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 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 explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness.Methods:A retrospective observational study was conducted. From January 2020 to May 2022, 5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria, including 6 males and 3 females, aged 35-69 years, including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses. After an adequate assessment of the damage by a multiple discipline team, titanium mesh removal, paranasal sinus debridement, and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh, and radical tumor resection was performed in patients with tumors, with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm, anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm, and sinus cavity depths of 1 to 4 cm. Depending on the perforator course of the descending branch of the lateral circumflex femoral artery, the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap (with flap area of 9 cm×4 cm to 19 cm×8 cm, muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm) was transplanted to repair the defect, and the donor site wound was sutured directly. The type of tissue flap transplanted, the blood vessel of the recipient area, and the vascular anastomosis way during the operation, the recovery of the donor and recipient areas and the occurrence of complications after operation were observed. The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up.Results:The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients, and the anterolateral femoral chimeric flap transplantation was performed in 3 patients. The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases. The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients, and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients. After operation, all the tissue flaps survived, and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage, no intracranial infection occurred, and the wounds in donor areas were healed well. Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area, and the shape was acceptable; 4 patients with exposed titanium mesh had no recurrence of ulceration, and 5 patients with tumor had no local tumor recurrence or metastasis.Conclusions:Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect, good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.

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 systematically evaluate therapeutic efficacy of Yanhuning injection in the treatment of epidemic mumps,explore valid way of evidence-based review,provide reference for the selection of new essential medicine list. METH-ODS:Retrieved from PubMed,CJFD,Wanfang database and VIP,randomized controlled trials(RCTs)about Yanhuning injection alone or combined with other positive drugs(trial group)vs. other positive drugs(control group)in the treatment of epidemic mumps. Meta-analysis was conducted by using Rev Man 5.3 statistical software after quality evaluation by modified Jadad scale. RE-SULTS:Totally 26 RCTs were included,involving 2613 patients. Results of Meta-analysis showed,overall response rate [OR=5.28,95%CI(3.92,7.11),P<0.001] of trial group was significantly higher than that of control group;defervescence time [MD=-1.97,95%CI(-2.83,-1.12),P<0.001],swelling disappearance time [MD=-2.05,95%CI(-2.53,-1.58),P<0.001] and pain disappearance time [MD=-1.39,95%CI(-2.02,-0.75),P<0.001] of trial group were significantly shorter than those of control group,there was statistical significance. CONCLUSIONS:Yanhuning injection has good curative effect for epidemic mumps,and can significantly shorten defervescence time,swelling disappearance time and pain disappearance time.

OBJECTIVE:To provide reference for the selection of new edition of Essential Medicine List by quantitative com-prehensive evaluation for additional essential medicine. METHODS:The evaluation factors were established according to Delphi method,and Analytic Hierarchy Process(AHP)was conducted to compare the factors in pairs,construct the judgment matrix,cal-culate the weight coefficients of every factor and do the consistency test. RESULTS:The evaluation model was composed of 6 first-class indexes(including effectiveness,safety,stability,availability,affordability and adaptability)and 24 second-class index-es,and the weight of each index to the target layer was calculated. Among them,the weight of validity and security is the top two. CONCLUSIONS:The weight coefficient can be determined scientifically and reasonably by AHP,and the reliability and operability of the evaluation index system can be improved. It is a useful attempt to explore the selection system of additional essential medi-cine.

Objective To evaluate the effect of pregnancy and delivery after renal transplantation (RT)on recipients,graft and offspring.Methods Clinical data of 6 pregnancies in 5 recipients were retrospectively studied and literature was reviewed.Results Among them,6 pregnancies and 4 deliveries occurred in 5 female RT recipients.The mean age at pregnancy was 31.1 years,with a mean interval between RT and pregnancy being 3.6 years.Preeclampsia developed in two pregnancies and hyperlipemia in one pregnancy.One RT recipient who discontinued immunosuppressant following pregnancy on her own exhibited subsequent renal failure.She underwent a second RT and delivered a healthy baby two years following the second RT.One RT recipient decreased the immunosuppressant dose to half after the pregnancy on her own and developed renal failure thereafter.Four patients underwent a Cesarean section at 38 th,35 th,35 th,and 38 th week,respectively.The mean birth weight was 3262.5 g with all Apgar scores of 10.Conclusion Our data coupled with prior reports suggest that for the recipients with normal renal function,successful pregnancy is achievable if immunosuppressant was taken correctly,but the pregnancy is at high risk,and careful monitoring is needed.

Objcetive To investigate the protective effects of the nitroxides R-1 on human liver cells exposed to ionizing radiation.Methods Human liver cells L-02 were cultured and irradiated with 60Co γ-rays at the doses of 0,1,2,4,and 8 Gy,in order to screen the proper irradiation dose.WR2721 at the terminal concentration of 4 mmol/L was used as positive control.L-02 cells irradiated with 4 Gy were added with R-1 at the terminal concentration of 0.25 μmol/L at 30 min before irradiation or immediately after irradiation.MIT method was used to screen the proper conditions for follow-up experiment 72 h later.L-02 cell culture fluid was added with R-1 at the concentrations of 0,0.125,0.25,0.5,and 1 μmol/L,respectively for 30 min before irradiation at the doses of 0,1,2,4,and 8 Gy to ealculate clone formation rate at 10 d post-irradiation.L-02 cells were cultured and divided into 4 groups:control group without any treatment.drug group pretreated by 0.25 μmol/L R-1 only,irradiation group,irradiated at 4 Gy only,and drug + irradiation group with combination of 0.25 μmol/L R-01 and 4 Gy irradiation.The inverted microscopy and Hoechst 33258 staining and flow eytometry were used to observe the apoptosis of the cells at 24,48,and 72 h later.Results Nitroxides R-1 did not inhibit the viability of L-02 cell when its concentration was less than 1 μmol/L and it inhibited the L-02 cell growth when the concentration wu higher than 2 μmoL/L.The A value and colony formation rate of different concentration of R-1 groups were all higher than those of the irradiation group,and the effect of the 0.25 μmol/L drug concentration group was the most significant.Consequently,the concentration 0.25 μmoL/L was selected for follow-up experiment.Compared with the irradiation group,the L-02 cells of the pretreatment group showed solid adherence, increased refraction,clear outline,less apoptotic and dead cells at 4 Gy post-irradiation.Conclusions Nitroxides R-1 can protect the human liver cells from 60Coγ-ray induced injury effectively.The mechanism of its protective effect may be the reduction of apoptosis.

Objective To investigate expression of β-site APP-cleaving enzymel(BACE1) and Aβ in brain of diabetes mellitus of Wistar rats,to study pathophysiological mechanism of Alzheimer disease from diabetic metabolic disorder. Methods Animal model of diabetes mellitus was established by streptozocin with intraperitoneal injection. Wistar rats were randomly divided into normal group (N), sham-operation group (S), 4 weeks diabetes mellitus model group (M4), 6 weeks diabetes mellitus model group (M6) and 8 weeks diabetes mellitus model group (M8). Behaviour was tested with Morris water maze and shuttle box test. Expression of Aβ was measured by enzyme linked immunosorbent assay and BACE1 by immunohistochemistry, enzyme linked immunosorbent assay, Western blotting and RT-PCR. The absorbance value was measured by imaging analysis. Results The electric times and latancy of memory and study were more increased in model group than that in N and S group but the times of escape more decreased(P<0.01). The expression of Aβ_(1-40) increased from (64.13±6.76)pg/mg in normal group to (86.43±7.03)pg/mg in model group by ELISA(P<0.001) and Aβ_(1-42) from (67.43±5.12 )pg/mg in normal group to (89.45±5.28) pg/mg (P<0.001) in model group. The expression of BACE1 increased from (116.46±8.10)pg/mg in normal group to (158.73±6.24)pg/mg in model group by ELISA and from 0.61±0.11 in normal group to 1.52±0.16 by Western blotting absorbance valule and from 1.62±0.26 in normal group to 3.61±0.32 by RT-PCR absorbance valule and from 0.81±0.21 in normal group to 2.01±0.36 by immunohistochemistry absorbance valule (P<0.001). The expression of BACE1 and Aβ in MT group was higher than that of in N and S group (P<0.01). The level of BACE1 and Aβ had positive correlation with cognitive impairment.Conclusion The expression of BACE1 and Aβ is increased in diabetes mellitus rats. Diabetes mellitus contributes to Alzheimer diseases that.

Objective To investigate the effect of phosphatidylinesitol-3 kinase/serine threonine kinase (PI3K/Akt) signaling pathway on expression of beta-site amyloid precursor protein cleaving enzyme-1 (BACE1) in the hippocampus neurons of rat brain. Methods Forty SD rats were randomly divided into 4 groups: blank control group, sham-operated group, insulin group and wortmannin group. Insulin or the specific inhibitor of PI3K, wortmannin was injected into hippocampus neurons to activate or inhibit the signaling pathway in insulin group or wortmannin group, respectively. Immunoprecipitation and Western blot were used to analyze the proteins levels of PI3K/Akt and BACE1. Results In insulin treatment group,among the proteins downstream of signaling pathway, expression of Akt increased (0. 952±0.060 vs 0.835±0.029,t=4.9150, P=0.0001), phospho-Akt set473 increased (0.800±0.075 vs 0.657± 0.025,t=4.5598, P=0.0002), phospho-GSK-3α decreased (0.604±0.062 vs 0.726±0.041, t= 3.5871, P=0.0018 ), and the expression of mature BACE1 and β-CTF significantly decreased. In wortmannin group, the expression of Akt and phospho-Akt ser473 were inhibited; phospho-GSK-3α increased ; mature BACEI (1.004±0.096) and β-CTF (1.031±0.048) increased (t=11.5980, P= 0.0000 and t =4.2194, P =0.0004, respectively). Conclusions PI3K/Akt signaling pathway might effect the expression of BACE1, in which impaired signaling pathway may cause the amyloid precursor protein to be easily processed by BACE1, and thus involves the pathology of Alzheimer' s disease.