Objective:To explore the clinical effect of a self-designed wound measurement grid on the design of lobulated perforator flap.Methods:From January 2019 to December 2022, soft tissue defects in limbs of 9 patients were reconstructed by lobulated perforator flaps in the Department of Orthopaedics and Traumatology of Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine. The patients were 7 males and 2 females aged 21-55 years old with 40.3 years old in average. There were 6 upper limb defects and 3 lower limb defects. Self-designed wound measuring grids were applied to guide the design and excision of lobulated perforator flaps during surgery. Five patients were treated by lobulated perforator flap pedicled with the descending branch of lateral circumflex femoral artery and 4 by perforator flaps pedicled with dorsal interosseous artery. The areas of soft tissue defect were 4.0 cm×1.5 cm-26.0 cm×8.0 cm, and the sizes of the flaps were 4.5 cm×1.8 cm-22.0 cm×10.0 cm. After surgery, the blood supply of flaps, flap survival and wound healing were monitored. Flap survival, donor site recovery and limb function were observed at outpatient clinic over the postoperative follow-up, and the limb function was evaluated by the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and Lower Extremity Measure(LEM).Results:In this study, a total of 17 of 18 lobes of the lobulated perforator flaps survived after surgery. One flap had venous occlusion and after exploration and further treatment, a necrosis occurred in 1 lobe of the lobulated flap and then a free flap transfer was performed again. All the wounds achieved stage-I healing. Postoperative follow-up lasted for 3-18 months with 8.6 months in average. All flaps had good colour and texture, satisfactory appearance and only linear scars remained in the donor sites, without pain and scar contracture. The reconstructed upper extremity defect were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 4 patients were in excellent and 2 in good. The reconstructed lower extremity defects were evaluated according to the LEM, and 2 patients were in excellent and 1 in good.Conclusion:The self-designed wound measurement grid was successfully applied in the design of lobed perforator flaps. It can accurately measure a wound surface and quickly extract a wound profile, and it is more convenient and intuitive to guide the design of flaps. It has a good effect in clinical application and further clinical trials are required.

Objective To study the quality standard of Gardenia jasminoides and its effective parts. Methods TLC was used to identify Gardenia jasminoides and its effective parts. The heavy metals, harmful elements, and moisture in Gardenia jasminoides and its effective parts were examined. The content of Gardenia jasminoides and its effective parts was determined by high performance liquid chromatography. Results TLC method could be used to identify Gardenia jasminoides and its effective parts. The moisture content of Gardenia jasminoides and its effective parts were 8.4% and 3.2%, respectively. ICP-MS was used to determine the contents of five elements in Gardenia jasminoides and its effective parts simultaneously. There was a good linear relationship between arsenic, cadmium, copper, mercury, and lead in the range of 0~20, 0~10, 0~500, 0~5 and 0~20 ng/ml, respectively; The method detection limit of each metal element was 3.3×10⁻⁵~1.3×10⁻³ mg/kg. The relative standard deviation (RSD) of precision was 0.32%~0.82%. RSD values of each element content showed that the method had good repeatability. And the recoveries of arsenic, cadmium, copper, mercury, and lead were 103%~112%, 98%~99%, 98%~99%, 105%~106% and 100%~103%, respectively (n=3). The stability of each element was good within 8 h. The contents of the five elements were within the limits of the current edition of Chinese Pharmacopoeia. The standard curve equation of gardenia was Y=15860X+22543, r=0.9999, indicating that there was a good linear relationship of gardenia in the range of 20.16~322.6 μg/ml. The RSD of precision was 1.86%. RSD of the two samples were 2.38% and 2.60%, respectively, indicated that the method had good repeatability. The average recovery of Gardenia was 99.1% (n=6). The stability of the two solutions was good within 8 h. The contents of gardenia and its effective parts were 5.71% and 34.2%, respectively. Conclusion The research on the quality of Gardenia jasminoides effective parts was carried out based on the research on the quality of Gardenia jasminoides, and the results met the requirements. Therefore, the method established in this experiment could control the quality of Gardenia jasminoides and its effective parts simultaneously.

Objective:To investigate the relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease (CSVD).Methods:One hundred and fifty-six patients with CSVD who were admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University or the Public People′s Hospital of Xinzheng from January 2020 to May 2022 were selected, and their brain artery remodeling (BAR) score was calculated. The patients with BAR score≤-1 standard deviation (SD) were defined as individuals with constrictive remodeling of intracranial arteries, and the patients with BAR score≥1 SD were defined as individuals with dilated remodeling of intracranial arteries. Imaging markers of CSVD [white matter hyperintensities (WMHs), lacune, cerebral microbleeds, enlarged perivascular spaces, and cerebral atrophy] were quantified, total CSVD load was calculated and patients were divided into low load group (0-2 points, n=91) and high load group (3-4 points, n=65) according to the total CSVD load scores. The correlation between intracranial artery remodeling and various imaging markers of CSVD and total load was analyzed by using univariate analysis and binary Logistic regression analysis. A nomogram prediction model was established and a receiver operating characteristic curve (ROC) was drawn to assess the predictive value of intracranial artery remodeling on high total CSVD load. Results:Dilated intracranial arterial remodeling was an independent influence factor on severe WMHs ( OR=3.66, 95% CI 1.38-9.72, P=0.009), lacune ( OR=3.78, 95% CI 1.17-12.19, P=0.026), cerebral atrophy ( OR=3.11, 95% CI=1.10-8.81, P=0.033), and high total CSVD load ( OR=6.66, 95% CI=2.14-20.77, P=0.001). Age was an independent influencing factor for high total CSVD load ( OR=1.12, 95% CI 1.07-1.16, P<0.01). A nomogram prediction model for high total CSVD load with age and BAR score≥1 SD as dependent variables had a good effect (C-index=0.826) and calibration ( P=0.024). The best cut-off point of ROC curve was 0.50, with an area under the curve of 0.83 (95% CI 0.76-0.89, P<0.01), the sensitivity and specificity of 0.72 and 0.82. Conclusions:Patients with dilated intracranial arterial remodeling may have a heavier CSVD load. Dilated intracranial arterial remodeling may serve as a new biomarker for assessing CSVD, but the mechanism of the association needs further study.

Abstract OBJECTIVE To develop LC-MS method for the simultaneous determination of impurities A, C, and D of caspofungin acetate. METHODS Waters CORTECS® C18+(4.6 mm×150 mm, 2.7 μm) was used as the chromatography column. Mobile phase A and B were 0.1% formic acid-H2O and 0.1% formic acid-CH3CN, respectively. Electrospray ion source-single quadrupole mass spectrometry was used to detect impurities A and C in positive ion mode and impurity D in negative ion mode. RESULTS The correlation coefficient r was ≥ 0.999 in linearity ranges of impurities A, C and D. The average recoveries were 100.5%, 104.1% and 105.2%, respectively, with RSD<4%(n=6). The LOQs (S/N=10) of impurities A, C and D were 31.8, 6.99 and 15.5 ng·mL-1 respectively. The contents of impurities A, C and D in the three samples were all below the limits. CONCLUSION The developed LC-MS method is simple, sensitive, and applicable, which can be used to simultaneously determine impurities A, C and D in caspofungin acetate and can also provide a reference for the detection of other impurities in caspofungin acetate.

OBJECTIVE To analyze caspofungin acetate and the samples under different strong degradation conditions by LC-QTOF-MS, and to study the characteristics in mass spectra of caspofungin and its related impurities(impurities A, B, C, D and E). METHODS Chromatographic separation was accomplished on Waters CORTECS® C18+(4.6 mm×150 mm, 2.7 μm) column using a gradient elution with monile phase of 0.1% formic acid-H2O(A) and 0.1% formic acid-CH3CN(B) at a flow velocity of 0.6 mL·min-1; The analytes was detected in positive ion scan mode by ESI-QTOF-MS. RESULTS In MS1 spectra, except that impurity D mainly showed single-charge quasi-molecular ion, caspofungin and the other four impurities showed muti-charge quasi-molecular ions with high abundance; In MS2 spectra, caspofungin and its impurities that containing ethylenediamine generated fragment ions at m/z 1 033 by losing the ethylenediamine and the groups attached to it; caspofungin and its impurities produced a series of fragment ions mainly through the cleavage of peptide bonds, as well as through the loss of hydroxyl, acyl, or amino groups from amino acid residues; Impurity A and C showed characteristic fragment ions m/z 137.070 8 and m/z 77.071 1 with high abundance, respectively, which could be used to distinguish them from caspofungin and the other impurities. CONCLUSION Caspofungin and its five impurities have distict characteristics in their mass spectra. The research results can provide reference for identifying the structures of unknown impurities that may occur in the production process of caspofungin, so as to quickly discover the potential problems in the production process and reduce the quality risk of the products.

Objective:To investigate the clinical effect of Flow-through perforator flap of posterior interosseous artery in repair of dorsal digital soft tissue defect with disorder of blood supply in digital tip.Methods:From January 2018 to June 2020, 12 patients who had digital dorsum soft tissue defect with digital tip blood supply disorder were treated with Flow-through perforator flap of posterior interosseous artery. The size of flaps was 2.0 cm× 2.0 cm-5.5 cm×3.0 cm. The posterior interosseous artery in the flap was bridged with the proper palmar artery of digit, 1 subcutaneous vein in the flap was anastomosed with the dorsal subcutaneous vein, and 1 subcutaneous vein in the posterior interosseous artery with the palmar subcutaneous vein. The donor sites were sutured directly. The wound healing, blood supply of digit and flap survival were observed after operation. The quality of flap survival and digital joint function were observed in the follow-up reviews at outpatient clinic.Results:All the 12 Flow-through perforator flaps of posterior interosseous artery survived, the blood supply of digit was good, and the wounds healed in the first stage. The follow-up period was 6-24 months. The appearance and texture of the flaps were good without obvious bloating. Only linear scar was left in the forearm donor site. According to the Trial Standard of Upper Limb Function Evaluation of Chinese Society of Hand Surgery, the results were excellent in 11 cases and good in 1 case.Conclusion:The perforator flap of posterior interosseous artery has constant anatomy, and the diameter of blood vessel matches the blood vessels of digits. It is suitable for Flow-through technique. It has less subcutaneous tissue, no secondary thinning, and the donor site can be closed directly. It is a good method to repair the dorsal soft tissue defect with disorder of digital end blood circulation.

Objective:To analyze the medication rule of treating orthopedics in Tibetan Medicine by data mining, in order to summarize the characteristics and theory of ethnic minorities medicine for treating orthopedics and traumatology.Methods:By collecting the treatment methods of orthopedics and traumatologic diseases in books of Chinese Materia Medica·Tibetan Medicine Volume and Chinese Medical Encyclopedia·Tibetan Medicine to analyze the frequency, cluster and association rules of Tibetan Medicines by using Office Excel 2019, IBM SPSS Statistics 26.0 and IBM SPSS modeler 14.1 respectively. Results:Among the 202 Tibetan Medicine prescriptions of Orthopedic Department, 338 belongs to Chinese medicines. The top 3 Chinese medicines that are frequently appeared are Chebulae Fructus, Inula racemosa Hook.f, and Carthami Flos. The properties of those medicines are mainly cold, warm and cool, and the tastes are mainly pungent, bitter and sweet; the meridians mainly belong to liver, lung, stomach and spleen; The priscriptions mainly cover four kinds of diseases: trauma, arthralgia syndrome, lumbosacral tendon injury, chest and back tendon injury. The four kinds of cluster combinations were obtained. The core Chinese medicines were Chebulae Fructus, Terminaliae Belliricae Fructus, Phyllanthi Fructus, Cassiae Semen, Olibanum, Abelmoschus moschatus, and the common medicine pair were Chebulae Fructus- Terminaliae Belliricae Fructus, Abelmoschus moschatus- Cassiae Semen, Olibanum- Abelmoschus moschatus and so on. Conclusions:Tibetan Medicines treat orthopedics and traumatological diseases with antipyretic medicines as the main yellow water, followed by blood activating, Qi regulating and wind dampness removing medicines. With Sanguo Decoction and Sanhuang water of Tibetan medicine as the core, they are often combined with other antipyretic and blood cooling medicines and bone connecting medicines. Tibetan Medicine pays attention to the application of dry yellow water theory, which reflects the role of the core theory of Qingxie method and yellow water theory of Tibetan Medicine in the diagnosis and treatment of orthopedic and traumatologic diseases.

Objective:To investigate the effect and mechanism of histone methyltransferase enhancer of zeste homolog 2 (EZH2) on sepsis-induced T cell dysfunction.Methods:Twenty-four male C57BL/6 mice were divided into three groups randomly: sham operated group, sepsis model group [cecum ligation and puncture (CLP)+dimethyl sulfoxide (DMSO) group] and EZH2 selective inhibitor treated group (CLP+GSK126 group), with 8 mice in each group. Sepsis murine model was reproduced by CLP. CLP+DMSO group and CLP+GSK126 group were treated with DMSO or GSK126 (10 mg/kg) respectively right after surgery through intraperitoneal injection. The mice were sacrificed 24 hours after operation, and the mesenteric lymph nodes were collected. The expression of EZH2, apoptosis rates, cell proliferation marker ki-67 antigen positive T lymphocytes (ki-67 + cell), interferon-γ positive T lymphocytes (IFN-γ + cell), programmed death receptor-1 positive T lymphocytes (PD-1 + cell) and programmed death-ligand 1 positive T lymphocytes (PD-L1 + cell) were determined by flow cytometry. Results:Compared with sham operated group, the expression of EZH2 in T lymphocytes was up-regulated on mesenteric lymph nodes of CLP+DMSO group. Compared with CLP+DMSO group, the ratio of CD3 + T lymphocytes in CLP+GSK126 group was up-regulated (0.70±0.02 vs. 0.50±0.07, P < 0.01), indicating that the EZH2 inhibitor could increase the number of T lymphocytes in lymph nodes of septic mice; the ratio of ki-67 + cells in CD4 + and CD8 + T lymphocytes in CLP+GSK126 group was increased (CD4 +: 0.74±0.05 vs. 0.63±0.04, CD8 +: 0.82±0.06 vs. 0.70±0.04, both P < 0.05), indicating that the EZH2 inhibitor could increase the ratio of T lymphocytes with high proliferative activity in lymph nodes of septic mice. However, no significant difference was found on both CD4 + and CD8 + T lymphocytes apoptosis rates in the mesenteric lymph nodes of mice between CLP+GSK126 group and CLP+DMSO group [CD4 +: (21.53±2.87)% vs. (20.48±3.21)%, CD8 +: (8.34±1.02)% vs. (7.71±1.38)%, both P > 0.05], indicating that no extra T lymphocytes apoptosis was induced by EZH2 inhibitor. Compared with CLP+DMSO group, the ratios of IFN-γ + CD4 + and IFN-γ + CD8 + T lymphocytes were increased in CLP+GSK126 group (IFN-γ +CD4 +: 0.31±0.11 vs. 0.14±0.06, IFN-γ +CD8 +: 0.30±0.10 vs. 0.13±0.06, both P < 0.05), suggesting that secretion of IFN-γ in lymph nodes by sepsis T lymphocytes was augmented after EZH2 inhibitor administration. Furthermore, compared with CLP+DMSO group, the ratio of PD-1 + cell in CD8 + T lymphocyte was down-regulated in CLP+GSK126 group (0.092±0.006 vs. 0.135±0.004, P < 0.01), suggesting that EZH2 inhibitor restrained the PD-1 expression on sepsis lymphoid node CD8 + T lymphocytes, however, it had no significant effect on PD-L1 + cells. Conclusion:EZH2, regulates sepsis-induced T lymphocyte dysfunction, possibly through modulating the expression of PD-1.

Objective:To investigate the application of self-designed wound measuring grid in the measurement of wound and the design of perforator flap.Methods:From February 2018 to February 2020, 31 cases of soft tissue defects of limbs were repaired by free transfer of perforator flap. During the operation, the self-designed membrane with measurement grid was used to measure the wound surface. The flaps were designed and harvested according to the accurate measurement of the wound. The flaps were reviewed at hospital clinic during follow-up.Results:All patients entered 3-15 months of follow-up with an average of 8 months. All 31 flaps survived, of which 2 flaps encountered vascular crisis and were rescued after surgical exploration. There was no infection of flaps and all flaps had stage I healing. The flaps were satisfactory in appearance with the sensation recovery to S 2 in 21 cases and S 3 in 10 cases. Only linear scars were left on the donor sites. Conclusion:The membrane with a measurement grid can accurately measure a wound, and help the design of the flap according to the measured size and profile of the wound. It can reduce the operation time and the risk as well as to improve the operation efficiency. The clinical application is satisfactory. Large scale and multi-centre studies are required to further prove the benefit of the measurement grid.

Diabetic kidney diseases （DKD） is one of the main microvascular complications of diabetes. According to the available studies， the initial factor of DKD is glomerular injury. However， in recent years， more and more studies have confirmed that renal tubular injury plays a key role in the development of DKD. Taking renal tubules and their interstitium as therapeutic targets has become a new idea for the treatment of DKD. Traditional Chinese medicine （TCM） can treat renal tubular injury in DKD via multiple pathways， targets， and links， demonstrating significant therapeutic effect and slight side effects. According to the etiology and pathogenesis of DKD， doctors differentiate different syndromes such as deficiency of both Qi and Yin， deficiency of spleen and kidney Yang， and Qi deficiency and blood stasis and then adopt the therapies of nourishing kidney and strengthening essence， clearing heat and eliminating dampness， tonifying Qi and nourishing yin and so on， which have shown significant effect in the treatment of renal tubular injury in DKD. This paper summarizes the experimental studies about the treatment of renal tubular injury in DKD by TCM compound prescriptions， as well as the effective parts， extracts， and active ingredient of Chinese herbal medicines. Chinese herbal medicines and their derivates can regulate Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB）， nuclear factor erythroid 2-related factor 2 （Nrf2）/antioxidant response element （ARE）， transforming growth factor-β₁ （TGF-β₁）/Smads and other signaling pathways to treat renal tubular injury from resisting oxidative stress， inhibiting apoptosis of renal tubular epithelial cells， and blocking renal tubular epithelial-mesenchymal transformation. With this review， we hope to provide a theoretical basis for the development and clinical application of new drugs for renal tubular injury in DKD.