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Objective:To investigate the results of coryoint flap harvested from lower abdominal wall for covering extremely soft tissue circular defects on limbs.Methods:From March 2018 to June 2020, 15 patients who suffered from severe degloved injury were admitted into the Department of Hand Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. The injuries were characterised as extreme circular defects on limbs. The dimension of defects ranged from 25.0 cm×9.0 cm to 30.0 cm×18.0 cm. All wounds were taken through emergency debridement and managed by VSD. Using lower abdomen as a donor site, a conjoined flap was dissected when the wound surface became granulating. The perforator vessels of the flaps included vessels of deep inferior epigastric artery(DIEA), superficial inferior epigastric artery(SIEA) and superficial circumflex iliac artery(SCIA). The donor sites were primary closed. Postoperative follow-ups were conducted by the surgeons in the same surgical team at outpatient clinic.Results:Fourteen flaps survived completely without significant complications. Distal necrosis occurred in 1 flap, which healed with a skin graft in the second stage surgery. All flaps were reviewed during the postoperative follow-up that lasted for 18-24(mean 20) months. The aesthetic outcomes were achieved on the recipient site without hairy nor hyper-pigmentation. A concealed linea scare left at the donor sites without hernia and limited function. At the last follow-up, 5 patients were in excellent and 2 in good evaluated by following the Disabilities of the arm, shoulder and hand(DASH). With the Lower extremity functional scale(LEFS), 5 patients were in excellent and 3 in good.Conclusion:The simultaneous reconstruction of extremely large soft tissue circular defects on limbs with best possible salvage surgery can be achieved by a conjoined flap. A conjoined flap offers a concealed donor site, easy to design, flexible perforators design and larger size of soft tissue.
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Objective:To investigate the feasibility and efficacy of retroperitoneal laparoscopy combined with lower abdominal incisions in the surgical treatment of upper urinary tract urothelial cell carcinoma.Methods:The clinical data of 52 patients with renal pelvic and ureteral cancer, who received radical nephrectomy using the retroperitoneal laparoscopy combined with a lower abdomen incision approach in Hubei Provincial General Hospital of Armed Police Force from April 2005 to December 2016, were retrospectively analyzed. All 52 patients had unilateral renal pelvic and ureteral cancer but with no lymph nodes or distant metastasis. During general anesthesia in a healthy side-lying position, patients underwent retroperitoneal laparoscopic radical nephrectomy. The affected ureter was clamped but not disconnected. Renal blood vessels were clamped with Hem-o-lock clips. Renal arteries and veins were cut off. Then the kidney was completely isolated. Three laparoscopic incisions were sutured. After taking the patients to be in the supine position, a 5-6 cm-long incision was made in the lower abdomen on the affected side. The lower ureter was dissociated from the bladder. A 1.5 cm-long bladder wall was dissected in the sleeve manner. The affected kidney and ureter were completely removed from the lower abdomen through the made small incision. A rubber drainage tube was inserted in another incision made at the lower end of the prior incision.Results:Operations were successful in all 52 cases. No cases were converted to open surgery, had blood transfused, or needed secondary surgery. There were no complications such as urinary leakage, incision infection, or massive bleeding. Postoperative pathology reported 41 cases of renal urothelial carcinoma and 11 cases of ureteral urothelial carcinoma. Forty-eight patients provided follow-up data, and four did not because of being lost. One patient died of a cardiovascular accident 13 months after surgery. Cystoscopy revealed that 47 cases had no bladder tumor, local or distant metastasis.Conclusion:The retroperitoneal laparoscopy combined with lower abdominal incisions approach is suitable for radical resection of renal pelvic or ureteral cancer owing to ease in operation, few requirements for surgical instruments, minimal invasion, and rapid recovery.
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Objective To evaluate the effect of plastic surgery for scar contracture after hand burn.Methods Clinical treatment data of 56 patients with scar contracture after hand burn was collected from December 2011 to December 2016.Different surgery methods were adopted to treat the scar contracture after hand burn according to different degree,different sites and different range.Results All cases were operated successfully,and the appearance and function of the hands were almost recovered during the 6 months' follow-up,without contracture again.Conclusion Appropriate surgical programs should be used in scar contracture with different parts and degrees,and reasonable postoperative rehabilitation can improve the function and appearance of hands better,which can avoid secondum contracture.
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Objective To explore the curative effect and security of transurethral holmium laser resection for adult ureterocele.Methods 22 cases with adult ureterocele were retrospectively studied.Eight adult ureterocele cases were male and 14 cases were female.The mean age was 36.5 years (ranged from 20 to 67years).All of the patients were unilateral onset,15 cases on the left side and 7 cases on the right side.The mean course of the disease was 31 months (ranged from 15d to 12 years).The clinical presentations were varied.All 22 cases were treated by tran-surethral holmium laser resection.About one -third of cyst wall were left in order to avoid vesicoureteral reflux and hydronephrosis.Results All 22 cases succeeded uneventfully.The pathologic study confirmed that 22 cases were ure-terocele.The mean hospital stay was 8days (ranged from 6 to 12days).Mean follow -up time was 17 months (12 -26 months),while 2 cases were lost.All 20 cases urine alalysis was normal.Five patients showed no hydronephrosis, while 10 cases showed less hydronephrosis.Cystoscopy showed all 20 cases ureteral healing was smooth,and none showed recurrence of ureterocele.Voiding cystourethrography showed none of vesicoureteral reflux.Conclusion Transurethral holmium laser resection would be a good choice for adult ureterocele,because the treatment has the advantages of simple operation,low requirement of equipment,safety and reliability.Especially for the primary level hospital,transurethral holmium laser resection is worth further clinical promotion.
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Objective To evaluate the clinical application value of flow fluorescence assay in determination of serum pepsinogenⅠ and Ⅱ.Methods The precision of flow fluorescence assay in the detection of serum pepsinogen Ⅰ and Ⅱ were evaluated. Methodology comparison were conducted between flow fluorescence assay and enzyme-linked immunosorbent assay(ELISA)kit through detecting clinical samples.The reference ranges for PGⅠ and PGⅡ/PGⅠ ratio of healthy population were established. The levels of PGⅠand PGⅡ/PGⅠ ratio were detected in serum samples of patients suffering superficial gastritis,atrophic gastritis and gastric cancer.Results The within-run and between-run coefficient of variation of PGⅠ were 4.26%-5.35% and 6.73%-7.75%,respectively.And those of PGⅡ were 5.48% - 6.42% and 8.46% -8.85%,respectively.Methodology comparison be-tween flow fluorescence assay and ELISA demonstrated good linear correlations.The linear equation wasY =0.91 1X -22.635(r=0.966,P <0.05)and Y =0.892X -0.548(r=0.980,P <0.05)for PGⅠ and PGⅡ,respectively.The lower limit of the reference range of PGⅠ and PGⅡ/PGⅠ ratio were 32.77 ng/mL and 4.1 6,respectively.The PGⅠ and PGⅠ /PGⅡ ratio of patients suf-fering atrophic gastritis and gastric cancer were statistically significantly lower than those in patients suffering superficial gastritis (P <0.05).Conclusion The flow fluorescence assay could conduct simultaneous detection of PGⅠ and PGⅡwith good methodo-logical performance and high efficiency.The determination of PGⅠ and PGⅡlevels through flow fluorescence assay could provide laboratory basis for the screening and diagnosis of atrophic gastritis and early gastric cancer.
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Objective To improve the detail of the surgery for cicatricial ectropion,and the the effect was investigated. Methods Based on 46 patients withⅡ,Ⅲdegree cicatricial ectropion admitted to our department,choose the junction of normal skin and scar tissue as the incision line according to the degree of ectropion and local situation,and to reserve and recover the orbicularis oculi muscle as possible. The released areas exceeded separately the external canthus and reached the level of eye fissure,take advantage of full-thickness skin graft to correct the parallel lines and make fixation to the eyelid ectropion fusion skin graft on external canthal ligament. Results After followed up for 6 months to 2 years,46 cases of eyelid skin grafts survived completely and eyelids were in good reduction,with none case of incomplete eyelid closure. Conclusion Choose the surgical incision and the released areas in a proper way to reserve the structural integrity of orbicu-laris muscle and make skin graft fixation to inner and external canthal skin can prevent effectively the recurrence of ectropion and improve surgical progress.
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BACKGROUND:Related studies have showed that poly D,L-lactide-co-glycolide can effectively package antisense oligonucleotides, smal interfering RNA, microRNA. Poly D,L-lactide-co-glycolide can better protect them against the destruction of the enzymes in vivo and have slow the drug release. Therefore, the number of drug administration can be reduced to achieve a long-term and effective therapeutic effect. ＜br> OBJECTIVE:To prepare poly D,L-lactide-co-glycolide-CXCR4-miRNA-nano-particles and to research the characteristics of the prepared nanoparticles. ＜br> METHODS:Poly D,L-lactide-co-glycolide-CXCR4-miRNA nanoparticles were prepared by double emulsion-evaporation process. Ultraviolet spectrophotometry was utilized for measurement of encapsulation efficiency and drug-loading rate, observing the shape of nanoparticles by transmission electron microscope, and measuring the size and distribution of nanoparticles by laser particle size analyzer. Sustained-release characteristics of nanoparticle suspension were observed in phosphate buffer. ＜br> RESULTS AND CONCLUSION:The prepared nanoparticles were spherical-shaped, smooth, evently distributed and inadhesive. The particle size was mainly distributed within 143-502 nm, with an average diameter of 280 nm. The average drug loading was (0.515±0.023)%, the average encapsulation ratio was 50.2%and difference between batches was smal . The nanoparticles could slowly release in vitro and the process initial y experienced the fast-release stage, and then reached a basical y stable platform stage at day 14. These finding indicate that the process to prepare poly D,L-lactide-co-glycolide CXCR4-miRNA-nanoparticles by double emulsion-evaporation is simple. The prepared nanoparticles are wel targeted and exhibit sustained-release effects.
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ObjectiveTo investigate the effects of rosiglitazone, the agent of highly selective peroxisome proliferator-activated receptor-γ agonist, on the renal injury of rats with severe acute pancreatitis. MethodsFifty-four male Wistar rats were randomly (random number) divided into three groups : sham operation group ( SO group), severe acute pancreatitis group ( SAP group ) and rosiglitazone pretreatment group (ROSI group) . Severe acute pancreatitis model was induced by retrograde infusion of 5％ sodium taurocholate into the biliopancreatic duct. Rosiglitazone (6 mg/kg) dissolved in 10％ DMSO were injected into the femoral vein 30 minutes prior to the modeling. The solution of 10％ DMSO was given to rats of SO group and SAP group. Rats were sacrificed 3, 12 and 24 h after modeling. The levels of serum amylase, serum creatinine, urea nitrogen, urinary albumin, urinary lgG and αl-microglobulin were measured and analyzed statistically. Kidney tissue samples were stained respectively with hematoxylin and eosin for histopathological evaluation.Results The levels of serum amylase, serum creatinine, urea nitrogen, urinary albumin, urinary IgG and αl-microglobulin were significantly increased (P ＜ 0. 05 )after modeling, while lesser increases were found in ROSI group 12 h and 24 h after modeling (P ＜0. 05)compared with those in SAP group. ConclusionsRenal injury can be induced by severe acute pancreatitis,while Rosiglitazone protects rats from renal injury in the setting of severe acute panereatitis.
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Objective To explore the surgical treatment of urethral recurrence after neobladder reconstruction in patients with bladder cancer. Methods In 89 consecutive patients with radical cystectomy, 5 patients (5.6%) presented with a noninvasive urethral recurrence at a median of 18 months (range 9 to 32 months). All 5 patients were treated by transurethral resection and intraurethral instillation with hydroxycamptothecin used as initial therapy. Mean follow-up was 37 months (24 - 52 months). Results All the 5 patients survived after the treatment. There was no one showed recurrence or distant metastasis. All the 5 cases achieved continence. Conclusion Urethral preservation at initial therapy for incipient noninvasive urethral recurrence would be a good choice and could maintain the quality of life.
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ObjectiveTo study the methods of how to protect facial nerve function following complete resection of acoustic neurinomas and the value of the techniques of F wave assisted electrophysiological monitoring intraoperatively.Methods Retrospectivelysummarizing theresultsof combining three electrophysiological monitoring techniques such as nasal muscle F wave recording,online EMG and triggered EMG to monitor 46 cases of microoperations for acoustic neurinomas intraoperatively during the period of Feb.2004 to Dec. 2008. Correlating every intraoperative monitoring index with their follow-up results of facial nerve function 1 day and 6 months after their operations.The tendency of the two continuous monitoring techniques between nasal F wave recording and online EMG of facial muscles has also been studied in this paper. Results Among 46 cases of acoustic neurinomas, 45(97.83 %) tumors have been totally resected, and 1 (2.17 %) tumor subtotally resected,lcase (2.17 %)died after operation,and 2ases occurred the leakage of cerebrospinal fluid(CSF) which have been cured through conservative treatment. The whole anatomic protection rate of facial nerve is 97.83 %,and their functional protection rates 6 months after operation are:HB Ⅰ - Ⅱ,75.56 %;Ⅲ-Ⅳ,22.22 % and Ⅴ-Ⅵ,2.22 %.The completely accordant rate between the intraoperative findings of nasal F wave recording and online EMG is 52.17 %, partially accordant rate is 45.65 %, and totally opposite rate is 2.17 % (x2 趋势= 6.113, P ＜0.05). The intraoperative monitoring indexes in nasal muscle F wave recording are correlated well with the facial nerve function in the 6th month' s follow-up (κ=0.429, P ＜0.001).In triggered EMG monitoring after tumors being resected,the stimulus threshold ratio and maximum amplitude ratio of facial nerve between leaving brain stem part and inner acoustic porus part are also correlated well with the facial nerve function 6 months after operation(κ=0.576, P ＜0.001; κ=0.595, P ＜0.001). ConclusionNasal muscle F wa recording cooperated well with online EMG and triggered EMG intraoperatively and correlates well with the postoperative facial nerve function, so they should be routinely applied together intraoperatively.
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Objective To study the changes of coagulation and fibrinolysis in rabbit model of non-overt disseminated intravascular coagulation induced by low-dose endotoxin and therapeutic effects of anticoagulation by heparin.Methods Twelve male rabbits were randomly divided into 2 groups,one receiving endotoxin intravenously(10 ?g/kg,n=6),one receiving endotoxin intravenously and 100 U/kg Heparin simultaneously(n=6).The blood sample obtained before experiment was used as control.Coagulation parameters including prothrombin time(PT),activated partial thromboplastin time(aPTT),thrombin time(TT),fibrinogen concentration,D-dimers,thrombelastography(TEG)were measured during 6 h after endotoxin induction.Tissue specimens of lungs and kidneys were examined.Results Parameters of coagulation deteriorated significantly in the endotoxin-induced rabbits,but was not altered in heparin-treated rabbits.TEG monitoring in the endotoxin-induced rabbits reflected consumption of clot factors and platelet dysfunction,and hypocoagulation status in heparin-treated rabbits.In endotoxin-induced group,fibrin deposition was found in lungs and kidneys.Conclusion Non-overt disseminated intravascular coagulation induced by low-dose endotoxin in rabbits is improved by heparin.