Analysis of Influencing Factors for Stackable and Expandable Acoustic Metamaterial with Multiple Tortuous Channels

To reduce the noise generated by large mechanical equipment, a stackable and expandable acoustic metamaterial with multiple tortuous channels (SEAM-MTCs) was developed in this study. The proposed SEAM-MTCs consisted of odd panels, even panels, chambers, and a final closing plate, and these component parts could be fabricated separately and then assembled. The influencing factors, including the number of layers N, the thickness of panel t0, the size of square aperture a, and the depth of chamber T0 were investigated using acoustic finite element simulation. The sound absorption mechanism was exhibited by the distributions of the total acoustic energy density at the resonance frequencies. The number of resonance frequencies increased from 13 to 31 with the number of layers N increasing from 2 to 6, and the average sound absorption coefficients in [200 Hz, 6000 Hz] was improved from 0.5169 to 0.6160. The experimental validation of actual sound absorption coefficients in [200 Hz, 1600 Hz] showed excellent consistency with simulation data, which proved the accuracy of the finite element simulation model and the reliability of the analysis of influencing factors. The proposed SEAM-MTCs has great potential in the field of equipment noise reduction.

[Malignant peripheral nerve sheath tumor: a clinicopathological analysis]

Objective: To investigate the clinicopathological, immunophenotypic, and genetic features of malignant peripheral nerve sheath tumor (MPNST). Methods: Twenty-three cases of MPNST were diagnosed at the Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), China, between January 2012 and December 2022 and thus included in the study. EnVision immunostaining and next-generation sequencing (NGS) were used to examine their immunophenotypical characteristics and genomic aberrations, respectively. Results: There were 10 males and 13 females, with an age range of 11 to 79 years (median 36 years), including 14 cases of neurofibromatosis type I-associated MPNST and 9 cases of sporadic MPNST. The tumors were located in extremities (7 cases), trunk (4 cases), neck and shoulder (3 cases), chest cavity (3 cases), paraspinal area (2 cases), abdominal cavity (2 cases), retroperitoneum (1 case), and pelvic cavity (1 case). Morphologically, the tumors were composed of dense spindle cells arranged in fascicles. Periphery neurofibroma-like pattern was found in 73.9% (17/23) of the cases. Under low magnification, alternating hypercellular and hypocellular areas resembled marbled appearance. Under high power, the tumor cell nuclei were irregular, presenting with oval, conical, comma-like, bullet-like or wavy contour. In 7 cases, the tumor cells demonstrated marked cytological pleomorphism and rare giant tumor cells. The mitotic figures were commonly not less than 3/10 HPF, and geographic necrosis was often noted. Immunohistochemically, tumor cells were positive for S-100 (14/23, 60.9%) and SOX10 (11/23, 47.8%). The loss of the CD34-positive fibroblastic network encountered in neurofibromas was observed in 14/17 of the MPNST cases. The loss of H3K27me3 expression was observed in 82.6% (19/23) of the cases. Moreover, SDHA and SDHB losses were presented in one case. NGS revealed that NF1 gene loss of function (germline or somatic) were found in all 5 cases tested. Furthermore, four cases accompanied with somatic mutations of SUZ12 gene and half of them had somatic mutations of TP53 gene, while one case with germline mutation in SDHA gene and somatic mutations in FAT1, BRAF, and KRAS genes. Available clinical follow-up was obtained in 19 cases and ranged from 1 to 67 months. Four patients died of the disease, all of whom had the clinical history of neurofibromatosis type Ⅰ. Conclusions: MPNST is difficult to be differentiated from a variety of spindle cell tumors due to its wide spectrum of histological morphology and complex genetic changes. H3K27me3 is a useful diagnostic marker, while the loss of CD34 positive fibroblastic network can also be a diagnostic feature of MPNST. NF1 gene inactivation mutations and complete loss of PRC2 activity are the common molecular diagnostic features, but other less commonly recurred genomic aberrations might also contribute to the MPNST pathogenesis.

[Prevalence of obesity and its association with dietary patterns: a cohort study among Tibetan pastoralists in Qinghai Province]

Objectives: To explore obesity prevalence and its association with dietary patterns among Tibetan pastoralists during the urbanization transition in Qinghai Province. Methods: Using an open cohort study design, 1 003 subjects were enrolled at baseline in 2018, 599 were followed up, and 1 012 were newly recruited in 2022. A total of 1 913 adults over 18 years were included in the study, and a questionnaire survey and health examination were conducted. Factor analysis was used to identify dietary patterns, and a mixed-effects model was used to analyze the association between dietary patterns and obesity. Results: From 2018 to 2022, the prevalence rates of overweight, obesity, and central obesity were 27.6%, 33.8%, and 54.6%, respectively. Age-sex-standardized prevalence of obesity and central obesity increased. Three dietary patterns were identified: the modern pattern was characterized by frequent consumption of pork, poultry, processed meat, fresh fruits, sugary drinks, salty snacks, etcetera; the urban pattern was characterized by frequent consumption of refined carbohydrates, beef and mutton, vegetables and eggs, etcetera; and pastoral pattern featured frequent consumption of tsamba, Tibetan cheese, buttered/milk tea, and whole-fat dairy products. After adjusting for demographic characteristics, socioeconomic status, and lifestyle factors, compared with the T1, subjects in the T3 of urban pattern scores were more likely to be overweight (OR=2.09, 95%CI: 1.10-3.95) and overweight/obese (OR=1.23, 95%CI: 1.00-1.51), whereas those in the T3 of pastoral pattern scores had a lower risk of overweight (OR=0.45, 95%CI: 0.24-0.84), obesity (OR=0.81, 95%CI: 0.69-0.95), overweight/obesity (OR=0.75, 95%CI: 0.61-0.91) and central obesity (OR=0.58, 95%CI: 0.38-0.89). Conclusions: Prevalence of obesity and central obesity was high among Tibetan pastoralists during the urbanization transition. Urban dietary pattern was a risk factor for overweight and overweight/obesity, whereas pastoral dietary pattern was a protective factor for overweight, obesity, overweight/obesity, and central obesity. Tailored interventions are needed to improve local people's health.

A Novel Trajectory Feature-Boosting Network for Trajectory Prediction

Trajectory prediction is an essential task in many applications, including autonomous driving, robotics, and surveillance systems. In this paper, we propose a novel trajectory prediction network, called TFBNet (trajectory feature-boosting network), that utilizes trajectory feature boosting to enhance prediction accuracy. TFBNet operates by mapping the original trajectory data to a high-dimensional space, analyzing the change rules of the trajectory in this space, and finally aggregating the trajectory goals to generate the final trajectory. Our approach presents a new perspective on trajectory prediction. We evaluate TFBNet on five real-world datasets and compare it to state-of-the-art methods. Our results demonstrate that TFBNet achieves significant improvements in the ADE (average displacement error) and FDE (final displacement error) indicators, with increases of 46% and 52%, respectively. These results validate the effectiveness of our proposed approach and its potential to improve the performance of trajectory prediction models in various applications.

Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

Study on Sound-Insulation Performance of an Acoustic Metamaterial of Air-Permeable Multiple-Parallel-Connection Folding Chambers by Acoustic Finite Element Simulation

In order to achieve a balance between sound insulation and ventilation, a novel acoustic metamaterial of air-permeable multiple-parallel-connection folding chambers was proposed in this study that was based on Fano-like interference, and its sound-insulation performance was investigated through acoustic finite element simulation. Each layer of the multiple-parallel-connection folding chambers consisted of a square front panel with many apertures and a corresponding chamber with many cavities, which were able to extend both in the thickness direction and in the plane direction. Parametric analysis was conducted for the number of layers n_l and turns n_t, the thickness of each layer L₂, the inner side lengths of the helical chamber a₁, and the interval s among the various cavities. With the parameters of n_l = 10, n_t = 1, L₂ = 10 mm, a₁ = 28 mm, and s = 1 mm, there were 21 sound-transmission-loss peaks in the frequency range 200-1600 Hz, and the sound-transmission loss reached 26.05 dB, 26.85 dB, 27.03 dB, and 33.6 dB at the low frequencies 468 Hz, 525 Hz, 560 Hz, and 580 Hz, respectively. Meanwhile, the corresponding open area for air passage reached 55.18%, which yielded a capacity for both efficient ventilation and high selective-sound-insulation performance.

[The rise and fall of the leprosy clinic in Ru Gao in the North of Jiangsu in the period of the Republic of China]

The North of Jiangsu was a traditional area for leprosy in Chinese history. In the period of the Republic of China, one of the largest leprosy clinics in China was established in Ru Gao (Jugao) with the help of Chinese and foreign charitable organizations, the Chinese central government and some squires. It was the only large clinic for leprosy in the North of Jiangsu. It was officially opened in 1924, attached to the Presbyterian Church hospital, and was closed in 1927 after the breakout of the civil war. It reopened in May 1933, hosted by a leprologist, Lee S. Huizenga. Ru Gao (Jugao) leprosy clinic treated around 1,000 lepers in the North of Jiangsu with medicines and language communication. The establishment of the leprosy clinic made a historical contribution in terms of preventing leprosy from spreading to Shanghai. It closed in the spring of 1938 because of the invasion of the Japanese military.

The effect of polyphenols in post stroke adults: A systematic review of randomised controlled trials

BACKGROUND

After a stroke, survivors are often left with significant disabilities and are at a greater risk of recurrent strokes. It is vital stroke survivors receive effective treatments to assist with rehabilitation and reduce risk factors for secondary stroke. Observational and preclinical studies have highlighted the promising role of polyphenols in these regards.

METHODS

A systematic review of original research which assessed the role of polyphenols on health outcomes in post stroke adults was conducted. PROQUEST, SCOPUS (Elsevier), MEDLINE (EBSCO), Embase and Cochrane Library databases were searched up to the 29th of October 2021.

RESULTS

A total of 9 studies met the full inclusion criteria and were included in this review. Several classes of polyphenols were assessed including hydroxybenzoic acids, stilbenes and flavonoids. Numerous health outcomes were assessed including vascular function, stroke disability, blood pressure, blood glucose and c-reactive protein. The majority of the studies included in this review (n = 8) note improvements in the polyphenol groups for at least one outcome measure. However, small sample sizes, short trial length and reporting bias prevent firm conclusions from being drawn.

CONCLUSION

This review provides promising preliminary evidence that polyphenols may be beneficial for post stroke adults, however, more research is required. To ensure reliable methodology and replication of results, future studies should include outcome statistics and effect sizes. Trials with a longer duration and large sample size should also be considered.

Effects of Aperture Shape on Absorption Property of Acoustic Metamaterial of Parallel-Connection Helmholtz Resonator

A Helmholtz resonator (HR) with an embedded aperture is an effective acoustic metamaterial for noise reduction in the low-frequency range. Its sound absorption property is significantly affected by the aperture shape. Sound absorption properties of HRs with the embedded aperture for various tangent sectional shapes were studied by a two-dimensional acoustic finite element simulation. The sequence of resonance frequency from low to high was olive, common trapeziform, reverse trapeziform, dumbbell and rectangle. Meanwhile, those HRs for various cross-sectional shapes were investigated by a three-dimensional acoustic finite element simulation. The sequence of resonance frequency from low to high were round, regular hexagon, square, regular triangle and regular pentagon. Moreover, the reason for these phenomena was analyzed by the distributions of sound pressure, acoustic velocity and temperature. Furthermore, on the basement of the optimum tangent and cross-sectional shape, the sound absorption property of parallel-connection Helmholtz resonators was optimized. The experimental sample with optimal parameters was fabricated, and its average sound absorption coefficient reached 0.7821 in 500-820 Hz with a limited thickness of 30 mm. The research achievements proved the significance of aperture shape, which provided guidance for the development of sound absorbers in the low-frequency range.

Longitudinal Relationship between Mobility Device Use, Falls and Fear of Falling (FOF) Differed by Frailty Status among Community-Dwelling Older Adults

OBJECTIVES

This study examined the longitudinal relationship between mobility device use, falls and fear of falling (FOF) among community-dwelling older adults by frailty status over a one-year follow-up.

DESIGN

A longitudinal cohort study.

SETTING

Communities in the United States.

PARTICIPANTS

Community-dwelling older adults from the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (N=5,896).

MEASUREMENTS

Based on yes or no response to the corresponding items for the variables, fall-related outcomes were determined separately including falls and FOF. Falls were assessed by asking participants whether they had a fall and if they had fallen down more than one time. FOF was measured by asking participants whether they worried about falling and if this worry ever limited activities. Mobility device use was determined by asking whether participants used any type of mobility devices and the number of devices used, including cane, walker, wheelchair and scooter. Frailty was assessed using the frailty phenotype. Multinomial logistic regression models were conducted to examine the association between mobility device use and fall-related outcomes among older adults by frailty status.

RESULTS

At Year 1, 28.6% of participants reported using mobility devices. Among robust participants, using one mobility device had 3.58 times higher risks of FOF with fear-related activity restriction (FAR) than non-device users (95% CI: 1.10-11.65). Cane-only robust users had 5.94 and 2.18 times higher risks of FOF with and without FAR (95% CI: 1.80-19.57; 95% CI: 1.12-4.22) than non-device users. Among pre-frail participants, using one mobility device was associated with recurrent falls and FOF with FAR (RRR=2.02, 95% CI: 1.30-3.14; RRR=2.13, 95% CI: 1.25-3.63). Using ≥2 devices was associated with one fall (RRR=2.08, 95% CI: 1.30-3.33), recurrent falls (RRR=2.92, 95% CI: 1.62-5.25) and FOF with FAR (RRR=2.84, 95% CI: 1.34-6.02). Pre-frail cane-only users were more likely to have one fall (RRR=1.57, 95% CI: 1.06-2.32), recurrent falls (RRR=2.36, 95% CI: 1.48-3.77) and FOF with FAR (RRR=2.08, 95% CI: 1.12-3.87) than non-device users. The number of mobility device used and the use of canes failed to be significantly associated with fall-related outcomes among frail participants.

CONCLUSION

The number of mobility devices used and the only use of canes were associated with fall-related outcomes among robust and pre-frail individuals. Further research is needed to develop targeted strategies for preventing falls and FOF among older adults with mobility device use, particularly for those in the early stages of frailty.

An improved graph convolutional network with feature and temporal attention for multivariate water quality prediction

The analysis and prediction of water quality are of great significance to water quality management and pollution control. In general, current water quality prediction methods are often aimed at single indicator, while the prediction effect is not ideal for multivariate water quality data. At the same time, there may be some correlations between multiple indicators which the conventional prediction models cannot capture. To resolve these problems, this paper proposes a deep learning model: Graph Convolutional Network with Feature and Temporal Attention (FTGCN), realizing the prediction for multivariable water quality data. Firstly, a feature attention mechanism based on multi-head self-attention is designed to capture the potential correlations between water indicators. Then, a temporal prediction module including temporal convolution and bidirectional GRU with a temporal attention mechanism is designed to deal with temporal dependencies of time series. Moreover, an adaptive graph learning mechanism is introduced to extract hidden associations between water quality indicators. An auto-regression module is also added to solve the disadvantage of non-linear nature of neural networks. Finally, an evolutionary algorithm is adopted to optimize the parameters of the proposed model. Our model is applied on four real-world water quality datasets, compared with other models for multivariate time series forecasting. Experimental results demonstrate that the proposed model has a better performance in water quality prediction than others by two indices.

Adjustable Sound Absorber of Multiple Parallel-Connection Helmholtz Resonators with Tunable Apertures Prepared by Low-Force Stereolithography of Photopolymer Resin

The variable noise spectrum for many actual application scenarios requires a sound absorber to adapt to this variation. An adjustable sound absorber of multiple parallel-connection Helmholtz resonators with tunable apertures (TA-MPCHRs) is prepared by the low-force stereolithography of photopolymer resin, which aims to improve the applicability of the proposed sound absorber for noise with various frequency ranges. The proposed TA-MPCHR metamaterial contains five metamaterial cells. Each metamaterial cell contains nine single Helmholtz resonators. It is treated as a basic structural unit for an array arrangement. The tunable aperture is realized by utilizing four segments of extendable cylindrical chambers with length l₀, which indicates that the length of the aperture l is in the range of [l₀, 4l₀], and that it is tunable. With a certain group of specific parameters for the proposed TA-MPCHR, the influence of the tunable aperture with a variable length is investigated by acoustic finite element simulation with a two-dimensional rotational symmetric model. For the given noise spectrum of certain actual equipment with four operating modes, the TA-MPCHR sample with a limited total thickness of 40 mm is optimized, which is made of photopolymer resin by the low-force stereolithography, and its actual average sound absorption coefficients for the frequency ranges of 500-800 Hz, 550-900 Hz, 600-1000 Hz and 700-1150 Hz reach 0.9203, 0.9202, 0.9436 and 0.9561, respectively. Relative to common non-adjustable metamaterials, the TA-MPCHR made of photopolymer resin can reduce occupied space and improve absorption efficiency, which is favorable in promoting its practical applications in the noise pollution prevention.

Investigation and Optimization of the Impact of Printing Orientation on Mechanical Properties of Resin Sample in the Low-Force Stereolithography Additive Manufacturing

The mechanical properties of resin samples in low-force stereolithography additive manufacturing were affected by the printing orientation, and were investigated and optimized to achieve excellent single or comprehensive tensile strength, compressive strength, and flexural modulus. The resin samples were fabricated using a Form3 3D printer based on light curing technology according to the corresponding national standards, and they were detected using a universal testing machine to test their mechanical properties. The influence of the printing orientation was represented by the rotation angle of the resin samples relative to the x-axis, y-axis and z-axis, and the parameters was selected in the range 0°-90° with an interval of 30°. The multiple regression models for the mechanical properties of the prepared resin samples were obtained based on least square estimation, which offered a foundation from which to optimize the parameters of the printing orientation by cuckoo search algorithm. The optimal parameters for the tensile strength, compressive strength and flexural modulus were 'α = 45°, β = 25°, γ = 90°', 'β = 0°, β = 51°, γ = 85°' and 'α = 26°, β = 0°, γ = 90°', respectively, which obtained the improvements of 80.52%, 15.94%, and 48.85%, respectively, relative to the worst conditions. The mechanism was qualitatively discussed based on the force analysis. The achievements obtained in this study proved that optimization of the printing orientation could improve the mechanical properties of the fabricated sample, which provided a reference for all additive manufacturing methods.

Optimal Design of Acoustic Metamaterial of Multiple Parallel Hexagonal Helmholtz Resonators by Combination of Finite Element Simulation and Cuckoo Search Algorithm

To achieve the broadband sound absorption at low frequencies within a limited space, an optimal design of joint simulation method incorporating the finite element simulation and cuckoo search algorithm was proposed. An acoustic metamaterial of multiple parallel hexagonal Helmholtz resonators with sub-wavelength dimensions was designed and optimized in this research. First, the initial geometric parameters of the investigated acoustic metamaterials were confirmed according to the actual noise reduction requirements to reduce the optimization burden and improve the optimization efficiency. Then, the acoustic metamaterial with the various depths of the necks was optimized by the joint simulation method, which combined the finite element simulation and the cuckoo search algorithm. The experimental sample was prepared using the 3D printer according to the obtained optimal parameters. The simulation results and experimental results exhibited excellent consistency. Compared with the derived sound absorption coefficients by theoretical modeling, those achieved in the finite element simulation were closer to the experimental results, which also verified the accuracy of this optimal design method. The results proved that the optimal design method was applicable to the achievement of broadband sound absorption with different low frequency ranges, which provided a novel method for the development and application of acoustic metamaterials.

Development of Adjustable Parallel Helmholtz Acoustic Metamaterial for Broad Low-Frequency Sound Absorption Band

For the common difficulties of noise control in a low frequency region, an adjustable parallel Helmholtz acoustic metamaterial (APH-AM) was developed to gain broad sound absorption band by introducing multiple resonant chambers to enlarge the absorption bandwidth and tuning length of rear cavity for each chamber. Based on the coupling analysis of double resonators, the generation mechanism of broad sound absorption by adjusting the structural parameters was analyzed, which provided a foundation for the development of APH-AM with tunable chambers. Different from other optimization designs by theoretical modeling or finite element simulation, the adjustment of sound absorption performance for the proposed APH-AM could be directly conducted in transfer function tube measurement by changing the length of rear cavity for each chamber. According to optimization process of APH-AM, The target for all sound absorption coefficients above 0.9 was achieved in 602-1287 Hz with normal incidence and that for all sound absorption coefficients above 0.85 was obtained in 618-1482 Hz. The distributions of sound pressure for peak absorption frequency points were obtained in the finite element simulation, which could exhibit its sound absorption mechanism. Meanwhile, the sound absorption performance of the APH-AM with larger length of the aperture and that with smaller diameter of the aperture were discussed by finite element simulation, which could further show the potential of APH-AM in the low-frequency sound absorption. The proposed APH-AM could improve efficiency and accuracy in adjusting sound absorption performance purposefully, which would promote its practical application in low-frequency noise control.

Social support and prenatal mental health problems: a systematic review and meta-analysis

Introduction

Pregnancy is a time of profound physical and emotional change as well as an increased risk of mental health problems. Providing social support is vital to reduce such risk.

Objectives

This systematic review and meta-analysis aimed at examining the relationship between social support and depression, anxiety and self-harm during pregnancy.

Methods

We searched observational studies from PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL databases. The Newcastle-Ottawa Scale tool was used for quality appraisal. The Q and the I² statistics were used to evaluate heterogeneity. A random-effects model was used to pool estimates. Publication bias was assessed using a funnel plot and Egger’s regression test and adjusted using trim and Fill analysis. All the analysis was conducted using STATA.

Results

Sixty-seven studies with 64,449 pregnant women were part of the current review. Of the total 67 studies, 22 and 45 studies were included in the narrative analysis and meta-analysis, respectively. From the studies included in the narrative analysis, 20(91%) of them reported a significant association between social support and the risk of mental health problems (i.e. depression, anxiety, and self-harm). After adjusting for publication bias, the results of the random-effect model revealed low social support was significantly associated with antenatal depression (AOR: 1.18, 95% CI: 1.01, 1.41) and antenatal anxiety (AOR: 1.97, 95% CI: 1.34, 2.92).

Conclusions

Low social support was significantly associated with depression, anxiety, and self-harm during pregnancy. Policy-makers and those working on maternity care should consider the development of targeted social support programs to help reduce mental health problems amongst pregnant women.

Disclosure

No significant relationships.

The association between social support and antenatal depressive and anxiety symptoms among Australian women

Introduction

Antenatal depression and antenatal anxiety adversely affect several obstetric and foetal outcomes, and increase the rate of postnatal mental illness. Thus, to tackle these challenges the need for social support during pregnancy is vital.

Objectives

This study examined the association between domains of social support and antenatal depressive and anxiety symptoms among Australian women.

Methods

Our study used data obtained from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), focusing upon women who reported being pregnant (n=493). Depression and anxiety were assessed using the Center for Epidemiological Studies Depression (CES-D-10) scale, and the 9-item Goldberg Anxiety and Depression scale (GADS) respectively. The 19 item-Medical Outcomes Study Social Support index (MOSS) was used to assess social support. A binary logistic regression model was used to examine the associations between domains of social support and antenatal depressive and anxiety symptoms.

Results

After adjusting for potential confounders, our study found that the odds of antenatal depressive symptoms was about four and threefold higher among pregnant women who reported low emotional/informational support (AOR=4.75; 95% CI: 1.45, 15.66; p=0.010) and low social support (overall support) (AOR: 3.26, 95%CI: 1.05, 10.10, p=0.040) respectively compared with their counterpart. In addition, the odds of antenatal anxiety symptoms was seven times higher among pregnant women who reported low affectionate support/positive social interaction (AOR=7.43; 95%CI: 1.75, 31.55; p=0.006).

Conclusions

Low emotional support and low affectionate support have a significant association with antenatal depressive and anxiety symptoms respectively. As such, targeted screening of expectant women for social support is essential.

Disclosure

No significant relationships.

Acoustic Metamaterials for Low-Frequency Noise Reduction Based on Parallel Connection of Multiple Spiral Chambers

Acoustic metamaterials based on Helmholtz resonance have perfect sound absorption characteristics with the subwavelength size, but the absorption bandwidth is narrow, which limits the practical applications for noise control with broadband. On the basis of the Fabry–Perot resonance principle, a novel sound absorber of the acoustic metamaterial by parallel connection of the multiple spiral chambers (abbreviated as MSC-AM) is proposed and investigated in this research. Through the theoretical modeling, finite element simulation, sample preparation and experimental validation, the effectiveness and practicability of the MSC-AM are verified. Actual sound absorption coefficients of the MSC-AM in the frequency range of 360–680 Hz (with the bandwidth Δf1 = 320 Hz) are larger than 0.8, which exhibit the extraordinarily low-frequency sound absorption performance. Moreover, actual sound absorption coefficients are above 0.5 in the 350–1600 Hz range (with a bandwidth Δf2 = 1250 Hz), which achieve broadband sound absorption in the low–middle frequency range. According to various actual demands, the structural parameters can be adjusted flexibly to realize the customization of sound absorption bandwidth, which provides a novel way to design and improve acoustic metamaterials to reduce the noise with various frequency bands and has promising prospects of application in low-frequency sound absorption.

[Application of three-dimensional visualization technique in laparoscopic D3 radical resection of right colon cancer]

OBJECTIVE

To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer.

METHODS

We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups.

RESULTS

The operative time was significantly shorter in 3D visualization group than in the control group (P < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups (P > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed the shape and direction of the colon, the location of the tumor, the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer, and showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan.

CONCLUSION

The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.

Development and Optimization of Broadband Acoustic Metamaterial Absorber Based on Parallel-Connection Square Helmholtz Resonators

An acoustic metamaterial absorber of parallel-connection square Helmholtz resonators is proposed in this study, and its sound absorption coefficients are optimized to reduce the noise for the given conditions in the factory. A two-dimensional equivalent simulation model is built to obtain the initial value of parameters and a three-dimensional finite element model is constructed to simulate the sound absorption performance of the metamaterial cell, which aims to improve the research efficiency. The optimal parameters of metamaterial cells are obtained through the particle swarm optimization algorithm, and its effectiveness and accuracy are validated through preparing the experimental sample using 3D printing and measuring the sound absorption coefficient by the standing wave tube detection. The consistency between the experimental data and simulation data verifies feasibility of the proposed optimization method and usefulness of the developed acoustic metamaterial absorber, and the desired sound absorption performances for given conditions are achieved. The experimental results prove that parallel-connection square Helmholtz resonators can achieve an adjustable frequency spectrum for the low frequency noise control by parameter optimization, which is propitious to promote its application in reducing the noise in the factory.

[The prevalence and associated factors of metabolic syndrome among Tibetan pastoralists in transition from nomadic to settled urban environment]

Objective: To study the prevalence and associated factors of metabolic syndrome (MS) among Tibetan pastoralists in transition from high altitude nomadic to settled urbanized environment, especially dietary factors. Methods: The community-based cross-sectional study included 920 Tibetan adults (men 419, women 501). Data were collected using questionnaires, anthropometric measurements, and biomarker tests. Questionnaires included socio-economic, lifestyle characteristics and food consumption. Principal component analysis was used to identify dietary patterns. The risk factors of MS and its components were analyzed by logistic regression model. Results: The prevalence rates of MS and its components were 32.8% (MS), 83.7% (decreased HDL-C), 62.1% (central obesity), 36.7% (elevated blood pressure), 11.8% (elevated TG), and 7.9% (elevated blood glucose), respectively. The prevalence of overweight was 31.2%, obesity 30.3%. Multivariate analysis showed smoking was associated factor for both of decreased HDL-C (OR=1.239, 95%CI: 1.025-1.496) and elevated TG (OR=1.277, 95%CI: 1.038-1.571). Alcohol drinking appeared as associated factor of elevated TG (OR=1.426, 95%CI: 1.055-1.927). However, physical activity showed as a protective factor for central obesity, decreased HDL-C, and elevated TG. With the increase of age, the adherence to the urban and western dietary patterns decreased, and that to the pastoral dietary pattern increased. By quintiles of dietary pattern scores, the urban dietary pattern was significantly associated with MS (trend test P=0.016). Conclusions: Tibetan pastoralists had high prevalence of both MS and obesity. Smoking, alcohol drinking, the transition from pastoral dietary pattern to urban dietary pattern and inadequate physical activity served as associated factors for MS and its components.

Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p^{↑}+p Collisions at sqrt[s]=200 GeV

Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200  GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.

A mechanical, electrical dual autonomous self-healing multifunctional composite hydrogel

The versatile properties make hydrogels a potential multipurpose material that finds wide applications. However, the preparation of multipurpose hydrogels is very challenging. Here, we report a method based on free radical reaction and composite mechanisms to prepare mechanical and electrical self-healing multifunctional hydrogels. In this study, the introduction of imidazolium salt ionic liquids and glycerol in the hydrogel system endows the gels with good antibacterial, conductive, and adhesive properties and excellent antifreeze properties. The testing results show that the as-prepared hydrogel has stable mechanical and electrical properties even under the extremely cold condition of -50°C after self-healing. Moreover, the active esters formed in the dynamic radical reaction have better reducibility, thus further investing the as-prepared hydrogel with high antioxidant activity. The application results show that these comprehensive properties make such hydrogel system very useful in wound repair and wearable strain sensors.

C-MYC-induced upregulation of LINC01503 promotes progression of non-small cell lung cancer

OBJECTIVE

The purpose of this study was to detect the expression of long intergenic non-protein-coding RNA 1503 (LINC01503) in non-small cell lung cancer (NSCLC), and to further study its biological function, as well as the regulatory relationships of c-MYC with LINC01503 and the extracellular signal regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) signaling pathway in NSCLC.

PATIENTS AND METHODS

Tissue specimens were collected from 36 NSCLC patients, and the relative expression level of LINC01503 in the 36 cases of NSCLC tissue specimens and NSCLC cells was then determined using quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR). Then, the effects of LINC01503 on the proliferation and apoptosis of NSCLC cells were detected in vitro via Cell-Counting Kit (CCK)-8 assay, colony-forming assay and flow cytometry. Besides, the possible LINC01503 promoter-binding transcription factor was predicted using bioinformatics. After interference with c-MYC expression, the changes in the expression of LINC01503 were examined through qRT-PCR. Finally, the changes in the expressions of the molecular markers in the ERK/MAPK signaling pathway after interference with LINC01503 and c-MYC expressions were evaluated using Western blotting.

RESULTS

According to qRT-PCR results, the expression of LINC01503 was upregulated in 30 out of 36 cases of NSCLC tissues. Compared with that in human normal bronchial epithelial cells, the expression of LINC01503 was elevated in NSCLC cells. As shown by the CCK-8 assay and colony-forming assay, the proliferation ability of NSCLC cells was weakened after interference with LINC01503 expression, and the flow cytometry results revealed the apoptosis rate of NSCLC cells was raised after interference with LINC01503 expression. Moreover, the bioinformatics prediction showed that c-MYC might be the LINC01503 promoter-binding transcription factor. Additionally, it was found through the qRT-PCR that the expression of LINC01503 declined after interference with c-MYC expression. Finally, based on Western blotting results, the expressions of phosphorylated ERK1/2 (p-ERK1/2) and p-MAPK/ERK kinase (MEK), the molecular markers in the ERK/MAPK signaling pathway, were inhibited after interference with c-MYC and LINC01503 expressions.

CONCLUSIONS

The transcription factor c-MYC promotes the expression of LINC01503 in NSCLC and activates the ERK/MAPK signaling pathway to drive the development and progression of NSCLC.

Tra2β protects against the degeneration of chondrocytes by inhibiting chondrocyte apoptosis via activating the PI3K/Akt signaling pathway

OBJECTIVE

Osteoarthritis (OA) is a common disease in the elderly and seriously affects the quality of life of patients. Tra2β is a protein that has been found to activate PI3K/Akt in recent years. The purpose of this study was to explore the protective effects of Tra2β on chondrocytes and its mechanisms.

PATIENTS AND METHODS

The expression of Tra2β in knee cartilage tissue of patients with OA and normal people was compared. In addition, human primary chondrocytes were cultured, the expression of Tra2β in chondrocytes by cell transfection was changed, and its effects on extracellular matrix, inflammation, and apoptosis in chondrocytes were examined. LY294002 was also used to inhibit the activity of PI3K/Akt signaling pathway to verify the mechanism of Tra2β to protect chondrocytes.

RESULTS

The expression of Tra2β in the cartilage tissue of the OA group was significantly lower than that of the control group, and the IL-1β-induced chondrocytes also expressed the lower Tra2β. The overexpression of Tra2β increased the expression of extracellular matrix collagen II and decreased the expressions of MMP3/13, inflammatory factors (IL-6, IL-8 and TNF-α), and apoptotic factors (caspase3/9, Bax). In addition, the overexpression of Tra2β also increased expression and phosphorylation of PI3K and Akt. However, LY294002 attenuated the protective effect of Tra2β on chondrocytes by inhibiting the PI3K/Akt signaling pathway.

CONCLUSIONS

Tra2β activates the PI3K/Akt signaling pathway, reduces the degradation of extracellular matrix of chondrocytes, reduces the level of inflammation and apoptosis of chondrocytes, and thus, plays a role in the treatment of OA.

Hsa_circRNA_101036 acts as tumor-suppressor in oral squamous cell carcinoma cells via inducing endoplasmic reticulum stress

OBJECTIVE

Endoplasmic reticulum (ER) stress has an effect on cancer cell proliferation and survival. TMTC1 has been reported to be involved in cell proliferation and inflammation, and development of ER. Hsa_circRNA_101036 is an exon circRNA formed by splicing of TMTC1 mRNA precursor. This study intends to explore the effect of hsa_circRNA_101036 on the malignant behavior of oral squamous cell carcinoma through endoplasmic reticulum stress.

MATERIALS AND METHODS

We firstly evaluated the levels of Hsa_circRNA_101036 in human oral mucous fibroblasts (hOMF), and in several OSCC cell lines, including FaDu, OECM1, SAS, HSC3. Then, we studied the effects of overexpression of Hsa_circRNA_101036 on the cell proliferation, apoptosis, invasion, migration, and cytokine release in OSCC cells. Finally, we evaluated the levels of CHOP that are critical in ER and the ROS levels in OSCC cells.

RESULTS

We found that compared with hOMF, a significantly lower mRNA expression of Hsa_circRNA_101036 was found in OECM1 and HSC3 cells. In OECM1 and HSC3 cells, with overexpression of Hsa_circRNA_101036, a significant decrease in cell proliferation, apoptosis, invasion, migration, and cytokine release was found. A significantly increased ROS, as well as increased protein level of CHOP, P38 and Bcl-2, was found in cells with Hsa_circRNA_101036 overexpression.

CONCLUSIONS

This study indicated that Hsa_circRNA_101036 may acts as a tumor suppressor in OSCC via regulating the ER in cancer cells.

Protective effects and molecular mechanisms of Achyranthes bidentata polypeptide k on Schwann cells

Background

Achyranthes bidentata polypeptide k (ABPPk) is an active ingredient used in traditional Chinese medicine separated from Achyranthes bidentata polypeptides. So far, the role of ABPPk in peripheral nerve protection has not been comprehensively studied.

Methods

In this study, primary Schwann cells exposed to serum deprivation were treated with ABPPk or nerve growth factor (NGF) in vitro. Cell viability, cell apoptosis, apoptosis-related protein expression, and antioxidant enzyme activity were analyzed. To further explore the underlying molecular mechanisms and key regulatory molecules involved in the effects of ABPPk, integrative and dynamic bioinformatics analysis at different time points was carried out following RNA-seq of Schwann cells subjected to serum deprivation.

Results

We found that ABPPk could effectively reduce Schwann cell apoptosis caused by serum deprivation, which was comparable to NGF’s anti-apoptotic effects. ABPPk had the largest number of upregulated and downregulated differential expression genes at the earliest 0.5 h time, while NGF had fewer differential expression genes at this early stage. The significant difference at this time point between the two groups was also displayed in heatmaps. The molecular regulation of diseases and functions and canonical pathways revealed that ABPPk had more participation and advantages in the vasculature and immune system areas, especially angiogenesis regulation. Also, ABPPk demonstrated an earlier start in these molecular regulations than NGF. Furthermore, the analysis of transcription factors also illustrated that ABPPk not only had more key initial regulatory factors participating in vascular-related processes, but these also remained for a longer period. There was no significant difference in neural-related molecular regulation between the two groups.

Conclusions

Using high-throughput sequencing technology, our work unveiled the protective effects of ABPPk on Schwann cells after serum deprivation in a more comprehensive manner. These results further enrich the positive functions and molecular mechanisms of ABPPk and traditional Chinese medicine and benefit the discovery of novel therapeutic targets for peripheral nerve regeneration.

Recent advances in focused ion beam nanofabrication for nanostructures and devices: fundamentals and applications

The past few decades have witnessed growing research interest in developing powerful nanofabrication technologies for three-dimensional (3D) structures and devices to achieve nano-scale and nano-precision manufacturing. Among the various fabrication techniques, focused ion beam (FIB) nanofabrication has been established as a well-suited and promising technique in nearly all fields of nanotechnology for the fabrication of 3D nanostructures and devices because of increasing demands from industry and research. In this article, a series of FIB nanofabrication factors related to the fabrication of 3D nanostructures and devices, including mechanisms, instruments, processes, and typical applications of FIB nanofabrication, are systematically summarized and analyzed in detail. Additionally, current challenges and future development trends of FIB nanofabrication in this field are also given. This work intends to provide guidance for practitioners, researchers, or engineers who wish to learn more about the FIB nanofabrication technology that is driving the revolution in 3D nanostructures and devices.

[Application of a small drainage tube in transoral endoscopic thyroidectomy vestibular approach]

Objective: To examine the feasibility of small drain in transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: A prospective research was performed in Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, from October 2018 to March 2019. Totally 103 patients who met the inclusion and exclusion criteria, signed the operation agreement of TOETVA, had their surgery completed and followed-up over 6 months, were enrolled in analysis. A central venous catheter was used as a drain tube in all cases (outer diameter 1.7 mm, inner diameter 1.0 mm). Visual analogue scale (VAS) was applied for assessing pain scores during the first 24 hours after the operation. Vancouver scar scale (VSS) was used for assessing the scar left by the drainage. The drainage volume (minimum scale:10 ml, approximate read: 1 ml) was recorded every 2 hours during the first postoperative 12 hours, every 4 hours during 12 to 24 hours, every 8 hours during 24 to 48 hours, and once from 48 hours until extubation. The volume of drainage, the cumulative volume and the percentage of cumulative volume accounting for the total volume were calculated. The data of residual volume (subtract the cumulative volume from the total volume) in the postoperative 24, 32 and 40 hours were analyzed, and their upper one-side P(95) was calculated by percentile method. Results: There were 12 males and 91 females. The age was (36.6±9.7) years (range: 18 to 58 years). The intraoperative tube-inserting time was (10.1±2.6) minutes (range: 6 to 18 minutes). The pain score on the first day was 2.7±1.1 (range: 1 to 5). The extubation time was (2.7±0.5) days (range: 2 to 4 days). VSS scores in the postoperative 1(st) month and 6(th) month were 2.9±1.3 (range: 0 to 7) and 0(2)(M(Q(R))), respectively. The size of the scar was 0 (2.5) mm in the postoperative 6(th) month. Sixty-four patients had no visible scars. There were 5 patients who had postoperative drain-related complications (1 for air leakage, 1 for tube blockage, 3 for subcutaneous hydrop, 2 for regional infection), who were all cured after proper treatment. The total volume of drainage for 98 patients without postoperative drain-related complications was (80.1±12.2) ml (range: 58 to 131 ml). The cumulative drainage within 8 hours accounted for (53.8±4.2)% (range: 41.0% to 62.9%) of the total drainage. The volume of residual fluids in the postoperative 32 hours was estimated to (5.8±2.7) ml (range: 0 to 12 ml,P(95)=10.0 ml). Conclusions: The small drain tubecan be applied in TOETVA, providing a satisfied cosmetic appearance and a reliable drainage. The main exudation period of the wound is within 8 hours after the operation. If a residual volume less than 10 ml is considered to be self-absorbable, the shortest safe extubation point for 95% patients without drain-related complications should be 32 hours after the operation.

[The epidemic, prophylaxis and treatment of cholera in Su-Wan Liberated Area in 1946]

Rugao and Haian belonging to First Branch of Su-Wan Liberated Area found fulminant cholera in 1946. The fulminant cholera spread throughout the Su-Wan Liberated Area in a short period of time. Thus, local mass and military led by CPC actively launched the Movement of Epidemic Prevention. They took some actions to clear up the circumstance, eliminate the pathogen, prevent the food contamination and cut off the route of transmission. Vaccination was carried out on a large scale. As a result of these measure, the fulminant cholera was efficiently controlled.

How to increase the value of self-reported health service data by using data linkage: a case study

Background

This is a case study for recurrent stroke prevention. Lifestyle factors account for about 80% of the risk of recurrent stroke. Most health services studies examining stroke prevention rely on stroke survivors' self-reported lifestyle behaviour data. How can researchers increase the value of collected self-reported data to provide additional information for more comprehensive assessments?

Methods

45 and Up Study is the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. This case study linked self-reported longitudinal lifestyle data in the 45 and Up Study, with corresponding mortality data (i.e. NSW Registry of Births, Deaths and Marriages & NSW Cause of Death Unit Record File) and hospital data (i.e. NSW Admitted Patient Data Collection) via the Centre for Health Record Linkage (CHeReL). The main outcome measures are health services, clinical outcomes, and mortality rates for stroke care. The analyses will include descriptive analysis, multivariate regression analysis, and survival analysis.

Results

A total of 8410 stroke survivors who participated in the 45 and Up Study were included in this data linkage study. From January 2006 to December 2015, 99249 hospital claims (mean: 13 times admission to hospital per person) and 2656 death registration records have been linked to these participants. The mean age of the stroke survivors was 72 (SD = 11) years, with 56% being males. These results are preliminary and more analyses will be conducted by using quality of life status, clinical diagnosis, comorbidities, and procedures.

Conclusions

Data linkage enables researchers to generate comprehensive findings on health services studies and gain a more holistic understanding of the determinants and outcomes of stroke prevention with lower data collection costs and less burden on participants.

Key messages

Data linkage brings about a new opportunity for self-reported data on health services utilisation. It is a cost-effective way to enhance existing self-reported data via the data linkage approach to increase its usefulness for informing health service planning.

High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

Background

Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke.

Methods

Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or &gt; 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders.

Results

We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2).

Conclusions

High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors.

Key messages

It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

[Selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection]

Objective: To explore the selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection. Methods: From January 2011 to February 2017, 31 patients with vulvar tumor who were admitted to Hunan Cancer Hospital underwent repair of wound after tumor resection with various flaps/myocutaneous flaps. The patients were composed of 5 males and 26 females, aged 39-76 years, with 27 vulvar cancer and 4 Paget's disease in primary diseases. The size of defects after vulvar tumor radical resection ranged from 8.0 cm×4.5 cm to 27.5 cm×24.0 cm. According to the theory of perforasome, the defects were repaired by the external pudendal artery perforator flap, deep inferior epigastric artery perforator flap, rectus abdominis myocutaneous flap, anterolateral thigh flap, internal pudendal artery perforator flap, gracilis myocutaneous flap, and profunda artery perforator flap based on the specific size and location of perineum and groin where the defect was located. According to the blood supply zone of flap, totally 17 local translocation flaps, 18 axial flaps/myocutaneous flaps, and 7 V-Y advancement flaps were resected, with an area of 7.0 cm×4.0 cm to 21.0 cm×13.0 cm. All the flaps/myocutaneous flaps were transferred in pedicled fashion, and the donor sites were closed without tension. The number of flaps/myocutaneous flaps, wound closure, flaps/myocutaneous flaps survival, and follow-up were observed and recorded. Results: Altogether 42 flaps/myocutaneous flaps were harvested in 31 patients. Two flaps/myocutaneous flaps were used in 11 cases for large circular defect repair. All the defects achieved tension-free primary closure. The blood supply of 32 flaps/myocutaneous flaps was good, while insufficient blood supply was noted in the other 10 flaps/myocutaneous flaps. Seventeen flaps/myocutaneous flaps survived smoothly. Wound dehiscence occurred in 5 flaps/myocutaneous flaps 8 to 14 days postoperatively, which was healed with dressing change. Temporary congestion was noted in 7 flaps/myocutaneous flaps 2 to 5 days postoperatively, which recovered without special treatment. Three flaps/myocutaneous flaps had infection 7 to 15 days postoperatively, two of which recovered after dressing change, while the other one had partial necrosis and received debridement and direct closure. Two flaps/myocutaneous flaps were totally necrotic 8 to 15 days postoperatively, which were repaired with pedicled rectus abdominis myocutaneous flap after debridement. Seven flaps/myocutaneous flaps had partial necrosis 7 to 20 days postoperatively and were healed after dressing change. Twenty-four patients were followed up for 9-38 months. The color of flaps/myocutaneous flaps was similar to that of the surrounding skin, the shape of vulva was natural, the movement of hip joint was not limited, the function of micturition and defecation was not affected, and tumor recurrence was noted in 3 patients. Conclusions: For the complicated large defect after perineum tumor resection, the flexible application of different forms of flaps/myocutaneous flaps to repair according to different areas regains the appearance and function. However, there are many complications, so it is necessary to further strengthen the postoperative care.

[Anatomical classification and application of chimeric myocutaneous medial thigh perforator flap in head and neck reconstruction]

Objective: To explore the anatomical classification and application of chimeric myocutaneous medial thigh perforator (MTP) flap in head and neck reconstruction. Methods: From September 2015 to December 2018, the clinical data of 74 patients (62 males and 12 females, age ranging from 31 to 69 years, with a mean age of 50.2 years) with oral tumor, who underwent radical resection in Hunan Cancer Hospital, including 39 cases of tongue carcinoma, 24 cases of gingival carcinoma and 11 cases of buccal cancer, 26 cases of stage T4N1M0, 22 cases of stage T4N0M0,15 cases of stage T3N1M0, and 11 cases of stage T3N2M0 were retrospectively analyzed in this work.The arteries and the veins contributing to MTP were anastomosed respectively with superior thyroid arteries, while the venae comitans were anastomosed with superior thyroid venae veins or internal jugular venae vein. The size of soft tissue defect, the length, width and thickness of free medial thigh flap, the length and source of vascular pedicle were recorded. The flap survival, functional status and donor area recovery were observed. Results: The postoperative defects in size ranged from 4.0 cm×3.5 cm to 9.0 cm×5.5 cm, which were reconstructed by free chimeric myocutaneous MTP flaps. The mean length of MTP flaps was (12.5±0.4) cm, the mean width was (7.2±0.4) cm, the mean thickness was (3.5±0.2) cm. The mean pedicle length was (8.6±0.4) cm. The perforators existed consistently in all cases, and the vascular origins were classified into 6 types. There were 4 cases (5.4%) of the perforating branches originating from femoral artery between the medial femoris and the adductor longus, 6 cases (8.1%) of the perforating branches of the profunda femoral artery from the adductor longus, 16 cases (21.6%) of the perforating branches of the profunda femoral artery from the gracilis, 9 cases (12.2%) of the perforating branches of the profunda femoral artery between the gracilis and the adductor longus, 29 cases (39.2%) of the perforating branches of the profunda femoral artery from the adductor longus, and 10 cases (13.5%) of branches of the profunda femoral artery from the semimembranous muscle. All 74 flaps survived uneventfully. The donor sites and recipient sites were closed directly in all cases. All patients were followed up for 12-36 months with satisfied esthetic and functional results. Only linear scars were left in the donor sites, and the thigh function was not affected. Local recurrence happened in 4 cases, which were treated with radical resection and the left defects were reconstructed with pedicled pectoral major myocutaneous flaps. Conclusion: The chimeric myocutaneous MTP flap has good color match and texture, with abundant tissue, and consistent blood supply, and it can be harvested in various forms while leaving minimal morbidity at donor site, being an idea choice for reconstruction after surgery of oral cancer.

[Effects of pedicled rectus abdominis myocutaneous flap combined with free deep inferior epigastric artery perforator flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy]

Objective: To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. Methods: From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. The location of deep inferior epigastric artery perforator was detected by audible Doppler ultrasound blood stream detector and computed tomography angiography for designing combined tissue flap, with length of (25.32±0.27) cm, width of (13.14±0.76) cm, and thickness of (3.55±0.34) cm. The donor site of combined tissue flap was closed by suturing, and two or more tubes for negative pressure drainage were placed according to the situation of donor site and recipient site. Operation time and average placing time of negative pressure drainage tube, postoperative condition of combined tissue flap and the donor site, reconstructed breast condition, recovery of upper limb lymphedema were documented and followed up. Results: The operation time was 290-420 (396±55) min. The average retaining time of negative pressure drainage tube in breast was 5.9 d, while the average retaining time of negative pressure drainage tube in abdomen was 4.3 d. Ecchymoma occurred in DIEAP flap of one patient and in the flap donor site of another patient. Delayed healing was also seen in the rectus abdominis myocutaneous flap of a patient, which healed eventually after dressing change, and the other flaps survived well. The appearance of reconstructed breast was good with good elasticity, and no contracture or deformation occurred in the tissue flap. The upper limb lymphedema in 7 patients was alleviated in varying degrees, with 2.0-4.0 cm reduction in circumference. During follow-up of 12-24 months of 9 patients, averaged 17.5 months, with 6 patients received long term bandage pressure therapy and physical therapy to the affected limbs after operation and all patients were satisfied with appearances of the affected limbs. Neuropathic pain in affected limbs was significantly relieved in 2 patients and stopped aggravating in the other 2 patients. Only linear scar was seen in the donor site of abdomen without affecting obviously the function of abdomen. Conclusions: The PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap is an effective way for breast reconstruction and upper limb lymphedema treatment post mastectomy.