Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Background and Aims:Iliac vein compression syndrome (IVCS) is a major cause of acute lower extremity deep vein thrombosis (DVT). Without timely treatment,it can lead to thrombus detachment,resulting in pulmonary embolism and increased mortality risk. Percutaneous mechanical thrombectomy,particularly using the AngioJet thrombectomy system,is a widely used thrombectomy method. The combination of AngioJet thrombectomy with iliac vein stent placement provides a novel treatment option for DVT associated with IVCS. This study was performed to evaluate the efficacy and safety of AngioJet thrombectomy combined with iliac vein stent placement in treating DVT with IVCS.Methods:The clinical data of 120 patients with DVT and IVCS treated between April 2019 and October 2022 were retrospectively analyzed. Sixty patients underwent AngioJet thrombectomy combined with iliac vein stent placement (observation group),while another 60 patients received catheter-directed thrombolysis (CDT) combined with stent placement (control group). The clinical efficacy,outcomes (thrombus clearance grade,thrombolysis duration,venous patency score,hospitalization duration,urokinase dosage,thigh circumference difference,and calf circumference difference),Villalta scores at various time points before and after treatment,and adverse events (chest tightness,mild pulmonary embolism,bleeding at the catheter insertion site,and mild renal function impairment) were compared between the two groups.Results:The overall efficacy rate in the observation group was significantly higher than that in the control group (98.33％ vs. 86.67％,P=0.015). While there was no significant difference in thrombus clearance grade between the two groups (P>0.05),the observation group had significantly shorter thrombolysis duration,lower urokinase dosage,and shorter hospitalization time compared to the control group (all P<0.05). Before treatment,there were no significant differences in thigh circumference difference,calf circumference difference,or venous patency score between the two groups (all P>0.05). After treatment,the observation group had significantly better venous patency score and smaller thigh and calf circumference differences than the control group (all P<0.05). There was no significant difference in Villalta score between the two groups before treatment (P>0.05). Post-treatment Villalta scores showed a significant decreasing trend over time in both groups compared to pre-treatment scores (all P<0.05),but there were no statistically significant differences in Villalta scores between the two groups at 1,6,and 12 months after treatment (all P>0.05). The total incidence of adverse events was not significantly different between the two groups (10.00％ vs. 3.33％,P=0.143).Conclusion:The use of AngioJet thrombectomy combined with iliac vein stent placement for the treatment of lower extremity DVT with IVCS can shorten thrombolysis and hospitalization duration,reduce thrombolytic drug dosage,and achieve better and safer outcomes,making it worthy of clinical application.

Background and Aims:Iliac vein compression syndrome (IVCS) is a major cause of acute lower extremity deep vein thrombosis (DVT). Without timely treatment,it can lead to thrombus detachment,resulting in pulmonary embolism and increased mortality risk. Percutaneous mechanical thrombectomy,particularly using the AngioJet thrombectomy system,is a widely used thrombectomy method. The combination of AngioJet thrombectomy with iliac vein stent placement provides a novel treatment option for DVT associated with IVCS. This study was performed to evaluate the efficacy and safety of AngioJet thrombectomy combined with iliac vein stent placement in treating DVT with IVCS.Methods:The clinical data of 120 patients with DVT and IVCS treated between April 2019 and October 2022 were retrospectively analyzed. Sixty patients underwent AngioJet thrombectomy combined with iliac vein stent placement (observation group),while another 60 patients received catheter-directed thrombolysis (CDT) combined with stent placement (control group). The clinical efficacy,outcomes (thrombus clearance grade,thrombolysis duration,venous patency score,hospitalization duration,urokinase dosage,thigh circumference difference,and calf circumference difference),Villalta scores at various time points before and after treatment,and adverse events (chest tightness,mild pulmonary embolism,bleeding at the catheter insertion site,and mild renal function impairment) were compared between the two groups.Results:The overall efficacy rate in the observation group was significantly higher than that in the control group (98.33％ vs. 86.67％,P=0.015). While there was no significant difference in thrombus clearance grade between the two groups (P>0.05),the observation group had significantly shorter thrombolysis duration,lower urokinase dosage,and shorter hospitalization time compared to the control group (all P<0.05). Before treatment,there were no significant differences in thigh circumference difference,calf circumference difference,or venous patency score between the two groups (all P>0.05). After treatment,the observation group had significantly better venous patency score and smaller thigh and calf circumference differences than the control group (all P<0.05). There was no significant difference in Villalta score between the two groups before treatment (P>0.05). Post-treatment Villalta scores showed a significant decreasing trend over time in both groups compared to pre-treatment scores (all P<0.05),but there were no statistically significant differences in Villalta scores between the two groups at 1,6,and 12 months after treatment (all P>0.05). The total incidence of adverse events was not significantly different between the two groups (10.00％ vs. 3.33％,P=0.143).Conclusion:The use of AngioJet thrombectomy combined with iliac vein stent placement for the treatment of lower extremity DVT with IVCS can shorten thrombolysis and hospitalization duration,reduce thrombolytic drug dosage,and achieve better and safer outcomes,making it worthy of clinical application.

OBJECTIVE: To investigate the correlation of stress-inducible phosphoprotein 1 (STIP1) expression level with prognosis of different cancers and its potential role in immunotherapy. METHODS: TCGA, TARGET and GTEx databases were used for bioinformatic analysis of STIP1 expression level and its prognostic value in different cancers. We also detected STIP1 expression immunohistochemically in 10 pairs of colorectal cancer and adjacent tissues. We further analyzed the correlation of STIP1 expression level with tumor mutational burden, microsatellite instability, immune cell infiltration, immune regulators and outcomes of different cancers. STIP1- related proteins were identified using protein- protein interaction (PPI) network analysis, and functional enrichment analysis was performed to analyze the regulatory pathways involving STIP1. RESULTS: Bioinformatics analysis showed that STIP1 was highly expressed in most tumors compared with the normal tissues (P < 0.05), which was confirmed by immunohistochemistry of the 10 pairs of colorectal cancer tissues. STIP1 expression level was correlated with clinical stages of multiple cancers (P < 0.05), and in some cancer types, an upregulated STIP1 expression was correlated with a poor prognosis of the patients in terms of overall survival, disease-specific survival, disease-free survival and progression-free survival (P < 0.05). STIP1 expression was significantly correlated with tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors in most tumors (P < 0.05). PPI network analysis indicated that STIP1-related proteins included HSPA4, HSPA8, and HSP90AA1. KEGG enrichment analysis suggested that the high expression of STIP1 in liver cancer was related mainly with valerate metabolism, tryptophan metabolism, and butyrate metabolism pathways; HALLMARK enrichment analysis suggested high STIP1 expression in liver cancer was involved in bile acid and fatty acid metabolism. CONCLUSION STIP1 is up-regulated in multiple cancer types and its expression level is correlated with clinical tumor stage, tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors.
Humans ; Microsatellite Instability ; Liver Neoplasms ; Immunotherapy ; Prognosis ; Computational Biology ; Heat-Shock Proteins ; Colorectal Neoplasms

Objective:To discuss outcomes of emergency repairing for Gustilo III B and III C fractures of forearm with complicated tissue defects and the related influence factors.Methods:From January 2014 to Feburary 2022, data of 98 cases of Gustilo III B and III C fractures with large compound defects of soft tissue, blood vessel, bone, tendon or muscle from elbow to wrist were collected. Primary debridement, bone fixation, wound coverage by free flap, bone transfer(or bone cement filling) or dynamic reconstruction of muscle were completed with emergency surgery in Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. Postoperative follow-ups were conducted through outpatient clinic visits, telephone and WeChat reviews. Video clips, questionnaires and the latest information of patients were also analysed. Rank sum test and Chi-square test were used to examine the relationship between independent variables such as general condition, disease condition and surgical procedures of chimeric tissue transfer group and simple flap transfer group, together with dependent variables such as limb salvage, number of surgery, wound healing, function scores, and complications. P<0.05 were further included in the regression equation to discover the relationship between multiple independent variables and dependent variables. Results:Follow-up lasted for 6-96 months, with an average of 71.1 months. In the chimeric group, the limb salvage rate was at 95.1%, with an infection rate of 8.50% and an average number of surgery was 2.13±0.89. In the simple flap transfer group, the limb salvage rate was at 87.5%, with an infection rate of 15.38% and an average number of surgery was 2.62±0.64. The good rate of Anderson score was 65.3% and the average score of Disability of the Arm, Shoulder and Hand(DASH) was 32.9(0-60) points for all the patients. There were significant differences in dependent variables of limb salvage and infection rate between the 2 groups ( P<0.05). Ischemia time and method of bone fixation led to significant differences in number of surgery ( P<0.05). Methods of bone fixation and the types of flap made significant differences in wound healing ( P<0.05). Underlying disease, bonedefect, Gustilo classification and method of bone fixation all contributed to the significant differences in function score ( P<0.05 or P<0.01) . Conclusion:Emergency surgery for repair of serious injury of forearm has a relatively high limb salvage rate and good functional effects. The limb salvage rate is not correlated with independent variables such as severity of injury, Mangledextremity Severity Score (MESS) and ischemia time, while transfer of a simple flap or a chimeric flap is significantly correlated with the limb salvage rate, infection and wound healing. The severity of injury, ischemia time and bone defect are correlated with functional assessment, number of surgery and bone healing.

Venous thromboembolism(VTE)is a high mortality disease involving multiple factors, and public hospitals assume the main responsibility for the diagnosis and treatment of VTE. Based on the concept of taking patients as the center, Zhejiang Provincial People′s Hospital improved the system design and digital level, and carried out digital practices such as patient timeline management, high-risk patient management, VTE special disease bank, and auxiliary decision-making system. The hospital evaluation rate and prevention rate continued to increase, the follow-up effect was good, and the workload of medical staff was reduced and satisfaction rate was improved.

Objective: To establish a microwave digestion-inductively coupled plasma mass spectrometry assay for simultaneous determination of multiple elements in placenta. Methods: Fresh placental tissues were dried at 60 ℃ for 15 h and ground into power. Then, 0.3 g homogenized samples were digested in a microwave digestion system. The interference from mass spectrometry was removed using the kinetic energy discrimination model in the inductively coupled plasma mass spectrometry, and the baseline interference was removed by online internal standards. The contents of 17 elements were determined in placental specimens using the established microwave digestion -inductively coupled plasma mass spectrometry assay, including V, Ni, Co, Fe, Cr, Cu, Zn, Mn, As, Sn, Sb, Ba, Se, Cd, Pb, Hg and Tl. Results: Good linearity was shown for V, Ni, Co, Cr, As, Se, Cd, Pb and Tl at 1 to 50 µg/L, Fe at 100 to 5 000 µg/L, Zn, Cu, Mn and Ba at 10 to 500 µg/L, Sn and Sb at 0.1 to 5 µg/L, and Hg at 0.2 to 2 µg/L, with all correlation coefficients of 0.999 8 and higher. The detection limits of these 17 elements ranged from 0.5 to 100 μg/kg, with relative standard deviations of 2.1% to 6.5%, and recovery rates of 83.3% to 110.0%. The determination results of 17 elements were all within the normal reference range defined in the certified reference materials of chicken (GBW10018). Conclusions The microwave digestion-inductively coupled plasma mass spectrometry established based on optimized pretreatments and mass spectrometry detection conditions, is feasible for simultaneous determination of multiple elements in placenta.