Objective:To investigate the effect and clinical efficacy of assisted negative pressure wound therapy (NPWT) dressing on reduction of the size of free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of limbs, and to observe the clinical efficacy of NPWT in free ALTPF surgery.Methods:From June 2022 to January 2024, 19 patient (13 males and 6 females) with soft tissue defects in limbs received surgical treatment using NPWT assisted transfer of free ALTPF in the Department of Repair and Reconstruction Surgery, Foshan Hospital of Traditional Chinese Medicine, the Eighth School of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine. Of the 19 defects, 8 were in calf, 7 in foot and around ankle, 3 in forearm and 1 around elbow. The soft tissue defects ranged from 11.2 cm×9.5 cm to 24.5 cm×10.5 cm, and with comminuted fracture in different degrees as well as the exposure of bone, tendon or nerve. During surgery, the ALTPFs were harvested with a reduced width from the donor sites at 10.5 cm×7.0 cm to 24.0 cm×7.5 cm in size. After an ALTPF had been transferred to the recipient site, the remaining defect that was not covered by the ALTPF was then covered by a NPWT dressing. After the flap was stabilised, NPWT dressing was removed and the defect was closed by directly suture. Surgical data were taken and recorded during surgery. The healing of wound and survival of flaps were observed after surgery. Scheduled postoperative follow-ups were conducted through outpatient clinic or via WeChat reviews to monitor the overall appearance of recipient and donor sites, colour of flap, complications and functional recovery, and other relevant information. Functional recovery of upper limb was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, and the functional recovery of lower extremity was evaluated according to the Lower Extremity Functional Scale (LEFS).Results:The flaps were all fully viable, with soft texture and good appearance, the width of the flaps was designed 2.0-3.5 cm smaller than that of the defect, and the size of the flaps was 32.9-77.3 cm 2 smaller than that of the defects. All donor sites were closed by suture in the primary surgery, and left with linear scars. Postoperative follow-up lasted for 4 to 18 months. Of the 4 patients with upper limb injuries, 3 achieved the limb function in excellent and 1 in good; While of the 15 patients with lower limb injuries, 12 achieved the limb function in excellent, 2 in good and 1 in fair. Conclusion:Combination of NPWT dressing and free ALTPF is in accordance with the theory of flap economics and the concept of minimal damage to donor site. It avoids the waste of soft tissues, and provides a new idea for traumatic surgery.

Objective:To investigate the effect and clinical efficacy of assisted negative pressure wound therapy (NPWT) dressing on reduction of the size of free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of limbs, and to observe the clinical efficacy of NPWT in free ALTPF surgery.Methods:From June 2022 to January 2024, 19 patient (13 males and 6 females) with soft tissue defects in limbs received surgical treatment using NPWT assisted transfer of free ALTPF in the Department of Repair and Reconstruction Surgery, Foshan Hospital of Traditional Chinese Medicine, the Eighth School of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine. Of the 19 defects, 8 were in calf, 7 in foot and around ankle, 3 in forearm and 1 around elbow. The soft tissue defects ranged from 11.2 cm×9.5 cm to 24.5 cm×10.5 cm, and with comminuted fracture in different degrees as well as the exposure of bone, tendon or nerve. During surgery, the ALTPFs were harvested with a reduced width from the donor sites at 10.5 cm×7.0 cm to 24.0 cm×7.5 cm in size. After an ALTPF had been transferred to the recipient site, the remaining defect that was not covered by the ALTPF was then covered by a NPWT dressing. After the flap was stabilised, NPWT dressing was removed and the defect was closed by directly suture. Surgical data were taken and recorded during surgery. The healing of wound and survival of flaps were observed after surgery. Scheduled postoperative follow-ups were conducted through outpatient clinic or via WeChat reviews to monitor the overall appearance of recipient and donor sites, colour of flap, complications and functional recovery, and other relevant information. Functional recovery of upper limb was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, and the functional recovery of lower extremity was evaluated according to the Lower Extremity Functional Scale (LEFS).Results:The flaps were all fully viable, with soft texture and good appearance, the width of the flaps was designed 2.0-3.5 cm smaller than that of the defect, and the size of the flaps was 32.9-77.3 cm 2 smaller than that of the defects. All donor sites were closed by suture in the primary surgery, and left with linear scars. Postoperative follow-up lasted for 4 to 18 months. Of the 4 patients with upper limb injuries, 3 achieved the limb function in excellent and 1 in good; While of the 15 patients with lower limb injuries, 12 achieved the limb function in excellent, 2 in good and 1 in fair. Conclusion:Combination of NPWT dressing and free ALTPF is in accordance with the theory of flap economics and the concept of minimal damage to donor site. It avoids the waste of soft tissues, and provides a new idea for traumatic surgery.

Objective To investigate the expression of OTU deubiquitinase 3(OTUD3)and interleukin en-hancer binding factor 2(ILF2)in esophageal squamous cell cancer and their correlation with clinicopathologi-cal characteristics and prognosis.Methods A total of 102 patients with esophageal squamous cell cancer who underwent radical resection in Huai'an Fifth People's Hospital between January 2019 and July 2020 were in-cluded in this study.Immunohistochemistry was used to detect OTUD3 and ILF2 expression.Spearman rank correlation analysis was conducted to assess the relationship between OTUD3 and ILF2.Kaplan-Meier surviv-al curves were used to analyze the impact of OTUD3 and ILF2 expression on patient survival prognosis.COX regression analysis was employed to identify prognostic factors.Results Compared with adjacent tissues,the positive rate of OTUD3 was lower and the positive rate of ILF2 was higher in esophageal squamous cell cancer tissues,and the differences were statistically significant(P＜0.05).A significant negative correlation was ob-served between the expression of OTUD3 and ILF2 in esophageal squamous cell cancer(r=-0.712,P＜0.001).Furthermore,patients with TNM stage Ⅲ,low differentiation,and lymph node metastasis exhibited a lower positive rate of OTUD3 and a higher positive rate of ILF2 compared to patients with TNM stage Ⅰ-Ⅱ,medium-high differentiation,and no lymph node metastasis(P＜0.05).The 3-year survival rate for the OTUD3-positive group was significantly higher than that of the OTUD3-negative group(Log-rank x2=5.869,P=0.015).The 3-year survival rate for the ILF2-positive group was significantly lower than that of the ILF2-negative group(Log-rank x2=16.257,P＜0.001).TNM staging,lymph node metastasis,degree of differentiation,OTUD3,and ILF2 were independent factors affecting the prognosis of esophageal squamous cell cancer patients.Conclusion Decreased expression of OTUD3 and increased expression of ILF2 in esopha-geal squamous cell cancer tissues are implicated in the malignant progression of esophageal squamous cell cancer and serve as independent factors affecting patient outcomes.

Objective To explore the correlation of molecular pathological grading with WHO grade 1 meningioma recurrence,malignant progression,and patients'survival.Methods The medical records and paraffin-embedded tissues of patients with surgically resected WHO grade 1 meningioma were collected.The molecular pathological risk grading suggested by Maas et al.was adopted,and the patients were graded as low,intermediate,and high risk.Univariate log-rank test and multivariate Cox regression analyses were performed to determine the relationship between molecular risk grading and patient progression-free survival(PFS),malignant progression-free survival(MPFS),and overall survival(OS).Results Among 198 patients,152(76.8%)were graded as low risk,showing no 1p deletion;42(21.2%)patients were graded as intermediate risk,including 18 patients with 1p deletion,10 patients with 1p combined with 6q deletion,and 14 patients with 1p combined with 14q deletion;and 4(2%)patients were graded as high risk,including two patients with TERT promoter mutation,one patient with CDKN2A/B homozygous deletion,and one patient with 1p,6p,and 14q combined deletion.Multivariate analysis showed that molecular risk grading was negatively associated with PFS(HR:0.029,95%CI:0.011-0.080),MPFS(HR:0.032,95%CI:0.004-0.274),and OS(HR:0.074,95%CI:0.032-0.174;P<0.05).Conclusion The biological behavior of histological grade 1 meningiomas still exhibits heterogeneity,and further molecular pathological risk grading can more accurately reflect their biological behavior and evaluate patient prognosis.

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

Objective:To analyze the epidemiological characteristics and influencing factors of venous thrombosis in elderly patients with severe trauma.Methods:A retrospective study was conducted to collect and statistically analyze general information[sex, age, body mass index(BMI)], causes of trauma, injury severity score(ISS), Glasgow coma score(GCS), coagulation function[prothrombin time(PT), international normalized ratio(INR), D-dimer], B-type natriuretic peptide(BNP), liver function(alanine aminotransferase, aspartate aminotransferase), creatinine, Caprini score, surgical approach, immobilization mode, days of hospitalization, and treatment cost.Results:Totally 179 elderly patients with severe trauma were enrolled, including 130 men(72.6%), aged(67.6±6.4)years.The BMI, ISS and GCS scores of elderly patients with severe trauma were(22.9±3.4)kg/m 2, 28.4±10.5 and 10.2±4.6, respectively.The Caprini score was 11.7±4.0.Of these patients, 32(17.9%)had VTE events.Compared with the VTE negative group, the VTE positive group was older( t=-2.214, P=0.028), with a higher Caprini score( t=-2.684, P=0.008)and more lower limb fractures( P=0.008)and pelvic fractures( P=0.001). There were no significant differences in coagulation function, liver function, atrial natriuretic peptide levels, creatinine levels and surgical approaches between the VTE negative group and the VTE positive group(all P<0.05). No significant difference was found in the proportion of patients receiving surgical treatment between the two groups( P=0.563). In the VTE positive group, 18.8% had no fracture, 50.0% had one fracture, and 31.2% had two or more fractures, and the difference was statistically significant compared with the VTE negative group( P=0.029). However, VTE events had no significant effect on the average length of stay and hospitalization costs in elderly trauma patients(all P<0.05). Conclusions:For elderly patients with severe trauma, VTE is more likely to occur with increased age, a high Caprini score, multiple fracture sites and pelvic fracture.In addition, pelvic fracture is an independent risk factor for VTE in very old trauma patients.Attention should be paid to prevention and treatment to achieve steady improvement in the overall prognosis of trauma in these patients.

Objective To investigate the influence of the interval between transcatheter arterial embolization (TAE) and radiofrequency ablation on the treatment outcome of small hepatocellular carcinoma. Methods A total of 70 patients with hepatocellular carcinoma who received treatment in Beijing YouAn Hospital, Capital Medical University, from January 2019 to June 2020 were enrolled and divided into observation group (radiofrequency ablation was performed on the day or the second day of TAE) and control group (radiofrequency ablation was performed at 1-2 weeks after TAE) using a random number table, with 35 patients in each group. The independent samples t -test was used for comparison of continuous data between two groups, and the paired t -test was used for comparison of observation indicators before and after surgery; the chi-square test was used for comparison of categorical data between two groups. Results The observation group had a significantly shorter length of hospital stay than the control group (7.80±2.76 days vs 14.31±2.19 days, t =-10.93, P < 0.001). There were no significant differences between the observation group and the control group in complete ablation rate (95.12% vs 95.00%, χ 2 =0.001, P =0.980), incidence rate of adverse reactions (25.71% vs 20.00%, χ 2 =0.324, P =0.569), and 1-year recurrence rate (11.43% vs 14.29%, χ 2 =0.128, P =0.721), and there were also no significant differences in laboratory markers between the two groups before and after treatment (all P > 0.05). Conclusion TAE combined with sequential radiofrequency ablation at a short interval is safe and effective in the treatment of small hepatocellular carcinoma and can significantly shorten the length of hospital stay and reduce hospital costs, and therefore, it holds promise for clinical application.

Objective:To investigate the risk factors for recurrence of early and late stage hepatocellular carcinoma after receiving hepatic artery embolization combined with radiofrequency ablation therapy.Methods:246 cases with hepatocellular carcinoma who underwent hepatic artery embolization combined with radiofrequency ablation in Beijing You'an Hospital Affiliated to Capital Medical University from January 2006 to January 2011 were selected. Clinical and follow-up data were collected. Univariate Cox analyses was used to determine the factors influencing recurrence of early and late stage HCC after hepatic artery embolization combined with radiofrequencies ablation. Multivariate Cox regression analysis was used to determine the independent factors.Results:246 case with hepatocellular carcinoma were treated with hepatic artery embolization combined with radiofrequency ablation, with median follow-up time of 99 months. A total of 179 cases had recurrence and 67 cases had no recurrence. Considering 24 months as the limit, 95 cases had early recurrence and 84 cases had late recurrence. The 1-, 2-, 3-, 5-, and 10-year recurrence rates were 21.3%, 39.0%, 53.0%, 67.3%, and 77.6%, respectively. Multivariate Cox regression analysis showed that the maximum tumor diameter ( HR = 2.183, 95% CI: 1.414-3.369, P < 0.01) and tumor number ( HR = 1.681, 95% CI: 1.110-2.545, P < 0.05) were independent factor influencing recurrence of early stage HCC after hepatic artery embolization combined with radiofrequency ablation. Liver cirrhosis ( HR = 0.421, 95% CI: 0.272-0.651, P < 0.01) was an independent factor influencing recurrence of late stage HCC after hepatic artery embolization combined with radiofrequency ablation. Conclusion:Tumor diameter and number are independent factors influencing recurrence of early stage HCC, while liver cirrhosis is an independent factor influencing recurrence of late stage HCC after hepatic artery embolization combined with radiofrequency ablation therapy.

ObjectiveTo explore the predictive role of the degree of prospective memory impairment on the treatment response to Selective Serotonin Reuptake Inhibitors （SSRIs） in patients with obsessive-compulsive disorder. MethodsA total of 30 patients with obsessive-compulsive disorder who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fourth edition， text revision （DSM-IV-TR） were selected， and all patients were treated with SSRIs for 4 weeks. The severity of obsessive-compulsive symptom was assessed using Yale-Brown Obsessive Compulsive Scale （Y-BOCS）， and the efficacy was evaluated by the reduction rate of Y-BOCS score. Moreover， the performance of event-based， time-based and activity-based prospective memory tasks were compared before and after treatment. ResultsAfter treatment， the total Y-BOCS score of patients was lower than before treatment ［（27.07±4.63） vs. （24.87±5.93）， F（1，29）=4.984， P=0.033］， meantime， the performance of event- and time- based prospective memory tasks was improved ［（0.78±0.21） vs. （0.88±0.11）， F（1，29）=9.022， P=0.005； （0.81±0.17） vs. （0.91±0.11）， F（1，29）=9.063， P=0.005］. Correlation analysis showed that the performance of event-based prospective memory at baseline was positively correlated with the reduction of Y-BOCS score （r=0.478， P=0.014）. The event-based prospective memory performance at baseline could positively predict the treatment response to SSRIs treatment in patients （β=0.441， P=0.014）. ConclusionThe event-based prospective memory function of patients with obsessive-compulsive disorder can positively predict SSRIs treatment outcome， and patients with better prospective memory performance yield better treatment responses.