OBJECTIVE: To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand. METHODS: A retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023. All patients were male, aged 22-65 years, with an average of 45.9 years. The duration of gout history ranged from 2 to 18 years, with an average of 8.8 years. The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months, with an average of 17.6 months. The gouty tophus eroded the flexor pollicis longus tendon in 4 cases, with Verdan flexor tendon zones being Ⅰ-Ⅱ in 1 case and Ⅳ-Ⅴ in 3 cases. The flexor digitorum profundus tendons were affected in 2 cases for the index finger, 1 for the middle finger, and 1 for the ring finger, all located in zone Ⅳ-Ⅴ. The long axis of the gouty tophus ranged from 2.3 to 4.5 cm, with an average of 3.4 cm. All 8 patients presented with limited finger flexion and extension. Among them, 4 cases were accompanied by median nerve compression symptoms, and 1 case had associated bone and joint destruction in the hand. The total active motion (TAM) of the affected finger was (81.3±30.2)° before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, and the functional evaluation was poor. The harvested palmaris longus tendon intraoperatively was 7-9 cm in length. RESULTS: Surgical incisions in all 8 patients healed by first intention, with no infections, graft non-union, or significant adhesion complications. All patients were followed up 8-25 months, with an average of 14.8 months. Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms. Patients did not experience wrist pain or other discomfort, and function was not compromised. At last follow-up, according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, the TAM of 8 patients was (197.5±55.8)°, which significantly improved when compared with that before operation ( t=11.638, P<0.001); the hand function of 1 patient with gouty tophus in zone Ⅰ-Ⅱ flexor pollicis longus tendon was good, and the other 7 patients were excellent. CONCLUSION Free palmaris longus tendon graft reconstruction demonstrates good effectiveness in treating gouty tophus erosion lesions in flexor tendon of wrist and hand.
Humans ; Middle Aged ; Male ; Adult ; Tendons/surgery* ; Retrospective Studies ; Aged ; Gout/complications* ; Wrist/surgery* ; Plastic Surgery Procedures/methods* ; Hand/surgery* ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the effectiveness of multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repair of amputated palm injury distal to the superficial palmar arch. METHODS: Between September 2018 and July 2023, 5 patients with amputated palm injury distal to the superficial palmar arch were treated. There were 3 males and 2 females with an average age of 35.4 years (range, 29-52 years). The time from injury to admission was 1-6 hours (mean, 3.2 hours). The multi-segment inverted Y-shaped vein transplantation in the anterior lateral malleolar venous network were used to repair the common and proper palmar digital arteries; the another anterior lateral malleolar venous network was used to repair the dorsal vein of the hand. The soft tissue defect of dorsal hand in 1 patient was repaired with the pedicled ilioinguinal flap, and the wound at the donor site was directly sutured. Postoperative treatment included anti-infection therapy, antispasmodic therapy, and thrombosis prevention measures. RESULTS: The partial necrosis of the fingertip of the thumb occurred in 1 case, and the marginal necrosis of the abdominal flap after operation occurred in 1 case. The remaining fingers showed good blood supply with normal tension. The incision at donor site of the abdominal flap healed by first intention. All patients were followed up 8-41 months (median, 19 months). At last follow-up, the hand contour was satisfactory; the grasping function, opposition function, and proprioception recovered, and two-point discrimination ranged from 5 to 7 mm (mean, 6 mm). According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the functional outcomes were excellent in 3 cases, good in 1 case, and fair in 1 case. CONCLUSION The multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repairing defects in the common and proper palmar digital arteries distal to the superficial palmar arch offers advantages such as superficial location, flexible harvesting, and high compatibility. This technique has demonstrated favorable outcomes in complex transmetacarpal amputation reconstruction.
Humans ; Adult ; Male ; Female ; Hand Injuries/surgery* ; Middle Aged ; Plastic Surgery Procedures/methods* ; Veins/transplantation* ; Surgical Flaps/blood supply* ; Hand/surgery* ; Treatment Outcome ; Soft Tissue Injuries/surgery*

The multi-campus mode is an important way to give full play to the advantages of public hospitals and promote the expansion of high-quality medical resources and balanced regional layout. The authors summarized the practical experience of the Second Affiliated Hospital Zhejiang University School of Medicine in promoting multi-campus cultural integration, including vertical dimensional initiatives including raising cultural construction to a strategic level, improving the working mechanism of cultural construction, and building a distinctive cultural identity system; horizontal dimensional initiatives including creating equal status and intergroup cooperation conducive to cultural integration, building a variety of forms of the main cultural communication platform, and building a unified and diverse cross-campus communication bridge. Through cultural integration, the internal cohesion of the hospital was enhanced and the influence of the hospital brand was improved. The authors suggested that cultural integration should always be based on the principle of " seeking common ground while preserving minor differences" , focusing on the construction of systems and standards, and focusing on the construction of communication platforms.

Objective:To investigate the effects of ectodysplasin-A1 (EDA1) on the proliferation and cell cycle of ameloblast-like epithelial cells (LS8 cells).Methods:Wild EDA1 plasmid pCR3-Flag-EDA1-W (wild group), syndrome mutant EDA1 plasmid pCR3-Flag-EDA1-H252L (mutant group) and empty vector plasmid pCR3-Flag (control group) were transfected into LS8 cells. Cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay and cell cycle was detected by flow cytometry. All tests were repeated three times.Results:Compared with the control group (0.105±0.032), the proliferation activity of the wild group (0.201±0.009) was significantly higher after 72 h ( P<0.05). Compared with the control group (0.168±0.054) and the mutant group (0.194±0.059), the proliferation activity of the wild group (0.386±0.066) was significantly higher after 96 h ( P<0.05). There was no significant difference between the mutant group and the control group at all time points ( P>0.05). In the G 0/G 1 phase, compared with the control group (65.4%±2.1%) and the mutant group (66.6%±3.1%), the cell distribution ratio of the wild group (51.2%±1.1%) was significantly lower ( P<0.01). In the S phase, compared with the control group (23.1%±2.0%) and the mutant group (21.9%±1.8%), the cell distribution ratio of the wild type group (37.3%±2.4%) was significantly higher ( P<0.01). There was no significant difference in cell cycle distribution between the mutant group and the control group ( P<0.05). Conclusions:Wild EDA1 promotes the proliferation of LS8 cells and the transformation from G 0/G 1 to S phase. The syndrome mutant EDA1 (EDA1-H252L) loses its function of regulating the cell proliferation and cell cycle of LS8 cells.

Objective:To analyze the mechanism of acidified silk protein sponge matrices and methanolized silk protein sponge matrices in promoting wound healing.Methods:The experimental method was conducted. Acidified silk protein sponge matrices with vascularization ability and methanolized silk protein sponge matrices without vascularization ability were prepared by improved freeze-drying method. General observation was performed. Internal morphology was observed with scanning electron microscope. The secondary structure was observed with X-ray diffractometer (XRD) and infrared spectrometer. Compressive modulus was tested by tensile machine. Two 3-week-old male Sprague-Dawley (SD) rats were used to isolate bone marrow mesenchymal stem cells (BMSCs) cultured in above-mentioned two silk protein sponge matrices, the number of cells was counted under laser scanning confocal microscope after 1, 6 days of culture. Four full-thickness skin defect wounds were made on each one of twelve 8-week-old male SD rats, which were divided into methanolized silk group (24 wounds) and acidified silk group (24 wounds) covered with the corresponding silk protein sponge matrices. On post operation day (POD) 3, 7, 10, and 14, general observation was performed and the remaining wound area was recorded. On POD 3, 7, and 14, the wounds and marginal tissue were collected for hematoxylin-eosin staining (HE) staining and Masson staining to observe growth of new tissue and collagen deposition and CD34 immunohistochemical staining to observe vascularization. Sample number of each index of each group at every time point in animal experiment was 6. Data were statistically analyzed with analysis of variance of factorial design, analysis of variance for repeated measurement, independent-samples t test, and Bonferroni correction. Results:Methanolized silk protein sponge matrices and acidified silk protein sponge matrices had the same composition and similar porous structure, with pore size of 300-500 μm. XRD showed that methanolized silk protein sponge matrices showed a significant crystallization peak, while acidified silk protein sponge matrices was mainly composed of amorphous structure. Infrared spectrometer showed that acidified silk protein sponge matrices appeared a strong absorption peak at 1 650 cm -1, and the methanolized silk protein sponge matrices appeared a strong absorption peak at 1 630 cm -1. Compressive modulus of methanolized silk protein sponge matrices was (23.8±1.3) kPa, which was significantly higher than (6.1±0.9) kPa of acidified silk protein sponge matrices ( t=19.550, P<0.01). After one day of culture, BMSCs successfully adhered to the two kinds of silk protein sponge matrices, and the cells were not spread. After six days of culture, BMSCs were spread on the two kinds of silk protein sponge matrices, and the number of cells on the acidified silk protein sponge matrices increased significantly. On POD 3, the wounds of the 2 groups did not shrink significantly. On POD 7, the wound area in acidified silk group was significantly smaller than that in methanolized silk group, and new epithelium growth occurred at the wound edge. On POD 14, the wounds of acidified silk group basically healed, and the wounds of methanolized silk group were dry and shrinked significantly. Remaining wound area of acidified silk group on POD 3, 7, 10, and 14 were significantly smaller compared with that in methanolized silk group ( t=7.782, 10.620, 3.707, 6.830, P<0.05 or P<0.01). HE staining, Masson staining, and CD34 immunohistochemical staining showed on POD 3, new tissue growing into silk protein sponge matrices of wounds of acidified silk group was more than that in methanolized silk group, the former group secreted a small amount of collagen, collagen formation was not observed in the latter group, the number of vascular endothelial cells migrated into the matrices were more in the former group than the latter group; on POD 7, the area of new tissue covering matrices hole of wounds of acidified silk group was larger than that in methanolized silk group, collagen in the former group was more than that in the latter group and was evenly distributed, the number of blood vessels in the former group was more than that on POD 3, and the new blood vessels in the latter group were scattered; on POD 14, the new tissue in acidified silk group was similar in structure to normal skin tissue and formed a certain thickness, the new tissue in methanolized silk group basically grew into the matrices, the former group had rich collagen deposition, the latter group had scattered collagen, and blood vessels in the former group distributed uniformly and density of blood vessels was significantly higher than that in the latter group ((55.7±6.0) and (34.1±1.0) pieces/mm 2, respectively, t=9.042, P<0.01). Conclusions:Angiogenesis-promoting acidified silk protein sponge matrices have good cytocompatibility, which can facilitate the rapid formation of vascular network in wound area, providing sufficient blood supply to accelerate the tissue regeneration and collagen deposition, thereby promoting wound healing and improving healing quality, these effects are better than methanolized silk protein sponge matrices.

Objective: To understand physical fitness of middle school students from 4 minorities in Yunnan Province and to provide the basis for the development of physical health promotion for minority middle school students. Methods: Data of physical fitness of students aged 13-18 years from the nationality of Jino, Lahu, Blang, Jingpo and Han in Yunnan Province collected during Sept. to Nov. of 2014 were analyzed. Comparative analysis was performed regarding body shape, function and quality indexes. Results: For total scores of physical fitness test, proportions of excellent and good scores were highest in the Jingpo nationality (10.8%, 57.7%), followed by the Jino nationality (6.7%, 57.4%), the Blang nationality (3.0%,30.3%) and the Lahu nationality (0.9%, 15.9%); proportions of excellent and good scores in boys were highest in the Jingpo nationality (20.1%, 54.0%), followed by the Jino nationality (6.4%, 43.9%), the Blang nationality (5.0%, 29.8%) and the Lahu nationality (1.5%, 18.1%); for girls, highest in the Jino nationality (7.1%, 71.1%), followed by the Jingpo nationality (2.4%, 61.0%), the Blang nationality (1.5%, 30.7%) and the Lahu nationality (0.5%, 14.4%). When compared with students from the Han nationality (5.1% excellent, 40.0% good), the Jingpo nationality and the Jino nationality showed higher overall scores while the Blang nationality and the Lahu nationality showed lower overall scores(Z=9.50，11.92，-11.54，-28.34，P<0.01). Conclusion Significant differences in physical fitness are observed in students with different minority background. Targeted measures should be proposed to promote physical health for minority students.

Objective: To gain a better understanding of the status quo of the physical condition of students in Lahu Nationality Middle School, so as to provide a basis for intervention measures to improve students’ physical health. Methods: A comparative analysis on the data of the physique investigation of the students in Lahu nationality middle school in 2019 and 2014 was carried out. Results: Compared with 2014, in 2019, the BMI of the males except aged 13 increased by 0.45 kg/m2, there was no statistically significant difference in the BMI of other age groups aged(P>0.05). In 2019, there was no statistically significant difference in the BMI of females aged 13 to 18 compared with 2014(P>0.05). The vital capacity/BMI respectively increased by 3.74 and 3.99 mL/kg in males aged 13 and 15, and the differences were statistically significant(t=2.36, 2.05, P<0.05). In 2019, the vital capacity/BMI of females aged 14-15 increased by 3.18, 3.64 mL/kg, respectively; the vital capacity/BMI of females aged 16 decreased by 2.50 mL/kg, the difference was statistically significant(P<0.05). For males aged 13-18 of the Lahu nationality and compared with 2014, in the 50m race, except that those aged 15, there was no statistically significant difference in the race time in other age groups(P>0.05); there was no statistically significant difference in the sit and reach of males aged 13 to 18(P>0.05); the males aged 14 was 20.52 s faster in the 1 000 m race, while those aged 17-18 were respectively 21.04 and 19.10 s slower in the-1 000 m-race, pull-ups in those aged 13 increased by 1.32, and decreased by 0.96 and 1.32 in those aged 17-18, the standing long jump of those aged 13 to 16 and 18 increased by 18.90, 16.36, 36.27, 13.32, 8.55 cm, respectively; and the differences were statistically significant(P<0.01). For females aged 13-18 of the Lahu nationality and compared with 2014, in the 50 m race, there was no statistically significant difference in the race time in those aged 13-18(P>0.05); the sit and reach of those aged 14-15 increased by 2.38 and 2.96 cm, respectively; the females aged 13-15 was 15.15, 14.48, 15.65 s faster in the 800 m race, respectively; while those aged 16-17 were respectively 18.16 and 10.74 s slower in the 800 m race; pull-ups in those aged 13-15 and 17-18 increased by 5.58, 6.97, 5.34, 2.04, 2.64, respectively; the standing long jump of those aged 13-18 increased by 14.75, 17.10, 14.76, 8.22, 10.47, 8.36 cm, respectively; and the differences were statistically significant(P<0.01). Conclusion The physical condition of middle school students in Lahu Nationality generally shows a slow-increasing trend, the physical shape of the male students presents an upward trend, and the physical fitness students shows a positive trend, albeit featured in imbalanced development. According to the problems existing in the physical development of the students in Lahu nationality, effective intervention measures should be taken to elevate the physical health condition of middle school students in Lahu nationality.

On November 29, 2019, in order to strengthen the management of the diagnosis and treatment of the chronic refractory wounds, the National Health Commission released a notice that requires the qualified medical institutions in China to establish wound repair department. To ease the concern that the establishment of wound repair department could hinder the construction and development of burn discipline, the authors put forward their views based on the necessity of establishing wound repair department, the space for the respective development of burn department and wound repair department, and how to coordinate the development of burn department and wound repair department. It is hoped that this paper would be used as a reference by doctors in both fields of burn care and wound repair.

Objective To evaluate the efficacy of adductor canal combined with interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block for multimodal analgesia after total knee arthroplasty (TKA).Methods Sixty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged 55-78 yr,scheduled for elective unilateral TKA under combined spinal-epidurai anesthesia,were assigned into 2 groups (n =30 each) using a computer random number method:adductor canal combined with IPACK block group (group A+Ⅰ) and adductor canal block group (group A).Preventive multimodal analgesia was applied as follows:preoperative pain management education was performed;flurbiprofen 50 mg was intravenously injected before induction of anesthesia,and celecoxib 200 mg was taken orally after surgery,twice a day,to control inflammatory pain;ultrasound-guided adductor canal combined with IPACK block was performed in group A+Ⅰ,and ultrasound-guided adductor canal block was performed in group A to inhibit incisional pain;nalbuphine 0.08 mg/kg was intravenously injected to inhibit breakthrough pain.Postoperative numeric rating scale (NRS) scores at rest (NRSr) and on movement (NRSm) were maintained ＜ 5 within 48 h after surgery.The area under the curve (AUC) of NRSr and NRSm (AUCNRsr and AUCNSm) were calculated within 48 h after surgery.The requirement for nalbuphine as rescue analgesic was recorded.The maximum number of ambulatory steps and maximum range of knee motion were recorded on 1 and 2 days after surgery.The development of nerve block-and postoperative rehabilitation training-related adverse events and postoperative length of hospitalization were also recorded.ResuRs Compared with group A,AUCNRSr and AUCNRSm were significantly decreased,the consumption of nalbuphine was reduced,and the maximum number of ambulatory steps and maximum range of knee motion were increased (P＜0.05),and no significant change was found in the requirement for nalbuphine or length of hospitalization in group A+Ⅰ (P＞0.05).No nerve block-and postoperative rehabilitation training-related adverse events were found in neither group.Conclusion Adductor canal combined with IPACK block can provide a relatively perfect efficacy when used for multimodal analgesia after TKA and is helpful for patient's recovery.

Objective: To study the molecular-epidemiological characteristics of Brucella species isolated from different countries, using the multiple locus tandem-repeat (MLVA) analysis. Methods: Eleven variable-number tandem-repeat (VNTR) loci were selected. VNTR strains of Brucella isolated from 48 different countries in 1953-2013, were analyzed by using the BioNumerics software. Unweighted Paired Arithmetic Average method was used to cluster and draw phylogenetic tree as well as the minimum spannin. Results: The evolutionary relationship of Brucella phylogenetic tree was consistent with the classical biological typing method. However, the Brucella suis biovar 5 strains were different from the other Brucella suis biovars 1, 2, 3 and 4. Brucella ceti strains were divided into two parts and different from each other. Worldwide epidemics of brucellosis were emerged from 2005 to 2008 under the MLVA11 Orsay analysis. China has been a brucellosis-prone regions, with Brucella melitensis as the main epidemic Brucella species, followed by Brucella abortus. Brucella suis was mainly identified in the southern provinces, but Brucella canis was mainly found in dogs. No human cases were found. Conclusion Molecular-epidemiological characteristics of the Brucella strains were related to factors as time, region and hosts of isolation, which are important to setting up prevention and control programs on brucellosis.