Objective:To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital, and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods:A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca, including transport constant(K trans), rate constant(K ep), percent volume of the extravascular extracellular space(V e)and fraction of the Intraplasmic contrast volume(V p), were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum, maximum, median, mean, area, 10 thpercentile, 25 thpercentile, 75 thpercentile and 90 thpercentile.The correlations between quantitative parameters and GS, and diagnostic efficiencies were analyzed. Results:102 Pca patients were divided into low-grade prostate cancer group(GS≤3+ 4)(n=44)and high-grade Pca group(GS≥4+ 3)(n=58). There were no statistically significant differences in age and location of lesions between the two groups( P>0.05), but there were statistically significant differences in Gleason score, PSA level and lesion diameter between the two groups( U=0.000, 730.000, 711.000, all P<0.05). The median, mean, 10 thpercentile, 25 thpercentile, 75 thpercentile, 90 thpercentile derived from K trans, and K ep(median, mean, 10%, 25%, 75%, 90%)together with maximum of K transand mean for V e were positively correlated with GS( r=0.405 to 0.583, P<0.05), in which mean of K transhad the highest positive correlation( r=0.583, P=0.000). The histogram parameters derived from V pwere negatively correlated with GS( r=-0.301 to 0.341, P<0.05). The area under ROC of 75th percentile derived from K transwas the highest(0.832). When the cut-off value of 75 thpercentile derived from K transwas ≥0.680/min, its Youden index, sensitivity, and specificity were 0.594, 0.776, 0.818, respectively. Conclusions:The three-dimensional histogram of DCE-MRI quantitative parameters has correlation with GS in Pca patients, can be used to discriminate low-grade from high-grade Pca.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:Report the nursing process of a patient with extensive degloving injuries who accept repeatedly replanted in the partial necrosis area after skin grafting merge wound infection.Methods:The main points: after patient admitted to hospital initiate first aid treatment and prepare the surgery; manage the blood volume, prevention and monitoring of wound infection at early postoperative; and positive nutrition support and avoid defecate contaminated wounds, early activity and rehabilitation at late postoperative phases.Results:Under careful treatment and care, after three months, all the skin grafts survived and scar healing.Conclusions:On the basis of life support system and skin grafting, taking positive measures to control the wound infection and promote skin survival, had played an important role in the treatment of this case.

The management of healthcare services for the suspected cases in non-designated hospitalsis a serious concern in controlling coronavirus disease 2019 (COVID-19) epidemic. Owing to the complexity of care providers, large requirement of medical supplies as well as the possible needs off frequent transfers, the major difficulty is preventing the coronavirus from spreading while caring the suspected critical cases before the 2019 novel coronavirus ribonucleic acid test results are reported. For the purpose of enhancing the prevention of the propagation of COVID-19, this article puts emphasis on the following aspects in non-designated hospital Peking University Third Hospital: preparatory procedures of receiving critical suspected patients, the management of medical personnel during the waiting session of RNA test results, the delivering procedures of testing samples, the management of referred medical wastes, daily operations including the cleaning and sanitizing of caring units and the management of related patients after the testing session.

Objective To investigate the application of expanded local flap in repairing extremity scars.Methods Thirty patients with extremity scars contracture as a result of trauma,surgery or infection during July 2000 and March 2013 were included.There were 11 male and 19 female patients with age ranging from 11 to 34 years.Tissue expansion,scar resection,flap transfer and scar management were involved in this process.Results There 24 patients suffered from upper extremity scars and 6 patients suffered from lower extremity scars.Expander exposure was noted in 3 patients,and 3 patients suffered from infection during the expansion.During the 6-month to 1-year follow-up,all patients satisfied with the results in terms of the skin texture,color,flexibility after the treatment with expanded local skin flap.Conclusions The expanded local flaps are suitable for the repair of the longitudinal and oblique scars in the extremities.

Objective To observe the effect of botulinum toxin type A (BTX-A) on the rate of skin expansion and the immediate retract rate of skin flaps in rats,and to explore new methods for drug-assisted skin expansion.Methods 18 Sprague-Dawley rats were randomly divided into two groups.After BTX-A or normal saline was injected intradermally into the back marking area,an expander was implanted.The expanders were inflated periodically by injecting normal saline to reach the designated intraexpander pressure.The inflation volume was recorded and the area of marked region was measured regularly.After 4 weeks of expansion,the expanded tissues were harvested and the immediate retract rates were measured.The hematoxylin-eosin staining was performed to observe the thickness of epidermis,dermis and the fibrous capsule,while Masson staining for detection of fibrous capsule collagen.Immunohistochemical staining with α-smooth muscle actin for myofibroblasts was also performed.Results The mean inflation volume and area of marked region of BTX-A group were significantly greater than those of the control group.There were lower immediate retract rate,thinner fibrous capsule,less collagen content and fewer α-SMA positive myofibroblasts in the fibrous capsule of the BTX-A group with statistically significant differences (P ＜ 0.05).There was no signigicant difference in the thicknesses of epidermis and dermis between the two groups (P＞0.05).Conclusions BTX-A can inhibit the formation of fibrous capsule to promote skin expansion,while reducing the immediate retract rate.It possess a potential for assisting effectively skin expansion.

Objective To investigate the application of the frontal branch of superficial temporal vessels pedicled flap in repairing lower eyelid ectropion.Methods Eight cases were collected from patients diagnosed with lower eyelid ectropion in our hospital from April 2012 to April 2015.In phase 1 of operation,the dilators were implanted into the frontal branch of superficial temporal vessels and fully expanded by normal saline injection;In phase 2,the scar of lower eyelid was incised,and the expanded forehead flaps were transferred to cover the wound after the lower eyelid released back to normal anatomy location;In phase 3,the flap delay operation was manipulated 3 weeks after phase 2,and the left wound after scar excision was finished by pedicle division 1 week later.Results All patients in the study showed a good appearance and function of lower eyelid.There were no complications such as flap congestion and necrosis occurred.Meantime there were no relapses observed according to the follow-ups ranging from 6 months to 1 year.Conclusions The application of the frontal branch of superficial temporal vessels pedicled flap shows a promising procedure in treatment of lower eyelid ectropion.

Objective To study the clinical efficacies of different surgical palliative treatments for patients with advanced pancreatic carcinoma.Methods A retrospective analysis was conducted on the clinical data of 119 patients with advanced pancreatic carcinoma who were treated in the department of General Surgery of Linyi's Central Hospital from January 2010 to January 2016.According to the different surgical methods the patients received,they were divided into the seed group (n =38),the radiofrequency ablation (RF) group (n =52) and the control group (n =29).Patients' general data,operation data,postoperative complications and follow-up profiles were analyzed.Results There was no significant difference in the patients'general data among the three groups of patients (P ＞ 0.05).The incidences of postoperative complication in the seed group,the RF group and the control group were 55.3％,38.5％ and 20.7％,respectively.There was significant differences between the incidences of postoperative complications between the seed group and the control group (P ＜ 0.05).There was no perioperative death.The postoperative follow-up rate was 91.6％.Pain in the seed group and the RF group significantly improved,while it was not significantly improved in the control group.There were significant differences in the postoperative pain scores (P ＜0.05).The 6 months,1-year and 2-year overall survival rates were 61.3％,25.9％,8.6％ respectively.The median survival was 8 months.In the seed group,the 6 months,1-year and 2-year survival rates were 75.2％,37.8％,18.9％ respectively.The median survival was 9 months.In the RF group,the 6 months,1-year and 2-year survival rates were 60.4％,25％,6.3％ respectively.The median survival was 8 months.In the control group,the 6 months,1-year and 2-year survival rates were 53.4％,15.3％,3.8％ respectively.The median survival was 6.5 months.On log-rank test,there was no significant difference in survival rates among the three groups (P =0.145).Conclusions Patients with advanced pancreatic carcinoma had poor prognosis.I125 radioactive particles implantation and radiofrequency ablation were useful to improve patients'quality of life and prolonged their survival.

Objective To discuss the repairing methods of the wound after upper lip lesion excision.Methods The wound after upper lip lesion excision was repaired by expanded pedicled submental flap.The 3 cm-long incision was located in 1 cm to sub-mandible.The 100 ml expander was placed beneath the platysma,and the aqueducts and spigots of the expanders were laid out of the skin.After complete expansion,the spastic scars of the upper lip and nasal bottom were resolved,the nasal columella and upper lip were put back to the normal position.The pedicled submental flap was transferred to the wound after upperlip excision according to the size of the wound.The pedicle was severed after 3 weeks.Results There were 5 cases of the expanded pedicled submental flap to repair the wound after upper lip excision.The flap survived without complications.The appearances were satisfied by the patients.Conclusions The method of the expanded submental flap is suitable for the wound after upper lip excision.