Objective:To compare the efficacy of low-dose febuxostat and low-dose benzbromarone in lowering serum uric acid and their impact on liver function in male patients with renal underexcretion gout.Methods:This prospective cohort study enrolled 303 patients with renal underexcretion gout and normal baseline liver function. Participants were assigned to either the low-dose febuxostat group(20 mg qd) or the low-dose benzbromarone group(25 mg qd). A linear mixed-effects model was used to compare the uric acid target achievement rate(<360 μmol/L) and changes in liver enzyme levels between the two groups.Results:At week 4, the proportion of patients achieving the serum uric acid target(<360 μmol/L) was significantly higher in the benzbromarone group than that in the febuxostat group(64.2% vs 42.3%, P<0.001), with a trend toward greater efficacy at weeks 8 and 12. The incidence of alanine aminotransferase(ALT) or aspartate aminotransferase(AST) elevation above the upper limit was significantly higher in the febuxostat group compared to the benzbromarone group(35.2% vs 13.85%, P<0.001). After adjusting for baseline liver enzyme levels in the mixed-effects model, mean ALT and AST levels remained significantly higher in the febuxostat group than those in the benzbromarone group at weeks 4, 8, and 12( P<0.05). In the febuxostat group, ALT and AST levels significantly increased over time during weeks 0-4 and 4-8 ( P<0.001), peaking at week 8 followed by a decreasing trend. By week 12, the levels were not significantly different from baseline ( P>0.05). Whereas there was no significant difference at each follow-up time point in the benzbromarone group( P>0.05). Conclusions:In male patients with renal underexcretion gout, low-dose benzbromarone demonstrated superior urate-lowering efficacy and better hepatic safety compared to low-dose febuxostat.

Porcine arthritis,one of the common chronic diseases in large-scale pig farms,can signifi-cantly reduce the production performance of meat pigs.In this study,a strain of Haemophilus pa-rasuis(HPS)was isolated from the joint fluid of a lame pig.The HPS was analyzed in terms of se-rotypes,virulence genes,and resistance genes.Additionally,it was treated with sensitive antibiotics to provide a theoretical basis for the comprehensive prevention and treatment of arthritis in meat pigs in future production settings.A strain of HPS type 14 was isolated from the joint fluid of dis-eased pigs.The HPS isolate demonstrated sensitivity to β-lactams and tetracyclines,while florfeni-col and polymyxin effectively inhibited its growth at low concentrations.However,the bacteria ex-hibited resistance to sulfonamides and ciprofloxacin.The treatment of affected pigs with clinical ar-thritis using doxycycline and enrofloxacin injections proved effective.Compared to the infected group,in which the sick pigs experienced difficulty flexing their carpal and tarsal joints and exhibi-ted significant lameness,the pigs in the treatment group showed marked improvement.Their joints were only slightly swollen,and the clinical symptoms of arthropathy were alleviated.

Porcine arthritis,one of the common chronic diseases in large-scale pig farms,can signifi-cantly reduce the production performance of meat pigs.In this study,a strain of Haemophilus pa-rasuis(HPS)was isolated from the joint fluid of a lame pig.The HPS was analyzed in terms of se-rotypes,virulence genes,and resistance genes.Additionally,it was treated with sensitive antibiotics to provide a theoretical basis for the comprehensive prevention and treatment of arthritis in meat pigs in future production settings.A strain of HPS type 14 was isolated from the joint fluid of dis-eased pigs.The HPS isolate demonstrated sensitivity to β-lactams and tetracyclines,while florfeni-col and polymyxin effectively inhibited its growth at low concentrations.However,the bacteria ex-hibited resistance to sulfonamides and ciprofloxacin.The treatment of affected pigs with clinical ar-thritis using doxycycline and enrofloxacin injections proved effective.Compared to the infected group,in which the sick pigs experienced difficulty flexing their carpal and tarsal joints and exhibi-ted significant lameness,the pigs in the treatment group showed marked improvement.Their joints were only slightly swollen,and the clinical symptoms of arthropathy were alleviated.

Objective:To compare the efficacy of low-dose febuxostat and low-dose benzbromarone in lowering serum uric acid and their impact on liver function in male patients with renal underexcretion gout.Methods:This prospective cohort study enrolled 303 patients with renal underexcretion gout and normal baseline liver function. Participants were assigned to either the low-dose febuxostat group(20 mg qd) or the low-dose benzbromarone group(25 mg qd). A linear mixed-effects model was used to compare the uric acid target achievement rate(<360 μmol/L) and changes in liver enzyme levels between the two groups.Results:At week 4, the proportion of patients achieving the serum uric acid target(<360 μmol/L) was significantly higher in the benzbromarone group than that in the febuxostat group(64.2% vs 42.3%, P<0.001), with a trend toward greater efficacy at weeks 8 and 12. The incidence of alanine aminotransferase(ALT) or aspartate aminotransferase(AST) elevation above the upper limit was significantly higher in the febuxostat group compared to the benzbromarone group(35.2% vs 13.85%, P<0.001). After adjusting for baseline liver enzyme levels in the mixed-effects model, mean ALT and AST levels remained significantly higher in the febuxostat group than those in the benzbromarone group at weeks 4, 8, and 12( P<0.05). In the febuxostat group, ALT and AST levels significantly increased over time during weeks 0-4 and 4-8 ( P<0.001), peaking at week 8 followed by a decreasing trend. By week 12, the levels were not significantly different from baseline ( P>0.05). Whereas there was no significant difference at each follow-up time point in the benzbromarone group( P>0.05). Conclusions:In male patients with renal underexcretion gout, low-dose benzbromarone demonstrated superior urate-lowering efficacy and better hepatic safety compared to low-dose febuxostat.

Suture techniques for microvascular anastomoses have been clinically adopted for decades. However, there are still some limitations in microvascular anastomosis. Therefore, the improvement of suture techniques for microvascular anastomosis has become the focused topics in the research of microsurgery. With the development of science and technology in microsurgery, the suture techniques, anastomotic instruments and training models for microvascular anastomoses have been continuously improved. This article summarises the progress in microvascular anastomosis based on literatures published on PubMed, Embase, Medline, CNKI and Wanfang Data, and provides a theoretical basis for promoting the development in anastomosis of microvessels.

Objective:To explore the clinical effect of reconstruction of soft tissue defect on the palmar side of 2 adjacent fingers with bilobed perforator flap of medial foot artery.Methods:From September 2020 to September 2023, 6 patients with soft tissue defects on the palmar side of 2 adjacent fingers were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. After admission, Doppler ultrasound scan was performed to locate the perforating branches of the deep and superficial branches of medial foot artery, as well as the course of medial foot artery. A bilobed flap with two perforating branches of medial foot artery was used to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. The perforators of medial foot artery were anastomosed with the proper palmar digital arteries, and the accompanying veins was anastomosed with the dorsal digital veins. The branches of saphenous nerve were anastomosed with the proper palmar digital nerves. The sizes of soft tissue defect were 4.5 cm×2.0 cm-3.0 cm×1.5 cm, and the flaps sized 5.0 cm×2.5 cm-3.5 cm×2.0 cm. All donor sites for the perforator flaps were covered by artificial dermis (4 patients) or autologous skin grafts (2 patients). Short and long-term follow-up for flap survival, flap shape, scar, and functions of interphalangeal joint and metacarpophalangeal joint function were evaluated in outpatient clinic and WeChat reviews.Results:All the bilobed perforator flaps of medial foot artery survived in 6 patients. There was no infection in the flap and donor area. Wounds in fingers and dornor sites in foot all healed well. Postoperative follow-up ranged 4-12 months, with an average of 9.3 months. The sensation of the palmar fingers recovered well with TPD at 7-10 mm and at 8.5 mm in average. The sensation recoveries were up to S 3-S 4. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of the Chinese Medical Association, 5 patients (10 fingers) were rated as excellent and 1 patient (2 fingers) as good. The donor sites healed well and walking, running, jumping, mountaineering and other food motions were not affected, and without any obvious discomfort. According to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hindfoot score, the ankle functions of 6 patients were evaluated as excellent. Conclusion:A bilobed perforator flap of medial foot artery is applied to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. It can simultaneously reconstruct 2 defects in a single surgery, and offer a fast functional recovery and aesthetical appearance.

Objective:To explore the clinical effect of reconstruction of soft tissue defect on the palmar side of 2 adjacent fingers with bilobed perforator flap of medial foot artery.Methods:From September 2020 to September 2023, 6 patients with soft tissue defects on the palmar side of 2 adjacent fingers were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. After admission, Doppler ultrasound scan was performed to locate the perforating branches of the deep and superficial branches of medial foot artery, as well as the course of medial foot artery. A bilobed flap with two perforating branches of medial foot artery was used to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. The perforators of medial foot artery were anastomosed with the proper palmar digital arteries, and the accompanying veins was anastomosed with the dorsal digital veins. The branches of saphenous nerve were anastomosed with the proper palmar digital nerves. The sizes of soft tissue defect were 4.5 cm×2.0 cm-3.0 cm×1.5 cm, and the flaps sized 5.0 cm×2.5 cm-3.5 cm×2.0 cm. All donor sites for the perforator flaps were covered by artificial dermis (4 patients) or autologous skin grafts (2 patients). Short and long-term follow-up for flap survival, flap shape, scar, and functions of interphalangeal joint and metacarpophalangeal joint function were evaluated in outpatient clinic and WeChat reviews.Results:All the bilobed perforator flaps of medial foot artery survived in 6 patients. There was no infection in the flap and donor area. Wounds in fingers and dornor sites in foot all healed well. Postoperative follow-up ranged 4-12 months, with an average of 9.3 months. The sensation of the palmar fingers recovered well with TPD at 7-10 mm and at 8.5 mm in average. The sensation recoveries were up to S 3-S 4. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of the Chinese Medical Association, 5 patients (10 fingers) were rated as excellent and 1 patient (2 fingers) as good. The donor sites healed well and walking, running, jumping, mountaineering and other food motions were not affected, and without any obvious discomfort. According to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hindfoot score, the ankle functions of 6 patients were evaluated as excellent. Conclusion:A bilobed perforator flap of medial foot artery is applied to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. It can simultaneously reconstruct 2 defects in a single surgery, and offer a fast functional recovery and aesthetical appearance.

Objective:To explore the surgical procedure and effect of reconstruction of soft tissue defects in the distal segment of dorsal finger with a perforator(joint branch) flap of proper palmar digital artery combined with a dorsal metacarpal artery flap.Methods:From January 2019 to June 2022, 9 patients with soft tissue defects in distal dorsal finger, mostly with avulsion at the extensor tendon insertion point, were treated in Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. The defect areas were 1.0 cm×1.0 cm-2.5 cm×2.0 cm. Steel wires were used to reconstruct the extensor tendon insertion point. The defects were reconstructed by a perforator(joint) flap of proximal phalanx artery and a dorsal metacarpal artery flap was used to repair the donor site for proximal flap. Postoperative follow-up and evaluation included flap survival, flap appearance, scars and function of interphalangeal and metacarpophalangeal joints, through outpatient clinical, WeChat and so on.Results:The flap of digital artery perforator (joint branch) and the fasciocutaneous flap of dorsal metacarpal artery all survived. One flap of the digital artery perforator(joint branch) appeared purple and tension blisters after surgery. The stitches of the pedicle of the flap were partially dismantled at 36-48 hours after surgery. The flap was then turned to ruddy in colour 7 days after surgery. The wounds of the distal finger joint and nail bed healed well without redness and infection. The postoperative follow-up lasted for 5 to 12 months, 9 months in average. The appearance, colour and texture of the skin at distal finger were similar to those at the dorsal proximal finger and dorsal palm. Sensation recovered well, all flaps exceeding S 3. The two-point resolution (TPD) was 8-10 mm, with an average of 9.5 mm. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 5 cases were in excellent and 4 in good. Conclusion:The perforator(joint branch) flap of proper palmar digital artery combined with a dorsal metacarpal artery flap is simple and safe treatment. It has a fast functional recovery with an aesthetic appearance in reconstruction of the soft tissue defect in distal segment of dorsal finger.

Objective:To investigate the clinical effect of bilateral anteriolateral thigh perforator flaps (ALTPF) pedicled with descending branch of lateral circumflex femoral artery in series on reconstruction of large soft tissue defects in lower limbs.Methods:A total of 9 patients with large soft tissue defects in lower limbs were selected in the study. The patients were 6 males and 3 females aged between 18 and 57 years old. They were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University from June 2018 to January 2023. Causes of injury: 4 of traffic accident, 2 of crushing, 2 of falling from height and 1 of explosion. Five patients had combined defects in dorsal feet and 4 with tibia fractures and anterior-and-posterior-tibial soft tissue defects. All affected limbs had tissue necroses and infections in various degrees. Deep tissue defects such as tendons, nerves, bones and joints or orthopaedic implants were exposed. The areas of soft tissue defects were 30 cm×14 cm-42 cm×14 cm. All the defects were reconstructed by the bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series. The size of proximal flaps was 25 cm×8 cm-33 cm×13 cm and 20 cm×7 cm-29 cm×13 cm for the distal flaps. Scheduled postoperative follow-ups were conducted to observe the survival of the transferred flaps and functional recovery of calfs and feet. Sensory recovery was assessed against British Medical Research Council (BMRC) criteria. Puno scoring was used to assess the functional recovery and the effectiveness of treatment.Results:All flaps survived and the donor sites healed well. One patient developed vascular compromise within 24 hours after surgery, but it was rectified after timely surgical exploration, however it left with a small area of necrosis at distal end of the flap. The necrosis and wound healed after skin grafting in stage-two surgery. Postoperative follow-up lasted for 8.3 months in average. Two patients underwent flap thinning in stage-two surgery due to bloating appearance, 2 patients had slightly bloated flaps at the calfs, and the rest of 5 patients had satisfactory flap appearance. Two patients received nerve reconstruction by anastomosis of the lateral femoral cutaneous nerves. At the final follow-up, the sensory recovery in 9 patients achieved S 2-S 3+ according to BMRC. The average Puno score achieved 88.36 point±5.36 point, of which 4 patients in excellent, 3 in good and 2 in fair. Conclusion:The use of bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series to reconstruct a large soft tissue defect in lower extremity has a good clinical value, and it has become one of the effective methods.

Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.