[Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities].

Objective: To investigate the clinical application effects of combination of different types of free perforator flaps in the repair of complex wounds in extremities. Methods: A retrospective observational study was conducted. From January 2018 to June 2022, 11 patients with complex wounds in extremities who met the inclusion criteria was admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 3 females, aged 28 to 55 years. The wounds in the upper extremities in 4 cases and in the lower extremities in 7 cases were repaired with different combination of free perforator flaps. After debridement, the wound area was 7.0 cm×6.0 cm-28.0 cm×12.0 cm. A combination of different types of perforator flaps were applied, including the perforator tri-leaf flap of the descending branch of the lateral femoral circumflex artery in 6 cases, the descending branch of lateral femoral circumflex artery combined with oblique branch perforating branch flap in 2 cases, the lobulated flap of the descending branch of the lateral femoral circumflex artery combined with the contralateral medial plantar artery perforator flap in 2 cases, and the bilateral perforator flap of the descending branch of lateral femoral circumflex artery combined with great toe nail flap in 1 case, with the size of a single flap ranged from 2.0 cm×2.0 cm-25.0 cm×6.0 cm. The donor site was repaired by direct suture, skin grafting, or flap transplantation. During free flap transplantation, the flap was cut and split according to the distribution of perforators, and end-to-end or end-to-side anastomosis was performed between the donor area and the recipient area. After surgery, the survival of transplanted flap in the primary recipient site, the occurrence of vascular crisis, the wound healing in the flap donor site, and the survival of transplanted skin or flap in the flap donor site were observed. During follow-up, the blood supply, appearance and texture of the transplanted flap in the primary recipient site were observed; and at the same time, the weight bearing of the plantar receiving area, the presence of sliding, ulcers, and sinus tracts of the flap, and the appearance and function of the hand were observed; the complications in the donor area were observed. Results: After surgery, one patient's transplanted flap in the primary recipient site had vascular crisis but survived after exploration+vein graft bridging; partial necrosis occurred in one lobe of anterolateral thigh lobulated flap transplanted to the primary recipient site in one patient and recovered after dressing change+skin grafting, and the different types of perforator flap transplanted to the primary recipient site in the other 9 patients all survived. After surgery, the wound with direct suture at the donor site healed well, and the skin or flap transplanted to the donor area survived well. During 3-24 months of follow-up, the blood supply, appearance, and texture of the transplanted flap at the primary recipient site were good. In two patients, the anterolateral thigh flap combined with the medial plantar flap were used to repair plantar defects. The plantar receiving area was able to bear weight, and the texture of the flaps in the recipient area was close to the normal plantar skin, without flap sliding, ulcer, or sinus tract formation. In one patient, bilateral anterolateral thigh flap combined with great toe nail flap were used to repair hand combined with soft forearm defect, and the appearance and function of hand, especially thumb were good. Only linear scar was left in the donor site without other obvious complications. Conclusions: The combination of different types of perforator flaps is a reliable clinical method to repair complex wounds in extremities with high safety, good efficacy, and less complications.

[Free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound after periorbital tumor resection and orbital enucleation].

Objective: To observe the clinical effect of free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound and after periorbital tumor resection and orbital enucleation. Methods: It was a retrospective case series study. Twelve patients with orbital tumors admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from February 2017 to April 2021 were included. There were 4 males and 8 females, aged 48 to 87 years. Nine patients had cutaneous squamous cell carcinoma, and 3 had basal cell carcinoma. All patients underwent extended resection of the tumor, resection of orbital contents and wound repair.All patients had the lesion completely removed, chimeric anterolateral thigh flap of the anterolateral femoral flap and perforator flap were transplanted to repair the wound. The donor area of the flaps was closed with tension sutures. The size of intraoperative resection lesion,intraoperative resection flap and muscle flap and the depth of the wound cavity were summarized. The postoperative flap survival, wound healing, surgical area appearance, flap color, thickness and texture, scarring and sensation in the surgical area, and tumor recurrence were observed. Results: The surgical procedures were successfully completed in all the 12 patients. The intraoperative resection lesion ranged from 7.0 cm × 5.0 cm to 15.0 cm × 8.0 cm. The depth of the wound cavity was 4.0 to 5.0 cm. The intraoperative resection flap range was 7.0 cm × 5.0 cm to 19.0 cm × 8.0 cm. The muscle flap size ranged from 4.0 cm × 3.0 cm to 5.0 cm × 4.0 cm. All flaps completely survived after surgery, and the wounds healed. The sutures at the recipient area were removed at 5 to 7 days after surgery, while the sutures at the donor area were removed at 12 to 14 days. All of the patients were followed up for 3 to 30 months. The scar at the periorbital area was concealed, and the color, thickness and texture of the flaps were similar to those of the surrounding normal skin. The scarring in the flap supply area was not hypertrophic, with localized decreased skin sensation around it. None of the patients had any tumor recurrence during the follow-up period. Conclusion: The anterolateral femoral muscle flap and perforator flap transplantation could efficiently repair the huge wound after orbital content removal, achieving satisfactory therapeutic effects.

[Preliminary observation on the short-term efficacy of laparoscopic and open pancreaticoduodenectomy in the treatment of periampullary malignant tumors].

Objective: To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients. Methods: The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ(2) test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results: A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)(t=-5.949,P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) (t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) (t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions: Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial.

PURPOSE: To investigate the effects of metabolic abnormalities, hyperandrogenemia and ovulation induction by clomiphene/acupuncture on liver function parameters among women with polycystic ovary syndrome (PCOS). METHODS: This is a secondary analysis of a randomized controlled trial. All 1000 subjects were diagnosed as PCOS by modified Rotterdam criteria. Liver function parameters, metabolic panel and hormone profile were measured at baseline and after treatment. The relationship between liver parameters with metabolic, hormonal parameters and ovulation induction was examined. RESULTS: PCOS women with metabolic syndrome had higher liver enzyme levels but lower bilirubin and bile acid levels than without. PCOS women with hyperandrogenemia had higher liver enzyme, bilirubin levels than without. Correlation analyses showed that worsening of metabolic parameters was associated with higher liver enzyme levels but lower bilirubin and bile acid levels, while increased androgen levels were associated with higher liver enzyme, bilirubin and bile acid levels. Ovulation induction with clomiphene citrate could decrease bilirubin and bile acid levels, while acupuncture had no obvious effect on liver function. CONCLUSIONS: Among PCOS women, metabolic abnormalities and hyperandrogenemia impaired different liver function parameters. Clomiphene could decrease the bilirubin and bile acid levels while acupuncture had no obvious effect on liver function.

Sonic hedgehog through Gli2 and Gli3 is required for the proper development of placental labyrinth.

Sonic hedgehog (Shh) functions as a conserved morphogen in the development of various organs in metazoans ranging from Drosophila to humans. Here, we have investigated the potential roles and underlying mechanisms of Shh signaling in murine placentation. Immunostaining revealed the abundant expression of the main components of Shh pathway in both the trophectoderm of blastocysts and developing placentas. Disruption of Shh led to impaired vascularogenesis of yolk sac, less branching and malformation of placental labyrinth, thereby leading to a robust decrease in capacity of transplacental passages. Moreover, placenta-specific gene incorporation by lentiviral transduction of mouse blastocysts and blastocyst transplantation robustly knocked down the expression of Gli3 and Gli2 in placenta but not in embryos. Finally, Gli3 knockdown in Shh(-/-) placentas partially rescued the defects of both yolk sac and placental labyrinth, and robustly restored the capacity of transplacental passages. Gli2 knockdown in Shh(+/)(-) placentas affected neither the capacity of tranplacental passages nor the vascularogenesis of yolk sac, however, it partially phenocopied the labyrinthine defects of Shh(-/-) placentas. Taken together, these results uncover that both Shh/Gli2 and Shh/Gli3 signals are required for proper development of murine placentas and are possibly essential for pregnant maintenance.

The (TTTA)n polymorphism in intron 4 of CYP19 and the polycystic ovary syndrome risk in a Chinese population.

Polycystic ovary syndrome (PCOS) is a heterogeneous disease with a strong genetic origin, but the specific determinants are still unknown. The aim of this study was to investigate the association between the (TTTA) n polymorphism in intron 4 of CYP19 and the PCOS risk in a Chinese population. We performed a case-control study which involved 222 PCOS patients and 281 controls. The fluorescent-labeled target DNA fragments containing the (TTTA)n short tandem repeats were obtained by PCR, thereafter genotyped via capillary electrophoresis. Representative alleles were directly sequenced to confirm their repeat numbers. Genotype analysis revealed seven different alleles including 7-3(∆)-, 7-, 8-, 10-, 11-, 12- and 13-TTTA-repeats. The most common allele in a Chinese population is (TTTA) 11 in our study (0.354 for PCOS and 0.390 for controls). PCOS patients showed a higher frequency of short alleles compared with controls (0.47 vs. 0.41, OR=1.245, 95% CI 0.97-1.60). The overall allelic distributions of this polymorphism did not show any significant differences between PCOS patients and the control group. No statistical differences were found in the clinical parameters or serum steroid hormone levels among PCOS patients with different genotypes. In conclusion, PCOS patients had a higher frequency of short alleles, albeit this might not strongly affect the risk of PCOS.

Effects of Ureaplasma urealyticum infection on the male reproductive system in experimental rats.

To study the effects of Ureaplasma urealyticum (Uu) infection on the male reproductive system, the mechanism of infertility induced by Uu infection was investigated in experimental rats. Male Sprague-Dowley rats were infected with Uu4 (serotype 4) through repeated natural sexual intercourse for 8 weeks to establish infection. After 8 weeks, the blood samples of the animals were collected and analysed for cytokine production, and the animals were microdissected for the analysis of the reproductive system. Morphological study showed that spermatozoa exhibited curling and breaks in the rats infected at different dosages. Of the infected rats, 27.5% had both soft and hard calculi in the urinary tract, compared with 12% in the control groups. Uu infection resulted in a decline of sperm quality, eventually leading to the death of the spermatozoa. In the infected animals, the serum interleukin 6 and interleukin 8 levels increased significantly (P < 0.05), while tumour necrosis factor-alpha and interferon-gamma showed only modest changes. Our observations showed that Uu infection has an impact on sperm morphology, leading to the death of the spermatozoa. It is plausible that the morphological alterations of spermatozoa induced by Uu infection are one of the possible factors that contribute to male infertility.

Ovarian-adrenal cross-talk in polycystic ovary syndrome: evidence from wedge resection.

OBJECTIVE: To determine whether the ovary influences adrenal androgen secretion in women with polycystic ovary syndrome (PCOS). DESIGN: Six PCOS-affected patients with clomiphene resistance and gonadotrophin hyperresponsivity, and six controls with regular ovulatory cycles, matched for age and body mass index. METHODS: Bilateral ovarian wedge resection was performed to induce ovulation surgically for these refractory women with PCOS. The adrenal androgen secretions were evaluated in PCOS patients before and again 6 months after this surgery, and in the controls, using an ACTH stimulation test (0.25mg synthetic ACTH(1-24)). RESULTS: Biochemically, basal levels and the maximum net increases (Delta) of 17-hydroxyprogesterone (17-OHP) and androstenedione, Delta17-OHP/Delta progesterone and Delta androstenedione/Delta17-OHP ratios in response to exogenous ACTH were significantly higher in PCOS patients before operation than those of controls. This purely ovarian surgery in women with PCOS was found to significantly reduce their basal androstenedione, testosterone and LH levels, insulin/glucose ratio, and post-corticotrophic Delta17-OHP, Delta androstenedione, Delta17-OHP/Delta progesterone and Delta androstenedione/Delta17-OHP, without obvious changes in FSH, oestradiol, sex hormone-binding globulin, Delta dehydroepiandrosterone, Delta dehydroepiandrosterone sulphate, Delta aldosterone and Delta cortisol values. CONCLUSIONS: Ovarian hyperandrogenicity from polycystic ovary may contribute to the enhanced adrenal P450c17alpha activity and subsequent Delta(4) androgen reserve revealed by the pharmacological corticotrophin stimulation in our special PCOS cases.

[An investigation on genotypes of hepatitis C virus in Anhui province].

To study the distribution of HCV genotypes in Anhui province, anti-HCV positive serum samples were collected from 371 hepatitis C patients, 60 patients under haemodialysis and 100 blood donors. HCVRNA was detected by reverse transcription polymerase chain reaction (RT-PCR). Based on the results of PCR positivity, HCV genotyping was investigated by restriction fragment length polymorphism. Results showed that among hepatitis C patients 143 (75.66%) were HCV type II infection, 25 (13.23%) were HCV type III and 12(6.35%) were type II/III co-infection. HCV type I and IV infection appeared in one of each (0.53%). HCV genotype could not be determined in 7 patients because of low HCVRNA titers. These results indicated that HCV II infection was the dominant genotype in Anhui Province. Geographically, HCV type II infection was higher in the southern areas. The patterns of genotype distribution in the southern and northern areas were significant different (P < 0.05). There was no significant difference between HCV genotypes in relation to the history of blood transfusion.

Wedge resection to improve insulin resistance in polycystic ovary syndrome: a study among Chinese women.

OBJECTIVE: To investigate the relation between androgen excess and insulin resistance in nonobese Chinese women with polycystic ovary syndrome. DESIGN: A prospective, controlled study. SETTING: School of Clinical Medicine, Nanjing University. SUBJECTS: There were three groups: Group 1 (n = 15) comprised nonobese women with polycystic ovary syndrome; Group 2 comprised 12 of these 15 women in whom bilateral wedge resection had been performed six months to one year before enrolling in the study. Group 3 was a control group comprised of 15 normally menstruating women of similar age and body mass index. METHODS: An oral glucose (100 g) tolerance test was performed in all women in each group. The areas under the response curve of serum glucose, insulin, C-peptide (C-P), insulin/glucose (I/G) and C-P/insulin (C/I) were calculated by trapezoid rule. RESULTS: When fasting the three groups had similar levels of glucose, insulin, C-P, I/G and C/I. During the oral glucose tolerance test women of Group 1 had a significantly higher mean serum area of the curve of glucose, insulin, C-P and I/G levels and lower C/I values, compared with the other two groups. Women of Group 2 and those in the control group showed similar levels of these indices during the oral glucose tolerance test. CONCLUSIONS: Androgen excess in women with polycystic ovary syndrome may be responsible for a defect in peripheral insulin sensitivity and hepatic extraction which could be reversed by removing excessive androgens with wedge resection.

Responses of somatostatin, beta-endorphin and dynorphin A to a glucose load in two groups of women with polycystic ovarian syndrome.

To investigate the relationship between elevated LH, hyperinsulinemia and neuropeptides in polycystic ovarian syndrome (PCOS), we measured the endogenous levels of insulin, somatostatin (SS), beta-endorphin (beta-EP) and dynorphin A (Dyn A) before and after a glucose load in three groups: group 1 (LH/ FSH > or = 3, n = 30); group 2 (LH/FSH < 3, n = 25), and controls (n = 15). In the basal state, significantly negative correlations were found between LH and SS (r = -0.51, p < 0.05) in group 1 and between LH and beta-EP (r = -0.49, p < 0.05) in group 2. After a glucose load, PCOS women had greater beta-EP and Dyn A responses in group 1 and impaired SS response in group 2 as compared with the control. The data suggest endogenously lower SS, higher beta-EP and Dyn A may contribute to the elevation of LH and insulin secretions in PCOS.

Psychological performance of accident-prone automobile drivers in China: a case-control study.

To evaluate the role of neurobehavioural factors in the aetiology of recurrent automobile accidents, we administered the Revised Wechsler Adult Intelligence Scale (WAIS-R), the Eysenck Personality Questionnaire (EPQ), and choice and simple reaction time tests to 31 accident-prone automobile drivers. These drivers who had caused three or more traffic accidents during the years 1980-1984, were selected from records of 2723 traffic accidents registered by Hefei Traffic Police Department during the years 1980-1984. The same tests were administered to an equal number of sex- and age-matched control drivers who had no reported involvement in automobile accidents. None of the subjects had suffered from any neuropsychiatric illness or head injury. Comparisons between the two groups indicated that for accident-prone drivers scores on picture completion and block design subtests of the WAIS-R were significantly lowered (p less than 0.05); scores for neurosis extrovert behaviour and psychosis (EPQ) were significantly higher (p less than 0.05); and the number of errors in the choice reaction time test was significantly higher (p less than 0.01). It is suggested that accident-prone drivers have lower psychological performance, poorer judgement and a higher tendency than safe drivers to be neurotic, extrovert and psychotic.

Relationship of menopausal status and sex hormones to serum lipids and blood pressure.

Arterial blood pressure and serum lipids were measured in 598 Chinese women aged 40-54 years. Menopausal or post-menopausal women had higher means of serum cholesterol, triglyceride and HDL-cholesterol, and had higher prevalence of hypertension, hypotension, hypercholesterolaemia and hypertriglyceridaemia than premenopausal counterparts. There were no differences in means of systolic and diastolic pressures among pre-menopausal, menopausal and postmenopausal women. Fat Synergic Index was first used in this study instead of Quetelex Index, and it was found that Fat Synergic Index is the strongest factor which affects serum cholesterol, triglyceride, HDL-cholesterol and systolic and diastolic blood pressure in multiple linear regression analyses. The role of oestradiol, progesterone and testosterone in three serum-lipid multiple regression models are different, but they are similar in systolic and diastolic blood pressure regression models. Conditional logistic regression analysis found that progesterone is a protective factor only and testosterone is one of the risk factors for hypertension.

A reusable perfusion supporting tissue-mimicking material for ultrasound hyperthermia phantoms.

A new ultrasonically and thermodynamically tissue-mimicking material is reported. The material is well suited for use in phantoms for testing ultrasound hyperthermia systems or related predictive models. Controlled convective heat transfer effects, mimicking to some extent perfusive heat transfer in tissues, can be instituted in the material with appropriate fluid sources and sinks. The material consists of closely packed agar spheres varying in diameters from 0.3-3.6 mm. The interstitial space between spheres is filled with 10% n-propanol solution. The material has two practical advantages over the solid-gel-type tissue-mimicking materials. The first advantage is that it allows rapid return of a hyperthermia phantom to thermal equilibrium following a heating test by rapid circulation of the perfusion fluid. The second advantage is that the material is in a "liquid" form. It can be easily siphoned in and out of phantom containers of any geometric shape for different purposes without change in its physical properties. Methods for measuring ultrasonic and thermodynamic properties of the material and the results of the measurements are reported. The physical parameters measured are the intensity attenuation and absorption coefficients, the ultrasonic speed, the thermal conductivity, specific-heat capacity and the mass density. Temperature measurements in a hyperthermia phantom made of the material are also reported.