Objective:To analyze the reflux parameters of patients with gastroesophageal reflux disease (GERD) in upright position, supine position and at 2 h after meals, and to explore the cut-off value, sensitivity and specificity of the reflux parameters in different positions and at 2 h after meals in GERD diagnosis.Methods:From January 2016 to July 2020, 200 GERD patients (GERD group) and 61 non-GERD patients (control group) who visited Huazhong University of Science and Technology Union Shenzhen Hospital (Former Nanshan District People′s Hospital), were selected. All the patients of the two groups received gastroesophageal reflux disease questionnaire (GERDQ), upper gastrointestinal endoscopy, esophageal high resolution manometry and 24 h esophageal pH combined impedance monitoring. T test, non-parametric test and chi-square test were used to compare the related parameters in upright position, supine position and at 2 h after meals between two groups and within each group. Receiver oparative characteristic (ROC) curves of reflux parameters in upright position, supine position and 2 h after meals were drawn to determine the cut-off value, sensitivity and specificity in GERD diagnosis. Results:The proportion of patients with acid reflux in supine position of the control group was higher than that of the GERD group (41.0%, 25/61 vs. 8.50%, 17/200), and the difference was statistically significant ( χ2=36.53, P<0.01). In the control group, the acid reflux time in upright position, number of acid reflux, acid exposure time (AET), longest reflux time and number of weak acid reflux were more than those of in supine position in the same group (6.00 min(2.00 min, 13.50 min) vs. 0.00 min(0.00 min, 1.50 min), 16.00(8.00, 27.00) vs. 1.00(0.00, 3.00), 0.90%(0.33%, 1.88%) vs. 0.00%(0.00%, 0.30%), 2.00 min(1.00 min, 4.00 min) vs. 0.00 min(0.00 min, 1.00 min), 7.00(3.00, 11.00) vs. 1.00(0.00, 2.00), respectively) and the differences were statistically significant ( Z=5.43, 6.61, 5.06, 3.58 and 6.24, all P<0.01). In the GERD group, the acid reflux time, number of acid reflux, AET, longest reflux time and number of weak acid reflux in upright position were higher than those in supine position (51.00 min, (31.00 min, 86.75 min) vs. 8.00 min(1.00 min, 42.00 min), 60.00(48.00, 83.75) vs.6.00(2.00, 19.50), 7.30%(3.90%, 12.10%) vs. 1.50%(0.20%, 6.50%), 7.00 min(4.00, 12.00 min) vs. 4.00 min(1.00 min, 17.00 min), 1.00(0.00, 3.00) vs. 0.00(0.00, 2.00), 7.00(3.00, 12.00) vs. 0.00(0.00, 1.00), respectively) and the differences were statistically significant ( Z=7.92, 11.22, 6.90, 2.56, 5.11 and 11.76, all P<0.05). The acid reflux time, number of acid reflux, AET, longest reflux time and number of weak acid reflux at 2 h postprandial were 3.00 min(2.00 min, 9.00 min), 10.00(5.00, 18.00), 0.90%(0.40%, 1.98%), 1.00 min(0.00 min, 3.00 min), 4.00(1.50, 8.50)and 28.50 min(15.00 min, 54.75 min), 35.00(24.00, 52.00), 8.30%(4.32%, 15.83%), 6.00 min(3.00 min, 11.00 min), 4.00(2.00, 7.25), in the control and GERD groups, respectively, which were significantly higher than those in supine position in the same group ( Z=4.30, 6.33, 5.50, 3.40, 5.71 and 3.76, 9.21, 5.76, 1.97, 10.46, all P<0.05). Among 200 GERD patients, 125 patients had symptoms recorded during the 24 h esophageal pH combined impedance monitoring, the incidence of reflux symptoms in upright position was higher than that in supine position (89.6%, 112/125 vs. 65.6%, 82/125), and the difference was statistically significant ( χ2=20.71, P<0.01). The results of ROC curve analysis showed that the accuracy of acid reflux time in upright position in GERD prediction was the highest, with AUC value of 0.94 and cut-off value of 24.5 min, and the sensitivity and specificity in GERD diagnosis were 81.50% and 95.08%, respectively. The prediction accuracy of acid reflux times in upright position and AET in upright position for GERD was secondary, AUC value both were 0.93 and the cut-off value of the acid reflux number in upright position was 39.5, and the sensitivity and specificity in GERD diagnosis were 84.00% and 95.08%, respectively. The cut-off value of AET in upright position was 2.75%, the sensitivity and specificity in GERD diagnosis were 85.00% and 93.33%, respectively. The AUC value, cut-off value, sensitivity and specificity of AET at 2 h postprandial were 0.91, 4.60%, and 73.49% and 95.00%, respectively. Conclusions:Both GERD patients and non-GERD patients have more reflux in upright position, especially within 2 h after meals. The diagnostic values of acid reflux time in upright position, number of acid reflux, AET and AET 2 h after meals for GERD is high, and the AUC values are all >0.90, which can be used as a more comprehensive basis for the analysis and diagnosis of GERD.

Objective To evaluate the clinical outcome of the method of repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator (SCIAP) chimeric flap.Methods Fourteen cases of thumb defect were recruited from April,2012 to January,2016.According to Gu Yudong's classification,5 cases met the criterion of type Ⅰ,4 cases met the criterion of type Ⅱ,and 5 cases met the criterion of type Ⅲ.For type Ⅰ,the thumb was reconstructed with the great toe wrap-around flap.For type Ⅱ and Ⅲ,the thumb was reconstructed by the combined tissue with mutual artery (great toe wrap-around flap,and the bonetendon tissue of the second toe).All the donor sites of foot were repaired utilizing SCIAP chimeric flap.Results All the reconstructed thumbs survived.Among 14 free flaps of donor site,1 case suffered venous crisis and survived after exploration and rescue surgery.Dorsal skin necrosis of the second toe was found in 1 case,which was healed by local skin flap transposition.All patients were followed-up ranged from 3 to 30 months (averaged at 16 months).In spite of slightly bloated,the color and texture of all the flaps' was satisfied,and the average healing time of the bone in the donor sites was 2.5 months.All patients did not feel painful and had no adverse effect when walking and running.Three months after the operation,5 slightly bloated flaps in the donor sites under went flap plastic and achieved better appearance.On the part of iliaca,there was only one inconspicuous linear scar without any discomfort.Conclusion Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method.Using this method,the reconstructed thumb can achieve good appearance and function,all the toes of donor site were reserved,and the disability of the donor site is minimized.

The sterilization effects of constant electromagnetic wave and instant pulse on foods and traditional Chinese medical pills are introduced in this paper. From the velum's voltage variation caused by the outward electric filed,the dielectric properties of membranaceous ion and the pass rate of the membranaceous ion, we could analyze the biological heating effect and the biological non-heating effect. The sterilization effect of constant electromagnetic wave is based on the biological heating effect, while the instant electromagnetic pulse is based on the biological non-heating effect. With the applied electronic field, the voltage of membrane could increase, which results in the gates of K+ open, and the flowing out of K+. And the variation of the membranaceous voltage makes the gates of Ca2+ open. The Ca2+ of large consistency could come into the cell by the gradient of voltage. It could induce the death of the cells. The greater the variation of membranaceous voltage becomes, the higher will be the death rate of the cells.
Electromagnetic Fields ; Electronics ; instrumentation ; Microwaves ; Sterilization ; methods

Objective To study the surgical techniques and the clinical curative ettect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap.Methods From February,2013 to May,2016,20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap.All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage.In order to reconstruct the sensation of two pulps in each patient,firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively,which were divided into 2 groups.Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery.There were 8 fingers in 4 patients with the index and middle finger pulp defects,12 fingers in 6 patients with the middle and ring finger defects.The flap size was from 5.0 cm×3.5 cm to 5.5 cm×4.0 cm,and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases.Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding.Also,no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly.The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery.The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3 ± 1.2) mm and (8.6 ±2.4) mm respectively.There was no significant difference between groups (P ＞ 0.05).These 20 pulp flaps were also assessed by the Semmes-Weinstein monofilament test with the result of diminished light touch in 14 pulps and diminished protective touch in 6 pulps.The total active motion in all 20 fingers was (248.0±4.5) °.No patients suffered cold intolerance and local pain but 1 had hypersensitiveness in the pulp flap.Conclusion The modified sensate free proximal ulnar arte~ perforator flap is a practical alternative for the reconstruction of two large adjacent pulps with satisfactory functional and aesthetic outcomes.

Objective:To introduce ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome and to evaluate the outcomes.Methods:From August 2012 to January 2015, data of 25 cases with ulnar impaction syndrome who were treated in our hospital with oblique osteotomy of the ulna and internal fixation were retrospectively analyzed. There were 14 males and 11 females with an average age of 32.5±4.9 years old (range, 18-62 years). All 25 cases had wrist triangular fibrocartilage complex (TFCC) injuries. Intraoperative arthroscopy was conducted to investigate the pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL), debridement of the synovial membrane and the free edge of the central perforation of TFCC, to remove the cartilage from the lunate and triangular bone, and to perform oblique osteotomy of the ulna and internal fixation after repairing of TFCC ulnar tear. We evaluated the outcomes by means of comparing the postoperative values of modified Mayo and visual analogue scale (VAS).Results:There were 5 cases of IB, 5 of IIA, 7 of IIB, 4 of IIC, 4 of IID according to Palmer's classification. All 25 cases were followed-up for 24.6±1.9 months (range, 12-46 months). All patients achieved bone healing with an average of 14.0±1.9 weeks (range, 12-20 weeks). The mean value of preoperative ulnar variation was 3.8 ±1.5 mm which decreased to -1.5±0.5 mm after operation. The preoperative VAS was 7.8±0.7 which decreased to 1.3±1.5 at the latest follow-up. The modified Mayo value increased from 52.8±15.8 to 83.0±11.2. There were 19 cases with excellent wrist function, 5 good and 1 fair. The excellent-good rate was 96% (24/25). Grip strength value increased from 6.3±1.5 kg preoperative to 12.3±1.9 kg postoperative. There was no postoperative infection, delayed or nonunion of bone, but irritation of steel plate appeared in 10 patients, which disappeared after the removal of the steel plate.Conclusion:Arthroscopy combined with ulnar shortening oblique osteotomy technique for ulnar impaction syndrome can reduce wrist pain, increase hand grip strength, improve the activity of the wrist joint, and the clinical effect is positive.

Objective: To evaluate the outcome of free hypothenar perforator flap, with different vascular perforators, in fingerskin defects repairment. Methods: From April 2014 to September 2016, 15 cases of skin defects on finger were treated with hypothenar perforator flap, based on different vascular perforators.Patients had nerves, vessels, tendons or bone exposure.Defects ranged from 1.5 cm×3.5 cm to 2.0 cm×4.5 cm in size. Fivecases were treated with hypothenar perforator flap based on a cutaneous perforator branch of the ulnar artery, 8 cases were based on acutaneous perforator branch of the ulnar digital artery, 2 cases were based on branch of the superficial volar arch.Donor site was closed directly. Results: Vascular crisis occurred in 3 cases postoperatively, which were rescued by propertreatment. Other 12 transferred free flaps survived uneventfully.After averaged 13.5-month postoperative follow-up (ranging from 3 to 24 months), the appearance of transferred flaps was satisfactory. Flap texture was good with no obvious atrophy. All the fingers had good function.The sensation of flaps recovered to S3, and two-point discrimination was 8-9 mm. The donor site was healed with linear scar. Conclusions The hypothenar perforator free flap was relatively easy to practice.Constant vascular anatomy, the appearance, texture and good functional recovery after hypothenar free flap transferring, suggest this is achoice for repairing small skin defects on finger.

Objective:To investigate the microsurgical anatomy of thoracodorsal artery perforators, and the clinical effect in repairing the soft tissue defect of hand with the thoracodorsal artery perforator flap (TAP).Methods:From October, 2014 to November, 2014, the axillary arteries in 10 thoracodorsal specimens were perfused with red latex. The number and diameter of the perforators of the thoracodorsal arteries were mearsured. From January, 2015 to February, 2019, 52 cases of soft tissue defects in hand combined with bone and extensor tendon exposure were repaired with TAP. The patients were followed-up in outpatient department to observe the clinical efficacy.Results:The number of perforators of thoracodorsal artery was 2-4 mostly, and 3 perforators was the most. The diameter of perforators was 0.22-0.68 mm, and the distance between the perforating point and the posterior axillary wall was 5.2-11.8 cm. All the operations were completed successfully, and the donor sites were closed directly. In 52 cases, 48 flaps survived, 2 had partially necrosis, and 2 had completely necrosis. The patients were followed-up for 5 to 24 months. The blood supply of the flaps was good with soft texture and good appearance.Conclusion:The TAP is an ideal flap because of its thin in thickness, concealed donor area and no obvious scar after direct suture.