Objective:To investigate the clinical effect of the modified vertical rectus abdominis myocutaneous flap in repairing the skin and soft tissue defect after abdominoperineal resection for rectal cancer.Methods:This study was a retrospective observational study. From June 2019 to July 2022, five male patients with low rectal cancer who were conformed to the inclusion criteria were admitted to the Department of Basic Surgery of Xiangya Hospital of Central South University, with ages ranging from 65 to 70 years and the sizes of the perianal skin ulcers ranging from 5 cm×4 cm to 11 cm×9 cm, and all of them underwent abdominoperineal resection. The secondary skin and soft tissue defects in the perineum with an area of 8 cm×6 cm-14 cm×12 cm (with the depth of pelvic floor dead space being 10-15 cm) were repaired intraoperatively with transplantation of modified vertical rectus abdominis myocutaneous flaps with the skin area being 9 cm×7 cm-16 cm×12 cm, the volume of the muscle being 18 cm×10 cm×5 cm-20 cm×12 cm×5 cm, and the vessel pedicle being 18-20 cm in length. During the operation, most of the anterior sheath of the rectus abdominis muscle was retained, the flap was transferred to the recipient area through the abdominal cavity, the remaining anterior sheaths of the rectus abdominis muscle on both sides of the donor area were repeatedly folded and sutured, the free edge of the transverse fascia of the abdomen was sutured with the anterior sheath of the rectus abdominis muscle, and the donor area skin was directly sutured. After the operation, the survival of the transplanted myocutaneous flap was observed. The occurrence of complications in the perineal recipient area was recorded within 2 weeks after the operation. The recovery of the perineal recipient area and the abdominal donor area was observed during follow-up, and the occurrence of complications in the donor area of the abdomen as well as the recurrence of tumors and metastasis were recorded.Results:All transplanted myocutaneous flaps in 5 patients survived after surgery. One patient had dehiscence of the incision in the perineal recipient area 2 days after surgery, which healed after 7 d with intermittent dressing changes and routine vacuum sealing drainage treatment. In the other 4 patients, no complications such as incisional rupture, incisional infection, or fat liquefaction occurred in the perineal recipient area within 2 weeks after surgery. Follow-up for 6-12 months after discharge showed that the skin of the perineal recipient area had good color, texture, and elasticity, and was not bloated in appearance; linear scars were left in the perineal recipient area and the abdominal donor area without obvious scar hyperplasia or hyperpigmentation; no complications such as incisional rupture, incisional infection, intestinal adhesion, intestinal obstruction, or weakening of the abdominal wall strength occurred in the abdominal donor area, and the abdominal appearance was good with no localized bulge or formation of abdominal hernia; there was no local recurrence of tumor or metastasis in any patient.Conclusions:The surgical approach of using the modified vertical rectus abdominis myocutaneous flap to repair the skin and soft tissue defects after abdominoperineal resection for rectal cancer is relatively simple in operation, can achieve good postoperative appearances of the donor and recipient areas with few complications, and is worthy of clinical promotion.

BACKGROUND:Stable intertrochanteric fractures can be treated by closed reduction and internal fixation,but there is no absolute advantage for unstable intertrochanteric fractures with osteoporosis. OBJECTIVE:To investigate the efficacy of arthroplasty in the treatment of unstable intertrochanteric fractures in the elderly with osteoporosis by comparing the indexes related to closed reduction internal fixation and arthroplasty. METHODS:Clinical data of 102 elderly patients with unstable intertrochanteric fractures of the femur treated in Affiliated Hospital of Qingdao University from January 2017 to January 2020 were retrospectively analyzed.Patients were divided into two groups according to the surgical method.In the Gamma3 group,62 cases received Gamma3 internal fixation system.In the joint replacement group,40 cases received an artificial femoral head replacement or total hip replacement.Surgical information,hospitalization,hip function,and postoperative complications were compared between the two groups. RESULTS AND CONCLUSION:(1)There were statistical differences between the Gamma3 group and the joint replacement group in weight-bearing time(P＜0.001),hospital stay(P＜0.05),intraoperative bleeding(P＜0.001),and length of surgery(P＜0.001).The mean weight-bearing time and hospital stay were shorter in the joint replacement group than in the Gamma3 group.Intraoperative bleeding and duration of surgery were better in the Gamma3 group than in the joint replacement group.(2)There was no significant difference in Harris hip score,subitem centesimal hip score,and postoperative complications 12 months after surgery in both groups(P=0.526,0.788,0.228).(3)It is indicated that arthroplasty has achieved better outcomes in the treatment of elderly unstable intertrochanteric fractures combined with osteoporosis,enabling early weight bearing and functional exercise.Careful selection of the appropriate patient and prosthesis type for arthroplasty will result in greater patient benefit.

BACKGROUND:Electrospun porous nanofiber exhibits excellent properties and designability.It is an effective way to control the release of traditional Chinese medicine and improve the bioavailability to design an advanced drug delivery system,which has a broad application prospect. OBJECTIVE:To review the construction methods of the electrospinning drug delivery system of traditional Chinese medicine and its related research progress in the medical field. METHODS:The literature search was performed in CNKI,PubMed,and Web of Science databases with the search terms"electrospinning,traditional Chinese medicine,drug carrier,drug delivery system,tissue engineering,dressing"in both English and Chinese for articles published from 2013 to 2023.Finally,62 articles were included in this review. RESULTS AND CONCLUSION:(1)The key elements of the electrospinning drug delivery system of Chinese medicine preparation are substrate material,traditional Chinese medicine composition,and drug loading method.(2)The preparation of the electrospinning drug delivery system of Chinese medicine can be carried out according to the application scenario and therapeutic purpose.Firstly,the types of Chinese medicine are selected,then the polymer matrix and solution suitable for them are selected,and finally,the fiber structure is designed according to the drug release requirements and the appropriate drug loading method is adopted.(3)At present,the medicinal agents used are mainly plant Chinese medicine,and there is a lack of systematic research on animal and mineral Chinese medicine.(4)Blended drug loading is the most studied and applied drug loading method,and its drug release characteristics and adaptation scenarios are constantly expanded by optimizing the physicochemical properties of the solution and selecting the diversity of loaded substances.Multilayer fibers with different compositions and properties can be prepared by coaxial,multi-axis,and sequential electrospinning methods,which have broad development prospects.(5)The early application of the electrospinning drug delivery system of Chinese medicine focused on medical dressings according to the antibacterial and hemostatic functions.In recent years,it has been studied in the field of tissue engineering because some components of traditional Chinese medicine can promote cell adhesion,proliferation,and differentiation.(6)At present,the research mainly focuses on the characterization and optimization of loading materials,processes,physicochemical properties,and biological properties,but the research on the mechanism is less.Its clinical application has not been widespread;the adverse reactions in vivo and the interaction between its degradation behavior and drug release behavior are still unknown.(7)Future studies need to consider:We should expand the application of Chinese medicine by improving the physicochemical properties and increasing the purification of Chinese medicine extracts.We need to comprehensively study the therapeutic effects and application mechanisms of Chinese medicine,and clarify the interaction of degradation behavior and drug release behavior,to achieve a more perfect combination and application of Chinese medicine and electrospinning nanofibers under a more accurate mechanism.

OBJECTIVES: Staphylococcus epidermidis (S. epidermidis) is a Gram-positive opportunistic pathogen that often causes hospital infections. With the abuse of antibiotics, the resistance of S. epidermidis gradually increases, and drug repurposing has become a research hotspot in the treating of refractory drug-resistant bacterial infections. This study aims to study the antimicrobial and antibiofilm effects of simeprevir, an antiviral hepatitis drug, on S. epidermidis in vitro. METHODS: The micro-dilution assay was used to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of simeprevir against S. epidermidis. Crystal violet staining assay was used to detect the biofilm inhibitory effect of simeprevir. The antimicrobial activity of simeprevir against S. epidermidis and its biofilm were explored by SYTO9/PI fluorescent staining. The combined effect between simeprevir and gentamycin was assessed by checkerboard assay and was confirmed by time-inhibition assay. RESULTS: Simeprevir showed significant antimicrobial effects against S. epidermidis type strains and clinical isolates with the MIC and MBC at 2-16 μg/mL and 4-32 μg/mL, respectively. The antimicrobial effects of simeprevir were confirmed by SYTO9/PI staining. Simeprevir at MIC could significantly inhibit and break the biofilm on cover slides. Similarly, simeprevir also significantly inhibit the biofilm formation on the surface of urine catheters either in TSB [from (0.700±0.020) to (0.050±0.004)] (t=54.03, P<0.001), or horse serum [from (1.00±0.02) to (0.13±0.01)] (t=82.78, P<0.001). Synergistic antimicrobial effect was found between simeprevir and gentamycin against S. epidermidis with the fractional inhibitory concentration index of 0.5. CONCLUSIONS Simeprevir shows antimicrobial effect and anti-biofilm activities against S. epidermidis.
Humans ; Simeprevir ; Antiviral Agents ; Anti-Bacterial Agents/pharmacology* ; Cross Infection ; Gentamicins

【Objective】 To investigate the relationship between maternal oral health behavior during pregnancy and premature birth. 【Methods】 A total of 248 preterm and 700 non-preterm pregnant women who delivered in Northwest Women’s and Children’s Hospital in Shaanxi Province from January to December 2022 were included in case group and control group, respectively. General demographic characteristics and oral health behavior during pregnancy were collected by questionnaires, and the oral health impact profile-14 (OHIP-14) was used to assess the oral health related life quality of pregnant women. Logistic regression model was used to analyze the relationship between maternal oral health behavior during pregnancy and premature birth. 【Results】 During pregnancy, maternal frequent eating after brushing teeth (OR=1.62, 95% CI: 1.03-2.57), unused fluoride toothpaste (OR=2.03, 95%CI: 1.25-3.05), late visit to the doctor for oral discomfort (OR=1.41, 95%CI: 1.02-1.96), brushing teeth less than twice one day (OR=1.77, 95%CI: 1.13-2.78) or less than 3 minutes each time (OR=1.52, 95%CI: 1.09-2.11), and elevated OHIP-14 score (OR=1.07, 95%CI: 1.04-1.10) increased the risk of premature birth. 【Conclusion】 Poor oral health behavior during pregnancy may increase the risk of premature birth. Therefore, more efforts should be made to publicize oral health knowledge and guide pregnant women to establish good oral health habits so as to improve oral health and promote maternal and child health.

Acute Achilles tendon rupture (AATR) is one of the most common sport injuries in clinical practice, which is usually treated surgically or non-surgically. Regardless of treatment choice, early weight bearing should be encouraged to promote tendon healing. After ruptured Achilles tendon is healed, permanent defects in the biomechanical function of the patients′ affected lower limbs are found and performance in running, jumping, and competitive sports is affected, which may be due to a decrease in the flexion strength of the ankle as a result of tendon elongation following the repair of an Achilles tendon. The methods for evaluating tendon elongation can be divided into indirect measurement and direct measurement. Achilles tendon resting angle (ATRA) is the most commonly used and reliable indirect measurement index, while ultrasound and MRI are commonly used for direct measurement. However, there is no recommended "gold standard" at present. Among the potential influencing factors of tendon elongation, the choice of surgical or non-surgical treatment, different tendon suturing methods and start time of weight bearing have attracted attention and are still controversial. The authors reviewed the research progress of tendon elongation's effects on lower limb biomechanics, evaluation of tendon elongation, and factors affecting tendon elongation so as to provide reference for clinical diagnosis and treatment as well as related researches.

Diastasis recti abdominis (DRA) is common in postpartum women. DRA seriously affects the physiological and psychological health of patients. Rehabilitation is the main intervention for DRA. It is necessary to clarify the effectiveness of different rehabilitation intervention. Neuromuscular electrical stimulation and exercise therapy can effectively optimize DRA in postpartum period, but the best intervention is not clear. Multi-center researches with large sample should be conducted to compare the treatment parameters in the future.

Objective    To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. Methods    The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. Results    The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). Conclusion    Robotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.

Metformin is currently a strong candidate anti-tumor agent in multiple cancers. However, its anti-tumor effectiveness varies among different cancers or subpopulations, potentially due to tumor heterogeneity. It thus remains unclear which hepatocellular carcinoma (HCC) patient subpopulation(s) can benefit from metformin treatment. Here, through a genome-wide CRISPR-Cas9-based knockout screen, we find that DOCK1 levels determine the anti-tumor effects of metformin and that DOCK1 is a synthetic lethal target of metformin in HCC. Mechanistically, metformin promotes DOCK1 phosphorylation, which activates RAC1 to facilitate cell survival, leading to metformin resistance. The DOCK1-selective inhibitor, TBOPP, potentiates anti-tumor activity by metformin in vitro in liver cancer cell lines and patient-derived HCC organoids, and in vivo in xenografted liver cancer cells and immunocompetent mouse liver cancer models. Notably, metformin improves overall survival of HCC patients with low DOCK1 levels but not among patients with high DOCK1 expression. This study shows that metformin effectiveness depends on DOCK1 levels and that combining metformin with DOCK1 inhibition may provide a promising personalized therapeutic strategy for metformin-resistant HCC patients.
Animals ; Antineoplastic Agents/therapeutic use* ; Carcinoma, Hepatocellular/metabolism* ; Cell Line, Tumor ; Clustered Regularly Interspaced Short Palindromic Repeats ; Genome ; Humans ; Liver Neoplasms/metabolism* ; Metformin/therapeutic use* ; Mice ; Phosphorylation ; Synthetic Lethal Mutations ; Transcription Factors/metabolism* ; rac GTP-Binding Proteins/metabolism*

【Objective】 To explore the factors influencing newborn birth weight under the universal two-child policy in Xi’an so as to provide information for maternal health. 【Methods】 For this study we selected the mothers who delivered babies at Xi’an Northwest Women’s and Children’s Hospital from May 2018 to November 2019. Their data included maternal demographic characteristics， delivery mode， and infants’ outcomes. Single factor analysis and multi-factor linear regression methods were used to analyze the factors influencing the birth weight of newborns of different age and mothers’ parity after the universal two-child policy. 【Results】 The newborns’ average birth weight was （3 377±449） g. The incidence of low birth weight and macrosomia was 7.4% and 2.5%， respectively. Multivariate linear regression analysis showed that gestational week of delivery （β=0.322， P<0.001）， gender （β=0.135， P<0.001）， pre-pregnancy BMI （β=0.148， P<0.001）， weight gain during pregnancy （β=0.144， P<0.001） all affected the birth weight of the newborns. In addition， in the dummy variable group， the birth weight of second-born mothers of right age （β=0.115， P<0.001） and second-born mothers （β=0.077， P=0.001） were significantly higher in elder age group than in the primipara of right age group （P<0.05）. The birth weight of the primipara in elder age group did not significantly differ from that of the primipara in right age group （P>0.05）. 【Conclusion】 Maternal women should do a good job in pre-pregnancy assessment， control pre-pregnancy weight， and gain reasonable weight during pregnancy. The community and hospitals should strengthen pre-pregnancy health education so as to scientifically and effectively improve maternal and infant outcomes.