Background::Pancreatic ductal adenocarcinoma (PDAC) is one of the main types of malignant tumor of the digestive system, and patient prognosis is affected by difficulties in early diagnosis, poor treatment response, and a high postoperative recurrence rate. Carbohydrate antigen 19-9 (CA19-9) has been widely used as a biomarker for the diagnosis and postoperative follow-up of PDAC patients. Nevertheless, the production mechanism and potential role of CA19-9 in PDAC progression have not yet been elucidated.Methods::We performed single-cell RNA sequencing on six samples pathologically diagnosed as PDAC (three CA19-9-positive and three CA19-9-negative PDAC samples) and two paracarcinoma samples. We also downloaded and integrated PDAC samples (each from three CA19-9-positive and CA19-9-negative patients) from an online database. The dynamics of the proportion and potential function of each cell type were verified through immunofluorescence. Moreover, we built an in vitro coculture cellular model to confirm the potential function of CA19-9. Results::Three subtypes of cancer cells with a high ability to produce CA19-9 were identified by the markers TOP2A, AQP5, and MUC5AC. CA19-9 production bypass was discovered on antigen-presenting cancer-associated fibroblasts (apCAFs). Importantly, the proportion of immature ficolin-1 positive (FCN1+) macrophages was high in the CA19-9-negative group, and the proportion of mature M2-like macrophages was high in the CA19-9-positive group. High proportions of these two macrophage subtypes were associated with an unfavourable clinical prognosis. Further experiments indicated that CA19-9 could facilitate the transformation of M0 macrophages into M2 macrophages in the tumor microenvironment. Conclusions::Our study described CA19-9 production at single-cell resolution and the dynamics of the immune atlas in CA19-9-positive and CA19-9-negative PDAC. CA19-9 could promote M2 polarization of macrophage in the pancreatic tumor microenvironment.

Objective:To investigate the feasibility and effectiveness of incision subcutaneous porous catheter combined with ropivacaine analgesia in enhanced recovery after laparoscopic gastrointestinal surgery.Methods:The clinical data of 140 patients underwent gastrointestinal surgery from August 2021 to April 2022 in Shanghai Fourth People′s Hospital, School of Medicine, Tongji University were retrospectively analyzed. Among them, 70 patients were given routine postoperative analgesia (control group), and 70 patients were given incision subcutaneous porous catheter combined with ropivacaine analgesia on the basis of routine postoperative analgesia (observation group). The visual analogue score (VAS) 4, 24, 32, 48, 56 and 72 h after operation was evaluated; and the complications of subcutaneous catheterization, incision infection, postoperative nausea vomiting, neurological symptoms, time to extubation, patient satisfaction degree, recovery time of intestinal function and hospital stay were recorded.Results:The VAS 4, 24, 32, 48, 56 and 72 h after operation in observation group was significantly lower than that in control group: 1.000 (- 0.250, 2.250) scores vs. 1.000 (- 1.000, 3.000) scores, 2.000 (1.000, 3.000) scores vs. 4.000 (2.000, 6.000) scores, 1.000 (0.000, 2.000) scores vs. 3.000 (1.000, 5.000) scores, 2.000 (1.000, 3.000) scores vs. 3.000 (1.750, 4.250) scores, (1.100 ± 0.934) scores vs. (2.085 ± 0.943) scores and (0.985 ± 0.842) scores vs. (1.814 ± 0.921) scores, and there was statistical difference ( P<0.05 or <0.01). The recovery time of intestinal function and hospital stay in observation group were significantly shorter than that that in control group: (1.743 ± 0.557) d vs. (2.200 ± 0.714) d and (8.043 ± 1.160) d vs. (8.757 ± 1.221) d, and there were statistical difference ( P<0.01); there were no statistical differences in the rate of incision infection, incidence of postoperative nausea vomiting, time to extubation and patient dissatisfaction rate between two groups ( P>0.05); there were no the complications of subcutaneous catheterization and neurological symptoms in two groups. Conclusions:The incision subcutaneous porous catheter combined with ropivacaine analgesia after laparoscopic gastrointestinal surgery is a safe, effective and feasible method. Multimodal analgesia under enhanced recovery after surgery can increase the postoperative recovery after gastrointestinal operations and shorten the postoperative hospital stay.

Objective:To investigate clinical efficacy of mucopolysaccharide polysulfate cream combined with sertaconazole nitrate cream in the treatment of scaly hyperkeratotic tinea pedis.Methods:From March 2019 to January 2020, 100 patients with scaly hyperkeratotic tinea pedis were enrolled into this study, and randomly and equally divided into 2 groups by using a random number table: control group treated with topical sertaconazole nitrate cream alone at a dose of 0.5-1 g twice a day; combined group treated with topical mucopolysaccharide polysulfate cream at a dose of 0.5-1 g followed by topical sertaconazole nitrate cream at a dose of 0.5-1 g 30 minutes later, which were performed twice a day. The treatment lasted 4 weeks. The time to clinical symptom relief, efficacy and incidence of adverse reactions were compared between the two groups. Dermatology life quality index (DLQI) was assessed at 0, 2 and 4 weeks after the start of treatment. Two-independent-sample t test, repeated measures analysis of variance and chi-square test were used for statistical analysis. Results:After treatment, the time to pruritus relief and that to desquamation improvement were 6.05 ± 1.98 and 12.03 ± 3.92 days respectively in the combined group, which were significantly shorter than those in the control group (8.39 ± 2.11, 15.11 ± 4.05 days, t = 5.72, 3.86, respectively, both P < 0.001) . During the 4 weeks of treatment, DLQI scores gradually decreased in both the 2 groups (all P < 0.001) , which were significantly lower in the combined group than in the control group at weeks 2 and 4 (both P < 0.001) . After 4-week treatment, the total response rate was 98% (49/50) in the combined group, significantly higher than that in the control group (82%, 41/50; χ2= 7.11, P= 0.007) . There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05) . Conclusion:Mucopolysaccharide polysulfate cream can improve the efficacy of sertaconazole nitrate cream in the treatment of scaly hyperkeratotic tinea pedis.

Objective:To investigate the clinical manifestation and the plastic surgery principles of perineal scar contracture deformity.Methods:Patients with perineal deformities admitted to Plastic Surgery Hospital, Chinese Academy of Medical Sciences, were enrolled from January 1, 2010 to December 31, 2018. For the purpose of scar release, wound coverage, and organ defect reconstruction, we applied multiple plastic surgery methods such as tissue expansion techniques, penile lengthening, penile reconstruction, and anoplasty.Patients were followed-up for at least 6 months after operations. Urinary function, defecation function, range of joint motion, the appearance of perineum and the scar of the operation site were evaluated.Results:16 cases, aged 13 to 44 years old, were enrolled in our study and were successfully followed up for 1 to 10 years. There were no postoperative complications in 12 patients, and poor survival of partial flaps was shown in 4 patients, and the wound healed after dress-changing. Satisfactory results were obtained as self-maintenance, self-controllable urination, and defecation were restored.Conclusions:Following principles of subarea reconstruction in plastic surgery and using multiple plastic surgery methods, satisfactory results can be obtained in the repair of perineal scar contracture, which highly improves the life qualities of patients.

Objective:To investigate the clinical manifestation and the plastic surgery principles of perineal scar contracture deformity.Methods:Patients with perineal deformities admitted to Plastic Surgery Hospital, Chinese Academy of Medical Sciences, were enrolled from January 1, 2010 to December 31, 2018. For the purpose of scar release, wound coverage, and organ defect reconstruction, we applied multiple plastic surgery methods such as tissue expansion techniques, penile lengthening, penile reconstruction, and anoplasty.Patients were followed-up for at least 6 months after operations. Urinary function, defecation function, range of joint motion, the appearance of perineum and the scar of the operation site were evaluated.Results:16 cases, aged 13 to 44 years old, were enrolled in our study and were successfully followed up for 1 to 10 years. There were no postoperative complications in 12 patients, and poor survival of partial flaps was shown in 4 patients, and the wound healed after dress-changing. Satisfactory results were obtained as self-maintenance, self-controllable urination, and defecation were restored.Conclusions:Following principles of subarea reconstruction in plastic surgery and using multiple plastic surgery methods, satisfactory results can be obtained in the repair of perineal scar contracture, which highly improves the life qualities of patients.

Objective: To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities. Methods: Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded. Results: All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion. Conclusions Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn′t enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.

Objective: To evaluate the feasibility of buccal musoca grafting in the treatment of longer anterior urethral stricture. Methods: From January 2012 to December 2017, 42 cases of anterior urethral stricture were treated in staged procedure. Stage 1 included the excision of the narrow urethra and the reconstruction of the urethra by transplanting buccal mucosa sheet or tube. In Stage 2, patients underwent operation including urethra anastomosis and transfer the scrotal flap for coverage, and perform suprapubic puncture cystostomy at the same time. Results: Thirty-eight of 42 cases were followed up for 5-12 months with an average of 8 months. In the followed-up 38 cases, 35 of them obtained satisfactory result. Complications occurred in 2 patients, all of them suffered from urethra restricture. One patient′s urethra stricture was located in the anastomosis, stricture length was 0.5 cm. This patient received excision of the narrow urethra and anastomosis. Stricture in another patient was located in the external urethral meatus, this patient received expansion of the external urethral meatus. With proper treatment, all of them were recovered. One patient was not satisfied with the appearence of penis postoperatively. Of all these patients, no urethral fistula or penile curvature was observed. Urination and ejaculation were normal. Conclusions A successful treatment of long anterior urethral stricture can be achieved with the excision of affected urethra, reconstruction of defect urethra with buccal mucosa flap in staged procedure, and covering the new urethra by transferring the scrotal flap.

Objecive: To assess the clinical outcomes of patients who received modified penile augmentation by free dermal-fat grafting. Methods: From April 2012 to December 2014, a total of 15 male adults (18-24 years of age) after hypospadias repairs were included. They underwent modified penile augmentation, including girth enhancement using free dermal-fat grafting, and penile elongation (suprapubic skin advancement-ligamentolysis). Penile measurements were performed using ruler before operation and 6 months after operation. The outcome was evaluated by patients, based on the Male Genital Image Scale. SPSS 22.0 was used to analyze the data. In-paired t-test and Wilcoxon test were applied. Results: In 6-84 months of follow-up, all patients achieved excellent cosmetic results, and satisfied with the appearance and diameter. In weak state, the penile length increased from (5.03±0.47) cm to (6.69±0.49) cm. The increased value was (1.67±0.24) cm (t=8.6, P<0.001). Under traction, the penile length increased from (7.29±0.74) cm to (9.21±0.73) cm. The increased value was (1.93±0.21) cm (t=7.8, P<0.001). In weak state, the diameter of the middle part of penis increased from (7.16±0.25) cm to (8.69±0.44) cm, with the increased value of (1.53±0.23) cm (t=8.2, P<0.001). The MGIS score grew from 31.73±4.86 to 40.20±4.54(Z=3.2, P=0.001). Conclusions This modified technique is safe and effective in enlarging penile size for patients who had underwent hypospadias repair. It is confirmed that physical dimensional enhancement does contribute to improving their self-estimation of penile size.

Objective: To explore the blood supply of expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck and the feasibility of this kind of flap for facial vulnus′resurfacing. Methods: At the first stage of the treatment, one rectangular expander was implanted in lateral neck in the subcutaneous pockets, overlying the platysma, the volume of the expander is about 200-600 ml. After 2-3 months inflation, the pre-expanded lateral neck flap combined with posterior auricular flap was advanced at the second stage of the operation, the flap was rotated to lateral face to resurface the vulnus defects located on anterior auricle. Results: Twelve cases of facial wounds were included in this research from January 2009 to November 2016. The size of the expanded flaps were ranged from 6 cm×12 cm to 7 cm×15 cm. According to 2 to 24 months follow-up postoperatively, 10 months in average, two flaps showed venous retardation at distal part of expanded flaps, which were recorvered with one-week dress changing after excoriation. The other ten flaps survived with good appearance and function. The flaps matched well to the recipient defects in terms of color, character and elasticity. The appearance and function of face and neck were ideally adjusted after treatment. Conclusions By expanding lateral neck skin overlying platysma, the expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck was obtained with high quality and maximum use of blood supply in the anterior neck, which guaranteed appearance and function of the donor area and the recipient area at the same time.