目的探讨辽宁省机关干部肥胖的患病率及其危险因素以及肥胖与其他代谢异常的关系。方法对辽宁省1680名机关干部随机抽样进行体格检查,并进行肥胖患病率的流行病学调查。结果本组人群肥胖患病率为20.42%,其中男性27.8%,女性21.9%,男女性之间有显著性差异(P<0.05);不同年龄组间肥胖患病率亦有显著性差异,其中以40～50岁中青年干部肥胖患病率最高,为26.25%;肥胖与生活方式及其他代谢异常密切相关。结论中青年机关干部的肥胖患病率明显高于中老年组,且与不良生活方式有关,同时合并有其他代谢紊乱。

Objective To investigate clinical manifestation of unspecified functional bowel disorder (UFBD), the features of coexistence with functional gastrointestinal disorder (FGID) and its relationship with psychological factors and sleep disturbance in the Chinese Army servicemen.Methodsc FGIDs were diagnosed based on the RomeⅢ Modular Questionnaire. The subjects were 189 servicemen with UFBD (UFBD group) and 372 without FGID (control group). All subjects completed symptom checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results'Have to rush to the toilet when having a desire to defecate' was the most frequent symptom of UFBD (93.7%). More than one half of UFBD patients had the symptom 'a feeling of incomplete emptying as bowel movements' or 'straining during bowel movements'. Twenty-eight percent of UFBD subjects had combined FGID (namely cFGID). Among them, the most frequent was proctalgia fugax (7.9%), followed by cyclic vomiting syndrome (6.3%), functional fecal incontinence (6.3%), functional dyspepsia (4.8%) and belching (4.8%). The UFBD group scored significantly higher than the control group in the global severity index (GSI) and in all SCL-90 subscales (P<0.05). The scores of the four domains (sleep quality, sleep latency , sleep disturbance and daytime function disorder), total PSQI score and proportion of poor sleeping quality were significantly higher in the UFBD group than in the control group (P<0.05). The subjects scored significantly higher in combined FGID group than in UFBD group in GSI and in all of SCL-90 subscales, except for phobic anxiety subscales (P<0.05). However, there was no significant difference in each domain, total PSQI and proportion of poor sleeping quality between the cFGID group and UFBD group (P>0.05).ConclusionPathogenesis of UFBD may be closely correlated with psychiatric and psychological factors and sleep disturbance. cFGID are associated with an increased severity of psychopathological features.

Objective:To summarize the clinical effect of the optimized lateral supramalleolar perforator pedicle flap in repairing the soft tissue defect of the foot and ankle.Methods:From January 2016 to June 2019, the Microorthopaedics of the Second Affiliated Hospital of Luohe Medical College admitted 16 patients with small and medium area skin and soft tissue defects of the ankles, including 12 males and 4 females. The age ranged from 18 to 63, with an average age of 48. The defects was repaired with the optimized laterals uprmalleolus perforator pedicle flap. The width of the wound was measured preoperatively, and the anterolateral skin in the middle lower or middle part of the calf was evaluated by "lifting and kneading" according to the width of the wound. After the evaluation, the doner arear can be closed directly. The lateral supramalleolar perforating vessels and there proximal perforation of peroneal artery can be detected by Doppler ultrasound flowmeter. The line of two perforating points is used as the central axis of the flap. The rotation point of flap was at lateral malleolus plane or the superior edge of the inferior tibiofibular syndesmosis. The distance from the rotation point to the proximal edge of the wound was used as the pedicle length of the vsscular tissue. During the operation, the perforating branch in the pedicle of the flap and the descending branch in the terminal perforating branch of the peroneal artery should be protected. After the perforating vessels above the lateral supramalleolar perforating branch were clipped with vessel clips, the tourniquet was relaxed to evaluate the blood supply of the flap. If necessary, the interosseous membrane can be opened to carry the peronerl artery. The flap was transferred to the recipient area through the open channel which was optimized to cover the pedicle with a blunt curved or semicircular flap. In 4 patients with perimalleolar and plantar skin defects, the head end of the superficial peroneal nerve in the flap was anastomosed with the side of the recipient sural nerve. The donor area was closed directly. The survival of the flap was observed after operation.Results:In this group of 16 cases, the area of the flap was 3.0 cm×1.5 cm-14.0 cm×6.0 cm. Only 1 case of flap showed blood stasis and swelling at 24 h after surgery, with poor blood flow at the distal end. Although the pedicle suture was removed, one week later, the tip of the flap still showed small area of necrosis. After dressing changes later, it gradually heals. The other flaps survived without special treatment. 12 patients were followed up for 4 months to 2 years, and the flap shape and function were satisfactory. Among the 4 patients with nerve anastomosis, 3 of them were followed up for 8-13 months, 1 case recovered to grade S2, and 2 cases recovered to grade S3.Conclusions:Through the optimal selection of the flap donor area, the optimal design of the open channel, the evaluation of the blood supply of the flap and the optimal treatment of the perforating vessels, the survival rate of flap was not only improved, but also a good shape and function was obtained. Although some patients may have different degrees of sensory dysfunction of the dorsal foot after excision of the superficial peroneal nerve, it can still be regarded as one of the ideal method to repair the skin and soft tissue in the middle and small area of foot and ankle.

Objective:To summarize the clinical effect of the optimized lateral supramalleolar perforator pedicle flap in repairing the soft tissue defect of the foot and ankle.Methods:From January 2016 to June 2019, the Microorthopaedics of the Second Affiliated Hospital of Luohe Medical College admitted 16 patients with small and medium area skin and soft tissue defects of the ankles, including 12 males and 4 females. The age ranged from 18 to 63, with an average age of 48. The defects was repaired with the optimized laterals uprmalleolus perforator pedicle flap. The width of the wound was measured preoperatively, and the anterolateral skin in the middle lower or middle part of the calf was evaluated by "lifting and kneading" according to the width of the wound. After the evaluation, the doner arear can be closed directly. The lateral supramalleolar perforating vessels and there proximal perforation of peroneal artery can be detected by Doppler ultrasound flowmeter. The line of two perforating points is used as the central axis of the flap. The rotation point of flap was at lateral malleolus plane or the superior edge of the inferior tibiofibular syndesmosis. The distance from the rotation point to the proximal edge of the wound was used as the pedicle length of the vsscular tissue. During the operation, the perforating branch in the pedicle of the flap and the descending branch in the terminal perforating branch of the peroneal artery should be protected. After the perforating vessels above the lateral supramalleolar perforating branch were clipped with vessel clips, the tourniquet was relaxed to evaluate the blood supply of the flap. If necessary, the interosseous membrane can be opened to carry the peronerl artery. The flap was transferred to the recipient area through the open channel which was optimized to cover the pedicle with a blunt curved or semicircular flap. In 4 patients with perimalleolar and plantar skin defects, the head end of the superficial peroneal nerve in the flap was anastomosed with the side of the recipient sural nerve. The donor area was closed directly. The survival of the flap was observed after operation.Results:In this group of 16 cases, the area of the flap was 3.0 cm×1.5 cm-14.0 cm×6.0 cm. Only 1 case of flap showed blood stasis and swelling at 24 h after surgery, with poor blood flow at the distal end. Although the pedicle suture was removed, one week later, the tip of the flap still showed small area of necrosis. After dressing changes later, it gradually heals. The other flaps survived without special treatment. 12 patients were followed up for 4 months to 2 years, and the flap shape and function were satisfactory. Among the 4 patients with nerve anastomosis, 3 of them were followed up for 8-13 months, 1 case recovered to grade S2, and 2 cases recovered to grade S3.Conclusions:Through the optimal selection of the flap donor area, the optimal design of the open channel, the evaluation of the blood supply of the flap and the optimal treatment of the perforating vessels, the survival rate of flap was not only improved, but also a good shape and function was obtained. Although some patients may have different degrees of sensory dysfunction of the dorsal foot after excision of the superficial peroneal nerve, it can still be regarded as one of the ideal method to repair the skin and soft tissue in the middle and small area of foot and ankle.

Objective:To investigate the differences in virological and immunological indicators of HIV-1 infected individuals with different degrees of immunosuppression, analyze the correlation between the sample/cutoff ratio (S/CO), viral load (VL), Western blot (WB) band type and immune status of HIV-1 infected individuals.Methods:A total of 639 HIV-1 antibodies positive and treatment-naive samples from Henan, Beijing and Yunnan during the period of 2017-2019 were divided into three groups: no immunosuppression (CD4≥500 cells/μl), mild immunosuppressive (350cells/μl≤CD4<500cells/μl), moderate immunosuppression (200 cells/μl≤CD4<350 cells/μl), severe immunosuppression (CD4<200 cells/μl). Chi-square test was used to compare S/CO, WB band type among different immunosuppression groups, analyze the relationship between various indicators and immune status.Results:In each immunosuppressive group, S/CO>20 had the highest occurrence rate (>37%), and showed a decreasing trend with the enhancement of immunity ( P<0.05), the occurrence rate of 119%), the occurrence rate of 078%), while the occurrence rates of p55 (<40%) and p39 (<3%) were the lowest, the differences of the occurrence rates of gp41 and p51 among different immunosuppression groups were statistically significant ( P<0.05). The area under the curve determined by S/CO value combined with viral load for no, mild, moderate and severe immunosuppression groups were respectively 0.651 (95% CI: 0.600-0.702; P<0.05), 0.587 (95% CI: 0.540-0.635; P<0.05), 0.605 (95% CI: 0.560~0.650; P<0.05), 0.647 (95% CI: 0.586-0.708; P<0.05). Conclusions:The S/CO value viral load was the best for the determination of non-immunosuppressive status; The absence of gp41 and p51, S/CO>20 suggest that the patient may be in non or severe immunosuppressed state, respectively.