Objective: To evaluate the efficacy and safety of ruxolitinib combined with low-dose hormone for patients with acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Thirty patients with aGVHD after allo-HSCT admitted to the Department of Hematology of the General Hospital of Western Theater Command from November 2021 to November 2024 were retrospectively analyzed. All patients were treated with low-dose hormone (methylprednisolone 0.3-1 mg kg -d ) combined with ruxolitinib 5-10 mg d . The efficacy and adverse reactions were observed during the follow-up period to analyze the survival outcomes of the patients. Results: A total of 30 patients with aGVHD after allo-HSCT were included in this study, consisting of 15 (50%) males and 15 (50%) females with a median age of 34 year-old (ranging from 14 to 62). Classification by disease type: there were 18 cases of acute myeloid leukemia, 4 cases of acute lymphoblastic leukemia, 4 cases of aplastic anemia, and 4 cases of myelodysplastic syndrome. Classification by aGVHD severity: there were 27 cases (90%) of Ⅱ-Ⅳ degree aGVHD and 11 cases (36.7%) of Ⅲ-Ⅳ degree aGVHD. Ruxolitinib in combination with low-dose glucocorticoid treatment yield responses in 28 (93.3%) patients, of which 27 (90%) achieved complete remission (CR), while 1 (3.3%) showed partial remission (PR). One patient (3.3%) had no response (NR), and 1 patient (3.3%) exhibited progressed disease (PD). Overall survival (OS) at 1 year of transplantation was 73.9% (95%CI 49.5% to 87.7%), progression-free survival (PFS) was 93.3% (95%CI 75.9% to 98.3%), non-relapse mortality (NRM) was 20.6% (95%CI 7.9% to 47.4%), and median survival time was 27.6 months. Conclusion: Ruxolitinib combined with low-dose hormones is safe and effective in the treatment of aGVHD after allo-HSCT.

Objective:To investigate the diagnostic value of gastroenteroscopic narrow band imaging(NBI)combine with serum amyloid A(SAA),C-reactive protein(CRP),D-Dimer(D-D)in children with abdominal henoch schonlein purpura(HSP).Methods:90 children with HSP who were admitted to our hospital from September 2022 to September 2024 were prospectively selected as the research objects,of which 50 children with abdominal HSP were included in the observation group and 40 children with other types of HSP were included in the control group.All children underwent gastroenteroscopic NBI examination and serum CRP,SAA and D-D levels were detected,and serum CRP,SAA and D-D levels were compared between the two groups,and the results of gastroenteroscopic NBI examination were analyzed in the two groups.Then the receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of gastroenteroscopic NBI and serum CRP,SAA,D-D alone or in combination in children with abdominal HSP.Results:Serum CRP,SAA and D-D levels in the observation group were significantly higher than those in the control group(P＜0.05);The results of gastroenteroscopic NBI showed that most of the children with abdominal HSP had some degree of changes in the gastric and duodenal mucosa,with mucosal congestion,edema,erosion,ulceration,and scattered bright or dark red bleeding spots as the main manifestations.Under gastroenteroscopic NBI,41 of 50 children with abdominal HSP were diagnosed as abdominal HSP,and 11 of 40 children with other types of HSP were diagnosed as abdominal HSP;the area under curve(AUC)of serum CRP,SAA,and D-D in the diagnosis of children with abdominal HSP were 0.668,0.720 and 0.771,respectively,and the AUC of the combination diagnosis of serum CRP,SAA and D-D in the diagnosis of children with abdominal HSP was 0.815;The AUC of the diagnosis of gastroenteroscopic NBI and serum CRP,SAA and D-D in children with abdominal HSP was 0.801 and 0.815,respectively,and the AUC of the combination diagnosis of gastroenteroscopic NBI in children with abdominal HSP was 0.867.Conclusion:Serum CRP,SAA and D-D in children with abdominal HSP were significantly increased,and the main manifestations under gastroenteroscopic NBI were mucosal congestion,edema,erosion,ulceration and scattered bright or dark red bleeding spots as the main manifestations.Gastroenteroscopic NBI combine with serum CRP,SAA and D-D could significantly improve the diagnostic efficiency of children with abdominal HSP.

Pseudomonas aeruginosa(PA)is an opportunistic pathogen commonly involved in environmental-and difffcult-to-treat nosocomial infection.Currently,multidrug-resistant(MDR)and extensively drug-resistant(XDR)strains of PA are e-merging due to the inappropriate use of antibiotics,which has become a major threat related to healthcare.The antibiotics re-sistance mechanism of PA is very complicated.PA can acquire resistance through mutations in genes encoding for membrane-associated proteins,antibiotics inactivation enzymes and their regulatory proteins,antibiotics target proteins,and two-compo-nent systems.Additionally,resistance genes acquired by horizontal gene transfer(HGT)lead to resistance of PA,which are frequently localized within mobile genetic elements(MGEs),including genes encoding enzymes that inactivate and modify anti-biotics,proteins genes that protect and modify antibiotic targets.In this review,acquired resistance mechanisms of PA involved in gene mutations and HGT was summarized.This review would provide references for the prevention and treatment of PA in-fection,as well as the research and development of new antibiotics.

Objective:To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.Methods:This study was a retrospective observational study. From July 2019 to July 2022, 11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University. The wounds were located on the hands in 2 cases, the ankles in 5 cases, and the feet in 4 cases. After debridement, the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm. All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation. Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm, respectively. Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm, respectively. Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery. The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm, and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm. The donor site wounds were directly sutured. The chimeric tissue flap was freely transplanted to the recipient wound site, of which the iliac bone graft was used to fill the bone defect, the muscle flap was utilized to fill the wound cavity, and the skin flap was employed to cover the wound surface; the arteries and veins in the vascular pedicle were anastomosed with those in the recipient area. At admission and 3 days post antibiotic-loaded bone cement implantation, the changes in white blood cell count, neutrophil and hypersensitive C-reactive protein level, as well as the bacterial culture of wound secretions specimen, and the growth of granulation tissue were observed. After stage Ⅱ surgery, the survival of transplanted chimeric tissue flaps, the occurrence of vascular crisis, and the healing of wounds in donor and recipient sites were observed. During follow-up, the blood supply, appearance, and texture of the transplanted tissue flaps in the recipient sites, the function and appearance of the affected limbs and fingers, and the complications in the donor and recipient sites were observed.Results:Three days post antibiotic-loaded bone cement implantation, white blood cell count, hypersensitive C-reactive protein level, and neutrophil significantly decreased compared with those at admission (with Z values of -2.93 and -2.93 respectively, t=8.63, P<0.05). At admission, all patients exhibited bacterial infections with redness and swelling around the wounds. Three days post antibiotic-loaded bone cement implantation, bacterial cultures of wound secretions specimen were negative, local redness resolved, and granulation tissue showed good growth. After stage Ⅱ surgery, all chimeric flaps survived without vascular crises. The wound healing in the recipient site of the dorsum of the foot in one patient was poor and delayed but healed after dressing changes; all the other recipient sites in remaining patients healed successfully. The donor incision healed well in all patients. During 6 to 24 months of follow-up, the flaps in the recipient area demonstrated good blood circulation, texture, and appearance. Bone healing was achieved in 4 patients with iliac grafts. Nine patients with lower limb wounds were able to bear weight, and the functions including gripping, palm alignment, and finger alignment were significantly improved in 2 patients with hand wounds. No significant complications were observed in donor or recipient sites. Conclusions:In treating patients with severe gouty wounds, the sequential strategy of stage Ⅰ debridement with antibiotic-loaded bone cement implantation followed by stage Ⅱ free chimeric osseous flaps or myocutaneous flaps repair can achieve effectively control of postoperative wound infection, promote wound healing, and well restore the functions of affected finger or limb with no obvious complications, which is worthy of promotion for clinical application.

Objective:To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area.Methods:This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot.Results:All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases.Conclusions:The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.

Pseudomonas aeruginosa(PA)is an opportunistic pathogen commonly involved in environmental-and difffcult-to-treat nosocomial infection.Currently,multidrug-resistant(MDR)and extensively drug-resistant(XDR)strains of PA are e-merging due to the inappropriate use of antibiotics,which has become a major threat related to healthcare.The antibiotics re-sistance mechanism of PA is very complicated.PA can acquire resistance through mutations in genes encoding for membrane-associated proteins,antibiotics inactivation enzymes and their regulatory proteins,antibiotics target proteins,and two-compo-nent systems.Additionally,resistance genes acquired by horizontal gene transfer(HGT)lead to resistance of PA,which are frequently localized within mobile genetic elements(MGEs),including genes encoding enzymes that inactivate and modify anti-biotics,proteins genes that protect and modify antibiotic targets.In this review,acquired resistance mechanisms of PA involved in gene mutations and HGT was summarized.This review would provide references for the prevention and treatment of PA in-fection,as well as the research and development of new antibiotics.

Objective:To investigate the clinical efficacy of the modified superior gluteal artery perforator (SGAP) flap V-Y advancement technique in the repair of sacrococcygeal pilonidal sinus.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent modified SGAP flap V-Y advancement for the reconstruction of sacrococcygeal pilonidal sinus wounds at the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, between January 2019 and January 2025. The surgical procedure involved two stages. During the first stage, the sinus tract was preoperatively marked with methylene blue, followed by complete excision of the sinus and surrounding involved tissues. The resultant wound was then treated with vacuum sealing drainage for 3 to 5 days. The second stage consisted of flap repair. A portable Doppler ultrasound was used to identify and mark the superior gluteal artery perforator on one side of the wound. A V-shaped flap was designed transversely, with the base corresponding to the length of the subcutaneous tissue defect on the wound side and the superior and inferior borders extending laterally along the wound margins, ensuring the 1-2 SGAP was included within the flap. Intraoperatively, the wound was re-debrided. The epidermis was removed from the base of the V-shaped flap, and the dermis and subcutaneous tissue were dissected. The dermis and superficial subcutaneous tissue of the contralateral wound edge were also dissected. The flap was then advanced in a V-Y fashion to cover the wound. The de-epithelialized portion of the flap was imbricated and sutured to the contralateral skin edge near the midline. The donor site at the apex of the V-shaped flap was closed directly after subcutaneous tissue tension relief, resulting in a Y-shaped closure. Postoperative flap survival, incision healing, and complications were observed. At the final follow-up, flap appearance, texture, surgical site scarring, and sinus recurrence were assessed, and patient satisfaction with the surgical outcome was investigated.Results:A total of eight patients were included in the study, comprising six males and two females, with ages ranging from 14 to 41 years (mean 22.4 years). Two patients presented with multiple sinus tracts, two with chronic sinus tracts and recurrent inflammation with scar formation, and four with postoperative recurrence. The area of the wound defect after debridement ranged from 4.5 cm×5.0 cm to 6.5 cm×8.0 cm. The flap dimensions ranged from 4.5 cm × 6.0 cm to 6.5 cm × 12.5 cm, with a mean V-shaped flap apex angle of 35° ± 2° (range 20° to 60°). In one patient, slight exudate was observed at the base of the flap, which healed after 12 days of dressing changes and drainage. The remaining flaps survived successfully, and primary closure was achieved in both the donor and recipient sites. The patients were followed for a period of 3 to 64 months, with a mean follow-up duration of 10.7 months. In all patients, the sacrococcygeal flap showed no evidence of bulkiness, exhibiting a color similar to the surrounding skin and a soft texture. Linear scars remained at the surgical site, with no complaints of itching, pain, or other discomfort affecting daily life. No recurrence of pilonidal sinus was observed during the follow-up period. Patients reported satisfaction with the appearance of their buttocks.Conclusion:The modified SGAP flap V-Y advancement technique for the repair of sacrococcygeal pilonidal sinus effectively elevates the gluteal cleft, facilitates off-midline closure, demonstrates reliable result, and provides a high level of patient satisfaction.

OBJECTIVE: To investigate the short-and med-term clinical efficacy of unicompartmental knee arthroplasty(UKA)for the treatment of medial knee osteoarthritis (OA) in elderly patients with anterior cruciate ligament deficiency(ACLD). METHODS: A retrospective analysis was conducted on 31 patients aged over 75 years old with primary medial knee OA and ACLD who underwent UKA between January 2018 and December 2022. The cohort included 12 males and 19 females, aged from 75 to 91 years with an average age of (79.56±4.54) years, with 13 left knee, 16 right knee, and 2 bilateral knees. Clinical outcomes were assessed preoperatively and at final follow-up using the visual analogue scale (VAS), Hospital for Special Surgery(HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA), and tibial component posterior slope angle (TCPSA). Complications such as infection, prosthesis wear, prosthesis loosening, and dislocation were also recorded. RESULTS: All 31 patients were followed up from 12 to 63 months with an average of (28.34±10.56) months. The average postoperative TCPSA was (4.83±1.31)° ranged from 2.5° to 6.8°. At the final follow-up, there was significant improvement in VAS (3.24±0.53) vs. (6.59±0.69), HSS score (85.19±4.45) vs. (64.38±5.94), ROM (118.83±5.38)° vs. (98.85±4.08)°, and HKA (176.83±5.16)° vs. (169.57±6.28)° compared to preoperative values (P<0.05). No cases of infection, prosthesis loosening, or dislocation were reported. CONCLUSION UKA provides favorable short-and mid-term outcomes for elderly patients with medial knee OA and ACLD . However, long-term clinical efficacy needs further investigation through extended follow-up.
Humans ; Male ; Female ; Arthroplasty, Replacement, Knee/methods* ; Aged ; Osteoarthritis, Knee/physiopathology* ; Retrospective Studies ; Aged, 80 and over ; Range of Motion, Articular ; Anterior Cruciate Ligament Injuries/surgery*

Objective:To explore the clinical application value of infrared thermal imaging in assisting the repair of complex joint tissue defects in children using the lateral femoral circumflex artery (LFCA) chimeric perforator flap.Methods:A retrospective analysis was conducted on clinical data from the Department of Burns and Plastic Surgery at the Affiliated Hospital of Zunyi Medical University between May 2019 and September 2023. The study included cases where the LFCA perforator chimeric flap was used to repair complex joint tissue defects in children. Preoperative perforator mapping was performed using an infrared thermal imaging device combined with a portable Doppler. The flap and fascial flap were designed based on the distribution of hot spots and thermal lines. Intraoperative confirmation of perforator distribution was carried out. Postoperative follow-ups were conducted to assess flap survival, the need for secondary thinning procedures, wound healing status, donor site scarring, joint swelling, and functional recovery.Results:A total of 11 pediatric patients were enrolled, including 8 males and 3 females, aged 2 to 14 years (mean age: 5.8 years). The injury mechanisms included traffic accidents (6 cases), wheel spoke injuries (2 cases), falls (2 cases), and heavy object crush injuries (1 case). Affected joints included the wrist (1 case), knee (2 cases), and ankle (8 cases). Associated injuries included metacarpal fracture (1 case), metatarsal fractures (2 cases), and extensor tendon defects (1 case). Tendon defect length was 3 cm, joint capsule defect area ranged from 2 cm × 3 cm to 4 cm × 6 cm, and fascial flap size ranged from 2 cm × 4 cm to 2 cm × 14 cm. Skin defect area ranged from 5 cm × 3 cm to 16 cm × 9 cm, and flap size ranged from 6 cm × 4 cm to 15 cm × 5 cm. Preoperative infrared thermography identified 28 hot spots, with 26 perforators confirmed intraoperatively (positive rate: 92.9%). Thermal line distribution zones consistently corresponded to perforator branches. All 11 flaps survived, with primary healing achieved at both donor and recipient sites. Follow-up duration ranged from 6 to 36 months (mean: 10.5 months). All recipient sites exhibited soft flap texture. One case required secondary debulking due to flap bulkiness. Donor sites showed only linear scarring. During follow-up, no significant joint swelling, functional impairment, or joint dislocation was observed.Conclusion:Infrared thermal imaging-assisted perforator mapping for the design of LFCA chimeric perforator flaps is a safe and reliable method for repairing complex joint tissue defects in children. It provides accurate perforator localization, offering significant clinical value for the design and harvesting of LFCA chimeric perforator flaps in pediatric patients.

Objective:To investigate the clinical efficacy of the modified superior gluteal artery perforator (SGAP) flap V-Y advancement technique in the repair of sacrococcygeal pilonidal sinus.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent modified SGAP flap V-Y advancement for the reconstruction of sacrococcygeal pilonidal sinus wounds at the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, between January 2019 and January 2025. The surgical procedure involved two stages. During the first stage, the sinus tract was preoperatively marked with methylene blue, followed by complete excision of the sinus and surrounding involved tissues. The resultant wound was then treated with vacuum sealing drainage for 3 to 5 days. The second stage consisted of flap repair. A portable Doppler ultrasound was used to identify and mark the superior gluteal artery perforator on one side of the wound. A V-shaped flap was designed transversely, with the base corresponding to the length of the subcutaneous tissue defect on the wound side and the superior and inferior borders extending laterally along the wound margins, ensuring the 1-2 SGAP was included within the flap. Intraoperatively, the wound was re-debrided. The epidermis was removed from the base of the V-shaped flap, and the dermis and subcutaneous tissue were dissected. The dermis and superficial subcutaneous tissue of the contralateral wound edge were also dissected. The flap was then advanced in a V-Y fashion to cover the wound. The de-epithelialized portion of the flap was imbricated and sutured to the contralateral skin edge near the midline. The donor site at the apex of the V-shaped flap was closed directly after subcutaneous tissue tension relief, resulting in a Y-shaped closure. Postoperative flap survival, incision healing, and complications were observed. At the final follow-up, flap appearance, texture, surgical site scarring, and sinus recurrence were assessed, and patient satisfaction with the surgical outcome was investigated.Results:A total of eight patients were included in the study, comprising six males and two females, with ages ranging from 14 to 41 years (mean 22.4 years). Two patients presented with multiple sinus tracts, two with chronic sinus tracts and recurrent inflammation with scar formation, and four with postoperative recurrence. The area of the wound defect after debridement ranged from 4.5 cm×5.0 cm to 6.5 cm×8.0 cm. The flap dimensions ranged from 4.5 cm × 6.0 cm to 6.5 cm × 12.5 cm, with a mean V-shaped flap apex angle of 35° ± 2° (range 20° to 60°). In one patient, slight exudate was observed at the base of the flap, which healed after 12 days of dressing changes and drainage. The remaining flaps survived successfully, and primary closure was achieved in both the donor and recipient sites. The patients were followed for a period of 3 to 64 months, with a mean follow-up duration of 10.7 months. In all patients, the sacrococcygeal flap showed no evidence of bulkiness, exhibiting a color similar to the surrounding skin and a soft texture. Linear scars remained at the surgical site, with no complaints of itching, pain, or other discomfort affecting daily life. No recurrence of pilonidal sinus was observed during the follow-up period. Patients reported satisfaction with the appearance of their buttocks.Conclusion:The modified SGAP flap V-Y advancement technique for the repair of sacrococcygeal pilonidal sinus effectively elevates the gluteal cleft, facilitates off-midline closure, demonstrates reliable result, and provides a high level of patient satisfaction.