Objective:To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture.Methods:This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ.Results:Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand.Conclusions:The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.

Objective:To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture.Methods:This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ.Results:Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand.Conclusions:The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.

Objective:To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux.Methods:From January 2019 to June 2022, 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux, with the first dorsal metatarsal artery as the pedicle, in the Department of Upper Limb Repair and Reconstruction Surgery, Guizhou Hospital of Beijing Jishuitan Hospital. The patients were 10 males and 5 females and aged 20 to 45 years old. Eight patients had the defects of thumbs and index fingers, 4 of thumbs and middle fingers, 2 of thumb, index and middle fingers and 1 of thumb, index and ring fingers. All the 15 digit injuries had nail bed defects to which reconstructive surgery were required. For the flaps of dorsal artery, flaps were 1.8 cm×2.0 cm-2.0 cm×3.1 cm in size and for those of plantar artery, the flaps sized 1.5 cm×2.0 cm-2.5 cm×3.0 cm. Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps. Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic, WeChat and telephone reviews to assess the appearance, function and sensation recovery of the digits.Results:All the 15 flaps survived. During the 6 to 24 months (16 months in average) of postoperative follow-up, the appearance and texture of all flaps were found close to the healthy digits, with good nail growth and without deformity. TPD were found between 8.0 mm and 12.0 mm. The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well, and the incisions were satisfactorily healed without the functions of walking, running or jumping being significantly affected.Conclusion:The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy, ease with flap harvest, similarity in the normal digital skin texture, and the capability to include a nail bed with the flap. A single donor from the hallux can simultaneously reconstruct two defects of digit-tip, making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits.

Objective To compare the value of the 2018 Chinese guideline prognostic score with that of the 2019 European Society of Cardiology(ESC)in the predicting efficiency for acute pulmonary embolism(APE)in 30-day all-cause mortality.Methods The data of the hospitalized patients with confirmed APE from January 2015 to December 2019 were retrospectively collected.According to death within 30 days,the patients were divided into a death group and a survival group.Subgroup analysis was performed according to gender,oxygen saturation and infection.The SPSS software was used to establish the receiver operating characteristic curve(ROC)for the two scores and calculated the area under the curve(AUC).The Delong's test was applied to compare the AUC differences.The net reclassification index(NRI)and integrated discrimination improvement(IDI)were calculated using the R software packages of survival,survIDINRI,and PredictABEL.Results 626 APE patients were enrolled,and 30-day death was predicted in those patients using two scores.In terms of overall discrimination,the 2018 Chinese guideline prognostic score was better than the 2019 ESC guideline prognostic score,with an AUC of 0.782 and 0.749,respectively;but there were no statistical differences between the two AUC(P＞0.05).In terms of prediction accuracy,the NRI of the 2019 ESC guideline prognostic score was 44.4%(95%CI:0.091～0.753),higher than that of the 2018 Chinese guidelines prognostic score,which increased by 58.6%(95%CI:0.161～0.917)in the correct reclassification to death group,while decreased by 14.2%(95%CI:-0.249～0.08)in the correct reclassification to survival group.IDI increased by 3.38%(P＜0.05).Subgroup analysis showed the prognostic scores of the 2018 Chinese guidelines and the 2019 ESC guidelines prognostic scores had predictive ability for patients with different gender and different oxygen saturation(P＜0.05),and the prognostic scores for co-infected population(AUC:0.749,0.772)(P＞0.05),non-coinfected population(AUC:0.652,0.833).Conclusions Both the 2018 Chinese guideline prognostic score and the 2019 ESC guideline prognostic score can predict 30-day mortality in APE patients,and have a better predictive ability for the co-infected population.However,the predictive accuracy of the former is higher than that of the latter in the survival group,and the score is more rapid and convenient for clinical application,while the latter has improved the prediction ability in the death group.

BACKGROUND:Currently,there is a lack of large sample studies to analyze the bone metabolism level of patients with femoral head necrosis of different etiologies and stages,which is not conducive to the development of better necrosis-promoting repair strategies. OBJECTIVE:To study the bone metabolism of patients with osteonecrosis of the femoral head with different etiologies and Association Research Circulation Osseous(ARCO)stages. METHODS:A retrospective study was performed on 401 patients diagnosed with osteonecrosis of the femoral head as the trial group,and 81 healthy subjects as the control group.The trial group could be divided into three groups according to different etiologies:steroid-induced osteonecrosis of the femoral head,alcoholic osteonecrosis of the femoral head and traumatic osteonecrosis of the femoral head,and were divided into stages Ⅱ/Ⅲ/Ⅳ according to different ARCO stages.Seven bone metabolism-related indicators of all subjects were collected,including bone metabolism-regulating hormone 25-hydroxyvitamin D and bone conversion markers:N-terminal propeptide of type Ⅰ procollagen,degradation product of type Ⅰ collagen,n-terminal middle molecular fragment of osteocalcin,general biochemical markers of bone metabolism:serum calcium,serum phosphorus,serum alkaline phosphatase.The bone metabolism levels of each group were compared and the independent factors associated with osteonecrosis of the femoral head were determined by binary Logistic regression analysis. RESULTS AND CONCLUSION:Compared with the control group,levels of degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,n-terminal middle molecular fragment of osteocalcin,serum phosphorus and alkaline phosphatase in the trial group were significantly increased(all P＜0.05).Based on the presence or absence of the disease,according to binary Logistic regression analysis,degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,and n-terminal middle molecular fragment of osteocalcin were independent factors associated with osteonecrosis of the femoral head.The levels of degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in three groups of patients with different etiologies were higher than normal reference values.The bone metabolism-regulating hormone 25-hydroxyvitamin D and serum calcium in the alcoholic osteonecrosis of the femoral head group were higher than those in the other two groups(P＜0.05).The level of bone metabolism-regulating hormone 25-hydroxyvitamin D in steroid-induced and traumatic osteonecrosis of the femoral head groups was lower than the normal value.There were no significant differences in seven bone metabolism-related indicators in patients with ARCO stages Ⅱ,Ⅲ and Ⅳ osteonecrosis of the femoral head(all P＞0.05),but degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in these three groups were higher than normal reference values.Bone metabolism-regulating hormone 25-hydroxyvitamin D in patients with ARCO stage Ⅱ and ARCO stage Ⅳ was lower than the normal reference value.It is concluded that the bone metabolism level of osteonecrosis of the femoral head patients was abnormal.The degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen of osteonecrosis of the femoral head patients with different etiologies and ARCO stages were all higher than the normal reference value,and they were in a state of high bone turnover.Degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen and n-terminal middle molecular fragment of osteocalcin may be risk factors for the pathogenesis of osteonecrosis of the femoral head.

Objective: QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. Methods: This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. Results: Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46).The median duration of response was 9.6 months (95% confidence interval [CI]=5.5–not estimable). The median progression-free survival was 8.1 months (95% CI=5.7–14.0). Fortyfive (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). Conclusion QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can’t tolerate bevacizumab, which needs to be further verified in phase III confirmatory study.

Objective: QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. Methods: This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. Results: Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46).The median duration of response was 9.6 months (95% confidence interval [CI]=5.5–not estimable). The median progression-free survival was 8.1 months (95% CI=5.7–14.0). Fortyfive (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). Conclusion QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can’t tolerate bevacizumab, which needs to be further verified in phase III confirmatory study.

Objective: QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. Methods: This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. Results: Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46).The median duration of response was 9.6 months (95% confidence interval [CI]=5.5–not estimable). The median progression-free survival was 8.1 months (95% CI=5.7–14.0). Fortyfive (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). Conclusion QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can’t tolerate bevacizumab, which needs to be further verified in phase III confirmatory study.

In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.

In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.