Soft tissue defects around knee joints repaired with thigh distal perforator propeller flap: a report of 72 cases / 中华显微外科杂志

Objective:To evaluate the clinical effect of soft tissue defects around knee joints repaired with thigh distal perforator propeller flap.Methods:Clinical data of 72 patients with defects around knee joints from January, 2009 to October, 2019 were analyzed retrospectively, including 43 males and 29 females, aged from 17 to 83 years. The sizes of soft tissue defects ranged from 4.0 cm×3.0 cm to 22.0 cm×13.0 cm. Perforator propeller flaps were designed and harvested to repair the defects according to anatomical features of the origin, course, branches, distribution and anastomosis of vascular network of the perforator vessels and location as well as the size and shape of defects. Nine patients repaired with the lateral distal perforator propeller flaps (LDF), 53 with descending genicular artery perforator propeller flaps (DGF) and 10 with direct popliteal artery perforator propeller flaps (DPF). The size of flap was 4.5 cm×3.5 cm to 24.0 cm×14.0 cm. The donor sites were sutured directly or covered with free full-thickness skin. To evaluate the effect, the skin swelling rating in early and later stage were taken. Three to 72 months of followed-up was conducted through outpatient clinic (78%), telephone (15%) and WeChat (7%).Results:The flaps totally survived in 65 patients and 7 patients underwent partial necrosis at the distal end of the flaps ( 2 cases of LDF, 4 cases of DGF, 1 case of DPF) who were treated with dressing, and the donor sites were completely healed. The appearance and shape of the repaired knee joints was good, and the color and elasticity was close to surrounding normal skin, TPD of the flaps were 7-10 mm, and the scar was small after 3 to 72 months' follow-up. The efficacy was satisfactory in 48 cases ( 4 cases of LDF, 39 cases of DGF, 5 cases of DPF), general in 24 cases ( 5 cases of LDF, 14 cases of DGF, 5 cases of DPF). Degree of flap swelling: in early stage, I° in 40 cases ( 4 cases of LDF, 31 cases of DGF, 5 cases of DPF), II° in 20 cases ( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF), III° in 10 cases ( 2 cases of LDF, 7 cases of DGF, 1 case of DPF), IV° in 2 cases(1 case of DGF, 1 case of DPF); in later stage: I° in 55 cases ( 6 cases of LDF, 41 cases of DGF, 8 cases of DPF), II° in 15 cases ( 2 cases of LDF, 12 cases of DGF, 1 case of DPF), III° in 2 cases ( 1 case of LDF, 1 case of DPF). The evaluation of knee joint function: excellent in 17 cases ( 2 cases of LDF, 12 cases of DGF, 3 cases of DPF), good in 35 cases( 4 cases of LDF, 27 cases of DGF, 4 cases of DPF), general in 20 cases( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF). The good rate was about 73%. The range of motion and stability of the knee joint were basically normal and there was no pain found to affect study and life. All the patients were satisfied with the effect.Conclusion:Repairing soft tissue defect around knee joint with thigh distal perforator propeller flap is reliable and clinical applicable.

Using the forearm proximal radial inferior cubital artery perforator flap to repair the wound defects of anterior elbow / 中华整形外科杂志

Objective@#To evaluate the design and clinical application of forearm proximal radial inferior cubital artery perforator flap.@*Methods@#The clinical data of 11 patients with defects of anterior elbow from June 2013 to June 2018 were analyzed retrospectively, in which including 8 male and 3 female, mean age is 51.5 years old, ranged from 48 to 76 years old. The sizes of soft tissue defects ranged from 7.5 cm×4.5 cm to 14 cm×7 cm. Forearm proximal inferior cubital artery perforator flaps were used to repair the defects according to flap their location, size and shape, in which the largest is 15 cm×10 cm and the smallest is 7 cm×5 cm. To evaluate the effect according to flap survival, infection control, elasticity and color, appearance, the scar of the donor site, cutaneous sense, and satisfaction of patients. The elbow efficacy and function were evaluated according to Mayo criteria and the swelling degree of flap was also evaluated.@*Results@#All the flaps survived in 11 cases, the incisions in donor and recipient site were primary healing. The survival of flaps is good and the appearance, color and elasticity are close to normal, on the other hand, the scar at the donor site is small after 6 to 36 months follow-up. The efficacy is satisfied in 8 cases, general in 3 cases and no dissatisfactory. The function of elbow is excellent in 4 cases, good in 6 cases and general in 1 case. Skin swelling rating in early stage is 1st degree in 6 cases, 2nd degree in 3 cases, 3rd degree in 2 cases; in later stage is 1st degree in 8 cases, 2nd degree in 2 cases, 3rd degree in 1 case.@*Conclusions@#The anatomic position of forearm proximal radial inferior cubital artery perforator flap is constant, the blood supply is good, and the operation method is simple and safe which could be a new supplementary method and be available for clinical selection to repair the soft tissue defects of elbow.

Disinfection effect and its influencing factors of rural drinking water in Zhejiang Province / 预防医学

Objective@#To learn the disinfection effect and its influencing factors of drinking water in rural areas of Zhejiang Province,so as to provide scientific basis for the control of microbial pollution in drinking water and prevention of waterborne diseases. @*Methods@#A total of 5 299 samples from 879 rural water plants Zhejiang Province were collected by stratified sampling method in 2017. The disinfection effect of water samples was assessed quality according to GB 5749-2006 Hygienic Standards for Drinking Water. Logistic regression models were used to analyze the influencing factors for disinfection effect of rural drinking water. @*Results@#There were 540 rural water plants in Zhejiang Province adopting routine process for water purification,accounting for 61.43%;771 ones using surface water,accounting for 87.72%. About 4 458 samples（84.13%）were disinfected and the qualified rate was 86.05%,22.32% of which were disinfected by chlorine dioxide and the qualified rate was 100.00%. The results of multivariate logistic regression analysis showed that scale of water plant,disinfectant residue,use frequency of disinfection equipment,disinfection,season and source water turbidity were the influencing factors for the disinfection effect of rural drinking water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment and source water turbidity were the influencing factors for the disinfection effect of finished water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors for the disinfection effect of tap water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors forthe disinfection effect of surface water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and pH were the influencing factors for the disinfection effect of groundwater（P<0.05）.@*Conclusion@#The disinfection effect of drinking water in rural areas of Zhejiang Province is associated with source water quality,scale of plants,water purification technique and so on. The disinfection process should be improved,the management of water plants should be strengthened to reduce the risk of microbial contamination.

Investigation on rural environmental sanitation and summer diarrhea among rural residents in Zhejiang Province / 预防医学

Objective @#To understand the status of rural environmental sanitation and summer diarrhea among rural residents in Zhejiang Province,and to provide evidence for improvement of rural environmental sanitation and prevention and control of summer diarrhea. @*Methods @#The stratified random sampling method was used. Five or six counties each were selected from the east,middle and west of Zhejiang Province;five townships（excluded Chengguan Town）were selected from each selected county;four villages were selected as field survey points from each township;five households were selected from each survey point;one family member（householder or housewife）was selected from each selected household. The information about the environmental sanitation status and prevalence of summer diarrhea were obtained by literature review,interviews,questionnaire suvey,field investigation and laboratory tests. Logistic regression model was used to analyze the influencing factors for occurrence of summer diarrhea among rural residents. @*Results @#There were 2 000 households surveyed. In the past two weeks,108 households had families with diarrhea and the prevalence of diarrhea was 5.40%. A total of 1 828 households disposed the household waste in the garbage bins or pools,accounting for 91.40%. There were 1 926 households with organized sewage discharge,accounting for 96.30%. There were 768 households with nymphs found in the kitchen,accounting for 38.40%;404 households with live egg sheaths found,accounting for 20.20%;592 households with cockroach traces found,accounting for 29.60%;564 households with rat traces found,accounting for 28.20%;and 1 206 households with flies found,accounted for 60.30%. There were 1 314 households with disease vectors around the house,accounting for 65.70%. There were 1 944 household with sanitary toilets,accounting for 97.20%. A total of 1 915 households had habits of drinking boiled water,accounting for 96.57%. The results of multivariate logistic regression analysis showed that rat traces found in the kitchen（OR=2.026,95%CI: 1.362-3.013）were a risk factor for summer diarrhea in rural residents,while drinking boiled water（OR=0.272,95%CI: 0.091-0.811）was a protective factor. @*Conclusion @#The sanitary environment and family health habits of rural residents were related to the prevalence of diarrhea in summer. Paying attention to kitchen hygiene and drinking boiled water could prevent summer diarrhea.

Transferring perforator fascial flap to repair skin soft tissue defect around ankle joint in elderly patients / 中华创伤杂志

Objective To evaluate the clinical effect of the perforator fascial flap of the lower leg for the repair of large skin and soft tissue defects around the ankle in the elderly.Methods A retrospective case series study was conducted on the clinical data of 23 elderly patients with skin and soft tissue defect around the ankle joint admitted to Xinhua Hospital (Chongming) Affiliated to Medical College of Shanghai Jiaotong University,from November 2013 to December 2017.There were 13 males and 10 females,aged 65-78 years (mean,71 years).The wound areas around the ankle joint ranged from 13.5 cm × 5.5 cm to 16.0 cm × 8.5 cm.According to the position,size,and shape of the wound area around the ankle joint of the lower leg,the perforator fascia flap was designed and transferred for repairing.The maximum flap area was 17.0 cm × 9.5 cm while the minimum area was 14.0 cm ×6.5 cm.According to the conditions of survivals of the skin flap,elasticity,color,appearance,infection control,donor site scar,skin sensation,joint activity,patient satisfaction,etc.,the ankle and foot function was evaluated by referring to Tornetta and other standards.Besides,the swelling degree of the flap was graded.Results A total of 21 flaps survived and the wound at both donor site and recipient site obtained stage Ⅰ union.Two cases of skin edge necrosis occurred at the distal end of the flap,and the wounds at the donor and recipient sites were completely healed after dressing change.The patients were followed up for 6-48 months,with an average of 15 months.The flaps had good survival,satisfactory shape,and small scar at donor site,with similar elasticity and color with the surrounding normal skin.Twenty patients were satisfied with the efficacy and three were fine with the outcome.In terms of functional evaluation of the ankle and foot,the results were excellent in eight patients,good in 12,and fair in three.Flap swelling grading was as follows:degree Ⅰ in 16 patients,degree Ⅱ in 5,and degree Ⅲ in 2 at the early stage;degree Ⅰ in 20 patients,degree Ⅱ in 2,and degree Ⅲ in 1 at the later stage.Conclusion In repairing large skin and soft tissue defects around the ankle in the elderly,the perforator fascia flap of the lower leg transferring is a convenient,safe,and reliable method with less damage,which can promote the wound healing and functional recovery of ankle and foot.

In situ suturing technique for severe amputation of facial composite tissues in 14 cases / 中华整形外科杂志

Objective@#To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues.@*Methods@#We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017.@*Results@#All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up.@*Conclusions@#In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.

The Impact of Sample-size and Sample-process on Several Usual Importance Evaluate Methods / 中国卫生统计

Objective Implement random sample from a simulation population,to evaluate the The impact of samplesize and sample-process on several usual importance evaluate methods,observe the stability of those methods.Methods This study introduced existed importance methods,using PROC SURVEYSELECT procedure to sample a fixed population for 1000 times,generating 1000 same size sample,to evaluate the stability of relative importance methods.We sampled the population to generate datasets with different sample size to observe impact of sample-size on those methods.Results The sum of squared correlation coefficients' estimator is bigger than model R-square,squared standardized regression coefficients' sum is smaller.In contrary,sum of the Product Measure,Relative Weight and Dominance Analysis are extremely close to model R-square.When the sample size small than 1000,the estimator have obviously variation,but the variation decreased when the sample size rise up.Conclusion The dominance analysis has best stability,also has the best match of model R2 in those methods.

Recent and long-term effection of cesarean section on newborn infants / 中华实用儿科临床杂志

Although the cesarean section has become an effective means to solve dystocia,high - risk pregnan-cy and other critical obstetrical disease,but the morbidity rate and hospitalization rate of newborn did not decreased obviously because of the continuous increasing of cesarean section rate. Contrary,in recent years,many domestic and foreign researches have found that,compared with normal vaginal delivery babies,cesarean section newborn infants have higher related disease incidence rate after birth,especially respiratory distress sydrome,transient tachypnea of newborn infants,persistent pulmonary hypertension and infection,and more attention should be paid to the fact that cesarean section children are more prone to allergic and immune system diseases as well as neuropsychiatric related diseases. Therefore,this article aims at integrating the researches and providing an overview on recent and long - term effection on newborn infants.

Shear stress induces interleukin-8 mRNA expression and transcriptional activation in human vascular endothelial cells / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To examine interleukin-8 (IL-8) mRNA expression induced by flow shear stress in human umbilical vein endothelial cells (HUVECs) and investigate its transcriptional activation.</p><p><b>METHODS</b>Flow laminar shear stress 4.2 dyne/cm(2) was used for the stimulating experiments. The flow shear stress-induced IL-8 mRNA expression was detected by reverse transcription-polymerase chain reaction (RT-PCR). pEGFP1 was used to construct IL-8 reporter gene pEGFP1-IL8USCS for determining IL-8 gene transcriptional activation through gene transfer and flow cytometric analysis. NF-kappaB nuclear translocation was observed by immunocytofluorescent staining. Western blot was used to examine IkappaB phosphorylation and degradation. RT-PCR, Northern blot, immunocytofluorescent staining and laser confocal microscopy were used to determine Toll-like receptor-4 (TLR-4) expression at mRNA and protein levels in the cells.</p><p><b>RESULTS</b>There was a marked increase in IL-8 mRNA expression in HUVECs after 120 min of exposure to laminar flow shear stress. When exposed to shear stress for 180 min, there was an increase in enhanced green fluorescent protein expression in pEGFP1-IL8USCS-transfected endothelial cells. NF-kappaB p65 immunocytofluorescent staining of HUVECs showed that when exposed to the same flow shear stress for 30 or 60 min, the cell nuclei became stained; after 90 or 120 min, the staining became much more pronounced. A significant increase in P-IkappaB in the cell lysates occurred after 10 min of exposure while blot density dramatically dropped after 60 min of exposure. The density of the IkappaB blot dropped with increasing exposure time after 30 min. TLR-4 was present on the surface of HUVECs. HUVECs constitutively expressed TLR-2 and TLR-4 mRNA; when exposed to flow shear stress for 60 min, TLR-4 mRNA expression increased.</p><p><b>CONCLUSION</b>NF-kappaB activation is involved in flow shear stress-induced IL-8 mRNA expression in human umbilical vein endothelial cells. TLR-4 receptor for innate immunity most likely mediate these events.</p>