Objective To explore the effect of self-management health education on promoting the medical compliance of patients with metabolic syndrome. Methods Fifty-six patients with metabolic syn-drome were divided into the observation group and the control group at random, with 28 patients in each group. The self-management health education was only given to the observation group, the control group was given rou-tine instruction. After three months, the patients' medical compliance and the ecological parameters (fasting blood glucose, 2 hours' postprandial blood glucose, glycosylated hemoglobin, triglyceride) were tested, the re-suits went through χ2 test and t test. Results The observation group had a better medical compliance than that of the control group, and the biochemieal parameters were greatly alleviated. Conclusions Nursing inter-vention is an ef-feetive measure to improve the medical compliance of patients with metabolic syndrome.

Objective To observe the effect of home nursing based upon protocol nursing theory on liq-uid intake compliance improvement of patients undergoing hemedialysis. Methods Forty-eight HD patients of hquid intake un-compliance were randomized into the observation group and the control group with 24 cases in each group. The control group received routine nursing, the observation group was given home care instruc-tion based upon protocol nursing theory for 1 month. The two groups both received follow-up for 3 months and their liquid intake comphance were evaluated before and after intervention. The relationship between family sup-port and relative increase of body weight during hemodialysis was also evaluated. Results The IDGW relative magnitude was lower, the compliance of liquid intake was higher, the level of family support was higher in the observation group than those of the control group. There was negative correlation between the family support and the IDGW relative magnitude the IDGW relative magnitude, family support, comphance of liquid intake. Conclusions Home care nursing based upon nursing theory facilitate patients to get effect family support, increase the compliance of hquid intake and make IDGW within desirable range.

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.

Objective:To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap (ALT) for repairing the circular wound of foot and ankle.Methods:Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed. The perforator was located by color Doppler ultrasound before the operation, and the flap was designed according to the size of the wound. Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected. When all perforating branches in the flap come from the same vascular trunk, two or more perforating branches are carried to cover the wound directly; when the branches come from the different trunks, the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap. All the donor areas were closed primarily. The sensory of flaps were elevated by the British Medical Research Council (BMRC) sensory function assessment standard, and the motor function was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 13 patients were enrolled in this study, including 8 males and 5 females.The age ranged from 21 to 65 years, with an average of 39 years. The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon. 12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap ( ALT) harvested from one thigh, and 1 case was repaired with the combined bilateral ALT flap due to the huge wound. The size of flap was 21.0 cm × 7.0 cm to 35.0 cm×10.0 cm. During the procedure, 14 flaps were successfully harvested, 9 flaps were supplied by two perforators, 4 by three perforators, and 1 by four skin perforators. Each flap had an average of 2.4 perforators. Among them, there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources. All flaps in this group finally survived. One flap suffered the venous crisis 24 hours after the operation and survived after removing the thrombus and re-anastomosing the vessel again. The stitches were removed 2 to 3 weeks after operation when the wound had healed. All wounds in the donor area healed primarily. 9 flaps underwent flap thinning and plastic surgery 6 to 10 months after the operation. Follow-up for 6 to 18 months showed the color and texture of the flap was close to the recipient area, and the sensation of the flap elevated by BMRC sensory function assessment standard was S2-S3. According to the AOFAS ankle and hindfoot scoring system, the function of the recipient area was 72-98 points, with an average of 92 points. Only linear scars were left in the donor area.Conclusions:Because of the advantages of rich blood supply, strong anti-infection ability, and less damage to the donor area, it is an ideal method to repair the circular wound of the foot and ankle with multiple-perforator extra-large anterolateral thigh flap.

Objective:To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap (ALT) for repairing the circular wound of foot and ankle.Methods:Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed. The perforator was located by color Doppler ultrasound before the operation, and the flap was designed according to the size of the wound. Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected. When all perforating branches in the flap come from the same vascular trunk, two or more perforating branches are carried to cover the wound directly; when the branches come from the different trunks, the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap. All the donor areas were closed primarily. The sensory of flaps were elevated by the British Medical Research Council (BMRC) sensory function assessment standard, and the motor function was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 13 patients were enrolled in this study, including 8 males and 5 females.The age ranged from 21 to 65 years, with an average of 39 years. The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon. 12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap ( ALT) harvested from one thigh, and 1 case was repaired with the combined bilateral ALT flap due to the huge wound. The size of flap was 21.0 cm × 7.0 cm to 35.0 cm×10.0 cm. During the procedure, 14 flaps were successfully harvested, 9 flaps were supplied by two perforators, 4 by three perforators, and 1 by four skin perforators. Each flap had an average of 2.4 perforators. Among them, there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources. All flaps in this group finally survived. One flap suffered the venous crisis 24 hours after the operation and survived after removing the thrombus and re-anastomosing the vessel again. The stitches were removed 2 to 3 weeks after operation when the wound had healed. All wounds in the donor area healed primarily. 9 flaps underwent flap thinning and plastic surgery 6 to 10 months after the operation. Follow-up for 6 to 18 months showed the color and texture of the flap was close to the recipient area, and the sensation of the flap elevated by BMRC sensory function assessment standard was S2-S3. According to the AOFAS ankle and hindfoot scoring system, the function of the recipient area was 72-98 points, with an average of 92 points. Only linear scars were left in the donor area.Conclusions:Because of the advantages of rich blood supply, strong anti-infection ability, and less damage to the donor area, it is an ideal method to repair the circular wound of the foot and ankle with multiple-perforator extra-large anterolateral thigh flap.

Objective:To investigate the social function in young and middle-aged coronary disease patients after percutaneous coronary intervention (PCI) and to analyze its influencing factors so as to provide a basis for making clinical intervention.Methods:From February 2019 to September 2019, this study selected 240 young and middle-aged coronary disease patients after PCI reexamined in Cardiovascular Medicine of a ClassⅢ Grade A general hospital in Nanning as subjects by convenience sampling. All of patients were investigated with the General Information Questionnaire, Social Dysfunction Screening Scale (SDSS) , Brief Illness Perception Questionnaire (BIPQ) and Event Related Rumination Inventory (ERRI) . Binary Logistic regression was used to analyze the influencing factors.Results:Among 240 young and middle-aged coronary disease patients after PCI, the total score of SDSS was (3.98±2.58) . The incidence of social dysfunction was 72.9% (175/240) . Binary Logistic regression analysis showed that the influencing factors of social dysfunction in young and middle-aged coronary disease patients after PCI included the average monthly income per person in family ( OR=0.383) , illness perception ( OR=1.558) , objective rumination ( OR=0.643) with statistical differences ( P<0.01) . Conclusions:Social function in young and middle-aged coronary disease patients after PCI needs to be improved. Effective intervention based on influencing factors should be taken to reduce the incidence of social dysfunction in young and middle-aged coronary disease patients after PCI.

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.