Objective To study the efficacy of medial plantar island flap for repairing soft tissue defect of the heel after excision of melanoma.Methods Five patients (including 3 males and 2 females) with malignant melanoma were treated.All lesions were located in the heel and were proved by pathological examination.Local extensive resection was performed in all cases.The surgical margin used for excision of melanoma was 2 cm,and the depth used was deep into periosteum of the calcaneus.Plantar medial artery island skin flaps were applied in the reparation according to the size of heel soft tissue defect and anatomic study.The postoperative follow-up was 8 to 14 months.Results The surgical reparation was successful in all 5 cases.The plantar medial artery was very suitable to cover the surgical wound surface and to recover the function and sense.Before 3 months the sense of flaps remained on the donor area and later went to the heel gradually.All patients remained alive and no tumor recurrence was observed.All the patients were walking normally and had protective sensation in the new heel pad comparable to the opposite normal heel.Two patients with more than 10 years follow-up were reported.Conclusions Plantar medial island flap can be used to repair the wound after malignant melanoma resection in the heel,which is an effective method.

Objective To discuss the technique and result of arthroscopic suprascapular nerve release.Methods From February 2008 to February 2011, nine cases of suprascapular nerve compression were treated.Four of them were transverse scapular ligament compression,and 5 cases with cyst compression around spinoglenoid notch,one case was double nerve compression.The patients were manifested nerve compressive symptoms, and MRI, EMG can be a useful tool to identify the locations of compressions. All the patients were treament with arthroscopic nerve release, by transverse scapular ligament releasing or cyst removing. Results The average follow up time was 10 months,the symptoms disappeared,the atrophy or weakness of supraspinatus and infraspinatus muscles were significantly improved after operation. Conclusion The Arthroscopic suprascapular nerve release is an effective,miniinvasive,and fast recovery technique.

In order to improve the surface properties of PLGA polymer for a better material/cell interface to modulate the cells behaviors, we prepared a novel three-block copolymer, PLGA-[ASP-PEG], and immobilized an RGD-containing peptide, Gly-Arg-Gly-Asp-Ser-Pro-Cys (GRGDSPC) on the surface of it. Transforming growth factor-beta1 (TGF-beta1) was transfected into bone marrow stromal cells (MSCs) employed as seeded cells. Cell adhesion, spreading, proliferation and differentiation on this material were investigated. The results showed that the cell adhesive ratio on RGD-modified materials was higher than on un-modified materials (P<0.05). The extent of cell spreading was also wider on RGD-modified materials than on un-modified materials. Cell proliferation indices of transfected MSCs were increased as compared with the un-transfected MSCs (P<0.05). The ALP activities in the MSCs cultured with RGD-modified materials were higher than on un-modified materials after 14 days (P<0.05), and those in transfected MSCs were higher than in un-transfected MSCs (P<0.05). It was suggested that the combined use of RGD-modification and TGF-beta gene transfection could improve the interaction of biomaterial and cells.

Objective To investigate the patients' radiation dose received in digital radiography (DR) and provide basic data for developing diagnostic reference levels.Methods The patient' s ESD was estimated using the TLDs and DAP was measured by the dose-area product meter.The E values were then calculated by the DAP using Monte Carlo data and RefDose software.Measurements were made for twelve types of examination:skull PA,skull LAT,chest PA,chest LAT,abdomen AP,pelvis AP,cervix spine PA,cervix spine LAT,thoracic spine PA,thoracic spine LAT,lumber spine PA and lumber spine LAT.Results Both kV and mAs varied in the same type of examination for ESD,DAP and E(F =33.47,24.68,43.19,P ＜ 0.05).The dose each time for lumber spine LAT was the highest,reached 4.62 mGy in ESD and 2.26 Gy·cm2 in DAP,respectively.The E of abdomen AP averaged as 0.59 mSv,higher than that of lumber spine LAT.Even for the same type of examination,the dose from each equipment was different.Conclusions DR has the potential to reduce the patients' radiation doses.The guidance levels suitable for Chinese population should be established as soon as possible.

An enrichment culture showing specific algae-lysing activity was isolated from the mixtures of different samples and Microcystis aeruginosa. The process of algal lysis was monitored by chlorophyll measurement, PCR, and denaturing gradient gel electrophoresis (DGGE). The result showed that the enrichment culture had still high algicidal activity against M. aeruginosa after 1/100000 dilution. Rubritepida sp. C1, Pseudomonas sp. C2 and Sphingomonas sp. C3, as accompanying bacteria, existed in M.aeruginosa. The bacterial community in M. aeruginosa showed significant change after adding the enrichment culture, where uncultured Flavorbacterium sp. A2, Sphingomonas sp. C3 and Hydrogenophaga sp. A3 were observed, and A2 became a dominant species. The obvious correlation can be seen between change of bacterial population and extinction of M. aeruginosa. Compared identification of pure bacterium with sequencing of DGGE band, it was inferred that uncultured bacteria were probably play an important role in controlling the growth and abundance of M. aeruginosa.

Objective To investigate the distribution and antibiotic resistance of the K lebsiella pneumoniae strains isolated from clinical infections in terms of serotypes K1 ,K2 and virulence factor rmpA gene .Methods The hypermucoviscous phenotype of K .pneumoniae isolate was determined by string test .K1 and K2 serotypes and rmpA gene were detected using multiplex polymerase chain reaction .Results Of the 144 strains of K .pneumoniae ,the prevalence of hypermucoviscous phenotype ,K1 , K2 serotypes and rmpA gene was 62 .5% (90/144) ,52 .1% (75/144) and 65 .3% (94/144) ,respectively .The prevalence of K1 ,K2 and rmpA K .pneumoniae strains was 90 .7% (68/75) in K1 ,K2 serotypes .The prevalence of K1 ,K2 isolates and rmpA in hypermucoviscous or non‐hypermucoviscous phenoype was 63 .3% (57/90) ,85 .6% (77/90) and 33 .3% (18/54) , 31 .5% (17/54) ,respectively .The prevalence of serotype K1 ,K2 with or without rmpA gene was 72 .3% (68/94) and 14 .0% (7/50 ) respectively . Of the 42 K . pneumoniae strains isolated from liver abscess ,85 .7% (36/42) were hypermucoviscous phenotype and 88 .1% (37/42 ) were serotypes K1 , K2 . For the strains from other abscess , bacteremia ,community acquried pneumonia (CAP) ,urinary tract infection (UTI) and biliary tract infection ,the prevalence of hypermucoviscous phenotype was 81 .3% (13/16) ,40 .5%(15/37) ,85 .7% (12/14) ,52 .4% (11/21) and 21 .4% (3/14) ,respectively ,and the prevalence of serotypes K1 ,K2 was 56 .3% (9/16) ,29 .7% (11/37) ,64 .3% (9/14) ,38 .1% (8/21) and 7 .1% (1/14) ,respectively .K1 serotype isolate accounted for 61 .9% of the strains from liver abscess .The ratio between serotype K1 and K2 was similar in the isolates from other abscess ,CAP ,UTI or bacteremia .Non‐K1 ,K2 serotype isolates were common in biliary tract infection .The prevalence of extended‐spectrum beta‐lactamases (ESBLs ) was 5 .5% in hypermucoviscous phenotypes and 33 .3% in the non‐hypermucoviscous phenotypes .Conclusions rmpA gene is associated with the hypermucoviscous phenotype of K .pneumoniae strains and commonly identified in K1 ,K2 serotype isolates .Serotypes K1 ,K2 isolates are important pathogens in liver abscess and CAP ,and also common in other abscess ,UTI and bacteremia .K1 serotype isolate was most common in liver abscess .The prevalence of K1 or K2 serotype was similar in other infections . The prevalence of ESBLs is lower in hypermucoviscous strains than in non‐hypermucoviscous strains and is associated with lower resistance rate to most of the antibiotics tested .

Objective To identify the effect of long hazardous drinking on cardiovascular function and cardiovascu?lar abnormalities among alcohol dependent patients. Methods A follow-up survey was conducted, 72 potential patients who were diagnosed as having alcohol dependence were recruited into case group and 75 staff who underwent routine health examination were subjected into control group. Furthermore, 52 patients were subdivided into long hazardous drinking group (GroupⅠ) according to the classification of alcohol consumption published by WHO. The rest patients in the case group were considered as not long hazardous drinkers (GroupⅡ). The blood lipid data, echocardiography and ca?rotid artery brachial artery ultrasonography measurement data were compared between the three groups. The high risk fac?tors for cardiovascular abnormalities among alcohol dependence patients were analyzed. And one year after discharge, telephone follow-up method was used to obtain the incidence of cardiovascular accident among patients. Results The dis?tribution of blood lipid data among GroupⅠ, Ⅱ and control group were not significantly different (P>0.05). The LVEF score in GroupⅠwas significantly lower than that in control group (P<0.01). The LAAEF score in GroupⅠwas signifi? cantly higher than that in control group and that in the GroupⅡ(P<0.05). While the FDM and IMT score in the GroupⅠwas significantly lower than that in control group (P<0.01). In the case group, the duration of drinking alcohol was neg?atively associated with LAPEF (r=-0.246, P=0.014) and LAAEF (r=0.239, P=0.016). The average daily alcohol consump?tion was positively associated with LVEF (r=0.256, P=0.010), while negatively correlated with FMD (r=-0.256,P=0.010). Multivariate logistic regression analysis showed that long hazardous drinking was an independent risk factor for cardiovas?cular abnormalities (OR=1.334, 95%CI: 1.060~1.678). Conclusion Long hazardous drinking can reduce left ventricular diastolic and vascular endothelial function. It is an independent risk factor for cardiovascular abnormalities in alcohol de?pendent patient.

Objective To investigate the prevalence and the transmission of oqxAB gene in clinical strains of Escherichia coli and Klebsiella pneumoniae .Methods Nonduplicate clinical isolates of E.coli (n=72)and K .pneumoniae (n=49)were col-lected.The oqxAB gene was amplified by PCR.The product was sequenced.Plasmid conjugation experiments were done in oqxAB-positive E.coli and K.pneumoniae strains to detemine whether oqxAB gene is located in plasmid.The MICs and mu-tant prevention concentrations (MPCs)for ciprofloxacin were determined in transconjugants with oqxAB gene by agar dilution method.Results The oqxA,oqxB and oqxAB were identified in 15,4,and 7 of the 72 strains of Escherichia coli and 4,1,and 34 of the 49 strains of K.pneumoniae,respectively.The oqxAB gene was positive in 2 (2/16)ciprofloxacin sensitive and 5 (5/56)ciprofloxacin resistant E.coli strains,in 8 (8/14)ciprofloxacin sensitive and 26 (26/35)ciprofloxacin resistant K. pneumoniae strains,respectively.The E.coli and K.pneumoniae strains with or without oqxAB did not show different sus-ceptibility to ciprofloxacin.The oqxA and oqxB sequences from E.coli and K.pneumoniae showed 99% similarity to the se-quences of GeneBank accession number AB601773.1 and accession number FJ975561.1,respectively.The oqxAB gene was successfully transferred in 4 of the 5 oqxAB-positive E.coli strains.The MIC of ciprofloxacin was 0.25-0.5 mg/L against the transconjugants,31-62 times higher than the MICs for the recipient strains.The MPC of ciprofloxacin was 8-16 mg/L against the transconjugants,32 times higher than that for recipient strain J53.The oqxAB gene were not transferred in K. pneumoniae. When the MIC of ciprofloxacin was ≤0.062 5 mg/L,the MPC of ciprofloxacin was 0.25-0.5 mg/L for K.pneumoniae strains with or without oqxAB.When MIC was 0.25-0.5 mg/L,the MPC of ciprofloxacin was 2-16 mg/L for K .pneumoniae strains with or without oqxAB .Conclusions oqxAB gene is present in E .coli and K .pneumoni-ae .The oqxAB gene spreads through plasmid in E .coli.The nonsiginificant difference of oqxAB prevalence between ciproflox-acin sensitive and ciprofloxacin resistant strains indicates that oqxAB gene may mediate low level resistance to ciprofloxacin in E.coli.The E.coli transconjugants of oqxAB gene can produce high level resistance under the selection pressure of ciproflox-acin.The high level resistance in K .pneumoniae under selection pressure of ciprofloxacin is not associated with oqxAB gene, but related to the ciprofloxacin MIC against these strains.

OBJECTIVE To provide reference for safe drug use in clinic by mining the adverse drug events （ADE） of 3 kinds of anti-influenza A virus drugs （oseltamivir， zanamivir， baloxavir marboxil）. METHODS The ADE data of oseltamivir， zanamivir and baloxavir marboxil were collected from the FDA adverse event reporting system （FAERS） between the first quarter in 2004 and the third quarter in 2022， and mined by using reporting odds ratio （ROR） method. The designated medical events （DME） were estimated. The system organ class （SOC） in the Medical Dictionary for Regulatory Activities （MedDRA， version 25.0） was used for the classification and statistics of drug ADE terminology. RESULTS A total of 12 636， 1 749 and 1 283 ADE reports were retrieved for oseltamivir， zanamivir and baloxavir marboxil， involving 26， 16 and 17 SOCs， respectively. Oseltamivir was strongly associated with sleep terror， abnormal behavior， hallucination and delirium. Zanamivir was implicated in abnormal behavior， delirium， incoherence， and altered state of consciousness with prominent signal intensity. Baloxavir marboxil was strongly associated with ischemic colitis， hemorrhagic cystitis， erythema multiforme and melaena. Erythema multiform was detected in the DME of three drugs with strong signals. CONCLUSIONS When clinically administering the three drugs， it is crucial to pay close attention to both common adverse reactions and those ADEs that are not explicitly mentioned in the drug instructions. For oseltamivir， clinicians should exercise caution due to the potential risk of acute kidney injury and fulminant hepatitis， necessitating regular monitoring of the patient’s liver and kidney function. When prescribing zanamivir， caution should be exercised due to ADEs related to the respiratory system， including acute respiratory distress syndrome and respiratory failure， necessitating close monitoring of the patient’s respiratory status. Similarly， for baloxavir marboxil， clinicians should be vigilant for potential ADEs such as erythema multiforme and rhabdomyolysis.

This paper discussed the main point specifically from the three aspects which are the certainty and uncertainty of technological function , the predictability and unpredictability of technological efficiency , and“should do”or“not should do”of technological application .It presented an ethics argument of medical technology clinical admittance restriction and defends the standpoint -what we can do does not mean what we should do , aiming to provide moral theoretical support of ethical review of medical technology application .