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 compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

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 evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets

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 clinical effect of chimeric flap with perforating branch of superficial circumflex iliac artery in reconstruction of complex tissue defect in Achilles tendon region.Methods:A retrospective analysis was conducted on 9 patients who underwent reconstruction of composite tissue defects in Achilles tendon region with the perforator flap of lateral femoral circumflex artery, from January 2017 to January 2023 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The patients were 7 males and 2 females and at 16 to 54 years, with 36.6 years in average. Causes of injury were: 5 patients by traffic accident, 2 by machine strangulation and 1 by heavy object, also 1 defect was caused by infection. The soft tissue defects were 4.5 cm×6.0 cm to 8.0 cm×12.0 cm in size, and the defects of Achilles tendon were 4.5 cm to 11.5 cm, with an average of 6.8 cm in length. The wounds were managed with VSD after primary surgery, and then stage Ⅰ surgery were followed to reconstruct the defects in Achilles tendon region with perforator flap of lateral femoral circumflex artery. The sizes of chimeric flaps were 6.5 cm×5.0 cm to 18.0 cm×6.5 cm, including 3 lobuated flaps. The fascia grafts were 5.5 cm to 12.0 cm, with an average of 7.0 cm. Scheduled postoperative follow-ups were conducted in outpatient clinic and via telephone or WeChat interviews, together with the advices for rehabilitation training. Postoperative functions of the Achilles tendon and ankle function were evaluated using Arner-Lindholm criteria and the ankle and hindfoot functional score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All of the 9 chimeric flaps survived and all the donor sites had primary healing. All patients were entered into the postoperative follow-up for 10 to 66 months, with 14.6 months in average. One chimeric flap was found bulky and a flap thinning surgery was further carried out in 3 months under the request of patient. The rest of patients were satisfied with the appearance and texture of the flaps. The range of ankle plantar flexions was found at 42.9°±1.8° and the dorsal flexions was at 16.2°±2.5°. There was no significant decrease in circumference and no discomfort or muscle re-rupture in the affected legs. Thompson test was found negative. There was no wound related complications during follow-up. Reconstructive surgery were found effective based on Arner-Lindholm criteria, with excellent in 6 patients, good in 2 and 1 in fair. The ankle and subtalar joint function was evaluated according to the ankle-hindfoot function score of AOFAS, with 7 patients scored 90-100 point and 2 scored 75-89 point, and 7 patients were in excellent and 2 in good.Conclusion:The chimeric perforator flap of lateral femoral circumflex artery is safe and reliable in reconstruction of composite tissue defects in Achilles tendon region. It can effectively restore the function and appearance of ankle and hindfoot in patients with composite tissue defects in the Achilles tendon region.

Objective:To explore the clinical effect of thin superficial circumflex iliac artery perforator flap with venous superdrainage in treatment of wound in extremities.Methods:Clinical data of 20 patients who were treated from January 2018 to January 2024 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University were retrospectively analysed. The soft tissue defects in extremity were reconstructed with thin perforator flaps of superficial iliac circumflex artery with venous superdrainage. There were 13 patients with upper limb defects and 7 with ankle defects. Of the defects, 12 were of trauma, 2 of tumour resection, 3 of scar release surgery and 3 of donor flat harvesting. The defects ranged from 5.0 cm×4.0 cm to 18.0 cm×7.0 cm in size. During the surgery, portable Doppler was used to detect the perforating branches of the superficial rotational iliac artery and design flaps. The flaps were 5.0 cm×5.0 cm to 20.0 cm×7.0 cm in size, including 16 single-lobed flaps, 3 double-lobed flaps and 1 triple-lobed flaps. The flaps were 2-7 mm in thickness, with an average of 4 mm. Based on the distribution of perforators, the flaps carried the superficial helioiliac artery and the accompanying vein, as well as the superficial helioiliac vein. The superficial helioiliac artery and the accompanying vein were anastomosed during the surgery, and the superficial helioiliac vein was anastomosed to the superficial or deep vein of the recipient site for superreflux. The donor sites were all directly sutured and closed. Postoperative follow-up was conducted by visits of outpatient clinic, and via telephone and WeChat interviews. The survival and appearance of the flaps and complications were observed.Results:A total of 22 arteries and 42 veins of the 20 flaps were anastomosed in surgery. All flaps survived. The donor sites were closed in the first stage. No vascular compromise occurred. One patient had early exudate under the flap on the exposed wound of interphalangeal joint, which healed after routine dressing change and drainage. All patients were included in the postoperative follow-up, with a peroid over 5 to 40 months, at 10.8 months in average. The flaps were thin and soft, with good wear resistance and without pigmentation. The healing of donor sites was good except 1 donore site that had early lymphatic leakage, which was cured after compression and drainage. A linear scar left at the donor sites and it was acceptable to the patients.Conclusion:The treatment of defective soft tissue wounds in extremities using thin perforator flap with venous superdrainage of the superficial circumflex iliac artery is safe and feasible. No further flap thinning surgery is required, and there is a reliable clinical effect.

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.