Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

Humans ; SARS-CoV-2 ; COVID-19 ; Antibodies ; Antibodies, Viral/therapeutic use* ; Antibodies, Neutralizing/therapeutic use*

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective To investigate the diagnosis and treatment of pulmonary tuberculosis in renal transplantation recipients.Method The clinical data of 8 renal transplantation recipients suffering from pulmonary tuberculosis infection were retrospectively analyzed.Result Fever,cough and expectoration were the most common symptoms,however,lacking typicality.Images of chest Xray and CT scan were various and couldn't verify TB infection from pneumonia.Seven of 8 cases were diagnosed through invasive methods,either bronchofibroscope or fiberthoracoscopy.Immunosuppressants were decreased in all cases.Three-drug regimens,including isoniazide,rifampicin and ethambutol or pyrazinarnide,were administrated as anti-tuberculosis chemotherapy.All the cases were cured,without episodes like acute rejection and liver function impairment.Conclusion Routine examinations are not sufficient to diagnose pulmonary tuberculosis in kidney transplantation recipients.While,invasive methods like bronchofibroscope and fiberthoracoscope are helpful.When diagnosed,patients should receive normative anti-tuberculosis treatment and immunosuppressive agents adjustment,which can benefit the prognosis of pulmonary tuberculosis in renal transplantation recipients.

Objective To observe the protection and distribution of bone marrow mesenchymal stem cells (MSCs) by distinct intravenous infusion time on renal ischemia reperfusion injury (IRI) in rats.Methods We used unilateral nephrectomy and contralateral vascular occlusion method to establish renal IRI model in rats.The experimental groups which received 2 × 106 MSCs infusion through the tail vein,were subsequently divided into 3 subgroups:2 h pre-reperfusion (PreOp,n =16),immediately after reperfusion (Op,n =16),6 h post-reperfusion (PostOp,n - 16).The control groups included sham operation group (n =16) and ischemia group (n =16).Chemotaxis of DAPI-labeled MSCs was detected 6 h after administration in the IR kidney.Renal function was detected at 6,24,and 48 h respectively after operation. Forty eight h after operation,the renal tissues were harvested to observe the pathological changes by HE staining and the tubular epithelial cell apoptosis via TUNEL assay.Results MSCs were found in the experimental groups after IR in the kidney,most in PostOp group.Twenty-four and 48 h after reperfusion,there was no significant difference in Cr and BUN between the experimental groups and sham operation group (P＞0.05),but the levels of Cr and BUN in the experimental groups were significantly lower than in the IR group (P＜ 0.05). As compared with IR group,the renal pathological injury was alleviated,the number of apoptotic cells was decreased in the experimental group,most significantly in PostOp group (P＜0.05).Conclusion MSCs can reduce the inflammatory response and inhibit renal tubular cell apoptosis in rat renal IRI.Post-reperfusion administration of MSCs leads to the best chemotaxis efficiency and protection.

ObjectiveTo explore the clinical efficacy of minitype vascularized superficial peroneal artery's singleness perforator flap,and then to accurately repair skin and soft tissue defects of hands and foots. MethodsFrom November 2009 to January 2011,eight cases(one case of left foot,one case of right foot,three cases of left hand and 3 cases of right band,1.3 cm × 5.0 cm - 2.5 cm× 6.0 cm of skin and soft tissue defects)were treated by minitype vascularized superficial peroneal artery's singleness perforator flap.Based on preoperative applied anatomy papers, it was the superficial peroneal artery's perforator position in the middle of the lateral lower leg to the fibula head;We designed the flap based on the size and shape of skin defect,and then to analysize the flap design,lap cut,he vascular anastomosis of flap and recipient,effect and characteristics of survival. ResultsAll the flaps(1.5 cm × 5.2 cm-2.8 cm × 6.2 cm) survived and satified in shape and texture, they acquired good functional recovery postoperation;There was blister,dark purple but survival after the scab off on 1 patient;There was phalanx ostomyelitis and healed after treatment on 1 patient.ConclusionThe clinical effects were satisfactory for repairing small skin and soft tissue defect of hands and foots by minitype vascularized superficial artery's singleness perforator flap.

OBJECTIVETo observe the change in IL-13 mRNA expression in rat lungs with acute lung injury (ALI) induced by lipopolysaccharide (LPS), so as to investigate the significance of anti-inflammatory mechanism in the development of ALI.

METHODS(1) Different doses (2 approximately 8 mg/kg) of LPS were injected via the tail vein to the rats to establish ALI model. (2) The IL-13 mRNA content in pulmonary tissue was determined by RT-PCR.

RESULTS(1) Different degrees of ALI was induced in the rats by different doses of LPS. ARDS was produced in the rats by LPS of 6 mg/kg. (2) The IL-13 mRNA expression in the pulmonary tissue could be enhanced by the induction of LPS, especially when its dose was larger than 6 mg/kg.

CONCLUSION(1) Rat ALI model could be produced by LPS injection via the tail vein. (2) LPS in dose of 6 mg/kg was the threshold for the production of rat ARDS. (3) The incidence of rat ARDS might be closely related to the enhanced expression of IL-13 mRNA in rat pulmonary tissue.

Acute Disease ; Animals ; Disease Models, Animal ; Female ; Interleukin-13 ; biosynthesis ; genetics ; Lipopolysaccharides ; Male ; RNA, Messenger ; biosynthesis ; Rats ; Rats, Wistar ; Respiratory Function Tests ; Respiratory Insufficiency ; chemically induced ; metabolism ; physiopathology

Objective The aim of present study was to observe the correlation between flagellin and tumor necrosis factor ?(TNF-?)in rats with sepsis-induced acute lung injury(ALI).Methods A total of 120 male healthy Wistar rats were randomly assigned into 2 groups:sepsis group which was reproduced by cecal ligation and puncture(CLP),and sham operated group which underwent laparotomy only.All the indexes were observed at the time points of 2h,4h,6h,12h,24h and 48h after operation.Changes in partial pressure of oxygen in artery(PaO2)were determined by blood gas analysis.Pathological changes in pulmonary-tissue were observed by light microscopy.The levels of flagellin in serum,bronchoalveolar lavage fluid and pneumono-homogenate,as well as TNF-? of serum,were determined by enzyme linked immunosorbent assay(ELISA).Results Rats with acute lung injury induced by sepsis was successfully reproduced.The PaO2 of sepsis group significantly decreased at 12h after injury and reached the lowest point at 48h after injury.PaO2 of sepsis group was remarkably lower than that of sham operated group at the time points of 12h,24h and 48h after injury(P

AIM:To investigate the inhibitory effect of P12,a kind of lipopolysaccharide(LPS)-binding protein(LBP) inhibitory peptide,on the binding of LPS to macrophage in vitro.METHODS:Human monocyte-like cell line(U937 cells) was grown in RPMI-1640 and stimulated with PMA in order to induce their differentiation to macrophage stage.The relative affinity of P12 to LPS was determined by enzyme-linked immunosorbent assay(ELISA).The effects of P12 on the binding of LPS to U937 cells were determined by flow cytometry analysis.The production of tumor necrosis factor-alpha(TNF-?) was measured by ELISA.RESULTS:The relative binding activity of P12 to LPS was higher than that of LBP in the same mass concentration.P12 inhibited the binding of FITC-conjugated LPS(FITC-LPS) to U937 cells.The productions of TNF-? was also significantly suppressed by P12.CONCLUSION:The results suggest that blockage of LBP at the inflammatory sites might attenuate LPS-induced circulatory shock.