Objective:To explore the clinical efficacy of Masquelet technique combined with tissue flap transfer in the treatment of infectious composite bone and soft tissue defects in the early and middle stages after internal fixation for tibial fractures.Methods:From October 2017 to November 2020, 12 patients (13 tibial fractures) with infectious bone and soft tissue defects in the early and middle stages after internal fixation were treated in the Department of Orthopaedics, 988th Hospital of the Joint Logistics Support Force of CPLA by two-phased surgery with retaining internal fixation. Phase I procedures were thoroughly removal of the infected lesions and failed screws, preserving internal implants as many as possible, implantation of absorbable calcium sulphate and an antibiotics blended string of beads into the distal and proximal medullary cavity of the fractured bones, filling the bone defect and wrapping the internal implants with antibiotics loaded bone cement. The size of defects was 3.5 cm × 5.0 cm-7.5 cm × 14.5 cm, and the flaps for wound coverage sized 4.0 cm × 5.5 cm-8.0 cm × 15.0 cm. As for the repair of donor site, 8 limbs were sutured directly, 5 limbs could not be closed completely, and the remaining wounds were covered by skin grafting after suture. Based on well control of infection and stable clinical signs, fillings of bone cement were then removed in Phase II surgery, or 6-9 weeks after primary surgery. Autologous cancellous bone pieces or composite allogeneic bone were fully implanted around the induction membrane formed by Masquelet technique, and auxiliary steel plates were implanted for internal fixation of unstable fractures. After discharge, the patients visited the outpatient clinic regularly, and combined with Wechat follow-up. The texture, colour and bone healing were observed. At the last follow-up, the function of the affected limbs were assessed according to Johner-Wruhs evaluation standard.Results:After Phase I surgery, 13 flaps survived smoothly without vascular compromise. The wounds healed in Phase I. Two patients (2 sides) had recurrent infections. Re-debridement was performed and external fixation was applied after removal of internal fixation. After Phase II surgery, all patients were included in 12-26 months of follow-up, with an average of 18 months. Thirteen lower leg fractures healed well, and the time of bone healing was 16-25 (average 19.5) weeks. The Johner Wruhs criteria was used in evaluation of the function of affected limbs, and it was found that 6 patients were in excellent, 5 in good and 2 in fair.Conclusion:It is feasible while preserving the internal implants, to use membrane induction technique (Masquelet technique) combined with flap transfer, together with the absorbable calcium sulphate antibiotic sustained-release beads as a carrier in the phased treatment of infectious bone defects and bone exposure in the early and middle stages after the surgery of tibial internal fixation. It also gives a higher rate of excellence in surgical outcome. This study explores a treatment procedure for traumatic bone infection combined with composite soft tissue defects.

Objective:To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods:From January 2016 to June 2021, 12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics, 988th Hospital of the Joint Logistics Support Force of PLA. The area of soft tissue defect around Achilles tendon was 2.5 cm× 4.5 cm-8.0 cm×12.5 cm, and the length of the defect of Achilles tendon was 3.0-7.0 cm. The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap (ATF) and the posterior perforating branch of peroneal artery was used as the vessel of blood supply. The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm, and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm. The donor sites were sutured directly (8 cases) or repaired with skin graft (4 cases). External fixation were put on for 6 weeks after surgery. Then the external fixation was removed and the functional exercise gradually started. Outpatient clinic follow-ups were carried out regularly. Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results:The chimeric ATF was harvested and the blood supply of each flap was good during the operation. There was no vascular crisis after surgery. The flaps survived smoothly and the wound achieved grade A healing. All patients were entered follow-up that lasted for 10-24 months. There was good appearance of flaps with minor bloating, and the colour of flaps was similar to the skin around the receiving site. The texture was soft with normal function of the lower legs and ankle. Tendon function was evaluated by Thermann Achilles tendon function assessment system, the result were 8 cases in excellent and 4 cases in good.Conclusion:The nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery can accurately repair a composite tissue defect in the Achilles tendon area, and it is one of the effective methods for the repair of a composite soft tissue wound with Achilles tendon defect.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective To establish an IT-based follow-up platform, and to explore its application effect in patients with ischemic stroke.Methods By constructing a follow-up model and a recurrence risk warning model for ischemic stroke patients, such a follow-up platform was established.Thanks to the retrospective comparative and analysis method, we built a study group comprising ischemic stroke patients discharged since the platform and a control group comprising 228 such patients discharged prior to the platform.These two groups were followed up by means of IT-based manner and traditional paper-based manner respectively at the first,third,sixth,ninth,and twelfth months since their discharge.These patients were analyzed in terms of their medication adherence,activities of daily living and recurrence rate.Results One year after the follow-up,32 cases were lost of contact in the study group and 42 cases from the control group.Medication adherence of the study group was higher than that of the control group at the sixth month (2.72 ±0.62), ninth month(2.86 ±0.37)and twelfth month(2.83 ±0.40)after discharge, with the differences being statistically significant(P <0.05).The recurrence rate of the study group at the ninth months(6.38%)and twelfth months(10.21%)after follow-up was lower than that of the control group,a difference being statistically significant(P<0.05).The difference of BI scores between the two groups was not statistically significant(P>0.05).Conclusions The IT-based follow-up platform could improve the medication adherence of ischemic stroke patients,and reduce the recurrence rate of ischemic stroke,but the effect of improving activities of daily living was still not significant.

Objective To investigate the morbidity and characteristics of adult osteonecrosis of the femoral head (ONFH) in Chengdu, and to further explore its related risk factors.Methods Self-designed questionnaires were used to collect data by the way of household or field survey. From January,2016 to February, 2018, a total of 544 cases (797 hips) diagnosed as ONFH were included in the study. The medical data including general condition, risk factors, diagnosis, disease stages and treatment were collected. Based on the data, the risk factors were analyzed statistically.Results The average age of 544 patients (392 males and 152 females) was 55 years old (range: 19 to 90 years); the bilateral incidence was 46.51% (253 cases). The proportion of Association Research Circulation Osseous stages was accounted respectively 3.64% for stage I, 6.15% for stage II, 8.41% for stage III and 81.81% for stage IV when confirmed ONFH initially. In all the reasons of ONFH, 52.39% were alcohol-associated osteonecrosis, 16.18% for steroid-induced osteonecrosis, 11.58% for traumatic osteonecrosis, 5.88% for dysplastic osteonecrosis, and 13.97% for other reasons.Conclusion The incidence of ONFH was higher in men than in women. Stages III-IV accounted for the highest proportion. The high intake of alcohol or overuse of steroid was the leading causes of adult ONFH, among which alcohol-associated osteonecrosis was the main for the males and steroid-induced osteonecrosis for the females.

Objective To investigate the clinicopathologic factors associated with neck control and distant metastasis in patients with neck metastases in head and neck squamous cell carcinoma (HNSCC)after postoperative radiation as adjuvant treatment.Methods Clinicopathologic data of 208 pathologic N + (pN +) patients with HNSCC initially treated with neck dissection and postoperative radiation in Bethune International Peace Hospital of China from January 2004 to December 2009 were reviewed.The clinicopathologic factors,includeding age,sex,primary tumor site,pathologic T and N stage,tumor growth pattern,histological grade,tumor resection margin,size and number of positive lymph node,number of levels with positive lymph node,and extracapsular nodal spread (ECS),were evaluated for their association with neck control and distant metastasis in patients with HNSCC after postoperative radiation.Univariate x2 test and multiple stepwise logistic regression model were used for the analysis.Results Overall 5-year neck control rate after postoperative radiotherapy was 72.6％ (151/208),with 84.0％ (63/75) for SND,72.9％ (78/107) for MRND,and 38.5％ (10/26) for RND,respectively.Univariate analysis showed that neck control after postoperative radiation was related with following factors:primary tumor site,pathologic N stage,size of positive node,number of levels with positive node,number of positive node,and ECS.Pathologic N stage and number of levels with positive lymph node were associated with distant metastasis.Multivariate analysis indicated that ECS was the most significant risk factor for neck metastasis after surgery and postoperative radiotherapy and the number of levels with positive node was the most significant risk factor for distant metastasis.Conclusions ECS is the most important pathologic factor in planning postoperative adjuvant treatment for pN + patients with HNSCC,therefore ECS should be evaluated routinely after neck dissection.The value of postoperative radiotherapy in controlling the ECS-related recurrence after surgery is limited.Postoperative concurrent chemoradiotherapy and targeted therapy can be considered in HNSCC patients with ECS.

A method for simultaneous determination of 20 Perfluorinated alkyl substances ( PFAS) in animal liver using QuEChERs and HPLC_MS/MS technique was developed. The samples were extracted with 0. 1%hydrochloric acetonitrile and cleaned up with C18 , N_Propylethylendiamine ( PSA ) and graphitized carbon blacks ( GCB ) . The analytes were separated by a reversed phase C18 column and gradiently eluted with a mixed solution of 5 mmol/L ammonium acetate methanol and 5 mmol/L ammonium acetate. The samples were quantified using isotope internal standard and external standard with the matrix matched standard calibration curve method. Good linearity was obtained for all the 20 PFAS at the concentration of 0. 1-10 μg/L with the linear correlation coefficients more than 0. 9995. The limits of detection (LOD) and the limits of quantification ( LOQ) for PFAS were 0. 05-0. 2 μg/kg and 0. 4-0. 5 μg/kg, respectively. The recoveries at three different concentration levels ( 0 . 5 , 2 and 5 μg/kg ) were in the range of 70 . 3% -108 . 1%. The repeatability expressed as relative standard deviations (RSD) was ranged from 2. 1% to 11. 9% (n=6).

OBJECTIVETo investigate the clinicopathologic features and associated risk factors for bilateral neck node metastasis (BNM) in head and neck squamous cell carcinoma (HNSCC).

METHODSTwo hundred eighty-six cases with HNSCC were retrospectively studied, including 83 cases of oral tongue cancers, 101 cases of hypopharyngeal cancers and 102 cases of supraglottic laryngeal cancers. All patients had unilateral or bilateral cervical lymph node metastasis confirmed by postoperative pathologic examinations. The following factors were evaluated to determine the risk for BNM in HNSCC: T staging, size, location, trans-midline condition, growth pattern, pathologic grading and infiltration of primary tumors; N staging; the size, number and extracapsular spread (ECS) of ipsilateral metastatic nodes; the number of involved levels on the ipsilateral neck. Chi-square test and logistic regression test were used for statistical analysis.

RESULTSBNM was found in 86 (30.1%) of 286 patients with HNSCC, including 52 (18.2%) cases of contralateral occult neck node metastasis. The incidence of BNM was 35.6% (36/101) in hypopharyngeal cancer, 31.4% (32/102) in supraglottic laryngeal cancer and 21.7% (18/83) in oral tongue cancer, respectively. N staging, the number and ECS of ipsilateral metastatic nodes, and the number of involved levels on the ipsilateral neck were important factors contributing to BNM. Multiple logistic regression analysis revealed that midline passing of primary tumor was associated with BNM in oral tongue cancer. The midline passing and ECS of ipsilateral metastatic node were key factors for BNM in hypopharyngeal and supraglottic laryngeal cancers. T staging, size and midline passing of primary tumor were closely related to BNM in oral tongue cancer. T staging and midline passing were associated with BNM in hypopharyngeal cancer. Midline passing was an important factor related to BNM in supraglottic laryngeal cancer.

CONCLUSIONMidline passing of primary tumor is the most important factor determining BNM in hypopharyngeal, supraglottic laryngeal and oral tongue cancers, whereas ECS of ipsilateral metastatic node is the most important factor impacting BNM in hypopharyngeal and supraglottic laryngeal cancers.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; Female ; Head and Neck Neoplasms ; pathology ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors

Objective To explore the clinical efficacy of metoprolol on elderly patients with chronic heart failure (CHF)and its influence on serum interleukin-12 (IL-12)and brain natriuretic peptide (BNP)levels.Methods A total of 86 patients with CHF served as study objects and ran-domly divided into observation group and control group,43 cases for each.Routine medicines were given to control group while observational group added with metoprolol for 12 weeks.Clinical effica-cy and changes of serum IL-12 and BNP levels were observed.Results Total response rate in obser-vation group was 93.02%,evidently higher than in control group (P <0.01),and there were sig-nificant differences before and after treatment and between two groups in blood pressure,heart rate and left ventricular ejection fraction (LVEF)(P <0.01).Conclusion Basic therapies concomitant with metoprolol have better clinical efficacy than single application of basic therapies,and can more effectively regulate serum IL-12 and BNP expressions and improve the internal environment of body of elderly patients with CHF.