Objective:To explore the clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers (DFUs) under a multi-disciplinary team (MDT) cooperation model.Methods:The study was a retrospective observational study. From June 2018 to December 2022, 49 DFU patients who met the inclusion criteria were admitted to the Department of Hand and Foot Microscopy and Wound Repair Surgery of Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), including 28 males and 21 females, aged from 47 to 68 years, with type 2 diabetes history period ranging from 6 months to 21 years. Under a MDT cooperation model, the physicians from department of endocrinology comprehensively assessed the patients, stabilized the patients' general condition, and controlled their complications, the surgeons from department of vascular surgery assessed and improved the patients' lower limb blood supply, the physicians from department of infectious diseases provided anti-infection treatment plans, the physicians from department of anesthesiology and perioperative medicine assessed the patients' perioperative risk and ensured their perioperative safety, and according to the patients' condition, the physicians from departments such as cardiology, neurology, nutrition, and rehabilitation actively and timely participated in the treatment. The surgeons from department of hand and foot microscopy and wound repair surgery prepared the wound base and used free anterolateral thigh perforator flaps to repair the wounds. After once or multiple debridement in the first stage, the wound area ranged from 5.0 cm×4.5 cm to 17.0 cm×10.0 cm. After once or twice vacuum sealing drainage treatment, the free anterolateral thigh perforator flaps were used to repair the wounds with incision area of 6 cm×5 cm to 18 cm×11 cm in the second stage. The descending branches of lateral circumflex femoral artery and the accompanying veins of flaps were anastomosed to the arteries and veins in the recipient sites, respectively. The wounds in the flap donor sites were sutured directly. After surgery, whether the patient's perioperative period was stable, the survival of flaps, the healing of wounds in the flap donor and recipient sites were observed. During the follow-up, the texture and appearance of flaps, whether there was a new ulcer, and the patient's walking ability were observed.Results:All the patients had stable perioperative period. Among them, the flaps in 46 patients survived successfully; the flaps in 2 patients developed complete necrosis, including 1 case whose ulcer was healed after repair of pedicled flap from the lower leg, and 1 case who underwent amputation of the lower leg; the flap in 1 patient developed partial necrosis, which was healed after dressing change and skin grafting. The wounds in the flap donor and recipient sites healed well. During the postoperative follow-up of 6-24 months, the flaps had good texture and appearance with no new ulcers, and the patients had no obvious impairment in daily walk.Conclusions:The MDT cooperation model can sufficiently ensure the perioperative safety of DFU patients. The free anterolateral thigh perforator flaps can repair the DFU wounds achieving good clinical effects with high flap survival rate and decreased amputation rate.

Objective:To investigate the clinical effect of free anterolateral thigh perforator flap(ALTPF) in reconstruction of temporal scalp defect after blood circulation reconstruction surgery for moyamoya disease.Methods:From May 2020 to July 2022, 7 patients with scalp defect after revascularisation of moyamoya disease were treated in Department of Hand and Foot Microsurgery, Henan Provincial People’s Hospital (People’s Hospital of Zhengzhou University). The patients were 4 males and 3 females, aged 33-59 years old, at 43 years old in average. There were 5 defects in left tempus and 2 in right tempus. The sizes of scalp defect were 4.5 cm × 5.5 cm-7.5 cm × 9.5 cm. Debridement and VSD management were primarily performed. After wounds were stabilised, ultrasound location of perforator vessels of ALTPFs was performed. Having confirmed that the perforator vessels were suitable for the surgical requirements, flap transfers were then performed. The descending branch of the lateral femoral circumflex artery was end-to-side anastomosed with the superficial temporal artery, and the descending branch of the lateral femoral circumflex vein was end-to-end anastomosed with the superficial temporal vein. Postoperative follow-up was conducted through outpatient clinic visits, telephone and WeChat reviews. Appearance, texture of ALTPFs and the flap donor sites were observed in follow-ups. Comparisons of the changes of nervous system before and after surgery were made. Cognitive function of the patients was assessed with the Mini Mental State Examination (MMSE), together with the Activities of Daily Living (ADL) .Results:All 7 flaps survived. One flap had vascular compromise 6 hours after surgery, and was rectified after surgical intervention. All the patients were included in the postoperative follow-up for 7-33 (average 19) months. All flaps had good appearance with soft texture. There was no obvious difference in colour comparing with the skin around the recipient region. The donor sites healed well without hypertrophic scar. Examinations of nervous system of the patients were found the same as that before surgery. Using Manual Muscle Testing (MMT), the average limb muscle strength of the patients was 4 before surgery and 4 after surgery, without change; Using the Ashworth assessment scale, the average preoperative and postoperative limb muscle tension in this group of patients was 1, without change; The Berg balance scale was used to evaluate the patient's balance function, with an average score of 42 before surgery and 42 after surgery, without any changes; There was no change in limb sensation before and after surgery; Using the MMSE, the average preoperative score and postoperative score of this group of patients were 25 points, without any change. Using the modified Barthel index scoring standard, the average preoperative score for this group of patients was 75 points, and the average postoperative score was 79 points, and the ADL of the patient had improved to various levels.Conclusion:Reconstruction of scalp defect with free ALTPF after revascularisation of moyamoya disease has obvious advantages, such as it closes the wound quickly, prevents infection and achieves a good appearance. This surgical procedure can produce a good clinical effect.

Objective:To investigate the surgical method and clinical effect of one-stage repair of soft tissue defects of dorsum of hand and multiple fingers by using the polyfoliate conjoined anterolateral thigh perforator flap (ALTP) .Methods:From November, 2015 to September, 2019, 9 cases of soft tissue defects of dorsum of hand and multiple fingers were treated, including 8 males and 1 female. The average age was 32 years old. Causes of injury: 4 cases of thermal injury, 3 cases of strangulation injury, and 2 cases of traffic accident injury. Location of injury: 7 cases of right hand, 2 cases of left hand. Three cases of dorsum of hand with 1st-4th fingers, 3 cases with 2nd-5th fingers, 2 cases with 2nd-4th fingers, and 1 case with 3rd-5th fingers; All with bone, joint and tendon exposure. There were 6 cases with fracture or joint dislocation. All of them had no obvious defect of bone and joint. VSD was used to cover them after debridement. According to the shape and size of the wound, all flaps were designed to repair the soft tissue defect as the polyfoliate conjoined ALTP. The flap size was 7 cm×13 cm-12 cm×17 cm. Regular outpatient, telephone and Wechat follow-up were carried out to evaluate the flap survival, appearance, color elasticity, donor scar, sensory recovery, finger function recovery and patient satisfaction.Results:Nine cases of flap survived well. The average followed-up time was 12 (6-18) months. The postoperative followed-up revealed satisfactory shapes of the flaps, protective touch and recovery of functions. The donor site had good healing and no effect on function. In the last followed-up, according to the trial criteria for function evaluation of upper limbs by Chinese Society of Hand Surgery, 5 cases were excellent, 3 cases were good, and 1 case was fair. The hand function recovered well and returned to work and daily life on average 6 weeks after operation.Conclusion:The polyfoliate conjoined ALTP can repair the soft tissue defect of hand dorsum with multiple fingers at one stage, and the flap is in good shape. There is no need to divide the fingers. It is one of the ideal methods to repair the soft tissue defect of hand dorsum.

Objective:To study the survival outcomes in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) treated with sorafenib combined with transcatheter arterial chemoembolization (TACE) versus sorafenib alone.Methods:The data of 92 patients with BCLC stage C HCC at Tianjin Medical University Cancer Institute& Hospital from January 2008 to December 2015 were retrospectively studied. There were 82 males and 10 females. The average age was 56.3 years. Classified according to whether there were vascular invasion and/or distant metastasis, patients were divided into the vascular invasion group ( n=24), the metastasis group ( n=48), and the vascular invasion combined with metastasis group ( n=20). All patients were treated with sorafenib, but some patients received combined treatment with TACE. The survival data of these patients on follow-up was collected. The Kaplan-Meier method was used for survival analysis, and the survival rates were compared by the log-rank test. Univariate and multivariate Cox analyses were used to determine the prognostic factors of patients’ survival. Results:There were no significant differences in the baseline clinical data among the three groups (all P>0.05). Multivariate Cox regression analysis showed that pre-treatment alpha fetal protein >20 μg/L ( HR=1.90, 95% CI: 1.13-3.12), alkaline phosphatase >125 U/L ( HR=1.60, 95% CI: 1.03-2.49) and sorafenib alone ( HR=2.11, 95% CI: 1.23-3.54) were independent risk factors of survival for these patients. There were no significant differences in the cumulative survival rates among the three groups ( P>0.05). In the vascular invasion group, the cumulative survival rates of patients treated with combined sorafenib and TACE ( n=4) were significantly higher than those treated with sorafenib alone ( n=20) ( P<0.05). Conclusion:Compared with sorafenib alone, sorafenib combined with TACE resulted in better prognosis for patients with BCLC stage C HCC. Subgroup analysis showed that patients with vascular invasion had significantly better survival treated with combined sorafenib and TACE than sorafenib alone.

Objective To compare the efficacy of radiofrequency ablation versus surgical resection in treatment of colorectal liver metastases with a maximum diameter ≤ 3 cm and a number ≤ 3, and to analyze the risk factors of recurrence. Methods The data of 97 patients with colorectal liver metastases from January 2012 to June 2016 treated at Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. There were 66 males and 31 females. The patients were divided into the radiofre-quency ablation group (23 patients) and the surgical resection group ( 74 patients). The patients were followed up. The clinicopathological features of the two groups before treatment were compared. Kaplan-Meier curves were drawn, and the recurrence-free survival curve and overall survival curve of the two groups were compared by log-rank test. Univariate and multivariate Cox regression analysis was used to analyze the risk factors of recurrence. Results There were no significant differences in age, location of primary tumor, number and size of liver metastases, and preoperative carcinoembryonic antigen level between the two groups (P＞0. 05). On the date this study was censored, there were 50 patients who had developed recurrence in the surgical resection group and 22 patients in the ablation group, (67. 6% vs. 95. 7% ). The difference was significant (P＜0. 05). The 1-and 2-year recurrence-free survival rates were 54. 6% and 39. 0% in the surgical resection group and 39. 1% and 8. 7% in the radiofrequency ablation group, respectively. The difference was significant (P＜0. 05). There was no local recurrence in either of the two groups. There was no significant difference in the overall survival curves between the two groups (P＞0. 05). Univariate and multivariate analysis showed that N 1 ～2 staging (HR=1. 908, 95% CI: 1. 094～3. 325), simultaneous liver metastasis (HR=1. 662, 95% CI: 1. 024～2. 695) and radiofrequency ablation (HR=2. 708, 95% CI: 1. 589～4. 617) were independent risk factors of recurrence for colorectal liver metastasis. Conclusions Radiofrequency ablation can achieve complete ablation in patients with colorectal liver metastases with maximum diameter ≤3 cm and number≤3, but the recurrence rate of radiofrequency ablation is significantly higher than that of surgical resection. N 1 ～2 staging, simultaneous liver metastasis and radiofrequency ablation were independent risk factors for recurrence of colorectal liver metastasis.

Objective To explore the clinical safety of peroral endoscopic cardial constriction for gastro-esophageal reflux.Methods Clinical data of 47 patients with gastro-esophageal reflux who underwent peroral endoscopic cardial constriction in Chinese PLA General Hospital were retrospectively studied from August 2013 to August 2016.Results A total of 47 patients underwent peroral endoscopic cardial constriction successfully with no perforation or fever.Retrostemal vague pain and discomfort occurred in 7 cases,mild dysphagia occurred in 2 cases,and mild hemoptysis occurred in one patient the day after the operation.No special measures were taken and all 10 patients showed symptom remission in less than two days.As for the postoperative treatment,22 (46.8％) patients were given a liquid diet on the day of operation,39(82.9％) patients were given semi-or liquid diet on the first day after the operation,and two days later,43 (91.5％) resumed semi-or liquid diet.Only 9 cases were given antibiotics for prophylaxis for infection.Conclusion Peroral endoscopic cardial constriction is safe and effective for gastro-esophageal reflux.The hospitalizing time is short and postoperative recovery is quick.

Objective To detect the effect ofXuebijing injection on the serum soluble CD40 ligand (soluble CD40 ligand, sCD40L), lipoprotein associated phospholipase A2 (lipoprotein-phospholipase A2, Lp-PLA2) of patients with acute coronary syndrome (ACS).Methods A total of 120 patients with ACS were randomized divided into the control group and treatment group, 60 in each group.The control group received the routine treatment of Western medicine, and the treatment group receivedXuebijing injectionbased on the intervention of control group. Both groups were treated for 2 weeks. ELISA method was used to detect serum sCD40L, Lp-PLA and IL-6, TNF-α and CRP.Results After treatment, the serum sCD40L(320.62 ± 35.81 pg/Lvs. 401.70 ± 4.84 pg/L, t=10.435), Lp-PLA2 (203.62 ± 33.13μg/L vs. 296.45 ± 4.422μg/L,t=12.831) level was significantly lower than those in the control group (P<0.01); The serum CRP (3.10 ± 2.00 mg/Lvs.4.74 ± 2.04 mg/L,t=4.006), IL-6 (2.10 ± 1.20 pg/Lvs.3.14 ± 1.40 pg/L,t=3.781), TNF (2.81 ± 1.50 pg/Lvs. 3.70 ± 1.70 pg/L,t=3.075) level was significantly lower than thosein the control group (P<0.01 orP<0.05). Compared with the control group, the effect rate (68.3%vs. 50.0%,χ2=4.174) of the treatment group was significantly higher (P=0.041).ConclusionXuebijing injection can improve the therapeutic effectof ACS patients, and reduce CD40L, Lp-PLA2 levels.

Objective To evaluate the curative effect ofXuebijing injection combined with routine western medicine therapy in the treatment of hypertensive renal damage.Methods A total of 114 patients with hypertension were randomly divided into 2 groups according to the random number table method, 57 patients in each group. The control group was given conventional treatment (maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium), and the treatment group were givenXuebijing injection based on the conventional treatment. The two groups were treated for 6 months. The changes of blood pressure, renal function and serum inflammatory cytokine levels were evaluated.Results After treatment, the mean value of 24 h systolic blood pressure, mean value of 24 h diastolic blood pressure, systolic blood pressure variability and diastolic blood pressure variability in the treatment group were significantly lower than those in the control group (2 months after treatment:t values were 5.256, 5.595, 5.265, 2.564,P<0.05; 6 months after treatment:t values were 6.251, 5.267, 4.466, 5.264,P<0.05); the urinary mAlb, beta 2-MG, and urine albumin to creatinine ratio in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 5.566, 5.282, 2.862,P<0.05; 6 months after treatment:t value were 5.263, 6.565, 3.642,P<0.05);two plasma D-dimer, IL-6, TNF-α and fibrinogen levels in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 3.565, 5.652, 3.985, 5.251,P<0.05; 6 months after treatment:t value were 5.268, 4.836, 3.622, 4.265,P<0.05).ConclusionsXuebijing injection combined with routine western medicine therapy on hypertensive renal damage may have protective effect, and its curative effect was superior to simple maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium therapy.

ObjectiveTo investigate the current status of malnutrition and its association with prognosis in hospitalized patients with decompensated liver cirrhosis. MethodsA total of 101 patients with decompensated liver cirrhosis who were treated in our department from January 2013 to December 2014 were enrolled, and according to the Nutritional Risk Screening 2002, they were divided into malnutrition risk group and non-malnutrition risk group. Serum nutritional indices, anthropometric parameters, body composition, and the incidence rates of complications and fatality within 6 months were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the non-malnutrition risk group, the malnutrition risk group had significantly lower serum levels of albumin, total cholesterol, triglyceride, and hemoglobin, body mass index, arm muscle circumference, triceps skinfold thickness, and grip strength (t=12.562, 5.967, 4.024, 14775, 4607, 7.182, 7.424, and 2.256, all P＜0.05). Compared with the non-malnutrition risk group, the malnutrition risk group had significantly lower intracellular water, total body water (TBW), protein, fat, and skeletal muscle content (t=2920, 6152, 1713, 2444, and 1.693, all P＜0.05), as well as a significantly higher extracellular water/TBW ratio (t=1.998, P＜005). Compared with the non-malnutrition risk group, the malnutrition risk group had significantly higher incidence rates of gastrointestinal bleeding, hepatic encephalopathy, portal vein thrombosis, and electrolyte disturbance and fatality (χ2=6.410, 4.436, 3.978, 4316, and 7.285, all P＜0.05). ConclusionPatients with decompensated liver cirrhosis and malnutrition have significantly increased incidence rates of complications and fatality, and it is necessary to enhance nutrition screening in the early stage of liver cirrhosis.

Cancer related anemia( CRA)is one of the ancer complications. The incidence rate of CRA is more than 70% in patients after receiving chemotherapy,radiation therapy,or both. CRA has severe clinical symptoms which significantly attenuate effectiveness of cancer treatment and the quality of patients' life. The current treatments for CRA,such as transfusion,recombinant EPO therapy,iron supplement and so on,could correct CRA in some sense. However,the present accepted therapeutic approaches could not be satisfied since there are complexity and diversity factors accounting for CRA. More effective and safety treatments of CRA are required in the near future.