OBJECTIVE To investigate the targeting effect of folic acid-modified crebanine nanoparticles （FA-Cre@PEG- PLGA NPs， hereinafter referred to as “NPs”） combined with ultrasound irradiation on M109 cells in vitro and in vivo after administration， and explore the anti-tumor mechanism. METHODS CCK-8 assay was used to detect the inhibitory effect of NPs combined with ultrasound irradiation on the proliferation of M109 cells， and the best ultrasound time was selected. Using human lung cancer A549 cells as a control， the targeting of NPs combined with ultrasound irradiation to M109 cells was evaluated by free folic acid blocking assay and cell uptake assay. The effects of NPs combined with ultrasound irradiation on the migration， invasion， apoptosis， cell cycle and reactive oxygen species （ROS） levels of M109 cells were detected by cell scratch test， Transwell chamber test and flow cytometry at 1 h after 958401536@qq.com administration； the changes of mitochondrial membrane potential （MMP） were observed by fluorescence inverted microscope. A mouse subcutaneous tumor model of M109 cells was constructed， and the in vivo tumor targeting of NPs combined with ultrasound irradiation was investigated by small animal in vivo imaging technology. RESULTS NPs combined with ultrasound irradiation could significantly inhibit the proliferation of M109 cells， and the optimal ultrasound time was 1 h after administration. The free folic acid could antagonize the inhibitory effect of NPs on the proliferation of M109 cells， and combined with ultrasound irradiation could partially reverse this antagonism. Compared with A549 cells， the uptake rate of NPs in M109 cells was significantly higher （P＜0.01）， and ultrasound irradiation could promote cellular uptake. NPs combined with ultrasound irradiation could inhibit the migration and invasion of M109 cells and block the cell cycle in the G0/G1 and G2/M phases. Compared with control group， the apoptosis rate of M109 cells and ROS level were increased significantly （P＜0.01）， while the MMP decreased significantly （P＜0.01） in the different concentration （100， 200， 300 μg/mL） groups of M109 cells. Compared with the mice in non-ultrasound group， the fluorescence intensity and tumor-targeting index of the tumor site in the 0 h ultrasound group were significantly enhanced （P＜0.05 or P＜0.01）. CONCLUSIONS NPs combined with ultrasound irradiation have a strong targeting effect on M109 cells in vitro and in vivo， the anti-tumor mechanism includes inhibiting cell migration and invasion， blocking cell cycle， and inducing apoptosis.

Objective:To evaluate the initial clinical outcome of applying a comprehensive debulking procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle to reconstruct the hypertrophic toes and forefoots in one-stage surgery in multiple toes macrodactyly in children.Methods:The clinical data of children with macrodactyly deformity treated by the Department of Burn and Plastic Surgery in Children’s Hospital of Chongqing Medical University from January 2022 to October 2023 were retrospectively analyzed. Design toe and plantar arbitrary flaps with a few vascular perforating branches which pedicle at the comparatively healthy proximal side and resect all tissues beyond the normal length. In severe toe, a composite tissue nail-flap with the artery was dissected to reconstruct the toenail. Fat debulking on the surface of deep plantar fascia as well as within the osseofascial sheath, resecting partially of the fatty infiltrated nerve, transverse and longitudinal osteotomy to shorten and narrowed phalanxes without epiphyseal block, arthroplasty and flexor tendon tightening were performed. Finally, toes shaped by wrapping toe flaps, and pelmas restored by plantar flaps which both with comparatively healthy proximal pedicle. The operation time, healing time, and whether the toes and toenails are preserved were all recorded. The maximum circumference of both foot, the difference in shoe size, the presence of skin ulcers, wound scars, toe webbing morphology, the presence of basic sensation, and the satisfaction of parents were followed-up after surgery. The modified follow-up questionnaire was used to evaluate the surgical effect, the total score is 0-12 points, and the higher the score, the better the surgical outcome. Descriptive methods was used for statistical analysis, and the measurement data conforming to normal distribution were expressed as Mean±SD.Results:A total of 15 patients were enrolled, including 11 males and 4 females. The median age at the time of operation was 2.75 years (0.9-10.8 years). There were 11 cases with 2 toes and 4 cases with 3 toes, a total of 34 toes involved. The average surgical duration was 4.13 hours (3.25 hours for 2 toes and 5.00 hours for 3 toes). Only one severe case with 3 toes involved was amputated the biggest toe ray and totally 2 toe nail flaps were harvested unsuccessfully intraoperative. Except 3 toes had distal skin partially necrosis and 2 nail flaps were completely necrotic which healed after dressing changes, the rest of the toes were healing well after operation. The average follow-up time was 4.8 months (3-11 months), the difference of circumference was less than 1.5 cm, as well as in length was less than 0.5 cm between feet and all children were able to wear the appropriate shoes with same size. A total of 4 toes failed to retain toenails, and 1 had a very thin toenail. Except for one case with insufficient web depth, the other toe webs were close to normal. There was no skin ulcer occurred, the basic sensation of the feet was present, and wound scars were inconspicuous. The score of the modified questionnaire was 10.54±0.88, all parents were satisfied with the results.Conclusion:Comprehensive procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle for debulking multiple toes macrodactyly in children could completely excise distal hypertrophic tissues in a single operation, and the size of the affected feet and toes can be greatly reduced to wearing shoes of the same size, and have a high success rate in preserving the toes, as well as nails. The reconstructed feet, toes and toe webbing have near-normal morphology, hidden scar, no ulcers after walked and achieve a good initial effect.

Objective:To evaluate the initial clinical outcome of applying a comprehensive debulking procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle to reconstruct the hypertrophic toes and forefoots in one-stage surgery in multiple toes macrodactyly in children.Methods:The clinical data of children with macrodactyly deformity treated by the Department of Burn and Plastic Surgery in Children’s Hospital of Chongqing Medical University from January 2022 to October 2023 were retrospectively analyzed. Design toe and plantar arbitrary flaps with a few vascular perforating branches which pedicle at the comparatively healthy proximal side and resect all tissues beyond the normal length. In severe toe, a composite tissue nail-flap with the artery was dissected to reconstruct the toenail. Fat debulking on the surface of deep plantar fascia as well as within the osseofascial sheath, resecting partially of the fatty infiltrated nerve, transverse and longitudinal osteotomy to shorten and narrowed phalanxes without epiphyseal block, arthroplasty and flexor tendon tightening were performed. Finally, toes shaped by wrapping toe flaps, and pelmas restored by plantar flaps which both with comparatively healthy proximal pedicle. The operation time, healing time, and whether the toes and toenails are preserved were all recorded. The maximum circumference of both foot, the difference in shoe size, the presence of skin ulcers, wound scars, toe webbing morphology, the presence of basic sensation, and the satisfaction of parents were followed-up after surgery. The modified follow-up questionnaire was used to evaluate the surgical effect, the total score is 0-12 points, and the higher the score, the better the surgical outcome. Descriptive methods was used for statistical analysis, and the measurement data conforming to normal distribution were expressed as Mean±SD.Results:A total of 15 patients were enrolled, including 11 males and 4 females. The median age at the time of operation was 2.75 years (0.9-10.8 years). There were 11 cases with 2 toes and 4 cases with 3 toes, a total of 34 toes involved. The average surgical duration was 4.13 hours (3.25 hours for 2 toes and 5.00 hours for 3 toes). Only one severe case with 3 toes involved was amputated the biggest toe ray and totally 2 toe nail flaps were harvested unsuccessfully intraoperative. Except 3 toes had distal skin partially necrosis and 2 nail flaps were completely necrotic which healed after dressing changes, the rest of the toes were healing well after operation. The average follow-up time was 4.8 months (3-11 months), the difference of circumference was less than 1.5 cm, as well as in length was less than 0.5 cm between feet and all children were able to wear the appropriate shoes with same size. A total of 4 toes failed to retain toenails, and 1 had a very thin toenail. Except for one case with insufficient web depth, the other toe webs were close to normal. There was no skin ulcer occurred, the basic sensation of the feet was present, and wound scars were inconspicuous. The score of the modified questionnaire was 10.54±0.88, all parents were satisfied with the results.Conclusion:Comprehensive procedure centered on the digital and plantar flaps with comparatively healthy proximal pedicle for debulking multiple toes macrodactyly in children could completely excise distal hypertrophic tissues in a single operation, and the size of the affected feet and toes can be greatly reduced to wearing shoes of the same size, and have a high success rate in preserving the toes, as well as nails. The reconstructed feet, toes and toe webbing have near-normal morphology, hidden scar, no ulcers after walked and achieve a good initial effect.

Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.

Objective:To analyze and report the anatomical characteristics, surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods:We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020. The clinical manifestations are duplicated hallux, with complete fusion of the main and auxiliary hallux, tibial hallux dysplasia, and fibular hallux with obvious varus deformity. The anatomical characteristics of this special polysyndactyly, surgical incision design, osteoarticular correction methods were analyzed, and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results:A total of 10 children with preaxial polysyndactyly (12 toes) were enrolled, including 6 male and 4 female patients. Age ranged from 5 to 45 months, with an average of 19.3 months. Eight cases were unilateral, and 2 cases were bilateral. All the cases had duplicated hallux, with tibial hallux dysplasia and proximal displacement. The fibular hallux was dominant but with varus deformity to varying degrees (varus angle 25°-90°, mean 55°). During the operation, the abductor hallucis (AbdH) was found to be attached to the tibial hallux, and the metatarsophalangeal (MTP) joint of the dominant hallux was dislocated to the tibial side, with an inclination of the joint surface. Incision design: zigzag incision around extra toes were used in 3 toes with varus angle from 25° -40°, proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°, and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°. Correction of bone and joint: after extra toe resected, the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint. The other 10 cases were obtained completely axially corrected after opening osteotomy performed at the tibial side of the metatarsal bone or phalanx, and nine of them were treated with bone graft for filling the bone defect. Wound closure: all wounds were successfully closed. Among these, 2 of the 3 toes that taking transferred proximal pedicle flap of extra toe were supplemented with skin grafts due to skin deficiency. Although the varus angle was large, the wounds of 6 toes with double Z-plasty incision were completely closed after lengthened the longitudinal skin of the tibial side of the big toe. Two cases were lost to follow-up, and the other 8 cases (10 toes) were followed up for 5-38 months (mean 13 months). Except for 1 toe with insufficient correction (hallux varus 15°) and 2 toes with overcorrection (hallux valgus 15°, 20°), the axial lines of the other big toes were normal. All cases wore shoes and walked normally.Conclusions:The anatomical characteristics of this type of preaxial polysyndactyly are the AbdH terminating in the deformed tibial toe and the medial dislocation of the associated main hallux MTP joint resulting in varus and the oblique planar of the metatarsal articulations. The deformity of hallux varus and the deficiency of tibial skin were the characteristics and the difficulties of this special type of preaxial polysyndactyly. Good axial correction can be obtained by means of opening osteotomy and intraoperative release of abductor insertion. Then the wound can be closed at one stage without skin grafting by using a double Z-plasty incision which could fully elongate the tibial side skin.

Objective:To analyze and report the anatomical characteristics, surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods:We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020. The clinical manifestations are duplicated hallux, with complete fusion of the main and auxiliary hallux, tibial hallux dysplasia, and fibular hallux with obvious varus deformity. The anatomical characteristics of this special polysyndactyly, surgical incision design, osteoarticular correction methods were analyzed, and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results:A total of 10 children with preaxial polysyndactyly (12 toes) were enrolled, including 6 male and 4 female patients. Age ranged from 5 to 45 months, with an average of 19.3 months. Eight cases were unilateral, and 2 cases were bilateral. All the cases had duplicated hallux, with tibial hallux dysplasia and proximal displacement. The fibular hallux was dominant but with varus deformity to varying degrees (varus angle 25°-90°, mean 55°). During the operation, the abductor hallucis (AbdH) was found to be attached to the tibial hallux, and the metatarsophalangeal (MTP) joint of the dominant hallux was dislocated to the tibial side, with an inclination of the joint surface. Incision design: zigzag incision around extra toes were used in 3 toes with varus angle from 25° -40°, proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°, and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°. Correction of bone and joint: after extra toe resected, the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint. The other 10 cases were obtained completely axially corrected after opening osteotomy performed at the tibial side of the metatarsal bone or phalanx, and nine of them were treated with bone graft for filling the bone defect. Wound closure: all wounds were successfully closed. Among these, 2 of the 3 toes that taking transferred proximal pedicle flap of extra toe were supplemented with skin grafts due to skin deficiency. Although the varus angle was large, the wounds of 6 toes with double Z-plasty incision were completely closed after lengthened the longitudinal skin of the tibial side of the big toe. Two cases were lost to follow-up, and the other 8 cases (10 toes) were followed up for 5-38 months (mean 13 months). Except for 1 toe with insufficient correction (hallux varus 15°) and 2 toes with overcorrection (hallux valgus 15°, 20°), the axial lines of the other big toes were normal. All cases wore shoes and walked normally.Conclusions:The anatomical characteristics of this type of preaxial polysyndactyly are the AbdH terminating in the deformed tibial toe and the medial dislocation of the associated main hallux MTP joint resulting in varus and the oblique planar of the metatarsal articulations. The deformity of hallux varus and the deficiency of tibial skin were the characteristics and the difficulties of this special type of preaxial polysyndactyly. Good axial correction can be obtained by means of opening osteotomy and intraoperative release of abductor insertion. Then the wound can be closed at one stage without skin grafting by using a double Z-plasty incision which could fully elongate the tibial side skin.

Objective:To explore the influencing factors of postoperative coping style of patients with esophageal cancer.Methods:This study was a cross-sectional study. From July 2018 to July 2020, convenience sampling was used to select 65 patients with esophageal cancer who underwent radical surgery for esophageal cancer in a ClassⅢ Grade A hospital in Henan Province as the research object. The General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) were used to investigate the patients one day before the patients were discharged. Single factor analysis was used to analyze influencing factors. A total of 65 questionnaires were distributed and 65 valid questionnaires were returned with the valid response rate of 100%.Results:The results of single factor analysis showed that there were statistically significant differences in the confrontation dimension scores of patients with different ages, education levels, and family monthly income per capita ( P<0.05) . There were statistically significant differences in the avoidance dimension scores of patients with different genders and ages ( P<0.05) . There were statistically significant differences in the resignation dimension scores of patients with different ages, occupational status, and family monthly income per capita ( P<0.05) . Conclusions:Age, gender, occupational status, education level, and family monthly income per capita are the influencing factors of postoperative coping style of patients with esophageal cancer. Medical and nursing staff can take targeted intervention measures based on their influencing factors and guide patients to adopt a positive coping style to face the disease.

Objective:To understand the views of various relevant personnel on the standardized training mode of resident doctors after the implementation of Beijing′s medical education synergy policy, so as to provide references for further improvement of China′s medical education synergy policy.Methods:From January to May 2019, a semi-structured interview method was used to investigate the resident training students, clinical teachers(professional postgraduate tutors and resident training trainees′ guiding doctors)as well as resident training managers in 35 resident training bases in Beijing. The original data of the interviews were sorted out, coded and analyzed by taking root theory and main frame method descriptive analysis.Results:A total of 687 valid interview results were received, of which 71.86% of the resident training managers thought that the mode was more reasonable and the advantages outweighed the disadvantages; 38.07% of the resident training students and 45.45% of the graduate supervisors mentioned that the mode effectively shortened the training time of clinical talents; however, 31.98% of the resident training students and 22.92% of the resident training students′ guiding physicians mentioned it was difficult to balance courses, scientific research and clinical work under this mode, 61.62% of graduate supervisors pointed out that the students were lack of time and energy to engage in scientific research.Conclusions:The training mode of the integration of the standardized training of resident doctors and the postgraduate training of master′s degree in clinical medicine, given its necessity and institutional advantages, is found with room of improvement in its mode setting, arrangement of scientific research courses and clinical rotation, supervision and assessment of the process.

Objective:To compare perioperative differences between posterior lumbar interbody fusion(PLIF)by a posterior median approach or open transforaminal lumbar interbody fusion(TLIF)and minimally invasive surgery TLIF(MIS-TLIF)by a paravertebral approach for lumbar spondylolisthesis(Ⅰ~Ⅱ°)in elderly patients.Methods:A retrospective study was conducted to analyze clinical data of patients aged 60 years and over with lumbar spondylolisthesis(n=68)who underwent PLIF or MIS-TLIF from January 2014 to December 2017.Patients were divided into the PLIF group(n=40, 12 males and 28 females)and the MIS-TLIF group(n=28, 6 males and 22 females)according to the type of surgery.Differences in operating time, blood loss, exposure frequency, postoperative drainage volume, indwelling duration, hospital stay length and complications were compared between the groups.Results:There was no significant difference in operative time between the PLIF group and the MIS-TLIF group(156±51)min vs.(153±38)min( P=0.77). There were significant differences in intraoperative blood loss and radiation exposure frequency between the PLIF group and the MIS-TLIF group(458±272)ml vs.(157±104)ml( P<0.001); (6.7±1.5)times vs.(30.6±6.9)times( P<0.01). There was no significant difference in intraoperative complications between the PLIF group and the MIS-TLIF group(25% or 10/40 vs.7.1% or 2/28, P=0.057). There were more postoperative drainage, longer indwelling time and hospitalization in the PLIF group than in the MIS-TLIF group(664±351)ml vs.(210±127)ml( P<0.001); (3.7±2.9)d vs.(2.2±0.8)d( P=0.002); (9.2±3.6)d vs.(6.9±1.7)d( P=0.001). The incidence of postoperative neurological complications was not significantly different between the PLIF group and the MIS-TLIF group(7.5% or 3/40 vs.14.3% or 4/28, P=0.365). The incidence of postoperative non-neurological complications was higher in the PLIF group than in the MIS-TLIF group(27.5% or 11/40 vs.7.1% or 2/28, P=0.036). Conclusions:Compared with PLIF, MIS-TLIF has the advantages of less intraoperative bleeding and postoperative drainage, shorter indwelling duration of urinary catheters, shorter hospital stays and fewer complications of non-neurological complications in treating Ⅰ-Ⅱ degree lumbar spondylolisthesis in the elderly, but it requires more radiation exposure.

Objective:To investigate the level of sleep quality among females treated firstly by IVF-ET and to find the moderate role of mindfulness in the relationship between stigma and sleep quality.Methods:From April 2018 to September 2018, we invited 380 IVF-ET females in the fertility hospital of Shandong Province to participate in the study and to finish a questionnaire survey including the Pittsburgh Sleep Quality Index(PSQI), the Mindful Attention Awareness Scale(MAAS), the simple measuring scale of stigma, and the general information questionnaire.Results:The average score of PSQI was (4.82±2.29), and the prevalence of sleep distress(PSQI>5) was 31.3%(118/380). Spearman correlation analysis showed that PSQI score was positively correlated with stigma( r=0.156, P=0.002), the infertility time( r=0.110, P=0.032), and the treatment time( r=0.142, P=0.005 ), was negatively correlated with mindfulness level( r=-0.325, P<0.001). The hierarchical regression showed that mindfulness level could moderate the correlation between stigma and sleep quality( P<0.001, Δ R2=2.8%). Furthermore, the Johnson-Neyman technique revealed that, within a specific region that was mindfulness above 72, the moderating role was significant. Conclusion:The sleep distress was common among females treated firstly by IVF-ET. Mindfulness level could moderate the correlation between stigma and sleep quality. It is suggested that the reproductive center should strengthen publicity and education to reduce the stigma level of patients, and carry out mindfulness related intervention to further improve their sleep quality.