Objective:To investigate the clinical effect of the modified vertical rectus abdominis myocutaneous flap in repairing the skin and soft tissue defect after abdominoperineal resection for rectal cancer.Methods:This study was a retrospective observational study. From June 2019 to July 2022, five male patients with low rectal cancer who were conformed to the inclusion criteria were admitted to the Department of Basic Surgery of Xiangya Hospital of Central South University, with ages ranging from 65 to 70 years and the sizes of the perianal skin ulcers ranging from 5 cm×4 cm to 11 cm×9 cm, and all of them underwent abdominoperineal resection. The secondary skin and soft tissue defects in the perineum with an area of 8 cm×6 cm-14 cm×12 cm (with the depth of pelvic floor dead space being 10-15 cm) were repaired intraoperatively with transplantation of modified vertical rectus abdominis myocutaneous flaps with the skin area being 9 cm×7 cm-16 cm×12 cm, the volume of the muscle being 18 cm×10 cm×5 cm-20 cm×12 cm×5 cm, and the vessel pedicle being 18-20 cm in length. During the operation, most of the anterior sheath of the rectus abdominis muscle was retained, the flap was transferred to the recipient area through the abdominal cavity, the remaining anterior sheaths of the rectus abdominis muscle on both sides of the donor area were repeatedly folded and sutured, the free edge of the transverse fascia of the abdomen was sutured with the anterior sheath of the rectus abdominis muscle, and the donor area skin was directly sutured. After the operation, the survival of the transplanted myocutaneous flap was observed. The occurrence of complications in the perineal recipient area was recorded within 2 weeks after the operation. The recovery of the perineal recipient area and the abdominal donor area was observed during follow-up, and the occurrence of complications in the donor area of the abdomen as well as the recurrence of tumors and metastasis were recorded.Results:All transplanted myocutaneous flaps in 5 patients survived after surgery. One patient had dehiscence of the incision in the perineal recipient area 2 days after surgery, which healed after 7 d with intermittent dressing changes and routine vacuum sealing drainage treatment. In the other 4 patients, no complications such as incisional rupture, incisional infection, or fat liquefaction occurred in the perineal recipient area within 2 weeks after surgery. Follow-up for 6-12 months after discharge showed that the skin of the perineal recipient area had good color, texture, and elasticity, and was not bloated in appearance; linear scars were left in the perineal recipient area and the abdominal donor area without obvious scar hyperplasia or hyperpigmentation; no complications such as incisional rupture, incisional infection, intestinal adhesion, intestinal obstruction, or weakening of the abdominal wall strength occurred in the abdominal donor area, and the abdominal appearance was good with no localized bulge or formation of abdominal hernia; there was no local recurrence of tumor or metastasis in any patient.Conclusions:The surgical approach of using the modified vertical rectus abdominis myocutaneous flap to repair the skin and soft tissue defects after abdominoperineal resection for rectal cancer is relatively simple in operation, can achieve good postoperative appearances of the donor and recipient areas with few complications, and is worthy of clinical promotion.

Objective To explore the diagnostic value of MRI signs combined with standard b-value diffusion weighted imaging(DWI)signals in meningioma.Methods A total of 134 patients with meningioma were selected.Using postoperative pathological examination results as the gold standard,the MRI signs,specific intensity of standard b-value DWI signals,apparent diffusion coefficient(ADC)value,and relative apparent diffusion coefficient(rADC)value between the two groups were compared;Receiver operating characteristic(ROC)curve was used to assess the ADC value and rADC value in differential diagnosis of low-grade and high-grade meningiomas.Results The proportions of no/mild peritumoral edema,clear tumor brain interface and tumor cystic changes in low-grade group were higher than high-grade group,and the proportion of lobulation sign was lower than high-grade group(P＜0.05).There was no statistically significant difference in DWI signal intensity between the two groups(P＞0.05).ADC and rADC values in low-grade group were higher than high-grade group(P＜0.05).The area under the curve(AUC)of ADC value,rADC value,and their combined differential diagnosis for low-grade and high-grade meningiomas were 0.765,0.844,and 0.903,respectively.Conclusion The standard b-value DWI signal intensity cannot be used for the diagnosis of meningioma,while MRI signs(peritumoral edema,tumor brain interface,tumor cystic changes,lobulation sign)and ADC value,rADC value have high clinical application value in the diagnosis of meningioma.

Objective:To investigate the clinical effect of repairing postoperative nasal skin cancer defect with subcutaneous pedicle flap based on partition and blood supply.Methods:From March 2018 to September 2020, 39 patients with skin cancer (basal cell carcinoma, Bowen′s disease, squamous cell carcinoma and malignant melanoma in situ) were repaired with kites subcutaneous pedicle flap after extensive resection.Results:Thirty-nine patients were treated with parafasal kite flaps, including 44 cases. The donor sites of the flap were nasal tip in 4 cases, bilateral alar in 7 cases, bilateral nasolabial sulcus in 19 cases, bilateral parasinal in 12 cases and interglabellar in 2 cases. There were no serious complications such as necrosis, hematoma or infection. During the follow-up period of 6 to 24 months, 2 patients complained of occasional tingling in the surgical area, 1 complained of occasional pruritus, and 1 patient had local recurrence of squamous cell carcinoma and underwent surgery again. The scar was evaluated 6 months after surgery, and the scores of Vancouver scar scale and visual analogue scale were 2.42±1.04 and 7.83±1.21, respectively. The skin color of the operation area was similar to that of the surrounding skin without obvious local strain deformation.Conclusions:The subcutaneous pedicle flap designed by considering the nasal division and blood supply has a high survival rate, fewer complications and small local appearance deformation, which is worthy of popularization and application.

Objective:To investigate the effect of activation of microglia in prefrontal cortex on long-term spatial memory in post-stroke depression mice.Methods:Forty-eight male C57BL/6 mice were divided into sham operation group, stroke group, post-stroke depression group and depression group according to the random number table method with 12 in each group, and 36 mice were divided into solvent group, enrofloxacin group and minocycline group according to the random number table method with 12 in each group.Middle cerebral artery occlusion (MCAO) was use to establish the stroke model, and forced swimming was used to establish the depression model.The post-stroke depression model mice were received MCAO first and then received forced swimming on the 4th day after stroke to establish the model.Mice in enrofloxacin group and minocycline group were treated with enrofloxacin and minocycline injection once a clay for 14 days from the 5th day after stroke, respectively.Forced swimming test and sugar water preference test were used to evaluate the depression of mice in each group, Morris water maze test was used to detect the spatial memory function of mice in each group, and Nissl staining and immunofluorescence staining were used to detect the neuronal function and the number and type of microglia activation.The expression of inflammatory cytokines IL-6 and IL-1β were detected by Western blot.GraphPad Prism 8.0.1 statistical software was used for statistical analysis.The single factor variance analysis was used to compare the difference among multiple groups, and pairwise comparison was performed with SNK- q test. Results:(1) There were statistically significant differences in depression, learning and memory, neuron damage, activation of microglia, inflammatory factors and other indicators in sham operation group, stroke group, post-stroke depression group and depression group ( F=43.58-255.70, all P<0.05). Compared with stroke group, post-stroke depression group had longer floating immobility time ((222.70±29.12) s, (79.25±46.78) s, P<0.05), the preference rate of sugar water was significantly lower ( (49.44±6.19) %, (84.49±4.73) %, P<0.05), and the average value of platform approach after correction was higher((125.00±9.95) mm, (96.79±12.57) mm, P<0.05), Nissl bodies expression was lower ((53.50±15.78) cells /mm 2, (85.67±17.52) cells /mm 2, P<0.05), NeuN positive expression rate was lower ((29.78±3.70) %, (45.73±4.51) %, P<0.05), the percent of M1 microglia expression was significantly higher ((75.55±8.84) %, (58.19±5.69) %, P<0.05), the percent of M2 microglia expression was lower ((43.46±5.11)%, (57.14±5.40)%, P<0.05), and the expression levels of IL-6 ((1.14±0.03), (0.94±0.05), P<0.05) and IL-1β((1.17±0.03), (0.56±0.04), P<0.05) were significantly higher.(2) Depression, learning and memory, neuron injury, activation of microglia, inflammatory factors and other indicators of mice in solvent group, enrofloxacin group and minocycline group were significantly different ( F=7.13-94.35, all P<0.05). Compared with enrofloxacin group, mice in minocycline group had shorter floating immobility time ((169.30±13.04) s, (224.30±22.60) s, P<0.05) and higher sugar water preference rate ((62.81±7.75) %, (47.71±8.11) %, P<0.05), the mean value of platform approach estimation after water maze correction was lower ((97.66±14.56) mm, (120.20±12.08) mm, P<0.05), and the expression level of Nissl bodies was higher ((80.17±10.55) cells /mm 2, (52.00±8.94) cells /mm 2, P<0.05), NeuN expression rate was high ((45.04±3.62) %, (28.88±4.50) %, P<0.05), Iba-1 expression was lower ((97.33±10.67) cells/mm 2, (112.50±6.54)cells/mm 2, P<0.05), the percent of M1 microglia expression was lower ((54.43±5.22) %, (73.82±6.88) %, P<0.05), and the percent of M2 microglia expression was significantly higher ((51.86±6.22) %, (36.30±5.72) %, P<0.05). The expression levels of IL-6 ((0.75±0.06), (1.21±0.07), P<0.05) and IL-1β ((0.61±0.06) (1.09±0.09), P<0.05) were lower. Conclusion:The long-term spatial memory impairment of post-stroke depression mice is aggravated, which is related to the neuron damage caused by increased activation of M1 microglia in PFC area.Inhibition of M1 microglia by minocycline can effectively improve the spatial memory ability of mice.

Objective:To evaluate the efficacy and safety of the micro-crosslinked hyaluronic acid injected by Shuiguang Needle Injection in facial rejuvenation.Methods:Thirty-two patients were enrolled. In this split face study, micro-crosslinked hyaluronic acid and non-crosslinked hyaluronic acid were randomly applied in the treated side of the face. Procedure efficacy (judged by VISIA), complication and subjects＇ satisfaction were assessed before treatment, one month, two months and three months after treatment.Results:According to the VISIA, 32 cases were effective one month after treatment on the treatment side, accounting for 100%; 28 cases were effective three months after the end of treatment, accounting for 87.51%. On the control side, 28 cases were effective one month after treatment, accounting for 87.50%, and 7 cases were effective after three months, accounting for 21.88%. There was no statistically significant difference in complications between the left and right sides; 31 patients were satisfied on the treatment side, accounting for 96.88%, and 28 patients on the control side were satisfied, accounting for 87.50%.Conclusions:The micro-crosslinked hyaluronic acid injected by Shuiguang Needle Injection appears to be effective and durable for facial rejuvenation. And it has a low complication rate and high subject satisfaction.

In clinical medicine, patient drainage monitoring and early warning have received extensive attention from the clinical medical community since they reflect the real-time status of patients. Firstly, this study points out the shortcomings of current medical drainage technology combined with actual clinical applications and proposes a detailed analysis of the current medical drainage monitoring technology and medical drainage equipment. Secondly, this study focuses on cloud medical, intelligent medical and other digital intelligent medical development. Combined with advanced artificial intelligence technology and cloud data processing technology, this study is proposed to realize the clinical promotion, and popularization of medical drainage technology and promote the medical industry's attention to the realization of comprehensive and intelligent drainage monitoring.
Artificial Intelligence ; Cloud Computing ; Drainage ; Humans ; Technology

Objective To study the relation between the expression of P130 Crk-associated substrate (P130Cas),phosphatase and tensin homolog (PTEN)and the epithelial-mesenchymal transition (EMT) of skin scar carcinoma.Methods Tissues of skin scar carcinoma,scar and normal skin were collected from 8 patients who were pathologically diagnosed as skin scar carcinoma with high differentiated squamous cell carcinoma.The expression of PTEN,P130Cas,E-cadherin and Vimentin in normal skin,skin scar and skin scar carcinoma tissues were detected by immunohistochemical method of S-P.Results The expression of PTEN,P130Cas and E-cadherin in normal skin,scar and skin scar carcinoma tissues were all significantly different (P ＜ 0.05).The expression of Vimentin in skin scar carcinoma tissues were significantly increased than that in normal skin and skin scar tissues,but there was no statistically significance difference between skin scar tissues and normal skin (P ＞ 0.05).The expression of PTEN in skin scar carcinoma tissues was negatively correlated with P130Cas (r =-0.78,P =0.023) and positively correlated with E-cadherin (r =0.83,P =0.011),but there were no correlation between PTEN and Vimentin (P ＞ 0.05);The expressions of P130Cas in skin scar carcinoma tissues was negatively correlated with Ecadherin (r =-0.74,P =0.035),but there were no statistically significant correlation between P130Cas and Vimentin (P＞0.05).Conclusions Both PTEN and P130Cas involved in the EMT process of skin scar carcinoma and may be an important mechanism in scar carcinogenesis.

Objective To investigate the short-term clinical effect of CT guided 125Ⅰ radioactive particle therapy in superficial malignant tumor. Methods The clinic data of 28 patients with metastatic superficial malignant tumor in our hospital were analyzed retrospectively.All patients were treated with CT guided 125Ⅰ radioactive particle therapy.The short-term effects,1 year survival rate and 1 year progression free survival rate of the patients were compared.Results Objective remission rate(ORR)and disease control rate(DCR)after 6 months were 92.86% and 100.00%.1 year overall survival and 1 year progression free survival were 96.43%(27/28)and 82.14%(23/28), respectively.The median overall survival and median progression free survival were 26.978 months (95%CI:22.558-31.399)and 16.932 months (95 % CI:14 .471-19.393).There were 27 cases of 0-Ⅱ degree adverse reactions,1 case of grade Ⅲ adverse reactions and no grade Ⅳ adverse reactions.No signs of 125Ⅰ radioactive particle translocation,vascular embolism and vascular rupture were found. Conclusion 125Ⅰ radioactive particle treatment of superficial malignant tumor has a definite short-term curative effect,with overall survival and progression free survival longer and higher safety,which can be considered in clinical application.

Objective To explore the influences of proliferation and differentiation of preadipocytes on high fat diet-induced obesity and obesity prevention through exercises in rats.Methods Forty male Sprague-Dawley rats were divided into a normal diet control group (C,n=8),a normal diet with exercises group (E,n=8),a high fat diet control group (H,n=14) and a high fat diet with exercises group (HE,n=10).Group C and group H kept sedentary,while group E and group HE underwent treadmill exercises at about 75％VO2max level.After 12 weeks of intervention,the body weight,epididymal,perirenal and retroperitoneal fat mass were recorded,and the total fat mass was determinated.Stereology method was used to calculate the number and average diameter of fat cells.Western Blotting was conducted to measure the expression of PPARγ and C/EBPα protein in adipose tissues.Results (1) The body weight and total fat mass of group H were significantly higher than those of group C (P＜0.01).Perirenal,retroperitoneal fat and total fat mass of group E and HE were significantly lower than those of group C and H respectively (P＜0.01).(2) The total fat cell number of group H was significantly higher than that of group C.The average diameter of fat cells in perirenal and retroperitoneal fat pads of group E were significantly lower than that of group C (P＜0.05,P＜0.01),while that of group HE in epididymal,perirenal and retroperitoneal fat pads was significantly lower than that of group H (P＜0.01).(3) Compared with group C,the expression of PPARγ protein of group E and H increased significantly in epididymal,perirenal and retroperitoneal fat pads (P＜0.01).The expression of C/EBPα protein of group H was significantly higher than that of group C in epididymal and perirenal fat pads (P＜0.01),the expression of C/EBPα protein of group E was significantly higher than that of group C in perirenal and retroperitoneal fat pads (P＜0.01),while the expression of C/EBPα protein of group HE was significantly lower than that of group H in perirenal fat pads(P＜0.01).Conclusion The proliferation and differentiation of preadipocyte was enhanced in the development of high fat diet induced obesity and exercises to prevent obesity,but its role and mechanisms were different.The high fat diet increases the number of fat cells which is a compensatory mechanism for the body to adapt to fat accumulation,while exercises might promote cell renewal and decrease the average size of fat cells which is an adaptive mechanism to improve fat storage.

BACKGROUND:Arteriovenous internal fistula is the first choice for hemodialysis. In the process of hemodialysis, many patients suffer from venous outflow stenosis. The methods including thrombolysis, intervention, surgical repair and fistula reconstruction al have their disadvantages. OBJECTIVE:To compare the midterm effects of polytetrafluoroethylene segment implantation and exclusively surgical repair in arteriovenous internal fistula with outflow tract obstruction. METHODS:Eighty patients with venous outflow stenosis, aged 22-80 years, were divided into test group (n=50;polytetrafluoroethylene segment implantation) and control group (n=30;simple surgical repair). The post-operative infection rate, postoperative time til recurrence of fistula dysfunction, and accumulate survival rate were compared between the two groups. RESULTS AND CONCLUSION:During the fol ow-up period of 10-28 months in the test group, there were nine patients with vascular access dysfunction, and the accumulate survival rate was 100%for 6 postoperative months, 92%for 12 months, and 82%for 18 months. In the control group, there were seven cases of vascular access dysfunction at 8-28 months of fol ow-up, and the accumulate survival rate was 93%for 6 postoperative months, 87%for 12 months, and 77%for 18 months. No statistical y significant difference in the postoperative infection rate was observed between the two groups. The Kaplan-Meier survival curves showed that the accumulate survival rate was slightly higher in the test group than the control group, but there was no significant difference based on log-rank test (P=0.44). These findings indicate that polytetrafluoroethylene segment implantation for arteriovenous internal fistula with outflow tract obstruction has the similar effects as the surgical repair if it does not alter the autologous behavior of the initial access and maximal y reserve the vessels for puncture.