Objective:To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers.Methods:The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded.Results:During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints.Conclusions:The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.

Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgi-cal specimens were included,including 193 pure mucinous car-cinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and im-mune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the me-dian tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67＞20％tumors(P＜0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2％)were T1-T2,and the proportions of MC component in all 6 MMCs were all ≥ 50％.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6％of cases(34/119)had LN involvement,and 16.8％(20/119)of cases showed high proliferative activity(Ki67＞20％).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,inclu-ding 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5％and 98.6％,respectively.PMC had a better prognosis than MMC(DFS:95.2％vs.90.6％;OS:99.5％vs.97.2％),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P＜0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different ev-olutionary pathways,that MC with precursor lesions of MLL and SPC have a good prognosis,and MC associated with high-grade DCIS are more aggressive.LN involvement,higher clinical grade,and younger age are associated with poor prognosis.Focu-sing on precursor lesions and high risk clinicopathological fea-tures can contribute to providing more effective treatments for these patients.

Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgi-cal specimens were included,including 193 pure mucinous car-cinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and im-mune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the me-dian tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67＞20％tumors(P＜0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2％)were T1-T2,and the proportions of MC component in all 6 MMCs were all ≥ 50％.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6％of cases(34/119)had LN involvement,and 16.8％(20/119)of cases showed high proliferative activity(Ki67＞20％).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,inclu-ding 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5％and 98.6％,respectively.PMC had a better prognosis than MMC(DFS:95.2％vs.90.6％;OS:99.5％vs.97.2％),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P＜0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different ev-olutionary pathways,that MC with precursor lesions of MLL and SPC have a good prognosis,and MC associated with high-grade DCIS are more aggressive.LN involvement,higher clinical grade,and younger age are associated with poor prognosis.Focu-sing on precursor lesions and high risk clinicopathological fea-tures can contribute to providing more effective treatments for these patients.

Objective:To introduce a surgical method and clinical effect of using Masquelet technique combined with skin graft to cover chronic refractory wounds in elderly patients.Methods:From September 2020 to September 2022, 20 elderly patients with wounds of bone or tendon exposure in lower limbs were treated in the Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University. Due to the age and poor general condition of the patients, flap transfer for wound coverage were not allowed. Masquelet technique was therefore applied in the treatment of chronic wounds of such patients. Sizes of wounds were found at 4.5 cm×3.0 cm to 15.0 cm×6.0 cm and all accompanied with tendon and bone exposure, after thorough debridement. Wounds were then sealed with antibiotic bone cement several times. After having induced formation of membrane in wounds, free mesh skin graft was used to cover the refractory wounds. The patients were entered in follow up regularly after surgery at outpatient service, and telephone or video reviews. The wound healing of patients and whether there were related complications in the skin donor area were observed. The number of operation times in the first stage was 1-4 with an average of 1.3 times ± 0.7 times. Lower Extremity Function Scale (LEFS) was used to evaluate the recovery of lower limb function.Results:All 20 wounds healed well. The follow-up time was 3-12 months, with an average of 7.6 months. The appearance and texture of the skin in the wounds area were satisfactory. The mean LEFS was 69.83 point ± 10.82 point.Conclusion:Using Masquelet technique combined with free skin grafting to treat refractory wounds in the elderly patients can achieve satisfactory clinical outcomes. It is a simple and reliable supplement to the wound repair, and can reduce the surgical risk.

Objective To investigate the effect of MOTOmed intelligent training system training on balance and lower limb motor function in stroke patients. Methods 120 stroke patients were randomly divided into observation group (n=60) and control group (n=60) according to the random number table. Both groups were treated with routine rehabilitation training, the observation group received MOTOmed intelligent training system in addition. They were evaluated with Fugl-Meyer assessment (FMA), Functional Ambulation Category (FAC), Barthel index (BI), Motricity index (MI-L), modified Ashworth scale (MAS) and Berg balance scale (BBS) before and 4, 8, 12 weeks after treatment. Results There was no difference in the score of FMA, BI, MI-L, BBS, MAS, FAC and the maximum walking speed, stride length and stride frequency between 2 groups before treatment (P>0.05). The scores of FMA, BI, MI-L, BBS, FAC and the maximum walking speed stride length and stride frequency increased in the observation group and there was a uptrend 4 weeks, 8 weeks and 12 weeks after treatment (P<0.05). The score of MAS decreased in the observation group and there was a downtrend after treatment (P<0.05). All the indexes were better in the observation group than in the control group (P<0.05). Conclusion MOTOmed training system combined with routine rehabilitation training can improve the balance and lower limb motor function in stroke patients.

Objective To investigate the expression of metabotropic glutamate receptor (mGluR) in murine podocytes.Methods Conditional immortalized podocytes were used in the research.RT-PCR was used to estimate the mRNA expression.Western blotting,immunofluorescence staining and immunoelectron microscopy were employed to determine the protein production.EIA,EMSA and Western blotting were used to examine the cAMP generation and cAMP response element-binding protein (CREB) activation.Intracellular calcium was investigated using confocal microscopy.Results mGluR1 and 5 mRNA and protein were expressed in murine brain and podocytes.In glomeruli,most of mGluR1 expression located in podocytes and was expressed in the submembrane space of the podocytes.Podocytes treated with (S)-3,5-dihydroxyphenylglycine (DHPG,an agonist for mGluR1/5) rapidly generated cAMP and activated CREB.(RS)-1-Aminoindan-1,5-dicarboxylic acid (AIDA,a selective antagonist of mGluR1/5) and SQ22536 (an adenylate cyclase inhibitor),but not 2-aminoethoxydiphenyl borate (2-APB an antagonist of canonical transient receptor potential) blocked DHPG-induced cAMP generation and CREB activation.Following DHPG treatment,intracellular calcium level rose and was prevented by pre-treatment with AIDA and 2-APB.DHPG-induced calcium influx was also prevented by incubation with calcium-free medium.Conclusion Podocytes express functional mGluR1 and mGluR5.