Repair of thumb pulp defect with transposition of pedicled radial proper palmar digital artery flap of middle finger / 中华显微外科杂志

Objective:To explore the surgical method and therapeutic effect of repairing thumb pulp defect with pedicled transposition of radial proper palmar digital artery flap of middle finger.Methods:Since June, 2006 to May, 2020, 17 cases(17 fingers) with thumb pulp defect were repaired by pedicled transposition of radial proper palmar digital artery flap of middle finger. The sizes of flap ranged from 1.5 cm × 1.5 cm to 4.2 cm × 2.0 cm. The antegrade pedicled flap of radial proper palmar digital artery of middle finger was used in 2 cases and the retrograde pedicled flap of middle finger was used in 15 cases. After the flap was resected, the donor sites were covered with a medium thickness skin graft transferred from the wrist or elbow. The skin graft did not need to be packed. The dorsal branch of the digital nerve was included in the flap and it was anastomosed with the proper nerve of the injured thumb stump. After 16-22 days of the operation, the pedicles were cut off. The patients were instructed to perform digit function exercise after the pedicle was cut off. After the operation, the patients were included in regularly follow-up through outpatient visit, telephone or WeChat interview. The appearance and sensation of the thumb and finger pulps and the function recovery of the thumb and finger joints were observed through the followed-ups.Results:All 17 flaps and donor site skin grafts survived over 3 to 32 months of follow-up. The flaps achieved good texture and natural appearance. The TPD recovered to 5~11 mm. According to the Michigan Hand Function Questionnaire, all the 17 patients were very satisfied with the overall appearance and function of the hands. According to TAM, the 17 cases were all in excellent.Conclusion:Repairing thumb pulp defect with radial proper palmar digital artery pedicled flap of middle finger, the flap resection is simple, and the donor site is hidden. The appearance and texture of flap is good. It is a safe, effective and good method.

Surgical Cooperation During Percutaneous Transforaminal Endoscopic Lumbar Discectomy Combined with Radiofrequency / 中国微创外科杂志

[Summary] The study summarized surgical cooperation key points during percutaneous transforaminal endoscopic lumbar discectomy combined with radiofrequency in 60 cases, including preoperative preparation, intraoperative care, and maintenance and sterilization of instruments after the surgery.All the 60 operations were successfully completed, without complications such as intraoperative dural rupture and nerve root injury.Postoperatively, an instant relief of low back pain was obtained and the lower limb straight leg raising test showed negative immediately.The preoperative preparation and proficiency with special surgical skills are conducive to successful operation and improvement of surgical outcomes.

The clinical significance of the serum estradiol-2,tumor necrosis factor-alpha and vascular endothelial growth factor in patients with endometriosis / 中国医师进修杂志

Objective To detect the level of the serum estradiol-2 (E_2), tumor necrosis factor-alpha (TNF- α) and vascular endothelial growth factor (VEGF) in patients with endometriosis (EMS) and explore their clinical significance. Methods Fifty-nine EMS patients from January 2006 to January 2009 were selected as EMS group and 60 normal women were selected as control group. The serum E_2,TNF-αand VEGF in EMS group 24 h pre-operation, 7 d post-operation and 6 months after operation were detected, and compared with control group. Results The levels of the serum E_2[(216.5 ± 59.7) ng/L],TNF- α [(30.4 ± 17.5) μg/L]and VEGF [(250.7 ± 88.7) ng/L]in EMS group pre-operation were significantly higher than those in control group [(100.2 ± 33.2) ng/L, (11.2 ± 3.6) μg/L, (103.2 ± 49.2) ng/L]and post-operation [(121.3±44.6) ng/L, (13.4 ± 6.2) μg/L, (153.9 ± 58.7) ng/L](P < 0.01). But there was no significant difference between control group and post-operation of EMS group (P > 0.05). The levels of the serum E_2 [(316.5 ± 77.6) ng/L],TNF-α [(51.1 ± 12.3) μg/L]and VEGF [(305.1±69.7) ng/L]with stage Ⅲ-Ⅳ in EMS group were higher than those in control group or those with stage Ⅰ - Ⅱ [(170.7±48.2) ng/L, (25.8 ± 10.1) μ g/L, (169.2 ± 36.1) ng/L](P < 0.05 or < 0.01). The levels of the serum E_2,TNF- α and VEGF with stage Ⅰ - Ⅱ in EMS group were also higher than those in control group (P < 0.05). Nine patients recurred at 6 months after the operation. The levels of the serum E_2[(187.8 ± 46.7) ng/L],TNF- α [(23.9 ± 9.5) μg/L]and VEGF [(185.3 ± 57.4) ng/L]of the recurred EMS patients stepped up significantly higher than those of the non-recurred EMS patients [(112.7±30.3) ng/L, (13.2±4.7) μg/L, (116.4±30.3) ng/L](P < 0.01). While there was no significant difference between control group and non-recurred EMS patients (P >0.05). Conclusions The serum E_2,TNF-αand VEGF may play important roles in the development of the EMS. And the detection of the serum E_2,TNF-αand VEGF is useful to judge the patient's condition and the prognosis of the EMS.

Early diagnosis value in of serum lysophosphatidic acid and CA-125 detection ovarian cancer / 中国基层医药

Objective To explore the clinical value of early diagnosis of ovarian cancer by serum lysophosphatidic acid(LPA) and CA-125.Methods 50 patients with ovarian cancer from October 2005 to February 2008 were selected as ovarian cancer group,at the same period selected 44 patients with ovarian benign tumor(ovarian benign disease group),and 50 healthy women as the healthy control group.All patients were diagnosed and confirmed by preoperative blood and pathology.The serum LPA and CA-125 of two groups were detected.Results The serum LPA level and the positive rate in the ovarian cancer group was higher than that of the ovaries benign group or the control group(P＜0.05).The CA-125 level in the ovarian cancer group was similar to that of the ovaries benign group(P＞0.05),while the CA-125 level in the ovarian cancer group or the ovaries benign group was higher than that of the control group(P＜0.05).The specificity of the LPA was better than that of the CA-125 detection.In the early diagnosis of ovarian cancer,the sensitivity of the combination(85.7%) was better than either of them(P＜0.01);the plasma LPA level and positive rate of CA-125 of the phase Ⅱ～Ⅳ ovarian cancer patients were higher than that of phase Ⅰ (P＜0.01);the CA-125 positive rate of the serious cystadenocarcinoma was higher than that of the cystadenocarcinoma(P＜0.01).Conclusion LPA is a sensitive biomarker for the early diagnosis of ovarian cancer,especially combined with CA-125.It should be widely used in clinic.

Detection of alpha-thalassemia gene by coelocentesis in early prenatal diagnosis / 中华围产医学杂志

Objective To investigate the safety and accuracy of diagnosing alpha-thalassemia with extraembryonic coelomic cells. Methods Coelocentesis was performed before artificial abortion to collect extraembryonic coelmic fluid in 40 women with singleton pregnancy during 6-10 gestational weeks. The villi was gathered after suction. PCR technique was used to amplify alpha-thalassemia gene in both extraembryonic coelomic cells and villi and concordant rate of two different kinds of samples were compared. Results The genotypes of alpha-thalassemia were successfully amplified in 37 cases of coelomic cells and all were concordant with the results of villi. Conclusion Extraembryonic coelomic cells can be used in early prenatal diagnosis of alpha-thalassemia by PCR technique and is practicable.