OBJECTIVE: To investigate the effectiveness of posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair. METHODS: Between December 2018 and December 2023, 16 patients with the maxillary malignant tumors were admitted. There were 10 males and 6 females, with an average age of 64.3 years (range, 54-75 years). There were 7 cases of maxillary gingival cancer, 5 cases of hard palate cancer, and 4 cases of maxillary sinus cancer. According to the 2017 American Joint Committee on Cancer (AJCC) TNM stage, there were 8 cases of stage Ⅲ, 6 cases of stage Ⅳa, and 2 cases of stage Ⅳb. After resection of the lesion, the remaining maxillary defects were classified into class Ⅱa in 3 cases, class Ⅱb in 5 cases, and class Ⅲb in 8 cases according to Brown's classification. The size of soft tissue defects ranged from 4 cm×3 cm to 8 cm×6 cm. The posterior lateral perforator flap in lower limb in size of 5 cm×4 cm-9 cm×7 cm were harvested to repair soft tissue defects, and free fibula in length of 6-11 cm were used to repair bone defects. The donor sites of the lower limb were sutured directly (6 cases) or repaired with free skin grafting (10 cases). Six patients with positive lymph node pathology were treated with radiotherapy after operation. At 6 and 12 months after operation, the self-assessment was performed by the University of Washington Quality of Survival Questionnaire Form (QUW-4) in five dimensions (facial appearance, swallowing function, chewing function, speech function, and mouth opening), and swallowing function was evaluated by using the Kubota water swallowing test. RESULTS: Postoperative pathological examination showed that all patients were squamous cell carcinoma. One patient who was treated with radiotherapy developed osteomyelitis and 1 patient developed venous crisis of skin flap. The rest of the flaps and all skin grafts survived, and the wounds healed by first intention. All patients were followed up 1-5 years (mean, 2.8 years). Two patients died of local recurrence of the tumor at the 4th and 5th years after operation, respectively. Except for the chewing function score and total score at 6 months after operation, which showed significant differences compared to preoperative scores ( P<0.05), there was no significant difference in other QUW-4 scale scores between different time points ( P>0.05). The patients' swallowing function evaluated by Kubota water swallowing test reached normal in 4 cases, suspicious in 9 cases, and abnormal in 3 cases at 6 months after operation, and 10, 6, and 0 cases at 12 months after operation, respectively. The swallowing function at 12 months was significantly better than that at 6 months ( Z=-2.382, P=0.017). CONCLUSION The posterior lateral perforator flap in the lower limb combined with free fibula to repair maxillary tissue defects can repair soft and hard tissue defects at the same time, so that the patient's facial appearance, swallowing function, chewing function, speech function, and mouth opening are satisfactorily restored and the mid-term effectiveness is good.
Humans ; Middle Aged ; Male ; Female ; Fibula/surgery* ; Aged ; Perforator Flap ; Plastic Surgery Procedures/methods* ; Maxilla/surgery* ; Maxillary Neoplasms/surgery* ; Free Tissue Flaps/transplantation* ; Lower Extremity/surgery* ; Bone Transplantation/methods* ; Treatment Outcome

ObjectiveTo explore the biological mechanism of drought improving the quality of Rhizoma Atractylodis Chinensis and establish a new method for the production of high-quality medicinal materials. MethodThe fresh roots of Atractylodes chinensis were soaked in 0 （control）， 5%， 10%， and 20% PEG-6000 solutions. The changes in reactive oxygen species （ROS） level， antioxidant enzyme activity， activities of key enzymes in primary metabolism and secondary metabolism， and content of secondary metabolites were compared. ResultCompared with the control group， the treatment with 20% PEG for 2 days elevated the levels of superoxide anion radicals （O2-·）， hydrogen peroxide （H₂O₂）， and malondialdehyde （MDA） by 172.5%， 56.9%， and 14.7%， respectively. The treatment did not change the activity of superoxide dismutase （SOD）， reduced the peroxidase （POD） activity， and increased the catalase （CAT） activity by 10.8%. It increased the activities of 3-hydroxy-3-methylglutaryl-CoA reductase （HMGR）， phosphoenolpyruvate carboxylase （PEPC）， and acetyl-CoA carboxylase （ACC） by 49.9%， 12.1%， and 19.0%， respectively. Furthermore， the content of atractylodin， β-eudesmol， atractylone， and atractylenolide Ⅱ was increased by 51.0%， 36.9%， 47.1%， and 91.5%， respectively. The simulated drought stress can cause the burst of ROS in the fresh roots of A. chinensis， induce the physiological state of plants under drought， change the antioxidant system， and promote the massive synthesis of secondary metabolites in a short time. ConclusionPEG-6000-simulated drought stress can greatly improve the quality of A. chinensis in cultivation.

ObjectiveTo investigate the effect of exogenous H₂O₂ on secondary metabolism in Atractylodes chinensis and its mechanism. MethodFresh rhizomes of A. chinensis were treated with 5.0， 1.0， 0.2， 0.04 mmol·L^-1 H₂O₂ solution and clean water， and the relationships between the contents of reactive oxygen species， activities of antioxidant enzymes， activities of key enzymes of secondary metabolites， and contents of secondary metabolites in A. chinensis were compared. ResultUnder treatment with exogenous H₂O₂， the content of reactive oxygen species and malondialdehyde （MDA） in the fresh rhizomes of A. chinensis were significantly elevated on the 4th day， and returned to normal level on the 6th-8th day. The activities of superoxide dismutase （SOD）， catalase （CAT） and peroxidase （POD） were all increased first and then decreased， and reached the peak on the 4th， 4^th-6^th and 2^th-4^th day， respectively. The activities of 3-hydroxy-3-methyl glutaryl coenzyme A reductase （HMGR） and acetyl CoA carboxylase （ACC）， key enzymes of the secondary metabolites， were remarkably enhanced， and under treatments with different concentrations of H₂O₂， the activities of key synthetic enzymes of the secondary metabolites in 0.2 mmol·L^-1 H₂O₂ group were increased most， with the highest biosynthesis of secondary metabolites. The contents of atractylodin， β-eudesmol， atractylone， atractylenolide Ⅱ， and atractylenolide Ⅲ on the 6th day of 0.2 mmol·L^-1 H₂O₂ treatment were 89.5%， 108.7%， 308.8%， 64.7% and 9.3%， respectively higher than those in the control. ConclusionThe antioxidant enzymes and secondary metabolites in A. chinensis synergistically maintain the balance of reactive oxygen species， and exogenous H₂O₂ can improve the medicinal quality of A. chinensis remarkably.

Objective To systematically evaluate the risk factors for ovarian metastasis of endometrial carcinoma(EC) to provide an evidence-based medicine basis for formulating the EC surgical mode and ovarian metastatic risk.Methods Studies about the risk factors for EC ovarian metastasis were retrieved by computer from the Pubmed,Embase,Cochrane Library,WanFang database,CNKI,China Biology Medicine(CBM) from Jan.1,1990 to Sep.1,2016.The quality evaluation of included literature was performed by using the Newcastle-Ottawa Scale(NOS).Results A total of 13 studies were included,involving 6 140 EC patients,of whom 344 cases(5.60％) had ovarian metastasis.The Meta analysis results showed that a total of 9 factors had statistical significance,which were deep myometrial infiltration(OR =0.28,95 ％ CI:0.21-0.39),cervical involvement (OR =0.27,95 ％ CI:0.16-0.45),lymph node involvement (OR =0.21,95 ％ CI:0.15-0.27),fallopian tube involvement (OR =0.05,95 ％ CI:0.02-0.10),non-endometrioid adenocarcinoma(OR=0.32,95％CI:0.24-0.43),low differentiation(OR=0.39,95％CI:0.31-0.50),positive ascites cytologic detection(OR=0.14,95％CI:0.09-0.20),high serum CA125 level(OR=0.12,95％CI:0.08-0.19) and lymphovascular cancer embolus(OR =0.34,95 ％ CI:0.23-0.50),the differences were statistically significant(P＜0.05).But the age,lesion location,lesion diameter and estrogenic receptor level had no statistical difference(P＞0.05).Conclusion Deep myometrial infiltration,cervical involvement,lymph node involvement,fallopian tube involvement,non-endometrioid adenocarcinoma,low differentiation and positive ascites cytologic detection,high CA125 level and lymphovascular cancer embolus are the risk factors for EC ovarian metastasis.

Objective To compare the curative effect of laparoscopic and laparotomic operation for elderly Chinese women with cervical cancer. Methods The randomized controlled trials (RCT) and case controlled trials (CCT) were collected by searches of WanFang database, CNKI, VIP, China Biology Medicine (CBM) , PubMed. Data were extracted from these trials and data analysis was performed by RevMan 5.2.9. Results There were no RCTs, however, a total of 10 CCTs met the inclusion criteria and had data extracted for this review. The baseline characteristics of the laparoscopic group were similar to those of the laparotomic group. Comparing to laparotomic group, the laparoscopic group have longer operation time (MD =32.60, 95%CI: 5.65~59.55, P = 0.020), less amount of bleeding (MD = -94.01, 95%CI: -130.65 ~ -57.37, P = 0.000), smaller number of lymph node dissection(MD = 1.69, 95%CI: 0.67 ~ 2.72, P = 0.001), earlier anus exhaustion (MD=-17.09, 95%CI: -21.19 ~ -12.98, P = 0.000) and shorter hospital stays (MD = -4.30, 95%CI: -5.57 ~ -3.02, P = 0.000). There was significant difference between the two groups. But there was no statistical significance in postoperative indwelling catheter time (MD = -0.67, 95%CI: -1.92 ~ 0.58, P = 0.290) and surgical complications incidence (OR=0.62, 95%CI: 0.27 ~ 1.42, P = 0.260) between the two groups. Conclusion Laparoscopic management has the advantages of less traumatic and recovered quickly, and did not increase the incidence of complications. Laparoscopic operation is an ideal procedure for elderly Chinese women with cervical carcinoma.

Objective To investigate the effect of electro-acupuncture pretreatment on content of interleukin (IL)-1βand IL-6 in serum and ischemic penumbra, and apoptosis in ischemic penumbra in rats after cerebral ischemia-reperfusion injury. Methods Thirty-six male Sprague-Dawley rats were randomly divided into sham group (n=12), model group (n=12), and electro-acupuncture pretreatment group (n=12). The middle cerebral arteries were occluded for 120 minutes and reperfused. Twenty-four hours after reperfusion, the level of IL-1βand IL-6 in serum and brain tissue was detected with enzyme-linked immunosorbent, and apoptosis of ischemic penumbra was detected with TU-NEL. Results The content of IL-1βand IL-6 in the serum and brain tissue, and the number of TUNEL-positive cells decreased in the elec-tro-acupuncture pretreatment group compared with that in the model group (P<0.01). Conclusion Electro-acupuncture pretreatment may in-hibit inflammatory response and apoptosis in cerebral ischemia-reperfusion injury.

Objectives:To evaluate essential medicines accessibility from the availability, drug price level and affordability perspective in Beijing. Methods:Data was collected from a sample of a Beijing social security database on diabetes in 2013 and a field research on 4 primary healthcare institutions. The essential medicine equipping rate, medium price ratio ( MPR) and poverty-inducing effect were selected as accessibility indicators. Results:Among 21 sample drugs, the nitrendipine, magnesium sulfate, sodium nitroprusside, prazosin, phentolamine and glyburide e-quipping rates are less than 15%. The 9 sample drugs MPR varied from 1. 3 to 27. 4. The hypertension, hyper-lipemia and diabete poverty-inducing rate varied from 0. 44% to 0. 70% in urban areas, and varied from 1. 17% to 1. 88% in rural areas. Conclusion:Some essential medicines in Beijing are equipped with a very low rate, but have a high price level, and the poverty-inducing population is large. We recommend strengthening the monitoring of es-sential medicines accessibility and introducing appropriate supporting policies.

Hypoxic-ischemic brain damage is a serious complication of perinatal asphyxia. Enriched environment is the living condi-tions for the promotion of feeling, cognition and behavior. Enriched environment may promote the repairing of hypoxic-ischemic brain dam-age in term of praxiology, morphology and molecular biology, that enriched environment may regulate the secretion and release of various factors, and enhance synaptic plasticity, induce neuron regeneration, inhibit its apoptosis, and result in ethological and morphological recov-ery.

Objective To study the effect of cluster needling of scalp acupuncture combined with rehabilitation on neurological function and expression of basic fibroblast growth factor (bFGF) and angiostatin (AS) in rats after focal cerebral ischemia. Methods 90 male Sprague-Dawley rats were randomly divided into sham operation group, model group, acupuncture treatment group, rehabilitation treatment group and acupuncture and rehabilitation treatment group, each group was further divided into 3 days, 7 days and 14 days subgroups (n=6). Permanent cerebral ischemia rat model was established according to Longa's method. The model group and the sham operation group accepted no treatment, the acupuncture treatment group was treated by cluster needling of scalp acupuncture, the rehabilitation treatment group received the treadmill training, the acupuncture and rehabilitation treatment group was treated by acupuncture and rehabilitation therapy. 3 days, 7 days, 14 days after operation, the neural function was evaluated with the modified Neurological Severity Score (mNSS), the expression levels of bFGF and AS proteins were detected by Western blotting. Results Compared with the model group, the acupuncture treatment group and the rehabilitation treatment group, mNSS decreased, the expression of bFGF protein increased, and the expression of AS protein decreased in the acupuncture and rehabilitation treatment group 3 days, 7 days, 14 days after operation (P<0.05). Conclusion Acupuncture and rehabilitation therapy can reduce the neurological function defect in rats with focal cerebral ischemia, which may be related to the upregulation of bFGF protein expression and down-regulation of AS protein expression.