Purpose To study the therapeutic methods of fatigue syndrome. Methods Seventy-nine cases of fatigue syndrome were treated by Tuina manipulation and a comprehensive assessment of main complaints and accompanied symptoms was made. Results After 3month's Tuina treatment, 21 cases were cured, 43 cases improved, 15 cases obtained no effects. Conclusion Tuina has a unique therapeutic effect on fatigue syndrome.

ObjectiveTo discuss the clinical efficacy of distal medial arm perforator flaps.MethodsAccording to the basic anatomy of distal medial arm perforator flaps,the distal medial arm perforator flaps were designed for repairing skin defects around elbow joints and at upper part of forearms in 15 cases.ResultsAll flaps were survived and first intention of wounds was obtained.At 3-36 months of follow-up,flap shape and elbow joint function revealed satisfactory recovery.Conclusions With the constant anatomical position,good blood supply,safe surgical approaches and cryptic donor site,the distal medial arm perforator flap is an alternative to repair the skin defects around elbow joints and in proximal forearms.

Objective To evaluate the emergency repair method and its effect for treatment of extensive avulsion injury of the lower extremity in the elderly patients.Methods From May 2008 to February 2015,11 patients aged over 60 years sustaining large avulsion injury (across the knee or ankle joint) of the lower limb in traffic crushes were treated by emergency debridement and one-stage repair with the procedures of autologous skin replantation,arteriovenous anastomosis and vacuum sealing drainage (VSD).Two patients sustained injury to both lower limbs,and nine patients sustained a unilateral injury.Effect of wound repair was evaluated with skin flap survival area.Active and passive motility of the knee and ankle were recorded at postoperative 24 h.Results One patient with multiple fracture and extensive muscular inactivity due to severe crush injury to the lower limbs had poor blood supply after the replantation and was amputated at postoperative 24 h.The remaining ten patients with large skin avulsion showed 90％ of the avulsed skin survived after operation.At the follow-up of 3-24 months,the ten patients showed no obvious pigmentation or scar tissue,were satisfied with the function recovery in knee (106°-110° in flexion and 0°-5°in extension) and ankle joint (15°-20°in dorsiflexion and 30°-35° in plantar flexion),and could walk freely,including excellence outcomes in 3 patients and good outcomes in 6 patients.Conclusion The emergency repair methods including autologous skin replantation,arteriovenous anastomosis and VSD combined with one-stage in situ repair can attain satisfactory clinical effect.

Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.

Objective Anatomical researches of two long superiror genicular vessels,the descending branch of lateral circumflex femoral artery (LCFA) and the descending genicular artery(DGA),were performed to discuss the feasibility of reconstruction in lower leg's destruction injury by free flaps transplant anastomoses with these two long superior genicular vessels.Methods Thirty embalmed lower limb specimens from adult cadavers perfused with red latex were used for this anatomical study.The superior of patella,anterior inferior iliac spine and adductor tubercle were used as observation landmark.Dissection started along the line that from the middle point of Inguinal Ligament to the middle point of superior line of patella,and dividedly turned over to posterior lateral part and posterior medial part.The followings were focused observed:①The external diameter at the beginning of the D-LCFA ; the 0.5 mm external diameter point of this artery,and its length to the beginning and superior of patella.②The external diameter at the beginning of DGA,the distance between the beginning of DGA and adductor tubercle.③Anastomoses relations of final branches of D-LCFA and DGA with other arteries around the knee.Results The external diameter of the beginning of D-LCFA was (2.73 ± 0.35) mm ; the 0.5 mm external diameter point of this artery's length to the beginning and to the superior of patella were (24.56 ± 0.92) cm and (6.09 ± 0.86) cm; both D-LCFA and DGA had sent out many perforator arteries on their ways; the final branch of D-LCFA and DGA had lots of anastomoses relations in perioseal deep fascia and superficial fascia with other genicular arteries.Conclusion Base on the anatomical researches,in theory,the two long superior genicular vessels (D-LCFA and DGA) have enough lengthes and blood supply to regress and anastomosis with free flaps transplant to repair lower leg's smashed wound.

To observe the clinical efficacy of massage therapy and Cisapride in the treatment of functional dyspepsia (FD).Methods:Eighty subjects were randomized into two groups:treatment group in which 40 cases were treated by massage therapy and control group in which 40 cases were treated by Cisapride,with a course of 4 weeks;meanwhile,another 40 healthy people were taken as normal group.Abdominal fullness,acid regurgitation,diminished appetite and anorexia,nausea and vomiting and health survey were observed;symptom scores were recorded.Results:These two treatment methods were effective for FD.Conclusion:Mental disorder is one cause of FD;massage therapy is quite effective for it.

Objective To provide anatomical basis for the thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators. Methods ① The course and distribution of thigh medial cutaneous nerve. ②Anastomosis between descending genicular artery perforators and thigh medial neurocutaneous vascular, were observed on 40 specimens of adult lower limb perfused with red latex. Mimic operation was performed on one side of fresh specimen. Results ①The line between the midpoint of inguinal ligament and medial femoral condyle can be considered as the projection on body surface of thigh medial cutaneous nerve. ②Perforating branches of descending genicular artery (infrapatellar branch )started from the lower edge of medial femoral condyle about 4 cm, and passed through the deep fascia in which the triangle depression surrounded by the vastus medialis muscle, adductor tendon and the medial femoral condyle to the subcutaneous. They also separated large number of small blood vessels, which closely aligned with the perineural and neural stem vascular chain of thigh medial cutaneous nerve. Then they formated vascular plexus in the upper part of thigh along the thigh medial cutaneous nerve longitudinal axis. Conclusion The thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators can be formed to repair soft tissue defect around knee joint.

Objective To further improve the awareness of the clinical feature of acute fibrinous and organizing pneumonia (AFOP).Methods One case of AFOP treated in our department was described in details.The relevant cases were searched in Wanfang database using key words acute fibrinous and organizing pneumonia [in Chinese].Results Four reports containing 9 cases were identified from published literature.A total of 10 cases (including this one) were analyzed.The patients included 7 males and 3 females (43 to 78 years of age).Eight patients presented with cough.Chest tightness and dyspnea were reported in 8 cases,and fever in 9 cases.Velcro crackles were heard in 4 patients.Laboratory tests showed WBC increased in 2 cases,increased neutrophil count in 6 cases,elevated C-reactive protein in 9 cases,and faster erythrocyte sedimentation rate in 8 cases.The partial oxygen pressure (PO2) ranged from 54 mmHg to 69 mmHg.Chest CT scan showed unilateral lesions in 3 cases and bilateral lesions in 7 cases initially.The main CT findings were patchy,consolidation and ground-glass opacities,sometimes associated with air bronchogram.The diagnosis was confirmed by lung biopsy in all the 10 cases.Bronchoscopy biopsy was conducted in 6 cases,and percutaneous lung biopsy in 3 cases.One patient received both bronchoscopy biopsy and percutaneous lung biopsy.Methylprednisolone was used in all cases.No patient received mechanical ventilation.One patient died.Conclusions AFOP is a new type of interstitial lung disease,the etiology of which is unknown.AFOP often occurs in middle-and old-aged patients.AFOP is easily misdiagnosed due to its unspecific clinical manifestations,which are similar to common pneumonia.The confirmation of AFOP diagnosis depends on pathological biopsy.Corticosteroids treatment is appropriate,but the dosage,duration,and long term effect of corticosteroids are not established.

Objective To explore the application of drones in blood emergency support during the 19th Asian Games Hangzhou in Shaoxing venue,so as to provide reference for future major events.Methods A retrospective analysis of drone delivery of emergency blood to two designated rescue hospitals in Shaoxing for the Asian Games was conducted.Ten emer-gency and 30 routine land blood delivery records from two designated hospitals in 2023 were randomly selected to compare with the blood delivery using drones.The blood temperature during the drone flight were monitored,the cold chain control during drone flight was evaluated,and the application of drone flight was reviewed.Results During the Hangzhou Asian Games,a total of 14 drones were used for blood delivery.The delivery time(min)by drone from the blood station to one of the designated hospitals was 11.83±0.09,and 20.80±3.29 by emergency land delivery and 23.23±3.54 by routine land de-livery(P＜0.05),meanwhile was 17.50±0.08,24.50±3.27 and 26.57±3.23 respectively to the other hospital(P＜0.05).Compared with land emergency blood delivery and routine blood delivery,blood delivery time by drone was much shorter,demonstrating better timeliness and stability.The temperature monitoring during the drone delivering showed that the suspen-ded red blood cells and platelets were in a range of 3.8-6.8℃ and 21.8-22.8℃,with a temperature difference of 0.5-0.9℃ and 0.2-1.0℃ between takeoff and landing respectively,demonstrating that the blood cold chain was under control,and the delivery ran safely and smoothly.Conclusion During major events,the use of drones for emergency blood delivery ensures the quality of the blood,with good timeliness,feasibility and operability,and is worthy of promotion and applica-tion.

Objective To explore the application of drones in blood emergency support during the 19th Asian Games Hangzhou in Shaoxing venue,so as to provide reference for future major events.Methods A retrospective analysis of drone delivery of emergency blood to two designated rescue hospitals in Shaoxing for the Asian Games was conducted.Ten emer-gency and 30 routine land blood delivery records from two designated hospitals in 2023 were randomly selected to compare with the blood delivery using drones.The blood temperature during the drone flight were monitored,the cold chain control during drone flight was evaluated,and the application of drone flight was reviewed.Results During the Hangzhou Asian Games,a total of 14 drones were used for blood delivery.The delivery time(min)by drone from the blood station to one of the designated hospitals was 11.83±0.09,and 20.80±3.29 by emergency land delivery and 23.23±3.54 by routine land de-livery(P＜0.05),meanwhile was 17.50±0.08,24.50±3.27 and 26.57±3.23 respectively to the other hospital(P＜0.05).Compared with land emergency blood delivery and routine blood delivery,blood delivery time by drone was much shorter,demonstrating better timeliness and stability.The temperature monitoring during the drone delivering showed that the suspen-ded red blood cells and platelets were in a range of 3.8-6.8℃ and 21.8-22.8℃,with a temperature difference of 0.5-0.9℃ and 0.2-1.0℃ between takeoff and landing respectively,demonstrating that the blood cold chain was under control,and the delivery ran safely and smoothly.Conclusion During major events,the use of drones for emergency blood delivery ensures the quality of the blood,with good timeliness,feasibility and operability,and is worthy of promotion and applica-tion.