Vitamin C supplementation reduces the odds of developing a common cold in Republic of Korea Army recruits: randomised controlled trial.

INTRODUCTION: The Republic of Korea (ROK) military has a high incidence of respiratory diseases at training centres. Vitamin C has been reported to reduce the incidence of colds. For the purpose of preventing soldiers' respiratory diseases, this study aimed to investigate whether vitamin C intake can prevent common colds in the ROK Army soldiers. METHODS: This was a randomised, placebo-controlled, and double-blind trial of soldiers who enlisted in the Korea Army Training Centre for 30 days from 12 February to 13 March 2018. The study participants were divided into groups (vitamin C vs placebo). The military medical records were searched to determine whether the participants had a common cold. Multiple logistic regression analysis was performed to identify the association between vitamin C intake and diagnosis of common colds. In addition, subgroup analysis on the relationship between vitamin C intake and common cold according to smoking status, training camp and physical rank was conducted. RESULTS: A total of 1444 participants were included in our study. Of these participants, 695 received vitamin C (6000 mg/day, vitamin C group), while 749 participants received placebo (0 mg/day, placebo group). The vitamin C group had a 0.80-fold lower risk of getting a common cold than did the placebo group. Subgroup analyses showed that this effect was stronger among subjects in camp A, among never smokers and among those in physical rank 3. CONCLUSION: Vitamin C intake provides evidence to suggest that reducing the common colds in Korean Army soldiers. Our results may serve as a basis for introducing military healthcare policies that can provide vitamin C supplementation for military personnel in basic military training.

FoxO1 as a Regulator of Aquaporin 5 Expression in the Salivary Gland.

Forkhead box O1 (FoxO1) is a multifunctional initiator, mediator, and repressor of autoimmune diseases in an organ- or disease-specific manner. However, the role of FoxO1 in the salivary gland has not yet been elucidated. In this study, we discovered that FoxO1 and aquaporin 5 (AQP5) are both significantly downregulated in the patients with primary Sjögren syndrome, an autoimmune disease accompanying salivary gland dysfunction. Pharmacologic or genetic perturbation of FoxO1 in the rat salivary gland acinar cell line, SMG-C6, induced a significant downregulation of AQP5 expression, as observed in clinical specimens. There was a strong correlation between FoxO1 and AQP5 expression because FoxO1 is a direct regulator of AQP5 expression in salivary gland acinar cells through its interaction with the promoter region of AQP5. Serial injection of a FoxO1 inhibitor into mice induced a reduction of AQP5 expression in submandibular glands and, consequently, hyposalivation, which is one of the major clinical symptoms of primary Sjögren syndrome. However, there was no sign of inflammation or cell damage in the submandibular glands harvested from mice treated with the FoxO1 inhibitor. In conclusion, our findings indicate that FoxO1 in salivary gland tissue acts as a direct regulator of AQP5 expression. Thus, downregulation of FoxO1 observed in primary Sjögren syndrome is a putative mechanism for hyposalivation without the involvement of previously reported soluble factors in primary Sjögren syndrome patient sera.

Identification of predictive variables for the recurrence of oral mucocele.

BACKGROUND: Oral mucocele is the most common minor salivary gland lesion with good prognosis after surgical removal. However, its recurrence is not rare, sometimes bothersome. This study aimed to identify the possible predictive variables affecting the recurrence rate of oral mucocele. MATERIAL AND METHODS: The histoclinical data of 164 patients diagnosed with oral mucocele were retrospectively obtained by reviewing dental records. The predictive variables for its recurrence were identified by analyzing its recurrence rate according to clinical variables. RESULTS: The recurrence rate showed the significant differences according to location and age. Oral mucocele recurred with significantly higher frequency on the ventral mucosa of tongue (50.0%) than on the labial/buccal mucosa (8.8%). Its recurrence was significantly more common in the younger patients (aged < 30 years, 16.0%) than in the older patients (aged > 30 years, 4.4%). However, there was no significant difference in recurrence rates between surgical procedures using scalpels and those using lasers. CONCLUSIONS: Patients with oral mucocele should be more carefully informed of its possible recurrence, especially when it is found on the ventral surface of the tongue or in a younger population.

A probiotic combination attenuates experimental colitis through inhibition of innate cytokine production.

Inflammatory bowel disease (IBD) is a severe immune cell-mediated syndrome characterised by extensive inflammatory and effector mucosal responses leading to tissue destruction in the colon and small intestine. The leading hypothesis is that dysbiosis of the gut flora causes an excessive immune response and inflammation in the gastrointestinal track. Lactic acid bacteria (LAB) can correct dysbiosis of the normal microbiota. In the current study, the therapeutic potential of seven LAB strains in combination to treat IBD was evaluated using experimental colitis model. This LAB cocktail, designated GI7, includes four strains of Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus rhamnosus, Lactococcus lactis, two strains of Bifidobacterium bifidum, Bifidobacterium breve, and one strain of Streptococcus thermophilus. We confirmed that GI7 suppressed pro-inflammatory cytokines in Raw264.7 macrophages. When dextran sulphate sodium-induced colitic mice were treated with GI7, their symptoms of colitis, as assessed by body weight, colon length, myeloperoxidase activity, intestinal bleeding, and histological damage, were reduced compared to untreated mice. In addition, GI7 treatment significantly inhibited the production of innate pro-inflammatory cytokines during colitic progression. Therefore, we suggest that GI7, a combination of seven LAB, has a potential role in the treatment of IBD.

Effects of warm acupuncture on breast cancer-related chronic lymphedema: a randomized controlled trial.

BACKGROUND: Effective treatment for breast cancer-related chronic lymphedema (bcrl) remains a clinical challenge. Acupuncture and moxibustion treatments have been shown to be beneficial and safe for treating bcrl. In the present randomized controlled trial, we compared the effectiveness of combined acupuncture and moxibustion ("warm acupuncture") with that of diosmin in bcrl. METHODS: Breast cancer patients who met the inclusion and exclusion criteria (n = 30) were randomized to experimental and control groups (15 per group). On alternate days, patients in the experimental group received 30 minutes of acupuncture at 6 acupoints, with 3 of the needles each being topped by a 3-cm moxa stick. The control treatment was diosmin 900 mg 3 times daily. The control and experimental treatments were administered for 30 days. Outcome measures included arm circumferences (index of effectiveness), range of motion [rom (shoulder joint function)], quality of life, clinical safety, and adverse events. RESULTS: Measured by the index of effectiveness, bcrl improved by 51.46% in the experimental group and by 26.27% in the control group (p < 0.00001). Effects were greatest at 10 cm above the elbow and at the wrist, where the warm needling was provided. Impairments in shoulder joint rom were minimal at baseline in both treatment groups. However, the roms of rear protraction, abduction, intorsion, and extorsion in the experimental group improved significantly; they did not change in the control group. Self-reported quality of life was significantly better with warm acupuncture than with diosmin. No adverse effects were reported during the treatment period, and laboratory examinations for clinical safety fell within the normal ranges. CONCLUSIONS: Compared with diosmin, warm acupuncture treatment can effectively reduce the degree of bcrl at the specific acupoints treated and can promote quality of life. Warm acupuncture showed good clinical safety, without any adverse effects on blood or the cardiovascular system.

Diagnostic profiling of salivary exosomal microRNAs in oral lichen planus patients.

OBJECTIVE: Oral lichen planus is a chronic inflammatory oral mucosal disease whose exact cause is unclear and which requires efficient diagnostic and therapeutic strategies. Identification of disease-specific biomarkers in saliva is an easy, quick, and non-invasive approach for molecular diagnosis. This study was designed to examine salivary exosomal microRNAs (miRNAs) that could be candidates for diagnosing and elucidating the pathogenesis of oral lichen planus. SUBJECTS AND METHODS: We compared miRNA profiles of salivary exosomes of patients with oral lichen planus with those of healthy controls. Saliva samples from 16 patients with oral lichen planus and eight healthy controls were divided into two sets and examined using miRNA microarray analysis and TaqMan quantitative PCR. RESULTS: The three miRNAs identified (miR-4484, miR-1246, and miR-1290) were further validated. Of these, miR-4484 was significantly upregulated in the salivary exosomes of patients with oral lichen planus. CONCLUSIONS: This study thus identifies a potential miRNA biomarker for oral lichen planus and provides insight into the functions of miRNAs in the pathogenesis of oral inflammatory diseases.

The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage.

BACKGROUND AND PURPOSE: The prognostic value of contrast accumulation from non-contrast brain computed tomography taken immediately after endovascular reperfusion treatment in acute ischaemic stroke patients to predict symptomatic hemorrhage was studied. METHODS: Between July 2007 and August 2014, acute anterior circulation ischaemic stroke patients who were treated by intra-arterial thrombolysis or thrombectomy were included. Contrast accumulation was defined as a high attenuation area from non-contrast brain computed tomography immediately taken after endovascular reperfusion treatment, and patients were categorized into three groups according to the presence and location of contrast: (i) negative, (ii) cortical involvement and (iii) non-cortical involvement. The rates of symptomatic hemorrhage after 24 h and functional outcome at discharge were compared between patients with and without cortical involvement. RESULTS: Of 64 patients who were treated by endovascular intervention, contrast accumulation was detected in 56, including 33 patients with cortical involvement and 23 patients without cortical involvement. The cortical involvement pattern was more frequently associated with symptomatic hemorrhage (13 vs. 1 patient, P = 0.003) and with grave outcome at discharge with modified Rankin Scale 5 or 6 (14 vs. 4, P = 0.048) than the non-cortical involvement group. Multivariate logistic regression analysis including initial collateral status and occlusion site disclosed that cortical involvement pattern independently predicted symptomatic hemorrhage after endovascular treatment (odds ratio 19.0, confidence interval 1.6-227.6, P = 0.020). CONCLUSION: Our study provides evidence that the cortical involvement of contrast accumulation is associated with symptomatic hemorrhage after endovascular reperfusion treatment.

Melanocyte-specific CD8+ T cells are associated with epidermal depigmentation in a novel mouse model of vitiligo.

In the present study, we established a novel murine model of vitiligo by sequential prime/boost immunizations into the hind footpad and tail dermis with tyrosinase-related protein 2 (TRP2)-180 (SVYDFFVWL) peptide, lipopolysaccharides and cytosine-phosphate-guanosine (CpG) oligodeoxynucleotides. Immunized mice developed epidermal depigmentation in the tail skin without hair depigmentation, thereby differentiating this approach from established models of vitiligo. Following intradermal tail immunization, activated CD8(+) interferon (IFN)-γ(+) T cells were recruited locally to the tail skin. In-vivo cytotoxicity assays demonstrated specific lysis of TRP2-180-presenting cells in immunized mice. Furthermore, the extent of skin depigmentation correlated with the frequency of TRP2-180-specific splenic CD8(+) T cells, as determined by IFN-γ and tumour necrosis factor (TNF)-α production, and cytotoxic degranulation evidenced by CD107a staining. These findings suggest a correlation between the presence of TRP2-180-specific CD8(+) effector T cells and the development of depigmented skin lesions in our vitiligo model. This new model of vitiligo, characterized by skin depigmentation without hair depigmentation, is more similar to human disease than previous murine models. Therefore, this model is well suited to future studies on the pathogenesis of vitiligo and the development of novel therapeutics for vitiligo.

Analysis of 2D periodic nanostructures with an oxide overlayer via spectroscopic ellipsometry.

The accurate nondestructive determination of the shapes or critical dimensions of periodic nanostructures is essential to the current integrated-circuits technology. Optical critical dimension (OCD) metrology is fast, nondestructive, and can be used in air, allows higher sampling rates compared to the non-optical methods such as scanning electron microscopy (SEM) or atomic-force microscopy (AFM), and does not damage the sample. The data are typically analyzed via rigorous coupled-wave analysis (RCWA), where the sample is modeled as a series of layers whose dimensional parameters are determined by a least-squares fit. The layers are typically approximated as a combination of core material and ambient. Oxide overlayers and surface roughness are common, however, and call into question two-phase approximation. In this study, a structure that is periodic in two dimensions and that is coated with a thin (3 nm) oxide was studied, and an extension of the RCWA method that allows structural information to be extracted from optical data even in the presence of oxide overlayers or surface roughness was developed.

Nondestructive analysis of coated periodic nanostructures from optical data.

Optical data are essential for the accurate nondestructive determination of profiles of periodic structures in integrated-circuit technology. In rigorous coupled-wave analysis, the sample is generally modeled as layers consisting of a single material and the ambient. We extend present capabilities to the analysis of structures with overlayers and demonstrate our approach by determining quantitatively the thicknesses of top, sidewall, and bottom oxides of deliberately and naturally oxidized structures.

Expression of nitric oxide synthase isoforms in the testes of pigs.

This study examined the expression of three isoforms of nitric oxide synthase (NOS) in the testes of pigs. Immunohistochemical studies demonstrated the presence of nNOS, eNOS and iNOS in interstitial cells, primary spermatocytes and spermatids. Positive immunoreactions for eNOS and iNOS were detected in peritubular myoid cells. Some vascular endothelial cells were positive for nNOS and eNOS. The expression of nitrotyrosine was detected in interstitial cells. In addition, the histochemical study revealed that all the interstitial cells were stained positively for NADPH-diaphorase, although some spermatids and vascular endothelial cells displayed moderate enzymatic activity. These findings suggest that three isoforms of NOS are expressed in the testis of pig and that they play important roles in the biology of interstitial cells that produce testosterone, as well as in spermatogenesis in the seminiferous tubules.

Singing, but not seizure, induces synaptotagmin IV in zebra finch song circuit nuclei.

Synaptotagmins are a family of proteins that function in membrane fusion events, including synaptic vesicle exocytosis. Within this family, synaptotagmin IV (Syt IV) is unique in being a depolarization-induced immediate early gene (IEG). Experimental perturbation of Syt IV modulates neurotransmitter release in mice, flies, and PC12 cells, and modulates learning in mice. Despite these features, induction of Syt IV expression by a natural behavior has not been previously reported. We used the zebra finch, a songbird species, to investigate Syt IV because song is a naturally learned behavior whose neuroanatomical basis is largely identified. We observed that, similar to rodents, Syt IV is inducible in songbirds. This induction was selective and depended on the nature of neuronal depolarization. Generalized seizures caused by the GABA(A) receptor antagonist, metrazole, induced the IEG, ZENK, in zebra finch brain. However, these same seizures failed to induce Syt IV in song control areas. In contrast, when nontreated birds sang, three song control areas showed striking Syt IV induction. Further, this induction appeared sensitive to the social context in which song was sung. Together, these data suggest that neural activity during singing can drive Syt IV expression within song circuitry whereas generalized seizure activity fails to do so even though song control areas are depolarized. Our findings indicate that, within this neural circuit for a procedurally learned sensorimotor behavior, Syt IV is selective and requires precisely patterned neural activity and/or neuromodulation associated with singing.

Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis.

BACKGROUND/AIMS: Hepatolithiasis is a risk factor for cholangiocarcinoma. However, it is difficult to detect early cholangiocarcinoma that occurs as a complication of hepatolithiasis. To identify the factors, which can be used for predicting cholangiocarcinomas in patients with hepatolithiasis, we compared the clinical characteristics of patients who had cholangiocarcinoma associated with hepatolithiasis with those of patients with hepatolithiasis only. METHODOLOGY: Forty patients with cholangiocarcinoma associated with hepatolithiasis (group HC) and 73 patients with hepatolithiasis only (group H) were randomly selected for this study. Mean tumor size was 6.1 +/- 2.4 cm in diameter. RESULTS: Patients of group HC were older (56.7 +/- 8.9 yr) than those of group H (49.2 +/- 12.9 yr) (p < 0.001). Weight loss was more frequent in group HC (51.5%) than in group H (5.5%) (p < 0.001) and serum alkaline phosphatase levels were higher in group HC (181 +/- 184 IU/L) than in group H (426 +/- 385 IU/L) (p < 0.001). The proportion of the patients who had hepatolithiasis in the right or both lobes of the liver was higher in group HC (72.5%) than in group H (50.6%) (p = 0.024). The optimal cutoff value of serum CEA level for cholangiocarcinoma detection was set at 4.2 ng/mL using ROC cure to give a sensitivity of 67.6% and a specificity of 90.5%. Group HC differed from group H because of its lower rates of both abdominal pain and cholangitis, longer duration of stone history, and lower serum albumin level. Factors that did not predict cholangiocarcinoma included sex ratio, white blood cell count, serum bilirubin level, and hepatic atrophy. CONCLUSIONS: Cholangiocarcinoma should be suspected in patients with hepatolithiasis, especially when, the patient is over 40 years old, has a long history of hepatolithiasis with weight loss, a higher level of serum alkaline phosphatase, a lower level of serum albumin, a serum carcinoembryonic antigen level exceeding 4.2 ng/mL, and hepatolithiasis that is located either in the right or both lobes of the liver.

Second toe to index finger transfer.

Between April 1994 and May 1998, 15 amputated index fingers were treated based on three classifications: group 1 consisted of patients with index finger defects immediately proximal to, yet including, the distal interphalangeal joint, group 2 were those patients with defects from the proximal part of the distal interphalangeal joint to the distal part of the proximal interphalangeal joint and group 3 comprised patients with more proximal defects than group 2. With a total of six men and nine women, seven cases were included in group 1, five in group 2 and three in group 3. For the patients in groups 1 and 2, only a partial length of the second toe was transferred to the index finger, whereas in group 3 the total length of the toe needed to be transferred. The results can be summarised as follows:1. The two-point discrimination of the reconstructed index tip was 2.2 mm for group 1, 2 mm for group 2 and 2.3 mm for group 3.2. In group 1, the average range of motion in the transferred toe was 43.8>> in the distal interphalangeal joint. In groups 2 and 3, the average range of motion in the transferred toe was 30>> and 30.7>> in the distal interphalangeal joint, and 50>> and 39.3>> in the proximal interphalangeal joint, respectively.3. When compared with the contralateral index finger, the pinching power was measured at 83% in group 1, 70% in group 2 and 60% in group 3.4. Excellent results were obtained in group 1, good results in group 2 and fair results in group 3. Accordingly, the more proximal the defect in the index finger, the less satisfactory the result obtained.

Replantation of avulsed scalps and secondary aesthetic correction.

Five patients with avulsed scalps were treated with replantation between 1992 and 1998. All patients were women age 20 to 36 years. The percentage of the avulsed scalp ranged from 50% to 100% of the whole scalp. The vessels chosen for anastomosis were the superficial temporal artery, occipital artery, and superficial temporal vein. A vein graft harvested from the cephalic vein of the forearm was performed on the venous and arterial sides in 1 patient. Two patients experienced complete survival of the replanted scalp. Three patients showed 40%, 50%, and 80% survival areas, with the remaining defects resurfaced as split-thickness skin grafts. Six months later, the scar areas in the last 3 patients were reconstructed with an expansion of the normal or replanted scalp. The follow-up period ranged from 1 to 7 years. In 4 patients a partial return of sensation in the replanted scalp and motor function of the frontalis muscle were observed. All patients were satisfied with the aesthetic results of their surgery.

Overall 5-year survival rate and prognostic factors in patients with stage IB and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection.

The objective of this paper was to analyze the 5-year survival rate and prognostic factors for stage Ib and IIa cervical cancer treated by radical hysterectomy. A total of 366 patients with invasive cervical cancer treated by radical hysterectomy from June 1985 to June 1994 at Chonnam National University Hospital, Kwangju, Korea were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier estimator. Multivariate analysis was performed using the Cox proportional hazards regression model. The overall 5-year survival rate was 92% in stage Ib and 87% in stage IIa. Factors assessed for prognostic value included age, FIGO stage, cell type, tumor size, depth of invasion, lymphovascular space invasion (LVSI), and pelvic lymph node metastases (LNM). In the multivariate analysis, age, cell type, and lymph node metastases were independent predictors of survival. Lower survival was associated with age greater than 50 years, adenocarcinoma, and presence of lymph node metastases. The higher survival rates in patients with single lymph node involvement or lymph node metastases below the level of the common iliac nodes (85 and 84.6%, respectively) versus multiple or extrapelvic lymph node metastases (50 and 20%, respectively) were statistically significant (P < 0.01). In conclusion, patients who had lymph node metastases, adenocarcinoma, and were older than 50 years had a poorer survival rate. Such patients require more intense postoperative treatment and closer surveillance. Low-risk patients with a single lymph node metastasis below the level of the common iliac nodes may benefit from thorough lymphadenectomy without adjuvant therapy to prevent unpleasant complications.

Dorsalis pedis tendocutaneous delayed arterialized venous flap in hand reconstruction.

We report two patients whose acute soft-tissue and tendon defects in the hand were treated with a dorsalis pedis tendocutaneous delayed arterialized venous flap between 1994 and 1997. The surviving surface area was 100 percent in both patients. The flap sizes were 10 x 10 cm and 6 x 6 cm. At 2 weeks postoperatively, active flexion and passive extension commenced, and progressive resistance exercises were performed for an additional 5 weeks. Flaps showed a similar color match and skin texture compared with the normal skin of the hand. Advantages of the tendocutaneous delayed arterialized venous flap are that a larger flap can be obtained than when using a pure venous flap or arterialized venous flap; the survival rate of the arterialized venous flap increases, which permits the use of a composite flap; the main artery of the donor site is preserved; thin, nonbulky tissue is used; and elevation is easy, without deep dissection. The disadvantages are the two-stage operation, donor-site scarring, and weak extension of the toes.

Pharyngoesophageal reconstruction with a tubed free radial forearm flap.

Various attempts at reconstruction of pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A tubed free radial forearm flap was used to reconstruct the pharyngoesophagus in 23 patients after resection of neoplasms from May 1989 to October 1995. Nineteen were males and four were females, the average patient age was 62.2 years. The follow-up ranged from 10 to 64 months (mean: 18 months). Oral intake within 3 weeks was possible in 18 patients (78 percent) The immediate postoperative complications were hematoma (n = 1), bleeding (n = 2), infection (n = 3), fistula (n = 4), and venous thrombosis (n = 1). A late complication was stricture of the lower anastomosing site (n = 3). The tubed free radial forearm flap has advantages over free jejunal transfer, including the larger caliber of the vascular pedicle, longer possible ischemic time, no laparotomy with less morbidity of the donor site, and better toleration of radiotherapy. Troublesome disadvantages include stricture and fistula formation at the suture sites. The authors modified the conventional free radial forearm flap to reduce complications. A small monitoring flap supplied by the septocutaneous branch of the radial artery was elevated to check the survival of the flap. During tubing, the vertical suture line was overlapped with a deepithelialized skin flap, and double layer sutures were done to prevent fistula. Two small triangular flaps were designed and inserted at the distal anastomotic site to prevent circular contracture. The outer-layer sutures were anchored to the surrounding rigid structure to withstand shrinkage and circular contraction. With this modification, the incidence of stricture and fistula formation was reduced to 13.0 percent and 17.4 percent, respectively, and these complications could be treated conservatively.

The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits.

The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Experimental groups included (1) a control group, (2) a surgical delay (4-day and 7-day delay) group, and (3) a combined surgical and chemical (doxazosin mesylate, nitroglycerine patch) delay group. These groups were further divided into subgroups (n = 10) depending on the delay period and the chemical agents. An arterialized venous flap was created on one ear of each rabbit. In the arterialized venous flap, arterial inflow was provided by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. In the control group, the arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. In the surgical delay group, the mean percentage survival of arterialized venous flaps was 36.6 percent in the 4-day delay group and 59.7 percent in the 7-day delay group. In the combined surgical and chemical delay group, a 3-day chemical delay followed by a 4-day simultaneous surgical and chemical delay resulted in mean percentage survival of the arterialized venous flaps of 81.1 percent in the doxazosin mesylate group, 72.8 percent in the nitroglycerine patch group, and 92.9 percent in a combination group of doxazosin mesylate and nitroglycerine patch. A 3-day chemical delay followed by a 7-day simultaneous surgical and chemical delay resulted in mean percentage survival of the arterialized venous flaps of 94 percent in the doxazosin mesylate group, 90.2 percent in the nitroglycerine patch group, and 99 percent in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increased the percentage survival of the arterialized venous flaps in proportion to the delay period. The combination group of surgical and chemical delay procedures had a significantly greater percentage survival than that of the surgical delay group (p < 0.001), and the delay period could be shortened.