Objective To evaluate the efficacy of Huachansu tablets combined with transarterial chemoembolization(TACE)for treatment of primary hepatocellular carcinoma(HCC)and prognostic influence factors.Methods One hundred and eight patients with HCC were recruited according to the inclusion and exclusion criteria.Patients were randomly divided into treatment group and control group.The treatment group was treated with Huachansu tablets combined with TACE,and the control group was treated with TACE alone,with overall survival time(OS)and progression-free survival time(PFS)as the evaluation indexes.The COX regression analysis was used to evaluate the survival and prognostic effects and their influence factors in both groups.Results A total of 108 HCC patients were enrolled.The OS was 13.5 months in treatment group and 9.2 months in control group;the PFS was 6.8 months in treatment group and 5.3 months in control group,and the differences were significant statistically(all P<0.05).Multivariate COX regression analysis showed that Child-Pugh grade and cirrhosis were the independent risk factors for PFS in HCC patients.Child-Pugh grade were the independent risk factors for OS in HCC patients.ALBI is a protective factor for OS in HCC patients.Conclusions The treatment of HCC by Huachansu tablets combined with TACE can delay the progression of HCC and prolong PFS and OS of the patients with HCC.Child-Pugh grade,cirrhosis status,and ALBI were important factors affecting the prognosis of the patients with HCC.

Objective:To analyze the risk factors for hospital acquired pulmonary infections in elderly lung cancer patients during chemotherapy, and construct a prediction model to provide personalized guidance for clinical nursing work.Methods:Using convenience sampling, clinical case data of 405 elderly lung cancer patients who underwent chemotherapy at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected. A total of 226 patients from January to December 2021 were selected as the modeling group, and 179 patients from January to December 2022 were selected as the validation group. In the modeling group, the patients were divided into two groups based on whether or not they had hospital acquired pulmonary infection, including the hospital acquired pulmonary infection group and the non-hospital acquired pulmonary infection group. Single factor analysis and multivariate Logistic regression analysis were used to determine the risk factors for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy. A risk prediction model for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy was constructed based on the results of multivariate analysis. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the prediction model, and a calibration map was drawn for consistency testing. The prediction model was validated in the validation group to evaluate its predictive performance.Results:The incidence of hospital acquired pulmonary infection in the modeling group was 14.6% (33/226). The results of multivariate Logistic regression analysis showed that basic diseases, tumor-node-metastasis (TNM) staging, neutropenia, and invasive procedures were risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy ( P<0.05). Based on this result, a prediction model was constructed, with an area under the ROC curve of 0.832 [95% CI (0.764, 0.900) ] in the modeling group and 0.759 [95% CI (0.695, 0.824) ] in the validation group. The calibration curves of the modeling and validation groups showed a good coincidence between the predicted results and the actual results. Conclusions:Basic diseases, neutropenia, invasive procedures, and advanced stages of tumors are risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy. For high-risk patients, individualized intervention should be carried out as soon as possible to reduce the incidence of hospital acquired pulmonary infection.

Objective:To evaluate the clinical effect of ultrapulse fractional CO 2 laser in the treatment of mild to moderate orbital aging in Asians. Methods:From January 2018 to December 2018, 36 patients (72 eyes) with mild to moderate orbital aging were enrolled, 22 women and 14 men, with an average age of 32.4 years. Each patient was randomly divided into two groups. In the traditional operation group, 36 eyes received blepharoplasty through traditional inferior conjunctival approach. In the ultrapulsed fractional CO 2 laser group, 36 eyesunderwent blepharoplasty through the lower eyelid conjunctival approach assisted by optoelectronics. Both groups were treated with ultrapulsed fractional CO 2 laser for periorbital aging. The operation time, detumescence time and postoperative complications were compared. At the same time, the periorbital skin relaxation was treated by the combination of the two groups. The patients were followed up for 12 months. Results:In the traditional operation group, 11 cases were evaluated as Barton grade Ⅰ preoperatively, and the efficacy score was 0.64±0.21. In 25 cases of Barton grade Ⅱ the efficacy score was 1.34±0.34. 17 cases were Barton Ⅰ in photoelectric assisted group, and the efficacy score was 0.92±0.18. In 19 cases of Barton grade Ⅱ, the efficacy score was 1.71±0.42. There was a statistically significant difference between the two groups in Barton Ⅰ efficacy score, P<0.05 ( P=0.016); There was also a statistically significant difference between the two groups in efficacy score of Barton Ⅱ, P<0.05 ( P=0.039). The operation time of the photoelectric assisted group was (12.00±1.82) minutes, and the edema duration was (4.0±1.8) days. The duration of operation in the conventional surgery group was (16.00±3.75) minutes, and the duration of edema was (7.0±2.4) days. The operation time and edema duration in the photoelectric assisted group were both shorter than those in the traditional operation group, and the differences were statistically significant ( P<0.05). Conclusions:The blepharoplasty through traditional inferior conjunctival approach assisted with ultrapulsed fractional CO 2 laser has no obvious bleeding, with shorter operation time, swelling reduction time and the number of complications than the traditional operation.This method can solve the symptoms of blepharoplasty, lower eyelid skin relaxation and wrinkles around eyes. This method is worthy of promotion in the treatment of patients with mild to moderate periorbital aging.

Objective:To explore the clinical effects of pre-expanded anterior perforator flap of transverse cervical artery in extensive facial and cervical scar reconstruction and contralateral pre-expanded thoracic random flap in relay in donor site repair.Methods:A retrospective cohort study was conducted. From May 2008 to December 2018, 10 patients with extensive facial and cervical scar after burns were treated in the Fourth Medical Center of PLA General Hospital, including 8 males and 2 females, aged 10-55 years. In the first stage of operation, two skin and soft tissue expanders of the same volume (with rated capacity of 250-600 mL) were respectively placed in the right side and left side of the chest according to the size of scar, and then the skin was expanded. The total amount of normal saline injected was 2 to 4 times of the rated capacity of the expander. In the second stage, the defect with area of 12 cm×8 cm-23 cm×15 cm caused by scar resection and release was repaired with unilateral pre-expanded anterior perforator flap of transverse cervical artery with area of 12 cm×9 cm-24 cm×16 cm. The contralateral pre-expanded thoracic random flap with the same area as that of the above-mentioned perforator flap was extended to repair the secondary defect with area of 8 cm×6 cm-17 cm×14 cm formed after transfer of the above-mentioned perforator flap. The exploration of perforating branch of transverse cervical artery, flap transfer and survival, injury repair, and complications were observed. The appearance and related function of donor and recipient sites and satisfaction of patients were followed up.Results:The perforating branches of transverse cervical artery appeared stably in the 10 patients. All the flaps were transferred to the recipient area without tension and survived. Both facial and cervical injuries were repaired successfully with no common complications. During the follow-up of 6 months-8 years, the color and texture of the pre-expanded anterior perforator flap of transverse cervical artery matched with the surrounding tissue, the functions of head raising and neck rotation of patients were significantly improved compared with those before operation, the color and texture of the flap transplanted in the first donor site matched with the original skin, linear scar left at the surgical incision, and 9 patients were satisfied with the restoration of the appearance and function of donor and recipient sites.Conclusions:The color and texture of the pre-expanded anterior perforator flap of transverse cervical artery match well with the face and neck, and the repairable area is large. After the perforator flap is removed, the secondary wound can be repaired with the pre-expanded thoracic random flap at the same time, and the injury of the chest donor site is alleviated. This relay repair method is a good choice for reconstructing extensive facial and cervical scar.

Objective:To observe the effect of isorhmnetin on the ER/TGF-β1/Smad3 signaling pathways in human dermal fibroblasts (HSF) damaged by UVA.Methods:HSF were divided into control group, model group, estradiol group, isorhmnetin groups with 100, 10, 1, 0.1, 0.01, 0.001 μmol/L by random number table method, and cell photoaging models were established in all groups excepting the control group. After the intervention with corresponding drugs, cell proliferation rates were detected with MTT method, and the effective concentration of isorhmnetin was screened. Then the cells were divided into control group, model group, estradiol group, isorhmnetin group, TGF-β1 blocker group, Samd3 blocker group, and COL1A1 blocker group. Cell photoaging models were established in all groups excepting the control group. After intervened with corresponding drugs, the TGF-β1, Smad3, Ⅰ collagen α1 (collagen, type Ⅰ, alpha 1, COL1A1) mRNA and protein expression in all groups were detected by the real-time quantitative PCR and the Wester blot method.Results:The proliferation rate of isor administration group were increased than those in the control group ( P<0.01). Compared to the UVA irradiation group, the expression of TGF-β1 mRNA (0.956 ± 0.020 vs. 0.718 ± 0.036), Smad3 mRNA (0.981 ± 0.044 vs. 0.753 ± 0.047), COL1A1 mRNA (0.998 ± 0.032 vs. 0.786 ± 0.031), TGF-β1 protion (0.761 ± 0.026 vs. 0.542 ± 0.023), Smad3 protion (0.776 ± 0.016 vs. 0.551 ± 0.025), COL1A1 protion (0.792 ± 0.025 vs. 0.584 ± 0.012) in isor administration group significantly increased ( P<0.01). Compared to the isor administration group, the TGF-β1 mRNA (0.762 ± 0.051, 0.802 ± 0.012, 0.828 ± 0.030 vs. 0.967 ± 0.026), Smad3 mRNA (0.784 ± 0.027, 0.816 ± 0.015, 0.830 ± 0.032 vs. 0.998 ± 0.021), COL1A1 mRNA (1.082 ± 0.025, 1.101 ± 0.012, 1.138 ± 0.011 vs. 1.263 ± 0.022), TGF-β1 protion (0.675 ± 0.028, 0.682 ± 0.026, 0.722 ± 0.015 vs. 0.862 ± 0.014), Smad3 protion (0.712 ± 0.013, 0.764 ± 0.012, 0.778 ± 0.011 vs. 0.901 ± 0.015), COL1A1 protion (0.738 ± 0.016, 0.770 ± 0.038, 0.792 ± 0.026 vs. 0.964 ± 0.017) in the TGF-β1 blocker group, Smad3 blocker group and COL1A1 blocker group significantly decreased ( P<0.01). Conclusions:Isorhmnetin can promote the collagen synthesis of photo aging HSF cells, and its mechanism is related to the regulation of ERβ/TGF-β1 signaling pathway.

Objective:To introduce the discovery and nomenclature of the intercondylar foramen of femur (IFF) and foramen of tibial intercondylar eminence (FTIE) and research the close relationship between the high recurrence rate of aggressive tumors around the knee joint and the foramina around the knee joint.Methods:①Radiographic observation and measurement: 3D reconstruction of CT scan of 200 patients in our hospital were used to obverse the common feature、position and measure of Inter-condylar foramen of femur and Foramen of tibial intercondylar eminence. ②Anatomical and histological observation: To proof the existence of IFF and FTIE through the anatomy of 15 cases of car accidents or tumor amputations and 60 cases of autopsy. Then the specific location, the surrounding structure, the proximal coverage, the contents, the apical construction, the wall and the bottom tissues of the IFF and FTIE were studied and analyzed. ③Histological and pathological observation of tumor anatomy: Through the study of the distal femur and tibia malignant tumor tissues(including primary bone tumors and metastatic tumors), we observed the relationship between the foraminal structures and the tumor, judged the situation of concealed transmission and two-way spread through the foramina, and analyzed the relationship between tumor recurrence and foraminal structures. ④The synovial membrane of foramina, especially in cases where the synovium was suspected to be involved by the lesions judged by the radiography was analyzed to observe whether the synovium was infiltrated by the tumor.Results:IFF and FTIE were the inherent physical structure of the human. Their physiological function was the vascular foramina that lead the branches of arteria media genus into the Intercondylar fossa of femur and tibial intercondylar eminence. Their opening was separated with the joint cavity by the synovial tissues, so IFF and FTIE were isolated with joint cavity by the synovial tissues、meniscus and cruciate ligaments. After invading the IFF and FTIE, the aggressive tumors did not break into the joint cavity immediately, but conceal in the foramina and invade the synovium with specific biological behavior with the sequence: reactive edema, hyperplasia, degeneration, calcification, hyaline degeneration (infiltration in some cases), synovial rupture, and then tumor invasion of the articular cavity. Usually, tumors or recurrence has been observed before synovial rupture. We also observed the tendency of tumors to spread along the arteria media genus to the popliteal vessels, peripheral soft tissues and lymphatic vessels with typical radiographic performance like popliteal lymphadenectasis. Color nodules and tumors in other parts could also invade or metastasize into bone through these foramina.Conclusions:IFF and FTIE are foramina nutricium of arteria media genus. They are the inherent physical structure of the human. The foramina play an important role in the spread, concealment and recurrence of peripheralkneeaggressive tumor.

Objective: To explore the subunit strategy for perineal defect reconstruction and flap selection. Methods: This is a respective study of 21 patients, with perineal defect, during January 2008 to December 2018. All patients were admitted to the fifth section of Burn and Plastic Surgery in the Fourth Medical Center of the People′s Liberation Army General Hospital. There were 10 males and 11 females, aged from 4 to 68 years old, with the mean age of 26.4 years. The causes of injury included burn (n=11), trauma (n=2), Paget′s disease (n=2), Brown′s disease (n=2), perineal squamous cell carcinoma (n=3)and hemangioma (n=1). The perineum is divided into 4 subunits, according to the anatomical structure: a front area monsveneris or pubic symphysis, 2 middle areas (labia or scrotum) and a posterior area (anal). The defects ranged 23 cm×11 cm-5 cm×3 cm after perineal lesions were removed. Appropriate flaps were selected based on tissue defect. Results: Nine patients were repaired with superficial inferior epigastric artery flap, 3 patients were repaired with superficial circumflex iliac artery flap, and 2 patients were repaired with combined superficial inferior epigastric artery flap and superficial circumflex iliac artery island flap. Internal pudendal arterial perforator flap was performed in 5 patients, and anterolateral thigh perforator flap in 2 patients. The size of flap was 25 cm×12 cm-6 cm×3 cm. All flaps survived, and incisions were primary healing. Patients were followed up for 6 months to 9 years, with an average of 13 months. The patients were satisfied with the appearances and functions of the recipient and doner sites. Scars were concealed well. Conclusions Appropriate flap can be chosen to repair perineal defects, based on the subunit principle in perineum, in order to restore function and appearance, and achieve satisfactory clinical outcomes.

Objective: To explore the clinical application of ultra-pulsed CO₂ laser skin abrasion combined with micro-skin graft in the treatment of skin depigmentation. Methods: From January 2010 to June 2014, depigmented skin specimens were used for ultra-pulsed CO₂ laser skin abrasion treatment, at 0, 10, 20, 30, 40, 50, 60 mJ. HE stain was performed to observe the abrasion depth under the 100 times microscope view. The most appropriate parameter was set to completely remove the epidermis, and leave dermis undamaged. From January 2011 to December 2017, 16 patients with skin depigmentation, 12 males and 4 females, aged 12-47 years, were treated with super-pulsed carbon dioxide laser and autologous microdermis transplantation. At 1, 3, 6 and 12 months after the operation, patients′ photos were record. The color improvement was analyzed using Image-Pro Plus 6.0 software. Results: The laser energy for complete epidermis removal is different at different sites. It is 50 mJ for back skin, 40 mJ for face and hand skin and 30 mJ for neck skin. After one year of follow-up, there was no hypertrophy scar caused by over-abrasion in all 16 patients. Combined with the micro-skingrafting, 15 patients with skin depigmentation were completely resolved, with more than 90%color improvement rate. The improvement rate was 75% in a patient with un-uniform appearance, due to part failure of micro-skin graft. The neck movement and uncertain fixation were the reasons. Conclusions The appropriate energy parameters can control the abrasion depth to avoid the hypertrophic scar. Combined with micro-skin graft, the depigmentation area can be improved with uniform color and reliable effect.

Objective To introduce the tibial intercondylar eminence hole (TIEH) and study its structure.Explore the connection between TIEH and the pathway how proximal tibial aggressive tumor break into the bony structure from articular cavity.Methods This retrospective study included 200 patient's CT 3-dimensional reconstruction materials from May 2017 to November 2017 in Qilu hospital randomly.There were 115 males and 85 females,the average age was 49 years (ranged from 12 to 90 years).To observe the existence of TIEH and identify its location and measurement with imaging techniques.According to 50 tibial plateau specimen after TKA and 5 specimen after car accident or amputation due to tumor,physical proof the existence of TIEH.The specific location,peripheral structure,coverage,content of TIEH as well as its top,walls and bottom were researched and analysed.Pathological staining was used and 1 cases undertook preoperation contrast agent observation.1 cases of typical cases were reviewed.Results TIEH was ubiquity according to all of the 200 cases.TIEH was located on the depression of tibial plateau,between the attachments of ACL and PCL.The hole was round type,and the diameter was 1.6±0.3 mm,the depth was 9.1±2.1 mm.1-3 Paraforamen (semidiamete≤7 mm) were found around the main TIEH in 53％ patients (106/200),the diameter and depth was less than the main hole.The CT value showed the orifice (472.5±30.1 HU) ＞ the pore wall (312.3±22.5 HU) ＞ the pore bottom (202.4±17.3 HU) ＞ the pore (118.3±10.4 HU) ＞ the orifice covering (75.0±11.1 HU).The synovial tissue septum was only 1 mm between the top of hole and the articular cavity.The top of TIEH was surrounded by articular cartilage,the walls and bottom were spongy bone,the content was dense connective tissue that didn't attach to the walls tightly.The peripheral spongy bone was easy to infiltrate by methylene blue.Preoperation radiography showed that TIEH had poor barrier function.Conclusion Tibial intercondylar eminence hole is an intrinsic structure of the human body.The coverage is weak,and it is easy to cause the tumor to hide and recur.The tumor may pass through this hole and bidirectionally enter between the proximal humerus and the joint cavity.

Objective To explore a method for repairing the appearance and function of the cheek aesthetic unit.Methods A single volume of 100 ml to 150 ml of tissue expander was implanted at the lower edge of the injury area on the cheek.The first injection was performed 5 days after the operation and twice a week after the injection.It took an average of about 4 months to complete the expansion,with 3-5 times over expanded.The lesions were resurfaced with the expanded flaps,and long term follow-up was observed for flap survival.Results 17 cases of cheek lesions had been successfully reconstructed,with the color,texture of the expanded flaps well matched to the surrounding skin after 3-12 months follow-up.The facial expression functions and configurations were satisfied.Conclusions Excessive expansion of the prefabricated skin flap of the jaw and neck can repair the cheek aesthetic unit successfully,which is a practical method and meets the needs of aesthetic unit repair.