Objective:To explore the clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma (CSCC).Methods:This study was a retrospective observational study. From July 2015 to July 2022, 21 patients with CSCC were treated in the Department of Burns and Plastic Surgery of Guizhou Provincial People's Hospital, including 15 males and 6 females, aged from 27 to 74 years. The area of skin and soft tissue defects after extended resection of CSCC was 7.5 cm×4.0 cm to 23.0 cm×8.5 cm. The wounds in 18 patients were repaired with anterolateral femoral perforator flaps; variations of perforating branch of the descending branch of lateral circumflex femoral artery were observed in 3 patients during the operation, and the wounds were repaired with anteromedial femoral perforator flaps. The flap areas were 8.0 cm×5.0 cm to 25.0 cm×10.0 cm. The wounds in the donor areas were sutured directly in 19 patients, and the wounds in the donor areas were repaired with thin and medium-thickness skin grafts in the contralateral thigh in 2 patients. The postoperative survival of flaps and the occurrence of vascular crisis were observed. The length of operation and the hospitalization day were recorded. The recurrence of tumor, the appearances of the donor and recipient areas of flaps, the function of the flap donor area were followed up. At the last follow-up, the satisfaction degree of patients for the curative effects was evaluated.Results:The flaps survived in 20 patients, while the vascular crisis occurred in 1 patient within 48 hours after operation, and the flap survived after immediate emergency operation. The length of operation was 4 to 5 hours, and the hospitalization day was 15 to 38 days. The patients were followed up for 1 to 6 years after operation, there was no local tumor recurrence, the color and texture of the flaps were with no obvious differences to those of the surrounding tissue, and the elasticity and appearance were good. The skin grafts in the flap donor areas of 2 patients survived well with local pigmentation. There was only linear scar in the flap donor areas of all patients, and there were no significant effects on sensory and motor functions. At the last follow-up, fifteen patients were satisfied with the curative effect, and 6 patients were generally satisfied with the curative effect.Conclusions:For skin and soft tissue defects after CSCC resection, the anterolateral femoral perforator flaps can be used preferentially. In the case of variation of the perforating branch of descending branch of the lateral circumflex femoral artery, the anteromedial femoral perforator flap is selected. The areas of the two flaps are large and can be adjusted according to the amount of defect tissue, thus accurately and effectively repairing skin and soft tissue defects after CSCC resection. The postoperative appearance and function are good.

The incidence of metabolic rheumatism gout has been increasing with a trend of more younger patients and atypical symptoms. Typical gout is easy to be diagnosed, but it is difficult for atypical cases. Finding uric acid crystal in articular fluid by polarizing light microscope is a gold standard of diagnosis, but it is an invasive diagnostic method and difficult to be widely used. The patients need further imaging examination for assistance of diagnosis and guide of follow-up treatment. This article reviews the research progress of different imaging methods used for diagnosis of gouty arthritis.

Objective To compare different drainage methods after right hepatectomy. Methods From April 2017 to February 2018, 90 patients who underwent right hepatectomy at Zhongshan Hospital of Fudan University were prospectively randomized to the latex tube group (right subphrenic drain with a latex tube connecting to a collection bag, n=30), the silicone tube group (right subphrenic drain with a silicone tube connecting to a closed-suction, n=30) or the combination group ( right subphrenic drain with a latex tub, combined with a silicone tube, n=30). The amount of fluid collection after the operation, complications after surgery, recovery of liver function, and length of hospital stay after operation were compared. Results There were no significant differences in the clinicopathological features among the 3 groups, including gender, age, cirrhosis status, extent of hepatectomy, and blood loss (P＞0. 05). There were no significant differences among the three groups on the incidences of postoperative complications [ the latex tube group, 20. 0% (6/30); the silicone tube group, 23. 3% (7/30); the combination group, 16. 7% (5/30); P＞0. 05]. Ultrasonography showed significantly lower rates of subphrenic collection in the combination group compared with the latex tube group and the silicone tube group [16. 7% (5/30) vs. 63. 3% (19/30) vs. 53. 3% (16/30); P＜0. 05]. The rates of postoperative fever, serum total bilirubin, ALT and postoperative hospital stay were similar among the three groups (P＞0. 05). Conclusions Drainage using the combina-tion of a latex tube connecting to a collection bag and a silicone tube connecting to closed-suction after right hepatectomy significantly reduced postoperatively subphrenic collection and prevented infection of the collec-tion. However, the treatment strategy did not delay liver function recovery, prolong hospital stay nor increase post-operative infection rate.

The lymphatic system plays an important role in the humoral circulation, immune activity and cancer metastasis, but the morphological characteristics of this system have to be studied thoroughly in order to adapt to the modern medicine development. Lymphatic vessels are hardly observed in general cadaveric dissection since their channels are tiny and transparent. Therefore, the improvement of the inspection techniques is the key factor for further study of the lymphatic system. In the early stage of lymphatic study, the researchers could only observe the distribution of the lymphatic vessels and nodes of the mesentery, chyle cistern and thoracic duct in postprandial mammals by anatomic dissection, but were unable to investigate the entire system of the body. Great progress in the study has been made with utilizing the direct lymphatic perfusion with mercury as a medium. Then, because of the toxicity of mercury, it was replaced by indirect injection with other instances, like dye, ink, radioisotope etc, which helped achieving rapid progress in the anatomic study and clinical application. The knowledge of the lymphatic system of the body in existing textbooks is largely based on the early anatomical studies, but quite often it does not explain some of the unexpected clinical findings. In early 2000s, a modified method of lymphatic perfusion has been applied for investigating the human lymphatic system. It has been confirmed that there could be significant differences in the lymphatic distribution of individuals. This paper reviews the current investigative approaches of lymphatic distribution of the upper extremity, from a historical perspective.

Objective To investigate clinicopathological features,diagnosis and treatment of cutaneous Merkel cell carcinoma (MCC).Methods CNKI,Wanfang,Vip databases were searched for reported domestic cases of MCC from January 1,1986 to October 1,2017,and clinical data were collected,and retrospectively analyzed and summarized.Results During 31 years between 1986 and 2017,a total of 171 domestic cases of MCC were reported.There were 78 males and 93 females,and the ratio of male to female was 1:1.19.Of the 171 patients,136 (79.5％) were aged more than 50 years,and lesions mostly occurred on the head and face or extremities in 139 (81.3％) patients.Clinically,149 (87.1％) patients were misdiagnosed as tumor of unknown origin (89 cases,52％),malignant lymphoma (34 cases,19.9％),benign tumors (15 cases,8.8％) or non-tumor diseases (11 cases,6.4％).As for clinical stage,84 (49.1％) patients had stage Ⅰ MCC,and 49 (28.6％)had stage Ⅱ MCC.One patient received immunotherapy,and 165 patients underwent surgical resection,including 91 patients receiving surgery alone,24 patients treated with postoperative radiotherapy,19 patients treated with postoperative chemotherapy,and 31 patients receiving postoperative chemoradiotherapy.Five patients did not describe the treatment.Among 74 patients who were followed up after the surgery,one-year survival rate and five-year survival rate were 52.7％ and 6.8％ respectively.The five-year survival rate was 6.1％ in the patients with stage Ⅰ MCC,5.6％ in those with stage Ⅱ MCC,and 0 in those with stage Ⅲ and Ⅳ MCC.Conclusions In China,cutaneous MCC mostly occurs on the head,face,neck and extremities of the middle-aged or elderly,with a high misdiagnosis rate.Surgical excision combined with radiotherapy or chemotherapy is a frequently used treatment protocol in China,but the prognosis is always poor.

ObjectiveTo observe the clinical efficacy of acupuncture in treating functional dyspepsia due to liver stomach disharmony and its action mechanism.MethodSixty-eight patients were divided into an acupuncture group and a Western medication group by using the random number table, 34 cases in each group. The acupuncture group was intervened by acupuncture [majorly selecting Neiguan (PC6), Qimen (LR14), Zhongwan (CV12), Tianshu (ST25), Zusanli (ST36), Taichong (LR3), and Xingjian (LR2)], while the Western medication group was by using Domperidone tablets, both for 2 weeks. The syndrome score of traditional Chinese medicine (TCM), serum ghrelin content and clinical efficacy were observed before and after treatment for comparison and analysis.ResultThe total effective rate was 91.2% in the acupuncture group, significantly different from that in the Western medication group (P<0.05); after treatment, the TCM syndrome scores decreased significantly (P<0.05) and serum ghrelin contents increased significantly (P<0.05) in both groups; while the improvements were more significant in the acupuncture group (P<0.05).ConclusionAcupuncture is effective in treating functional dyspepsia due to liver stomach disharmony, and its action mechanism is possibly related to the increase of serum ghrelin.

Objective To explore the investigation method of complicated and profound traditional Chinese herbal medicine,the potential action mechanisms of flavonoids from Scutellaria baicalensis were studied by docking calculation.Methods In total, eight flavonoids (aglycones and their glicosides) from S. baicalensis were selected as ligands.The crystalline structures of targets related to common diseases were used as the receptors for calculation. The calculations were conducted with Schr(o)dinger software package. The grading standard of selectivity was developed according to G-score between ligands and receptors. Results Twenty-six pharmacologic actions have been reported.Among all effects in literature, nine of them can be deduced from the docking calculation of aglycone. From glycosides with grade ++, 25 reported effects can be estimated by calculation. Apparently, the target selectivity of aglycones and their glycosides are different form the virtual evaluation. The virtual evaluation results of glycosides were closer to the reported effects. Conclusion Our proposed virtual evaluation method seems an effective way to investigate the complicated system of traditional Chinese herbal medicine. It suggests that aglycones may be effective as the form of glucoside in vivo, and metabolism is a very important factor for virtual evaluation.

Objective To elucidate potential activities of phthalides and terpenoids from Angelica sinensis by theoreticaldocking calculation.Methods Eleven components of phthalides and terpenoids were selected as ligand.Thecrystalline structures of targets related to common diseases were used as the receptors for calculation.Thecalculations were conducted with Schr(o)dinger software package.The grading standard of selectivity was developedaccording to G-score between ligands and receptors.Results Selective targets of phthalides and terpenoids wererelated to nevous system diseases,cancer,pain,diabetes,cardiovascular disease,liver cirrhosis,nephrotic syndrome,inflammatory diseases,rheumatoid arthritis,dermatosis,leukemia,microbial inflections,immune diseases,andhypercholesterolemia.In addition to the medical treatments reported in the literature,our research also indicated thatthese two classes of compounds may be used for tumor,diabetes,rheumatoid arthritis,dermatosis,leukemia,livercirrhosis,and nephrotic syndrome.According to our research,the effects of phthalides and terpenoids may be not sostrong.Conclusion The effects of phthalides and terpenoids on diseases founded through virtual evaluation accord greatly with those reported in experiment and clinic.The combination of computer-aided drug evaluation technique and experiment is definitely an important and fast way to investigate the effects and mechanisms of traditional Chinese medicine.

In order to study the changes of main oxidase and antioxidase in the pathological scars,the tissues of hypertrophic scar(10 cases),keloid(10 cases)and normal skin(8 cases)were obtained.The concentration of malonaldehyde(MDA)and the activities of xanthine oxidase(XO),copper,zinc-superoxide dismutase(CuZn-SOD),catalase(CAT)as well as glutathione peroxidase(GPX)were detected by spectrophotometric method.Compared with normal skin tissues,the concentration of malonaldehyde and xanthine oxidase activity were significantly higer in pathological scars(P

0.05).On 1,3 and 5 days after the operation,the PHS and PVAS of Group B decreased significantly than those of Group A(P