Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

Patients with endometriosis are often associated with follicular growth retardation and oocyte maturation disorders, severely affecting patient fertility. In patients with endometriosis, the occurrence of apoptosis and oxidative stress events in granulosa cells, impaired cellular energy metabolism and steroid synthesis in patients with endometriosis may be the cause of abnormal follicular development and decreased oocyte quality. The inflammatory response caused by endometrioma, which afterwards leads excessive activation of follicles and fibrosis of the ovarian cortex, which directly reduces ovarian reserve. This article discusses the oxidative stress and apoptosis of follicle granulosa cells, steroid hormone synthesis, energy metabolism abnormality in patients with endometriosis, and explains the adverse effects of endometrioma on ovarian reserve from the perspective of inflammatory response.

Patients with endometriosis are often associated with follicular growth retardation and oocyte maturation disorders, severely affecting patient fertility. In patients with endometriosis, the occurrence of apoptosis and oxidative stress events in granulosa cells, impaired cellular energy metabolism and steroid synthesis in patients with endometriosis may be the cause of abnormal follicular development and decreased oocyte quality. The inflammatory response caused by endometrioma, which afterwards leads excessive activation of follicles and fibrosis of the ovarian cortex, which directly reduces ovarian reserve. This article discusses the oxidative stress and apoptosis of follicle granulosa cells, steroid hormone synthesis, energy metabolism abnormality in patients with endometriosis, and explains the adverse effects of endometrioma on ovarian reserve from the perspective of inflammatory response.

Objective Using of cumulative live birth rate(CLBR)per oocytes retrieved cycle,to assess the clinical outcomes of in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI),and to explore impact factors on CLBR following utilization of all fresh and frozen embryos in one complete IVF/ICSI cycle using gonadotropin-releasing hormone(GnRH)agonist, GnRH-antagonist and clomiphene mild stimulation protocols. Methods Of the patients who underwent IVF/ICSI from January 1st, 2014 to December 31st, 2015 in the First Affiliated Hospital, Nanjing Medical University, a total of 6 142 oocytes retrieved cycles were included. The clinical and laboratory parameters of different ovarian stimulation protocols, and the effects of the age, number of oocytes retrieved and number of embryos available on the CLBR of each oocytes retrieved cycle were analyzed.Results The CLBR was 69.0%(2 004/2 906)in the GnRH-agonist protocol versus 67.4%(644/955)in the GnRH-antagonist protocol (P>0.05); the CLBR of clomiphene mild stimulation protocol was 53.2%(1 215/2 281),significantly lower than those of the other two protocols (all P<0.05). The CLBR significantly decreased with age increased. When divided into four groups according to the patients′ age, we found that CLBR were not statistically significant using three different protocols in the 20-25 years old group(all P>0.05).There was a strong association between the number of oocytes retrieved and embryos available on CLBR. CLBR rose significantly with an increasing number of oocytes up to 6, then the rising trend slowed down. Patients were categorized into four groups according to the number of oocytes retrieved,CLBR was significantly higher using GnRH-antagonist protocol (50.0%)than mild stimulation protocol(37.0%)in low ovarian responder(0-4 oocytes)group(P<0.05). The CLBR were no significant difference among three protocols in normal(10-15 oocytes)and high responders(≥15 oocytes)group(all P>0.05).The incidence rate of ovarian hyperstimulation syndrome in GnRH-agonist protocols(5.2%,152/2 906)were significantly higher than those of GnRH-antagonist(4.4%, 42/955)and clomiphene mild stimulation protocols(1.5%,34/2 281;all P<0.05).Conclusions CLBR is an important index to assess the clinical outcomes of IVF/ICSI. Age, number of oocytes retrieved and embryos available could affect CLBR obviously. According to the different age and ovarian response of patients, we should design ovarian stimulation protocols based on target oocytes number in order to get higher CLBR and reduce complications.