Objective:To explore the feasibility for reconstruction of soft tissue defects in limbs and trunk with perforator pedicled kite flap, and to summarise its clinical efficacy.Methods:A retrospective study was conducted on 14 patients with soft tissue defects and admitted to the Department of Hand Microsurgery of Xiangya Hospital, Central South University from January 2016 to September 2023. Among the 14 patients (6 males and 8 females), 7 had defects in calf, 2 in sacrococcygeal area, 2 in the back and 3 in forearm. All of the defects were reconstructed with the perforator pedicled kite flaps, of which 6 flaps had the pedicles of single perforator, 3 of 2 perforators, 4 of 3 perforators and 1 of 5 perforators. Single V-Y advancement flaps were used for defect reconstruction in 8 patients, and double V-Y advancement flaps were used in 6 patients. The size of the defects ranged from 2.2 cm×1.8 cm to 8.0 cm×16.0 cm, and the size of the flaps ranged from 3.0 cm×5.5 cm to 9.0 cm×23.0 cm. All donor sites were closed directly. Postoperative follow-up was conducted at outpatient clinic, by telephone reviews and WeChat after surgery, to observe the flap survival and postoperative complications.Results:All flaps survived completely. All the flaps and donor sites healed primarily. The postoperative follow-up lasted for 3 to 36 (mean, 14.5) months. Thirteen flaps presented with soft texture, good appearance, with similar texture to the surrounding skin and without obvious swelling. The patients were satisfied with the aesthetic outcomes. One patient had a local ulcer with exudation at the recipient site and the ulcer healed after removal of the steel plate and thoroughly debridement.Conclusion:With a perforator pedicled kite flap, vascular anastomosis or sacrifice of a second donor site can be avoided. A perforator pedicled kite flap can be applied to many recipient sites, with a simple surgical procedure and a good postoperative appearance. It is an ideal flap for reconstruction of small to medium-sized soft tissue defects in trunk and limbs. More studies are required to evaluate the feasibility of the flap to be applied in local hospitals.

Objective Analyzing risk factors for prolonged ICU stay after cardiac surgery of Infective Endocarditis(IE)provides a basis for preventing extended ICU durations in postoperative IE cases.Methods From January 1,2019,to March 31,2021,a total of 223 patients with infective endocarditis who underwent cardiac surgery in the cardiac surgery department of Guangdong Provincial People's Hospital were included.Patients were divided into non-prolonged group(<3 days)and prolonged group(≥3 days)based on postoperative ICU stay duration.There were 156 cases in the non-prolonged group and 67 cases in the prolonged group.Single-factor analysis of risk factors for prolonged ICU stay was conducted using t-tests or rank-sum tests.Variables with P<0.05 in the single-factor analysis were further subjected to binary logistic regression for multivariate analysis.The accuracy of the model was evaluated using the ROC curve.Results Among the 223 patients,67 experienced prolonged ICU stay,with an incidence rate of 30%.Single-factor analysis results included gender,age,history of coronary heart disease,history of stroke,preoperative heart failure,aortic valve regurgitation area,left ventricular end-diastolic diameter,left ventricular ejection fraction(LVEF)<60%,extracorporeal circulation time,aortic cross-clamp time,use of Intra-Aortic Balloon Pump(IABP),endotracheal tube reintubation,pulmonary infection,use of Continuous Renal Replacement Therapy(CRRT),and prolonged mechanical ventilation time(>24 hours),among others.Multivariate analysis results revealed that preoperative LVEF<60%(OR=3.004,P=0.041),postopera-tive use of IABP(OR=31.686,P=0.008),and mechanical ventilation time>24 hours(OR=8.135,P<0.001)were independent risk factors for prolonged ICU stay after cardiac surgery.The model's AUC value for predicting risk factors for prolonged ICU stay was 0.858(95%CI:0.806～0.901,P<0.001).Conclusion Preoperative left ventricular ejection fraction(LVEF)<60%,the use of IABP,and mechanical ventilation time>24 hours were identified as independent risk factors for prolonged ICU stay after infective endocarditis(IE)surgery.In clinical practice,it is important to comprehensively address and manage various risk factors with the aim of reducing ICU stay duration and improving the overall success rate of the surgery.

Objective To evaluate the efficacy of hypothermia therapy in neonates with hypoxic-ischemic encephalopathy(HIE)through the analysis of amplitude-integrated electroencephalography.Methods A retrospective analysis was conducted on 59 neonates with moderate to severe HIE.They were divided into observation group(n=31,hypothermia therapy)and control group(n=28,conventional therapy)according to different treatment protocols.Chi-square test,independent sample t-test,and one-factor Mann-Whitney U test were used for intergroup difference analysis.Results Significant differences between two groups were observed in lower boundary amplitude after 24 h of treatment,sleep-awake cycle after 72 h of treatment,and total scores after 72 h of treatment(P<0.05).After 48 and 72 h of treatment,the neonates in hypothermia therapy group had obviously lower neuro-specific enolase level than those in control group(P<0.05).Conclusion Early application of hypothermia therapy can significantly improve cerebral function in neonates with HIE and lower the neuro-specific enolase level.

Objective:To examine the associations of BMI and waist circumference (WC) with the risk of chronic kidney disease (CKD) and its subtypes in adults in China.Methods:The data from the China Kadoorie Biobank were used. After excluding those with cancer, coronary heart disease, stroke, or CKD at baseline survey, 480 430 participants were included in this study. Their body height and weight, and WC were measured at baseline survey. Total CKD was defined as diabetic kidney disease (DKD), hypertensive nephropathy (HTN), glomerulonephritis (GN), chronic tubulointerstitial nephritis (CTIN), obstructive nephropathy (ON), CKD due to other causes, and chronic kidney failure. Cox proportional hazards regression model was used to estimate the associations between exposure factors and risks of outcomes.Results:During a follow-up period of (11.8±2.2) years, 5 486 cases of total CKD were identified, including 1 147 cases of DKD, 340 cases of HTN, 1 458 cases of GN, 460 cases of CTIN, 598 cases of ON, 418 cases of CKD due to other causes, and 1 065 cases of chronic kidney failure. After adjusting for socio-demographic factors, lifestyle factors, baseline prevalence of hypertension and diabetes, and WC and compared to participants with normal BMI (18.5-23.9 kg/m 2), the hazard ratios ( HRs) of total CKD for underweight (<18.5 kg/m 2), overweight (24.0-27.9 kg/m 2), and obese (≥28.0 kg/m 2) were 1.42 (95% CI: 1.23-1.63), 1.00 (95% CI: 0.93-1.08) and 0.98 (95% CI: 0.87-1.10), respectively. Stratification analysis by WC showed that BMI was negatively associated with risk for total CKD in non-central obese participants (WC: <85.0 cm in men and <80.0 cm in women) ( HR=0.97, 95% CI: 0.96-0.99), while the association was positive in central obese participants (≥90.0 cm in men and ≥85.0 cm in women) ( HR=1.03, 95% CI: 1.01-1.05). The association between BMI and GN was similar to that of total CKD. BMI was associated with an increased risk for HTN, with a HR of 1.12 (95% CI: 1.06-1.18) per 1.0 kg/m 2 higher BMI. After adjusting for potential confounders and BMI, compared to participants with non-central obesity, the HRs for pre-central obesity (WC: 85.0-89.9 cm in men and 80.0-84.9 in women) and central obesity were 1.26 (95% CI: 1.16-1.36) and 1.32 (95% CI: 1.20-1.45), respectively. With the exception of HTN and CTIN, WC was positively associated with risks for all CKD subtypes. Conclusions:BMI-defined underweight and central obesity were independent risk factors for total CKD, and BMI and WC had different associations with risks for disease subtypes.

Objective:To explore the efficiency of radial collateral artery perforator flap to reconstruct defects of thumb web contracture release.Methods:The data of patients with moderate to severe thumb web contracture treated with radial collateral artery perforator flap from September 2018 to September 2022 in Department of Orthopedics-Hand Microsurgery of Xiangya Hospital, Central South University were analyzed retrospectively. A skin flap with the radial collateral artery perforating point as the center and the line connecting the deltoid muscle insertion point and the apex of the humeral lateral condyle as the axis were designed before surgery. During the operation, the skin scar in the thumb web area was first removed, and the contracted tissues such as deep fascia and muscles were loosened. Then, a skin flap was harvested along the design line and transferred to the recipient site. After vascular and nerve anastomosis under a microscope, the incision was intermittently sutured and a drainage tube was placed. The blood flow of the flap and complication were monitored closely. In the last follow-up, the distance and angle of thumb web were observed; the appearance, sensory recovery (excellent, good, moderate, and poor) and the hand function (S0 level to S4 level represented feeling no recovery to complete recovery) were evaluated.Results:A total of 8 patients were included, including 7 males and 1 female, aged 23-56 years (average of 40.3 years old). The distance of thumb web was 20-38 mm (average 26.9 mm), and the angle was 22°-36° (average 27.4°) before surgery. Five hands were classified as severe thumb web contracture, and 3 hands were moderate. The sizes of perforator flap were from 5.5 cm×3.5 cm-13.0 cm×6.5 cm. Seven flaps survived uneventfully and venous congestion occurred in 1 flap. After exploration, the flap survived completely. Primary healing of wounds occurred in the donor and recipient areas. Postoperative follow-up ranged from 6 months to 2.5 years (average 13.6 months). In the last follow-up, the distance of thumb web was 48-63 mm (average 57.1 mm), and the angle was 40°-52° (average 44.8°) post-operation. Thumb web function evaluation: excellent in 5 cases and good in 3 cases. All patients were satisfied with the thumb web. Sensory recovered to S3 in 3 cases, S2 in 4 cases and S1 in 1 case. The donor site healed well, leaving scars. There was no radial nerve damage, and elbow joint movement was normal.Conclusion:The radial collateral artery perforator flap has reliable blood supply, relatively simple operation and the appearance and function of thumb web restored well postoperatively. The application of radial collateral artery perforator flap is an effective procedure to repair the thumb web contracture.

Objective:To explore the efficiency of radial collateral artery perforator flap to reconstruct defects of thumb web contracture release.Methods:The data of patients with moderate to severe thumb web contracture treated with radial collateral artery perforator flap from September 2018 to September 2022 in Department of Orthopedics-Hand Microsurgery of Xiangya Hospital, Central South University were analyzed retrospectively. A skin flap with the radial collateral artery perforating point as the center and the line connecting the deltoid muscle insertion point and the apex of the humeral lateral condyle as the axis were designed before surgery. During the operation, the skin scar in the thumb web area was first removed, and the contracted tissues such as deep fascia and muscles were loosened. Then, a skin flap was harvested along the design line and transferred to the recipient site. After vascular and nerve anastomosis under a microscope, the incision was intermittently sutured and a drainage tube was placed. The blood flow of the flap and complication were monitored closely. In the last follow-up, the distance and angle of thumb web were observed; the appearance, sensory recovery (excellent, good, moderate, and poor) and the hand function (S0 level to S4 level represented feeling no recovery to complete recovery) were evaluated.Results:A total of 8 patients were included, including 7 males and 1 female, aged 23-56 years (average of 40.3 years old). The distance of thumb web was 20-38 mm (average 26.9 mm), and the angle was 22°-36° (average 27.4°) before surgery. Five hands were classified as severe thumb web contracture, and 3 hands were moderate. The sizes of perforator flap were from 5.5 cm×3.5 cm-13.0 cm×6.5 cm. Seven flaps survived uneventfully and venous congestion occurred in 1 flap. After exploration, the flap survived completely. Primary healing of wounds occurred in the donor and recipient areas. Postoperative follow-up ranged from 6 months to 2.5 years (average 13.6 months). In the last follow-up, the distance of thumb web was 48-63 mm (average 57.1 mm), and the angle was 40°-52° (average 44.8°) post-operation. Thumb web function evaluation: excellent in 5 cases and good in 3 cases. All patients were satisfied with the thumb web. Sensory recovered to S3 in 3 cases, S2 in 4 cases and S1 in 1 case. The donor site healed well, leaving scars. There was no radial nerve damage, and elbow joint movement was normal.Conclusion:The radial collateral artery perforator flap has reliable blood supply, relatively simple operation and the appearance and function of thumb web restored well postoperatively. The application of radial collateral artery perforator flap is an effective procedure to repair the thumb web contracture.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective:To compare the clinical efficacy of laparoscopic and open surgery in the treatment of hepatocellular carcinoma (HCC) at specific sites of liver.Methods:Data of patients with HCC undergoing hepatectomy in Mengchao Hepatobiliary Hospital of Fujian Medical University from September 2014 to May 2019 were retrospective analyzed. A total of 205 patients were enrolled, including 174 males and 31 females, aged (56.7±11.3) years. According to the surgical methods, patients were divided into laparoscopic group ( n=105) and open group ( n=100). The Child-Pugh score, maximum tumor diameter, tumor location, intraoperative blood loss, postoperative complication rate, liver function(glutamate transaminase, alanine transaminase, etc.) and length of hospital stay were compared between the two groups. Postoperative survival and recurrence were followed up. Survival curves and rates were analyzed by Kaplan-Meier and log-rank test. Results:There were no significant differences in Child-Pugh score, maximum tumor diameter, tumor location between the two groups. Compared to the open group, the laparoscopic group had a decreased blood loss [100 (50, 200) ml vs 150 (100, 200) ml], a lower incidence of postoperative complications[7.6%(8/105) vs 17.0%(17/100)], and a shorter hospital stay [(8.6±1.9) days vs (13.0±3.4) days](all P<0.05). The postoperative glutamate transaminase and alanine transaminase levels were lower in the laparoscopic group than those in the open group. The 1, 3, 5-year overall survival and recurrence-free survival were not significantly different between the two groups (χ 2=0.56, 0.21, P=0.456, 0.648). Conclusion:Laparoscopic surgery in the treatment of HCC at specific sites of liver is a safe, feasible and effective procedure.

ObjectiveTo compare the efficacy and safety of acupuncture combined with auricular acupoints patches and nicotine transdermal patch in treating moderate to severe nicotine dependence. MethodsIn a rando-mized controlled trial， 64 quit smoking voluntary subjects with moderate to severe nicotine dependence were randomly divided at a ratio of 1∶1 into a treatment group and a control group， with 32 cases in each group. The treatment group was given acupuncture combined with auricular acupoints patches， twice weekly， four weeks as a course for two courses. The control group was given nicotine transdermal patch， one patch per day for 24 hours， 8 weeks. The cure rate was assessed after treatment and at follow-up （the 16th week after treatment）.The daily smoking volume， exhaled carbon monoxide （CO） value， Nicotine Dependence Scale （FTND）， Minnesota Nicotine Withdrawal Symptoms Scale （MNWS）， and Pittsburgh Sleepiness Index Inventory （PSQI） were evaluated before and after treatment and at follow-up， and adverse effects were recorded. ResultsIn terms of the cure rate， there were both six cured cases （20%） after treatment and at follow-up in the treatment group， while in the control group， seven （23.3%） and five （16.7%） patients were cured after treatment and at follow-up， respectively， with no statistically significant differences between the two groups both after treatment and at follow-up （P＞0.05）. The daily smoking volume and exhaled CO value significantly decreased after treatment and at follow-up in both groups （P＜0.05）， but were not significantly different between the groups after treatment and at follow-up （P＞0.05）. After treatment and at follow-up， FTND， MNWS， and PSQI scores were significantly reduced in both groups compared with those before treatment （P＜0.05）. There was no statistically significant difference in the FTND scale scores between the two groups after treatment and at follow-up （P＞0.05）， while the MNWS and PSQI scale scores were lower in the treatment group than in the control group （P＜0.05）. ConclusionAcupuncture combined with auricular acupoint patches for moderate to severe nicotine dependence has comparable effect with the first-line drug nicotine patch in terms of increasing the cure rate and decreasing the degree of nicotine dependence， and is superior to nicotine patch in terms of relieving withdrawal symptoms and improving sleep， with stable long-term effect.

Objective:Based on the method of metabonomics, the intervention effect of Dingchuan decoction on neutrophilic asthma and its possible mechanism were analyzed from the changes of endogenous metabolites.Methods:Forty C57BL/6 mice were randomly divided into five groups: normal group (group A), neutrophilic asthma model group (group B), Dingchuan decoction low dose treatment group (group C), Dingchuan decoction medium dose treatment group (group D), and Dingchuan decoction high dose treatment group (group E), with 8 mice in each group.B/C/D/E group used ovalbumin (OVA) and complete Freund′s adjuvant (CFA) to induce sensitized mice to establish neutrophilic asthma model, and C/D/E group used Dingchuan decoction with different concentrations of crude drugs for intervention treatment.Buxco small animal lung function tester was used to evaluate the airway reactivity of mice; The total number of white blood cells in bronchoalveolar lavage fluid (BALF) was counted by counting plate, and the number was classified by cell smear staining; The pathological changes of lung tissue were observed by hematoxylin and eosin (HE) staining.The serum metabolites of mice in each group were detected by high performance liquid chromatography coupled with four pole time of flight mass spectrometry (UPLC-Q-TOF-MS/MS). The commonly used principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), orthogonal partial least squares discriminant analysis (OPLS-DA) models were used for statistical analysis of the metabolite profiles in serum. The intervention effect of Dingchuan decoction and its possible mechanism were reflected from the changes of endogenous metabolites.Results:(1) General behavior observation: except mice in group A, mice in other groups showed asthma symptoms of different degrees during the challenge period. The symptoms of mice in each treatment group (group C, D, E) of Dingchuan decoction were less than those in group B. (2) Airway reactivity: the airway reactivity of mice in group B to methacholine (MCh) increased with the inhalation concentration, and the airway resistance at each concentration of MCh was significantly higher than that in group A (all P<0.01); the airway reactivity in group C, D and E was lower than that in group B (all P<0.01); the airway reactivity in group D and E was lower than that in group C (all P<0.05). There was no significant difference in airway reactivity between group D and E ( P>0.05). (3) Airway inflammatory cell infiltration: the total number of white blood cells (WBC) and percentage of neutrophil in BALF of group B were significantly higher than those of group A (all P<0.01). The total WBC and percentage of neutrophil in group C, D and E were lower than those in group B (all P<0.01). The total number of WBC and percentage of neutrophil in group D and E were lower than those in group C (all P<0.01). There was no significant difference between group D and group E (all P>0.05). (4) Pathological changes of lung tissues: no pathological changes were observed in the lung tissues of group A mice. In group B, typical pathological changes such as bronchial lumen stenosis, intraluminal mucosal folds hyperplasia, epithelial cell exfoliation, swelling, mucous embolus, alveolar and lung tissue structure destruction, massive inflammatory cell infiltration around bronchus and blood vessels were observed, among which neutrophil and lymphocyte infiltration were the most obvious. The damage of lung tissue structure, bronchial mucosa edema and inflammatory cell infiltration in Dingchuan decoction treatment groups were significantly improved compared with group B, and the pathological changes of lung tissue in group D were relatively light. (5) Metabolomics analysis: PCA, PLS-DA and OPLS-DA analysis of serum metabolites in each group showed that serum metabolites in group A and group B were significantly different. The metabolic pathway analysis showed that Dingchuan decoction with different crude drug concentrations could improve the metabolic disorders caused by asthma in different degrees. Conclusions:Dingchuan decoction can effectively reduce airway inflammation and airway hyperresponsiveness in mice with neutrophil asthma, and effectively regulate metabolic abnormalities caused by neutrophil asthma.