Objective:To compare the therapeutic effects of modified plantar skin grafting and thigh skin grafting on the deep burn wounds of the back and buttocks.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with deep burn wounds on their back and buttocks who were admitted to the 910th Hospital of Joint Logistic Support Force of PLA from January 2021 to April 2023, including 26 males and 4 females, aged 21-72 years [(49.9±14.0)years]. The total burn size was 50%-97% of the total body surface area (TBSA), with the third-degree burn on the back and buttocks 6%-16% TBSA. The burn wounds on the back and buttocks were repaired using plantar skin grafts alone, thigh skin grafts alone or plantar skin grafts combined with the grafts from other body parts. The patients were grouped according to the skin graft donor sites and the times of harvesting skin grafts: there were 20 patients undergone plantar skin grafting including 10 patient with plantar skin graft harvested once (group of plantar skin graft harvested once) and 10 patients with plantar skin graft harvested twice or three times (group of plantar skin graft harvested more than once), and 10 patients undergone thigh skin grafting harvested once (group of thigh skin graft harvested once). The areas of plantar skin grafts harvested at the last time and the wound areas on the back and butts that could be repaired each time were calculated. After the last harvest, the thickness of the stratum corneum, 7-day survival rate of the skin grafts, proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month Vancouver Scar Scale (VSS) scores of the donor sites in the group of plantar skin graft harvested once were compared with those in the group of thigh skin graft harvested once and the group of plantar skin graft harvested more than once. The appearance and texture of the skin graft, patients′ walking patterns and complications were observed at 6 months after the last skin harvest.Results:All the patients were followed up for 6-18 months [(7.8±1.6)months]. In the 20 patients with plantar skin grafts harvested, the areas of skin grafts harvested at the last time were 2.5%-4.5% TBSA [(3.4±0.6)% TBSA] and the wound areas that could be repaired each time were 3%-8% TBSA [(5.5±1.5)% TBSA]. After the last harvest, the thickness of the stratum corneum in the group of plantar skin graft harvested once was (190.4±8.9)μm, which was significantly thicker than that in the group of thigh skin graft harvested once [(50.0±6.6)μm] and that in the group of plantar skin graft harvested more than once [(166.8±21.9)μm] ( P<0.01); the 7-day survival rate of the skin grafts, proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month VSS scores of the donor sites were (93.6±2.3)%, 2.0 (0.1, 3.5)%, (9.9±1.8)days and (1.7±0.7)points in the group of plantar skin graft harvested once, (78.0±6.6)%, 5.3 (4.0, 5.8)%, (14.0±1.4)days and (4.9±2.3)points in the group of thigh skin graft harvested once, and (93.4±2.6) %, 2.0 (0.1, 3.8)%, (10.0±1.2)days and (1.8±0.8)points in the group of plantar skin graft harvested more than once. The group of plantar skin graft harvested once showed a significant increase in the 7-day survival rate and a significant decrease in the proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month VSS scores of the donor sites in comparison with the group of thigh skin graft harvested once ( P<0.05 or 0.01), while there were no significant differences in above mentioned indices between the group of plantar skin graft harvested once and the group of plantar skin graft harvested more than once ( P>0.05). At 6 months after the last skin harvest, the skin graft areas on the back and buttocks were flat, hard and firm and all the patients in the three groups could walk normally, with no complications such as severe itching, pain or folliculitis in the skin graft area. Conclusions:In the treatment of burn wounds on the back and buttocks, compared with thigh skin grafting, modified plantar skin grafting has advantages of thicker stratum corneum, better wear resistance and pressure resistance in the skin graft areas, a higher survival rate of skin grafts, rapid healing, mild scar, and undisturbed walking pattern after surgery and no common complications. Moreover, skin grafts can be harvested repeatedly from the donor sites, with no impact on the therapeutic effects.

Objective:To explore the clinical effect of application of a posterior femoral perforator flap (PFPF) relayed an adjacent flap of recipient site in reconstruction of the recurrent pressure sores in sacrococcygeal region.Methods:Retrospective observation method was used in this study. From December 2019 to May 2023, 13 patients with recurrent pressure sores in sacrococcygeal region were admitted in the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA. The patients were 8 males and 5 females who aged 42-69 years old. All the pressure sores were in Grade Ⅲ-Ⅳ. Eight patients had pressure sores for a second time and 5 for a third time. After preoperative preparations, the surgical treatment was planned in 2 stages. In the first stage, the pressure sores were thoroughly debrided, and the wounds after debridement were at 5.0 cm×6.0 cm-15.0 cm×9.0 cm in size. After debridement, the wounds were covered by VSD for 7 days. Flap reconstruction of the wounds of pressure sores were performed in the second stage surgery. According to the location and size of the wounds and the remaining normal skin tissue around the wounds, the adjacent flaps were taken to reconstruct the wounds of sacrococcygeal pressure sore. PFPFs were employed to reconstruct the donor site wounds left by the adjacent flap. The sizes of the adjacent flap were 6.0 cm×7.0 cm-16.0 cm×9.5 cm, and the PFPFs were 9.0 cm×8.0 cm-18.0 cm×10.0 cm in size. PFPF was rotated in a manner of propeller. The donor sites of PFPF were directly sutured. After surgery, survival of the adjacent flaps and PFPFs, the wound healing in the donor sites as well as the healing time were observed. The appearance, texture and recurrence of pressure sores of the flap reconstruction sites were observed at outpatient clinic, via WeChat reviews or telephone interviews up to January 2024.Results:Twenty-six flaps of 13 patients survived after surgery, inclusive of 1 patient with the adjacent flap partially split due to turn-over and transport of the patient after surgery, and healed after a re-suture under local anaesthesia. In addition, 1 patient had effusion under the adjacent flap and 1 patient had partial split under the PFPF, both of which healed after dressing changes, with an overall healing time of 16-30 days. Postoperative follow-ups lasted for 6-12 months. The flaps had good appearance, soft texture, no surface rupture and without the recurrence of a pressure sore.Conclusion:Treatment of recurrent pressure sores in sacrococcygeal region by reconstructive surgery with PFPF relaid adjacent flap can achieve the effects of closure of wound, high survival rate of flap and good wound healing. It does not require skin grafting for the donor site at posterior thigh and achieves a good and long-term therapeutic effects under the circumstance that only a small amount of normal skin tissue is left on the buttocks.

Objective:To explore the clinical effects of plantar split-thickness skin grafts in repairing the deep burn wounds in the back and buttocks.Methods:A retrospective observational study was conducted. From January 2011 to February 2022, 98 patients with deep burn who met the inclusion criteria were admitted to the 910 th Hospital of Joint Service Support Unit of PLA, including 64 males and 34 females, aged 17 to 78 years, with total burn areas of 35%-95% total body surface area (TBSA). The area of full-thickness burns in the back and buttocks ranged from 5% to 17% TBSA and the wounds were repaired only using stamp-shaped split-thickness skin grafts from plantar areas of both feet or combined with Meek microskin grafts or stamp-shaped skin grafts from other sites. According to the times of skin graft harvesting from both soles, these patients were divided into one-harvesting group (29 cases), two-harvesting group (38 cases), three-harvesting group (21 cases), and four-harvesting group (10 cases). The area of skin grafts harvested each time from both soles, the healing time of donor sites after each skin graft harvesting, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting in 98 patients, the interval between two adjacent skin graft harvesting in 69 patients with skin grafts harvested twice or more, as well as the healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups were recorded. The patients were followed up to observe the appearance, texture, and scar in recipient site of plantar skin grafts as well as the scar and function in plantar donor sites. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and chi-square test. Results:In the 98 patients, the area of skin graft was 2.0%-4.5% ((3.4±0.6)%) TBSA harvested each time from both soles, the healing time of donor site after each skin graft harvesting was 7-10 (7.8±1.1) d, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting was 93% (92%, 95%). The interval between two adjacent skin graft harvesting in the 69 patients was 7-38 (11.2±0.5) d. The healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups showed no statistically significant differences ( P>0.05). A total of 88 patients were followed up for 3 months to 5 years, the appearance in recipient site of plantar skin graft was smooth, the texture was firm, the scar hyperplasia was mild, and the area was compressive- and wear-resistant. Among them, the plantar donor site recovered well in 85 patients, without obvious scar hyperplasia and only 3 patients had small area of scar hyperplasia in the non-weight-bearing areas which did not affect walking or wearing shoes or socks. Ten patients were lost in the follow up after discharge. Conclusions:Stamp-shaped split-thickness skin grafts can be repeatedly harvested from both soles of patient to repair the deep burn wounds in the back and buttocks, with high survival rate of skin grafts, thus can reduce the burden of other donor sites. Moreover, the skin grafts have good wear-resistance and pressure-resistance, without affecting postoperative normal walk.

Objective:To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) for neonatal refractory respiratory failure in a single medical center of Southwest China.Methods:From June 2020 to November 2021, the clinical data of neonates with refractory respiratory failure who received ECMO in the neonatal department of our hospital were retrospectively reviewed. The neonates were assigned into the survival group and the deceased group.Their general profile, clinical diagnosis, laboratory tests, ECMO operation, complications and prognosis were compared.Results:Eight neonates were included with five successfully withdrawal of ECMO and survived (5/8). For the three deceased neonates, two discontinued treatment because of intraventricular hemorrhage (grade Ⅲ~Ⅳ) and one confirmed congenital adrenal hyperplasia. No significant differences existed between the survival and the deceased groups in oxygenation index (OI), ECMO preparation and operation duration, usage of heparin, red blood cell suspension, platelet and sedative/analgesic drugs, therapeutic hypothermia and ECMO-associated complications. However, the deceased group had high OI values ( P=0.001), low lactate clearance ( P=0.005), more urine output during the first 24 h after ECMO ( P=0.046) and more fresh frozen plasma usage ( P=0.038). None of the five surviving children had significant developmental delay and neurological abnormalities during the 1-year follow-up. Conclusions:ECMO is effective treating neonatal refractory respiratory failure. Reducing the risk of intraventricular hemorrhage during ECMO may improve the survival rate.

OBJECTIVE：To provide reference for the quality control of the leaves of Toricellia angulata . METHODS ：HPLC method was adopted. The determination was performed on Agela Promosil C 18 column with 0.2％ phosphoric acid solution-acetonitrile（gradient elution ）as mobile phase at the flow rate of 1.0 mL/min. The detection wavelength was set at 210 nm，and column temperature was 35 ℃. The sample size was 10 μL. HPLC fingerprint of 10 batches of the leaves of T. angulata was established and similarity evaluation was conducted by using Similarity Evaluation System of TCM Chromatographic Fingerprint（2004 edition）. The chromatographic peak was identified by comparing with the chromatogram of reference substance. Cluster analysis ，PCA and PLS-DA were used to identify chemical patterns ，and the quality differential markers were screened. The contents of hyperoside and isoquercitrin were determined by the same HPLC. RESULTS ：The similarities of HPLC fingerprint of 10 batches of the leaves of T. angulata with control fingerprint were 0.923-0.983. A total of 11 common peaks were identified ，and the peaks 4 and 5 were hyperoside and isoquercitrin ，respectively. Results of cluster analysis ，PCA and PLS-DA showed that 10 batches of leaves of T. angulata could be divided into two categories ，Y10 was clustered into one category ，and others were clustered into one category. PLS-DA analysis showed that 6 common peaks （peaks 4，3，10，2，6 and 11） with variable importance projection （VIP）greater than 1 were selected. Average contents of hyperoside and isoquercitrin in 10 batches of the leaves of T. angulata were 0.47-6.97，0.21-1.87 mg/g，respectively. CONCLUSIONS ：Established HPLC fingerprint and the method for content determination are stable and reliable ，and can be used for the quality control of the leaves of T. angulata from different areas. Six quality differential markers including hyperoside in the leaves of T. angulata from different areas are qnyz202034） preliminarily screened.

Objective To solve the problems in medical equipment utilization,supervision,management,clinical safety and etc.Methods A centralized management and sharing system of medical equipment was developed with functional requirements analysis,C/S architecture and programming.Results The system eliminated the needs for manual accounting and allocation,enhanced medical equipment usage rate and improved equipment borrowing procedure.Conclusion The system contributes to dynamic management and efficacy evaluation of medical equipment,so as the working efficiency can be increased while the costs can be decreased for manpower and materials.

The repair, regeneration and functional recovery of peripheral nerve defects are the clinical problems needed to be solved urgently.Researches showed that the hollow conduits of bridging nerve defects only had the functions of support and isolation, but the composite conduits could simulate nerve regeneration microenvironment and possess biological activity, which could effectively guide the migration of Schwann cells and the regeneration of axons to achieve satisfactory effects of restoration and functional recovery.With the development of tissue engineering, regenerative medicine, biomaterial and the techniques of cells and molecular biology, the construction of biomimetic and functional nerve conduits to bridge long nerve defects has attracted more and more attention. This review will provide a brief overview of the construction strategy of nerve conduits repairing long nerve defects of peripheral nerves.

AIM:To investigate the protective effect of pinacidil postconditioning on rat myocardium suffering ischemia/reperfusion injury by mitochondrial proteomics .METHODS: Langendorff apparatus was used to establish the model of myocardial ischemia/reperfusion injury .Sprague-Dawley rats were randomly divided into 2 groups:pinacidil post-conditioning group (Pina group) and ischemia/reperfusion injury group (I/R group).After 20 min of perfusion with K-H solution, the perfusion was suspended for 40-min (global ischemia) follow by 60 min of reperfusion in I/R group.In Pina group at the end of 40 min global ischemia , the isolated hearts were perfused with K-H solution containing pinacidil ( 50μmol/L) for 2 min followed 58-min perfusion with regular K-H solution.Total proteins extracted from the mitochondria were applied to the two-dimensional gel electrophoresis (2-DE).The differentially expressed protein spots over 2 times were evaluated by a software .Then they were subjected to in-gel digestion , and analyzed by spectrometry .RESULTS:The expression levels of NDUFA10, NDUFS2 and NDUFV2 were elevated but those of IDHA and ECH 1 were decreased in Pina group compared with I/R group.Interestingly, 2 spots in the 2-DE map were identified as ATPase subunit δ.The ex-pression levels of one spot was elevated , while the other was decreased .CONCLUSION:Pinacidil postconditioning may decrease the degree of increased expression levels of NDUFA 10, NDUFS2 and NDUFV2, promote the expression of IDHA and ECH1, and induce the phosphorylation of ATPase subunit δ, which may be related to the protective mechanism of pinacidil postconditioning .

Objective To investigate the application of microemulsion thin layer chromatography (TLC) for separation and identification of various active components in Xinnaomaitong capsule .Methods The all-grass of Bluecalyx japanese rabo-dosia,rootof Puerarialobata,rootandrhizomeof Salviamiltiorrhiza,rhizomeof LigusticumchuanxionginXinnaomaitong capsule were separated and identified simultaneously with the polyamide film as stationary phase and the microemulsion as mo-bile phases .Different factors ,such as the sodium dodecyl sulfate (SDS) ,oil phase and water phase which effect on the separa-tion of the components were evaluated .Results The all-grass of Bluecalyx japanese rabodosia ,root of Pueraria lobata ,root andrhizomeof Salviamiltiorrhiza,rhizomeof LigusticumchuanxionginXinnaomaitongcapsulewereseparatedandidentified simultaneously with mobile phase of microemulsion∶formic acid∶acetone (5∶1∶1) .The constituent of microemulsion was SDS∶butyl alcohol∶n-Heptane∶water = 6 .7∶15 .8∶2 .5∶75 .0 (g/g) .The spots were clear ,the negative control was no interference ,and it showed an ideal separation .Conclusion Microemulsion TLC is simple ,accurate ,and reproducible .It can identify a variety of active components in traditional Chinese medicine simultaneously .

Objective To observe the effect of scalp-body acupuncture plus psychological intervention in treating post-stroke depression.Method Seventy-eight patients with post-stroke depression were divided into a treatment group (40 cases) and a control group (38 cases). In addition to ordinary neurological treatments, the treatment group also received scalp-body acupuncture plus psychological intervention while the control group also received Fluoxetine hydrochloride (Prozac). The interventions were given once a day, 4 weeks as a treatment course, for 2 courses in total. Hamilton Rating Scale for Depression (HAMD) and neurological impairment severity scale (NISS) were observed before intervention, after 1 treatment course and at the end of the intervention.Result After intervention, the HAMD and NISS scores dropped significantly in both groups, and the treatment group was markedly better than the control group (P＜0.05). The total effective rates of anti-depression and recovery of neurological function in the treatment group were significantly higher than those in the control group (P＜0.05).Conclusion Scalp-body acupuncture plus psychological intervention can produce a content efficacy in improving depression and recovering neurological function.