[Pollution Characteristics and Source Apportionment of Volatile Organic Compounds in Lishui Area of Nanjing].

To understand the changes in the components of volatile organic compounds(VOCs), the contribution proportion of each component to ozone, and the VOCs sources, we monitored the VOCs for a year in Lishui. The results showed that theρ(TVOC) was 223.46 µg·m-3, ρ(alkanes) was 49.45 µg·m-3(22.3%), ρ(OVOCs) was 50.63 µg·m-3(22.66%), ρ(halogenated hydrocarbons) was 64.73 µg·m-3(28.95%), ρ(aromatic hydrocarbons) was 35.46 µg·m-3(15.87%), ρ(alkenes) was 18.26 µg·m-3(8.19%), and ρ(others) was 4.9 µg·m-3(2.2%). ρ(TVOC) was higher in summer(263.75 µg·m-3) and lower in winter(187.2 µg·m-3), with 246.11 µg·m-3 in spring and 204.77 µg·m-3 in autumn. The daily concentration of VOCs showed two peaks, one from 9:00 to 10:00 and another from 14:00 to 15:00, and the high concentration was mainly found in the urban main road area with dense human activities. The ozone formation potential(OFP) was 278.92 µg·m-3, and those of olefin and aromatic hydrocarbon were 114.47 µg·m-3(41.1%) and 113.49 µg·m-3(40.8%), respectively, contributing over 80%, which was an important precursor of ozone. On the other hand, the ratio of characteristic compounds to toluene/benzene(T/B) was 4.13, which indicated that it was greatly affected by the solvent usage. In the end, the results of positive matrix factorization(PMF) source apportionment showed that VOCs mainly came from solvent usage, industrial production, and traffic emissions. The VOCs pollution had a great influence on ozone, so it was necessary to strengthen the treatment of industrial production, solvent usages, and traffic emissions.

Effect of home-based early intensive behavioral intervention using VB-MAPP on verbal ability in children with autism spectrum disorder / 四川精神卫生

BackgroundHome-based intervention occupies a prominent place in the treatment of autism spectrum disorder （ASD） in children， whereas previous studies on the effect of home-based early intensive behavioral intervention on verbal ability of children with ASD are somewhat inadequate. ObjectiveTo study the effects of intensive family behavioral of intervention based on Verbal Behavior Milestones Assessment and Placement Program （VB-MAPP） on the language ability of children with ASD， so as to provide references for the development of family intervention strategies for children with ASD. MethodsChildren aged 2 to 3 years old who attended the Children's Rehabilitation Department of the Second Affiliated Hospital of Shantou University Medical College from September 2020 to December 2021 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for ASD were selected as the study objects. A non-randomized concurrent control trial was conducted to compare a study group （n=24） receiving home-based early intensive behavioral intervention using VB-MAPP with a control group （n=14） receiving training from other special institutions or early childhood education institutions. The intervention lasted for 6 months in both groups. Before and after the intervention， the VB-MAPP milestone assessment was performed in the two groups， and the VB-MAPP milestone score， mand， trac and listener responds were selected as the study indicators. Then the intervention effect was compared between two groups， and the multiple linear regression was performed to screen the related influencing factors. ResultsAfter intervention， the total milestone assessment score， mand， tact and listener responds scores of study group were higher than those of control group， with statistical difference （Z=-4.339~-2.195， P<0.05 or 0.01）. Multiple linear regression analysis denoted that the average weekly hours of home-based intervention in the first three months had certain effect on listener responds （β=1.029， P<0.05）. ConclusionApplication of home-based early intensive behavior intervention using VB-MAPP may contribute to the improvement of verbal abilities such as mand， tact and listener responds in children with ASD. ［Funded by 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund （number， 20200601）］

Discovery of 5,7-Dihydro-6H-pyrrolo[2,3-d]pyrimidin-6-ones as Highly Selective CDK2 Inhibitors.

A series of exceptionally selective CDK2 inhibitors are described. Starting from an HTS hit, we successfully scaffold hopped to a 5,7-dihydro-6H-pyrrolo[2,3-d]pyrimidin-6-one core structure, which imparted a promising initial selectivity within the CDK family. Extensive further SAR identified additional factors that drove selectivity to above 200× for CDKs 1/4/6/7/9. General kinome selectivity was also greatly improved. Finally, use of in vivo metabolite identification allowed us to pinpoint sulfonamide dealkylation as the primary metabolite, which was ameliorated through the deuterium effect.

Discovery of Novel Pyrazolopyrimidines as Potent, Selective, and Orally Bioavailable Inhibitors of ALK2.

Activin receptor-like kinase 2 (ALK2) is a transmembrane kinase receptor that mediates the signaling of the members of the TGF-ß superfamily. The aberrant activation of ALK2 has been linked to the rare genetic disorder fibrodysplasia ossificans progressiva (FOP) and diffuse intrinsic pontine glioma (DIPG) that are associated with severely reduced life expectancy in pediatric patients. ALK2 has also been shown to play an essential role in iron metabolism by regulating hepcidin levels and affecting anemia of chronic disease. Thus, selective inhibition of ALK2 has emerged as a promising strategy for the treatment of multiple disorders. Herein, we report the discovery of a novel pyrazolopyrimidines series as highly potent, selective, and orally bioavailable inhibitors of ALK2. Structure-based drug design and systematic structure-activity relationship studies were employed to identify potent inhibitors displaying high selectivity against other ALK subtypes with good pharmacokinetic profiles.

Characterization of INCB086550: A Potent and Novel Small-Molecule PD-L1 Inhibitor.

Blocking the activity of the programmed cell death protein 1 (PD-1) inhibitory receptor with therapeutic antibodies against either the ligand (PD-L1) or PD-1 itself has proven to be an effective treatment modality for multiple cancers. Contrasting with antibodies, small molecules could demonstrate increased tissue penetration, distinct pharmacology, and potentially enhanced antitumor activity. Here, we describe the identification and characterization of INCB086550, a novel, oral, small-molecule PD-L1 inhibitor. In vitro, INCB086550 selectively and potently blocked the PD-L1/PD-1 interaction, induced PD-L1 dimerization and internalization, and induced stimulation-dependent cytokine production in primary human immune cells. In vivo, INCB086550 reduced tumor growth in CD34+ humanized mice and induced T-cell activation gene signatures, consistent with PD-L1/PD-1 pathway blockade. Preliminary data from an ongoing phase I study confirmed PD-L1/PD-1 blockade in peripheral blood cells, with increased immune activation and tumor growth control. These data support continued clinical evaluation of INCB086550 as an alternative to antibody-based therapies. SIGNIFICANCE: We have identified a potent small-molecule inhibitor of PD-L1, INCB086550, which has biological properties similar to PD-L1/PD-1 monoclonal antibodies and may represent an alternative to antibody therapy. Preliminary clinical data in patients demonstrated increased immune activation and tumor growth control, which support continued clinical evaluation of this approach. See related commentary by Capparelli and Aplin, p. 1413. This article is highlighted in the In This Issue feature, p. 1397.

Temporal Muscle Thickness is an Independent Prognostic Biomarker in Patients with Glioma: Analysis of 261 Cases.

PURPOSE: Temporal muscle thickness (TMT) has been proposed as a novel surrogate marker for skeletal muscle mass in head and neck malignancies. This study investigated the TMT prognostic relevance with gliomas and evaluated the influence of TMT values on survival in patients with gliomas of different grades and IDH subtypes. METHODS: The patients' TMT was measured on contrast-enhanced T1-weighted magnetic resonance images before surgical treatment. Patients were divided into two cohorts based on their median TMT values. The Kaplan-Meier curve was used to compute the overall survival (OS) of different categories and all gliomas. Univariate and multivariate Cox regression analyses were conducted to assess the association between OS and TMT, hematological markers, and other clinical factors in glioma patients. Moreover, the clinical diagnostic efficiency of single and combination biomarkers was evaluated using receiver operating characteristic curve analysis. RESULTS: We retrospectively analyzed 261 patients with newly diagnosed glioma between November 2016 and May 2020 at Hunan Cancer Hospital. Cox analysis indicated that higher TMT (HR 0.286, P< 0.001) and higher KPS score (HR 0.629, P= 0.012) were protective prognostic factors and IDH wildtype status (HR 2.946, P< 0.001), RDW > 12.6 (HR 1.513, P= 0.036), and NLR > 4 (HR 1.560, P= 0.042) were poor prognostic factors for gliomas. Subsequently, patients with thicker TMT were found to have significantly better overall survival (P<0.001) than patients with thinner TMT among WHO III and WHO IV grade and patients with or without IDH mutation. TMT was considered a better single biomarker than recently prevalent hematological biomarkers for predicting high-grade [0.856 (0.797-0.916)] and IDH- wild-type [0.864 (0.786-0.941)] gliomas. CONCLUSION: This study suggests that TMT is a positive biomarker for clinical prognosis in gliomas and that patients with thicker TMT have greater overall survival for gliomas of different grades and IDH subtypes.

Effects of Cognitive Behavioral Therapy for Depression and Anxiety, Response Rates and Adverse Events in Patients with Locoregional Advanced Nasopharyngeal Carcinoma.

PURPOSE: This retrospective study investigated the effects of cognitive behavioral therapy (CBT) on depression, anxiety, response rates, and adverse events in patients with locoregional advanced nasopharyngeal carcinoma (NPC). METHODS: A total of 269 patients with diagnosis of stage III-IVA NPC received either CBT plus chemoradiotherapy (CBT group, n = 136) or treatment as usual (TAU) plus chemoradiotherapy (TAU group, n = 133). Patients in the CBT group received a series of 6 CBT sessions for 6 weeks during concurrent chemoradiotherapy. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) score at baseline, the completion of radiotherapy, and 6, 12, and 24 months after radiotherapy. Response rates and adverse events were also evaluated. RESULTS: Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group after the completion of radiotherapy (P < .05). Complete response rates were 99.3% (135/136) and 92.5% (123/133) in the CBT group and TAU group with a small effect size (Phi coefficient = .171), respectively (P = .005). Compared with the TAU group, the CBT group showed a significantly lower incidence of acute adverse events and late toxic effects. CONCLUSIONS: The addition of CBT to chemoradiotherapy significantly reduced depressive and anxiety symptoms. CBT combined with chemoradiotherapy is associated with improved response rates, with reduced incidence of toxic effects in patients with locoregional advanced NPC. Based on this study, we registered a randomized controlled clinical trials to better define the role of CBT in patients with locoregional advanced NPC (Registration number: ChiCTR2000034701).

Itacitinib (INCB039110), a JAK1 Inhibitor, Reduces Cytokines Associated with Cytokine Release Syndrome Induced by CAR T-cell Therapy.

PURPOSE: T cells engineered to express a chimeric antigen receptor (CAR) are a promising cancer immunotherapy. Such targeted therapies have shown long-term relapse-free survival in patients with B-cell leukemia and lymphoma. However, cytokine release syndrome (CRS) represents a serious, potentially life-threatening side effect often associated with CAR T-cell therapy. CRS manifests as a rapid (hyper)immune reaction driven by excessive inflammatory cytokine release, including IFNγ and IL6. EXPERIMENTAL DESIGN: Many cytokines implicated in CRS are known to signal through the JAK-STAT pathway. Here we study the effect of blocking JAK pathway signaling on CAR T-cell proliferation, antitumor activity, and cytokine levels in in vitro and in vivo models. RESULTS: We report that itacitinib, a potent, selective JAK1 inhibitor, was able to significantly and dose-dependently reduce levels of multiple cytokines implicated in CRS in several in vitro and in vivo models. Importantly, we also report that at clinically relevant doses that mimic human JAK1 pharmacologic inhibition, itacitinib did not significantly inhibit proliferation or antitumor killing capacity of three different human CAR T-cell constructs (GD2, EGFR, and CD19). Finally, in an in vivo model, antitumor activity of CD19-CAR T cells adoptively transferred into CD19+ tumor-bearing immunodeficient animals was unabated by oral itacitinib treatment. CONCLUSIONS: Together, these data suggest that itacitinib has potential as a prophylactic agent for the prevention of CAR T cell-induced CRS, and a phase II clinical trial of itacitinib for prevention of CRS induced by CAR T-cell therapy has been initiated (NCT04071366).

Associated factors of masked obesity in female college students / 中国学校卫生

Objective@#The status of masked obesity in female college students and the related factors were investigated to provide a theoretical reference for instructing the physical health education of female college students and improving their physical exercises.@*Methods@#Body composition tests were performed on 2 975 female college students, selected from 3 colleges in North China by using cluster sampling method during October to December in 2018, and their basic information and lifestyle were investigated using questionnaires.@*Results@#The incidence of masked obesity among female college students was 33.18%, of which 2.53% came from low-weight people. The difference in the incidence of masked obesity among female college students with different take-out frequencies was statistically significant (χ2=21.98, P<0.01). Compared with those who never take takeaway, people who take takeaway every day have an increased risk of masked obesity (OR=1.49, 95%CI=0.76-2.91). The difference in the incidence of masked obesity with the frequency of eating midnight snack was statistically significant (χ2=20.80, P<0.05). The difference in the incidence of masked obesity among female college students with different exercise time was statistically significant (χ2=18.49, P<0.01). Compared with exercise time above 60 min/d, female college students who are not exercising have an increased risk of masked obesity (OR=3.20, 95%CI=1.63-6.30). The difference in the incidence of masked obesity among female college students with different weight satisfaction was statistically significant (χ2=217.54, P<0.01). Compared with female college students who were satisfied with weight, female college students who were not satisfied with weight had an increased risk of masked obesity (OR=3.47, 95%CI=1.91-6.31). The difference in the incidence of masked obesity in different weightdown plans is statistically significant (χ2=186.40, P<0.01). Those who want to lose weight have a higher risk of developing masked obesity than those who want to gain weight (OR=18.11, 95%CI=5.54-50.13).@*Conclusion@#Female college students who drink a small amount of water, eat takeaways often, eat midnight snacks, do not exercise, and are not satisfied with their weight are more likely to develop masked obesity.

Dietary conjugated linoleic acid modulates morphology, selective immune parameters, and gene expressions in the intestine of grass carp.

Conjugated linoleic acid (CLA) has been shown to exhibit anti-inflammatory properties in the intestine in mammals. However, the effect of CLA on intestinal immune response in fish is still unknown. Therefore, a 65-day growth trial was conducted to investigate the effects of dietary conjugated linoleic acid (CLA) on morphology, selective immune parameters, and gene expressions in the intestine of grass carp. Seven isonitrogenous and isolipidic diets were formulated as follows: 0 (control), 0.5 (CLA0.5), 1 (CLA1), 1.5 (CLA1.5), 2 (CLA2), 2.5 (CLA2.5), and 3 (CLA3) g CLA per 100g of feed. RESULTS: showed that dietary supplementation of 1.5-3% CLA significantly (P < 0.05) increased the fold and enterocyte heights in the PI and MI of grass carp. Complement 3 (C3) and immunoglobulin M (IgM) contents in three intestinal segments were significantly (P < 0.05) higher in fish fed with CLA1.5 to CLA2.5 diets compared to fish fed the control diet. CLA1.5 to CLA2.5 diets significantly (P < 0.05) increased the mRNA expression levels of anti-inflammatory cytokines (IL-10 and TGFß1) and significantly (P < 0.05) reduced the mRNA expression levels of pro-inflammatory cytokines (IL-1ß, IL-8, and TNF-α) in the PI, MI, and DI. This improved expression of anti-inflammatory cytokines and the inhibited expression of pro-inflammatory cytokines in the intestine of grass carp, might be mediated via TLR4/NF-κB-signaling pathway. Our results suggested that CLA1.5 to CLA2 diets improved intestinal morphology, increased the expression of anti-inflammatory cytokines, and inhibited the expression of pro-inflammatory cytokines in the intestine of grass carp. In conclusion, dietary supplementation of 1.5%-2% CLA show the anti-inflammatory therapeutic potential in the intestine of grass carp. The anti-inflammatory therapeutic potential of CLA might be mediated via TLR4/NF-κB-signaling pathway.

Clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction / 中华烧伤杂志

Objective@#To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction.@*Methods@#From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded.@*Results@#(1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications.@*Conclusions@#Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.

The clinical applied analysis of the modified transoral endoscopic thyroidectomy vestibular approach / 中华外科杂志

Objective@#To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice.@*Methods@#Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized.@*Results@#Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury.@*Conclusion@#The modified TOETVA by dissection of mental nerve is safe and feasible.

Prevalence of malocclusion among 5 387 12- to 14-year-old adolescents in Jiangxi province, China: an epidemiological study / 华西口腔医学杂志

OBJECTIVE@#We provided baseline data for oral public health through epidemiological surveys to investigate the prevalence of malocclusion and orthodontic treatment proportion in 12- to 14-year-old adolescents in Jiangxi province, China.@*METHODS@#Multi-stage random cluster sampling was used. A total of 5 387 12- to 14-year-old adolescents were examined by three professional dentists according to Angle's classification of malocclusion. The subjects were recruited from 30 secondary schools in five counties in Jiangxi Province. Results were statistically analyzed by SPSS19.0.@*RESULTS@#The prevalence of malocclusion was 79.67% among adolescents aged 12-14 years in Jiangxi province. The composition ratios of ClassⅠ, Class Ⅱ Division 1, Class Ⅱ Division 2, and Class Ⅲ malocclusion were 30.96%, 16.36%, 12.78%, and 19.13% respectively. ClassⅠmalocclusion had the highest composition ratio, and the most common clinical manifestation of malocclusion was dentition crowding with a prevalence of 91.30%. The prevalence rate of malocclusion was higher in boys than in girls at 81.16% and 78.21%, respectively (P<0.05). This condition had different prevalence rates in Nanchang, Yichun, Jiujiang, Shangrao, and Ganzhou (P<0.05) with the highest in Nanchang and lowest in Ganzhou. Malocclusion was related to caries, and its prevalence rate was higher in patients with caries than in those without caries (P<0.05). The orthodontic rate of malocclusion was 2.63%, and the value was higher for girls than that for boys (P<0.05). The rate of orthodontic in urban areas was higher than that in rural areas (P<0.05).@*CONCLUSIONS@#Compared with local and international findings on malocclusion of adolescents, high prevalence and low orthodontic rate were found in Jiangxi province. Strengthening the combination of prevention and treatment is important for the physical and mental health of adolescents. We should actively conduct oral health education, popularize the knowledge of malocclusion, and actively treat caries.

The clinical application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment-Lessons learned and countermeasures / 中国医师杂志

Objective To review outcome and experience in application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment.Methods From January 2008 to February 2016,61 cases (included 58 female patients and 3 male patients) were admitted,the age ranged from 39 to 57 years old.Among these cases,37 cases received mastectomy and one-staged breast reconstructive operation and multiple chemotherapy preoperatively.The other 24 patients suffered from chest wall radiation ulcer,all occurred after mastectomy and radiotherapy,the course ranged from 12 to 56 months,all received long-time conservative therapy but the patient's condition worsened.Of those patients 8 cases suffered radioactive bone injury,involved clavicle,rib and sterum;3 cases suffered pleura injury;2 cases suffered lung injury;2 cases suffered brachial plexus injury and upper extremity lymphedema,resulted in upper extremity dysfunction.The patients were treated with pure pedicled transverse rectus abdominis musculocutaneous flap (TRAM) musculocutaneous flap in 31 cases,frec TRAM musculocutaneous flap in 3 cases,pedicled TRAM musculocutaneous flap plus superficial inferior epigastric vein anastomosis in 13 cases,and pedicled TRAM musculocutaneous flap combined with contralateral free deep inferior epigastric perforator (DIEP) flap in 14 cases.Results The area of flap for chest wall reconstruction ranged from 22 cm × 10 cm to 38 cm× 15 cm,the size of flap for breast reconstruction ranged from 16 cm × 10 cm to 22 cm× 13 cm.The donor site was closed directly in all cases.Distal part necrosis and fat liquefaction were noted in 3 cases used pure pedicled TRAM musculocutaneous flap,in 1 case the defect was closed directly after radical debridement,in other 2 cases free anterolateral thigh flap was applied after debridement.All other 58 flaps survived uneventfully.All patients were followed up for 12 -108 months with satisfied esthetic and functional results in reconstructed chest wall and breast.No local recurrence or ulcer happened.Only linear scar left in the donor sites,no hernia occurred.Conclusions Transverse rectus abdominis musculocutaneous flap is one of the first choice for breast reconstruction and chest wall radioactive ulcer.To ensure the operation success,it is efficient to apply different forms of transverse rectus abdominis musculocutaneous flap according to the flap size and blood supply.

Surgical reconstruction of complex and huge defect after locally advanced breast cancer ablation / 中华整形外科杂志

Objective@#The purpose of this study is to review the single institutional experience in oncoplastic treatment of locally advanced breast cancer (LABC).@*Methods@#This is a retrospective analysis of 246 female patients who underwent breast and chest wall reconstruction after LABC ablation in the department from August 2007 to December 2015. The mean age of the patients is 43.7 years old, range from 34 to 70 years old. The soft tissue defect size ranged from 12 cm×6 cm to 32 cm×28 cm, different flaps were chosen for reconstruction, flap size ranged from 13 cm×6 cm to 33 cm×29 cm. Simple rib defects or sternum defects occurred in 65 cases, using mesh repair and flap reconstruction; simple soft tissue defects were noted in 112 cases, pedicled flap or free flap was used; in 69 cases complicated composite chest wall defects involving multiple layers (soft tissue, ribs/sternum, and intrathoracic organs) were repaired with methylmethacrylate/polypropylene mesh sandwich prostheses. The breast and chest wall soft tissue defects were repaired with pedicled or free flap.@*Results@#In 3 cases with pedicled rectus abdominis flap partial necrosis was noted, local flap was used after further debridement in 2 cases, in the third case with extensive defect left, free anterolateral thigh flap was transferred for reconstruction. In 2 cases with free deep inferior epigastric artery perforator flap, postoperative venous congestion occurred. The re-exploration procedure was carried out, edema was removed and the flap survived thoroughly. In 2 cases with free deep inferior epigastric artery perforator flap postoperative course margin dehiscence and chest wall basement partial necrosis was noted, free anterolateral thigh flap was transferred for reconstruction after thoroughly debridement, the wounds healed smoothly. All other wounds healed uneventfully, all flaps survived totally. The hospital stay time ranged from 12 days to 42 days, all patients received further therapy. The mean follow-up was 28.8±0.4 months, with a range from 9 to 96 months. 26 cases were lost for follow up, in the rest 220 cases, local tumor recurrence was noted in 52 cases, distant metastasis was noted in 42 cases, all other patients recovered well, the function and appearance of flaps were satisfactory, the life quality of patients improved notably.@*Conclusions@#Oncoplastic techniques are suitable and safe for LABC reconstruction, helpful for oncological local control, can improve patients life quality.

Clinical application of the bilateral radial forearm flap for tongue cancer reconstruction / 中华口腔医学杂志

The forearm radial flap is a reliable flap for the repair of the defect caused by tongue cancer resection. The clinical data of 11 tongue cancer patients that received this surgery were retrospectively analyzed. The clinical application of this technique is preliminarily discussed.

Status and strategies of oral health service demand and medical treatment utilization among 3- to 5-year-old preschool children in Jiangxi province / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the oral health service needs and dental treatment among 3-year-old to 5-year-old preschool children in Jiangxi province and provide data to support the development of relevant oral health policies, enhance the oral health service utilization and visit rate, and optimize oral manpower and service resources.@*METHODS@#A total of 2 880 preschool children were selected via stratified cluster sampling. Dental examination methods and criteria according to the fourth national oral health epidemiological survey were adopted. Excel 2007 and SPSS 19.0 softwares were used for statistics analysis. Chi-square test and logistic regression analysis were performed.@*RESULTS@#The caries prevalence was 49.13% (1 415/2 880) among the 2 880 cases of 3-
year-old to 5-year-old preschool children in Jiangxi province, approximately 53.37% (1 537/2 880) of which possessed oral health service needs. The parents of younger children assessed the oral situation better in older age than in their younger years (P<0.05), which was better in urban children than in rural children (P<0.05). The visiting rate of all the respondents was 12.33% (355/2 880), while the visiting rate of children with oral diseases was 17.31% (266/1 537). The top three reasons why patients did not visit the dentist were as follows: children's teeth have no problem, the teeth damage in teeth was considerably minimal, and primary teeth would be replaced without the need for treatment. The influencing factors included lower visiting rate in females than in males (OR=0.499, 95%CI: 0.411-0.606) and lower visiting rates in rural areas than in urban areas (OR=0.428, 95%CI: 0.353-0.519). Subjects with poor oral health and high oral knowledge scores possessed high dental service visit rates.@*CONCLUSIONS@#The prevalence of caries in 3-year-old to 5-year-old preschool children in Jiangxi province is at a lower level than that in the national level. The proportion of the population actively seeking medical services is low, and their main purpose of treatment is to treat rather than prevention. Oral health education should be strengthened, and it should be incorporated to the contents of the kindergarten teacher training program to improve residents' awareness regarding children's oral health.

Association of blood lipids with childhood asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association of blood lipids with the development, clinical stage, allergic condition, and pulmonary function of asthma.</p><p><b>METHODS</b>A total of 56 children with asthma who attended the hospital between October 2016 and March 2017 were enrolled as the asthma group, and 46 children who underwent physical examination as the healthy control group. According to the clinical manifestations, the children with asthma were divided into acute exacerbation group (n=24) and chronic persistent group (n=32). According to the results of skin prick test (SPT) and serum IgE measurement, the children with asthma were divided into non-allergic asthma group (n=16) and allergic asthma group (n=38). Fasting blood lipid levels were measured in both asthma and control groups. Pulmonary function tests were performed for asthmatic children.</p><p><b>RESULTS</b>There were no significant differences in blood lipid levels between the asthma and control groups (P>0.05). The acute exacerbation group had significantly lower serum levels of high-density lipoprotein (HDL) and total cholesterol compared with the control group and the chronic persistent group (P<0.05). The allergic asthma group had a significantly lower serum HDL level than the non-allergic asthma group (P<0.05). In asthmatic children aged 6-13 years, the ratios of the measured values to the predicted values for forced vital capacity, peak expiratory flow, and maximal expiratory flow at 50% of vital capacity had a linear regression relationship with HDL and were positively correlated with HDL (P<0.05). Forced expiratory volume in one second and maximal mid-expiratory flow had a linear regression relationship with both HDL and LDL and were positively correlated with them (P<0.05).</p><p><b>CONCLUSIONS</b>Blood lipids are associated with the clinical stage, allergic condition, and lung function of childhood asthma. This indicates that blood lipids may be involved in several aspects of the pathogenesis of childhood asthma.</p>

Relaying anterolateral thigh (ALT) perforator flap in resurfacing of the donor defect after anteromedial thigh (AMT) perforator flap transfer / 中国医师杂志

Objective To introduce the clinical experience of relaying anterolateral thigh (ALT)flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer.Methods From February 2014 to December 2015,16 cases with oral carcinoma underwent radical resection,leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps.The flap size ranged from 7.5 cm ×4.5 cm to 13.0 cm × 7.5 cm [the patients was 45.6 years (range 31-72 years),body mass index (BMI) range 17.5-24.3 kg/m2].Flaps'width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5％ on average (ranging from 9.8％ to 15.7％).The flap donor sites were reconstructed with relaying ALT flap at the same stage,the flap size ranged from 7.5 cm × 4.0 cm to 12.0 cm x 7.0 cm.Results The AMT and ALT perforators existed consistently in all cases of this serie.All free AMT flaps and relaying ALT flaps survived uneventfully.All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites.2-point discrimination distance of AMT flaps ranged from 7 to 14 mm,2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm,the function of thighs were not affected.Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap.

A general algorithm for complex oncologic chest wall reconstruction based on a retrospective review / 中华胸心血管外科杂志

Objective To review our single institutional 10-year experience in complex chest wall reconstruction and identify a working algorithm based on our retrospective analysis.Methods A retrospective analysis of 87 patients who underwent chest wallreconstruction in our department from January 2005 to December 2015.Fifty female patients and 37 male patients who underwent the above procedure were reviewed retrospectively.The median age of the patients is 52.3 years (24-75years).Histologic diagnosis including squamous-cell carcinoma (n =10),soft tissue sarcoma(n =22),chondrosarcomas(n =13) and metastasis from breast cancer(n =42).Type of skeletal defect including partial ribs/sternum defects in 19 cases,soft tissue defects alone in 33 cases,complicated composite chest wall defects involving multiple layers(soft tissue,ribs/sternum,and intrathoracic organs) in 35 cases.Sole methylmethacrylate/polypropylene mesh was used for small sized rib defects in 26cases.Methylmethacrylate/polypropylene mesh sandwich prostheses was used in 28 cases with extensive skeletal reconstruction after partial sternectomy and rib resection.The chest wall defects were repaired with pedicled internal mammary artery perforator flap(3 cases),pedicled deep superior epigastric artery perforator flap(4 cases),pedicled pectoralis major flap(8 cases),free anterolateral thigh perforator flap(9 cases),free deep inferior epigastric artery perforator flap(17 cases),pedicled lateral thoracic flap(5 cases),pedicled latissimus dorsi flap(17 cases),pedicled rectus abdominis flap(15 cases),free deep inferior epigastric artery perforator flap combined with pedicled rectus abdominis flap (4 cases),pedicled bipaddled latissimus dorsi flap(5 cases).11 cases with extensive full-thickness defects of the chest wall,the skeletal reconstruction was achieved with prosthetic sandwich and then covered with the omental flap,further free flaps were harvested for skin and soft tissue repairing.Results 1 case with pedicled rectus abdominis flap partial necrosis was noted,free anterolateral thigh flap was used for repairmen after further revision.1 case with edicled bipaddled latissimus dorsi flap,necrosis of the distal 1/4 part of one paddle was noted,healed with dressing therapy,no secondary skin grafting was required.Postoperative venous congestion occurred in 2 cases with deep inferior epigastric artery flap transplantation,in which both skin flaps exhibited venous crisis within 24 h after surgery.The reexploration procedures were successful in both cases and the flaps survived totally.All other flaps survived.The mean follow-up was 31 months,ranged from 9 to 72 months.No tumour extirpation was noted,functional and appearance results were satisfied.Conclusion According to the size and location of chest wall defect,different pedicled and free flaps should be chosen to achieve optimal outcome.Free flaps are efficient for large complex chest defects reconstruction.