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Objective:To discuss outcomes of emergency repairing for Gustilo III B and III C fractures of forearm with complicated tissue defects and the related influence factors.Methods:From January 2014 to Feburary 2022, data of 98 cases of Gustilo III B and III C fractures with large compound defects of soft tissue, blood vessel, bone, tendon or muscle from elbow to wrist were collected. Primary debridement, bone fixation, wound coverage by free flap, bone transfer(or bone cement filling) or dynamic reconstruction of muscle were completed with emergency surgery in Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. Postoperative follow-ups were conducted through outpatient clinic visits, telephone and WeChat reviews. Video clips, questionnaires and the latest information of patients were also analysed. Rank sum test and Chi-square test were used to examine the relationship between independent variables such as general condition, disease condition and surgical procedures of chimeric tissue transfer group and simple flap transfer group, together with dependent variables such as limb salvage, number of surgery, wound healing, function scores, and complications. P<0.05 were further included in the regression equation to discover the relationship between multiple independent variables and dependent variables. Results:Follow-up lasted for 6-96 months, with an average of 71.1 months. In the chimeric group, the limb salvage rate was at 95.1%, with an infection rate of 8.50% and an average number of surgery was 2.13±0.89. In the simple flap transfer group, the limb salvage rate was at 87.5%, with an infection rate of 15.38% and an average number of surgery was 2.62±0.64. The good rate of Anderson score was 65.3% and the average score of Disability of the Arm, Shoulder and Hand(DASH) was 32.9(0-60) points for all the patients. There were significant differences in dependent variables of limb salvage and infection rate between the 2 groups ( P<0.05). Ischemia time and method of bone fixation led to significant differences in number of surgery ( P<0.05). Methods of bone fixation and the types of flap made significant differences in wound healing ( P<0.05). Underlying disease, bonedefect, Gustilo classification and method of bone fixation all contributed to the significant differences in function score ( P<0.05 or P<0.01) . Conclusion:Emergency surgery for repair of serious injury of forearm has a relatively high limb salvage rate and good functional effects. The limb salvage rate is not correlated with independent variables such as severity of injury, Mangledextremity Severity Score (MESS) and ischemia time, while transfer of a simple flap or a chimeric flap is significantly correlated with the limb salvage rate, infection and wound healing. The severity of injury, ischemia time and bone defect are correlated with functional assessment, number of surgery and bone healing.
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Objective:To explore the feasibility and clinical effect of emergency lateral thigh muscle transfer in functional reconstruction of major traumatic muscle defects.Methods:Emergency surgeries for 8 patients(7 males and 1 female) with muscle defects were carried out subject to emergently reconstruct the power of lateral femoral muscle superficial region, between March 2020 and December 2021, in the Department of Hand and Foot Microsurgery Hospital, Xi'an Fengcheng Hospital. The 8 patients were 23 to 52 years old with an average of 37.6 years old. Five patients injured by machine crush, 2 by heavy object crush and 1 by traffic accident. Five patients were in Gustilo III B injury in forearm, including 2 with flexor muscle group defects, 2 with extensor muscle group defects and 1 with defect of dorsal metacarpal flexor muscle and extensor muscle. Among the 5 patients, 2 patients had the defects in left forearm and 3 in right forearm. One patient had defect of right 1st metacarpal bone and skin and thenar muscle. One patient suffered a complete right upper arm detachment with musculocutaneous nerve being drawn out from the bicipital muscle. One patient had Gustilo III C injury in the right calf with defects of extensor hallucis longus and extensor digitorum. The areas of soft tissue defect were 10.0 cm×8.0 cm-36.0 cm×11.0 cm and the size of flaps was 12.0 cm×6.0 cm-38.0 cm×12.0 cm with the volumes of excised muscle at 18.0 cm×9.0 cm×1.5 cm-10.0 cm×2.0 cm×1.0 cm. The anatomical cross-section and length of the corresponding muscle on the healthy side were measured by musculoskeletal ultrasound. The chimeric tissue flap was designed on the anterolateral side of the thigh. The flap was designed according to the size of the wound and the corresponding flap. Then 1 or 2 muscle tissue blocks were designed and cut from the superficial region of the lateral femoral muscle according to the condition of the muscle defect, to cover the wound and reconstruct the muscle power. Postoperative follow-ups were conducted by scheduled hospital visit. The contents of follow-up included dynamic observation, evaluation and record through musculoskeletal ultrasound, electromyography and strength of muscle.Results:For the 8 patients who were subject to a muscle reconstruction, the transferred muscles and flaps survived in stage-one without vascular event. Postoperative follow-ups lasted for 10 to 32 months with an average of 19.6 months. The strength of muscle was evaluated according to the M 4 strength of muscle. Strength of muscle restored to M 4 or above in 7 patients who could lift, hook or push a heavy object in 5-30 kg of weight, with free joint movement. One patient restored the strength of muscle to M 3+. Muscle contraction was detected 2-4 months after surgery by musculoskeletal B ultrasound. The average ratio of contraction to resting cross sectional area in 5 cases was 1.45±0.42. The shape of limb was bilaterally symmetrical. There was no discomfort in the donor site and knee joint. The flaps were soft and glossy, with protective sensation restored. Conclusion:Muscle transfer from the lateral femoral muscle superficial region in emergency surgery for functional reconstruction of traumatic muscle defects is feasible and effective with a good clinical effect.
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The outbreak of COVID-19 has infected millions of people and caused hundreds of thousands of deaths worldwide. As there is no specific medicines or effective vaccines against 2019-nCoV at present, it is an alternative strategy to repurpose existing drugs for new diseases. Cyclosporin A inhibits the replication of coronaviruses by binding to cellular cyclophilins. Chloroquine/hydroxychloroquine can block virus-receptor binding through interfering with terminal glycosylation of the cellular receptor angiotensin-converting enzyme 2 (ACE2). Trastuzumab prevents the binding of IL-6 to both sIL-6R and mIL-6R and thereby inhibits the cytokine storm syndrome induced by COVID-19. This paper discussed the potential anti-2019-nCoV effects of some common immunosuppressant including cyclosporine, chloroquine/hydroxychloroquine, and tocilizumab.
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Objective To investigate the mRNA expression of survivin, livin and XIAP gene in peripheral blood of patients with gastric cancer and its relationship with clinico-pathological features.Methods This study included 50 patients with gastric cancer and 20 healthy donors. The expression of survivin, livin and XIAP gene was detected by reverse transcription-quantitative polymerase chain reaction (RT-QPCR) using a molecular beacon probe, while recombination plasmid containing the sequence of survivin, livin and XIAP was standard. The relationship between copies of survivin, livin and XIAP gene expression in peripheral blood with gastric cancer and clinical data was analyzed. Results A linear standard curve was obtained between 103 ～ 1010 copies. The copies of survivin, livin and XIAP mRNA in peripheral blood of patients with gastric cancer did not correlate with gender, age, and histological types ( P ＞ 0.05). There were positive relationships between copies of survivin, livin and XIAP gene with lymph node metastasis and TNM stage (P ＜0.05 ). The expression of survivine, livin and XIAP was all negative in peripheral blood of healthy people. 52% (17/33) of patients suffered from recurrence or metastasis who had positive expression of survivin and/or livin and/or XIAP mRNA, while it was 18% (3/17)among the negative survivin and/or livin and/or XIAP mRNA caces ( P ＜ 0.05). Conclusions The expression of survivin, livin and XIAP mRNA can be used to detecte micro-metastasis in peripheral blood circulation of gastric cancer.
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Objective:To investigate a method to identify Actinobacillus actinomycetemcomitans serotypes by polymerase chain reaction. Methods:18 Actinobacillus actinomycetemcomitans strains representing serotypes a to f were used in the test. 6 pairs of specific oligonucleotide primers for gene clusters involved in the biosynthesis of serotype specific polysaccharide antigens were designed. The primers were developed and evaluated in a genetic method of identifying serotypes of Actinobacillus actinomycetemcomitans strains by using a PCR assay. Results: Each pair of primers can specifically identify one serotype of Actinobacillus actinomycetemcomitans strains. No cross reaction was observed in all 18 strains. The PCR product sizes were as follows: 428 bp (serotype a), 298 bp (serotype b), 559 bp (serotype c), 690 bp (serotype d), 211 bp (serotype e) and 232 bp (serotype f). Conclusion:PCR method may be useful to identify Actinobacillus actinomycetemcomitans serotypes rapidly and directly.
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Objective To observe the therapeutic effect of chitosan oral ulcer spray in treatment of recurrent aphthous ulcer(RAU).Methods Sixty patients suffered with RAU were randomly divided into two groups.The test group was treated with chitosan oral ulcer spray,while the control group was given a traditional Chinese medicine named Xileisan.To evaluate the efficacy according to a specialized evaluate standard.Results The disease course of test group was shorter than that of the control group.The test group was more effective in mitigating the pain of RAU than that of the control group.ConclusionThe efficacy of chitosan oral ulcer spray in treatment of RAU is superior to Xileisan.