Objective:To explore the clinical efficacy of free superficial circumflex iliac artery perforator flap (SCIAPF) in reconstruction of soft tissue defects of hand and foot in children.Methods:From August 2021 to August 2023, free SCIAPFs were used to reconstruct soft tissue defects of hands and feet in 8 children at the Department of Hand and Foot Surgery, Zhoukou Huaihai Hospital. There were 6 boys and 2 girls aged between 2 and 7 years old. The sites of soft tissue defect were: 1 of metacarpophalangeal joint in the functional area of left thumb, 2 of dorsal right hand, 1 of dorsal left foot, 2 of medial malleolus of right foot, and 2 of right forefoot, and all were accompanied with tendon and bone exposure. The size of soft tissue defects ranged from 2.5 cm×3.0 cm to 6.0 cm×3.5 cm. After emergency debridement, the children received flap transfers, the flaps sized from 3.0 cm×3.5 cm to 7.0 cm×4.0 cm. Donor sites were closed by running intradermal suture. All children were included in the scheduled postoperative follow-up by visit of outpatient clinic, WeChat interviews and home visits to observe the appearance, colour, texture and sensation of the flaps, the functional recovery of the affected hands and feet, as well as the healing of donor sites.Results:After surgery, all 8 flaps survived beside 1 had a partial necrosis at the edge and healed with a scab after dressing change. Flap donor sites healed in one stage. Scheduled postoperative follow-up lasted from 7 to 22 months, with an average of 10 months. The flaps presented a slightly bloated appearance, soft texture with a restored protective sensation and satisfactory functional recovery of hands and feet. Linear scars were left at the donor sites. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 1 child was of excellent and 2 children of good in hand function of the 3 children with hand injury. The Maryland Foot Score revealed 3 children were of excellent and 2 of good in foot function of the 5 children with foot injury.Conclusion:Free SCIAPF is an ideal option for reconstruction of soft tissue defects of hand and foot in children, with concealed donor site, convenient flap harvesting, fewer complications and satisfactory reconstructive effect.

Objective:To explore the clinical effect of using great toe fibular flaps of both feet on reconstruction of pulp defects of two neighbouring digits.Methods:A total of 14 digit pulp defects in 7 cases were repaired in Zhoukou Huaihai Hospital using great toe fibular flaps of both feet from August 2020 to January 2023. Of the 7 cases, there were 4 males and 3 females, with an average of 28 years old, ranging from 19 to 45 years old. Meanwhile, there were 4 cases in left hand and 3 cases in right hand. There were 3 cases of digit pulp defects in index and middle fingers, 2 in middle and ring fingers, and 2 in thumb and index fingers. The area of soft tissue defect in 1.2 cm×1.5 cm-3.0 cm×2.5 cm, and flap was 1.5 cm ×1.8 cm-3.2 cm×2.8 cm. Furthermore, 1 case underwent emergency surgery and 5 were repaired in elective surgery. The donor site of the flap was closed directly, and an intermediate-thickness skin graft was prepared from the medial plantar area for transfer in the case of high suture tension at the wound edge. After surgery, patients received postoperative by outpatient clinic and WeChat to observe the appearance, sensation, functional recovery and flap contracture of digits, as well as the movement of the great toes of both feet.Results:After the surgery, all flaps in the 7 cases survived smoothly and the donor sites healed. All patients entered scheduled follow-ups postoperatively for 6 months to 2 years, with an average of 9 months. The flap showed an aesthetic appearance and excellent sensation, with a TPD of 3-6 mm, and satisfactory digit function. The donor site of the great toe fibular flap left linear scars only, without abnormality in range of motion and gait in walking. In addition, there were 5 in excellent and 2 in good according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:Application of great toe fibular flaps of both feet is an ideal option for the simultaneous repair of pulp defects of two neighbouring digits, which can achieve good reconstructive results.

BackgroundThe persistently high prevalence of insomnia seriously affects the quality of life of all populations. Studies showed that state-trait anxiety， resilience and neuroticism are related to the occurrence of insomnia， while the research on the relationship among the four factors in college students is still insufficient. ObjectiveTo discuss the impact of neuroticism on insomnia among college students， and to examine the mediating role of state-trait anxiety and resilience in the relationship between neuroticism and insomnia， thus providing references for the intervention of insomnia in college students. MethodsFrom September to December 2020， simple random sampling techniques were utilized to select 1 416 students in a university in Sichuan province， and all subjects were assessed using State-Trait Anxiety Inventory （STAI）， Connor-Davidson Resilience Scale （CD-RISC）， Chinese Big Five Personality Inventory-15 （CBF-PI-15） and Insomnia Severity Index （ISI）. Then Pearson correlation analysis was conducted to examine the correlation among the above four scales， and the mediating role of STAI and CD-RISC in the relationship between CBF-PI-15 neuroticism dimension and ISI was verified by Process macro mediation analysis. ResultsInsomnia was reported in 241/1 416 （17.02%） college students. The prevalence rate of insomnia in male students was higher than that in female students， with statistical difference （χ²=16.417， P<0.01）. Total ISI score was positively correlated with CBF-PI-15 neuroticism dimension and total STAI score （r=0.127， 0.563， P<0.01）， and negatively correlated with total CD-RISC score （r=-0.149， P<0.01）. State-trait anxiety and resilience of college students had a chain mediation effect on the relationship between neuroticism and insomnia （indirect effect size was -0.011）， and the size of direct effect of neuroticism on insomnia was 0.120， accounting for 75.00% of the total effect. ConclusionState-trait anxiety and resilience of college students exert a chain mediation effect on the relationship between neuroticism and insomnia， so the neuroticism causes an impact on insomnia both directly and indirectly through the chain mediating effect of state-trait anxiety and resilience.

Objective:To investigate the correlation between endothelial dysfunction and cardiomyocyte apoptosis during myocardial ischemia-reperfusion.Methods:A total of 63 male rats were selected to establish the rat model of myocardial ischemia-reperfusion by the ligation of the left anterior descending(LAD)coronary artery to simulate myocardial ischemia.Rats were divided into the control group and group Ⅰb, group Ⅰa, group Ⅱb, group Ⅱa, group Ⅲb and group Ⅲa.Control rats were treated only with LAD threading without ligation.In observation group, at 30, 90, 120 min after LAD ligation(marked as Ⅰ, Ⅱ, Ⅲ group respectively), loosen the ligation to simulate ischemia-reperfusion.In the observation group, captopril sublingual injection of 0.25 mg/kg before ligation were marked as group b, and as group a with no captopril injection.The circulating endothelial cells(CEC), endothelin(ET), nitric oxide(NO)and the apoptosis rate of cardiomyocytes in each group were measured.Results:The CEC and ET levels showed a continuous upward trend, and a NO level showed a continuous downward trend from group Ⅰa to Ⅱa to Ⅲa as compared with the control group( P<0.05). After using preventive intervention of captopril, the CEC and ET levels were lower and NO levels were higher in group Ⅱb and Ⅲb than in group Ⅱa and Ⅲa, respectively( P<0.05). The apoptotic rate of cardiomyocytes was higher in group Ⅰa than in the control group, and the apoptotic rate from high to low were from group Ⅲa[(235.71±40.25)%]to group Ⅱa[(197.28±43.56)%]to group Ⅰa[(138.55±32.87)%]and to the control group[(5.81±2.02)%]( P<0.05). The apoptotic rate of cardiomyocytes was lower in group Ⅱb[(125.67±26.51)%]and Ⅲb[(124.91±33.28)%]than in group Ⅱa and Ⅲa, respectively( P<0.05). Conclusions:The ischemia-reperfusion can cause endothelial dysfunction and the apoptosis of cardiomyocytes, and there is a close relationship between the degree of this lesions and the duration of ischemia-reperfusion.While, the appropriate application of angiotensin converting enzyme inhibitor can inhibit the damage of cardiomyocytes to a some extent.

Objective To explore the surgical treatment for patients with aortic valve disease and ascending aorta dilatation.Methods The patients were divided into two groups according to the condition of aortic valve leaflet and surgical treatment.The changes of ascending aorta after different treatment were measured by echocardiography.Results Among tricuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement decreased by 0.471 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty decreased 0.27 mm averagely per year.Among bicuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement increased by 2.28 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty increased 2.923 mm averagely per year.Conclusion The patients with bicuspid aortic valve are more likely to develop ascending aorta dilatation after the operation of the aortic valve.Patients with bicuspid aortic valve should undergo ascending aorta replacement when aorta diameters are more than 40 mm.Patients with tricuspid aortic valve undergoing surgery must be very cautious.

Objective To explore the surgical treatment for patients with aortic valve disease and ascending aorta dilatation.Methods The patients were divided into two groups according to the condition of aortic valve leaflet and surgical treatment.The changes of ascending aorta after different treatment were measured by echocardiography.Results Among tricuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement decreased by 0.471 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty decreased 0.27 mm averagely per year.Among bicuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement increased by 2.28 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty increased 2.923 mm averagely per year.Conclusion The patients with bicuspid aortic valve are more likely to develop ascending aorta dilatation after the operation of the aortic valve.Patients with bicuspid aortic valve should undergo ascending aorta replacement when aorta diameters are more than 40 mm.Patients with tricuspid aortic valve undergoing surgery must be very cautious.

Objective To investigate and analyze the mental health status of the students from poor families and non-poor students by comparative study.Methods Conducting the cluster sampling methods,the author investigated 885 medical students with questionnaires.We input data with Epidata 3.0 software and described it with SPSS 11.0 statistical software,which also did the nonparametric rank sum test.Results 92.7％(667/719) students from poor families considered their economic status among the general level or much lower level.There were 41.9％(294/702) students from poor families who thought families' financial difficulties had positive effects on mental health.92.3％(664/719) students from poor families were never afraid that people around knew they were in work-study program.87.5％(629/719) students from poor families were satisfied with their life.Facing psychological problems,there's no difference with dissatisfaction in daily life and recourses for help between students from poor families and non-poor students except psychological consultation center and lovers P＞0.05).Conclusion Compared with non-poor students,the mental health of students from poor families in medical universities is good.The universities are supposed to pay more attention to the mental health of students who are neither poor nor non-poor and few students from poor families who are negatively impacted by their families' financial difficulties.

Objective To summarize our experience in endovascular repair of 83 cases with type B aortic dissection.Methods A retrospective analysis was performed in 83 cases of type B aortic dissections who were treated in our hospital.Results The surgical procedure was successful for all the patients.Two patients died peri-operatively.One case encountered a coma,but no post-operative paraplegia occurred.Conclusion Endovascular repair for type B aortic dissection is a micro-invasive,safe and effective technique.Long-term follow-up is required to give a comprehensive evaluation.

Objective To describe the treatment experience of post-operative complications after total arch replacement for acute type A aortic dissection in 34 cases.Methods The subjects were 34 consecutive patients (Twenty-eight males and 6 females,age 34.0 -60.0 yrs) who received total arch replacement for acute Stanford type A aortic dissection from Jan.2005 to Oct.2010 in our hospital.The duration from the onset of the symptoms to the hospitalization ranged from 4 - 18 hrs.Pre-operative 2-D Echo revealed aortic valve regurgitation in 8 patients and mitral valve regurgitation in 1 patient.Results Three patients died after operation ( mortality 8.8％ ).Severe complications included acute kidney injury in 13 cases,respiratory dysfunction in 12 cases,paraplegia in 1 case,mental disorder in 10 cases and excessive post-operative bleeding in 2 cases.Conclusion The incidence of the complications after total arch replacement is still high and severe.Intensive care should be stressed peri-operatively and early diagnosis and treatment for post-operative complications are important procedures.

Objective To describe the follow-up data of 34 patients receiving total arch replacement with an open stent graft for acute type Ⅰ aortic dissection.Methods The subjects were 34 consecutive patients with type Ⅰ acute aortic dissection ( Twenty-eight males and 6 females,aged 34.0 - 46.0 yrs) who received total arch replacement with an open stent graft in our hospital from Jan.2005 to Oct.2010.Thirty of the 34 patients were followed up for 2 - 70 months.CT scanning was performed at the 3 and 12 months and then yearly after operation to detect the thrombus formation,absorption of thrombus,and obliteration of the false lumen after its exclusion by the stent graft.Results Three patients died peri-operatively with the mortality of 8.8％.One patient died during the follow-up period.Obliteration was recognized in all the patients at the distal side of the stent graft during the follow-up period.The false lumen remained in 10 patients at the distal part of descending aorta,but the diameter of the false lumen was not enlarged.Conclusion In patients with acute type Ⅰ aortic dissection,it is relative safe to perform extensive primary repair of the thoracic aorta by stent grafting.This method may enhance the obliteration of the false lumen and reduce the possibility for further operations to manage a residual false lumen.