Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

Objective By using CiteSpace-based visualization analysis to investigate the main research contents,research frontiers,author cooperation network and institutional cooperation network of traditional Chinese medicine(TCM)treatment for patients after receiving percutaneous coronary intervention(PCI)so as to provide reference for the TCM diagnosis,treatment and research of patients after receiving PCI.Methods A computerized retrieval of academic papers concerning TCM treatment of patients after receiving PCI from CNKI,VIP and Wanfang databases was conducted.The retrieved literature materials were input into NoteExpress software to make the literature screening and the data cleaning.CiteSpace software was used to analyze the key words,authors,institutions,etc.Results A total of 1 708 articles were obtained;the number of published articles in 2020 was the largest,which was up to 137 articles.The core authors accounted for 4.37％of the total number of authors who had written articles,but no core author group had been formed yet.Liaoning province of China was the region where the number of published articles was the largest,and there was no effective collaboration network between different areas.The cluster analysis yielded 25 clusters,448 key nodes and 1 266 lines.The main cluster results were coronary heart disease,acute coronary syndrome,acute myocardial infarction,restenosis,etc.The analysis of emergent words(i.e.the suddenly increased frequency of a certain key word in a certain period)yielded 24 emergent words,including syndrome differentiation of TCM,ginseng peony oral liquid,cardiac rehabilitation,etc.Conclusion The main research contents of TCM treatment for patients after PCI include syndrome differentiation of TCM,etiology and pathogenesis,clinical trials,etc.Postoperative pathological phenomena such as restenosis are the research difficulties in this field,and anxiety,dual-mind TCM,and cardiac rehabilitation are the current research hotspots.TCM has definite efficacy in promoting the recovery of cardiac function after PCI,in reducing the incidence of postoperative events such as restenosis,and in improving anxiety and depression.

Objective To investigate the characteristics of bone marrow megakaryocytes in patients with idiopathic thrombocytopenic purpura (ITP) complicated with positive for antinuclear antibody (ANA) but cannot be diagnosed as rheumatic immune diseases. Methods Newly diagnosed ITP patients in the First Hospital Affiliated to Sun Yat-sen University were retrospectively selected and divided into ITP1 group (ITP patients with positive ANA) and ITP2 group (ITP patients with negative rheumatic indicators). Degree of thrombocytopenia, the total number of bone marrow megakaryocytes, and the ratios of various types of megakaryocytes at the initial diagnosis were compared between the two groups. Results A total of 42 newly diagnosed ITP patients were included, with 20 cases in the ITP1 group and 22 cases in the ITP2 group. There were no significant differences in general information such as gender and age between the two groups (P>0.05). The platelet (PLT) count was (7.55±0.96)×10⁹/L in the ITP1 group, which was lower than (10.23±1.21)×10⁹/L in the ITP2 group, but there was no significant between-group difference (t=1.697, P=0.097). Compared with the ITP2 group, the total number of megakaryocytes in the ITP1 group was significantly decreased (t=3.071, P < 0.01), and the ratio of granular megakaryocytes was significantly increased while the ratio of naked nuclear megakaryocytes was significantly decreased (P < 0.05); there were no significant differences in the ratios of immature and platelet-producing megakaryocytes between the two groups (P>0.05). Conclusion Patients with ITP and positive ANA have a tendency of decreased PLT, and a more significant maturation disorder of bone marrow megakaryocytes, with a lower degree of megakaryocyte proliferation compared to patients without positive ANA. ANA may exacerbate the severity of ITP by aggravating the developmental disorder of bone marrow megakaryocytes.

Objective:To explore the effect of music relaxation training combined with Huangqi Jianzhong Decoction oral administration and foot bath on fatigue status and quality of life in patients with cancer related fatigue.Methods:A total of 90 patients with cancer related fatigue in our hospital from January 2019 to October 2020 were selected. The patients were divided into 2 groups by random number table method, with 45 in each group. Both groups were given health and diet education. The control group was given music relaxation training, and the observation group took Huangqi Jianzhong Decoction oral administration and foot bathing on the basis of the control group. Both groups have a course of treatment of 4 weeks, a total of 3 courses. The TCM syndrome scores were observed before and after treatment, and the Piper Fatigue Score (PFS) was used to evaluate fatigue status, and the Karnofsky functional state score was used to evaluate the quality of life of patients, evaluation of clinical efficacy.Results:After treatment, 43 patients in the observation group and 42 patients in the control group were analyzed. The total effective rate of the observation group was 83.72% (36/43), which was significantly higher than 64.29% (27/42) of the control group ( χ2=4.18, P=0.041). After treatment, the TCM syndrome scores in the observation group was significantly lower than that of the control group ( t=2.48, P=0.015). After treatment, the Karnofsky functional state score in the observation group was significantly higher than that of the control group ( t=2.83, P=0.006). After treatment, the emotion score (4.35±1.02 vs. 5.03±1.01, t=3.09), feeling score (4.31±1.06 vs. 5.00±1.02, t=3.06) and total score (4.23±1.07 vs. 4.87±1.10, t=2.72) in the observation group were significantly lower than those in the control group ( P<0.01). Conclusion:Music relaxation training combined with Huangqi Jianzhong Decoction oral administration and foot bathing can alleviate the fatigue state of CRF patients and improve the quality of life.

OBJECTIVE: To observe the direct intervention effects of electroacupuncture (EA) and non-steroid anti-inflammatory drugs (NSAIDs) on pain memory, and to explore their effects on cAMP/PKA/cAMP pathway in anterior cingulate gyrus (ACC). METHODS: Fifty clean healthy male SD rats were randomly divided into a control group, a model group, an indomethacin group, an EA group and a sham EA group, 10 rats in each group. Except the control group, the pain memory model was established in the remaining four groups by twice injection of carrageenan at foot; 0.1 mL of 2%λ-carrageenan was subcutaneously injected at the left foot of rats; 14 days later, when the pain threshold of rats of each group returned to the basic level, the second injection was performed with the same procedure. The rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36) for 30 min; the rats in the indomethacin group was treated with indomethacin intragastric administration with the dose of 3 mg/kg; the rats in the sham EA group was treated with EA without electricity at the point 0.3 mm forward "Zusanli" (ST 36) with the depth of 2 mm for 30 min; the rats in the control group was not given any invention. All the above interventions were performed 5 h, 1 d, 2 d and 3 d after the second injection of 2% λ-carrageenan. The left-side paw withdrawal thresholds (PWT) were observed before the first injection, 4 h, 3 d, 5 d after the first injection, before the second injection and 4 h, 1 d, 2 d, 3 d after the second injection. Three days after the second injection, the number of positive cells of cAMP, p-PKA, p-CREB and the number of positive cells of protein co-expression in the right ACC brain area were detected by immunofluorescence, and the relative protein expression of p-PKA and p-CREB were detected by Western blot. RESULTS: Compared with the control group, the PWTs in the model group decreased significantly 4 h, 3 d and 5 d after the first injection and 1 d, 2 d and 3 d after the second injection (<0.05); compared with the control group, the positive expression of cAMP, p-PKA and p-CREB in the right ACC brain area in the model group increased significantly (<0.05), and the number of positive cells of the co-expression of cAMP/p-PKA and p-PKA/p-CREB also increased significantly (<0.05). Compared with the model group, indomethacin group and sham EA group, the PWTs in the EA group were increased significantly 1 d, 2 d and 3 d after the second injection (<0.05); compared with the model group, indomethacin group and sham EA group, the positive expression of p-PKA and p-CREB in the right ACC brain area in the EA group decreased significantly (<0.05), and the number of positive cells of co-expression of cAMP/p-PKA and p-PKA/p-CREB was decreased significantly (<0.05). Compared with the model group and sham EA group, the positive expression of cAMP in the right ACC brain area was decreased in the EA group (<0.05). CONCLUSION EA have a direct intervention effect on pain memory, which have significant advantage over NSAIDs in the treatment of chronic pain. The advantage effect of EA on pain memory may be related to the inhibition of cAMP/PKA/CREB pathway in ACC area.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Cyclic AMP ; metabolism ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Cyclic AMP-Dependent Protein Kinases ; metabolism ; Electroacupuncture ; Gyrus Cinguli ; metabolism ; Male ; Pain Threshold ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction

Identification of genetic variants via high-throughput sequencing (HTS) technologies has been essential for both fundamental and clinical studies. However, to what extent the genome sequence composition affects variant calling remains unclear. In this study, we identified 63,897 multi-copy sequences (MCSs) with a minimum length of 300 bp, each of which occurs at least twice in the human genome. The 151,749 genomic loci (multi-copy regions, or MCRs) harboring these MCSs account for 1.98％of the genome and are distributed unevenly across chromosomes. MCRs containing the same MCS tend to be located on the same chromosome. Gene Ontology (GO) anal-yses revealed that 3800 genes whose UTRs or exons overlap with MCRs are enriched for Golgi-related cellular component terms and various enzymatic activities in the GO biological function cat-egory. MCRs are also enriched for loci that are sensitive to neocarzinostatin-induced double-strand breaks. Moreover, genetic variants discovered by genome-wide association studies and recorded indbSNP are significantly underrepresented in MCRs. Using simulated HTS datasets, we show that false variant discovery rates are significantly higher in MCRs than in other genomic regions. These results suggest that extra caution must be taken when identifying genetic variants in the MCRs via HTS technologies.

Objective: To study the efficacy, safety and long-term outcomes of integrated strategy of bortezomib-based induction regimens followed by autologous hematopoietic stem cell (ASCT) and maintenance therapy in Chinese multiple myeloma (MM) patients. Methods: 200 MM patients receiving integrated strategy of bortezomib--based induction regimens followed by ASCT and maintenance therapy were retrospectively and prospectively analyzed from December 1. 2006 to April 30. 2018. Results: The complete remission rates (CR) and better than very good partial remission rates (VGPR) after induction therapy, transplantation and maintenance therapy were respectively 31% and 75.5%, 51.8% and 87.7%,73.6% and 93.4%. There was no difference between 4 cycles and more than 5 cycles induction chemotherapy. The negative rate of MRD detection by flow cytometry was 17.6% and 38.2% respectively after induction and 3 months after transplantation. The negative rate of MRD gradually increased during the maintenance therapy. The success rate of high dose CTX combined with G-CSF mobilization was 95.5% and transplantation related mortality (TRM) was zero. The median time to progress (TTP) was 75.3 months and the median overall survival (OS) was 99.5 months. TTP of patients obtaining CR and negative MRD after induction were longer that those of no CR and positive MRD. TTP and OS of patients receiving triple-drug induction and ASCT in early stage were longer than those of double-drug induction and ASCT in late stage. LDH≥240 U/L, high risk cytogenetics, ISS II+III stage and HBsAg positive were prognostic factors at diagnosis. However, only MRD and high risk cytogenetics were independent prognostic factors after transplantation and maintenance therapy. The clinical characteristics of patients of TTP ≥6 years were listed below: light-chain type M protein, ISS I stage, normal level of hemoglobin and platelet, normal LDH, HBsAg negative, chromosome 17p-negative, good response and sustained good response. Conclusions Integrated strategy of bortezomib-based induction regimens followed by ASCT and maintenance therapy can significantly improve the short-term and long-term efficacy. The prognostic factors of TTP in different disease stages were different. Response to treatment, especially MRD, played a more important role in prognostic factors.

OBJECTIVE: To investigate the evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio (LMR) on the prognosis of patients with stage III colon cancer undergoing radical resection and postoperative adjuvant chemotherapy. METHODS: Electronic medical record were retrospectively retrived for stage III colon cancer patients who underwent radical surgery at Sun Yat-sen University Cancer Center from December 2007 to December 2013. Inclusion criteria were pathologically comfirmed colon adenocarcinoma, complete clinicopathological data, and postoperative XELOX (oxaliplatin + capecitabine) chemotherapy with follow-up of at least 3 months. Patients with neoadjuvant anti-tumor therapy, infectious disease, other malignant tumors and death of non-tumor causes within 3 months after operation were excluded. A total of 258 patients were included in this retrospective cohort study, including 146 males and 112 females with median age of 55 (22 to 85) years. Tumors of 100(38.8%) patients were located in the right hemicolon, and of 158 (61.2%) in the left hemicolon. Tumors of 194(75.2%) patients were highly and moderately differentiated, and of 64 (24.8%) were poorly differentiated. According to the TNM tumor pathological stage of AJCC 7th edition, 196 (76.0%) patients were stage IIIA to IIIB, and 62(24.0%) patients were stage IIIC. The median preoperative CEA was 3.8 (0.3 to 287.5) μg /L and the median cycle of the adjuvant chemotherapy was 6 (1 to 8). The cut-off value of preoperative LMR in prediction of 3-year overall survival (OS) outcome was determined by receiver operating characteristic (ROC) curve analysis. All patients were divided into low LMR group and high LMR group according to the critical value. Clinicopathological characteristics between the two groups were compared by using chi-square test or Fisher's exact test as appropriate. The 3-year disease-free survival and overall survival rate were estimated with the Kaplan-Meier method, and differences between two groups were assessed with the log-rank test. Univariate and multivariate analyses were performed through Cox regression model. RESULTS: ROC curve showed that the cut-off value of preoperative LMR in predicting 3-year overall survival was 4.29. Then 143 patients were divided into low LMR group (LMR<4.29) and 115 patients into high LMR group (LMR ≥ 4.29). Compared with high LMR group, the low LMR group presented higher proportions of male [62.2%(89/143) vs. 50.4%(58/115), χ²=4.167, P=0.041], right hemicolon cancer [44.8% (64/143) vs. 31.3% (36/115), χ²=4.858, P=0.028], and the largest tumor diameter>4 cm [60.1% (86/143) vs. 33.0% (38/115), χ²=18.748, P<0.001]. During a median follow-up of 46.0 (range, 3.0 to 74.0) months, 3-year disease-free survival rate was 83.8% in high LMR group and 78.9% in low LMR group, which was not significantly different (P=0.210). While 3-year overall survival rate in low LMR group was significant lower than that in high LMR group (86.6% vs. 97.2%, P=0.018). Univariate analysis revealed that preoperative low LMR (HR=2.841, 95%CI: 1.146 to 7.043, P=0.024), right hemicolon cancer (HR=2.865, 95%CI: 1.312 to 6.258, P=0.008) and postoperative adjuvant chemotherapy≥6 cycles (HR=0.420, 95%CI: 0.188 to 0.935, P=0.034) were the risk factors for poor overall survival. Multivariate analysis identified that preoperative low LMR (HR=2.550, 95%CI: 1.024 to 6.347, P=0.004) and right hemicolon cancer (HR=2.611, 95%CI: 1.191 to 5.723, P=0.017) were the independent risk factors for overall survival. CONCLUSIONS Preoperative peripheral blood LMR level represents an effective prognostic predictor for patients with stage III colon cancer receiving radical therapy. Low LMR indicates the poor prognosis and such patients require aggressive postoperative treatment strategy.
Adenocarcinoma ; blood ; drug therapy ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Chemotherapy, Adjuvant ; Colonic Neoplasms ; blood ; drug therapy ; surgery ; therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Leukocyte Count ; methods ; Lymphocytes ; Male ; Middle Aged ; Monocytes ; Preoperative Care ; Prognosis ; Retrospective Studies ; Young Adult

OBJECTIVETo explore clinicopathologic characteristics, surgical features and prognostic factors in patients with primary gastrointestinal lymphoma(PGIL) in order to provide evidence for optimizing surgical treatment.

METHODSClinicopathological data of 57 PGIL patients undergoing abdominal surgery in Sun Yat-sen University Cancer Center between October 1990 and January 2015 were retrospectively collected. The survival rates were compared among patients with different clinicopathologic characteristics by Kaplan-Meier method, while Cox regression model was employed to analyze the prognostic factors.

RESULTSAmong 57 patients, 43 were male and 14 were female, with a median age of 48 (range 16 to 80) years. Seventeen (29.8%) cases were classified as Musshoff I( stage, 19 (33.3%) cases as II( stage, 9 (15.8%) cases as III( stage, and 12(21.1%) cases as IIII( stage. Forty-four (77.2%) cases underwent selective operation, 13(22.8%) cases underwent emergent operation due to acute abdomen. Thirty-two(56.1%) cases had radical resection, 18 (31.6%) cases had partial resection and the rest 7(12.3%) cases failed to perform resection. Four (7.0%) cases received simple surgical operation, and 53 (93.0%) cases received comprehensive treatment, including 5(8.8%) cases with preoperative chemotherapy and surgery, 40 (70.2%) cases with surgery and postoperative chemotherapy, and 8 (14.0%) cases with surgery and perioperative chemotherapy. Stage III( and IIII( accounted for 76.9%(10/13) in patients undergoing emergent operation and accounted for 25.0%(11/44) in patients undergoing selective operation, whose difference was statistically significant (χ=9.503, P=0.002). Univariate prognostic analysis showed that T lymphocyte source pathological cell phenotype (P=0.000), clinical Musshoff stage III( and IIII((P=0.001), emergent operation (P=0.000) and incomplete tumor resection(P=0.007) had worse 5-year overall survival. Multivariate Cox regression analysis indicated that tumor pathological cell phenotype (HR=13.75, 95%CI:3.546-53.308, P=0.000) and surgical timing (HR=7.497, 95%CI:1.163-48.313, P=0.034) were independent prognostic risk factors of patients with stage I( and II(.

CONCLUSIONSSurgical operation is an important part of comprehensive treatment for PGIL. T lymphocyte source and ulcerative lymphoma indicates poorer prognosis.