Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Hematoma enlargement is a common harmful event after cerebral hemorrhage, which can lead to deterioration of neurological function and poor outcome. Early detection of high-risk patients can help prevent hematoma enlargement and improve the outcome of patients. Although the exact mechanism of hematoma enlargement is unclear, more and more evidence shows that many imaging signs may be related to hematoma enlargement, such as dot sign, mixed sign, black hole sign, island sign, etc. This article mainly reviews the relevant imaging prediction factors of hematoma enlargement from the perspective of imaging.

Objective:To investigate the reparative efficacy and mechanism of pressure-adjustable macroporous antibacterial hydrogel in the treatment of infected wounds.Methods:Staphylococcus aureus was used to establish wound infection models in healthy C57BL/6 mice. The models were divided into 3 groups subjected to 3 different treatments: a negative control group with no hydrogel treatment (group A), a control group treated by common medical hydrogel (group B) and an experiment group treated by pressure-adjustable macroporous antibacterial hydrogel (group C). On days 1, 3, 6, 9 and 12, the effects of 3 treatments were compared on the wound area and the number of bacterial colonies under scab, on the apoptosis of fibroblasts based on the changes of type Ⅰ procollagen, and on the inhibition of inflammation during wound repair by detecting the expression of interleukin-6 (IL-6) and tumor necrosis factor (TNF-α).Results:On days 1 and 3, there was no significant difference between the 3 groups in the wound area ( P>0.05), but on days 6, 9 and 12, there were significant differences between the 3 groups in the wound area ( P<0.05). On day 6, the wound areas in group B (1.23 cm 2 ± 0.16 cm 2) and in group C (1.14 cm 2 ± 0.12 cm 2) were significantly smaller than that in group A (1.56 cm 2 ± 0.16 cm 2) ( P<0.05), but there was no significant difference between groups B and C ( P>0.05). On days 9 and 12, the wound areas in group B (0.97 cm 2 ± 0.13 cm 2 and 0.76 cm 2 ± 0.10 cm 2) and in group C (0.66 cm 2 ± 0.06 cm 2 and 0.48 cm 2 ± 0.07 cm 2) were significantly smaller than those in group A (1.49 cm 2 ± 0.11 cm 2 and 1.39 cm 2 ± 0.13 cm 2), and those in group C were significantly smaller than those in group B (all P<0.05). On day 1, there was no significant difference between the 3 groups in the number of bacterial colonies under scab ( P>0.05). On days 3, 6, 9 and 12, the numbers of bacterial colonies under scab in groups B and C were significantly smaller than that in group A ( P<0.05), and that in group C was significantly smaller than that in group B ( P< 0.05). The nucleic acid electrophoresis showed that the grayscale bands in group C were significantly darker than those in groups A and B. The early apoptosis rate of the fibroblasts in group C[low-right positive fluorescence (LR%): 9.72%] was significantly lower than that in group A (43.99%) and that in group B (38.43%), and that in group B was significantly lower than that in group A ( P<0.05). On day 12, the ratio of the gray values of IL-6 and β-actin (0.64 ± 0.10) and the ratio of the gray values of TNF-α and β-actin (0.34 ± 0.05) in the fibroblasts in group C were significantly higher than those in group A (1.22 ± 0.21 and 0.60 ± 0.14) and in group B (0.88 ± 0.02 and 0.41 ± 0.06) ( P<0.01). Conclusion:The pressure-adjustable macroporous antibacterial hydrogel is an effective treatment of infected wounds and its mechanism may be related to the reduced apoptosis of fibroblasts.

Objective To investigate the predictive value of central venous-to-arterial carbon dioxide difference (Pcv-aCO2) on the prognosis of elderly patients with sepsis.Methods 208 elderly patients who met the diagnostic criteria of the Sepsis-3 and with the age of more than 60 years old, and admitted to intensive care unit (ICU) of Guangdong General Hospital from January to December in 2017 were enrolled. According to the prognosis, the patients were divided into death group (n = 46) and survival group (n = 162). The Pcv-aCO2, central venous oxygen saturation (ScvO2), serum procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) were collected for all patients. The differences of each index between the two groups were compared. The correlations between Pcv-aCO2 and ScvO2, PCT, CRP, SOFA, APACHEⅡscores were analyzed respectively with Pearson correlation. The prognostic value of Pcv-aCO2 in elderly patients with sepsis was assessed by receiver operating characteristic curve (ROC).Results Compared with survival group, the Pcv-aCO2, PCT, CRP, SOFA and APACHEⅡscores in death group were significantly increased [Pcv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.13±3.33 vs. 4.40±2.65, PCT (μg/L): 31.41±12.83 vs. 3.01±2.69, CRP (mg/L): 130.51± 42.23 vs. 104.46±50.12, SOFA: 12.01±2.25 vs. 9.05±2.06, APACHEⅡ: 29.52±5.03 vs. 20.01±3.21, allP < 0.05], and ScvO2 in death group was significantly decreased (0.571±0.136 vs. 0.685±0.106,P < 0.01). Correlation analysis showed that the Pcv-aCO2 was negatively correlated with ScvO2 (r = -0.762,P = 0.001) and was positively correlated with PCT, CRP, SOFA and APACHEⅡscores (r value was 0.737, 0.625, 0.738, 0.713, respectively, allP < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of Pcv-aCO2 prediction of death in patients with sepsis was 0.826, the cut-off was 6.62 mmHg, the sensitivity was 84.7％, the specificity was 77.5％, the positive likelihood ratio was 3.76, and the negative likelihood ratio was 0.19.Conclusion Pcv-aCO2 has a great value in evaluating the prognosis of elderly patients with sepsis and can accurately determine the prognosis of sepsis.

OBJECTIVE:To investigate risk factors of multidrug-resistant organisms (MDROs) infection in elderly patients of ICU,and to provide reference for formulation and implementation of MDROs prevention and control measures.METHODS:A total of 146 elderly patients were selected from ICU of our hospital during Dec.2013-Jun.2016.Throat swab,sputum swab and anal swab specimens (1 copy,respectively) were collected to conduct active screening of MRSA and ESBLs-producing Enterobacteriaceae.Risk factors of MDROs infection,pathogen distribution and drug resistance were analyzed.RESULTS:Among samples of 146 patients,there were 34 MRSA positive samples in throat swab with positive rate of 23.3％;there were 30 MRSA positive samples in sputum swab with positive rate of 20.5％;there were 99 ESBLs-producing bacteria positive samples in anal swab (containing 50 ESBLs-producing Escherichia coli positive samples and 49 ESBLs-producing Klebsiella pneumoniae positive samples) with positive rate of 67.8％.The positive rate of throat swab MRSA screening was not correlated with patient's gender,age,tracheal intubation or mechanical ventilation (P＞0.05),but it was related with hospitalization time in ICU (P＜0.05).The positive rate of sputum swab MRSA screening was not correlated with patient' s gender,tracheal intubation or mechanical ventilation;the positive rate of anal swab ESBLs-producing bacteria screening were not related with patient's gender(P＞0.05).But they were related with age and hospitalization time in ICU (P＜0.05).Compared with negative patients,there was no statistical significance in the times of fiberoptic bronchoscopy in throat/sputum swab MRSA screening positive patients (P＞0.05).The times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter in anal swab ESBLs-producing bacteria screening positive patients were significantly more or longer than negative patients,with statistical significance (P＜0.05).Binary Logistic regression analysis showed that hospitalization time in ICU was risk factor of positive active screening of throat swab in elderly patients of ICU[OR=1.119,95 ％ CI (1.071,1.385),P=0.021];age was risk factor of positive active screening of sputum swab[OR=1.893,95 ％ CI (1.232,4.042),P=0.032];age and hospitalization time in ICU were risk factors of positive active screening of anal swab [OR were 1.046,1.022,95％CI were (1.005,1.088) (1.006,3.283),P were 0.027,0.031].A total of 163 strains of MDROs were detected,among which there were 64 strains of MRSA,50 strains of ESBLs-producing E.coli and 49 strains of ESBLs-producing K.pneumoniae.They were generally highly resistant to compound preparation containing enzyme inhibitors.CONCLUSIONS:The results of MDROs active screening in elderly patients of ICU are related with age,hospitalization time in ICU,the times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter.Age and hospitalization time in ICU were risk factors of MDROs infection.The pathogens are mainly ESBLs-producing Enterobacteriaceae,and drug resistance is severe.For elderly critical patients with MDROs infection,clinical prevention and intervention measures should be taken to prevent and control the prevalence and spread of MDROs in ICU.

OBJECTIVE:To observe the effects of Alprostadil dried emulsion for injection combined with Butylphthalide soft capsules on nerve function,inflammatory factor and coagulation function of patients with severe ischemic stroke. METHODS:A total of 66 patients with severe ischemic stroke selected from our hospital during Jun. 2015-Oct. 2017 were divided into control group and observation group according to random number table,with 33 cases in each group. On the basis of routine treatment, control group was additionally given Butyphthalide soft capsules 0.2 g/time,orally at fasting state,tid. On the basis of control group,observation group was additionally given Alprostadil dried emulsion for injection 10 μg added into 0.9% Sodium chloride injection 10 mL,via slow infusion or slow dripping with pipkin,qd. Both groups were treated for 14 days. NIHSS and Barthel index scores,the levels of serum inflammatory factors(CRP,PCT)and coagulation function indexes(D-D,TT,PT,APTT, FIB)were observed in 2 groups before and after treatment,and the occurrence of ADR was also recorded. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05).After treatment,NIHSS scores,the levels of CRP,PCT,D-D and FIB in 2 groups were deceased significantly,while Barthel index scores were increased significantly,TT,PT,APTT were prolonged significantly;observation group was significantly better than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Alprostadil dried emulsion for injection combined with Butylphthalide soft capsules can effectively improve nerve function and coagulation function of patients with severe ischemic stroke,and reduce the levels of inflammatory factor with good safety.

Objective To investigate the effect of Simo decoction oral liquid on inflammatory in acute respiratory distress syndrome (ARDS) mouse serum and the bronchoalveolar lavage fluid (BALF) and to explore the mechanism.Methods Fifty BALB/c mice were divided into normal control group, ARDS model group, small, moderate and large dose Simo decoction oral liquid-treated groups (simplified as Simo groups) according to random number table method (n=10, in each group). The ARDS model mice were replicated by lipopolysaccharide (LPS) tracheal instillation, and the mice in normal control group were given the same amount of normal saline. Immediately after the success of modeling, the mice were gavaged with 1, 2, 4 times the equivalent dose Simo decoction oral liquid of 7.56 mL·kg-1·d-1 in small, moderate or large dose Simo groups respectively, and there was no intervention in the normal control group or ARDS model group. All the mice were sacrificed at 24 hours after the respective drug amount or normal saline was given in various groups. The lung samples were taken for histologic evaluation, and BALF and serum samples were analyzed for the tumor necrosis factor-α(TNF-α), interleukin (IL-1β, IL-6), and in the mean time the level of serum superoxide dismutase (SOD) was detected.Results The pathological observation of lung tissue showed: there was no obvious inflammatory exudation in lung tissue of mice in normal control group; the inflammatory exudation in lung tissue of mice was increased significantly, the level of TNF-α (ng/L: 1759±303 vs. 104±27, 2506±674 vs. 507±46), IL-1β(ng/L: 209±16 vs. 114±11, 7325±826 vs. 3513±498) and IL-6 (ng/L: 144±38 vs. 47±7, 126±38 vs. 15±7) in serum and BALF were significantly increased, and the content of SOD (kU/L: 40.26±2.54 vs. 50.68±3.75) in serum was significantly decreased in ARDS model group (allP < 0.05), indicating that animal model of ARDS was set up successfully. Compared with ARDS model group, in small, moderate and large dose Simo groups, the inflammation exudation in lung tissue of mouse was reduced, the levels of TNF-α, IL-1βand IL-6 in serum and BALF were reduced, and the content of SOD in serum was increased [serum: TNF-α(ng/L) was 1642±276, 1126±154, 817±102 vs. 1759±303, IL-1β(ng/L)was 198±12, 170±11, 141±13 vs. 209±16, IL-6 (ng/L) was 127±22, 82±16, 41±15 vs. 144±38, SOD (kU/L) was 42.11±1.64, 48.09±1.23 vs. 40.26±2.54; BALF: TNF-α(ng/L) was 2479±446, 1632±330, 1067±223 vs. 2506±674, IL-1β(ng/L): 6939±725, 5398±625, 4401±210 vs. 7325±826, IL-6 (ng/L): 106±30, 68±13, 34±10 vs. 126±38, allP < 0.05], showing the Simo decoction inhibiting the lung inflammation and the above levels of indexes inserum and BALF was in a dose-dependent manner, and the changes in large dose Simo group was the most significant 45.18±1.15, .Conclusions Simo decoction oral liquid can inhibit the inflammatory response of ARDS, reduce the oxidative stress and decrease the lung injury of mice with ARDS.

BACKGROUND:Vertebroplasty and kyphoplasty can effectively repair osteoporotic vertebral compression fractures, but bone cement injection can cause the change of stress in the fractured vertebrae and adjacent vertebrae after surgery, leading to new fractures.
OBJECTIVE: To analyze the stress changes of the fractured vertebrae and adjacent vertebrae after vertebroplasty with different elastic modulus bone cement by a three-dimensional finite element method.
METHODS: One healthy adult male volunteer was selected for lumbar spine CT scan. The acquired images were imported for three-dimensional reconstruction using Mimics. The three-dimensional model was smoothed, polished and denoised by Geomagic software, and then the solid mode was built under Workbench Ansys. An osteoporotic vertebral compression fracture model in L2-4 segments was established after assignment. Bone cement (4 mL) with different elastic moduli (8 000, 4 000, 2 000 and 1 000 MPa) injected into the L3 segment distributed in the middle of the vertebrae as spherical shape. 500 N pre-load was applied on the L2 surface with an additional bending moment of 50 N?m. The lower surface free degree of L4 was restrained. The L2-4 forward flexion, posterior extension, right flexion and axial rotation on the right side were stimulated. The stress changes of the fractured vertebrae and the upper and lower adjacent vertebrae before and after bone cement injection with different elastic moduli were compared.
RESULTS AND CONCLUSION:The stress of the fractured vertebrae and adjacent vertebrae were significantly increased compared with that before operation. With the increase of elastic modulus, the stress of the fractured vertebrae increased, but there were no changes in the stress of adjacent vertebrae. These findings indicate that the elastic modulus of bone cement may be a method to reduce new fractures of the fractured and adjacent vertebrae after bone cement injection.

Objective To compare the curative effects of multi-level puncture versus single-level puncture percutaneous vertebroplasty(PVP) for treatment of multiple-level osteoporotic vertebral body compression fractures(OVCF) in senile patients.Methods From June 2008 through November 2014,89 senile patients with fresh multiple-level OVCF underwent PVP guided by C-arm fluoroscopy in prone position.Of them,51 received PVP in which the vertebrae of multiple levels were simultaneously punctured for bone cement injection while the other 38 received PVP in which the vertebrae of multiple levels were punctured one by one for bone cement injection.The 2 groups were compatible with no significant differences in preoperative demographic data (P ＞ 0.05).The 2 groups were compared in terms of visual analgesic scale (VAS),operation time for a single vertebra,fluoroscopy times for a single vertebra,bone cement injection amount for a single vertebra,and extraosseous cement leakage.Results PVP procedures were successful in both groups without serious complications.The VAS scores in both groups at 2 days post-operation were significantly lower than those at pre-operation(P ＜ 0.05).The operation time and fluoroscopy times for a single vertebra in the multi-level puncture PVP group were significantly less than those in the single-level puncture PVP group (P ＜ 0.05).There were no significant differences between the 2 groups in bone cement injection amount for a single vertebra or extraosseous cement leakage (P ＞ 0.05).Conclusions The curative effects of multi-level puncture and single-level PVP are satisfactory for senile OVCF,but multi-level puncture PVP may lead to less operation time and less X-ray exposure.