Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic.Methods During January,2010 to February,2015,a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx.The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm.In addition,palmar soft tissue defect (n =15) of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries,and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm.Full-thickness skin graft urethroplasty was used in the donor sites.Flap shape,texture,sensory recovery and texture of the skin region,function recovery of the wounded fingers were followed up at 1,3,and 6 months after operation.Results Thirty-five patients were followed up from 6 to 13 months (average of 7 months).All flaps survived completely in the incorporated 35 cases postoperatively.Flaps had satisfactory appearance,fine texture,and soft texture in the skin transplantation area.The postoperative improvement of sensory function was between S2 and S3,and the two-point discrimination was 10-15 mm.Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent,10 cases as good,and 2 cases as fair.Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection,reliable blood supply,and no major blood vessels needed to be sacrificed,which is an effective procedure for finger soft issue defect repairing.

Obejective To explore the diagnostic and curative evaluation value of gastrin-releasing pep-tide precursor (ProGRP) and neuron specific enolization enzyme (NSE) in small cell lung cancer (SCLC). Methods Sixty SCLC patients, sixty non-small cell lung cancer (NSCLC) patients and forty patients with be-nign pulmonary disease were collected fromJanuary 2014 to October 2015. The levels of serum ProGRP and NSE in all patients were determined by ELISA method and radioimmunoassay respectively then the clinical value of ProGRP and NSE on SCLC was evaluated. Results The levels of ProGRP and NSE in SCLC group were signif-icantly higher than those in NSCLC group and those in lung benign disease group (P < 0.05). The levels of Pro-GRP and NSE in extensive stage were higher than those in limited stage in SCLC group (P < 0.05). The bound-ary value of SCLC through ProGRP identified through ROC curve was 64.68 pg/mL. The diagnostic sensitivity , specific degree and Youdenindex of ProGRP in SCLC were 86.7%, 97.5% and 0.842 respectively, which were significantly higher than NSE (P < 0.05). After 2 cycles of chemotherapy, serum ProGRP in SCLC disease con-trol groupwere significantly decreased(P < 0.05) but on difference of serum ProGRP was found in SCLC progres-siongroup (P > 0.05). Conclusion ProGRP and NSE can be used as markers for the diagnostic and curative evaluation of SCLC. And ProGRP has higher sensitivity and specificity than NSE and can be promoted in clinic.

Objective To evaluate the diagnostic value of CT and PET-CT characteristics in predicting the presence of epidermal growth factor receptor(EGFR) gene mutations in lung adenocarcinomas. Methods One hundred and sixty-eight lung adenocarcinomas cases confirmed by pathology were enrolled in our study. They were divided into EGFR gene mutations group (89 cases) and wild types group (79cases) according to whether EGFR gene mutation occurred. All patients underwent CT examination. Seventy-five patients underwent PET-CT examination, including 37 gene mutationsand 38 wild types.The demographic (the patients' age, the gender and smoking history), CT characteristics(lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram, ground glass opacity/tumor ratio(G/T) and the maximum diameter of tumor(Dmax)) and PET-CT characteristics(the maximum standardized uptake value, (SUVmax))between these two groups were retrospectively compared. The independent sample t test was used to analyze the
difference between these two groups regarding the patients' age,Dmax,SUVmax. The χ2 test was used to demonstrate the difference between these two groups regarding the gender, smoking history and CT features including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram and G/T.The trend analysis between SUVmax and EGFR gene mutations was performed by usingχ2 test for trend.Results No significant difference was found regarding partial CT characteristics of lesions including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram (P>0.05),however, the Dmax of EGFR gene mutations group and wild types group were(2.53±1.39),(3.00±1.77)cm, respectively. The amount of G/T>50%in EGFR gene mutations group and wild types group was 21 and 5, respectively. Significant differences were found regarding the G/T and Dmax(χ2=9.538, P<0.05;t=1.974,P<0.05). The SUVmax in EGFR gene mutations group (37 cases) and wild types group (38 cases) were 5.13 ± 4.35 and 9.64 ± 5.12, respectively. Significant difference was found regarding SUVmax(t=4.104, P<0.05). The sensitivity and specificity in predicting EGFR gene mutations were 24%and 93%, respectively, using G/T>50%as diagnostic criterion. Receiver operating characteristic (ROC) results indicated Dmax=1.85 cm was the optimal value in predicting EGFR gene mutations, with the sensitivity and specificity of 76% and 42%, respectively. Meanwhile, SUVmax=6.85 was the optimal value, with the sensitivity and specificity of 71% and 73%, respectively. Moreover,χ2 test for trend showed that an obvious trend was found to associate SUVmax with the incidence of EGFR gene mutations (χ2=15.755, P<0.05). Conclusion SUVmax may be helpful in predicting EGFR gene mutations in lung adenocarcinomas with relatively high diagnostic value.

BACKGROUND:Studies have shown that percutaneous pedicle screw internal fixation in repair of single segment of thoracolumbar fracture can overcome quadrilateral effect, get better biomechanical properties, meanwhile, it also can provide three-point fixation, reduce suspension effect, and reduce the formation of kyphosis. OBJECTIVE: To investigate the clinical efficacy and incidence of complications of the percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures. METHODS:Totaly 36 patients with single segment thoracolumbar fractures treated by percutaneous pedicle screw internal fixation were enroled. A total of 36 vertebral bodies were treated: T11=5, T12=8, L1=17, L2=6. The visual analog scale scores before treatment and at 3, 6 and 12 months after treatment, the Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment, the Cobb angle before treatment, the first day and at the 12th month after treatment were compared and observed. The incidence of complications was recorded. RESULTS AND CONCLUSION:The visual analog scale scores at 3, 6 and 12 months after treatment was significantly lower than those before treatment (P < 0.001). The Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment were significantly lower those that before treatment (P < 0.001).The Cobb angle before treatment, at the first day and at the 12th month after treatment was significantly smaler than that before treatment (P < 0.001). Only three (8%) patients had complications, including pedicle screw penetrating pedicle into the spinal canal, pedicle screws loosing and the infection in puncture site. These results suggest that percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and the incidence of complications is low.

BACKGROUND: It is stil controversial about whether percutaneous vertebroplasty can be as an option for treatment of non-osteoporotic single-segmental vertebral traumatic compression fractures. OBJECTIVE: To observe the effect of percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumatic compression fractures. METHODS: Total y 20 patients who underwent percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumatic compression fractures between March 2010 and January 2013 were col ected. The variation of visual analog scale scores and the Oswestry disability index scores of patients was observed before and after the repair. RESULTS AND CONCLUSION: (1) The visual analog scale scores and the Oswestry disability index scores of patients were significantly reduced after repair compared with those before repair, moreover, the visual analog scale scores and the Oswestry disability index scores of patients at the 3, 6, 12 and 18 months after repair were similar. (2) Al patients had no adverse effects and complications. (3) These results suggest that percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumatic compression fractures quickly relieves back pain and improves the actives of thoracolumbar segments.

Objective To explore the effect of Drotaverine hydrochloride on preventing bladder spasm after transurethral prostatectomy.Methods 124 patients after transurethral prostatectomy were divided into patient-controlled epidural analgesia pump group (group I, n=61) and Drotaverine hydrochloride group (group II, n=63). Group I received bupivacaine by patient-controlled epidural analgesia, and the pump was withdrawed after 72 h. Group II received Drotaverine hydrochloride by intramuscular injection, 80 mg every 12 h, and then orally taken after anal exhaust for 3 days. Bladder spasm and adverse reaction were recorded in both groups. Results There was no significant difference in bladder spasm between group I (11.48%) and group II (12.70%) (P>0.05), as well as in side reaction between group I (16.39%) and group II (17.46%) (P>0.05). Conclusion Drotaverine hydrochloride is effective on preventing bladder spasm after transurethral resection of the prostate, with small side effect.

Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block for analgesia after laparoscopic cholecystectomy. Methods Sixty American Society of Anesthesiologists physi-cal statusⅠorⅡ patients, aged 18-64 yr, with body mass index of 20-27 kg∕m2 , scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table meth-od: ultrasound-guided transversus abdominis plane block group ( group T) and ultrasound-guided quadratus lumborum block group (group Q). In T and Q groups, bilateral ultrasound-guided transversus abdominis plane block and quadratus lumborum block were performed after general anesthesia induction, respectively, with 0. 25％ ropivacaine 20 ml for each side. All the patients received patient-controlled intravenous analge-sia with morphine after surgery, and visual analoge scale scores were maintained≤3 in the two groups. The cumulative consumption of morphine was recorded at 2, 4, 6, 12, 24 and 48 h after surgery. The occur-rence of adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression was observed and recorded in the analgesic period. The operation time for nerve blocks and nerve blocks-related complications such as bleeding, accidental puncture into the abdominal cavity or intestinal injuries were re-corded. Results Compared with group T, the cumulative consumption of morphine was significantly de-creased at 6, 12, 24 and 48 h after surgery in group Q ( P<0. 05) . There was no significant difference in the operation time for nerve blocks between the two groups ( P>0. 05 ) . There were no adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression or nerve blocks-related compli-cations in the two groups. Conclusion Ultrasound-guided quadratus lumborum block provides better effica-cy than transversus abdominis plane block when used for analgesia after laparoscopic cholecystectomy.

Objective:To investigate the role of Caveolin (Cav-3)/extracellular signal-regulated kinase (ERK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in rats with chronic heart failure.Methods:Clean-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, were used in this study.Chronic heart failure was induced by ligating the left anterior descending coronary artery for 6 weeks.Thirty-six Langendorff-perfused hearts with chronic heart failure were divided into 4 groups ( n=9 each) by a random number table method: myocardial I/R group (group IR), morphine preconditioning group (group MP), morphine preconditioning plus methyl-β-cyclodextrin group (group MP+ MβCD), and methyl-β-cyclodextrin group (group MβCD). Global myocardial I/R was induced by 30 min ischemia followed by 120 min reperfusion.In group MP, after 15 min of equilibration, hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing 1 μmol/L morphine for preconditioning followed by 5 min perfusion with K-H solution, 30 min in total, and after the end of treatment, hearts were subjected to 30 min ischemia followed by 120 min reperfusion.In group MP+ MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 10 min before preconditioning with morphine, and the other treatments were similar to those previously described in group MP.In group MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 40 min before ischemia, and the other treatments were similar to those previously described in group IR.At the end of 15 min of equilibration (T 0) and 5 and 10 min of reperfusion (T 1, 2), coronary outflow was collected for determination of actate dehydrogenase (LDH) activity by chemical colorimetry.Myocardial infarct size (IS) and area at risk (AAR) were measured, and IS/AAR was calculated at the end of 120 min reperfusion.Myocardial tissues of left ventricle were taken to detect the expression of Cav-3, ERK1/2 and phosphorylated ERK1/2 (p-ERK1/2) by Western blot, and p-ERK1/2/ERK1/2 ratio was calculated. Results:Compared with group IR, IS, IS/AAR and LDH activity in coronary outflow were significantly decreased, the expression of Cav-3 was up-regulated, and p-ERK1/2/ERK1/2 ratio was increased in group MP ( P<0.05). Compared with group MP, IS, IS/AAR and LDH activity in coronary outflow were significantly increased, the expression of Cav-3 was down-regulated, and p-ERK1/2/ERK1/2 ratio was decreased in group MP+ MβCD ( P<0.05). Conclusions:The mechanism by which morphine preconditioning reduces I/R injury may be related to activation of Cav-3/ERK signaling pathway in rats with chronic heart failure.

Objective To understand the status of depression and anxiety in patients with chronic hepatitis B in Tianjin, and to analyze its influencing factors, so as to provide references for scientific psychological intervention and health education. Methods Chronic hepatitis B cases whose addresses were Tianjin were randomly selected from the report of infectious disease surveillance system from January 2018 to December 2019 as the study subjects. A certain number of healthy people living in Tianjin were selected as the control. A unified mental health questionnaire survey was conducted by telephone follow-up or face-to-face survey. The distribution characteristics of depression and anxiety were described, and influencing factors of depression and anxiety were analyzed by univariate and multivariate logistic regression analysis. Results A total of 825 cases of chronic hepatitis B and 376 cases of healthy people were investigated. The crude SDS and SAS were (35.47±9.34) and (32.33±8.26), respectively, which were higher than those of healthy people ( P <0.05). The rates of depression and anxiety in chronic hepatitis B patients were 25.45% and 20.61%, respectively, which were significantly higher than those in healthy people (15.96% and 11.70%, respectively) (P < 0.001). The analysis of depression influencing factors showed that the OR of high average monthly income was 0.791 ( 95% CI：0.655～0.955 ), the OR of not knowing correct preventive measures was 1.509 (95% CI：1.084～2.102 ), and the OR of feeling discriminated was 1.650 ( 95% CI：1.166～2.335 ). The multifactor analysis of anxiety influencing factors showed that the OR of not knowing correct preventive measures was 1.490 ( 95% CI:1.049～2.117)), while the OR of feeling discriminated was 1.854 ( 95% CI: 1.289～2.666). Conclusion The levels of depression and anxiety of chronic hepatitis B patients were higher than that of general healthy people. Not knowing correct preventive measures and feeling discriminated in daily life were risk factors while high income was a protective factor.

【Objective】 Coronary no-reflow during percutaneous conranary intervention (PCI) often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events (MACE). The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI. 【Methods】 We consecutively recruited 1 118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011. Main demographic data, cardiovascular risk factors, blood lipid and other biochemical indicators were recorded. Coronary angiography was performed by a radial artery approach using the standard Judkins technique. Coronary no-reflow was evaluated by at least two independent experienced cardiologists. The GRACE risk score was calculated with a computer program. All the cases were followed up by medical records, face-to-face interviews or telephone calls. Finally, we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI. 【Results】 During a median period of 36 months, 58 of the 1 118 patients (5.2%) were lost to follow-up. Of the remaining 1 060 patients, 118 (11.1%) had no-reflow and 147 (13.9%) had MACE. The GRACE score was higher in patients with no-reflow than those without no-reflow. Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow (OR=1.034; P=0.002). And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE. The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697, respectively. Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure, reinfarction, all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score. 【Conclusion】 The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.