Objective To report the anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap. Methods Latex injection studies were performed on 24 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel artery and its perforators in the distal leg were documented. 16 vascularized fibul osteoseptocutaneous flaps were performed for reconstruction of composite soft-tissue defect of limbs. The flap areas ranged from 6 cm×4 cm to 16 cm× 8 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. 40.6% of them were muscularcutanous perforators, and the other were septacutanous perforators. The perforating vessels were all located within 3.1 cm from the postlateral fibula. The average diameter was 1.1 mm at the deep fascial level, and the interval of them was 4-8 cm. There were two constant perforators which located about 15-25 cm and 4-7 cm from the lateral maleolar respectively. All of the 16 clinical cases survived uneventfully and the time to union of the graft-host junction site were 3 to 5 months. The appearance of flaps and the function of the limbs were satisfied during 10 to 36 months following up. Conclusion It is the anatomic basis that there are pedorating vessels of the peroneal constantly. The vnscularized compound fibula perforating osteoseptocutaneous flap has the advantage of flexible design. It is the safe and suitable choice in the cases when compound bone and soft tissue defects of the limbs are required for reconstruction.

Objective To estimate the effects of the dietary approaches to stop hypertension (DASH) diet on blood pressure (BP) of children and adolescents by using meta-analysis. Methods The articles of the randomized controlled clinical trials (RCT) on the DASH diet were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate the weighted mean difference (WMD) and 95% confidence interval (CI) to assess the blood pressure change associated with DASH diet in children and adolescents. Results Eight RCT papers involving experimental group for 838 and the control group for 1 222 were included. All the papers had high methodological quality. According to comparative analysis between the lowest tertiles of DASH Score and highest tertiles of DASH Score, the DASH-style pattern led to lower systolic BP(SBP) (WMD=-2.29 mmHg, 95%CI:-3.20--1.38) (1 mmHg=0.133 kPa)and diastolic BP(DBP) (WMD=-2.18 mmHg, 95%CI:-3.00--1.35) levels. Comparing with pre-DASH diet, the DASH diet was more effective in lowing SBP (WMD=-5.83 mmHg, 95%CI:-9.55--2.11)and DBP(WMD=-2.78 mmHg, 95%CI:-4.74--0.83). Comparing with the routine care (RC), the DASH diet was proved more effective than RC in lowing SBP(WMD=-4.98 mmHg, 95%CI:-7.37--2.59) and DBP(WMD=-1.47 mmHg, 95%CI:-2.53--0.41) in children and adolescents. The DASH diet was more effective in lowing SBP(WMD=-3.25 mmHg, 95%CI:-5.46--1.05)than DBP in children and adolescents. Conclusion This research suggested that DASH diet had a positive clinical efficacy on blood pressure in children and adolescents, and caused a greater decrease in SBP than in DBP.

OBJECTIVE: To explore the correlations between symptom-based principal factors of rheumatoid arthritis (RA) and the effect of traditional Chinese medicine or Western medicine on RA after factor analysis of RA symptoms. METHODS: Four hundred and thirteen RA patients from 9 clinical centers were included in the clinical trial. They were randomly divided into Western medicine (WM) treated group with 204 cases and traditional Chinese medicine (CM) treated group with 209 cases. A complete physical examination and 18 common clinical manifestations were recorded before the randomization and after the treatment. The WM therapy included voltaren extended action tablet, methotrexate and sulfasalazine. The CM therapy included glucosidorum Tripterygll totorum tablet and Yishen Juanbi Tablet. The American College of Rheumatology 20 (ACR20) was used for efficacy evaluation. All data were analyzed on SAS 8.2 statistical package. Eighteen symptoms in the RA patients were analyzed by factor analysis and the relationships between the factors and effects were analyzed with Chi-Square test. RESULTS: Four principal factors were obtained from the analysis results of the 18 symptoms. The factors could represent the symptoms related to joints, cold-syndrome, deficiency syndrome and heat-syndrome in traditional Chinese medicine (TCM), respectively. The effect of WM therapy was better than CM therapy. After 12 weeks of treatment, the effect of CM on patients without deficiency-syndrome was better than the patients with deficiency-syndrome. After 24 weeks of treatment, WM therapy showed better effect on patients with cold syndrome than patients without cold syndrome. CONCLUSION: The results based on the factor analysis of RA symptoms are similar to the results of syndrome differentiation of TCM, and the factor-related different categories of symptoms are associated with the curative effect, thus further research on the symptoms is necessary.

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.

Abstract: Objective To investigate the prevalence of dissociative tendency and its influencing factors among middle school students, so as to provide insights into prevention and early interventions of adolescent dissociative tendency. Methods: Students at ages of 13 to 18 years that studied in 9 high schools were sampled using a multistage, stratified, cluster sampling method from 3 counties (districts) of Hangzhou City from January, 2021 and March, 2022. Participants' demographics and social, school, family environment and psychological factors were collected using self-designed questionnaires and standardized scales. The dissociative tendency was initially screened using the Adolescent Dissociative Experience Scale (A-DES), and the diagnosed by three psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Factors affecting ADT were identified using a multivariable logistic regression model. Results: Totally 3 240 students were recruited, and 2 841 students were qualified, with a response rate of 87.69%. The respondents included 1 389 men (48.89%) and 1 452 women (51.11%), and had a mean age of (15.69±1.58) years. The prevalence of dissociative tendency was 24.04%, and the detection of dissociative tendency was higher among men than among women (29.23% vs. 19.08%; χ2=24.529, P<0.001). Multivariable logistic regression analysis identified negative teacher-student relationship (OR=1.055, 95%CI: 1.010-1.103), family emotional expressiveness (OR=0.872, 95%CI: 0.777-0.978), family conflict (OR=1.152, 95%CI: 1.045-1.271), family organization (OR=0.880, 95%CI: 0.780-0.992) and family cohesion (OR=0.871, 95%CI: 0.766-0.987) as factors affecting dissociative tendency among men, and somatization (OR=1.041, 95%CI: 1.002-1.082) and paranoid ideation (OR=1.094, 95%CI: 1.006-1.190) as factors affecting dissociative tendency among women. Conclusions The prevalence of dissociative tendency was 24.04% among middle school students. Negative teacher-student relationship, family emotional expressiveness, family conflict, family organization, and family cohesion may affect dissociative tendency among men, while somatization and paranoid ideation may affect dissociative tendency among women.

Objective: To investigate the urban and rural differences in adverse outcomes of pulmonary tuberculosis (PTB) in patients with pulmonary tuberculosis-diabetes mellitus comorbidity (PTB-DM), so as to provide insights into improving the prevention and treatment measures for PTB-DM. Methods: Patients with PTB-DM who were admitted and discharged from 14 designated tuberculosis hospitals in Hangzhou City from 2018 to 2022 were selected. Basic information, and history of diagnosis and treatment were collected through hospital information systems. The adverse outcomes of PTB were defined as endpoints, and the proportions of adverse outcomes of PTB in urban and rural patients with PTB-DM were analyzed. Factors affecting the adverse outcomes of PTB were identified using a multivariable Cox proportional hazards regression model. Results: A total of 823 patients with PTB-DM were enrolled, including 354 (43.01%) urban and 469 (56.99%) rural patients. There were 112 (13.61%) patients with adverse outcomes of PTB. The proportions of adverse outcomes of PTB in urban and rural patients were 14.41% and 13.01%, respectively, with no statistically significant difference (P>0.05). Multivariable Cox proportional hazards regression analysis identified first diagnosed in county-level hospitals or above (HR=2.107, 95%CI: 1.181-3.758) and drug resistance (HR=3.303, 95%CI: 1.653-6.600) as the risk factors for adverse outcomes of PTB in urban patients with PTB-DM, while the treatment/observed management throughout the process (HR=0.470, 95%CI: 0.274-0.803) and fixed-dose combinations throughout the process (HR=0.331, 95%CI: 0.151-0.729) as the protective factors for adverse outcomes in rural patients with PTB-DM. Conclusions There are differences in influencing factors for adverse outcomes of PTB in urban and rural patients with PTB-DM. The adverse outcomes of PTB are associated with first diagnosed hospitals and drug resistance in urban patients, and are associated with the treatment/observed management and fixed-dose combinations throughout the process in rural patients.

To explore gambogenic acid (GNA)-induced apoptosis and underlying mechanism in vivo. A549 nude mice xenografts were used as in vivo model to study anticancer effect of GNA by observing tumor growth curve and weight of the tumor. Ultrastructure of A549 cells treated by GNA was observed by TE. Expression of COX-2 and VEGF were detected by immunohistochemistry. TUNEL assay was applied in examining apoptosis index of tumor cells. The tumor isolated from mice treated by GNA (8, 16 mg kg(-1)) took on a slow growth condition compared with control group. The results suggested that weight and volume of the tumor from experimental groups were remarkably decreased compared with control group (P < 0.05). Ultrastructure change of the tumor, such as vacuolization, abnormal distribution of the heterochromosome, volume of the tumor cells, even apoptotic bodies, were observed in GNA-treated group. While no apparent morphological change was observed in the normal group. Typical apoptotic characteristics could be distinctly observed in the mouse treated by GNA for 20 days and apoptosis index in GNA-treated group was significantly higher than model group. Expression of COX-2 and VEGF were significantly down-regulated in GNA-treated groups in comparison with control group (P < 0.01). These results indicate that GNA could affect the development and progression of A549 cells through inducing apoptosis, mediating the expression of VEGF in vascular cells and COX-2 in tumor cells.
Animals ; Antineoplastic Agents, Phytogenic ; therapeutic use ; Apoptosis ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cyclooxygenase 2 ; metabolism ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lung Neoplasms ; drug therapy ; metabolism ; ultrastructure ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Microscopy, Electron, Transmission ; Terpenes ; therapeutic use ; Vascular Endothelial Growth Factor A ; metabolism ; Xanthenes ; Xanthones ; therapeutic use ; Xenograft Model Antitumor Assays

Objective To develop and validate a mortality risk prediction model for patients infected with avian influenza A H 7N9 virus.Methods A stratified and random sampling method was adopted for selection of subjects .A total of 102 patients infected with avian influenza A H7N9 virus, who were admitted to the designated hospitals in Zhejiang Province during March 2013 and March 2015, were enrolled.Standard questionnaires were used to collect data about demographic , epidemiologic and clinical characteristics , and the data were retrospectively reviewed . Univariate analysis and stepwise logistic regression analysis were used to identify the mortality risk factors of patients infected with avian influenza A H7N9 virus, and nomogram was applied to develop the risk prediction model .The accuracy of the prediction model was assessed using Concordance index (C-index) and receiver operating characteristic (ROC) curve. Results Stepwise multiple logistic regression analysis showed that age ≥60 years (χ2 =3.98, OR=2.99, 95%CI:1.05-9.21, P<0.05), increased initial neutrophil count (χ2 =6.66,OR=5.06, 95%CI:1.56-18.83, P<0.05), C-reactive protein≥120mg/L (χ2 =8.63, OR=5.15, 95%CI:1.79-16.31, P<0. 01), poor hand hygiene (χ2 =6.83, OR =10.29, 95%CI:2.18-81.49, P <0.01) and 5 days of incubation period or shorter (χ2 =7.23, OR=4.75, 95%CI:1.59-15.80, P<0.01) were independent risk factors for mortality of patients .Based on the above study , a risk prediction model of nomogram was developed.Poor hand hygiene (grade A, 100.0 points) ranked on the top of all risk factors, followed by C-reactive protein≥120 mg/L (grade B, 76.5 points), increased initial neutrophil count (grade C, 70.5 points), 5 days of incubation period or shorter (grade D, 62.0 points) and age ≥60 years (grade E, 51.0 points).The C-index and the area under the curve were 0.833 and 0.817 for the nomogram model , respectively;and the nomogram model fitted well .Conclusion Nomogram model can effectively predict and estimate the risk of death for patients infected with avian influenza A H 7N9 virus.

To establish a rat model of rheumatoid arthritis (RA) with kidney deficiency syndrome.

OBJECTIVE: To analyze the indications of the therapies for rheumatoid arthritis (RA) with neural network model analysis. METHODS: Three hundred and ninety-seven patients were included in the clinical trial from 9 clinical centers. They were randomly divided into Western medicine (WM) treated group, 194 cases; and traditional Chinese herbal medicine (CM) treated group, 203 cases. A complete physical examination and 18 common clinical manifestations were prepared before the randomization and after the treatment. The WM therapy included voltaren extended action tablet, methotrexate and sulfasalazine. The CM therapy included Glucosidorum Tripterygii Totorum Tablet and syndrome differentiation treatment. The American College of Rheumatology 20 (ACR20) was taken as efficacy evaluation. All data were analyzed on SAS 8.2 statistical package. The relationships between each variable and efficacy were analyzed, and the variables with P<0.2 were included for the data mining analysis with neural network model. All data were classified into training set (75%) and verification set (25%) for further verification on the data-mining model. RESULTS: Eighteen variables in CM and 24 variables in WM were included in the data-mining model. In CM, morning stiffness, swollen joint number, peripheral immunoglobulin M (IgM) level, tenderness joint number, tenderness, rheumatoid factor (RF), C-reactive protein (CRP) and joint pain were positively related to the efficacy, and disease duration and more urination at night negatively related to the efficacy. In WM, erythrocyte sedimentation rate (ESR), weak waist, white fur in tongue, joint pain, joint stiffness and swollen joint were positively related to the efficacy, and yellow fur in tongue, red tongue, white blood negatively related to the efficacy. In the analysis with the neural network model in the patients of verification set, the predictive response rates of 20% patients would be 100% and 90% in the treatment with CM and WM, respectively. CONCLUSION: Neural network model analysis, based on the full clinical trial data with collection of both traditional Chinese medicine and modern medicine diagnostic information, shows a good predictive role for the information in the efficacy in rheumatoid arthritis.