Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Scaffold hopping refers to computer-aided screening for active compounds with different structures against the same receptor to enrich privileged scaffolds, which is a topic of high interest in organic and medicinal chemistry. However, most approaches cannot efficiently predict the potency level of candidates after scaffold hopping. Herein, we identified potent PDE5 inhibitors with a novel scaffold via a free energy perturbation (FEP)-guided scaffold-hopping strategy, and FEP shows great advantages to precisely predict the theoretical binding potencies ΔG _FEP between ligands and their target, which were more consistent with the experimental binding potencies ΔG _EXP (the mean absolute deviations | Δ G FEP - Δ G EXP |  < 2 kcal/mol) than those ΔG _MM-PBSA or ΔG _MM-GBSA predicted by the MM-PBSA or MM-GBSA method. Lead L12 had an IC₅₀ of 8.7 nmol/L and exhibited a different binding pattern in its crystal structure with PDE5 from the famous starting drug tadalafil. Our work provides the first report via the FEP-guided scaffold hopping strategy for potent inhibitor discovery with a novel scaffold, implying that it will have a variety of future applications in rational molecular design and drug discovery.

Objective:To explore the clinical application of conjoined bipedicle deep inferior epigastric perforator flap (DIEP) in reconstruction of unilateral breast for patients with breast cancer.Methods:From August, 2007 to Feburary, 2017, 41 cases of breast cancer patients received conjoined bipedicle DIEP to reconstruct breasts at the same time of radial operation of mastocarcinoma or in the second phase. Their age ranged from 27 to 49 (34.5±2.7) years old. Twenty-two cases had one-staged and other 19 had two-staged breast reconstruction. All patients were in scheduled followed-up.Results:In this study, 41 conjoined bipedicle DIEP were harvested, including 12 of lateral branch type, 9 of medial branch type, and 20 of combined lateral and medial branch type. The length of flap was (24.5±0.5) cm, the width of flap was (10.8±2.8) cm, and the thickness of flap was(5.5±0.4) cm. The length of flap pedicle was (12.5±0.6) cm. The average weight of flap was 565 (ranged 365-1 050) g. The vascular combinations in the receiving area included: ①Eighteen cases of proximal and distal thoracic vessels. ②Eleven cases proximal ends of internal mammary vessels and lateral thoracic vessels. ③Eight cases of proximal ends of internal mammary vessels and thoracodorsal vessels. ④Four cases thoracodorsal vessels and lateral thoracic vessels. In 3 patients, in order to further promote the venous outflow of the flap, the superficial inferior epigastric vein of the flap was anastomosed with the thoracoacromial vein of the recipient area. All flaps were successful and completely survived without marginal necrosis or infection. The shape, texture and elasticity of the reconstructed breasts were good without flap contractive deformity. There were only linear scars left in the donor sites, and function of abdomen was not affected. All 41 patients were followed-up for 12 to 50 months, with an average of 15.8 months with satisfied results. No local recurrence happened. Only linear scar was left in the donor site of abdomen, and the function of abdominal wall was not affected. In all cases bilateral rectus abdominis muscle strength was level 5.Conclusion:The conjoined bipedicle DIEP could be a safe and valuable option as an alternative method for autologous breast reconstruction.

Objective:To introduce the advantages and clinical experience of relaying antero thigh flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer for oral cancer defect reconstruction.Methods:The number, courses and location of antero thigh perforators were recorded in 6 adult specimens, (3 male and 3 female). Specimen was produced via femoral artery perfusion after joining lead oxide red setting, up to the inguinal ligament, down to the superior margin of patella, lateral to the lateral femoral intermuscular septum, medial near the lateral margin of adductor longus muscle. From February 2016 to December 2018 in Hunan Provincial Cancer Hospital, 13 cases (11 male and 2 female) with oral carcinoma (8 tongue carcinoma and 5 buccal cancer), leaving tongue or mouth defects which were reconstructed by free AMT perforator flaps.Results:All free AMT flaps were harvested smoothly, the flap size ranged from 7.5 cm×4.5 cm to 13.0 cm×7.5 cm, the donor sites were reconstructed with relaying ALT flaps in 10 cases, with relaying AMT flaps in 3 cases, the relaying ALT flap size ranged from 8.5 cm×5.0 cm to 18.0 cm×7.0 cm, the relaying AMT flap size ranged from 7.5 cm×4.0 cm to 15.0 cm×7.0 cm. All flaps survived uneventfully, no vascular crisis or wound dehiscence, infection occurred. All patients were followed up for 12~28 months, all flaps healed smoothly, only linear scar was left in the donor sites, the color, appearance and contour of flaps were natural, and the function of thighs were not affected.Conclusions:When it is difficult to elevate the free anterolateral thigh flap, the free anteromedial thigh flap can be used to repair the oral cancer defect. When the direct closure of the flap donor area is of big tension, the relaying antero flap can be used to reconstruct the donor site, minimize the operation time and improve the outcome.

Objective:To explore the extending design and anatomical basis of pedicled gracilis musculocutaneous flaps in perineal reconstruction.Methods:On six female cadavers (age ranged from 27 to 52 years old, 41.2 on average), bilateral gracilis flaps were designed, raised and transferred in the standard surgical manner and tunneled under the adductor longus muscle. Measured the distance from the tip of 12 flaps to the bilateral anterior superior iliac spine (ASIS). The myocutaneous flaps were then transferred and the distances from the tip of flaps to the ASIS were measured again. The paired sample t test (double tail) was used to compare the data measured by the two transfer method.Results:Cadaveric dissection revealed that in 6 corpses, bilateral profunda artery muscular branches all courses between the longus adductor and mangus adductor muscles, the pedicle length of 12 gracilis musculocutaneous flaps was(7.84±0.71) cm. In the standard surgical manner group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (9.23±0.95) cm, ranged from 6.9 cm to 10.5 cm, the distance from the tip of flaps to the contralateral ASIS was(11.45±2.27) cm, ranged from 7.5 cm to 14.8 cm. In the tunnelled under the adductor longus muscle extension design group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (4.52±1.18) cm, ranged from 2.7 cm to 6.5 cm, the distance from the tip of flaps to the contralateral ASIS was (8.92 ±1.82) cm, ranged from 4.8 cm to 11.7 cm. Compared with the standard surgical manner group, tunneling the flap under the adductor longus muscle to the ipsilateral side increased the reach by 3.5 cm to 7.3 cm, (4.71±1.14) cm, to contralateral side increased the reach by 0.9 cm to 4.1 cm, (2.53±0.89) cm. The distance to the ipsilateral anterior superior iliac spine measured by the two method , t=13.194, P<0.001, and the distance to the contralateral anterior superior iliac spine, t=9.057, P<0.001. The difference was statistically significant. The tunneled under the adductor longus muscle extension design group can increase the reach of reconstructive scope by 3.62 cm on average. The additional increasing length of tunneled under the adductor longus muscle method is 46.2%(3.62/7.84) of the average vascular pedicle length. Conclusions:Cadaveric dissection result have shown that tunneling of the gracilis musculocutaneous flap in a novel extension design way can enlengthen the pedicle length, increase its reach across the perineum.

Objective:To explore the extending design and anatomical basis of pedicled gracilis musculocutaneous flaps in perineal reconstruction.Methods:On six female cadavers (age ranged from 27 to 52 years old, 41.2 on average), bilateral gracilis flaps were designed, raised and transferred in the standard surgical manner and tunneled under the adductor longus muscle. Measured the distance from the tip of 12 flaps to the bilateral anterior superior iliac spine (ASIS). The myocutaneous flaps were then transferred and the distances from the tip of flaps to the ASIS were measured again. The paired sample t test (double tail) was used to compare the data measured by the two transfer method.Results:Cadaveric dissection revealed that in 6 corpses, bilateral profunda artery muscular branches all courses between the longus adductor and mangus adductor muscles, the pedicle length of 12 gracilis musculocutaneous flaps was(7.84±0.71) cm. In the standard surgical manner group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (9.23±0.95) cm, ranged from 6.9 cm to 10.5 cm, the distance from the tip of flaps to the contralateral ASIS was(11.45±2.27) cm, ranged from 7.5 cm to 14.8 cm. In the tunnelled under the adductor longus muscle extension design group, after transferring, the distance from the tip of flaps to the ipsilateral ASIS was (4.52±1.18) cm, ranged from 2.7 cm to 6.5 cm, the distance from the tip of flaps to the contralateral ASIS was (8.92 ±1.82) cm, ranged from 4.8 cm to 11.7 cm. Compared with the standard surgical manner group, tunneling the flap under the adductor longus muscle to the ipsilateral side increased the reach by 3.5 cm to 7.3 cm, (4.71±1.14) cm, to contralateral side increased the reach by 0.9 cm to 4.1 cm, (2.53±0.89) cm. The distance to the ipsilateral anterior superior iliac spine measured by the two method , t=13.194, P<0.001, and the distance to the contralateral anterior superior iliac spine, t=9.057, P<0.001. The difference was statistically significant. The tunneled under the adductor longus muscle extension design group can increase the reach of reconstructive scope by 3.62 cm on average. The additional increasing length of tunneled under the adductor longus muscle method is 46.2%(3.62/7.84) of the average vascular pedicle length. Conclusions:Cadaveric dissection result have shown that tunneling of the gracilis musculocutaneous flap in a novel extension design way can enlengthen the pedicle length, increase its reach across the perineum.

Objective To explore the advantage of motor evoked potentials (MEPs) monitoring for postoperativemotor deficit evaluation under threshold-level electrical stimulation using cranial peg-screw electrode (CPSE) during cerebral aneurysm keyhole approach microsurgery. Methods A total of 31 patients who underwent anterior circulation aneurysm microsurgery through keyhole approach were selected in this study. MEPs monitoring of the operation side was conducted with threshold-level electrical stimulation using CPSE, and that of the non-operation side was conducted with transcranial electric stimulation using the same stimulation threshold. The change of minimum voltage required for MEPs monitoring was observed and recorded. The intraoperative MEPs monitoring results and postoperative neurological functions were analyzed by prospective observational study. Results MEPs of the operation side was successfully induced in 28 cases. No complications related to MEPs monitoring were observed. Intraoperative MEPs abnormalities were monitored in3 cases, and2 of them had postoperative transient hemiplegia, showing a sensitivity of 100% (2/2). No motor dysfunction was observed in the other 26 cases who were not presented with intraoperative MEPs abnormalities in 25 cases, showing a specificity of 96. 30% (26/27). Conclusion MEPs monitoring with threshold-level electrical stimulation using CPSE is a feasible and reliable method and t has satisfactory sensitivity and specificity for predicting motor dysfunction induced by cerebral ischemia, indicating that this method can be an alternative for routine MEPs monitoring with conventional transcranial electrical stimulation in cerebral aneurysm microsurgery.

OBJECTIVETo investigate the effects of transurethral resection of the prostate (TURP) on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) complicated by histological prostatitis.

METHODSThis study included 432 cases of BPH pathologically confirmed after TURP. Excluding those with LUTS-related factors before and after surgery and based on the international prostatitis histological classification of diagnostic criteria, the remaining 144 cases were divided into groups A (pure BPH, n = 30), B (mild inflammation, n = 55), C (moderate inflammation, n = 31), and D (severe inflammation, n = 28). Each group was evaluated for LUTS by IPSS before and a month after surgery.

RESULTSA total of 399 cases (92.4%) were diagnosed as BPH with histological prostatitis, 269 (67.4%) mild, 86 (21.6%) moderate and 44 (11.0%) severe. The preoperative IPSS was 21.43 +/- 6.09 in group A, 21.75 +/- 5.97 in B, 27.84 +/- 4.18 in C and 31.00 +/- 2.92 in D, with statistically significant differences among different groups (P < 0.001) except between A and B (P = 1.000); the postoperative IPSS was 5.60 +/- 2.16 in A, 7.36 +/- 2.77 in B, 11.55 +/- 3.39 in C and 16.89 +/- 3.37 in D, with statistically significant differences among different groups (P < 0.01), and remarkably lower than the preoperative one (P < 0.001). Almost all the infiltrating inflammatory cells in BPH with histological prostatitis were lymphocytes.

CONCLUSIONBPH is mostly complicated with histological chronic prostatitis. The severity of LUTS is higher in BPH patients with histological prostatitis than in those without before and after TURP, and positively correlated with the grade of inflammation. Those complicated with moderate or severe histological prostatitis should take medication for the management of LUTS.

Chronic Disease ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostatic Hyperplasia ; complications ; surgery ; Prostatitis ; complications ; surgery ; Transurethral Resection of Prostate ; Treatment Outcome

Objective To discuss the microsurgical skills of management of acoustic neuroma and the protection of facial nerve. Methods One hundred and sixty-eight patients with acoustic neuroma, admitted to our hospital from August 2002 to December 2010, received microsurgery through suboccipital retrosigmoid approach. Under intraoperative electromyography (EMG) monitoring, the facial nerve was separated sharply from both sides, and the tumors were removed by alternate intracapsular excision and capsule wall excision. The microsurgical skill and the method of protection of facial nerve were evaluated retrospectively. Results Total resection was performed in 149 cases (88.69％), partial resection in 19 cases (11.31％). Facial nerve was protected in 146 cases (86.9％) during the operation. Two patients were dead shortly after the surgery. The facial nerve functions were evaluated 6 months after the surgery: 91 (54.26％) belonged to grade Ⅰ and grade Ⅱ, and 52 (30.95％) belonged to grade Ⅲ and grade Ⅳ, while 52 (14.89％) belonged to grade Ⅴ and grade Ⅵ according to House-Brackmann grade. Conclusion The microsurgical removal of acoustic neuroma through suboccipital retrosigmoid approach is safe and effective. The intraoperative electromyography monitoring could improve the reservation rate of facial nerve. Skilled microsurgical technique is the key to the total removal of acoustic minor and the protection of facial nerve.