[Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle].

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

[Progress in research of genomic epidemiology of pathogenic fungi].

Genomic epidemiology, based on whole-genome sequencing technology and bioinformatics analysis, can make up for the shortcomings of traditional molecular typing methods and provide a novel insight for the genetic evolution and transmission of pathogenic fungi. The combination of genetic information and epidemiological methods of pathogenic fungi can predict fungi transmission routes and risks, and provide a theoretical basis for the development of public health strategies for fungi infection prevention and control. This paper summarizes the development of molecular epidemiology and genomic epidemiology, as well as the application of genomic epidemiology methods in the analyses of genetic relationship, origin, evolution, drug resistance, virulence, and genome-wide association of pathogenic fungi, and discusses the development of pathogenic fungi genomic epidemiology.

[MiR-4484 regulates the expression of integrin α 6 in gastric cancer tissues and its significance].

Objective: To investigate the relationship between the expression of integrin α 6 (ITGA6), miR-4484 and the pathologic stage of gastric cancer. Methods: Gastric cancer tissues and normal gastric mucosa tissues adjacent to cancer (>5 cm from tumor margin) of 30 patients with primary gastric cancer who underwent direct surgical resection without adjuvant therapy from June to September 2017 in West China Hospital of Sichuan University were selected. Real-time quantitative polymerase chain reaction (PCR) was used to detect the expression levels of miR-4484 and ITGA6, western blot was used to detect the expression level of ITGA6 protein, dual luciferase reporter gene was used to verify the relationship between ITGA6 and miR-4484. Spearman's correlation analysis was used to determine the relationship between miR-4484 and ITGA6 expression levels in gastric cancer tissues. Results: The expression level of ITGΑ6 in gastric cancer (32.30±13.47) was higher than that in matched normal gastric tissues (24.55±10.25, P=0.015), the area under the receiver operating characteristic (ROC) curve was 0.660 and the diagnostic sensitivity and specificity were 43.3% and 96.7%, respectively. The expression level of miR-4484 in gastric cancer (4.11±2.87) was lower than that of matched normal gastric tissues (5.75±2.80, P=0.029), the area under the ROC curve was 0.690 and the diagnostic sensitivity and specificity were 30.0% and 86.7%, respectively. The expression level of miR-4484 was negatively correlated with ITGA6 in gastric cancer tissues (r=-0.621, P<0.001). The expression level of ITGA6 protein in gastric cancer tissues (0.65±0.19) was higher than that in normal adjacent tissues (0.26±0.12, P<0.001). Compared with ITGA6 3'UTR wild-type+ miR-NC group, ITGA6 3'UTR wild-type+ miRNA mimics group had lower luciferase activity (50.69±5.10, 34.00±1.19, P<0.001), while the luciferase activity of ITGA6 3'UTR wild-type+ ASO miR-4484 group was higher than that of ITGA6 3'UTR wild-type+ miR-NC group (82.44±6.37, 50.69±5.10, P<0.001), indicated that ITGA6 was the direct target gene of miR-4484. The expression levels of miR-4484 in T1, T2, T3 and T4 (4a and 4b) gastric cancer tissues were 9.98±2.24, 5.28±2.03, 2.92±2.04 and 4.11±2.87, respectively, with statistical significance (P<0.001). The expression levels of ITGA6 in N0, N1, N2 and N3 gastric cancer tissues were 29.55±8.32, 21.71±3.75, 24.60±8.79 and 40.69±15.83, respectively, with statistical significance (P=0.022). The expression levels of miR-4484 in N0, N1, N2 and N3 gastric cancer tissues were 5.01±3.52, 5.48±2.76, 5.88±1.83 and 2.30±1.56, respectively, with statistical significance (P=0.032). The expression levels of ITGA6 in M0 and M1 gastric cancer tissues were 26.28±7.66 and 52.08±8.12, respectively, with statistical significance (P<0.001). The expression levels of miR-4484 in M0 and M1 gastric cancer tissues were 4.95±2.74 and 1.34±0.80, respectively, with statistical significance (P<0.001). Conclusions: ITGA6 is upregulated in gastric cancer tissues, while miR-4484 is downregulated in the gastric cancer group, and its expression level is related to the clinicopathological features of gastric cancer. ITGA6 is the direct target gene of miR-4484, implicates that miR-4484 may inhibit the invasion and metastasis of gastric cancer by regulating the expression of ITGA6. Both miR-4484 and ITGA6 may be the new prognostic markers and potential therapeutic targets of gastric cancer.

Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery: a randomized trial.

BACKGROUND: Postoperative agitation after general anesthesia is a common complication in children; however, pain or uncomfortable feeling is the main reason of emergence agitation. Here, we have investigated the effects of fascia iliaca compartment block (FICB) combined with general laryngeal mask airway (LMA) anesthesia in children undergoing femoral surgery. METHODS: Eighty children undergoing femoral surgery were randomly divided into two groups: FICB + LMA group and control group (n=40). The FICB + LMA group received FICB combined with general LMA anesthesia, and the control group received tracheal intubation general anesthesia alone. Anesthesia was maintained with nitrous oxide and sevoflurane. Hemodynamic parameters were monitored, and pain was assessed by verbal numeric score within 24 hours postoperatively. Time to extubation, time to discharge from the postanesthesia care unit and postoperative complications were recorded. RESULTS: Hemodynamic parameters were more stable in the FICB + LMA group than in the control group during anesthesia induction (P<0.05). Verbal numeric score values were lower in the FICB + LMA group than in the control group at 2-8 hours postoperatively (P>0.05). Compared with the control group, the time to extubation and time to discharge from postanesthesia care unit were shorter in the FICB + LMA group (P<0.05). Additionally, postoperative complications were less in the FICB + LMA group. CONCLUSION: The FICB combined with general LMA anesthesia may provide intra- and postoperative analgesia, shorten emergence time and reduce postoperative agitation in children undergoing femoral surgery. TRIAL REGISTRATION: This study is registered at http://www.chictr.org.cn (registration number: ChiCTR-IOR-17012725).

Effect of intravenous magnesium sulfate on bupivacaine spinal anesthesia in preeclamptic patients.

BACKGROUND: Magnesium sulfate (MgSO4) is the standard therapy for the treatment of preeclampsia and prevention of eclamptic seizures in labor. This study aimed to determine the effect of the magnesium administered intravenously as a bolus prior to spinal anesthesia on the speed of onset and duration of the spinal anesthesia in preeclamptic women. METHODS: Sixty women undergoing caesarean section were randomly divided into the MgSO4 group and the control group. The MgSO4 group received 50 mg/kg MgSO4 (total 50 ml) infused intravenously within 15 min and the control group received the same volume normal saline, then spinal anesthesia was administered using a standardized technique. The onset and duration of sensory and motor block, and duration of spinal anesthesia were studied. Hemodynamic parameters were monitored and postoperative pain was measured using a visual analogue scale (VAS). Side effects if any were recorded. RESULTS: The onset of sensory block was significantly shorter (5.15 ± 1.35 vs. 6.25 ± 1.75 min, P < 0.05), and the duration of sensory block, motor block and spinal anesthesia was significantly longer in the MgSO4 group (261.3 ± 64.7 vs. 226.5 ± 56.4 min, 194.6 ± 35.4 vs.175.7 ± 27.6 min and 81.5 ± 18.6 vs. 71.4 ± 16.5 min, respectively, P < 0.05), while the onset of motor block was not significantly shorter in the MgSO4 group (4.15 ± 1.05 min vs. 4.50 ± 0.95 min, P > 0.05). Side effects were similar between the groups. CONCLUSIONS: Intravenous MgSO4 can hasten the onset of sensory block, prolong the duration of sensory block, motor block and spinal anesthesia, alleviate postoperative pain, but not hasten the onset of motor block in preeclamptic women undergoing spinal anesthesia without additional side effects. (www.chictr.org.cn, registration number: ChiCTR-IOR-15006856).

Comparison of the treatment effects of methoxamine and combining methoxamine with atropine infusion to maintain blood pressure during spinal anesthesia for cesarean delivery: a double blind randomized trial.

OBJECTIVE: Hypotension is a common complication of spinal anesthesia for cesarean delivery. Atropine is a vagus nerve blocker that can antagonize vagus excitation to mitigate the reflex bradycardia. We aimed to assess the effect of methoxamine-atropine therapy in treating spinal anesthesia hypotension for cesarean section. PATIENTS AND METHODS: This is a double-blind randomized controlled study. Women under spinal anesthesia for elective caesarean delivery received boluses of methoxamine 2 mg alone (Group M, n = 40), or with addition of atropine 0.1 mg (Group MA1, n = 40), atropine 0.2 mg (Group MA2, n = 40) or atropine 0.3 mg (Group MA3, n = 40) upon a maternal systolic pressure ≤ 80% of baseline. The primary endpoint was systolic blood pressure and the secondary endpoints were maternal heart rates, instant neonatal heart rates, umbilical artery pH and umbilical artery base excess. RESULTS: Changes in systolic blood pressure were similar among the four groups. The incidences of bradycardia in groups M and MA1 were significantly higher than those in group MA2 and MA3. The fetal heart rates after delivery in groups MA2 and MA3 were higher than those in group M and MA1 but within the normal range. The acid-base status had no difference in the four groups. CONCLUSIONS: Methoxamine-atropine combination has a similar efficacy to methoxamine alone but has an increased hemodynamic stability and a less adverse effect occurrence.

Development of a new animal model of liver cirrhosis in swine.

This study aimed to develop a new experimental model of liver cirrhosis in swine by using carbon tetrachloride (CCl(4)) and ethanol. Liver cirrhosis was induced by intraperitoneal injection of CCl(4) twice a week for 9 weeks. Maize flour was the only food provided and the animals drunk a 5% alcohol-water mixture. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, bilirubin and portal venous pressure (PVP) levels were determined throughout CCl(4) treatment. The animals were sacrificed under general anesthesia at week 9 and liver samples were collected for histological analysis. 83.3% of the swine had liver cirrhosis and 33.3% had died. There was no change of body weight during the course of the experiment (p > 0.05). The AST and ALT levels increased significantly in the early stage of the study but had a trend to decrease during the late phase. The level of bilirubin increased greatly and albumin decreased during the whole experiment (p < 0.05). PVP levels decreased in the early stage in CCl(4)-treated swine, but increased significantly at the late phase. In conclusion, this study was successful in producing liver cirrhosis and offers an ideal experimental model for observing surgical therapeutic efficacy.

Evaluation of mobile nylon bag technique for determining apparent ileal digestibilities of protein and amino acids in growing pigs.

The mobile nylon bag technique (MNBT) may offer a simple, rapid means for assessing ileal AA digestibility of pig feed ingredients. In the present study, the effects of washing bags recovered from digesta, the amount and fineness of feeds, and feed trypsin inhibitor activity on apparent ileal digestibilities (AID) of CP and AA were determined with the MNBT. Twenty-four ileorectal anastomosed pigs (Yorkshire x Chinese Black barrows, 30 kg initial BW), of which 12 were fitted with duodenal T-cannulas, were used. Not washing the bags recovered from ileal digesta resulted in a reduction (P < 0.05) in apparent ileal digestibilities of CP and AA determined by MNBT. Washing the bags for more than 4 min overestimated (P < 0.05) the apparent ileal digestibilities of CP and AA compared with those determined with the anastomosed pigs. Sample size and fineness of grinding also affected (P < 0.05) apparent ileal digestibilities of CP determined by MNBT. The apparent ileal digestibilities of CP determined by MNBT were reduced (P < 0.05) when sample size exceeded 0.75 g and when feed was ground through screens with a mesh size of more than 1.0 mm. The closest agreement between results obtained by MNBT and a conventional ileal digestibility assay occurred when 0.75 g of feed ground through a 1.0-mm mesh screen was used per bag and bags were washed for 2 min after retrieval from digesta. Further studies are warranted to investigate the use of the mobile nylon bag technique for predicting the ileal digestibilty of AA for feeds containing antinutritional factors.