Objective: To propose an improved method for constructing the internal quality control (IQC) framework for ELISA assays and validate its efficacy by statistically analyzing IQC data from nine blood center laboratories. Methods: 1) IQC data was collected from nine blood centers and analyzed using a domestic HBsAg ELISA detection kit as an example. 2) Differences between IQC values across batches within Blood Center 1 were assessed. 3) Statistical analyses were performed on batch usage, number of batches used, days of use, number of QC points, batch-specific means, and coefficients of variation (CV) across all nine centers. 4) Using the improved construction method for IQC framework, provisional and permanent frames were established for batches within Blood Center 1 and Blood Center 9, followed by outlier determination. Results: 1) Statistically significant differences were observed in IQC data between batches within Blood Center 1 (P<0.01). It is recommended that both the control material/reagents and the control chart framework be replaced simultaneously. 2) There were substantial differences among 9 blood centers regarding the control material/reagent lot numbers used, the number of QC runs per batch, and the QC values for identical lots. Therefore, individual laboratories should establish their own IQC chart frameworks. 3) The improved IQC framework construction method for ELISA assays is as follows: provisional frames are established via frame-shifting, using the pre-experimental mean and cumulative coefficient of variation (CV) from the preceding batch. For batches used >20 days with >20 QC points, permanent frames are constructed by aggregating in-control data accumulated over ≥20 days with ≥20 points to calculate cumulative mean and standard deviation. The provisional and permanent frames constructed by this method identified all 26 extreme outliers across Blood Centers 1 and 9 as out-of-control. Among the 218 general outliers, 10 were classified as normal by the provisional frames, while the remainder were designated as warnings or out-of-control. This method effectively monitors assay stability. Conclusion: Based on the statistical analysis of IQC practices across blood centers of varying scales, combined with the inherent characteristics of ELISA assays and the batch-to-batch instability of reagents/QC materials, it is recommended to reconstruct QC charts upon lot changes. The proposed method—utilizing frame-shifting for provisional frames and establishing permanent frames based on cumulative data—is applicable to blood center laboratories of differing sizes and effectively monitors the stability of the ELISA assay process.

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Objective:To explore the relationship between macrophage infiltration in the coronary plaque and downstream myocardial perfusion in mice.Methods:The experimental group consisted of 20 ApoE knockout mice models of the coronary plaque established by feeding with cholesterol-rich diets, and the control group consisted of 20 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice.Adenosine stress myocardial contrast echocardiography was performed on all experimental animals to obtain the values of A, β and A×β of the left ventricular myocardium in anteroseptal and posterior walls both in the resting status and during adenosine stress. Concentrations of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were determined using mouse enzyme-linked immunosorbent assay kits according to the manufacturer′s instructions. The degree of macrophage infiltration in the coronary plaque was evaluated by pathological immunohistochemistry staining and the correlations with the above indicators were analyzed.Results:There were no statistically significant differences in heart rate and left ventricular structural parameters between two groups (all P>0.05). The experimental group had a lower left ventricular ejection fraction( P=0.021), and higher weight and serum levels of triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, IL-6, and TNF-α than the control group (all P<0.05). The values of A, β and A × β of the left ventricular myocardium in anteroseptal and posterior walls in the experimental group were significantly lower than those in the control group during adenosine stress (all P<0.05). In the experimental group, the value of the macrophage infiltration found in the plaque of the left main coronary artery correlated positively with the level of serum TNF-α ( r=0.63, P=0.003) and negatively correlated with the values of A×β of the left ventricular myocardium in anteroseptal and posterior walls during adenosine stress ( r=-0.74, P<0.001; r=-0.72, P<0.001; respectively). Conclusions:Myocardial perfusion in ApoE knockout mice models of the coronary atherosclerosis was related with degree of macrophage infiltration in the coronary plaque, and macrophages may play a role by releasing inflammatory mediator TNF-α.

Objective:The traction method for correcting congenital nipple inversion was observed to induce varying degrees of hemodynamic compromise in the nipple skin microcirculation after surgery. In this study, the laser Doppler scattering flowmetry was employed to measure the postoperative nipple skin microcirculation perfusion to verify the difference in nipple skin microcirculation perfusion with different grades of hemodynamic disorders. Furthermore, we aimed to describe the trend of postoperative nipple skin microcirculation perfusion and to elucidate the patterns of nipple breast skin microcirculation in healthy women.Methods:From October 2016 to October 2022, the Department of Plastic and Reconstructive Surgery of Peking Union Medical College Hospital performed traction correction of 72 congenital inverted nipples using wire braces in 37 women. The age of the patients in the surgical group ranged from 21 to 51 years with a mean age of 27.4±1.8 years. Concurrently, the control group consisted of 65 normal nipples of 34 healthy women aged between 18 to 50 years (mean age 26.5±1.7 years). In both groups, nipple and areola skin microcirculatory perfusion was measured using a laser Doppler scatter flow meter PeriCam PSI system. The control group underwent a single measurement whereas the surgical group was evaluated three times postoperatively at two days, five days, and one month.Results:In the control group, the mean value of nipple skin microcirculation perfusion was 137.77±22.94, significantly higher than that for breast skin, which stood at 68.94±10.43 ( t=-14.116, P<0.001). The mean value of nipple skin microcirculation perfusion in the surgical group was 179.57±41.48 at two days postoperatively, which resulted in a significant increase in postoperative nipple skin microcirculation perfusion compared to the control group nipple skin microcirculation perfusion (137.77±22.94), and a decrease in nipple skin microcirculation perfusion at five days postoperatively (167.28±38.16), which was normalized at one month postoperatively (131.45±39.64). Notably, instances of hemodynamic disturbances such as skin breakdown or partial necrosis, the nipple skin microcirculation perfusion were significantly reduced (118.63±58.66), supporting the postoperative nipple hemodynamic classification. Conclusions:The nipple skin microcirculation perfusion in healthy female is significantly higher than breast skin microcirculation perfusion. Surgical interventions for correcting congenital inverted nipples markedly enhance nipple skin microcirculatory perfusion, though the perfusion rate is prone to reduction in the case of postoperative hemodynamic disorders, manifesting as nipple skin breakdown or localized necrosis. The integrity of nipple skin can be used as a crucial metric for clinical evaluation. Notably, following postoperative dressing changes, all instances of nipple skin breakdowns heal with the microcirculation perfusion values reverting to normal by one month.

Objective:To explore the surgical procedure and clinical effect of a free transverse carpal flap based on the superficial palmar branch of radial artery in reconstruction of soft tissue defect of digits.Methods:From February 2014 to May 2022, 17 cases of soft tissue defects with tendon or phalanges in digits were treated in the Department of Hand and Foot Surgery, Hainan Zhongde Orthopaedic Hospital. All 17 cases were treated by the free transverse carpal flap based on the superficial palmar branch of radial artery. The flap size was 2.0 cm×2.0 cm-4.5 cm×2.0 cm. The anastomosed artery was digital artery or common digital artery, and the vein was the accompanying vein or superficial subcutaneous vein. All donor sites were directly sutured. Preventive measures of anti-infection, anticoagulation, anti-vasospasm and symptomatic treatment were given after surgery. After discharge of patients, scheduled follow-ups were conducted through outpatient clinic, telephone or WeChat interviews to observe the clinical effects. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, hand functional recovery was good in 14 cases and good in 1 case.Results:All 17 flaps had survived with 16 completed the postoperative follow-up. Follow-ups ranged from 6 to 18 months, with a mean of 14 months. At the last follow-up, the flaps were good in shape, soft texture, in normal flexion and extension and with good protective sensation. Two-point discrimination (TPD) was 8-12 mm, with an average of 8 mm. There was no other adverse effect in the donor sites except a linear scar.Conclusion:Application of transverse carpal flap based on the superficial palmar branch of radial artery from same limb to restore the digit function is feasible. It is an ideal surgical procedure of flap transfer.

Objective:To evaluate the efficacy and safety of immediate intraoperative transapical beating-heart septal myectomy (TA-BSM) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and explored the clinical value of three-dimensional transesophageal echocardiography (3D-TEE) during the procedure of TA-BSM.Methods:One hundred and thirty-seven HOCM patients who underwent TA-BSM surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2022 to March 2023 were selected.During the operation, 3D-TEE was used to locate the position of the myocardial circumcision system and navigate the range of myocardial circumcision. The interventricular septal thickness( IVST) and peak pressure gradient of the left ventricular outflow tract (LVOT-PG) were measured, and the degree of mitral systolic anterior motion (SAM) and mitral regurgitation (MR) were evaluated in HOCM patients before and after the operation. The range of the incisal margin was measured, and the number of resection knives and the weight of the removed myocardium were recorded.Results:TA-BSM under 3D-TEE navigation was successfully performed in 137 HOCM patients. The number of resection was 7(5, 9), and the weight of the removed myocardium was 5.6(3.4, 8.9)g. During the operation, there were no adverse events such as death, aortic valve injury, and iatrogenic interventricular septal perforation. Compared with those before the operation, the wall thickness of basal and middle segments of the anterior and posterior interventricular septum decreased significantly (all P<0.001), and LVOT-PG decreased significantly ( P<0.001). After TA-BSM, the number of patients with SAM≥3 decreased from 94 cases (68.6%) to 2 cases (1.5%), and the number of patients with MR≥3+ decreased from 86 cases (62.8%) to 9 cases (6.6%)(all P<0.001). For the patients with different degrees of ventricular septal hypertrophy (mild, moderate, and severe), the postoperative IVST and LVOT-PG were significantly lower than the preoperative values, and the degree of MR and SAM signs was relieved considerably. The length of the incisal margin, the weight of excised myocardium, and the number of resection in the group with extensive septal hypertrophy in all three regions were significantly higher than those in the group with localized interventricular septal hypertrophy in single or two areas (all P<0.05). Conclusions:3D-TEE can guide and monitor the process of TA-BSM myocardial resection in real-time. By accurately evaluating the IVST and the range and hemodynamic characteristics of HOCM patients, it can effectively relieve LVOTO and significantly reduce MR to ensure the safety and effectiveness of TA-BSM in HOCM patients with different degrees and ranges of hypertrophy.

Objective:To analyze the clinical effects of the pre-expanded internal mammary artery perforator flap in large chest keloids surgical treatment.Methods:Patients with large chest keloid were treated with the pre-expanded internal mammary artery perforator flap between January 2017 and September 2021. The surgical treatment was divided into two different phases. In the first phase, a tissue expander was implanted beneath the skin within the angiosome of the internal mammary artery perforator. The expander was injected with normal saline once a week. In the second phase, the expander and the keloid tissue were removed, and a pre-expanded internal mammary artery perforator flap was designed to cover the wound. Radiotherapy and hyperbaric oxygen therapy were performed in the postoperative period. The treatment effect was followed up. The postoperative complications were analyzed, and the recurrence and patient satisfaction rates were recorded.Results:A total of 41 patients were enrolled, including 20 male and 21 female patients. The patients’ age ranged from 24 to 64, with a mean disease history of 11.9 years. The mean size of the keloid was 9 cm × 8 cm. Some patients were treated with one expander, but four expanders were needed in some extensive cases. The volume of the expander ranged from 80 to 600 ml. The mean volume was 300 ml, with a mean expansion time of 3 months. The mean flap size was 9 cm × 8 cm. Two cases with distal necrosis were observed. Five cases suffered from partial incision scar hyperplasia. No recurrence occurred during the followed-up period. Thirty-six patients (87.8%) were satisfied with the operation effect, and five (12.2%) thought the effect was acceptable.Conclusions:The pre-expanded internal mammary artery perforator flap is an effective treatment for the large chest keloid. It can provide sufficient skin tissue for wound repair, with a stable blood supply and an excellent curative effect.

Objective:To analyze the clinical effects of the pre-expanded internal mammary artery perforator flap in large chest keloids surgical treatment.Methods:Patients with large chest keloid were treated with the pre-expanded internal mammary artery perforator flap between January 2017 and September 2021. The surgical treatment was divided into two different phases. In the first phase, a tissue expander was implanted beneath the skin within the angiosome of the internal mammary artery perforator. The expander was injected with normal saline once a week. In the second phase, the expander and the keloid tissue were removed, and a pre-expanded internal mammary artery perforator flap was designed to cover the wound. Radiotherapy and hyperbaric oxygen therapy were performed in the postoperative period. The treatment effect was followed up. The postoperative complications were analyzed, and the recurrence and patient satisfaction rates were recorded.Results:A total of 41 patients were enrolled, including 20 male and 21 female patients. The patients’ age ranged from 24 to 64, with a mean disease history of 11.9 years. The mean size of the keloid was 9 cm × 8 cm. Some patients were treated with one expander, but four expanders were needed in some extensive cases. The volume of the expander ranged from 80 to 600 ml. The mean volume was 300 ml, with a mean expansion time of 3 months. The mean flap size was 9 cm × 8 cm. Two cases with distal necrosis were observed. Five cases suffered from partial incision scar hyperplasia. No recurrence occurred during the followed-up period. Thirty-six patients (87.8%) were satisfied with the operation effect, and five (12.2%) thought the effect was acceptable.Conclusions:The pre-expanded internal mammary artery perforator flap is an effective treatment for the large chest keloid. It can provide sufficient skin tissue for wound repair, with a stable blood supply and an excellent curative effect.

Objective:To explore the clinical effect of repairing the ankle soft tissue defects with bone exposure using descending branch of lateral circumflex femoral artery (LCFA-db) perforator flap.Methods:From May 2014 to March 2018, 11 patients with ankle soft tissue defect with bone and tendon exposure were treated in the First Central Hospital of Baoding City ( 9 males and 2 females, aged from 19 to 47 years). VSD treatment was performed after debridement. When the wound show no signs of infection, the secondary repair was performed using the LCFA-db perforator flap. The area of the flap was 6.5 cm×4.5 cm-16.5 cm×8.5 cm. Followed-up was acquired to be used for evaluating the clinical effect.Results:There were no complications such as vasospasm or vascular crisis for transplanted flap after surgery. In 11 cases, 2 cases had necrosis of 0.5-1.0 cm in the distal part of the flap. Both were completely healed after dressing and related treatment. The flaps in the rest of patients survived successfully. The patients were followed up for 4-16 months with a mean time of 10.4 months. These flaps survived with good appearance, no swelling, no need for secondary surgery, soft texture, abrasion resistant and no pigmentation. Protective sense was restored. At the last follow-up, the American Orthopedic Foot and Ankle Society Score (AOFAS) score was ranging from 74 to 98 in 11 cases with the average score of 90.55. The outcomes were excellent in 8 cases, good in 2 cases and fair in 1 case. The donor site of the flap healed well. The flexion and extension of knee joint were normal with the good appearance and no impaired function.Conclusions:LCFA-db perforator flap may serve as an alternative option for reconstructing the ankle with soft-tissue defect.

Objective:To explore the clinical effect of repairing the ankle soft tissue defects with bone exposure using descending branch of lateral circumflex femoral artery (LCFA-db) perforator flap.Methods:From May 2014 to March 2018, 11 patients with ankle soft tissue defect with bone and tendon exposure were treated in the First Central Hospital of Baoding City ( 9 males and 2 females, aged from 19 to 47 years). VSD treatment was performed after debridement. When the wound show no signs of infection, the secondary repair was performed using the LCFA-db perforator flap. The area of the flap was 6.5 cm×4.5 cm-16.5 cm×8.5 cm. Followed-up was acquired to be used for evaluating the clinical effect.Results:There were no complications such as vasospasm or vascular crisis for transplanted flap after surgery. In 11 cases, 2 cases had necrosis of 0.5-1.0 cm in the distal part of the flap. Both were completely healed after dressing and related treatment. The flaps in the rest of patients survived successfully. The patients were followed up for 4-16 months with a mean time of 10.4 months. These flaps survived with good appearance, no swelling, no need for secondary surgery, soft texture, abrasion resistant and no pigmentation. Protective sense was restored. At the last follow-up, the American Orthopedic Foot and Ankle Society Score (AOFAS) score was ranging from 74 to 98 in 11 cases with the average score of 90.55. The outcomes were excellent in 8 cases, good in 2 cases and fair in 1 case. The donor site of the flap healed well. The flexion and extension of knee joint were normal with the good appearance and no impaired function.Conclusions:LCFA-db perforator flap may serve as an alternative option for reconstructing the ankle with soft-tissue defect.