To investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous.According to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients.From Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results.These two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.
A clinical perspective study was designed for patients undergoing a modified parotidectomy to reduce complications of parotidectomy.110 patients were divided randomly into two groups; Group 1 (55 cases) was operated via routine surgical modality. Group 2(55 cases) was treated with preserving the fascia parotideomasseterica and great auricular nerve and partial parotidectomy. Tumor size, blood loss, operating time, temporary facial paralysis, tumour recurrence were compared between the two groups. The follow-up period was 2 years. The incidence of Frey's syndrome was clinically evaluated by Minor test (starch-iodine test). The feeling of the region around the auricular lobule was also evaluated. The data were analyzed using SPSS10.0 software package for Student's t test and Chi-square test.There was no significant difference between the two groups in tumor size, temporary facial paralysis and tumor recurrence. Group 1 was significantly lower than that in Group 2 in the bleeding volume and operating time. The incidence rate of Frey's syndrome in Group 1 was significantly lower than that in Group 2 by objective observation and Minor test. There was significant difference between the feeling of pro- operation and pre-operation in the auricular lobule.The modified parotidectomy is a function-preserving surgery for benign parotid tumours, which improves the cosmetics, the feeling around ear, reduces the duration of surgery, and the incidence rate of Frey's syndrome. Supported by Research Fund of Science and Technology Bureau of Shanxi Province [Grant No.2005K14-G8(2)] and Science and Technology Project of Xi'an City [Grant No.SF08008-(4)].
Objective To explore the effect of the island flap application on repairing large scale defects on the face.Methods Based on the defect size,shape and location,preauricula narrow stem side geny-neck flap,submental island flap,angular artery flap,eyelid musculus orbicularis flap and nasolabial groove island flap were used to repair the large scale defects of the face in a one-stage operation.Results All flaps survived well without any obvious complications.35 patients were followed up for 1 to 36 months.Repaired tissues were well matched with the surrounding tissue.Resulting facial contour and appearance were good,and cosmetic results overall were satisfactory.Conclusion The application of island flaps to repair the large scale defects on the face in a one-stage operation is a better method that can achieve good contour and satisfactory cosmetic results.
Key words:
Face; Skin defect; Island flap
Carotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.This study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2-6/3-6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.SMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19-111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2-6, and a total of 10 (15.4%) patients had a mRS of 3-6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2-6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3-6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2-6 was 3.06 (95% CI 1.05-12.59, P = 0.041) and 0.51 (95% CI 0.31-0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3-6 was 6.11 (95% CI 1.19-31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59-0.87), 0.76 (95% CI 0.64-0.89) and 0.85 (95% CI 0.76-0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63-0.95).Intraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.
Abstract Objective: To contrast the effects and complications in unilateral and bilateral percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures in elderly patients. Methods: Multiple databases were adopted to search relevant studies, and the articles eventually satisfied the criteria were included. All the meta-analyses were conducted with the Review Manager 5.2. To estimate the quality of each article, risk of bias table was performed. Results: Finally, 627 patients were enrolled in 9 studies and ultimately met the eligibility criteria. The unilateral and bilateral surgical samples were 314 and 313, respectively. The meta-analysis showed no significant difference in Visual Analog Scale/Score (VAS) (MD = −0.05, 95% confidence interval [CI] [−0.24, 0.13], P = .57), Oswestry Disability Index (ODI) score (MD = 0.03, 95% CI [−0.57, 0.62], P = .93) and cement leakage (OR = 1.00, 95% CI [0.67, 1.50], P = 1.00) between unilateral group and bilateral group. The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = −8.42, 95% CI [−13.17, −3.66], P = .0005). Patients with bilateral PVP surgery have been injected more cement than patients with a unilateral surgery (MD = −2.56, 95% CI [−2.79, −2.33], P <.00001). Conclusion This study demonstrated unipedicular approach is the preferred surgical technique for treatment of osteoporotic vertebral fracture (OVF) compared with bilateral PVP since unipedicular approach injects less cement and cost less surgery time.
Introduction The purpose of this study was to investigate the predictive factors of atrial fibrillation (AF) recurrence in patients after first-time radiofrequency catheter ablation (RFCA) and to develop a nomogram predictive model that can provide valuable information for determining the ablation strategy. Methods In total, 500 patients who had received first-time RFCA for AF were retrospectively enrolled in the study. The patients were divided into a training cohort ( n = 300) and a validation cohort ( n = 200) randomly at a 6:4 ratio. Lasso and multivariate logistic regression analyses were used to screen the predictors for AF recurrence during a 2-year follow-up. The C-index and a calibration plot were used to detect the discriminative ability and calibration of the nomogram. The performance of the nomogram was assessed compared with the APPLE score, CAAP-AF score, and MB-LATER score using the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), integrated discrimination index (IDI), and net reclassification index (NRI). Results A total of 78 patients experienced the recurrence of AF after first-time RFCA in the training cohort. The six strongest predictors for AF recurrence in the training cohort were persistent AF, duration of AF, left atrial diameter (LAD), estimated glomerular filtration rate (eGFR), N-terminal pro-brain natriuretic peptide (NT-proBNP), and autoantibody against M2-muscarinic receptor (anti-M2-R). Based on the above six variables, a nomogram prediction model was constructed with a C-index of 0.862 (95% CI, 0.815–0.909), while the C-index was 0.831 (95% CI, 0.771–0.890) in the validation cohort. DCA showed that this nomogram had greater net benefits compared with other models. Furthermore, the nomogram showed a noticeable improvement in predictive performance, sensitivity, and reclassification for AF recurrence compared with the APPLE score, CAAP-AF score, or MB-LATER score. Conclusion We established a novel predictive tool for AF recurrence after the first-time RFCA during a 2-year follow-up period that could accurately predict individual AF recurrence.
Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation, and is associated with systolic dysfunction and increased action potential duration. Approximately 50% of DCM cases are caused by inherited gene mutations with genetic and phenotypic heterogeneity. Next generation sequencing may be useful in screening unknown mutations in such cases. A family was identified with DCM, in which the affected family members developed heart failure, arrhythmia, and sudden death. Probands and 4 affected family members underwent whole exome sequencing (WES), bioinformatics methods, and gene annotation to identify potentially causative variants. The Sanger sequencing method was used to verify the candidate mutation. WES yielded 2,238,831 variations. KCNJ12 (p.Glu334del) was identified as a candidate mutation, and the heterozygous mutation was verified by Sanger sequencing. Our study emphasizes the application of WES in identifying causative mutations in DCM. This report is the first to describe the KCNJ12 gene as a cause of DCM in patients.
Abstract Background : Gastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery. Methods : This was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were observed in both groups. Results : A total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter anaesthesia resuscitation time (7 [6,9] h vs. 9 [7,11] h, p = 0.013) and first postoperative exhaustion time (11 [8,14] h vs. 14 [11,18], p = 0.003) were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007). Conclusion : The esketamine-based opioid-sparing anaesthesia protocol may shorten gastrointestinal function recovery time, reduce the incidence of PONV, and promote early recovery in patients after benign gynaecological laparoscopic surgery. Also, the application of esketamine may reduce the postoperative opioid dosage requirement of patients. Trial registration : This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021)
Potent analgesics such as sufentanil and remifentanil play a pivotal role in general anesthesia, but these medications have disadvantages, including respiratory depression, nausea, vomiting, immune system suppression, and gastrointestinal function inhibition. This study aimed to evaluate the effects of the transversus thoracic muscle plane–pectoral nerves (TTP-PECS) block on postoperative analgesia, immune function and early postoperative recovery quality in patients undergoing modified radical mastectomy under opioid-sparing general anesthesia. A total of 100 patients scheduled for modified radical mastectomy under general anesthesia were randomly divided into the TTP-PECS block combined with opioid-sparing general anesthesia group (TO group, n = 50) or the conventional general anesthesia group (GA group, n = 50). The TO group underwent TTP-PECS block prior to induction, using oxycodone as the analgesic during induction instead of sufentanil, no additional continuous infusion of analgesic was performed intra-operatively. Visual analogue scale (VAS) scores at rest and during movement at different time points were recorded in both groups, and the levels of T cell subsets, natural killer (NK) cells were measured before the surgery and at 24 h and 48 h after the surgery. Quality of Recovery-40 (QoR-40) scores were assessed at 24 h postoperatively, and the incidence of peri-operative adverse reactions was also observed in both groups. Except for 48 h postoperatively, patients in the TO group had significantly lower VAS scores than those in the GA group at 2 h, 6 h, 12 h, and 24 h postoperatively at rest and during movement (P < 0.05). At 24 h and 48 h postoperatively, the expression of CD4+ T cells and the CD4+/CD8+ ratio were significantly higher in the TO group than in the GA group (P < 0.05). The QoR-40 scale, assessed at 24 h postoperatively, showed that the TO group significantly outperformed the GA group in total scores as well as in sub-scores for emotional state, physical comfort, physical independence, psychological support, and pain (P < 0.05). In addition, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were lower at time points T1–T4 than at T0 in both groups (P < 0.05), but the differences between the two groups were not statistically significant(P > 0.05). The incidence of cough reflex during induction and postoperative nausea and vomiting were significantly lower in the TO group than in the GA group (P < 0.05). There was no statistically significant difference between the two groups in the incidence of other adverse reactions (P > 0.05). The combination of TTP—PECS block and oxycodone–propofol opioid-sparing general anesthesia can provide superior postoperative analgesia and reduce the incidence of postoperative nausea and vomiting. It also alleviated the suppression of cellular immune function and improves the quality of early recovery in breast cancer patients. At the same time, opioid-sparing general anesthesia is a safe strategy for modified radical mastectomy. Chinese Clinical Trial Registry; ChiCTR2200066753.
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