Objective:To discusses the feasibility and clinical efficacy of the chimeric musculocutaneous flap pedicled with a superior gluteal artery perforator (SGAP) in treatment of Grade Ⅳ pressure sore around ischial tuberosity.Methods:A retrospective case study was conducted on 8 patients with Grade Ⅳ pressure sores around ischial tuberosity and treated in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University from May 2019 to June 2023. The patients included 5 males and 3 females, aged 66.8 (40-78) years. All patients had paraplegia for 2 months to 10 years (mean, 59.2 months) and were complicated with hypoproteinemia. Two of the patients were also with sepsis. History of the Grade Ⅳ pressure sore was up to 1 month to 3.5 years (mean, 19.3 months). The sores were located on the right hip in 5 patients and left hip in 3 patients. The tissue defects of the pressure sore measured at 5 cm×5 cm to 6 cm×9 cm in size and all extended to the ischial tuberosity. Chimeric musculocutaneous flaps pedicled with a SGAP were used in the treatment of defect. The flap size ranged from 4 cm×8 cm to 7 cm×15 cm, and the muscular flap were at 8 cm×4 cm×2 cm to 14 cm×7 cm×5 cm in size. The muscular flaps were used to fill the cavities formed by the ulcer, while the flaps were used to cover the wounds. Donor and recipient site were sutured directly. The postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews, and focused on evaluations of flap survival, complications, flap appearance and the recurrence of ulcer.Results:All the 8 flaps survived. All patients were included in the 3 to 16 months of postoperative follow-up, with 11.8 months in average. One flap had a partial edge split due to excessive pressure during negative pressure drainage, and healed after debridement and re-suture. Otherwise, the rest of 7 patients had primary healing at both the donor and recipient sites. All flaps had good appearance without ulceration, infection or recurrence of pressure sore.Conclusion:The chimeric musculocutaneous flap pedicled with SGAP offers a reliable blood supply, flexible rotation and sufficient tissue volume. It can be used to effectively reconstruct Grade Ⅳ pressure sore around ischial tuberosity with a reliable clinical effect.

Objective:To investigate the surgical technique and clinical outcomes of the tri-lobed chain medial plantar perforator flaps for reconstruction of soft tissue defects in palmar hand.Methods:A retrospective analysis was conducted on 6 patients (4 males and 2 females; aged 21-63 years with mean age of 39.2 years) who had soft tissue defects in palmar hands and were reconstructed with tri-lobed chain medial plantar perforator flaps in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University between July 2024 and April 2025. All defects were located on palmar aspect of the injured hands. Following admission, debridement, fracture reduction and fixation and tendon repairs were carried out in primary surgery for 5 patients who had traumatic injuries with digital or metacarpal fractures and tendon ruptures, and stage-II surgery for soft tissue reconstruction was conducted at 7-9 days later. The patient with scar contracture received preoperative evaluation then followed by a scar excision and release surgery, prior to a reconstructive surgery for soft tissue defects. Four patients presented with multi-site defects, of whom, 1 patient had proximal phalangeal defects of index and middle fingers and a defect of metacarpophalangeal joint of ring finger, 1 patient had a defect of metacarpophalangeal joint of index finger and defects of proximal phalanges of middle and ring fingers, 1 patient had defects of proximal phalanges of index, middle and little fingers, and 1 patient had defects of proximal phalanges of middle, ring and little fingers. Of the patients with finger defects, the sizes of defect ranged from 2.0 cm ×1.8 cm to 6.0 cm×2.8 cm and the defects were reconstructed with individually harvested tri-lobed chain medial plantar perforator flaps. Two patients had soft tissue defects in palmar hands and they were measured at 6.0 cm×5.5 cm and 6.0 cm×7.0 cm in size. The palmar defects were reconstructed using combined tri-lobed chain flaps with the sizes of individual lobulated flap ranging from 2.1 cm×1.9 cm to 6.0 cm×2.9 cm. All foot donor sites were primarily closed with interrupted sutures. Postoperative management included routine anti-inflammatory, anticoagulant and antispasmodic treatment. Patients were discharged at 8-10 days after surgery and the postoperative follow-ups were conducted at outpatient clinic to monitor flap survival, contour, hand function, donor site healing, scar formation and foot function.Results:All flaps survived with primary healing of donor sites. Over the 1 to 9 (mean 6.1) months of postoperative follow-up, all flaps survived well with colour and thickness matching with the surrounding hand skin. At 6 months after surgery, two-point discrimination (TPD) of flaps achieved to 8-11 (mean 8.6) mm. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved function recovery of fingers in excellent and 2 in good. Donor sites exhibited linear scars without painful scarring or paraesthesia, with normal ankle function and gaits.Conclusion:Tri-lobed medial plantar perforator flaps can be used to reconstruct soft tissue defects in palmar hand with primary and direct closure of the flap donor sites. They can simultaneously reconstruct multiple or a large defects, and provide satisfactory aesthetic and functional outcomes. It is a feasible surgical option.

Objective:To investigate the effect of donor blood lipid levels and the degree of fat deposition on the pancreatic surface on the outcome of islet isolation.Method:A retrospective analysis was conducted on 171 cases of islet isolation data from organ donors between May 2015 and December 2024. According to the percentage of fat deposition area on the surface of the pancreatic capsule after trimming, the samples were divided into three groups: mild surface fat group (<30%, 60 cases) , moderate surface fat group (30%–70%, 55 cases) , and severe surface fat group (>70%, 56 cases). The modified Ricordi method was used to digest pancreatic tissue, and islets were purified by continuous density gradient centrifugation. The digestion efficiency, digestion time, islet yield (islet equivalent/quantity) , purity, score, and size were analyzed and compared among groups. One-way ANOVA was used for inter-group comparisons, and Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between blood lipid levels and islet isolation parameters.Result:The severe surface fat group had significantly higher pre-purification and post-purification islet equivalents, islet number, amount of digested pancreatic tissue, donor triglyceride levels, and low density lipoprotein (LDL) levels than the other groups (all P<0. 05) . Correlation analysis showed that LDL level was positively correlated with pre-purification islet equivalents (62 cases, r=0. 298, P=0. 019) and islet number (58 cases, r=0. 285, P=0. 030) . Donor high density lipoprotein (HDL) level was negatively correlated with post-purification islet equivalents (54 cases, r= – 0. 282, P=0. 039) ; donor triglyceride level was positively correlated with the amount of digested tissue (56 cases, r=0. 268, P=0. 046) and negatively correlated with purity (51 cases, r= - 0. 297, P=0. 035) ; donor very low density lipoprotein (VLDL) level was positively correlated with the amount of digested tissue (67 cases, r=0. 337, P=0. 005) and negatively correlated with purity (61 cases, r=- 0. 348 , P=0. 006) ; donor total cholesterol level was negatively correlated with pancreatic digestion efficiency (34 cases, r= - 0. 370, P=0. 032) , and the above differences were all statistically significant. Conclusion:Pancreata with heavier surface fat deposition can yield a higher number of islets. Meanwhile, donor blood lipid levels are correlated with islet isolation outcomes and can serve as important indicators for donor pancreas selection.

BACKGROUND:Neuroinflammation is a major cause of exacerbation after spinal cord injury.In recent years,pyroptosis has received much attention due to its remarkable pro-inflammatory features.Some of these natural products can significantly inhibit the inflammatory response and improve the damaged nerve function by regulating the level of pyroptosis after spinal cord injury,which provides a new therapeutic idea for spinal cord injury.OBJECTIVE:To summarize the mechanism of action of natural products in regulating pyroptosis for the treatment of spinal cord injury,with a view to providing lessons and references for future research on the treatment of spinal cord injury.METHODS:The search terms"spinal cord injury,pyroptosis,inflammasome,natural products,natural compounds,traditional Chinese medicine"in Chinese and English were used to search for relevant literature since the establishment of the database up to September 2024 in the databases of PubMed,Web of Science,WanFang,and CNKI.According to the inclusion and exclusion criteria,75 relevant articles were finally obtained.RESULTS AND CONCLUSION:(1)Pyroptosis is an important pro-inflammatory pathway in spinal cord injury,and controlling pyroptosis is an effective way to improve damaged nerve function.(2)Some natural products can regulate pyroptosis via the NLRP3/Caspase-1 classical pyroptosis pathway,the NF-κB-related pathway,other upstream pathways such as Nrf2/HO-1,and autophagy,thereby affecting the level of tissue inflammation and accelerating neurological recovery after spinal cord injury.(3)The anti-pyroptosis effects of these natural products are mostly dependent on the NLRP3 classical pyroptosis pathway,and there is a lack of studies on other pyroptosis pathways.(4)There are still many problems in this field,such as the fact that these natural products are not currently supported by evidence from appropriate clinical studies.(5)The natural product has great potential in regulating pyroptosis and is expected to be a powerful weapon in the treatment of spinal cord injury.

BACKGROUND:Neuroinflammation is a major cause of exacerbation after spinal cord injury.In recent years,pyroptosis has received much attention due to its remarkable pro-inflammatory features.Some of these natural products can significantly inhibit the inflammatory response and improve the damaged nerve function by regulating the level of pyroptosis after spinal cord injury,which provides a new therapeutic idea for spinal cord injury.OBJECTIVE:To summarize the mechanism of action of natural products in regulating pyroptosis for the treatment of spinal cord injury,with a view to providing lessons and references for future research on the treatment of spinal cord injury.METHODS:The search terms"spinal cord injury,pyroptosis,inflammasome,natural products,natural compounds,traditional Chinese medicine"in Chinese and English were used to search for relevant literature since the establishment of the database up to September 2024 in the databases of PubMed,Web of Science,WanFang,and CNKI.According to the inclusion and exclusion criteria,75 relevant articles were finally obtained.RESULTS AND CONCLUSION:(1)Pyroptosis is an important pro-inflammatory pathway in spinal cord injury,and controlling pyroptosis is an effective way to improve damaged nerve function.(2)Some natural products can regulate pyroptosis via the NLRP3/Caspase-1 classical pyroptosis pathway,the NF-κB-related pathway,other upstream pathways such as Nrf2/HO-1,and autophagy,thereby affecting the level of tissue inflammation and accelerating neurological recovery after spinal cord injury.(3)The anti-pyroptosis effects of these natural products are mostly dependent on the NLRP3 classical pyroptosis pathway,and there is a lack of studies on other pyroptosis pathways.(4)There are still many problems in this field,such as the fact that these natural products are not currently supported by evidence from appropriate clinical studies.(5)The natural product has great potential in regulating pyroptosis and is expected to be a powerful weapon in the treatment of spinal cord injury.

Objective:To discusses the feasibility and clinical efficacy of the chimeric musculocutaneous flap pedicled with a superior gluteal artery perforator (SGAP) in treatment of Grade Ⅳ pressure sore around ischial tuberosity.Methods:A retrospective case study was conducted on 8 patients with Grade Ⅳ pressure sores around ischial tuberosity and treated in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University from May 2019 to June 2023. The patients included 5 males and 3 females, aged 66.8 (40-78) years. All patients had paraplegia for 2 months to 10 years (mean, 59.2 months) and were complicated with hypoproteinemia. Two of the patients were also with sepsis. History of the Grade Ⅳ pressure sore was up to 1 month to 3.5 years (mean, 19.3 months). The sores were located on the right hip in 5 patients and left hip in 3 patients. The tissue defects of the pressure sore measured at 5 cm×5 cm to 6 cm×9 cm in size and all extended to the ischial tuberosity. Chimeric musculocutaneous flaps pedicled with a SGAP were used in the treatment of defect. The flap size ranged from 4 cm×8 cm to 7 cm×15 cm, and the muscular flap were at 8 cm×4 cm×2 cm to 14 cm×7 cm×5 cm in size. The muscular flaps were used to fill the cavities formed by the ulcer, while the flaps were used to cover the wounds. Donor and recipient site were sutured directly. The postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews, and focused on evaluations of flap survival, complications, flap appearance and the recurrence of ulcer.Results:All the 8 flaps survived. All patients were included in the 3 to 16 months of postoperative follow-up, with 11.8 months in average. One flap had a partial edge split due to excessive pressure during negative pressure drainage, and healed after debridement and re-suture. Otherwise, the rest of 7 patients had primary healing at both the donor and recipient sites. All flaps had good appearance without ulceration, infection or recurrence of pressure sore.Conclusion:The chimeric musculocutaneous flap pedicled with SGAP offers a reliable blood supply, flexible rotation and sufficient tissue volume. It can be used to effectively reconstruct Grade Ⅳ pressure sore around ischial tuberosity with a reliable clinical effect.

Objective:To investigate the surgical technique and clinical outcomes of the tri-lobed chain medial plantar perforator flaps for reconstruction of soft tissue defects in palmar hand.Methods:A retrospective analysis was conducted on 6 patients (4 males and 2 females; aged 21-63 years with mean age of 39.2 years) who had soft tissue defects in palmar hands and were reconstructed with tri-lobed chain medial plantar perforator flaps in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University between July 2024 and April 2025. All defects were located on palmar aspect of the injured hands. Following admission, debridement, fracture reduction and fixation and tendon repairs were carried out in primary surgery for 5 patients who had traumatic injuries with digital or metacarpal fractures and tendon ruptures, and stage-II surgery for soft tissue reconstruction was conducted at 7-9 days later. The patient with scar contracture received preoperative evaluation then followed by a scar excision and release surgery, prior to a reconstructive surgery for soft tissue defects. Four patients presented with multi-site defects, of whom, 1 patient had proximal phalangeal defects of index and middle fingers and a defect of metacarpophalangeal joint of ring finger, 1 patient had a defect of metacarpophalangeal joint of index finger and defects of proximal phalanges of middle and ring fingers, 1 patient had defects of proximal phalanges of index, middle and little fingers, and 1 patient had defects of proximal phalanges of middle, ring and little fingers. Of the patients with finger defects, the sizes of defect ranged from 2.0 cm ×1.8 cm to 6.0 cm×2.8 cm and the defects were reconstructed with individually harvested tri-lobed chain medial plantar perforator flaps. Two patients had soft tissue defects in palmar hands and they were measured at 6.0 cm×5.5 cm and 6.0 cm×7.0 cm in size. The palmar defects were reconstructed using combined tri-lobed chain flaps with the sizes of individual lobulated flap ranging from 2.1 cm×1.9 cm to 6.0 cm×2.9 cm. All foot donor sites were primarily closed with interrupted sutures. Postoperative management included routine anti-inflammatory, anticoagulant and antispasmodic treatment. Patients were discharged at 8-10 days after surgery and the postoperative follow-ups were conducted at outpatient clinic to monitor flap survival, contour, hand function, donor site healing, scar formation and foot function.Results:All flaps survived with primary healing of donor sites. Over the 1 to 9 (mean 6.1) months of postoperative follow-up, all flaps survived well with colour and thickness matching with the surrounding hand skin. At 6 months after surgery, two-point discrimination (TPD) of flaps achieved to 8-11 (mean 8.6) mm. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved function recovery of fingers in excellent and 2 in good. Donor sites exhibited linear scars without painful scarring or paraesthesia, with normal ankle function and gaits.Conclusion:Tri-lobed medial plantar perforator flaps can be used to reconstruct soft tissue defects in palmar hand with primary and direct closure of the flap donor sites. They can simultaneously reconstruct multiple or a large defects, and provide satisfactory aesthetic and functional outcomes. It is a feasible surgical option.

Objective:To investigate the effect of donor blood lipid levels and the degree of fat deposition on the pancreatic surface on the outcome of islet isolation.Method:A retrospective analysis was conducted on 171 cases of islet isolation data from organ donors between May 2015 and December 2024. According to the percentage of fat deposition area on the surface of the pancreatic capsule after trimming, the samples were divided into three groups: mild surface fat group (<30%, 60 cases) , moderate surface fat group (30%–70%, 55 cases) , and severe surface fat group (>70%, 56 cases). The modified Ricordi method was used to digest pancreatic tissue, and islets were purified by continuous density gradient centrifugation. The digestion efficiency, digestion time, islet yield (islet equivalent/quantity) , purity, score, and size were analyzed and compared among groups. One-way ANOVA was used for inter-group comparisons, and Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between blood lipid levels and islet isolation parameters.Result:The severe surface fat group had significantly higher pre-purification and post-purification islet equivalents, islet number, amount of digested pancreatic tissue, donor triglyceride levels, and low density lipoprotein (LDL) levels than the other groups (all P<0. 05) . Correlation analysis showed that LDL level was positively correlated with pre-purification islet equivalents (62 cases, r=0. 298, P=0. 019) and islet number (58 cases, r=0. 285, P=0. 030) . Donor high density lipoprotein (HDL) level was negatively correlated with post-purification islet equivalents (54 cases, r= – 0. 282, P=0. 039) ; donor triglyceride level was positively correlated with the amount of digested tissue (56 cases, r=0. 268, P=0. 046) and negatively correlated with purity (51 cases, r= - 0. 297, P=0. 035) ; donor very low density lipoprotein (VLDL) level was positively correlated with the amount of digested tissue (67 cases, r=0. 337, P=0. 005) and negatively correlated with purity (61 cases, r=- 0. 348 , P=0. 006) ; donor total cholesterol level was negatively correlated with pancreatic digestion efficiency (34 cases, r= - 0. 370, P=0. 032) , and the above differences were all statistically significant. Conclusion:Pancreata with heavier surface fat deposition can yield a higher number of islets. Meanwhile, donor blood lipid levels are correlated with islet isolation outcomes and can serve as important indicators for donor pancreas selection.

Specific tumor-targeted gene delivery remains an unsolved therapeutic issue due to aberrant vascularization in tumor microenvironment (TME). Some bacteria exhibit spontaneous chemotaxis toward the anaerobic and immune-suppressive TME, which makes them ideal natural vehicles for cancer gene therapy. Here, we conjugated ZIF-8 metal-organic frameworks encapsulating eukaryotic murine interleukin 2 (Il2) expression plasmid onto the surface of VNP20009, an attenuated Salmonella typhimurium strain with well-documented anti-cancer activity, and constructed a TME-targeted Il2 delivery system named Il2/ZIF-8@Salmonella. Both in vitro and in vivo experiments demonstrated that Il2/ZIF-8@Salmonella maintained the tumor-targeting feature of bacteria, and could be effectively phagocytosed by intratumoral macrophages, thus leading to the expression and secretion of IL2 in TME. The detailed analysis of tumor immune microenvironment (TIME) showed that one dose of combinatorial Il2/ZIF-8@Salmonella achieved synergistic actions on a potent remodeling of TIME, marked by the activation of cytotoxic T cells and M1-polarization of macrophages in TME, thus leading to significant anti-tumor effects in melanoma, orthotopic hepatocellular carcinoma, and pulmonary metastasis models. More importantly, Il2/ZIF-8@Salmonella exhibited high safety to major organs and hematopoietic systems. Taken together, we report a novel plasmid/ZIF-8@Salmonella system that simultaneously achieves effective TME-targeted delivery of therapeutic gene, as well as synergistic re-activation of TIME.

Objective:To investigate the changes of β-cell dedifferentiation in type 2 diabetes mellitus(T2DM) and aging subjects.Methods:Using pancreatic samples from 12 prediabetic individuals, 21 type 2 diabetic patients, and 27 control, the level of β-cell dedifferentiation was assessed by immunofluorescence staining for FOXO1 and insulin expression. Correlation analyses were performed between β-cell dedifferentiation levels and hemoglobin A 1C(HbA 1C) level in 60 human pancreatic samples. Correlation analyses were performed between β-cell dedifferentiation levels and age in non-diabetic and T2DM. Results:FOXO1 was mainly expressed in the cytoplasm of human islet β-cells. The proportion of FOXO1 -INS + /INS + cells in T2DM significantly increased compared with control and pre-diabetes, and positively correlated with HbA 1C level( r=0.623, P<0.001). The proportion of FOXO1 -INS + /INS + cells in the young group of T2DM was significantly higher than that in the non-diabetic young and elderly groups, and further significantly increased in elderly group. In T2DM, the proportion of FOXO1 -INS + /INS + cells was positively correlated with age( r=-0.53, P<0.05). Conclusion:Hyperglycemia and aging lead to an increased level of β-cell dedifferentiation in T2DM.