Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique

ObjectiveTo describe our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in the management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.MethodsA pedicled flap with a marked perforator artery was applied for soft tissue coverage after radical debridement and temporary external fixation. In the second stage, the Ilizarov external fixator was used in place of the temporary external fixator for reconstruction of the segmental bone defect by distraction osteogenesis. Twenty‐five patients (16 men and nine women; mean age, 39.2 years) were treated by using this combined technique between 2008 and 2016. All cases were graded initially as Gustilo–Anderson grade IIIB open fractures. The soft tissue defect after radical debridement ranged from 9 cm × 5 cm to 14 cm × 11 cm, and the average size of segmental defect was 5.2 (Range, 2.5–8.5) cm. Seventeen of these patients had a history of local infection. The bone structure and function were evaluated by two independent evaluators using Paley''s criteria.ResultsTwenty‐five patients were followed up for an average of 28.96 (Range, 15–48) months. The distally based sural neurovascular flap was applied in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. The flap area ranged from 10 cm × 5 cm to 14 cm × 12 cm. Sufficient coverage of soft tissue defect was achieved in all cases. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.94 (Range, 4.5–9.5) cm. The residual discrepancy was <1 cm in all cases, which was not clinically significant. The function was evaluated as excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in seven patients. Complications during treatment included pain, pin tract infections, ankle midfoot joint stiffness, and docking site nonunion. No recurrence of infection was observed in infected patients. All cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.ConclusionsThe combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis is an effective alternative approach in the salvage treatment of massively traumatized and chronically infected lower extremities.     

The FLT3 Y842D mutation may be highly sensitive to midostaurin: a case report

A Y842D mutation within the activation loop of fms-like tyrosine kinase 3 (FLT3) has been shown to confer strong resistance to sorafenib in vitro. Whether this type of mutation exerts clinically significant effects in patients with acute myeloid leukaemia (AML) remains unclear. Here, a novel Y842D activating mutation within the kinase domain of FLT3, in a pregnant patient with de novo hyperleucocyte acute myeloid leukaemia, is described. Following induction failure with standard dose idarubicin and cytarabine (IA), the patient received re-induction combined with midostaurin, a promising agent targeting mutant-FLT3, and IA regimen. Fortunately, morphological remission was achieved. During the period of midostaurin treatment, the patient exhibited a symptom that was characteristic of differentiation syndrome, which disappeared following treatment with methylprednisolone. The present case revealed that Y842D, an uncommon activating mutation in the activation loop of FLT3, may be a midostaurin-sensitive mutation type in patients with acute myeloid leukaemia.     

Comparative study on the gastrointestinal- and immune- regulation functions of Hedysari Radix Paeparata Cum Melle and Astragali Radix Praeparata cum Melle in rats with spleen-qi deficiency,based on fuzzy matter-element analysis

ContextHedysari Radix Praeparata Cum Melle (HRPCM) and Astragali Radix Praeparata Cum Melle (ARPCM) are used interchangeably in clinics to treat spleen-qi deficiency (SQD) symptom mainly including gastrointestinal dysfunction and decreased immunity, which has unknown differences in efficacy.ObjectiveTo investigate the differences between HRPCM and ARPCM on intervening gastrointestinal- and immune-function with SQD syndrome.Materials and methodsAfter the SQD model was established, the Sprague–Dawley (SD) rats were randomly divided into nine groups (n = 10): normal; model; Bu-Zhong-Yi-Qi Pills; 18.9, 12.6 and 6.3 g/kg dose groups of HRPCM and ARPCM. Gastrointestinal function including d-xylose, gastrin, amylase vasoactive intestinal peptide, motilin, pepsin, H⁺/K⁺-ATPase, Na⁺/K⁺-ATPase, sodium-glucose cotransporter 1 (SGLT1), glucose transporter 2 (GLUT2) and immune function including spleen and thymus index, blood routine, interleukin (IL)-2, IL-6, interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), immunoglobulin (Ig) M, IgA, IgG and delayed-type hypersensitivity (DTH) were detected. Finally, the efficacy differences were analysed comprehensively by the fuzzy matter-element method.ResultsIn regulating immune, the doses differences in efficacy between HRPCM and ARPCM showed in the high-dose (18.9 g/kg), but there were no differences in the middle- and low- dose (12.6 and 6.3 g/kg); the efficacy differences were primarily reflected in levels of IL-6, IFN-γ, TNF-α and IgM in serum, and the mRNA expression of IL-6 and IFN-γ in the spleen. In regulating gastrointestinal, the efficacy differences were primarily reflected in the levels of D-xylose, MTL, and GAS in serum, and the mRNA and protein expression of SGLT1 and GLUT2 in jejunum and ileum.Discussion and conclusionsHRPCM is more effective than ARPCM on regulating gastrointestinal function and immune function with SQD syndrome. Therefore, we propose that HRPCM should be mainly used to treat SQD syndrome in the future.     

家庭参与式一体化照护对早产儿生长发育 及家庭照护能力的影响

目的 探讨基于家庭参与式护理模式的一体化照护对早产儿生长发育及家庭照护能力的影响。方法 选取74例早产儿及其家庭作为研究对象,随机分为干预组和对照组各37例。对照组接受早产儿常规护理;干预组接受基于家庭参与式护理模式的一体化照护方案,由专业照护团队在早产儿出生时、出生后及出院后提供全程一体化照护支持服务。比较两组早产儿的生长发育、母乳喂养情况及早产儿家庭照护能力。结果 两组各36例完成全程随访。两组早产儿在出生时、1月龄、3月龄身长、体质量、头围比较,差异无统计学意义(均P>0.05)。干预组早产儿在出院前、1月龄、3月龄的纯母乳喂养率显著高于对照组,且干预组父母在出院时家庭照护能力评分显著高于对照组(均P<0.05)。结论 基于家庭参与式护理模式的一体化照护能够有效促进早产儿纯母乳喂养、提高早产儿家庭照护能力,为早产儿顺利过渡至家庭照护提供有利保障。     

慢性疼痛患者疼痛灾难化水平及影响因素分析

目的 探讨慢性疼痛患者疼痛灾难化现状及影响因素,为实施针对性干预提供参考。方法 采用便利抽样法选择武汉市某三甲医院门诊303例慢性疼痛患者为研究对象,运用一般资料调查表及疼痛灾难化量表进行调查。结果 慢性疼痛患者疼痛灾难化得分28.00(17.00,39.00)分,沉思维度得分最高,无助维度得分最低;93例(30.7%)患者有疼痛灾难化倾向。多元线性回归分析显示,平均疼痛程度、疼痛类型、疼痛部位个数、个人月收入、文化程度是疼痛灾难化的影响因素(均P<0.05),共解释34.0%的变异量。结论 慢性疼痛患者疼痛灾难化较高,需重点关注疼痛程度高、疼痛部位多、月收入和文化程度低的患者,进行针对性干预,以减轻疼痛,从而降低患者疼痛灾难化认知水平。     

儿科3.0 T专用磁共振对早产儿脑损伤图像质量评价研究

目的 比较3.0 T儿科专用磁共振和3.0 T全身磁共振评估早产儿脑部图像质量,以评估3.0 T儿科专用磁共振在早产儿脑部成像的应用价值。材料与方法 本研究分别在3.0 T儿科专用磁共振和3.0 T全身磁共振进行颅脑成像扫描,采集序列包括常规序列和扩散加权成像(diffusion weighted imaging,DWI)序列,并对两组T2加权成像序列进行主观评分,对3D T1加权成像序列信噪比(signal-to-noise ratio, SNR)、对比噪声比(contrast-to-noise ratio, CNR)和DWI的表观扩散系数(apparent diffusion coefficient,ADC)值进行测量。结果 主观评分显示,3.0 T儿科专用磁共振图像质量与3.0 T全身磁共振评分相当,达到临床诊断需求。儿科专用磁共振图像的双侧额叶、顶叶、颞叶、枕叶灰质和白质,中脑,小脑SNR与全身磁共振图像差异无统计学意义(P>0.05),CNR相当或优于全身磁共振;双侧额叶、顶叶、颞叶、枕叶ADC值与全身磁共振图像差异无统计学意义(P>0.05)。结论 3.0 T儿...     

Rotenone,an environmental toxin,causes abnormal methylation of the mouse brain organoid's genome and ferroptosis

More and more reports have pointed out that rotenone, as an insecticide, has high neurotoxicity and reproductive toxicity to livestock and mammals. As a highly physiological correlation system of internal organs, quasi-organs have great potential in the fields of drug toxicity and efficacy test, toxicology research, developmental biology and so on. In this study, brain organs (mBOs) derived from mouse neural stem cells were used to investigate the effects of rotenone on the physiological activity and epigenetic modification of mBOs. At the same time, Rotenone could significantly stimulate the increase of the concentration of LPO, lactic acid and hydroxyl radical in mBOs, and inhibit the expression of neuronal marker Tuj1, CHAT, PAX6 and so on. Further analysis showed that Rotenonem could induce mitochondrial damage in mBOs. The results of qPCR and Western blot showed that Rotenone could up-regulate the expressions of ferroptosis promoting protein p53, Cox2 and so on, while inhibit the expressions of negative regulatory protein of ferroptosis GPX4, FTH1, SLC7A11. In addition, the results of RRBS-Seq sequencing showed that the methylation modification at DMR level in Rotenone-treated mBOs group was significantly higher than that in Ctrl group. The results of KEGG analysis showed that compared with Ctrl, the genes with hypermethylation of promoter and Genebody in Rotenone-treated mBOs were mainly located in the Neuro active ligand-receptor interaction signal transduction pathway. In summary, rotenone can significantly lead to abnormal methylation of mouse brain organs, and lead to the loss of normal physiological function of neurons by inducing ferroptosis.