Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective To establish interferon-induced transmembrane protein 3(Ifitm3)knockout mice and to explore the effects of Ifitm3 on the proliferation and differentiation of adult neural stem cells of mice(aNSCs).Methods IFITM3 knockout mice were established by the CRISPR/Cas9 method and identified by genotype identification and Western Blot.The differences between Ifitm3-knockout mice and wild-type mice were analyzed by hematoxylin-eosin(HE)staining and flow cytometry.The aNSCs of wild-type mice and Ifitm3-knockout mice were isolated and cultured,the number and size of neurospheres were detected,The ability of aNSCs to proliferate and differentiate were detected by quantitative reverse-transcription polymerase chain reaction,Western Blot,and immunofluorescence.Results Ifitm3-knockout mice were successfully established.The mice developed normally,and there were no obvious abnormalities either histopathologically or the immune system.In vitro experiments showed that Ifitm3 knockout inhibited the self-renewal potential of aNSCs,led to a decrease in the proliferation ability of aNSCs,and inhibited the differentiation of aNSCs into immature neurons and astrocytes.Conclusions This study finds that a lack of IFITM3 result in the ability of aNSCs to proliferate and differentiate decreased,IFITM3 may regulate the function of aNSCs.

Objective This study aims to analyze the relationship between reproductive tract microecological changes,metabolic differences,and pregnancy outcomes at different time points in the frozen-thawed embryo transfer cycle while patients are undergoing hormone replacement therapy,which will be a breakthrough point for improving outcomes.Methods A total of 20 women undergoing frozen-thawed single blastocyst transfer for the first time at the Reproductive Medicine Center of Fujian Maternal and Child Health Hospital between July 2022 and January 2023 were recruited for this study.Their vaginal and cervical secretions were collected for 16S rRNA sequencing and non-targeted metabolomics analysis on days 2-5 of menstruation,day 7 after estrogen replacement therapy started,the day when progesterone was added,and the day of transplantation.The subjects were divided into different groups according to their clinical pregnancy status and the sequencing results were analyzed using bioinformatics methods.Results 1)The alpha-diversity index of the vaginal and cervical microbiota was higher on days 2-5 of menstruation(P<0.01),but did not differ significantly on day 7 after oral estrogen replacement therapy started,the day of progesterone administration,and the day of transplantation(P≥0.1).2)Both the pregnant group and the non-pregnant group showed a variety of microorganisms and metabolites with significant differences in the lower reproductive tract at different time points.3)Microbial analysis at different time points showed that there were significant differences in vaginal flora,including Peptoniphilus,Enterocloster,Finegoldia,Klebsiella,Anaerobutyricum,Agathobaculum,Sporanaerobacter,Bilophila,Prevotella,and Anaerococcus in the pregnant group(P<0.05).4)Metabolite analysis at different time points showed that there were significant differences in 3-hydroxybenzoic acid,linatine,(R)-amphetamine,hydroxychloroquine,and L-altarate in the vaginal secretions of the pregnant group(P<0.05),and that there were significant differences in isocitric acid,quassin,citrinin,and 12(R)-HETE in the cervical secretions(P<0.05).5)Metabolite analysis at different time points showed that,in the non-pregnant group,there were significant differences in linatine,decanoyl-L-carnitine,aspartame,sphingosine,and hydroxychloroquine in the vaginal secretions(P<0.05),and the isocitric acid,quassin,ctrinin,and 12(R)-HETE in the cervical secretions(P<0.05).6)Combined microbiome and metabolomics analysis showed that certain metabolites were significantly associated with microbial communities,especially Klebsiella.Conclusions Significant differences in the microbiota genera and metabolites at different time points were found during the frozen-embryo transfer cycle of hormone replacement therapy,which may be used as potential biomarkers to predict pregnancy outcomes of embryo transfer.

Objective:To analyze the efficacy of vertebroplasty combined with posterior decompression and internal fixation in the treatment of spinal metastases with neurological symptoms.Methods:This study was a retrospective analysis of 32 cases with neurological symptoms caused by spinal metastatic tumor in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from June 2016 to January 2022. All 32 patients (20 males, 12 females) aged between 39 to 85 years were enrolled in this study, with a mean age of (64.8±11.9) years. Surgery time, bleeding volume, modified Tokuhashi score, spinal instability neoplastic score (SINS) were collected. The visual analogue score (VAS), Oswestry disability index (ODI), Karnofsky performance scale (KPS) and American spinal cord injury association (ASIA) score before surgery, 1 month after surgery, 3 months after surgery and 6 months after surgery were collected and analyzed. Measurement data with normal distribution were represented as mean±standard deviation( ± s), and the comparison before and after surgery was conducted using repeated-measures analysis of variance test. Measurement data with skewed distribution were represented as M( Q1, Q3). Results:All 32 patients were followed up for 6 months. The operation time was (209.6±49.0) min, and the blood loss was (462.9±298.3) mL. 14 patients(43.8%) were treated with blood transfusion. The modified Tokuhashi score was 8.09±2.89, and the SINS was 8.81±1.97. The VAS score before surgery, postoperative 1, 3, 6 months were 7.47±0.98, 3.87±0.87, 2.91±0.73 and 2.34±0.60, respectively. ODI score before surgery, postoperative 1, 3, 6 months were 79.13±9.50, 39.14±6.31, 34.43±6.42 and 31.08±4.80, respectively. KPS score before surgery, postoperative 1, 3, 6 months were 49.69±14.70, 64.68±15.02, 71.88±12.81 and 75.63±10.76, respectively. The ASIA grading at 6 months follow-up was improved compared to preoperative baseline. Postoperative complications occurred in 4 cases, including nerve root injury (1 case), bone cement leakage in paravertebral soft tissue (1cases), bone cement leakage in paravertebral vein(1case) and acute thoracic epidural hematoma (1case).Conclusion:Vertebroplasty combined with posterior decompression and internal fixation can effectively relieve pain, relieve the compression of spinal cord and nerve, recover nerve functions, and improve the quality of life of patients with spinal metastatic tumor.

Objective: To investigate the effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger. Methods: From August 2013 to May 2017, 18 patients with skin and soft tissue defect of finger pulp at the end of finger were admitted to our unit, with 12 men and 6 women aged 16 to 54 years. As the skin and soft tissue defect sites, there were 3 cases of thumb, 8 cases of index finger, 4 cases of middle finger, and 3 cases of ring finger. The area of defects ranged from 2.0 cm×1.4 cm to 3.5 cm×2.4 cm. Free mini-flaps on tibial side of third toes were designed according to area and shape of defects, and the length and width of flaps were 0.1 to 0.2 cm longer than the length and width of the defects, respectively. The area of flaps ranged from 2.1 cm×1.5 cm to 3.7 cm×2.6 cm. The end-to-end anastomosis of subcutaneous veins of flaps and superficial veins of the finger-palm side or superficial dorsal digital vein, the end-to-end tension-free anastomosis of the base metatarsal arteries on tibial side of third toe and proper digital arteries of recipient finger were performed. Besides, anastomosis of base metatarsal nerve on tibial side of third toe and proper digital nerve of recipient finger was performed. The donor sites on feet were sutured directly or repaired with full-thickness skin grafts on medial upper leg of the same side. The survival of flaps after operation and the follow-up of patients were observed. Results: All flaps survived well, with good blood supply. Among the 18 patients, 2 patients lost to follow-up, and 16 patients were followed up for 4 to 36 months. The shape and texture of flaps were good. After reconstruction, finger pulps at the end of finger were plump, with fingerprint. Function of the finger restored well, and the two-point discriminatory distances of flaps were 5 to 10 mm. The donor sites on feet of 14 patients healed after the operation, the other 2 patients had necrosis on edge and central area of skin grafts, and the necrotic area healed after dressing change. The skin graft areas on feet were wear-resistant, with slight damage to donor sites and did not influence shoes wearing and walking. Besides, patients did not feel uncomfortable. Conclusions Skin and soft tissue defects of finger pulp at the end of finger repaired by free mini-flaps on tibial side of third toe are with good shape and slight damage to donor sites, and the operation is simple. It is worthy of popularization and application in clinic.

Objective: To explore the feasibility of preoperative designing for anterolateral femoral flap using three longitudinal and five transversal strategy. Methods: From September 2015 to January 2017, 71 patients (73 pieces) were treated using anterolateral thigh flap in the Affiliated Hospital of Zunyi Medical University. There were 48 males and 23 females, with the age of (36±18) years. The three longitudinal and five transversal designing was performed before operation. Portable Doppler ultrasound was used to detect the piercing-out position (P point) of perforators in Ⅰ, Ⅱ, Ⅲ, Ⅳ areas. The diameter, direction and length (lower subcutaneous segment of perforators) of perforators after leaving piercing-out position were observed during the operation. The piercing-in positions on superficial fascia and the dermis were observed. Results: The data of 71 adults (73 legs) were evaluated. Before and during the operation, all the perforations were found in Ⅰ, Ⅱ, Ⅲ and Ⅳ areas. The number of perforators in region Ⅰ was 1.32±0.33, with the diameter of perforator at the piercing-out position was (0.79±0.13) mm. The length of subfascial segment of perforators was (1.54±0.97) cm, and the direction was oblique superolateral. The number of perforators in Ⅱ region was 1.21±0.53, with the diameter of perforator at the piercing-out position was (0.63±0.13) mm. The length of subfascial segment of perforators was (2.25±0.54) cm, and the direction was oblique inferoanterior. The distance form piercing-in position to line L was (0.84±0.42) cm. The number of perforators in the Ⅲ area was 2.22±0.49, with the diameter of perforators at the piercing-out position was (0.53±0.12) mm. The length of subfascial segment of perforator was (1.96±0.44) cm, and the direction was oblique inferoanterior. The distance between piercing-in positions to line L was (0.74±0.51) cm. The number of perforators in region Ⅳ was 1.41±0.72, with the length of subfascial segment of perforators was (1.22±0.45) cm and the direction was oblique inferolateral. There were 27 cases with oblique perforators, accounting for 37% of the total number of thighs. Conclusions This three longitudinal and five transversal designing is helpful to detect the expenditure point in the anterolateral femoral region, and is assistant to skin flap designing.

Objective: To provide clinical guidance for clinical selection, through retrospective analysis for the advantages and disadvantages of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair. Methods: From July 2016 to January 2018, 89 cases were repaired with superficial iliac circumflex artery or lateral femoral circumflex artery perforator flap, including 32 cases of superficial circumflex iliac artery perforator flap, 18 cases of upper limb, 6 cases of face and neck, and 8 cases of lower extremity. There were 52 cases of lateral circumflex femoral artery perforator flap, 21 cases of upper limb, 2 cases of neck, 3 cases of trunk, 26 cases of lower extremity, 5 cases of superficial circumflex iliac artery perforator flap combined with lateral femoral circumflex artery perforator flap, 3 cases of upper limb and 2 cases of lower extremity. The perforators of superficial circumflex iliac artery or (and) lateral circumflex femoral artery were detected by portable Doppler flow detector before operation. According to the wound size, the superficial circumflex artery perforator flap or (and) lateral circumflex femoral artery perforator flap was or (were) designed and resected. End-to-end or end-to-side anastomosis was performed in vascular pedicle. In the combined resection group, the end-to-end or end-to-side anastomosis of the perforator of the lateral circumflex thigh artery was performed, and the pedicled part of the superficial circumflex iliac artery was used for supercharging. Results: All the flaps survived successfully except one combined flap had tip necrosis on the superficial iliac circumflex artery perforator flap part. and healed after 2 weeks of dressing change. Venous crisis occurred on the first day after operation of superficial iliac circumflex artery perforator flap in 1 case.10 cases of lateral femoral circumflex artery perforator flap were slightly bloated and 3 cases returned to hospital for secondary thinning. All the flaps were soft in texture, satisfactory in shape and function, and numbed in the small area of the donor region of the perforator flap of lateral femoral circumflex artery in the early stage. All the patients had no severe complications after follow-up. Conclusions The perforator flap of superficial iliac circumflex artery and lateral femoral circumflex artery are ideal donor areas for wound repair. The perforator flap of superficial iliac circumflex artery is preferred for small area wound, hand wound and small bone defect. Lateral circumflex femoral perforator flap is suitable for all trunk and limbs with large or complex wounds.

Exploratory experiment is the key to the experimental physiology,which is universally applicable training of innovative talents.More importantly,it is an important way to cultivate innovative talents of medicine.On the basis of the original multi-subject evaluation system,we have formed a comprehensive evaluation system through refining the scoring item for teachers and students,enriching the forms of student evaluation,and building the student self-assessment.This comprehensive evaluation system is set to promote the development of experimental physiology,especially the exploratory experiments.The practice of this evaluation system effectively improve the objectivity of the evaluation,provide a basis for reform of exploratory experiment,and then promote the training of innovative talents.

Objective: To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle. Methods: Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm×4 cm to 23 cm×10 cm. Patients were treated with debridement and vacuum sealing drainage (VSD) after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroneal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm×5 cm to 25 cm×12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side. Results: After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well. Conclusions Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.