The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

Antitumor activity of aumolertinib, a third-generation EGFR tyrosine kinase inhibitor, in non-small-cell lung cancer harboring uncommon EGFR mutations

Uncommon epidermal growth factor receptor (EGFR) mutations account for 10%-20% of all EGFR mutations in non-small-cell lung cancer (NSCLC). The uncommon EGFR-mutated NSCLC is associated with poor clinical outcomes and generally achieved unsatisfactory effects to the current therapies using standard EGFR-tyrosine kinase inhibitors (TKIs), including afatinib and osimertinib. Therefore, it is necessary to develop more novel EGFR-TKIs to treat uncommon EGFR-mutated NSCLC. Aumolertinib is a third-generation EGFR-TKI approved in China for treating advanced NSCLC with common EGFR mutations. However, it remains unclear whether aumolertinib is effective in uncommon EGFR-mutated NSCLC. In this work, the in vitro anticancer activity of aumolertinib was investigated in engineered Ba/F3 cells and patient-derived cells bearing diverse uncommon EGFR mutations. Aumolertinib was shown to be more potent in inhibiting the viability of various uncommon EGFR-mutated cell lines than those with wild-type EGFR. And in vivo, aumolertinib could also significantly inhibit tumor growth in two mouse allograft models (V769-D770insASV and L861Q mutations) and a patient-derived xenografts model (H773-V774insNPH mutation). Importantly, aumolertinib exerts responses against tumors in advanced NSCLC patients with uncommon EGFR mutations. These results suggest that aumolertinib has the potential as a promising therapeutic candidate for the treatment of uncommon EGFR-mutated NSCLC.

Systematic review of Shenqi Fuzheng Injection combined with chemotherapy for treatment of breast cancer / 中国中药杂志

Databases including China Biological Medicine database(CBM), Chinese scientific journals full-text database(VIP), China National Knowledge Infrastructure database(CNKI), WanFang Data, PubMed, and EMbase were searched from inception to March 2018 to collect the randomized controlled trials(RCTs) on Shenqi Fuzheng Injection combined with chemotherapy for the treatment of breast cancer. All included studies were critically appraised by two independent reviewers by following the cochrane systematic review method and using Revman 5.3 software and State 12.0 for data analysis. After screening, 20 RCTs involving 2 095 patients were included in the study. Meta-analysis showed that as compared with control group of chemotherapy alone, Shenqi Fuzheng Injection combined with chemotherapy could improve the clinical curative efficiency, the KPS score, and immune function indexes such as total T cells, Th cells and Ts cells; inhibit the decline of white blood cells(WBC), platelets in blood system, T-lymphocyte subsets such as CD3~+, CD4~+, CD4~+/CD8~+, alleviate myelosuppression and reduce the incidence of side effects such as gastrointestinal adverse reaction, liver and kidney dysfunction and abnormal electrocardiogram. The results revealed that for clinical breast cancer patients, Shenqi Fuzheng Injection combined with chemotherapy could significantly improve its clinical efficacy and reduce adverse reactions. However, the conclusions still need to be verified by high-quality, multi-center, large-sample, prospective, randomized and double-blind clinical trials. In conclusion, this study has systemically evaluated the efficacy and safety of Shenqi Fuzheng Injection combined with chemotherapy in treatment of breast cancer and provided the reference of evidence-based medicine for safe and effective clinical application of medicines.

Exploration on acupoint-selection patterns based on data mining for the treatment of chronic atrophic gastritis / 针灸推拿医学（英文版）

Objective: To analyze the features and patterns of acupoint selection in acupuncture-moxibustion treatment of chronic atrophic gastritis (CAG) by data mining technique. Methods:Relevant clinical studies published before 25 June, 2017 were searched in databases including PubMed, EMBASE, Cochrane library, Chinese Biomedical Literature Database (CBM), China National Knowledge infrastructure (CNKI), and Wanfang Academic Journal Full-text Database (Wanfang). Results:A total of 122 papers were included, involving 69 points. It was found that the top three points on the frequency list were Zusanli (ST 36), Zhongwan (CV 12) and Weishu (BL 21). The points selected were distributed in 11 meridians, in which the Stomach Meridian of Foot Yangming, Conception Vessel, and Bladder Meridian of Foot Taiyang ranked the top and accounted for 74.0％ of the total frequency. Of the involved specific points, Five Shu-Transmitting points, crossing points and Back-Shu points ranked the top, accounting for 47.1％. The analysis of association pattern has shown that Zusanli (ST 36) and Zhongwan (CV 12) won the highest support rate in the paired groups; Zusanli (ST 36), Weishu (BL 21) and Zhongwan (CV 12) had the highest support rate among the point groups. The Five Shu-Transmitting points and the Lower He-Sea points had the highest support rate among the specific point groups. Conclusion: The data mining results of the studies on acupuncture-moxibustion for CAG are substantially in line with the acupuncture-moxibustion treatment theories in traditional Chinese medicine. The results can reflect the acupoint selection patterns in treatment of CAG and provide reference for acupuncture-moxibustion treatment of CAG in clinic.

Therapeutic effect of compound Danshen dripping pills combined atorvastatin on coronary heart disease complicated hyperlipidemia and its influence on serum TRAIL level / 心血管康复医学杂志

Objective :To explore therapeutic effect of compound Danshen dripping pills combined atorvastatin on cor-onary heart disease (CHD) complicated hyperlipidemia and its influence on serum level of tumor necrosis factor-re-lated apoptosis inducing ligand (TRAIL).Methods : A total of 109 CHD patients with hyperlipidemia treated in our department of cardiology were collected ,randomly divided into atorvastatin group (n＝57) and combined treatment group (n＝ 52 ,received atorvastatin combined compound Danshen dripping pills ) ,both groups were continuously treated for three months .Cardiac function ,levels of blood lipids ,serum tumor necrosis factor (TNF)-α ,TRAIL and quality of life (QOL ) were measured and compared between two groups before and after treatment .Results :Compared with before treatment ,there were significant improvements in cardiac function and blood lipid levels , and significant reductions in serum levels of TNF-α and TRAIL in two groups after treatment , P＝0-001 all ;com-pared with atorvastatin group after treatment ,there were significant rise in cardiac output [ (4-1 ± 0-8) L／min vs. (4-9 ± 0-6) L／min] ,cardiac index [ (3-9 ± 0-6) L·min-1 ·m-2 vs.(4-2 ± 0-7) L·min-1 ·m-2 ] ,LVEF [ (52-4 ± 1-6)% vs.(59-6 ± 1-5)%] ,serum HDL-C [ (1-5 ± 0-4) mmol／L vs.(1-9 ± 0-5) mmol／L] and QOL [ (6-2 ± 0-8) scores vs .(7-1 ± 1-1) scores] ,and significant reductions in LVEDd [ (5-4 ± 0-6) cm vs.(5-0 ± 0-7) cm] ,serum levels of TC [ (4-1 ± 0-7) mmol／L vs.(3-7 ± 0-9) mmol／L] ,TG [ (1-4 ± 0-6) mmol／L vs.(1-1 ± 0-5) mmol／L] , LDL-C [ (2-9 ± 0-8) mmol／L vs .(2-4 ± 0-8) mmol／L] ,TNF-α [ (52-1 ± 12-6) ng／L vs.(41-3 ± 14-2) ng／L] and TRAIL [ (44-7 ± 24-1) pg／ml vs.(34-1 ± 26-6) pg／ml] in combined treatment group , P＜0-05 or ＜ 0-01- Conclusion : Compound Danshen dripping pills combined atorvastatin can significantly improve heart function ,re-duce blood lipid levels and improve quality of life in CHD patients with hyperlipidemia .

Systematic review on efficacy and safety of Danshen Chuanxiongqin Injection in treatment of acute cerebral infarction / 中国中药杂志

To systemically evaluate the therapeutic efficacy and safety of Danshen Chuanxiongqin Injection in treatment of acute cerebral infarction and provide the reference of evidence-based medicine for its clinical safety and effective drug use. Databases including CNKI, WanFang Data, SinoMed, the Cochrane Library, EMbase and PubMed were searched from inception to April 2018 to collect the randomized controlled trials (RCTs) on Danshen Chuanxiongqin Injection in the treatment of acute cerebral infarction. The quality of all included studies was evaluated by two independent reviewers following the cochrane systematic review method and using Revman5.3 software and State13.0 for Meta-analysis. A total of 30 RCTs involving 3 233 patients with acute cerebral infarction were included in the study after literature quality evaluation. Meta-analysis showed that as compared with the control group of conventional western medicine alone, Danshen Chuanxiongqin Injection combined with conventional western medicine can achieve better efficacy in treatment of acute cerebral infarction, increase the clinical total effective rate (RR=1.22, 95% CI [1.18, 1.27], <0.000 01) and activities of daily living (MD=9.42, 95% CI [8.12, 10.72], <0.000 01), and improve the degree of neurological impairment (MD=-3.99, 95% CI [-4.89, -3.07], <0.000 01). Furthermore, the result showed that Danshen Chuanxiongqin Injection in the treatment of acute cerebral infarction can significantly decrease the whole blood high-shear viscosity, whole blood low-shear viscosity, plasma viscosity, fibrinogen level and other hemorheological indexes (<0.01). This Meta-analysis demonstrated that Danshen Chuan xiongqin injection in the treatment of acute cerebral infarction is safe and effective, but lacks the large multicenter clinical randomized trials to support the treatment outcome.

Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer / 中华医学杂志(英文版)

<p><b>Background</b>The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer.</p><p><b>Methods</b>Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0.</p><p><b>Results</b>Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30-74 months).</p><p><b>Conclusion</b>With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.</p>

Characteristics and Impact Factors of Renal Threshold for Glucose Excretion in Patients with Type 2 Diabetes Mellitus

Sodium glucose co-transporter 2 (SGLT-2) inhibitors are newly developed but promising medicine for type 2 diabetes. However, patients with a different renal threshold for glucose excretion (RT(G)) may have a different reaction to this medicine. Therefore, the objective of this study was to investigate the characteristics of RT(G) and its impact factors in patients with type 2 diabetes mellitus (T2DM). The clinical and laboratory data of 36 healthy individuals and 168 in-hospital patients with T2DM were collected and analyzed, RTG was calculated using blood glucose (BG) measured by dynamic BG monitoring, urinary glucose excretion (UGE) and estimated glomerular filtration rate (eGFR). The characteristics of RT(G) were investigated. The risk factors for high RT(G) were analyzed using non-conditional logistic regression analysis. Our results found that RT(G) of the T2DM group was higher than that of the healthy individuals (P < 0.05); and 22.22% from the healthy individuals group but 58.33% from the T2DM group had high RT(G). Age, duration of diabetes, body mass index (BMI), and homeostasis model assessment insulin resistance index (HOMA-IR) were independently associated with high RT(G) (P < 0.05). Further stratified analysis revealed that RT(G) in T2DM patients increased with age, duration of diabetes, and BMI. In conclusion, RT(G) is increased in patients with T2DM, especially in those with longer diabetic duration, higher BMI, and those who are older. Therefore, these patients may be more sensitive to SGLT-2 inhibitors.

Role of MicroRNAs in Malignant Glioma / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>This overview seeked to bring together the microRNA (miRNA) researches on biogenesis and bio-function in these areas of clinical diagnosis and therapy for malignant glioma.</p><p><b>DATA SOURCES</b>Using the keyword terms "glioma" and "miRNA," we performed the literature search in PubMed, Ovid, and web.metstr.com databases from their inception to October 2014.</p><p><b>STUDY SELECTION</b>In screening out the quality of the articles, factors such as clinical setting of the study, the size of clinical samples were taken into consideration. Animal studied for verification and reviews article were also included in our data collection.</p><p><b>RESULTS</b>Despite many advance in miRNA for malignant glioma, further studies were still required to focus on the following aspects: (i) Improving the understanding about biogenesis of miRNA and up-down regulation; (ii) utilizing high-throughput miRNA expression analysis to screen out the core miRNA for glioma; (iii) Focusing related miRNAs on the signal transduction pathways that regulate the proliferation and growth of glioma.</p><p><b>CONCLUSIONS</b>We discussed the most promising miRNA, correlative signaling pathway and their relation with gliomas in the way of prompting miRNA target into being a clinical therapeutic strategy.</p>

Finite element analysis on anterior and posterior internal fixation for treating type ⅡHangman’s fracture / 医用生物力学

Objective To evaluate biomechanical differences between anterior titanium plate internal fixation and posterior pedicle screw internal fixation for treating type Ⅱ unstable Hangman’s fracture by finite element analysis. Methods An intact finite element model of the upper cervical spine (C0-3) was established and validated, and an unstable model was also established. Two different internal fixation models, i.e. anterior titanium plate+Cage with bone graft (Plate+Cage) and C2 pedicle screws+C3 lateral mass screws (C2PS+C3LMS) were established, respectively, based on the unstable model. The vertical load of 40 N was applied on the occiput to simulate head weight and 1.5 N•m torque was applied on the occiput to simulate loading conditions of flexion, extension, lateral bending and rotation. Range of motion (ROM) of C2-3, force pathway and strain at the fractured line were calculated and analyzed. ResultsCompared with the unstable model, the Plate+Cage model could decrease the ROM by 92.4%, 97.1%, 96.5% and 90.0%, while the C2PS+C3LMS model could decrease the ROM by 88.6%, 90.2%, 95.7% and 90.3%, in flexion, extension, lateral bending and axial rotation, respectively. The maximum stress of the Plate+Cage model was smaller than that of the C2PS+C3LMS model under 4 loading conditions. Conclusions The anterior Plate+Cage fixation possesses better stability than the posterior C2PS+C3LMS fixation in flexion and extension, while both fixation methods show similar stability in lateral bending and axial rotation. The anterior Plate+Cage fixation is more reasonable in structure and stress distributions, and can achieve reduction, decompression, fixation and fusion in one step, thus it is an effective operative procedure for treating typeⅡ Hangman’s fracture.

Surgical management of postoperative stricture of anastomosis after operation of intersphincteric resection for lower rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study surgical treatment of postoperative stricture of anastomosis for lower rectal cancer.</p><p><b>METHODS</b>The data of 9 cases who were diagnosed as postoperative stricture of anastomosis after operation of intersphincteric resection for lower rectal cancer during January 2008 to June 2011 were analyzed retrospectively. Transanal excision of stricture were used in 3 cases diagnosed as membranous stricture. Transanal radial incision of stricture were used in 5 cases diagnosed as tubulous stricture. Biologic patch was used to repair the defect of the posterior wall of rectum after excision of severe stricture in 1 case.</p><p><b>RESULTS</b>All 9 cases of postoperative stricture of anastomosis were cured by surgery. Anal dilation were performed every day by patients themselves after discharge. Digital examination showed that 1 to 2 fingers could pass through the anastomosis after operation. The patient whose rectal defect was repaired by biological patch underwent colonoscopy examination two weeks after operation. Colonoscopy showed that the biological patch had been filled with granulation and integrated into the surrounding intestinal tissue. All patients defecated without difficulty and the anal function of all patients was good after restoration of intestinal continuity.</p><p><b>CONCLUSION</b>Aggressive surgery, combining with the use of biological patch if necessary is an effective therapy of postoperative stricture of anastomosis for lower rectal cancer.</p>

Gene sequence analysis and prokaryotic expression of sigmaB protein of Muscovy duck reovirus YB strain / 病毒学报

Muscovy ducks reovirus (DRV) is an important pathogen with a high mortality rate in Muscovy ducks, the researches in the test and the immunity were useful for the prevention and control of DRV infection. In this study, the S3 genes of the three Fujian DRVs were cloned by RT-PCR and sequencing technology. It was found that DRV-YH and YJL were close to avian reovirus (ARV) in the genetic distance, with high identities ranged from 94. 6% to 98. 9%, however, the identities of DRV-YB strain and reference ARV strains in the S3 gene were only 60.6% - 61.7%. The expression vector pET-30a-S3 harboring DRV YB strain S3 gene was constructed and transformed into E. coli BL21, and then the fusion sigmaB protein expression was induced with IPTG. The SDS-PAGE of the expressed products indicated that the fusion protein of approximately 42ku in molecular weight was expressed highly in inclusion body, and made up 67. 7% of the total proteins. The most efficient concentration of IPTG and inducing time were 0. 1 mM and 5h respectively, while the best temperature for expression was 37 degrees C. After purification with the Ni2+ affinity chromatography, the fusion sigmaB protein was 93% of the total proteins, and the purified protein amounted to 0. 86g/L. The Western blot analysis showed that the fusion aB protein was recognized specifically by the antiserum against DRV, confirming that the recombinant fusion protein had good immunoreactivity.

Technical improvements and results of individual cylindrical abdominoperineal resection for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer.</p><p><b>METHODS</b>From June 2011 to February 2012, 11 patients with locally advanced low rectal cancer underwent individual CAPR. There were 7 male and 4 female patients, aged from 32 to 74 years with a median of 64 years. Forty-seven patients underwent classic CAPR from January 2008 to February 2012. Preoperative and postoperative parameters such as clinical information of patients, tissue morphometry and complications were compared.</p><p><b>RESULTS</b>In the individual surgical group, 6 patients were treated with one side levator ani muscle totally or partially reserved, 3 patients with sacrococcyx reserved, and 2 patients with dissection close to the anterior rectal wall. Compared with classical surgery, the individual surgical specimens of horizontal section area ((2197 ± 501) mm(2)) and intrinsic muscle layer outer area ((1722 ± 414) mm(2)) were small, but the difference was not statistically significant (P = 0.150 and 0.167). The operative time, intraoperative blood loss, circumferential resection margin, total cross sectional tissue area, cross sectional tissue area outside the muscularis propria and bowel perforation rate between the two groups were not significantly different. Individual CAPR showed less incidence of chronic perineal pain (2/11, χ(2) = 6.116, P = 0.013) and sexual dysfunction (2/9, χ(2) = 4.412, P = 0.036) compared with classic CAPR.</p><p><b>CONCLUSIONS</b>Individual CAPR has the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influencing the radical effect when compare with classic CAPR for the treatment of low rectal cancer.</p>

Ribosome display screening of a novel human anti-IgE scFv fragment / 药学学报

Total mRNA was extracted from lymphocytes separated from the peripheral blood of allergic patients, and then variable region of heavy chain (VH) and variable region of light chain (VL) cDNA library were constructed by RT-PCR. Human scFv templates for rabbit reticulocyte lysate ribosome display were assembled by primers and linker peptide (Gly4Ser)3. mRNA bound in antibody-ribosome-mRNA complexes was recovered using in-situ single primer RT-PCR, and three rounds of anti-IgE scFv DNA were enriched. The target DNA fragments were double enzyme digested and ligated into plasmid pET22b (+), followed by transformation in E. coli Rosseta (DE3). Positive clones were screened using clone PCR, Dot blotting and antigen ELISA. The correct lengths of VH (400 bp) and VL (710 bp) PCR products were obtained. The expected 1,000 bp ribosome display templates were also observed in agarose gel electrophoresis. After three rounds of ribosome display target sequences were effectively enriched, leading to a library of 10(13) members. Antibodies with the highest ELISA value for IgE were generated in the strain pET-IgE-6. A human anti-IgE scFv library was successfully constructed as described herein. Ribosome display using single primer in-situ RT-PCR as the recovery procedure effectively enriched target sequences. Anti-IgE scFv with high affinity and specificity were identified. The prepared human anti-IgE scFv fragment might be self-developed to a lead drug for treating asthma. Our study provides an alternative method for rapid discovery of human antibodies of therapeutic importance.

Reconstruction of combined skin and bilateral artey defects at palmar side of fingers by free posterior interrosseous artery flap in a bridge fashion / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and therapeutic effect of free posterior interrosseous artery flap in a bridge fashion for combined skin and bilateral artery defects at palmar side of fingers.</p><p><b>METHODS</b>6 cases with combined skin and bilateral artery defects at palmar side of fingers were treated with long-pedicled free posterior interrosseous artery flap in a bridge fashion. The flap size ranged from 3.5 cm x 2.0 cm to 6.5 em x 3.0 cm. The wounds at donor sites were closed directly.</p><p><b>RESULTS</b>All the 6 flaps survived completely without any complication, and the wounds healed primarily. The blood supply and vein drainage in all the 6 fingers were normal. 4 cases were followed up for 1-12 months (average, 7 months). Satisfactory cosmetic and functional results were achieved. The flaps looked a little bit thicker than the surrounding tissue.</p><p><b>CONCLUSIONS</b>The long-pedicled free posterior interrosseous artery flap in a bridge fashion is a good option for reconstruction of the combined skin and bilateral artery defects at palmar side of fingers in one stage.</p>

Repair of finger soft tissue defects using axial pattern flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and effect of different types of axial pattern flaps in repairing soft tissue defects of the fingers.</p><p><b>METHODS</b>Five types of axial pattern flaps were used to repair soft tissue defects of the fingers of 30 patients admitted to the Second Hospital of Shaoxing Municipality from 2005 to 2010, including distally-based dorsal thumb neurocutaneous vascular flaps in 4 cases, free flaps from the fibular side of the great toe in 6 cases, modified retrograde dorsal metacarpal artery flaps in 8 cases, free flaps based on the radial dorsal septum muscular perforator of the posterior interosseous artery in 6 cases, and free posterior interosseous artery flaps carrying a long segment of the posterior interosseous artery in 6 cases. The flap size ranged from 2.5 cm × 2.0 cm to 8.0 cm × 3.0 cm. The donor sites were sutured directly or covered with skin graft. The condition of flaps was observed. The local feeling, function, and appearance of affected hands were followed up.</p><p><b>RESULTS</b>Twenty-seven flaps grew well without infection. Partial necrosis at the distal portion in two flaps and venous congestion in 1 flap were observed after surgery, and they were healed with suitable treatment. Eighteen patients were followed up for 1 to 12 months. The flaps were found to have good color, texture, and thickness. Satisfactory appearance and function both in the donor sites and in the recipient areas were found in most patients. The sense of two-point discrimination of repaired fingers ranged from 5 to 9 mm.</p><p><b>CONCLUSIONS</b>Optimizing the repair method for soft tissue defects in the fingers by taking both the characteristics of various axial pattern flaps and the specific conditions of soft tissue defects into account can achieve expected effect.</p>

Value of self-expanding metallic stent for obstructing left-sided colon cancer or rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic value of self-expanding metallic stent (SEMS) for resectable obstructing left-sided colon cancer or rectal cancer.</p><p><b>METHODS</b>Clinical data of 73 patients who had acute obstruction due to left-sided colon cancer or rectal cancer during May 2007 to January 2012 were retrospectively analyzed. The patients were divided into 2 groups: SEMS group (34 cases) underwent surgical resection after insertion of SEMS; emergency surgery group (39 cases) underwent emergency operation. The 2 group patients were compared for the incidence of primary anastomosis, stoma rate, laparoscopic surgery rate, mortality, postoperative morbidity, ICU admission rate, length of ICU stay, hospital stay, and hospitalization costs.</p><p><b>RESULTS</b>The incidence of primary anastomosis in SEMS group was significantly higher than that in emergency surgery group (97.1% vs. 56.4%, χ(2) = 16.256, P < 0.001), and the protective stoma rate and permanent stoma rate in SEMS group were both lower than those in emergency surgery group (33.3% vs. 86.3%, 2.9% vs. 43.6%, χ(2) value were 14.972 and 16.156, both P < 0.001). Patients in SEMS group underwent significantly more laparoscopic surgery than in emergency surgery group (47.1% vs. 0, χ(2) = 23.505, P < 0.001). There were no significant difference in postoperative mortality (2.9% vs. 10.3%, P = 0.364). The postoperative morbidity in SEMS group was significantly lower than that in emergency surgery group (35.3% vs. 66.7%, P = 0.007). Incisional infection was the most common complication in both groups, and the incidence of which seemed to be more higher in emergency surgery group (17.6% vs. 38.5%, χ(2) = 3.840, P = 0.050). There was a lower ICU admission rate in SEMS group (24.2% vs. 53.9%, χ(2) = 6.972, P = 0.008), and the mean length of ICU stay and hospital stay were both shorter in SEMS group ((69.5 ± 7.4) hours vs. (114.3 ± 10.9) hours, t = -20.23, P < 0.001; (19.6 ± 4.8) days vs. (23.4 ± 6.2) days, t = -2.90, P = 0.005). The cost of hospitalization was less in SEMS group (45 383 ± 15 648 vs. 61 485 ± 20 380, t = -3.74, P < 0.001).</p><p><b>CONCLUSIONS</b>SEMS can effectively relieve the large intestinal obstruction caused by left-sided colon cancer or rectal cancer, and change the traditional emergency surgery into a selective surgery with better outcomes. SEMS appears to be a valuable technique for resectable obstructing left-sided colorectal cancer.</p>

Study of healing mechanism of acellular dermal matrix in the treatment of anal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of acellular dermal matrix(ADM) in the closure of anal fistula in an experimental porcine model, and to explore its healing mechanism.</p><p><b>METHODS</b>The fistula-in-ano model was created and treated with ADM in the porcine model (n=14). Fistula specimens were obtained at hour 12, 24 and day 3, 7, 14, 28, 60 respectively with 2 pigs in each time point. Hematoxylin and eosin staining and immunohistochemical staining for the alpha smooth muscle actin (α-SMA) were performed.</p><p><b>RESULTS</b>At 12 hours after implantation, neutrophils and scattered cells with a fibroblastic appearance were present at the interface and began to infiltrate into the ADM. The cell density increased from hour 12 (218.2±58.2) to day 7(998.7±128.0) (P<0.01), and decreased from day 7 to day 28. Mature vessels and myofibroblasts stained with α-SMA were identified at the edge of ADM at day 7. The density of vessels (11.2±3.3 vs. 30.5±5.2, P<0.01) and myofibroblasts (3.8±0.8 vs. 6.8±0.4, P<0.01) increased from day 7 to day 14. Partially organized bundles of muscle were found at day 60.</p><p><b>CONCLUSIONS</b>ADM is a reasonable new option for the closure of anal fistula. The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing and other chronic septic wound.</p>

Endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce the method and evaluate the efficacy of endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap.</p><p><b>METHODS</b>Twelve patients with perforation of nasal septum were encountered since February 2006 to October 2010. The most common symptoms and sings were nasal obstruction and crusting at the margin of the perforation. Eight of 12 patients were iatrogenic following surgery. The perforation typically located at anterior medial part of the nasal septum, with their sizes ranged approximately 1.0-2.3 cm in diameter. The incision was made at the anterior edge of the perforation from the left nasal cavity and continued to the nasal floor horizontally. It ended at the lateral nasal cavity. Then, another incision was made parallel to the first one, which was 1.5 cm from the posterior of the perforation. The two incisions was connected. The mucoperichondrium was stripped along with the incisions and the pedicle of mucoperichondrial flap kept on the nasal septum. Then, the flap was turned up to cover the perforation and fixed with apposition suture. Put the acellular dermal matrix graft on the perforation from the right nasal cavity and fixed it with apposition suture.</p><p><b>RESULTS</b>The healing of the acellular dermal matrix and mucoperichondrium was good in the first week postoperatively and there was no rejective reaction and contracture. The epithelization of the nasal septal perforation finished 4 weeks after surgery. Follow-up ranged from 3 months to 4 years. Eleven patients had successful outcomes with complete closure of their perforations. One patient failed the operation. All of them had no complications.</p><p><b>CONCLUSIONS</b>Using acellular dermal matrix graft and mucoperichondrial flap to repair the septal perforation is a simple method and the success rate is high. Therefore, it is an effective way to repair the perforation of nasal septum.</p>

Repair of soft tissue defects in the upper limbs using multiple types of posterior interosseous artery flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the therapeutic effect of multiple types of posterior interosseous artery flaps for repair of soft tissue defects in the upper extremities.</p><p><b>METHODS</b>From March 2003 to June 2010, 42 cases with soft tissue defects in the upper limbs resulting from burn and traumatic injuries were treated using multiple types of posterior interosseous artery flaps, including retrograde flaps and composite flaps, antegrade flaps ,and free flaps. Flap size ranged from 2.5 cm x 2.0 cm-14.0 cm x 9.0 cm. The defects in the donor sites were closed directly or covered by skin graft.</p><p><b>RESULTS</b>The conventional retrograde posterior interosseous artery flaps were used in 11 cases, the modified retrograde posterior interosseous artery flaps were used in 13 cases, the retrograde posterior interosseous artery composite flaps incorporating partial extensors were used in 2 cases, the antegrade posterior interosseous artery flaps were used in 3 cases, the free posterior interosseous artery flaps were used in 7 cases, and the free perforator flap based on the radiodorsal septocutaneous perforator of the posterior interosseous artery were used in 6 cases. Partial necrosis happened in one case at the distal portion of the flap. Muscular branch of the posterior interosseous nerve was injured in one case with conventional reverse posterior interosseous artery flaps. All the other flaps survived uneventually with no complication. All wounds were primarily healed. 32 cases were followed up for 1 to 48 months with satisfactory aesthetic and functional results both in the donor sites and in the recipient areas. The color,texture and thickness of the flaps were satisfied as well.</p><p><b>CONCLUSIONS</b>The posterior interosseous artery flap has a constant vascular anatomy and a great flexibility, which is practical and suitable for repair of Soft tissue defect in the upper extremities arising from burn and traumatic injury.</p>