Rhubarb attenuates cerebral edema via inhibition of the extracellular signal-regulated kinase pathway following traumatic brain injury in rats

Background:

Rhubarb is a traditional Chinese medicine for treating traumatic brain injury (TBI).

Purpose:

The purpose of this study is to elucidate the potential mechanism of rhubarb by suppressing extracellular signal-regulated kinase (ERK) to ameliorate brain edema.

Materials and Methods:

Sprague-Dawley rats were separated into four groups at random. One group received 3 g/kg rhubarb, and another group received 12 g/kg rhubarb, and the vehicle group and sham group were administered the same dose of saline solution. The blood–brain barrier disruption and edema were detected by Evans blue extravasation and water content, respectively. ERK, Matrix metalloproteinase 9 (MMP-9), and zonula occluden-1 (ZO-1) in the damaged tissue were measured by western blot analysis and quantitative real-time polymerase chain reaction.

Results:

Rhubarb attenuated the brain edema after TBI, especially at the dose of 12 g/kg. Rhubarb significantly suppressed ERK, down-regulated MMP-9, and up-regulated ZO-1. Rhubarb might be a prospective therapeutic regimen to decrease edema in TBI.

Conclusions:

Rhubarb alleviates the edema by restraining the ERK signaling pathway. Our results contribute to the validation of the traditional use of rhubarb in the treatment of TBI and its mechanism.

SUMMARY

The aim of this study was to explore the potential mechanism of rhubarb by suppressing extracellular signal-regulated kinase to ameliorate brain edema. Results: Rhubarb ameliorates edema caused by traumatic brain injury by inhibiting the ERK/Matrix metalloproteinase 9/zonula occluden-1 signaling pathway.

Abbreviations used: TBI: Traumatic brain injury, ERK: Extracellular signal-regulated kinase pathway, MMP-9: Matrix metalloproteinase 9, ZO-1: Zonula occluden-1, BBB: Blood-brain barrier, PCR: Polymerase chain reaction, TCM: Traditional Chinese medicine, MAPKs: Mitogen-activated protein kinases, CCI: Controlled cortical impact, DL: Rhubarb 3 g/kg in distilled water, DH: Rhubarb 12 g/kg in distilled water, EB: Evans blue, IOD: Integral optical density, MEK: Mitogen extracellular kinase, MMPs: Matrix metalloproteinases, NADPH: Nicotinamide adenine dinucleotide phosphate: ROS, reactive oxygen species.

Radiomic features of pretreatment MRI could identify T stage in patients with rectal cancer: Preliminary findings

BACKGROUND

Recent studies have shown that magnetic resonance (MR) radiomic analysis is feasible and has some value in identifying tumor characteristics, but there are few data regarding the role of MR-based radiomic features in rectal cancer.

PURPOSE

The aim of this study was to determine whether radiomic features extracted from T2 -weighted imaging (T2 WI) can identify pathological features in rectal cancer.

STUDY TYPE

Retrospective study.

POPULATION/SUBJECTS

A cohort comprising 119 rectal cancer patients who underwent surgery between January 2015 and November 2016.

FIELD STRENGTH/SEQUENCE

3.0T, axial high-resolution T2 -weighted turbo spin echo (TSE) sequence.

ASSESSMENT

Patients were classified according to pathological features such as T stage, N stage, perineural invasion, histological grade, lymph-vascular invasion, tumor deposits, and circumferential resection margin (CRM). The whole tumor volume (WTV) was distinguished, and segments were quantified on axial high-resolution T2 WI by a radiologist. A total of 256 radiomic features were extracted.

STATISTICAL TESTS

To achieve reliable results, cluster analysis and least absolute shrinkage and selection operator (LASSO) were implemented. In the cluster analysis, the patients were divided into two groups, and chi-square tests were performed to investigate the relationship between the pathological features and the radiomic-based clusters. The area under the curve (AUC) was calculated to evaluate the predictability of the model in the LASSO analysis.

RESULTS

The cluster results revealed that patients could be stratified into two groups, and the chi-square test results indicated that the pT stage was correlated with the radiomic feature cluster results (P = 0.002). The prediction model AUC for the diagnostic T stage was 0.852 (95% confidence interval: 0.677-1; sensitivity: 79.0%, specificity: 82.0%).

DATA CONCLUSION

The use of MRI-derived radiomic features to identify the T stage is feasible in rectal cancer.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Measurements of Multiparticle Correlations in d+Au Collisions at 200, 62.4, 39, and 19.6 GeV and p+Au Collisions at 200 GeV and Implications for Collective Behavior

Recently, multiparticle-correlation measurements of relativistic p/d/^{3}He+Au, p+Pb, and even p+p collisions show surprising collective signatures. Here, we present beam-energy-scan measurements of two-, four-, and six-particle angular correlations in d+Au collisions at sqrt[s_{NN}]=200, 62.4, 39, and 19.6 GeV. We also present measurements of two- and four-particle angular correlations in p+Au collisions at sqrt[s_{NN}]=200  GeV. We find the four-particle cumulant to be real valued for d+Au collisions at all four energies. We also find that the four-particle cumulant in p+Au has the opposite sign as that in d+Au. Further, we find that the six-particle cumulant agrees with the four-particle cumulant in d+Au collisions at 200 GeV, indicating that nonflow effects are subdominant. These observations provide strong evidence that the correlations originate from the initial geometric configuration, which is then translated into the momentum distribution for all particles, commonly referred to as collectivity.

2D Superparamagnetic Tantalum Carbide Composite MXenes for Efficient Breast-Cancer Theranostics

Background: The emergence of two-dimensional MXenes has spurred their versatile applications in broad fields, but the exploring of novel MXene-based family members and their potential applications in theranostic nanomedicine (concurrent diagnostic imaging and therapy) have been rarely explored. In this work, we report the construction of a novel superparamagnetic MXene-based theranostic nanoplatform for efficient breast-cancer theranostics, which was based on intriguing tantalum carbide (Ta₄C₃) MXene and its further rational surface-superparamagnetic iron-oxide functionalization (Ta₄C₃-IONP-SPs composite MXenes) for efficient breast-cancer theranostic. Methods: The fabrication of ultrathin Ta₄C₃ nanosheets was based on an exfoliation strategy and superparamagnetic iron oxide nanoparticles were in-situ grown onto the surface of Ta₄C₃ MXene according to the redox reaction of MXene. Ta₄C₃-IONP MXenes were modified with soybean phospholipid (SP) to guarantee high stability in physiological conditions. The photothermal therapy, contrast-enhanced CT, T₂-weighted magnetic resonance imaging and the high biocompatibility of these composite nanosheets have also been evaluated in vitro at cellular level and in vivo on mice breast tumor allograft tumor model. Results: The Ta component of Ta₄C₃-IONP-SPs exhibits high performance for contrast-enhanced CT imaging because of its high atomic number and high X-ray attenuation coefficient, and the integrated superparamagnetic IONPs act as excellent contrast agents for T₂-weighted magnetic resonance imaging. Especially, these Ta₄C₃-IONP-SPs composite nanosheets with high photothermal-conversion efficiency (η: 32.5%) has achieved complete tumor eradication without reoccurrence, verifying their highly efficient breast-tumor photo-ablation performance. Conclusion: This work not only significantly broadens the biomedical applications of MXene-based nanoplatforms (Ta₄C₃ MXene) by exploring their novel family members and further functionalization strategies (magnetic functionalization in this work), but also provides a novel and efficient theranostic nanoplatform for efficient breast-cancer theranostics.

Nuclear Dependence of the Transverse-Single-Spin Asymmetry for Forward Neutron Production in Polarized p+A Collisions at sqrt[s_{NN}]=200 GeV

During 2015, the Relativistic Heavy Ion Collider (RHIC) provided collisions of transversely polarized protons with Au and Al nuclei for the first time, enabling the exploration of transverse-single-spin asymmetries with heavy nuclei. Large single-spin asymmetries in very forward neutron production have been previously observed in transversely polarized p+p collisions at RHIC, and the existing theoretical framework that was successful in describing the single-spin asymmetry in p+p collisions predicts only a moderate atomic-mass-number (A) dependence. In contrast, the asymmetries observed at RHIC in p+A collisions showed a surprisingly strong A dependence in inclusive forward neutron production. The observed asymmetry in p+Al collisions is much smaller, while the asymmetry in p+Au collisions is a factor of 3 larger in absolute value and of opposite sign. The interplay of different neutron production mechanisms is discussed as a possible explanation of the observed A dependence.

[Free medial thigh perforator flaps with various pedicle origins for the reconstruction of defect after buccal mucosa squamous cell carcinoma resection]

Objective: To explore investigate the application of free medial thigh perforator flaps with different pedicle origins in the reconstruction of defect after radical resection of buccal mucosa squamous cell carcinoma. Methods: From January 2015 to December 2016, 32 cases with buccal mucosa squamous cell carcinoma underwent radical resection and buccal mucosa defect after surgery was reconstructed by free medial thigh perforator flap at the same stage. The patients included 32 males and 5 females, ranged in age from 36 to 71 years (45.2 years on average). According to UICC stage: T4N0M0 13 cases, T4N1M0 12 cases, T3N1M0 5 cases, T3N2M0 2 cases. The course ranged from 1 to 30 months (9.6 months on average). Results: The perforator flaps ranged from 8.0 cm×3.5 cm to 15.5 cm×6.0 cm in size, from 2.0 to 4.5 cm in thickness.The mean length of pedicles from gracilis muscle was (8.7±0.4) cm in 19 cases, the mean length of pedicles from adductor magnus muscle was (9.5±0.4) cm in 9 cases and the length of pedicles from femoral artery was (6.9±0.5) cm in 4 cases.All 44 perforator flaps survived uneventfully. The donor sites in the medial thigh were closed directly and healed well in all cases. Patients were followed up for 8 to 32 months with satisfied esthetic and functional results in reconstructed tongue, with no local recurrence. Only linear scars left in the donor sites, the functions of thighs were not affected. Conclusion: The free medial thigh perforator flap is an idea choice to reconstruct the defect after radical resection of buccal mucosa squamous cell carcinoma.

Blue light-induced immunosuppression in Bactrocera dorsalis adults, as a carryover effect of larval exposure

Detrimental effects of ultraviolet (UV) light on living organisms are well understood, little is known about the effects of blue light irradiation. Although a recent study revealed that blue light caused more harmful effects on insects than UV light and blue light irradiation killed insect pests of various orders including Diptera, the effects of blue light on physiology of insects are still largely unknown. Here we studied the effects of blue light irradiation on cuticular melanin in larval and the immune response in adult stage of Bactrocera dorsalis. We also evaluated the effects of blue light exposure in larval stage on various age and mass at metamorphosis and the mediatory role of cuticular melanin in carryover effects of larval stressors across metamorphosis. We found that larvae exposed to blue light decreased melanin contents in their exoskeleton with smaller mass and delayed metamorphosis than insects reared without blue light exposure. Across metamorphosis, lower melanotic encapsulation response and higher susceptibility to Beauveria bassiana was detected in adults that had been exposed to blue light at their larval stage, thereby constituting the first evidence that blue light impaired adult immune function in B. dorsalis as a carryover effect of larval exposure.

3d-4f coupling and multiferroicity in frustrated Cairo Pentagonal oxide DyMn2O5

In solid state science, multifunctional materials and especially multiferroics have attracted a great deal of attention, as they open the possibility for next generation spintronic and data storage devices. Interestingly, while many of them host coexisting 3d and 4f elements, the role of the coupling between these two magnetic entities has remained elusive. By means of single crystal neutron diffraction and inelastic neutron scattering experiments we shed light on this issue in the particular case of the multiferroic oxide DyMn₂O₅. This compound undergoes a first order magnetic transition from a high temperature incommensurate phase to a low temperature commensurate one. Our investigation reveals that although these two phases have very different magnetic structures, the spin excitations are quite similar indicating a fragile low temperature ground state with respect to the high temperature one. Such a rare scenario is argued to be a manifestation of the competition between the exchange interaction and 4f magnetic anisotropy present in the system. It is concluded that the magnetic structure, hence the ferroelectricity, can be finely tuned depending on the anisotropy of the rare earth.

Metabolomics reveals the effect of Xuefu Zhuyu Decoction on plasma metabolism in rats with acute traumatic brain injury

Xuefu Zhuyu Decoction (XFZY), an important traditional Chinese herbal formula, has been reported effective on traumatic brain injury (TBI) in rats. However, its cerebral protection mechanism has not been clarified at the metabolic level. This work aims to explore the global metabolic characteristics of XFZY in rats during the acute phase of TBI on days 1 and 3. A plasma metabolomics method based on gas chromatography-mass spectrometry coupled with univariate analysis and multivariate statistical analysis was performed in three groups (Sham, Vehicle, XFZY). Then, a pathway analysis using MetaboAnalyst 3.0 was performed to illustrate the pathways of therapeutic action of XFZY in TBI. XFZY treatment attenuates neurological dysfunction and cortical lesion volume post-injury on day 3, and reverses the plasma metabolite abnormalities (glutamic acid, lactic acid, 3-hydroxybutyric acid, and ribitol, etc.). These differential metabolites are mainly involved in D-glutamine and D-glutamate metabolism, alanine, aspartate and glutamate metabolism, and inositol phosphate metabolism. Our study reveals potential biomarkers and metabolic networks of acute TBI and neuroprotection effects of XFZY, and shows this metabolomics approach with MetaboAnalyst would be a feasible way to systematically study therapeutic effects of XFZY on TBI.

Xuefu zhuyu decoction improves cognitive impairment in experimental traumatic brain injury via synaptic regulation

An overarching consequence of traumatic brain injury (TBI) is the cognitive impairment. It may hinder individual performance of daily tasks and determine people's subjective well-being. The damage to synaptic plasticity, one of the key mechanisms of cognitive dysfunction, becomes the potential therapeutic strategy of TBI. In this study, we aimed to investigate whether Xuefu Zhuyu Decoction (XFZYD), a traditional Chinese medicine, provided a synaptic regulation to improve cognitive disorder following TBI. Morris water maze and modified neurological severity scores were performed to assess the neurological and cognitive abilities. The PubChem Compound IDs of the major compounds of XFZYD were submitted into BATMAN-TCM, an online bioinformatics analysis tool, to predict the druggable targets related to synaptic function. Furthermore, we validated the prediction through immunohistochemical, RT-PCR and western blot analyses. We found that XFZYD enhanced neuroprotection, simultaneously improved learning and memory performances in controlled cortical impact rats. Bioinformatics analysis revealed that the improvements of XFZYD implied the Long-term potentiation relative proteins including NMDAR1, CaMKII and GAP-43. The further confirmation of molecular biological studies confirmed that XFZYD upregulated the mRNA and protein levels of NMDAR1, CaMKII and GAP-43. Pharmacological synaptic regulation of XFZYD could provide a novel therapeutic strategy for cognitive impairment following TBI.

Distinct Hippocampal Expression Profiles of Long Non-coding RNAs in an Alzheimer's Disease Model

Alzheimer's disease (AD), the most prevalent form of dementia worldwide, is a complex neurodegenerative disease characterized by the progressive loss of memory and other cognitive functions. The pathogenesis of AD is not yet completely understood. Although long non-coding RNAs (lncRNAs) have recently been shown to play a role in AD pathogenesis, the specific influences of lncRNAs in AD remain largely unknown; in particular, hippocampal lncRNA expression profiles in AD rats are lacking. In this study, microarray analysis was performed to investigate the hippocampal expression patterns of dysregulated lncRNAs in a rat model of AD. A total of 315 lncRNAs and 311 mRNAs were found to be significantly dysregulated in the AD model (≥2.0 fold, p < 0.05). Then, quantitative real-time PCR was used to validate the expression of selected lncRNAs and mRNAs. Bioinformatics tools and databases were employed to explore the potential lncRNA functions. This is the first study to comprehensively identify dysregulated hippocampal lncRNAs in AD and to demonstrate the involvement of different lncRNA expression patterns in the hippocampal pathogenesis of AD. This information will enable further research on the pathogenesis of AD and facilitate the development of novel AD therapeutics targeting lncRNAs.

Association Between Background Parenchymal Enhancement and Pathologic Complete Remission Throughout the Neoadjuvant Chemotherapy in Breast Cancer Patients

PURPOSE

To retrospectively investigate the quantitative background parenchymal enhancement (BPE) of the contralateral normal breast in patients with unilateral invasive breast cancer throughout multiple monitoring points of neoadjuvant chemotherapy (NAC) and to further determine whether BPE is associated with tumor response, especially at the early stage of NAC.

MATERIALS AND METHODS

A total of 90 patients with unilateral breast cancer who then received six or eight cycles of NAC before surgery were analyzed retrospectively. BPE was measured in dynamic contrast-enhanced MRI at baseline and after 2nd, 4th, and 6th NAC, respectively. Correlation between BPE and tumor size was analyzed, and the association between pathologic complete remission (pCR) and BPE was also analyzed.

RESULTS

The BPE of contralateral normal breast showed a constant reduction throughout NAC therapy regardless of the menopausal status (P<.001 in all). Both the BPEs and the changes of BPE in each of the three monitoring points were significantly correlated with those in tumor size (P<.05 in all), and the reduction of BPE after 2nd NAC had the largest diagnostic value for pCR (AUC=0.726, P<.001), particularly in hormonal receptor (HR)-negative patients (OR=0.243, 95%CI=0.083 to 0.706, P=.009).

CONCLUSION

The BPE of contralateral normal breast had a constant decreased tendency similar to the change of tumor size in NAC. Reduction of BPE at the early stage of NAC was positively associated with pCR, especially in HR-negative status.

Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI

BACKGROUND AND PURPOSE

High-resolution 3T MR imaging can visualize intracranial atherosclerotic plaque. However, histologic validation is still lacking. This study aimed to evaluate the ability of 3T MR imaging to identify and quantitatively assess intracranial atherosclerotic plaque components ex vivo with histologic validation.

MATERIALS AND METHODS

Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR imaging with T1, T2, and proton-density-weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. Fibrous cap thickness and maximum wall thickness were also quantified. The percentage of areas of the main plaque components, the ratio of fibrous cap thickness to maximum wall thickness, and plaque burden were calculated and compared.

RESULTS

The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences (P < .01) and was comparable on T1-weighted sequences (P = 1.00). Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Plaque component mean percentages were comparable between MR imaging and histology: fibrous component (81.86% ± 10.59% versus 81.87% ± 11.59%, P = .999), lipid core (19.51% ± 10.76% versus 19.86% ± 11.56%, P = .863), and fibrous cap (31.10% ± 11.28% versus 30.83% ± 8.51%, P = .463). However, MR imaging overestimated mean calcification (9.68% ± 5.21% versus 8.83% ± 5.67%, P = .030) and plaque burden (65.18% ± 9.01% versus 52.71% ± 14.58%, P < .001).

CONCLUSIONS

Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.

Naoling decoction restores cognitive function by inhibiting the neuroinflammatory network in a rat model of Alzheimer's disease

Neuroinflammation is central to the pathogenesis of Alzheimer's disease (AD). We previously showed that Naoling decoction (NLD), a traditional Chinese medicine, was effective against AD, acting by inhibiting expression of IL-1β and IL-6. In the present study, we generated the rat model of AD by injecting Aβ1-42 peptide intracerebroventricularly and evaluated the dose-dependent effects of NLD treatment. The NLD-treated rats exhibited significant improvements in cognitive function as evaluated by the Morris water maze test. Golgi-Cox staining revealed that NLD treatment dose-dependently increased dendritic spines in the CA1 region, which were diminished in vehicle-treated rats. Further, NLD treatment normalized hippocampal Chromogranin A levels, which were elevated by Aβ1-42 induction. NLD also attenuated activation of microglia and astrocytes induced by Aβ1-42. Subsequently, NLD dose-dependently reduced levels TNF-α, IL-1β and IL-6 by inhibiting the NF-κB signaling pathway and the ASC-dependent inflammasome in the hippocampus. These findings reveal that NLD is a promising therapeutic agent that exerts inhibitory effects at multiple sites within the neuroinflammatory network induced in AD.

Effects of Improving Primary Health Care Workers' Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning

Background

Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs’ competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers’ education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning.

Objective

The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach.

Methods

The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs—the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs—the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses’ knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]).

Results

The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% CI 92.49-93.93) in experimental group versus 88.29 (95% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95% CI 93.37-94.73) in the experimental group vs 90.22 (95% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95% CI 93.08-94.68) in the experimental group versus 89.09 (95% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95% CI 1.08-2.48; P=.02).

Conclusions

Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings.

[Free medial thigh chimeric myocutaneous perforator flap for the reconstruction of tongue defect after tongue carcinoma resection]

Objective: To investigate the application of free medial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. Methods: From June 2013 to November 2015, 17 cases with tongue carcinoma underwent radical resection and tongue and mouth floor defects after surgery were reconstructed with medial thigh chimeric myocutaneous perforator flaps at the same stage. These 17 cases included tongue carcinoma on lingual margin (n=9), ventral tongue (n=7) and mouth floor (n=1). Appearance and functional results were evaluated with follow-up. Results: Medial thigh chimeric myocutaneous perforator flap was (9.0±0.3) cm in length, (4.5±0.3) cm in width , and (1.8±0.4) cm in thickness. The length of pedicle was (7.4±0.6) cm. All of the 17 flaps survived uneventfully, and the donor sites were closed directly in all cases. All patients were followed up for 10-28 months with satisfied esthetic and functional results in reconstructed tongue. Aside from linear scar in the donor sites, the functions of thighs were not affected. No local recurrence occurred. Conclusion: The free medial thigh chimeric myocutaneous perforator flap is an ideal choice to reconstruct the tongue and mouth floor defect after radical resection of tongue carcinoma.

[Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection]

Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two-point discrimination distances of the sites repaired with relaying ALT perforator flaps were ranged from 7 to 12 mm. The function of thigh was not obviously affected, and patients could walk normally and do related daily activities. Conclusions: Reconstruction of defect after oral tumor radical resection with free AMT perforator flap can achieve good outcome, and wound in the donor site of free AMT perforator flap repaired with relaying ALT perforator flap can achieve good appearance and function recovery.