Objective:To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers.Methods:The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded.Results:During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints.Conclusions:The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.

OBJECTIVE: To investigate the consistency and diagnostic performance of magnetic resonance imaging (MRI) for detecting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) and the validity of deep learning attention mechanisms and clinical features for MVI grade prediction. METHODS: This retrospective study was conducted among 158 patients with HCC treated in Shunde Hospital Affiliated to Southern Medical University between January, 2017 and February, 2020. The imaging data and clinical data of the patients were collected to establish single sequence deep learning models and fusion models based on the EfficientNetB0 and attention modules. The imaging data included conventional MRI sequences (T₁WI, T₂WI, and DWI), enhanced MRI sequences (AP, PP, EP, and HBP) and synthesized MRI sequences (T1mapping-pre and T1mapping-20 min), and the high-risk areas of MVI were visualized using deep learning visualization techniques. RESULTS: The fusion model based on T1mapping-20min sequence and clinical features outperformed other fusion models with an accuracy of 0.8376, a sensitivity of 0.8378, a specificity of 0.8702, and an AUC of 0.8501 for detecting MVI. The deep fusion models were also capable of displaying the high-risk areas of MVI. CONCLUSION The fusion models based on multiple MRI sequences can effectively detect MVI in patients with HCC, demonstrating the validity of deep learning algorithm that combines attention mechanism and clinical features for MVI grade prediction.
Humans ; Carcinoma, Hepatocellular ; Retrospective Studies ; Liver Neoplasms ; Magnetic Resonance Imaging ; Algorithms

Objective:Verstaile free superficial circumflex iliac artery perforator flap(SCIAPF) were adopted for various reconstructive scenarios, and its clinical effect and value was evaluated.Methods:Retrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019. Nine patients had injury in the foot, 8 in ankle, 8 in calf, 7 in forearm, 9 in hand, and 1 in the mouth. All of the defects were repaired by SCIAPF, including 28 single soft tissue defect wounds, 8 multiple soft tissue defect, and 6 composite defects. The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm. The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm. The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps, functional recovery and complications.Results:In this series, there were 28 flaps, including 18 pedicled with superficia branch of superficial circumflex iliac artery, 2 pedicled with deep branch of superficial circumflex iliac artery, and 8 pedicled with 2 branches. Six were chimeric flaps. Among them, 4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps, and 2 were superficial iliac circumflex artery flap with sartorius muscle flap. Eight cases were resurfaced with lobulated SCIAPF. Arterial anastomoses: end-to-side in 35 arteries and end-to-end in 7 arteries. Venous anastomosis: end-to-end in 27 veins and end-to-side in 15 veins. Venous return through superficial iliac circumflex vein in 25 flaps, through venae comitantes in 12 flaps and through both in 5 flaps. All flap donor sites were sutured directly. All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding, and survived after re-anastomosis. All flaps and donor sites healed primarily. During the follow-up of 6-24(mean, 11.5) months, the pliable flaps were ruddy in colour and soft in texture, without obvious bloatness and pigmentation. The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases. The donor hip function were normal. Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.Conclusion:New applications of lobulated or chimeric SCIAPF, based on the SCIA vasculature or its branches, can meet most of the clinical repair requirement.

OBJECTIVE To investigate the effects of total glucosides of paeony （TGP） on enhancing efficacy and reducing toxicity of Tripterygium wilfordii polyglycoside （TWP） in the treatment of eczema. METHODS Totally 50 SD male rats were collected to establish eczema model by sensitizing with 2，4-dinitrofluorobenzene-acetone olive oil solution （volume ratio was 4∶1） on the abdominal area and provoking on the back and ear. Model rats were randomly divided into model group， loratadine group （0.9 mg/kg）， TWP group （9.45 mg/kg）， TGP group （162 mg/kg） and compatibility group （TWP 9.45 mg/kg+TGP 162 mg/kg）， with 10 rats in each group. Other 10 rats were collected to set as normal group. Three days after the first sensitization， administration groups were given relevant medicine intragastrically， and normal group and model group were given constant volume of 0.1% CMC-Na solution intragastrically， once a day， for consecutive 21 d. Twenty-four hours later after the final administration， the general condition of rats in each group was observed， and the eczema area and severity index （EASI） were scored； ear swelling degree of rats was measured， and the skinhistomorphology observation and pathological score were performed； protein expressions of p38 mitogen-activated 13938427612@126.com protein kinase （p38 MAPK）， phosphorylated p38 MAPK （p- MAPK） and phosphorylation level of p38 MAPK in rat skin tissue were detected； the levels of inflammatory indexes （interleukin-4， interferon- γ）， liver and kidney function indexes [glutamic-pyruvic transaminase （GPT）， glutamic-oxaloacetic transaminase （GOT）， serum creatinine （SCr） and blood urea nitrogen （BUN）] and oxidant stress indexes [total superoxide dismutase （T-SOD） and malondialdehyde （MDA）] were measured. RESULTS Compared with normal group， EASI score， ear swelling degree， pathological score， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation level of p38 MAPK， the levels of inflammatory indexes and BUN were all increased significantly in model group （P＜0.05）. Compared with model group， EASI scores， ear swelling degree， pathological scores， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation levels of p38 MAPK and levels of inflammatory indexes were all improved significantly in administration groups （P＜0.05）. The levels of GPT， GOT， SCr and BUN were increased significantly in TWP group， while the serum levels of GOT and SCr in TGP group and serum level of SCr in loratadine group were all decreased significantly （P＜0.05）. The levels of T-SOD in liver and kidney tissue were all decreased significantly in TWP group and compatibility group， while the levels of MDA were increased significantly （P＜0.05）. The compatibility group showed more obvious effect in improving the ear swelling degree， pathological score， p38 MAPK expression and its phosphorylation level and levels of inflammatory indexes， and could reverse the abnormality of liver and kidney indexes caused by TWP （P＜0.05）. CONCLUSIONS The combination of TGP and TWP has the effects of anti-inflammatory， synergistic and hepatorenal detoxification in eczema model rats. Its mechanism may be associated with down-regulating the expression of serum proinflammatory indexes and inhibiting the activation of p38 MAPK pathway.

Autoimmune hepatitis (AIH) affects all age group and occurs mainly in women. Pyroptosis is a novel programmed cell death featured with cell bursting and release of proinflammatory cytokines. A deeper understanding of AIH pathogenesis will contribute to novel therapy for AIH patients. Here, we aimed to investigate the role of IL-17 in immune-mediated liver injury.The levels of cytokines were measured by ELISA, and mRNA levels of STAT3 and IFN gammainducible protein 16 (IFI16) were detected by PCR. Expressions of STAT3, IFI16, gasdermin D and cleaved caspase-1 were measured by western-blotting. Immunohistochemical staining and transmission electron microscopy were applied to evaluate liver histopathological changes of the treated mice. Our results showed that the levels of IFI16 was increased in hepatocytes treated with IL-17 protein, and further elevated after STAT3-overexpressed (STAT3-OE) lentivirus treatment. The levels of IFI16 were reduced in hepatocytes treated with IL-17 neutralizing Ab (nAb), but were significantly increased after STAT3-OE treatment. Pyroptosis was observed in hepatocytes treated with IL-17 protein, and further cell damage was observed after STAT3-OE lentivirus treatment. Liver damage was alleviated in mice treated with IL-17 nAb, however sever damage was experienced after STAT3-OE lentivirus treatment. A binding interaction between IFI16 and STAT3 was detected in IL-17 treated hepatocytes. Glutathione transaminase activity was enhanced in concanavalin A-induced AIH mice compared to the control group (p<0.01). IL-17 plays an important role in activating STAT3 and up-regulating IFI16, which may promote the pyroptosis in AIH-related liver injury through STAT3-IFI16 axis.

Objective:To introduce a surgical method and clinical effect of using Masquelet technique combined with skin graft to cover chronic refractory wounds in elderly patients.Methods:From September 2020 to September 2022, 20 elderly patients with wounds of bone or tendon exposure in lower limbs were treated in the Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University. Due to the age and poor general condition of the patients, flap transfer for wound coverage were not allowed. Masquelet technique was therefore applied in the treatment of chronic wounds of such patients. Sizes of wounds were found at 4.5 cm×3.0 cm to 15.0 cm×6.0 cm and all accompanied with tendon and bone exposure, after thorough debridement. Wounds were then sealed with antibiotic bone cement several times. After having induced formation of membrane in wounds, free mesh skin graft was used to cover the refractory wounds. The patients were entered in follow up regularly after surgery at outpatient service, and telephone or video reviews. The wound healing of patients and whether there were related complications in the skin donor area were observed. The number of operation times in the first stage was 1-4 with an average of 1.3 times ± 0.7 times. Lower Extremity Function Scale (LEFS) was used to evaluate the recovery of lower limb function.Results:All 20 wounds healed well. The follow-up time was 3-12 months, with an average of 7.6 months. The appearance and texture of the skin in the wounds area were satisfactory. The mean LEFS was 69.83 point ± 10.82 point.Conclusion:Using Masquelet technique combined with free skin grafting to treat refractory wounds in the elderly patients can achieve satisfactory clinical outcomes. It is a simple and reliable supplement to the wound repair, and can reduce the surgical risk.

OBJECTIVE To study the intervention effect of Bushen qiangshen tablet on polycystic ovary syndrome （PCOS） model rats and its mechanism . METHODS Totally 50 rats were given letrozole suspension （1 mg/kg，once a day ，for consecutive 21 d） instragastrically to induce PCOS model . Model rars were randomly divided into model group ，positive control group （Ethinylestradiol and cyproterone acetate tables 0.2 mg/kg+Metformin hydrochloride tables 230 mg/kg），Bushen qiangshen tablet low-dose，medium-dose and high -dose groups （189，378，756 mg/kg），with 10 rats in each group . Another 10 healthy rats were included in normal group . Each group was given the corresponding drugs ，once a day ，for consecutive 30 d. Twenty-four hours after the last administration ，serum levels of estrogen （E2），testosterone（T），gonadotropin-releasing hormone （GnRH），follicle- stimulating hormone （FSH）and luteinizing hormone （LH）were measured . The ovary index was calculated ，and pathological changes of ovary were observed . The protein expressions of phosphoinositide 3-kinase（PI3K），phosphorylated protein kinase B （p- Akt），phosphorylated mammalian target of rapamycin （p-mTOR）and glucose transporter 4（GLUT4）in ovary were detected ，and mRNA expressions of PI 3K，Akt，mTOR and GLUT 4 in ovary were detected . RESULTS Compared with normal group ，ovarian index and ovarian cystic disease score were significantly increased in model group （P＜0.05），and serum levels of T ，GnRH and LH were significantly increased （P＜0.05）；serum levels of FSH and E 2，protein expressions of PI 3K，p-Akt，p-mTOR and GLUT4，and mRNA expression of PI 3K，AKT，mTOR and GLUT 4 in ovarian tissue were all significantly decreased in the model group （P＜0.05）；in ovarian tissue ，the number of atresia follicles and non -cumulus cystic follicles increased ，and the number of granulosa cell layers decreased . Compared with model group ， above indexes of Bushen qiangshen tablet medium-dose and high -dose g roups were reversed significantly 86550201。E-mail：mary868@163.com （P＜0.05），and most above indexes of low -dose group were reversed significantly （P＜0.05），the pathological changes of ovarian tissue were improved to varying degrees . CONCLUSIONS Bushen qiangshen tablet can regulate the secretion of sex hormones in PCOS model rats and improve ovarian cystic lesions . Its mechanism may be related to the upregulation of PI 3K/Akt/mTOR and PI 3K/Akt/GLUT4 signaling pathways .

OBJECTIVE To investigate the effect of Compound danshen tablet s o n improving the blood lipid levels and the mechanism of protecting renal functions in hyperlipidemia model rats. METHODS Sixty male SD rats were divided into normal group，model group ，simvastatin combined with （2S）-N-[N-（3，5-difluorophenylacetyl）-L-alanyl]-2-phenylglycine tert butyl （DAPT）group and low-dose ，medium-dose and high-dose groups of Compound danshen tablets ，with 10 rats in each group. Rats in the normal group received routine diet. The other 5 groups were intraperitoneally injected with 75％ yolk emulsion 10 mL/kg， fasting and drinking freely. After 16 h，they were fed high-fat diet for 4 weeks. Simvastatin combined with DAPT group was given simvastatin 0.002 g/kg and DAPT 0.012 g/kg at the same time of modeling. The low-dose ，medium-dose and high-dose groups of Compound danshen tablets were given Compound danshen tablets 0.25，0.5 and 1 g/kg respectively at the same time of modeling ， the normal group and model group were given equal volume of distilled water ，once a day ，for 4 weeks. The serum levels of total cholesterol（TC），triglyceride（TG），creatinine（Cr）and urea nitrogen （BUN）in serum were detected by biochemical method ； kidney coefficient of rats was calculated ；histopathological changes of rat kidney were observed by HE staining ，and the renal injury was scored according to the degree of renal tubular injury and glomerular sclerosis in renal cortex ；expression levels of Notch signal receptor 1（Notch 1），Notch signal ligand 1（Jagged1）and hairy division associated enhancer 1（Hes1）in kidney were detected by immunohistochemistry ；mRNA expressions of Notch 1，Jagged1 and Hes 1 in renal tissue were detected by real-time fluorescence quantitative polymerase chain reaction. RESULTS Compared with normal group ，the serum levels of TG ， TC，Cr and BUN were increased significantly in model group （P＜0.05）；renal coefficient increased significantly （P＜0.05）； pathological changes occurred in renal tissue ，and the scores of renal tubular injury and glomerular sclerosis increased significantly （P＜0.05）；protein and mRNA expressions of Notch1， Jagged1， Hes1 in renal tissue were increased significantly（P＜0.05）. Compared with model group ，serum levels of TG ，TC，Cr and BUN ，renal coefficient ，the scores of renal tubular injury and glomerular sclerosis ，protein and mRNA expression of Notch 1，Jagged1 and Hes 1 in renal tissue were all decreased in low-dose ，medium-dose and high-dose groups of Compound danshen tablets （P＜0.05），and most indexes showed a dose-dependent trend ；the degree of renal lesions was reduced. CONCLUSIONS Compound danshen tablets possess obvious hypolipidemic effect ，and can protect the renal function of hyperlipidemia model rats by down-regulating Notch 1/Jagged1 signal pathway.

Objective:To explore the feasibility and clinical effect of the infrared vascular imager in the transplantation of free arterialized venous flaps.Methods:A retrospective analysis was conducted with patient data of hand microsurgery using free arterialized venous flaps to repair hand wounds in the Second Affiliated Hospital of Wenzhou Medical University from March 2019 to November 2020. An arterialized venous flap was designed according to the Goldschlager’s Type Ⅲ flap design with the aid of a magnifying glass following the venous course. The flap was transfer to cover the wound of the recipient area. The reconstructive effect was observed postoperatively, including the blood supply, color, texture, survival of the flap, the flexion and extension of the affected finger, and the appearance of the forearm donor site. The hand function was evaluated by the Chinese Medical Association Hand Surgery Society’s upper limb function evaluation trial standard.Results:A total of 17 patients were included, including 11 males and 6 females, ranging in age from 19 to 68 years old, with an average age of 34.6 years. A total of 18 skin flaps were designed and elevated, and the flap size ranged from 2.0 cm × 3.0 cm to 8.0 cm × 9.0 cm. The patients were followed up 3 to 12 months after the operation, with an average follow-up of 6 months. Blisters appeared on the second day after the operation in 8 flaps, and the affected limbs were raised to maintain the integrity of the blisters. The blisters of the flaps subsided one week after the operation. Congestion occurred on the second day after operation in 7 flaps, which subsided after two weeks after routine treatment, such as raising the affected limb and removing some sutures. One flap developed progressive hypoperfusion one week after the operation, and eventually necrosis. Seventeen flaps survived, and one flap failure was observe. All the surviving skin flaps were free of bloat and had a good appearance. In two cases, the skin graft area was pigmented, and the flexion and extension activities of the affected fingers were suitable. Using the Chinese Medical Association Society of Hand Surgery’s upper limb function evaluation trial standard, 16 patients (excluding one flap failure) were evaluated for hand function, showing 11 cases were excellent and 5 cases were good.Conclusions:Infrared vascular imaging technology enables free arterialized venous flap transplantation to realize non-contact, non-invasive, simple operation, intuitive and accurate, and truly realizes rapid flap design under direct vision. Infrared vascular imaging technology is an effective auxiliary tool for free arterialized venous flap transplantation.

Objective:To explore the feasibility and clinical effect of the infrared vascular imager in the transplantation of free arterialized venous flaps.Methods:A retrospective analysis was conducted with patient data of hand microsurgery using free arterialized venous flaps to repair hand wounds in the Second Affiliated Hospital of Wenzhou Medical University from March 2019 to November 2020. An arterialized venous flap was designed according to the Goldschlager’s Type Ⅲ flap design with the aid of a magnifying glass following the venous course. The flap was transfer to cover the wound of the recipient area. The reconstructive effect was observed postoperatively, including the blood supply, color, texture, survival of the flap, the flexion and extension of the affected finger, and the appearance of the forearm donor site. The hand function was evaluated by the Chinese Medical Association Hand Surgery Society’s upper limb function evaluation trial standard.Results:A total of 17 patients were included, including 11 males and 6 females, ranging in age from 19 to 68 years old, with an average age of 34.6 years. A total of 18 skin flaps were designed and elevated, and the flap size ranged from 2.0 cm × 3.0 cm to 8.0 cm × 9.0 cm. The patients were followed up 3 to 12 months after the operation, with an average follow-up of 6 months. Blisters appeared on the second day after the operation in 8 flaps, and the affected limbs were raised to maintain the integrity of the blisters. The blisters of the flaps subsided one week after the operation. Congestion occurred on the second day after operation in 7 flaps, which subsided after two weeks after routine treatment, such as raising the affected limb and removing some sutures. One flap developed progressive hypoperfusion one week after the operation, and eventually necrosis. Seventeen flaps survived, and one flap failure was observe. All the surviving skin flaps were free of bloat and had a good appearance. In two cases, the skin graft area was pigmented, and the flexion and extension activities of the affected fingers were suitable. Using the Chinese Medical Association Society of Hand Surgery’s upper limb function evaluation trial standard, 16 patients (excluding one flap failure) were evaluated for hand function, showing 11 cases were excellent and 5 cases were good.Conclusions:Infrared vascular imaging technology enables free arterialized venous flap transplantation to realize non-contact, non-invasive, simple operation, intuitive and accurate, and truly realizes rapid flap design under direct vision. Infrared vascular imaging technology is an effective auxiliary tool for free arterialized venous flap transplantation.