0.05).The acute toxicity was more severe in the no-response group and response-LCAF group than in the response-CF group.Conclusion:LCAF did not improve the local control rate and survival rate on grades Ⅰ&Ⅱ esophageal carcinoma when 40Gy had been given by CF.Grades Ⅲ&Ⅳ esophageal carcinoma will get benefit from LCAF.

In order to select better seeding sludge and promote start-up of Anammox reactors, we studied the start-up performances of three Anammox-EGSB bioreactors inoculated with anaerobic methanogenic sludge (AMS) (R1), Fresh Anammox sludge (FAS) (R2) and stored Anammox sludge (SAS) (R3), respectively. Results showed that these three seeding sludges could start up Anammox-EGSB bioreactors successfully, but the start-up progresses showed different characteristics. The start-up course of R1 could be divided into three phases including autolysis phase (15 d), lag phase (54 d) and activity elevation phase (40 d). However, the start-up courses of R2 and R3 only included lag phase (2 d and 12 d, respectively) and activity elevation phase (15 d and 57 d, respectively). Besides, the performance of R3 was better than that of R1, but worse than that of R2. Furthermore, bathing the Anammox sludge in the effluent of bioreactors was a convenient and effective way to keep the activity of the Anammox sludge. The ammonia removal efficiency, percentage of denitrification and the stoichiometric ratios of NH4(+)-Nr/NO2(-)-Nr and NO3(-)-Np/NH4(+)-Nr could serve as indicators to monitor the start-up of Anammox bioreactors.
Bacteria, Anaerobic ; metabolism ; Biodegradation, Environmental ; Bioreactors ; microbiology ; Nitrogen ; metabolism ; Oxidation-Reduction ; Quaternary Ammonium Compounds ; metabolism ; Sewage ; chemistry ; Water Pollutants, Chemical ; metabolism

Objective To investigate the feasibility and clinical effects of chimeric perforator flap based on the descending branch of lateral circumflex femoral artery (d-LCFA) for reconstructing the three-dimensional tissue defect in lower extremities. Methods From May, 2008 to June, 2017, 79 cases of soft tissue defects with dead space were repaired by using a d-LCFA chimeric perforator flap, in which 33 cases of car accident trauma, 12 cases of chronic tibial osteomyelitis, 10 cases of plowing machine injury, 9 cases of chronic calcaneal osteomyelitis, 6 cases of falling injury, 5 cases of crushing injury, 3 cases of spoke injury, and 1 case of suppurative knee arthritis. These patients were accompany with different degrees of infection and dead space after radical debridement. The dead cavity was filled by muscular flap, and perforator flap covered the superficial wound. Recording the flap 's appearance, color, texture, osteomyelitis recurrence and the patient 's knee extension at 1, 3, 6, 9 and 12 months followed-up. Results Seventy-five flaps survived without complications, and the donor sites were closed directly. All patients had no post-operative hematoma or secondary infection. Vascular crisis occurred in 2 days after the operation in 4 flaps, 1 flap had an arterial crisis on the second-postoperative-day, and the flap was necrotic after surgical exploration. The deep cir-cumflex iliac artery chimeric perforator flap was used for repairing. Three flaps with venous crisis during 48 h after operation, in which 2 flaps survived eventually after surgical exploration, and another flap was necrosis and repaired by skin graft. The followed-up periods ranged from 3 months to 30 months (mean, 9.7 months). All flaps had satisfied with appearance and texture. There were no osteomyelitis recurrence and any ranges of motion limitations in the hip and knee joints of the operated leg. Conclusion The chimeric perforator flap with d-LCFA merely anastomosed 1 group vascular pedicle can make the dead space be filled and cover the superficial wound simultaneously. It is an ideal option for reconstructing the skin defect with dead space in lower extremity, which can improve the quality of restoration of recipient site and reduce the damage of donor site.

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs.Methods From September,2008 to October,2016,8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap,including 4 cases of traffic accident trauma,2 cases of chronic ulcer,1 case of a fall injury,1 case of the scar after fracture operation.The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm.Seven patients were accompanied by different degrees of infections.The deep femoral artery third perforating artery perforator flap was designed to repair,including 5 cases of pedicled flaps and 3 cases of free flaps.The flap's appearance,color,texture,infection recurrence and the recovery of lower limb function were recorded at 1,3,6,9 and 12 months followed-up.Results One flap suffered partial necrosis due to cross-zone backflow disorder,the ipsilateral medial sural artery pedicled perforator flap was used to repair.The rest of the flaps survived successfully.Skin graft was used to close the donor site in 1 case,and other donor sites were closed directly.All patients had no postoperative hematoma or secondary infection.The followed-up periods ranged from 2 to 28 months (mean,8.1 months).All flaps had satisfied appearance and texture.There were no complications such as paresthesia and numbness in the donor sites.And no motion limitations in hip and knee joint of the operated leg.Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps,which is a feasible method to repair soft tissue defect in lower limbs.

Objective To investigate the application value of CT perfusion (CTP) imaging for the revascularization treatment in adult patients with Moyamoya disease.Methods Adult patients with Moyamoya disease underwent revascularization in the Department of Neurosurgery,Wuhan No.1 Hospital from July 2009 to December 2016 were analyzed retrospectively.CTP and clinical evaluation were performed before and after 3-6 months of procedure.The modified Rankin Scale (mRS) was used to assess the functional outcomes.Results A total of 20 patients were enrolled in the study,including 9 females and 11 males,aged 29 to 73 years,with an average of 53.5 years.The initial symptom was ischemic stroke in 10 patients,transient isehemic attack in 7 patients,and hemorrhagic stroke in 3 patients.All patients underwent superficial temporal artery-middle cerebral artery bypass grafting plus encephalomyo-synangiosis under general anesthesia.All patients have different degrees of improvement in cerebral blood flow after procedure,and the CTP parameters were significantly improved compared with those before procedure (all P ＜0.05).The clinical symptoms were significantly improved in 3 cases (15％) and recovered in 13 cases (65％) at 6 months after procedure.The proportion of the mRS score 0-2 was significantly higher than that before procedure (90.0％ [18/20] 对 50.0％ [10/20];x2 =7.619,P =0.006).Conclusion CTP can evaluate the cerebral perfusion status in various vascular areas through hemodynamic parameters in early stage,which can effectively guide the operation mode of Moyamoya disease,and evaluate the changes of cerebral perfusion status after procedure as a means of follow-up of the disease.

Objective:To investigate the feasibility and clinical effects of the chimeric multi-paddled anteriolateral thigh perforator flap (ALTP) for reconstruction of complex defects in extremities, which was pedicled with the descending branch of lateral circumflex femoral artery (d-LCFA).Methods:From August, 2010 to December, 2017, 11 cases of severe soft-tissue defects were repaired with this flap, including 4 cases of car accident trauma, 2 of machine injury, 2 of fall injuries, 1 of ploughing machine injury, 1 of crushing injury, and 1 of spoke injury. The injuries accompanied with different degrees of infections, dead space and left huge soft-tissue defects after radical debridement (10.0 cm×9.0 cm-20.0 cm×18.0 cm) . Dead cavity was filled by the muscular flap, and the large area soft-tissue defects were repaired by chimeric multi-paddled perforator flap. Appearance, colour and texture of the flap, recurrence of infection and knee extension were recorded at 1, 3, 6, 9 and 12 months follow-up.Results:After the operation, all recipient sites had no hematoma and no infection. Eight flaps survived successfully, and donor sites healed primarily. One flap had partial necrosis because of a mechanical stretch of the perforator during the operation, then repaired by the ipsilateral chimeric perforator flap based on d-LCFA. One flap occurred vascular crisis on the second day after the surgery, and it was rescued and survived completely after surgical exploration. The other flap which repaired wound on hand had partial necrosis too, and then repaired with posterior interosseous artery perforator flap. The follow-up periods ranged from 2 to 32 (mean, 10.2) months. All flaps had satisfactory appearance and texture. Only linear scars left at the donor sites. There were no motion limitations at the hip and knee joints of the effected leg.Conclusion:The anteriolateral thigh perforator flap combined with multi-paddled and chimeric techniques can reduce donor site morbidities, simplify the anastomosis of blood vessel, and improve the appearance and effects of the recipient site. It is a feasible method in repairing severe soft tissue defects of limbs.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.