Objective:To investigate the application value of jigsaw puzzle flap based on free-style perforator in repairing the defect on groin and adjacent organ after tumor extended resection.Methods:From December 2013 to August 2019, the data was focused on the patients who underwent soft tissue defect repair of groin and adjacent areas in the Second Affiliated Hospital of Chengdu Medical College. After the defect was predetermined preoperatively, portable ultrasound Doppler was used to map multiple perforators adjacent to the defect. The large defect was divided into several small parts, based on the location of perforators, the intensity of the Doppler, the safety size of flap that can be perfused by a single free-style perforator, and the donor sites can be closed primarily. Each component part corresponds to a free-style perforator flap. The perforator vessels were reversely dissected, and small flaps of V-Y advancement, rotation and propeller pedicled with perforator vessels were formed (appropriate modification of flaps can be made according to actual anatomical perforator vessels). All flaps were transferred to the defect site and reassembled according to the preoperative design (film simulation) to repair the large wound or deep space after the extended resection of the tumor in the groin and adjacent organs. Meanwhile, the donor site was closed and sutured primarily. The color, temperature, capillary reaction of the skin flap were observed during the first 3 days after procedure, and appearance and function after repair were observed after long-term follow-up.Results:A total of 31 patients were enrolled, including 18 males and 13 females. The ages of the patients ranged from 48 to 82 years with an average of 66 years. The defect area of skin and soft tissue was 8.0 cm×10.0 cm-15.5 cm×20.0 cm, with an average of 12.0 cm×15.0 cm. A total of 65 flaps were harvested, including 32 propeller flaps, 18 rotating flaps and 15 V-Y advancement flaps. There were 3 cases with 3 flaps and 28 cases with 2 flaps. The average skin flap area was 12.0 cm×20.0 cm-5.0 cm×10.0 cm, with an average of 8.0 cm×13.0 cm, and the diameter of the pedicle perforator vessel was 0.5 mm-4.0 mm. The color, temperature and capillary reaction of the skin flap were normal during the first 3 days after operation. Too much tension resulted in congestion of the flap in one case and poor wound healing. The wound was treated with dressing change, and healed in two weeks. The patients were followed up for 3 months to 5 years, with an average of 1.5 years. 30 patients survived primarily. The postoperative appearance was good.Conclusions:The combination of multiple small free-style perforator flaps can repair the large skin and soft tissue defects of malignant tumors after extensive resection on the groin and its adjacent area, and the donor site can be closed primarily. This method is easy to operate and avoids micro anastomosis and skin grafting. It is a kind of repair approach for clinical reference.

Objective:To investigate the application value of jigsaw puzzle flap based on free-style perforator in repairing the defect on groin and adjacent organ after tumor extended resection.Methods:From December 2013 to August 2019, the data was focused on the patients who underwent soft tissue defect repair of groin and adjacent areas in the Second Affiliated Hospital of Chengdu Medical College. After the defect was predetermined preoperatively, portable ultrasound Doppler was used to map multiple perforators adjacent to the defect. The large defect was divided into several small parts, based on the location of perforators, the intensity of the Doppler, the safety size of flap that can be perfused by a single free-style perforator, and the donor sites can be closed primarily. Each component part corresponds to a free-style perforator flap. The perforator vessels were reversely dissected, and small flaps of V-Y advancement, rotation and propeller pedicled with perforator vessels were formed (appropriate modification of flaps can be made according to actual anatomical perforator vessels). All flaps were transferred to the defect site and reassembled according to the preoperative design (film simulation) to repair the large wound or deep space after the extended resection of the tumor in the groin and adjacent organs. Meanwhile, the donor site was closed and sutured primarily. The color, temperature, capillary reaction of the skin flap were observed during the first 3 days after procedure, and appearance and function after repair were observed after long-term follow-up.Results:A total of 31 patients were enrolled, including 18 males and 13 females. The ages of the patients ranged from 48 to 82 years with an average of 66 years. The defect area of skin and soft tissue was 8.0 cm×10.0 cm-15.5 cm×20.0 cm, with an average of 12.0 cm×15.0 cm. A total of 65 flaps were harvested, including 32 propeller flaps, 18 rotating flaps and 15 V-Y advancement flaps. There were 3 cases with 3 flaps and 28 cases with 2 flaps. The average skin flap area was 12.0 cm×20.0 cm-5.0 cm×10.0 cm, with an average of 8.0 cm×13.0 cm, and the diameter of the pedicle perforator vessel was 0.5 mm-4.0 mm. The color, temperature and capillary reaction of the skin flap were normal during the first 3 days after operation. Too much tension resulted in congestion of the flap in one case and poor wound healing. The wound was treated with dressing change, and healed in two weeks. The patients were followed up for 3 months to 5 years, with an average of 1.5 years. 30 patients survived primarily. The postoperative appearance was good.Conclusions:The combination of multiple small free-style perforator flaps can repair the large skin and soft tissue defects of malignant tumors after extensive resection on the groin and its adjacent area, and the donor site can be closed primarily. This method is easy to operate and avoids micro anastomosis and skin grafting. It is a kind of repair approach for clinical reference.

Objective:To study the collapse of the contralateral femoral head after the total hip arthroplasty (THA) in patients with bilateral steroid-induced femoral head necrosis leg-length discrepancy (LLD) influences.Methods:A total of 108 patients with bilateral steroid-induced femoral head necrosis who were treated in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to June 2016 underwent THA surgery on the hip joints that had symptoms and developed to Association Research Circulation Osseous (ARCO) Ⅲ. At the same time, the non-surgical hip-preserving treatment of the non-collapsed femoral head developed to the ARCO Ⅱ stage was performed. The follow-up period was 2 years, and 98 cases were finally included. According to the size of the leg-length discrepancy [LLD<3 mm group ( n=50), LLD≥3 mm group ( n=48)] and the type of leg-length discrepancy[non collapse side longer group ( n=58) and shorter group ( n=58)], the collapse of the femoral head and the THA were observed. Results:Finally, a total of 56 cases of femoral head collapse occurred in the non collapse side of the hip, of which 50 cases underwent THA within 24 months. There were significant statistical differences in THA and femoral head collapse between LLD<3 mm group and LLD≥3 mm group, non collapse side longer group and non collapse side shorter group ( P<0.05). The 2-year survival rate without collapse in the LLD<3 mm group and LLD≥3 mm group were 52.1% and 34.0%, respectively, and the 2-year survival rates in the longer and shorter non-collapsed limb groups were 56.9% and 22.5%, respectively. Compared with patients with moderate lesions, the survival rate of femoral heads in patients with larger lesions was lower ( OR: 4.25, 95% CI: 1.55-11.26; P=0.003). LLD<3 mm group ( OR: 0.24, 95% CI: 0.06-0.50; P<0.01) or non collapse side longer group ( OR: 0.13, 95% CI: 0.04-0.29; P<0.01) had lower risk of contralateral femoral head collapse after THA. Conclusions:For patients with bilateral steroid-induced femoral head necrosis who have collapsed lateral THA, postoperative leg-length discrepancy extremities is a potential risk factor for collapse of non-collapsed femoral head. LLD<3 mm and avoiding shortening of the uncollapsed limb may reduce the risk of collapse of the uncollapsed femoral head.

Objective:To assess the clinical outcome of the novel computer assisted reduction malarplasty using angled double L-shaped osteotomies.Methods:Retrospective analysis of the 35 female patients who received reduction malarplasty surgery during June 2014 to April 2019 was conducted. Patients were divided into the conventional surgery group (9 cases) and the computer assisted surgery group (26 cases) based on their personal will. For the conventional surgery group, the zygomatic arch was repositioned inwardly after L-shaped osteotomy, and was rigidly fixed with miniplates and screws. The computer assisted reduction malarplasty was as follows: computer assisted angled double L-shaped osteotomies with surgical guide was performed intraorally, and the pre-bent titanium was used to setback the resected zygoma bone, which was then fixed with titanium miniplates and screws. Operation time, patients’ satisfaction (3-month follow-up) and postoperative complications (asymmetry and bone nonunion) were recorded and assessed. CT scans were performed to compare the preoperative design and 3-month postoperative follow-up for the computer assisted patient group. For statistical analysis, independent sample t test was used to analyze operation time of the 2 groups and chi-square test was used to analyze the data of patients’ satisfaction and asymmetry occurrence. P<0.05 was considered as statistically significant. Results:The mean operation time was (85.1 ± 17.8) min during computer assisted surgery versus (62.2±11.7) min during conventional surgery. The difference between the two groups was statistically significant ( t=3.53, P=0.020). Neither group showed noticeable resected bone shifting or soft tissue drooping. One patient in the conventional surgery group had bone nonunion on the right zygoma and partial absorption of the left zygomatic bone. The incidence of asymmetry in the computer-assisted group was 3.8% (1/26, surgical correction was not required), and 33.3% in the conventional surgery group (3/9, one patient required surgical correction). There was a statistically significant difference between the two groups ( χ2=6.179, P=0.046). Patients’ satisfaction in the computer-assisted group was 100% (26/26), and 78% (7/9) in the conventional surgery group ( χ2=7.929, P=0.019). Comparisons between the postoperative CT and preoperative simulation CT images showed that the position deviation of the resected bones was (0.21 ± 0.19) mm. Conclusions:In the present study, improved precision of zygomatic bone resection and bone setback was achieved in reduction malarplasty by using the angled double L-shaped osteotomies with computer assistance. Moreover, complication occurrences (asymmetry, bone nonunion etc.) were significantly decreased. Also, patients’ expectation was better achieved with this method.

Objective:To assess the clinical outcome of the novel computer assisted reduction malarplasty using angled double L-shaped osteotomies.Methods:Retrospective analysis of the 35 female patients who received reduction malarplasty surgery during June 2014 to April 2019 was conducted. Patients were divided into the conventional surgery group (9 cases) and the computer assisted surgery group (26 cases) based on their personal will. For the conventional surgery group, the zygomatic arch was repositioned inwardly after L-shaped osteotomy, and was rigidly fixed with miniplates and screws. The computer assisted reduction malarplasty was as follows: computer assisted angled double L-shaped osteotomies with surgical guide was performed intraorally, and the pre-bent titanium was used to setback the resected zygoma bone, which was then fixed with titanium miniplates and screws. Operation time, patients’ satisfaction (3-month follow-up) and postoperative complications (asymmetry and bone nonunion) were recorded and assessed. CT scans were performed to compare the preoperative design and 3-month postoperative follow-up for the computer assisted patient group. For statistical analysis, independent sample t test was used to analyze operation time of the 2 groups and chi-square test was used to analyze the data of patients’ satisfaction and asymmetry occurrence. P<0.05 was considered as statistically significant. Results:The mean operation time was (85.1 ± 17.8) min during computer assisted surgery versus (62.2±11.7) min during conventional surgery. The difference between the two groups was statistically significant ( t=3.53, P=0.020). Neither group showed noticeable resected bone shifting or soft tissue drooping. One patient in the conventional surgery group had bone nonunion on the right zygoma and partial absorption of the left zygomatic bone. The incidence of asymmetry in the computer-assisted group was 3.8% (1/26, surgical correction was not required), and 33.3% in the conventional surgery group (3/9, one patient required surgical correction). There was a statistically significant difference between the two groups ( χ2=6.179, P=0.046). Patients’ satisfaction in the computer-assisted group was 100% (26/26), and 78% (7/9) in the conventional surgery group ( χ2=7.929, P=0.019). Comparisons between the postoperative CT and preoperative simulation CT images showed that the position deviation of the resected bones was (0.21 ± 0.19) mm. Conclusions:In the present study, improved precision of zygomatic bone resection and bone setback was achieved in reduction malarplasty by using the angled double L-shaped osteotomies with computer assistance. Moreover, complication occurrences (asymmetry, bone nonunion etc.) were significantly decreased. Also, patients’ expectation was better achieved with this method.

Lung cancer is the most common cancer and the leading cause of cancer death. Non-small cell lung cancer (NSCLC) represents over 85% of all lung cancers, and up to 50% of Asian NSCLC patients harboring epidermal growth factor receptor (EGFR) gene mutations. A number of studies have consistently demonstrated that uncommon EGFR-mutated NSCLC patients treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs) can achieve better survival outcomes. However, because uncommon EGFR mutations are generally associated with reduced sensitivity to EGFR-TKIs, which will bring a negative impact on the result of the study, the majority of clinical trials investigating the efficacy of EGFR-TKIs have included only patients with common EGFR mutations. In addition, uncommon EGFR mutations are rare in themselves, leading to the small number of such patients enrolled in these trials. Due to the small number and highly heterogeneous sensitivity of uncommon EGFR mutations, the efficacy of EGFR-TKIs in patients harboring uncommon EGFR mutations remains elusive. This article reviews the efficacy of EGFR-TKIs in patients with uncommon EGFR mutations, and give some reasonable advice about the selection of treatments for patients with NSCLC who harbor uncommon EGFR mutations.

Objective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI),and after ROSC,the effects of various factors on midian survival time and on 2-year survival.Methods In a registry study from January 2005 to January 2015,all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled.The survivors were followed-up for 2 years.Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival.Multivariable logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis.Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC.Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival.Results A total of 254 cases with CA after AMI were enrolled,including 129 cases of ROSC and 71 cases of 2-year survival.Univariate analysis showed age ≥ 70 years,CA occurred during 22:00-8:00,the duration time ofCPR ≥ 15 min and adrenaline dosage ＞ 5 mg were unfavorable predictors of ROSC;while,left ventricular ejection fraction (LVEF) ≥ 40％ before CA,shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors.Besides,age ≥ 70 years,intubation during CPR,adrenaline dosage ＞ 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival;While,male,normal daily activity before CA and PCI treatment were favorable predictors.Multivariable analysis showed age,the duration of CPR,adrenaline dosage,LVEF before CA,the rhythm during CPR and PCI therapy were independent predictors of ROSC.Age and PCI therapy were independent predictors of 2-year survival.Among patients,the survival time was affected by various factors after ROSC,and the factors with minimum 25％ and small median value were associated with cardiac rupture,cancer,adrenaline dosage ＞ 5 mg and cardiogenic shock.The factor with maximum 25％ value was PCI treatment (216 days).Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test,P=0.007);while,PCI treatment was a favorable factor (Log-rank test,P＜0.01).PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI,the number of infarctrelated artery and the difference in culprit lesion.Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival.PCI treatment was favorable to both ROSC and 2-year survival.

Objective:To explore the clinical effect of group psychotherapy on relieving anxiety and depression symptoms in patients with alcohol dependence.Methods:Totally 117 patients with alcohol dependence accompanied with anxiety and depression symptoms were selected from the Second People's Hospital of Puer City from 2014 January 1 to December 31.The anxiety and depression symptoms were assessed with the Self-Rating Anxiety Scale (SAS),Self-Rating Depression Scale (SDS) and Brief Psychiatric Rating Scale (BPRS).They were divided into drug combined group (intervention group,n =89) and single drug treatment group (control group,n =88).The two groups were administrated diazepam replacement therapy,and the intervention group combined group psychotherapy.Eight weeks later,treatment effect of the two groups were evaluated with the Clinical Global Impression Scale (CGI).Results:After intervention,the scores of SAS,SDS,BPRS,and CGI in intervention group decreased [(21.1 ±8.3) vs.(65.3± 10.2),(35.1 ±3.5) vs.(51.7 ±5.6),(4.3 ± 1) vs.(5.4 ±0.6),Ps ＜0.05].There was no significant difference in above scores between before and after treatment in the control group (Ps ＞ 0.05).Conclusion:The effect of group psychotherapy on the basis of medicine may be better than that of single drug therapy on relieving anxiety and depression in patients with alcohol dependence.

Multi-component Chinese medicine has been considered an important developmental direction for traditional Chinese medicine (TCM) formula.Nowadays,it is unfit to target a molecule for preventing or curing a disease because it resulted from multiple of factors and resulted in many indications.Thus,the idea focusing on the multiple targets for therapy is increasingly accepted by physicians and scientists.Here,we conceived a new simplified method for screening the active multi-component Chinese medicine based on the complexity of Chinese medicine,the multi-target property of protein signal transduction and the principle of Chinese medicine prescription.Combined with the traditional knowledge on tumor and latest antitumor research results of Chinese medicine and its compounds,the method was concretely illustrated.It helps us to transform the herbal compounds to new complex drugs targeting multiple signaling.

Tumor metastasis is one of the important biological characteristics of malignant tumor,which is closely related with the prognosis of the cancer patients.High expression of ADAM8 in varieties of tumors was revealed in many recent studies,and such aberrant expression played a crucial role in regulating of tumor metastasis.Studies showed that overexpression of ADAM8 attenuated the intercellular adhesion effect,promoted tumor angiogenesis,and enhanced the degradation of ECM as well as the releasing of cytokines.Therefore,suppression of ADAM8 may lead to inhibition of tumor metastasis,which makes ADAM8 a particular attractive target as it can be used as a prognostic indicator and a potential therapeutic target of malignant tumor.A review about the relations between ADAM8 protein′s abnormal expression and tumor occurrence was discussed in this paper,also include discussion about the mechanisms of ADAM8 protein′s disorder-induced tumor formation,as well as therapeutic strategies based on ADAM8-targeted,which may provide references for follow-up research and clinical treatment.