OBJECTIVE: To explore the method and effectiveness of index finger proximal dorsal island flap supplied by the nutrient vessels of superficial branch of radial nerve for treatment of thumb skin and soft tissue defect. METHODS: Between August 2019 and December 2024, 12 patients with thumb skin and soft tissue defects caused by trauma accompanied by variation of the first dorsal metacarpal artery were treated. There were 8 males and 4 females, aged 19-55 years, with an average age of 32 years. The wound area ranged from 2.2 cm×2.0 cm to 5.5 cm×3.5 cm. The time from injury to operation ranged from 1.5 to 6.0 hours, with an average of 4.5 hours. After thorough debridement, the wound was repaired with a index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve. The flap area ranged from 2.4 cm×2.2 cm to 6.0 cm×4.0 cm. The donor site was repaired with free skin grafting. Regular follow-up was conducted postoperatively to observe the appearance, texture, sensory recovery of the flap, and the condition of the donor site. RESULTS: The operation time ranged from 30 to 72 minutes, with an average of 47 minutes; intraoperative blood loss ranged from 30 to 70 mL, with an average of 46 mL. After operation, partial necrosis occurred at the skin edge of the radial incision on the dorsum of the hand in 1 case, which healed after dressing changes; all other flaps survived uneventfully, with primary wound healing. The skin grafts at the donor sites all survived. All 12 patients were followed up 5-36 months, with an average of 14 months. The appearance and texture of the flaps were good. At last follow-up, the two-point discrimination of the flaps ranged from 4 to 9 mm, with an average of 5.2 mm. According to the functional evaluation criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 11 cases and good in 1 case. No scar contracture, pain, or joint movement limitation was observed at the donor sites. CONCLUSION For patients with skin and soft tissue defects of the thumb accompanied by variation of the first dorsal metacarpal artery, the index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve can be selected. This method has advantages such as shorter operation time, less intraoperative bleeding, and good postoperative appearance and sensation of the flap.
Humans ; Male ; Adult ; Female ; Thumb/surgery* ; Soft Tissue Injuries/surgery* ; Radial Nerve/surgery* ; Middle Aged ; Surgical Flaps/innervation* ; Plastic Surgery Procedures/methods* ; Skin Transplantation/methods* ; Young Adult ; Treatment Outcome ; Fingers/surgery* ; Skin/injuries*

Despite therapy with potent antiviral agents, chronic hepatitis B (CHB) patients remain at high risk of hepatocellular carcinoma (HCC). While metabolites have been rediscovered as active drivers of biological processes including carcinogenesis, the specific metabolites modulating HCC risk in CHB patients are largely unknown. Here, we demonstrate that baseline plasma from CHB patients who later developed HCC during follow-up exhibits growth-promoting properties in a case-control design nested within a large-scale, prospective cohort. Metabolomics analysis reveals a reduction in long-chain acylcarnitines (LCACs) in the baseline plasma of patients with HCC development. LCACs preferentially inhibit the proliferation of HCC cells in vitro at a physiological concentration and prevent the occurrence of HCC in vivo without hepatorenal toxicity. Uptake and metabolism of circulating LCACs increase the intracellular level of acetyl coenzyme A, which upregulates histone H3 Lys14 acetylation at the promoter region of KLF6 gene and thereby activates KLF6/p21 pathway. Indeed, blocking LCAC metabolism attenuates the difference in KLF6/p21 expression induced by baseline plasma of HCC/non-HCC patients. The deficiency of circulating LCACs represents a driver of HCC in CHB patients with viral control. These insights provide a promising direction for developing therapeutic strategies to reduce HCC risk further in the antiviral era.

Oropharyngeal squamous cell carcinoma(OPSCC)is a malignant tumor originating from the squamous epithelium of the oro-pharyngeal mucosa,accounting for more than 90％of oropharyngeal malignancies.In recent years,human papillomavirus(HPV)infec-tion has become one of the primary etiological factors of oropharyngeal squamous carcinoma.The incidence of HPV-associated oropharyn-geal squamous carcinoma has been rising annually,with a noticeable trend toward younger populations,posing a significant threat to hu-man health.Due to the distinct biological behavior and clinical characteristics of HPV-associated oropharyngeal squamous carcinoma com-pared to its non-HPV-related counterpart,the diagnostic and treatment strategies for oropharyngeal squamous carcinoma have undergone substantial changes.Prevention and screening for oropharyngeal squamous carcinoma are of critical importance.The diagnostic and treat-ment process involves multi-disciplinary collaboration,including oral and maxillofacial surgery,otolaryngology,head and neck surgery,oncology,radiology and pathology.Based on evidence from clinical practice,a comprehensive,integrated diagnostic and therapeutic ap-proach has been established,centered around the concept of"prevention,screening,diagnosis,treatment,and rehabilitation",covering the entire patient lifecycle and providing a valuable reference for clinical practice.

Objective To investigate the effects of cornuside on intestinal injury in rats with septic shock,and clarify its possible mechanism.Methods SD rats were randomly divided into normal control group,model group,low-,medium-,and high-dose comecarpine glycosides groups,and TREM1 inhibitor(LR12)group.HE staining was used to observe the pathological injury of small intestinal mucosa.The levels of D-lactic acid(D-LA)and diamine oxidase(DAO)in serum and secretory immunoglobulin(sIg A)in small intestine were detected by ELISA.Intestinal mucosal permeability was detected by fluorescein isothiocyanate-dextran(FITC-D)tracer method.ELISA was used to detect the levels of interferon(IFN)-γ,tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-10 and arginase(Arg)-1 in serum.The polarization of macrophages in small intestinal tissue was detected by flow cytometry.Western blot was used to detect the protein expression levels of triggering receptor expressed on myeloid cells 1(TREM1),CD86 and CD206 in small intestine.Results Compared with the normal control group,the model group had serious pathological injury of the small intestinal mucosa,and the serum levels of D-LA,DAO,FITC-D,IFN-γ,TNF-α,and IL-1β significantly increased(P<0.05),while the levels of sIg A,IL-10,and Arg-1 significantly decreased(P<0.05).The M1/M2 ratio of macrophages and the expression levels of TREM1 and CD86 proteins in the small intestine tissue significantly increased(P<0.05),while the expression level of CD206 protein significantly decreased(P<0.05).Compared with the model group,the small intestinal mucosal injury of the rats in each dose cornuside group and LR12 group significantly improved,and the serum levels of D-LA,DAO,FITC-D,IFN-γ,TNF-α,and IL-1β significantly decreased(P<0.05),while the levels of sIg A,IL-10,and Arg-1 significantly increased(P<0.05).The M1/M2 ratio of macrophages and the expression levels of TREM1 and CD86 proteins in the small intestine tissue significantly decreased(P<0.05),while the expression level of CD206 protein significantly increased(P<0.05).Conclusion Cornuside can reduce intestinal injury in rats with septic shock,and the mechanism may be related to inhibiting TREM1-mediated M1 polarization of macrophages.

Objective:To analyze the clinical efficacy of vascular resection and reconstruction during radical resection in patients with hilar cholangiocarcinoma.Methods:A retrospective analysis was conducted on the clinical data of 151 patients with hilar cholangiocarcinoma who underwent radical resection in the Department of Hepatobiliary and Pancreatic Surgery at the First Affiliated Hospital of Anhui Medical University from April 2018 to April 2025. Among them, there were 91 males and 60 females, with an age of (65.4±10.5) years. According to whether radical resection of hilar cholangiocarcinoma was combined with vascular resection, the patients were divided into the vascular resection group ( n=19) and the control group ( n=132). Postoperative complications such as bleeding, biliary fistula, and thrombosis were recorded, along with intraoperative blood loss, R 0 resection rate, perioperative mortality, and recurrence rate at six months postoperatively. Results:The preoperative bilirubin reduction and intraoperative blood loss in the vascular resection group were 6 (31.6) and 200 (200, 200) ml, respectively, while those in the control group were 45 (34.1) and 200 (100, 200) ml, respectively. There were no statistically significant differences between the two groups (all P>0.05). The combined liver resection, Billroth operation type Ⅰ-Ⅱ, and operation time in the vascular resection group were 18 (94.7), 1 (5.3), and 420 (377.5, 512.5) min, respectively, while those in the control group were 79 (59.8), 38 (28.8), and 322.5 (260, 410) min, respectively. There were statistically significant differences between the two groups (all P<0.05). The R 0 resection, perioperative mortality rate, postoperative bleeding, postoperative biliary fistula, postoperative thrombosis, postoperative pathology (adenocarcinoma), and recurrence rate at 6 months after surgery in the vascular resection group were 16 (84.2), 2 (10.5), 2 (10.5), 3 (15.8), 1 (5.3), 18 (94.7), and 1 (5.9), respectively, while those in the control group were 103 (78.0), 5 (3.8), 5 (3.8), 25 (18.9), 2 (1.5), 121 (91.7), and 6 (4.7), respectively. There were no statistically significant differences between the two groups (all P>0.05). The postoperative hospital stay, alanine aminotransferase on the 1st and 3rd day after surgery, and postoperative liver failure in the vascular resection group were 18 (13.5, 21.5) days, 619 (305.4, 1 634.0) U/L, and 1 (5.3), respectively, while those in the control group were 14 (11, 18), 254.5 (139.3, 468.3) U/L, and 3 (2.3), respectively. There were statistically significant differences between the two groups (all P<0.05). Conclusion:Vascular resection and reconstruction during radical resection of hilar cholangiocarcinoma in patients has certain safety and efficacy.

OBJECTIVE To establish management index system for rational drug use of key monitoring drugs， and provide reference for the management of key monitoring drugs in the hospitals. METHODS First， the management index system for rational drug use of key monitoring drugs was drafted by collecting the evidence from related medical literature. Next， using a modified Delphi method， twenty experienced experts from the fields of pharmacy， medical practice， healthcare insurance， and finance were selected to participate in two rounds of questionnaire consultations. Based on the expert enthusiasm coefficient， authority coefficient， degree of opinion concentration， and degree of coordination， the final indicators were determined to establish a management index system for rational drug use of key monitored drugs in medical institutions. RESULTS The expert enthusiasm coefficients reached 100% in both rounds of consultation. In first-level， second-level and third-level indicators， the authority coefficients of experts were 0.89， 0.86 and 0.87， and coordination coefficients of the experts in importance score were 0.300 （P＜ 0.05）， 0.125 （P＜0.05） and 0.139 （P＜0.05）， respectively. The average score for the importance of all indicators reached over 3.5， in which the full score ratio ranged from 35% to 100%. Except that the variation coefficient of a third-level indicator “number of specifications purchased for key monitored drugs” was 0.26， the variation coefficients of rest indicators were less than or equal to 0.25. Based on the results of expert consultation， final version of the management index system established in this study， including two first-level indicators （drug procurement and use， and rational drug use）， five second-level indicators （such as the accessibility， cost-effectiveness） and twenty third-level indicators （such as the number of specifications purchased for key monitored drugs， the increase in the cost of key monitored drugs）. CONCLUSIONS The management index system established in this study possesses high reliability and strong operability， and may provide a reference for the management of key monitoring drugs in the hospitals.

Objective:To explore the long-term survival outcomes of patients with anaplastic thyroid cancer (ATC) and analyze key factors influencing the prognosis.Methods:A retrospective analysis was conducted on the clinical and follow-up data of 77 ATC patients treated at the Sun Yat-sen University Cancer Center from March 2000 to July 2022, with tumor-specific survival as the primary endpoint. The Kaplan-Meier method was used to plot the survival curves, and univariate and multivariate Cox regression analyses were performed to identify the prognostic factors.Results:Among the 77 patients, 64 underwent surgical treatment, with 33 receiving surgery alone, 8 undergoing surgery combined with chemotherapy, 13 undergoing surgery with radiotherapy, 1 undergoing surgery with chemotherapy and radiotherapy, 2 receiving surgery combined with chemotherapy and targeted therapy, 3 receiving surgery with targeted therapy, and 4 receiving surgery with immunotherapy and targeted therapy. Among the 13 patients who did not undergo surgery, 2 received chemotherapy alone, 3 received targeted therapy alone, 1 received immunotherapy alone, 1 received chemoradiotherapy, 5 received chemotherapy combined with immunotherapy, and 1 received immunotherapy combined with targeted therapy. The median follow-up time was 8.4 months, with 58 patients (75.3%) died, and the median survival time was 6.63 months. Univariate Cox regression analysis showed that C-reactive protein, monocyte count, lymphocyte count, abnormal albumin levels, the maximum diameter of the primary tumor, BMI, and whether immunotherapy was administered were significantly associated with survival in ATC patients (all P＜0.05). Multivariate Cox regression analysis indicated that immunotherapy was an independent factor for survival in ATC patients ( HR=0.18, 95% CI: 0.05-0.62, P=0.007). Among the 40 patients admitted after 2015, the 11 patients who received immunotherapy had a median survival time of 17.2 months, which was superior to the 29 patients who did not receive this treatment (median survival time 6.2 months, P=0.03). Conclusions:ATC patients receiving immunotherapy had a better prognosis and longer survival. Additionally, elevated C-reactive protein, abnormal albumin, monocyte count, lymphocyte count, and BMI might be associated with poorer prognosis in ATC. Tailoring treatment based on the individual characteristics of ATC patients may be beneficial for their long-term survival.

In recent decades,the incidence of human papillomavirus(HPV)-associated oropharyngeal squamous cell carcinoma(OPSCC)has shown a marked increase.Significant changes have also occurred in the OPSCC diagnosis and treatment paradigm.Deter-mining HPV status prior to treatment is now essential,and radiotherapy/chemotherapy,immunotherapy,and minimally invasive surgical techniques have progressively emerged as key modalities for managing OPSCC.However,alongside these paradigm shifts,a comprehen-sive technical consensus guiding the entire diagnostic and therapeutic process for OPSCC patients is currently lacking.Given China's large population base and the rising incidence of OPSCC,an expert panel convened to develop a clinical technical consensus on OPSCC diagno-sis and management tailored to China's specific context.This consensus aims to further enhance and standardize understanding of OPSCC management techniques among relevant healthcare professionals.

Oral squamous cell carcinoma(OSCC)is a malignant lesion originating from the oral mucosal squamous epithelium,account-ing for over 80％of oral and maxillofacial malignancies.Key etiological factors include tobacco,alcohol abuse,and betel quid chewing.In China,its incidence has shown an overall upward trend,posing a significant threat to public health.OSCC exhibits high local invasive-ness,making early diagnosis critical for improving prognosis.Its clinical management requires close multidisciplinary collaboration among oral and maxillofacial surgery,head and neck surgery,radiation oncology,medical oncology,reconstructive surgery,radiology,patholo-gy,and nutritional support teams.Given the increasing disease burden of OSCC and rapid development of multidisciplinary collaborative models,an expert panel has formulated this integrated management consensus based on evidence-based medicine and extensive deliber-ation.Centered on the'Prevention-Screening-Diagnosis-Treatment-Rehabilitation'framework,the consensus provides comprehensive guidance for the entire disease course of OSCC patients,aiming to standardize clinical practice.

OBJECTIVE To observe the clinical efficacy of Shaoqi Yijia Prescription in the treatment of Hashimoto's thyroiditis(HT)with liver depression and spleen deficiency in the non-hypothyroidism stage and its effect on serum inflammatory factors.METHODS A total of 74 patients with Hashimoto's thyroiditis of liver depression and spleen deficiency type in the non-hypothyroid-ism stage who were treated in Putuo District Central Hospital in Shanghai from June to August 2024 were selected and randomly divided into the observation group and the control group with 37 cases in each group(2 cases dropped out in each group).The control group was treated with oral selenium yeast tablets,and the observation group was treated with Shaoqi Yijia Prescription,both for 12 weeks.The traditional Chinese medicine(TCM)syndrome scores,Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and fatigue self-assessment scale(FSAS)scores were evaluated before and after treatment;the thyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb)and serum inflammatory factors interleukin 4(IL-4),IL-6,IL-10,TNF-α and IFN-γ levels were detected before and after treatment in the two groups of patients.RESULTS After treatment,the total score of TCM syndrome and the scores of epigastric or hypochondrium pain,abdominal distension,poor appetite,depression or irritability,and frequent sighs in the observation group were significantly reduced(P<0.05,P<0.01),and the total score of the observation group was better than that of the control group(P<0.01);after treatment,the serum TPOAb level of the observation group was significantly re-duced(P<0.05),the serum TPOAb level of the control group did not change significantly(P>0.05),and the serum TgAb and TPO-Ab levels of the observation group were better than those of the control group(P<0.05);after treatment,the HAMA and HAMD scores of the observation group were significantly reduced(P<0.01),and the HAMA,HAMD and FSAS scores of the observation group were better than those of the control group(P<0.05);after treatment,the serum IL-4 and IL-10 levels of the observation group were in-creased(P<0.05),and the IL-6,IFN-γ and TNF-α levels were decreased compared with those before treatment(P<0.05).The se-rum IL-4,IL-6 and IL-10 levels of the observation group were significantly different from those of the control group(P<0.05).CONCLUSION Shaoqi Yijia Prescription can alleviate the clinical symptoms of patients with Hashimoto's thyroiditis of liver depres-sion and spleen deficiency type in the non-hypothyroid period,and improve anxiety and depression,which may be related to improving the body's inflammatory response.