Necrotizing fasciitis (NF) is a fatal disease with a high mortality rate that can be easily misdiagnosed. The aim of this study was to improve the diagnostic rate of NF and overall survival. We conducted a single-center, retrospective, noncontrolled study involving 36 patients who were admitted to our department between December 2017 and October 2019, and summarized the diagnostic key points and timing of surgical treatment. All patients were diagnosed at our department and underwent multiple courses of treatment. The records included information regarding underlying diseases, bacterial culture results, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of procedures, and type of antibiotics. All 36 cases of NF were cured and showed good patient condition on follow-up; the mean number of surgeries was three, and the mean duration of hospitalization was 37 days (range, 21-83 days). The LRINEC scores of 16 patients were ≥8 points. Seventeen patients with underlying diabetic disease had higher inflammatory index scores than those without diabetes. The LRINEC scores of patients with (n = 17) and without (n = 19) DM were 7.40 ± 2.99 and 3.80 ± 2.39, respectively (P < .01). Cases of NF that were treated with early incision and surgical abscess drainage required fewer surgeries and a shorter length of hospitalization. Thus, surgeons should be more aware of NF and aim to make an early and accurate diagnosis using various approaches. Complete surgical debridement plays an essential role in NF treatment, and diabetes mellitus is a significant adverse factor that exacerbates the severity of NF. Negative-pressure techniques are useful in cases involving nonanaerobic infections and cause minimal complications.

目的 探讨不同时期瘢痕挛缩状态的治疗方式选择及临床治疗效果.方法 回顾性分析自2019年3月至2021年3月,江苏省人民医院(南京医科大学第一附属医院)整形烧伤外科收治的 55例瘢痕患者.一组为早期瘢痕患者(早期组,1～6个月)共 34 例,采用超脉冲CO2 点阵激光治疗,间隔 3 个月行第 2 次治疗,分别于首次治疗前和末次治疗后 3 个月,按照温哥华瘢痕量表(vancouver scar scale,VSS)评分评估瘢痕情况,关节处按照关节最大活动角度测量方法,对比治疗前后情况.记录治疗过程中的不良反应情况.另一组为稳定期挛缩瘢痕(稳定期组,6 个月至 48 年),共 21 例,伴有关节功能障碍患者 15 例,采用瘢痕组织瓣(皮下蒂菱形皮瓣、Z成形术及衍生瓣等)松解挛缩瘢痕,设计的松解切口均在瘢痕组织内,部分缺损联合少量0.35 mm的断层皮片移植修复.术前及术后 6 个月测量关节最大活动度,比较关节功能改善情况;记录皮瓣/皮片成活情况,手术并发症等.结果 早期组末次治疗后 3 个月,瘢痕的色泽、厚度、血管分布、柔软度以及VSS总评分均较治疗前明显降低(t=4.95、5.78、6.40、5.92、15.37,P均<0.05).涉及关节区域者在随访时均无功能障碍,关节活动度(range of motion,ROM)较治疗前明显变大(t=-5.07,-4.97,-4.29,-4.68,P均<0.05),分别有 28 例(82.4%)显效,5 例(14.7%)有效,1 例(2.9%)无效,总有效率为 97.06%(33/34),所有患者无增厚、感染.稳定期组治疗后,所有关节功能均得到有效改善,差异有统计学意义(P<0.05).17 例(81.0%)显效,4 例(19.0%)有效,无无效患者,总有效率为 100%(21/21).1 例皮片少许感染溶解,1 例皮瓣尖端淤紫,均在换药处理后愈合.结论 瘢痕的挛缩治疗应在早期干预,改善瘢痕质地的同时,治疗或预防了关节功能障碍,CO2 点阵激光对早期瘢痕挛缩状态的治疗是有效的.手术采用瘢痕组织瓣设计治疗稳定期的挛缩瘢痕,既能有效改善挛缩状态、改善关节功能障碍,又最大限度的减少了对正常皮肤的损伤.

Background: The diagnosis and cure rate of gastroesophageal reflux disease (GERD) is low, and its pathogenesis remains unclear. Aims: In this study, we aimed to construct the competing endogenous RNA (ceRNA) of GERD by bioinformatics and explore the potential therapeutic drugs for GERD. Methods: The differentially expressed genes (DEGs) were got by limma package and visualized by ggplot2 and pheatmap package in R version 4.1.3 from the GSE63401 gene microarray data. The pro-tein-protein interaction (PPI) network was constructed by the STRING database. The hub genes and subnetwork modules were obtained by Cytoscape software. The microRNA and lncRNA were pre-dicted by the miRTarBase and miRNet databases to construct the ceRNA network. Potential drugs tar-geting DEGs were screened by the CMAP database. Results: In this study, a total of 571 GEDs were obtained, including 462 up-regulated genes and 109 down-regulated genes, which mainly participated in the leukocyte migration process and the cytokine-cytokine receptor interaction pathway. Seventeen miRNAs and three key lncRNAs involved in regulat-ing hub genes were screened through miRTarBase and miRNet databases. Finally, nine ceRNA net-works were obtained, including TTN-AS1/NEAT1/XIST - miR-139-5p - CXCR4 axis, TTN-AS1/NEAT1/XIST - miR-185-5p - IL1B axis and TTN-AS1/NEAT1/XIST - miR-495-3p - LYN axis. In addition, five potential drugs (Pimavanserin, BMS-182874, CL-218872, Losartan, and Laropiprant) for GERD were obtained through the CMAP database. Conclusion: We constructed nine GERD-related ceRNA networks and screened five potential thera-peutic drugs for GERD, providing a theoretical basis for further research on the pathogenesis of GERD.

Background: Local flap reconstruction is the most common method to repair facial defects. In this study, authors have explored and introduced a modified suture technique with rotation flap to repair facial defects that makes scarring more discreet and easier to perform. Methods: Patients with facial defects who underwent surgical treatment of the rotation flaps reconstructions and were admitted to our department between October 2014 and October 2019 were included in this retrospective study. The rotating flap is designed along the Relaxed Skin Tension Line (RSTLs) and contour lines, parts of patients received modified suture depending on the shape and size of the defect. Observe the flaps’ survival and complications. Assessments of the scars with Vancouver Scar Scale (VSS) regularly and follow-ups. Results: This five-year retrospective study evaluated a total of 56 patients; of these, 45 patients underwent modified suture surgery, the average defects were 19.7±4.5×25.5±5.2mm, and the average duration of follow-up was 13.8±5.0 months. Scar appearance was evaluated using the VSS score, range from 0-5, with an average of 1.6±1.1, and mainly reflected in pigmentation and vascularity. Postsurgical scar concealment is made afterward, and all flaps survive. No hemodynamic disorder or necrosis was found. Conclusion: The rotation flap was designed based on RSTLs/ contour lines to repair the facial defect and make the scarring well concealed. The modified suture method makes the flap line consistent with the RSTLs/ contour line of the facial skin to the maximum extent and leads to better facial aesthetics results.

Background Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient. Objective To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue. Materials and Methods Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6-24 months. Results Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%. Conclusion Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.

Abstract Background Esophageal cancer (EC), known for its high malignancy and difficulty in treatment, has seen a significant increase in incidence in recent years. Studies on prognosis of EC are extremely urgent to provide personalized medicine which will benefit more patients individually. Pyroptosis, an inflammatory form of programmed cell death triggered by caspase-1/4/5/11 which is activated by some inflammasomes has been connected to cancer in recent studies. However, the association between pyroptosis-related genes and esophageal cancer has not been elucidated, and their vital role in the development and prognosis of esophageal cancer needs further research. Methods We obtained 290 samples from both TCGA and GEO database,including 11 normal people and 279 EC patients. Then we screened pyroptosis-related regulators that were differentially expressed in normal esophageal and cancer tissues. We next exerted univariate Cox regression analysis and LASSO analysis to further choose key genes.Validation of these genes’ expression in cells was also conducted in vitro. Using these genes and other clinical features, we next constructed a risk model and a nomogram for predicting the prognosis of EC patients. Functions of pyroptosis-related genes and their relevance to clinical characteristics were discussed through two clustering analyses, Finally, we constructed a pyroptosis score system to predict the prognosis of EC. Results We finally screened 32 differentially expressed genes between normal and tumor tissues.And 8 key genes were identified after univariate Cox regression and LASSO analysis. Then the risk model and nomogram built based on them both showed strong predictive power according to our survival curves and ROC curves.Our subsequent invitro validation on key genes above also appeared high agreement with the regression analysis result. Finally, we calculated the pyroptosis score and it showed strong relationship with clinical features. Conclusion Pyroptosis-related genes are intimately related with EC and can be used to predict the prognosis of EC, which may also provide novel therapeutic schedule for EC patients.

Introduction: Abnormal iron metabolism has received increasing attention in the development of liver injury. Recent findings have shown that iron metabolism may be associated with elevated alanine aminotransferase (ALT), and the aim of this study was to investigate the relationship between iron metabolism-related indicators and elevated ALT.Methods: Based on the data of Chinese adults aged 18 years and older in the China Health and Nutrition Survey (CHNS), we analyzed the correlations between glucose, lipid, and iron metabolism-related indicators and elevated ALT, and explored iron metabolism-related indicators affecting ALT levels using binary logistic regression models.Results: Serum ferritin levels and transferrin levels were positively correlated with elevated ALT. The OR of elevated ALT in the highest serum ferritin level group was 7.34 (95% CI: 4.66-11.54, P<0.001) compared to the lowest serum ferritin level group. The OR for elevated ALT in the highest transferrin group was 3.65 (95% CI: 2.34-5.68, P < 0.001) compared to the lowest transferrin group. In addition, hypoplasticemia was significantly associated with an increased risk of elevated ALT (OR=3.98, 95%IC: 2.16-7.34, P<0.001). These relationships persisted after adjustment for covariates.Conclusion: High ferritin and transferrin levels and hypoplasticemia are associated with elevated ALT. Unexplained elevation of ALT may suggest the development of metabolic-associated fatty liver disease (MAFLD), so this study provides clues to investigate the role of iron metabolism in the pathogenesis of MAFLD.Funding Information: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.Declaration of Interests: The authors declare that the research was conducted in the absence of any financial relationships that could be construed as a potential conflict of interest.Ethics Approval Statement: Data of this study was from the China Health and Nutrition Survey (CHNS). CHNS was approved by the Institutional Review Committees of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention. This research uses data from China Health and Nutrition Survey (CHNS). We thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center (P2C HD050924, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077, D43 TW007709) for financial support for the CHNS data collection and analysis files from 1989 to 2015 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011.

Scars are nearly impossible to avoid after a skin injury, but despite advancements in the treatment modalities, they remain a clinical problem, especially hypertrophic scars (HS). Many studies include the mechanism of formation and inhibition of HS, but it is not fully understood yet. Circular RNA HECTD1 (circHECTD1), for the first time, has been found to have roles in HS physiology. We determined the relative circHECTD1 levels in HS fibrous cells and tissues by RT-qPCR. Afterward, the effect of circHECTD1 knockdown on the proliferation, migration, invasion, fibrosis, and Transforming Growth Factor-beta/small mothers against decapentaplegic (TGF-β/Smad) signaling was studied using CCK-8, wound healing, Transwell, and western blot assays. After the role of circHECTD1 was clarified, its targeted micro RNA (miR) was predicted using the Starbase database, and we constructed a miR-142-3p mimic to study the details of its regulation mechanism. We used the TargetScan database to predict the downstream target high mobility group box 1 (HMGB1) of miR-142-3p, and the luciferase report assay verified the binding, and then its effect was determined by RT-qPCR. circHECTD1 is highly expressed in HS tissues and human skin hypertrophic scar fibroblasts (HSF); its loss of function inhibits cell proliferation, migration, invasion, fibrosis, and TGF-β/Smad signaling. However, miR-142-3p inhibitor reverses the effect of circHECTD1 on all the above-mentioned aspects, including HMGB1 expression. In conclusion, circHECTD1 knockdown interrupts TGF-β/Smad signaling through miR-142-3p/HMGB1 and suppresses scar fibrosis.

The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients' judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.

Osteosarcoma (OS) is a rare soft-tissue malignant tumor with high lung metastasis and mortality rates. Preoperative chemotherapy, surgical resection of the lesion and postoperative chemotherapy are still the main treatments for osteosarcoma. The prognosis, however, is poor for patients with nonresectable, primary metastatic or relapsed disease. Recent studies have shown that targeted therapy for OS based on the characteristics of exosomes is very attractive. Exosomes are nanosized extracellular vesicles (EVs) that participate in cell-to-cell communication by transporting biologically active cargo molecules, causing changes in OS cell function and playing important roles in OS disease progression. With the characteristics of secretory cells, exosomes transport cargo (e.g., microRNAs) that can be used to detect the progress of a disease and can serve as markers and/or therapeutic targets for clinical diagnosis of OS. In this review, the roles of exosomes in OS pathogenesis, invasion, metastasis, drug resistance, diagnosis and treatment are summarized. In addition, this article elaborates a series of challenges to overcome before exosomes are applied in clinical practice and provides suggestions based on current evidence for the direction of future research.

Stevens-Johnson syndrome (SJS) is a severe type of pleomorphic erythema and a rare disorder of the skin and mucous membranes, which can lead to serious infections, pulmonary embolism, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and other serious consequences. Patients with SJS are usually treated in burn centers. SJS complicated by severe burns is very rare, and this is associated with a high risk of infection and other more serious complications. With SJS, the availability of donor sites is compromised given the lack of healthy epidermis, and this makes it more difficult to treat. The patient was a 52-year-old man with 45% TBSA burns with 40% TBSA full-thickness burns on both lower limbs. During treatment, his condition was complicated by SJS, renal failure, and respiratory failure. After 31 days, he was transferred to our department. On the 22nd day, the patient recovered from SJS, and after undergoing four skin grafting procedures, the burn wounds healed, and the donor site had healed spontaneously. He was discharged after 86 days of treatment in our department. In conclusion, major burns complicated with SJS are rare clinical presentations. The skin affected by the drug eruptions can be used as a donor site for transplantation to the burn wounds, and this donor area can also heal.

Objective To introduce an excellent one-stage procedure for repairing defects of the middle and distal part of the nose:nasal dorsal glabellar flap.Methods According to the size,shape and location of nasal defect,homologous nasal dorsal glabellar flap was selected to cover the nasal defect in 17 cases.Among 17 cases,there were 7 men and 10 women,with age of 38 to 76 years.The locations were nasal tip in 9 cases and dorsum of nose in 8 cases,The area of the defect ranged from 15 mm× 15 mm to 30 mm× 26 mm.The nasal dorsal glabellar flap,which received a versatile axial blood supply from branches of the facial artery and ophthalmic artery,took tissue from the lax glabellar skin and might appear to be too aggressive for closure of a distal nasal or mid-nasal defect.However,because its design was primarily that of a rotation flap with a back-cut in the glabella region,it was greater than the primary defect in order to maximize tissue movement and decreased wound closure tension at the flap donor site.The secondary defect of donor site was directly sutured.Results The nasal defect was successfully repaired in all patients,and the all flaps survived.The patients were available for follow-up of 1 to 6 months,no tumor recurrence occurred,and the repaired tissue were good match with surrounding tissue in color,thickness and texture,good nasal contour was obtained and no secondary deformity occurred,and therefore the cosmetic results were satisfactory.Conclusions The nasal glabellar flap has evolved into a choice flap for nasal defects of cover since it provides local skin with an exact color,thickness,and texture match for the nasal skin.It allows large reconstructions for up to 30 mm defects leaving minimal scars.It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose.

目的 观察超脉冲CO2点阵激光治疗面部瘢痕的临床疗效.方法 对73例不同原因所致的面部瘢痕患者,根据瘢痕的厚度、形态选择超脉冲CO2点阵激光适合的治疗参数,如波长10600nm,能量20～ 175mJ,功率1～60W,频率30～300 Hz,密度3％～5％.同时根据温哥华瘢痕量表(vancouver scar scale,VSS)对治疗前后进行评分及数码拍照和疗效判断,并记录不良反应发生情况.结果 本组73例患者,共进行了95次治疗.治疗前VSS评分为(6.35±3.51)分;治疗后VSS评分为(3.27±2.07)分,与治疗前比较总分明显下降,其差异有统计学意义(P＜0.05).71例患者治疗后的外观均有显著改善,总有效率为97.3％;2例患者无效,其中1例发生感染,1例不满意.结论 采用超脉冲CO2点阵激光治疗面部瘢痕,疗效良好,操作安全,值得临床推广应用.

目的:探讨耳甲腔皮肤、软骨复合组织联合额部皮瓣行较严重的鼻缺损再造的手术方法及术后效果.方法:选取因外伤、鼻部肿瘤造成的半侧鼻或全鼻缺损患者,根据鼻尖、鼻翼、鼻小柱等缺损面积,设计额部皮瓣和耳甲腔皮肤、软骨复合组织,分期行复合组织瓣预制、转移、断蒂等,完成半侧鼻或全鼻再造,尽可能修补鼻的骨架支撑和外形.结果:本组20例患者采用上述方法行鼻再造,未发生移植物、皮瓣坏死,术区瘢痕轻微,鼻部外观及功能良好,耳部供区无畸形.结论:耳甲腔复合组织联合额部皮瓣行鼻再造可达到理想的外观和功能恢复.