically significantly increased by an average of 1.26±2.12 ( P=0.005) and (5.40±8.92) mm ( P=0.006), respectively. Endometrial thickness and bilateral ovarian volume increased after treatment although without statistically significance (all P>0.05). However, the ovarian volume, the number of follicles, and the maximum diameter of follicles with greater changes between the left and right sides of the treatment, were found to statistically significantly increase after treatment ( P=0.007, P<0.001, P=0.002). Besides, the levels of FSH, LH, progesterone, and prolactin decreased with no statistical significance (all P>0.05). The stratified analysis of disease types found that endometrial thickness, the number of bilateral ovarian follicles, and the maximum diameter of bilateral ovarian follicles after treatment tended to increase, but only the number of bilateral follicles and the maximum diameter of bilateral ovarian follicles in patients with perimenopausal syndrome showed statistical significance ( P=0.008, P=0.047). Conclusion:The present study suggested that autologous bone marrow nuclear cell therapy could improve ovarian function to some extent, and is expected to be a new treatment method for patients with premature ovarian insufficiency, perimenopausal syndrome, and repeated assisted reproduction failure. However, further studies with larger sample sizes are needed to corroborate the findings.

BACKGROUND: Thoracodorsal artery perforator flap can relieve damage to donor site and avoid bulk in the recipient site,but dissociation of perforating branch took time.Some one believed that it should be done by very experienced physicians and some muscle tissues should be reserved.OBJECTIVE: To investigate the method,effectiveness and clinical application of improved latissimus dorsi flap based on perforator flap conception for reconstruction of soft tissue defects of lower extremity.METHODS: A total of 17 patients needing skin flap transplantation were selected.12 latissimus dorsi musculocutaneous/muscle flaps,3 latissimus dorsi flaps with a few muscle and 2 double-leaf segmental latissimus dorsi compound flaps were designed based on perforator flap conception.According to the territory of latissimus dorsi musculocutaneous flap,a skin paddle in which anterior underlying muscle and main perforator was designed,extend about to the anterior edge of the latissimus dorsi muscle.An additional latissimus dorsi muscle flap was selected for soft tissue enlargement if necessary.Sometimes,double-leaf segmental latissimus dorsi musculocutaneous/muscle flap,including one muscle-sparing latissimus dorsi musculocutaneous flap and the other segmental latissimus dorsi muscle flap nourished by the lateral branches of the thoracodorsal vessels was selected to repair two adjacent defects.The harvested tissue area ranged from 12 cm×8 cm to 28 cm×17 cm.Survival state of skin flap,together with shape and function of donor site and recipient site of skin flap were observed.RESULTS AND CONCLUSION: Following skin flap transplantation,one case developed vascular crisis that was relieved following re-exploration for vessel anastomosis.All skin flap survived.Second-stage skin grafting was done on one muscle flap wound.All donor sites were sutured directly.After a follow-up of 3 to 18 months in 15 cases,only two cases received two-stage plastic operation because bulky flaps brought some trouble in wearing shoes.Improved latissimus dorsi flap based on perforator flap conception can reduce damage to the donor site and the receipt area bulk.Double-leaf segmental latissimus dorsi compound flaps can repair both heel and toe wound.The versatile latissimus dorsi flap designed using thoracodorsal artery perforator flap conception is an ideal flap for repairing widespread soft tissue defects in the lower extremity.