Objective:Exploring the clinical efficacy of using ultra-thin lobulated anterolateral thigh perforator flap(ALTPF) with retrograde separation of perforating vessels from the superficial and deep junction layer of the superficial fascia to repair large soft tissue defects in the foot.Methods:From August 2021 to November 2022, 8 patients (5 males and 3 females) were admitted to the Second Department of Hand and Foot Surgery, the Affiliated Central Hospital of Dalian University of Technology. The patients were 28 to 52 years old in age. The soft tissue defects were located in dorsal and plantar foot. At the plantar foot, the wound involved the weight-bearing area with explosion of bone, tendon or internal fixtures. The area of soft tissue defects was 6.0 cm × 5.0 cm - 16.0 cm × 8.0 cm, and the sizes of ALTPF were 8.0 cm ×5.5 cm - 18.0 cm × 8.5 cm. Preoperative high frequency CUD combined with CTA angiography were employed to locate the 2 flap perforator vessels. By keeping the perforator vessels at center and according to the soft tissue defect area and the wound shape, an ALTPF with a proper size and shape was designed in anterolateral thigh. The perforator were separated in the boundary layer between superficial and deep fascia, where it helped to obviously thin the flap. After the flap was harvested, it was further lobulated between the 2 perforators into 2 lobes after having confirmed the effective blood supply. Finally the lobulated ALTPF was transferred to covered the defect in foot. Cautions should be taken to ensure that the flap covered the weight-bearing area of foot. All the donor sites were directly sutured. Postoperative follow-up was conducted to observe the survival of flaps and the functional recovery of the reconstructed site, also to evaluate the clinical effect. Postoperative follow-up included outpatient visits and reviews over WeChat or telephone. Recovery of the ankle motor function was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hind foot score scale.Results:All 8 ALTPF survived. Over 6 to 18 months (10.8 months in average) of follow-up, the transferred flaps had good blood supply, soft in texture, with good elasticity and thin in appearance. Appearance and function of donor sites recovered well, except 1 patient who had mild scar hyperplasia. The plantar flap had good abrasion resistance. No flap damage, bleeding or granulation tissue hyperplasia occurred when walking. The mean score of AOFAS ankle-hind foot score achieved 95.6.Conclusion:The application of ultra-thin lobulated ALTPF with retrograde separation of perforating vessels from the superficial fascia at the junction layer for repairing large soft tissue defects in the foot has good clinical efficacy.

Objective:To explore the effect of cloud follow-up system in post-hospital follow-up management of hyperuricemia gout patients.Methods:Using the convenient sampling method, a total of 120 gout patients who were discharged after treatment in Taizhou Central Hospital in June 2021 were selected as the research objects and they were randomly divided into the control group and the experimental group according to the random number table method, with 60 cases in each group. The control group carried out routine follow-up, while the experimental group carried out follow-up based on cloud follow-up system. The serum uric acid level and self-management ability of gout patients were compared between the two groups before and after 6 months of follow-up.Results:After 6 months of follow-up, the serum uric acid levels of the control group and the experimental group were lower than those before follow-up and that of the experimental group was lower than the control group, and the differences were statistically significant ( P<0.05) . After 6 months of follow-up, the self-management ability score of the experimental group was higher than that before follow-up and higher than that after follow-up of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The new follow-up model based on cloud follow-up system is helpful to improve the self-management ability of gout patients and reduce the blood uric acid level of gout patients.

Objective To compare expression of Toll?like receptors 7 and 9(TLR7, TLR9)as well as their regulatory molecules myeloid differentiation factor 88(MyD88)and nuclear factor?κB(NF?κB)in peripheral blood mononuclear cells(PBMCs)between patients with vitiligo and healthy individuals, and to explore their significance. Methods Flow cytometry was performed to measure expression of TLR7 and TLR9 in PBMCs among 36 patients with vitiligo and 22 healthy controls, and real?time fluorescence?based quantitative PCR(RT?PCR)was conducted to determine mRNA expression of MyD88 and NF?κB in the above blood samples. Results Compared with healthy controls, patients with vitiligo showed higher expression of TLR7 and mRNA expression of MyD88 and NF?κB, but lower expression of TLR9. However, significant differences were only observed in the mRNA expression of NF?κB(t=2.814, P=0.008), but not in the expression of TLR7 and TLR9 or the mRNA expression of MyD88 between patients and controls (t = 1.477, 1.761, 0.058, all P > 0.05). Conclusion NF?κB, as a key signaling molecule of TLR7 and TLR9 regulation pathways, increases obviously in patients with vitiligo, suggesting that NF?κB may be involved in the pathogenesis of vitiligo.

Objective This research investigated the coagulation of critically ill patients for predicting the prognosis of 28 day in a university hospital emergency room.Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital,Capital Medical University from June 2015 to May 2016,and 28-day mortality was recorded.Whole blood cell analysis,blood gas analysis and clotting test were done and repeated after patients in hospital.Results A total of 1 992 patients were enrolled,and divided into two groups:survival (n =1 522) and dead (n =470).No significant difference of age,gender,body mass index and disease composition were found between the two groups (P ＞0.05).APACHE Ⅱ of the survival and dead groups were (12.11 ±4.12) and (21.15 ± 5.55) respectively.D-dimer and platelet account of the dead group were M (Qr) 265 (0,718) μg/L and (208.16±89.87) × 109/L-1 respectively,significant differences were found between the two groups (P ＜ 0.05).Coagulation was found deteriorated progressively in the dead group,whereas improved in the survival group.The risk factors of poor prognosis,which were the increased APACHE Ⅱ and D-dimer,were detected by Logistic analysis and ROC curve,especially the D-dimer.Conclusions Coagulation abnormalities were found in the critically ill patients of emergency room.The increasing of D-dimer is one of the risk factors of poor prognosis.

Objective To explore the outcome of the tibial bone-skin flap grafts in the management of severe traumatic osteomyelitis complicated with bone and skin defect in leg.Methods Twenty-seven cases of the traumatic osteomyelitis complicated with bone and skin defect in leg were treated with vascularized tibial bone-skin flap grafe from August, 2007 to November, 2013.Reconstruction of limb tibia continuity and cover the wound.Results The tibial bone-skin flaps were completely survived in 26 of the 27 cases except 1 ease which was repaired by adjacent flap because of the disorder blood circulation.The followed-up showed that all flaps had good blood circulation.The infection was controlled completely.The leg function and contour were satisfactory.Conclusion The tibial boneskin flap has the advantages of abundant blood supply, full bone-skin flap supply, shortens hospitalization and suitable for treatment of traumatic osteomyelitis complicated with bone and skin defect in leg.

Objective To evaluate the effects of mild hypothermia therapy on cerebral function and edema as assessed by magnetic resonance imaging (MRI ) during the first 72 hours after restoration of spontaneous circulation (ROSC)in a porcine model.Methods Ventricular fibrillation was induced in 33 Inbred Wuzhishan miniature swine.After ventricular fibrillation untreated for 8 min,standard CPR was initiated and 30 animals got ROSC.The ROSC animals were randomly (random number)assigned to normothermia group (n=15 ) and hypothermia group (n =15 ).The hypothermia group immediately received endovascular cooling to regulate temperature to 33 ℃,which was maintained for 12 h,followed by passive rewarming at 0.5 ℃/h to 37 ℃.The two groups were scanned to get Diffusion-weighted imaging (DWI)at baseline (before experiment),6 h,12 h,24 h,and 72 h after ROSC.The statistical analysis was carried out with Student t test,One-way repeated-measures and Kaplan-Meier survival analysis.Results Compared with the normothermia group,the hypothermia group exhibited a higher 72-h survival rate (73.3% vs.40%,P<0.05),lower neurological deficit scores (43.81 vs.119.50;P<0.01),a lesser decrease in the apparent diffusion coefficient during DWI and milder cerebral edema on DWI image. Conclusions Cerebral edema occurred at early stage after ROSC.Cerebral edema was worst at 6 hours after ROSC and then subsided gradually.Hypothermia therapy could reduce cerebral edema and produce a protective effect on neurological function.MRI could effectively reflect the underlying trend of cerebral injury of swine within the first 72 h after ROSC,and demonstrated that hypothermia could reduce brain edema, increase cerebral blood flow,and reduce the production of toxic metabolites.DWI could monitor brain injury after resuscitation and could be used to evaluate the efficacy of hypothermia intervention dynamically.

ObjectiveTo detect the expressions of Toll-like receptor(TLR) 7 and 9 mRNA in peripheral blood mononuclear cells(PBMCs) from patients with vitiligo and their significance.Methods Real-time fluorescence-based quantitative reverse transcription-PCR was performed to detect the expressions of TLR7 and TLR9 mRNA in PBMCs from 50 patients with vitiligo and 25 normal human controls.Two-sample t test was conducted by using SPSS 11.5 software to compare the expression difference of TLR7 and TLR9 mRNA between the patients and controls.ResultsThe mRNA expression level (the ratio of the absolute copy number of a target gene to a control gene) of TLR7 and TLR9 in PBMCs were significantly higher in patients with vitiligo than in the normal human controls(0.85 ± 1.90 vs.0.44 ± 1.18,P ＜ 0.05; 0.94 ± 2.25 vs.0.11 ±0.31,P ＜ 0.01 ).No significant difference was observed in the expression level of TLR7 or TLR9 mRNA in PBMCs between patients with stable and active vitiligo,or between patients with localized and generalized vitiligo(both P ＞ 0.05).ConclusionsThe expression level of TLR7 and TLR9 mRNA is elevated in PBMCs from patients with vitiligo,which may be involved in the pathogenesis of vitiligo.

Objective To investigate the cause of fracture nonunion and discuss the experience of locking plates fixation combined with autoallergic cancellous bone in the management of non-infective long bone nonunion.Methods A retrospective analysis was made in 38 patients(29 males and 9 females)with fracture nonunion treated with locking plates fixation combined with autoallergic cancellous bone from August 2006 to August 2010.Of all,22 patients were treated with plates and 16 with interlocking intramedullary nails.Results All the patients were followed up for a mean of 12 months(range,6-24 months).The bone union time for all the fractures averaged 5.3 months(range,3-7 months),with no complications like implant loosening or fracture.Conclusions Iatrogenic factor is the main cause for fracture nonunion after open reduction and internal fixation of long bone fractures and the locking plates combined with autoallergic cancellous bone are a safe and effective treatment procedure.

Objective To investigate the expressions of complements 3 (C3), 4B1 (C4B1) and apolipoprotein E (ApoE) in pancreatic cancer and relations with TNM staging and lymph node metastasis of pancreatic cancer. Methods Thirty-eight pancreatic cancer biopsy specimens, 20 fresh pancreatic cancer specimens and 20 adjacent normal tissues of pancreatic cancer were collected. The expressions of C3, C4B1, ApoE in pancreatic cancers and normal pancreatic tissues were detected by immunohistochemistry and Western-Blot, the positive expression rates of C3, C4B1, ApoE and the differences in gray scale were also observed. Their association with pancreatic cancer TNM staging and lymph node metastasis were analyzed by SPSS 13.0. Results The expression rates of C3, C4B1, ApoE in pancreatic cancer were 73.68% (28/38), 86.84%(29/38) and 76.31% (33/38) respectively, higher than those in normal pancreatic tissues which were 42.11% (16/38), 26.32% (10/38) and 42.11% (16/38) accordingly, the differences were statistically significant (χ2 was 7.77, 19.01, 16.6, and P value were 0.01, 0.00, 0.00 respectively). The gray scale of C3, C4B1 and ApoE in pancreatic cancer were 1.63±0.28,1.25±0.18 and 2.57±0.22 respectively, higher than those in normal pancreatic tissue (0.88±0.19,0.65±0.13,1.28±0.24 respectively), the differences were statistically significant (t value were 9.93,11.81,17.71 and all P value were 0.00, respectively). There was no association between C3 and TNM staging or lymphatic metastasis of pancreatic cancer. C4B1 and ApoE were closely related with TNM stage and lymph node metastases. The expressions of C4B1 and ApoE in stage Ⅱ to Ⅳ pancreatic cancer or with lymphatic metastasis were significantly higher than those in stage Ⅰpancreatic cancer and those without lymph node metastasis. Conclusion C3, C4B1 and ApoE were all highly expressed in pancreatic cancer. C3 was only involved in early event in pancreatic cancer, not related with development of pancreatic cancer. C4B1 and ApoE were involved in tumor growth and metastasis.

Objective To investigate the expression of apolipoprotein E (ApoE) and complement C4b1 in pancreatic carcinoma and study its significance. Methods Immunohistochemistry was used to detect the expression of ApoE and C4b1 protein in 38 cases of pancreatic carcinoma tissues and adjacent normal pancreatic tissues, and RT-PCR was used to detect the expression of ApoE and C4b1 mRNA in 20 cases of pancreatic carcinoma tissues and adjancent normal pancreatic tissues. The relevance of ApoE and C4b1 expressions to the biological features of pancreatic carcinoma were analyzed. Results The positive rates of ApoE and C4b1 expressions are 86.8% (33/38) and 76.3% (29/38) in pancreatic carcinoma, respectively,which were significantly higher than those in normal pancreatic tissues [42.1% (16/38) and 26.3% ( 10/38 ),P ＜ 0.01]. The positive rates of ApoE and C4b1 expressions [78.3% ( 18/23 ) and 73.9% ( 17/23 )] in patients with metastasis were significantly higher than in those without metastasis [(33.3% (5/15) and 40.0%(6/15), P ＜ 0.05). Significantly higher expressions of ApoE and C4b1 mRNA were noted in pancreatic carcinoma(4.83 ± 0.65 and 7.94 ± 0. 95 ) than those in the normal pancreatic tissue ( 1.78 ± 0.74and 1.22 ±0.57, P ＜ 0.01 ), and patients with metastasis showed significantly higher expression of ApoE and C4b1 mRNA (5.05 ±0.71 and 8.24 ± 1.07) than those without metastasis (4.42 ±0.25 and 7.39 ±0.15,P ＜ 0.05). Conclusions ApoE and C4b1 were highly expressed in pancreatic cancer, and may be closely related with lymph node metastasis.