Using the posterior tibial artery and peroneal artery perforator flaps to repair heel wounds: 18 cases report / 中华显微外科杂志

To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue de-fect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respec-tively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm.After operation, the patients were followed-up regularly.The time of wound healing, appear-ance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps sur-vived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later.Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally.All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvi-ous limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Or-thopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair.The flap is based on a long vascular pedicle.And the clinical effect is satisfied.

Free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar / 中华显微外科杂志

Objective To explore the surgical technique and clinical effects of free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar.Methods From February,2014 to July,2016,dorsal tendon and soft tissue defect of ophisthenar in 13 cases was repaired by free anterolateral thigh flaps with fascia lata.The area of soft tissue defect was 5.0 cm×6.0 cm-9.0 cm×12.0 cm.Extensor tendon defect and bone exposure occurred in all cases.The area of flap was 6.0 cm×7.0 cm-10.0 cm×13.0 cm,while the area of anterolateral thigh flap was 3.0 cm×4.0 cm-6.0 cm×8.0 cm.The regular post-operatively followed-up was performed.Results All flaps survived.The donor sites healed well without skin graft.The followed-up time was 6-36 months with the average of 13 months.The appearance of the flap was good.The color and texture of flaps was similar to the dorsal skin of ophisthenar.Three female patients who were not satisfied with the flap appearance received the revision and the results were satisfactory.The activity of finger flexion and extension was satisfactory.All patients walked well without difficulty.According to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,the function recovery result was excellent in 8 cases,good in 4 cases,and poor in 1 case.Conclusion It is a good method to use the free anterolateral thigh flaps with fascia lata to repair of dorsal tendon and soft tissue defect of ophisthenar.

Multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds / 中华烧伤杂志

Objective@#To explore the effects of multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds.@*Methods@#From November 2017 to December 2018, eight cases with eighteen hand wounds were hospitalized in our unit. Among them, wounds were distributed in the forefinger and middle finger in four cases, wounds were distributed in the middle finger and ring finger in two cases, wounds were distributed in the forefinger, middle finger, and ring finger in one case, and wounds were distributed in the middle finger, ring finger, and little finger in one case. The area of skin defect ranged from 1.5 cm×0.8 cm to 4.0 cm×3.0 cm. There were 4 males and 4 females, aged 34-62 years. Wounds of six cases were repaired by two free superficial peroneal artery perforator flaps from homolateral crus, and those of two cases were repaired by three free superficial peroneal artery perforator flaps from homolateral crus. Superficial peroneal artery and its accompanying vein of flap were anastomosed by end to end with digital artery and palmar or dorsal subcutaneous vein of recipient site during the operation. The area of flap ranged from 2.5 cm×1.2 cm to 5.0 cm×4.0 cm. No nerve was harvested during the operation, and donor site was sutured directly. The survival of the flaps and the healing of donor sites were recorded. During follow-up, the recovery of donor and recipient sites was observed.@*Results@#All flaps survived well, donor site healed well. No vascular crisis occurred. Follow-up for 4 to 12 months showed that the appearance of flap was satisfactory with good color, texture, elasticity, and function. Protective sensation of recipient site was recovered. Five months after operation, flap of finger pulp in one case was swollen slightly with two-points discrimination of 10 mm, which received the thinning surgery. Obvious scar formation was not observed in donor site of crus. The appearance of the donor site was good without functional damage.@*Conclusions@#The application of multiple free homologous superficial peroneal artery perforator flaps of crus to repair the multiple hand wounds has advantages of easy acquisition, easy operation, little effect on donor sites, and satisfactory clinical effects.

Establishment of comprehensive prediction model of acute gastrointestinal injury classification of critically ill patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To develop the comprehensive prediction model of acute gastrointestinal injury (AGI) grades of critically ill patients.</p><p><b>METHODS</b>From April 2015 to November 2015, the binary channel gastrointestinal sounds (GIS) monitor system which has been developed and verified by the research group was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of Chinese PLA General Hospital. Also, the AGI grades (Grande I(-IIII(, the higher the level, the heavier the gastrointestinal dysfunction) were evaluated. Meanwhile, the clinical data and physiological and biochemical indexes of included patients were collected and recorded daily, including illness severity score (APACHE II( score, consisting of the acute physiology score, age grade and chronic health evaluation), sequential organ failure assessment (SOFA score, including respiration, coagulation, liver, cardioascular, central nervous system and kidney) and Glasgow coma scale (GCS); body mass index, blood lactate and glucose, and treatment details (including mechanical ventilation, sedatives, vasoactive drugs, enteral nutrition, etc.) Then principal component analysis was performed on the significantly correlated GIS (five indexes of gastrointestinal sounds were found to be negatively correlated with AGI grades, which included the number, percentage of time, mean power, maximum power and maximum time of GIS wave from the channel located at the stomach) and clinical factors after standardization. The top 5 post-normalized main components were selected for back-propagation (BP) neural network training, to establish comprehensive AGI grades models of critically ill patients based on the neural network model.</p><p><b>RESULTS</b>The 60 patients aged 19 to 98 (mean 54.6) years and included 42 males (70.0%). There were 22 cases of multiple fractures, 15 cases of severe infection, 7 cases of cervical vertebral fracture, 7 cases of aortic repair, 5 cases of post-toxicosis and 4 cases of cerebral trauma. There were 33 emergency operation, 10 cases of elecoperectomy and 17 cases of drug treatment. There were 56 cases of diabetes(93.3%). Forty-five cases (75.0%) used vasoactive drugs, 37 cases (61.7%) used mechanical ventilation and 44 cases (73.3%) used enteral nutrition. APACHE II( score were 4.0 to 28.0(average 16.8) points. Four clinical factors were significantly positively related with AGI grades, including lactic acid level (r=0.215, P=0.000), SOFA score (r=0.383, P=0.000), the use of vascular active drugs (r=0.611, P=0.000) and mechanical ventilation (r=0.142, P=0.014). In addition to the five indexes of gastric bowel sounds which were found to be negatively correlated with AGI grades, the characteristics of 333 by 9 were composed of these nine indexes with high correlation of AGI grades. Five main components were selected after principal component analysis of these nine correlated indexes. A comprehensive AGI grades model of critically ill patients with a fitting degree of 0.967 3 and an accuracy rate of 82.61% was built by BP artificial neural network.</p><p><b>CONCLUSION</b>The comprehensive model to classify AGI grades with the GIS is developed, which can help further predicting the classification of AGI grades of critically ill patients.</p>

Establishment of prediction model of acute gastrointestinal injury classification of critically ill patients based on digital gastrointestinal sounds monitoring / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To develop the prediction model of acute gastrointestinal injury (AGI) classification of critically ill patients.</p><p><b>METHODS</b>The binary channel gastrointestinal sounds (GIS) monitor system was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of PLA General Hospital from April 2015 to November 2015 (patients with chronic gastrointestinal disease or history of gastrointestinal surgery were excluded). Meanwhile, the AGI grades were evaluated according to the ESICM guidelines of AGI grading system. Correlations between GIS and AGI classification were examined with Spearman rank correlation. Then principal component analysis was performed on the significantly correlated parameters after standardization. The top 3 post-normalized main components were selected for back-propagation (BP) neural network training to establish primary AGI grade model of critically ill patients based on the neural network model.</p><p><b>RESULTS</b>A total of 1 132 GIS and 333 AGI were collected from 60 patients. The number (P = 0.0005), percentage of time (P = 0.0004), mean power (P = 0.0088), maximum power (P = 0.0101) and maximum time (P = 0.0025) of GIS wave from the channel located at the stomach were negatively correlated with the AGI grades, while the parameters of GIS wave from the channel located at the intestine had no significant correlation with the AGI grades(all P > 0.05). Three main components were selected after principal component analysis of these five correlated parameters. An AGI grade network model including 9 hide layers, with a fitting degree of 0.981 64 was built by BP artificial neural network based on the analysis of these three main components of GIS. The accuracy rate of the model to predict the AGI grade was 70.83%.</p><p><b>CONCLUSION</b>The preliminary model based on GIS in classifying AGI grade is established successfully, which can help predict the classification of AGI grade of critically ill patients.</p>

Tolerance of patients with chronic liver diseases undergoing gynecologic laparoscopic operations / 中国综合临床

Objective To investigate the liver function of patients with chronic liver diseases undergoing gynecologic laparoscopic operations.Methods Twenty-six asymptomatic HBV carriers,28 mild chronic hepatitis,21 compensatory cirrhosis were assigned to undergo gynecologic laparoscopic operations.Liver function were tested and compared in these three groups before operation and on the 1st、3rd、7th day after operation.Results 1st day after operation,ALT and AST in asymptomatic carriers and mild chronic hepatitis groups were significantly higher than preoperation ( asymptomatic carriers:ALT P ＜ 0.05,AST P ＜ 0.05 ; mild chronic hepatitis:ALT P ＜ 0.05,AST P ＜ 0.05 ).Then they recovered on the 3rd day after operation ( asymptomatic carriers:ALT P ＞ 0.05,AST P ＞ 0.05 ; mild chronic hepatitis:ALT P ＞ 0.05,AST P ＞ 0.05 ).ALB,total bilirubin (Tbil) after operation were not significantly different from those before operation on every tested day in these two groups ( asymptomatic carriers:ALB P ＞ 0.05,Tbil P ＞ 0.05 ; mild chronic hepatitis:ALB P ＞ 0.05,Tbil P ＞ 0.05 ).In compensatory cirrhosis group,ALT,AST,Tbil were significantly higher on the 1st day,3rd day after operation than preoperation ( 1st day:ALT P ＜0.01,AST P ＜0.01,Tbil P ＜0.01 ;3rd day:ALT P ＜ 0.05,AST P ＜ 0.05,Tbil P ＜ 0.05 ).ALB levels were significantly lower on the 1st day,3rd day after operation than preoperation ( 1st day:P ＜0.01 ;3rd day:P ＜0.05 ).All the indexes recovered to the levels of preoperation on the 7th day after operation( ALT P ＞ 0.05,AST P ＞ 0.05,Tbil P ＞ 0.05,ALB P ＞0.05).Conclusions To some extent,gynecologic laparoscopic operations have some adverse effects on short-term liver function after operation in patients with chronic liver diseases.Compensatory cirrhosis patients present delayed recovery compared with asymptomatic carriers and mild chronic hepatitis patients.

Study of relationship between IL-18 and IFN therapy of chronic hepatitis B / 中国免疫学杂志

Objective:To evaluate the possible roles of IL-18 in HBV infection, and to clarify the immune state during IFN? therapy. Methods:Peripheral blood lymphocytes from 2 groups of HBV infectors(including 15 asymptomatic carriers,26 patients with chronic hepatitis B) and 10 healthy individuals (as normal controls) were analyzed by flow cytometry. The levels of IL-18 were also detected before, during, and at the end of IFNa therapy,Results: (1)The level of IL-18 was the lowest in asymptomatic carrier group. However there was no significant difference between chronic hepatitis and normal control. (2)The patients with chronic hepatitis were further divided into 4 subgroups according to the inflammation degree of liver. Results showed that the severity degree of liver inflammation was accompanied with the elevation of IL-18 production. (3)IL-18 in chronic hepatitis B correlated with serum ALT positively ( r = 0.61,P

Effect of laparoscopic surgery on the balance of Th1/Th2 cells in patients with uterine myomas / 中国免疫学杂志

Objective:To investigate the influences of laparoscopic surgery on Th1/Th2 balance in patients with uterine myomas.Methods:In a prospective study,the number of the Th subsets,Th1/Th2 ratio,the serum level of IL-18 and IL-10 in 20 patients submitted to laparoscopic operation and 20 patients undergoing conventional open operation were evaluated preoperatively as well as 2,24,48 h postoperatively.Results:The level of Th1 cell,IL-18,and the Th1/Th2 ratio decreased significantly (laparoscopic group: P