Objective:To evaluate the predictive value of sequential organ failure assessment (SOFA) for 28-day mortality in patients with post-cardiac arrest syndrome (PCAS).Methods:Retrospective analysis of 125 patients with PCAS who were treated in Emergency Intensive Care Unit (EICU) of Wenzhou People's Hospital from July 2016 to July 2021. Clinical data were collected, including age, gender, underlying diseases, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), SOFA score on admission to EICU and 28-day mortality. Univariate and multivariate Logistic regression model was constructed to analyze the influencing factors of PCAS patients, which was used to examine the independent correlation between SOFA score and 28-day mortality. Receiver operator characteristic curve (ROC curve) was used to determine the best predictive value of SOFA score and 28-day mortality in PCAS patients.Results:Among the 125 PCAS patients, there were 91 males and 34 females with an average age of (58.7±15.1) years old, and 97 died and 28 survived within 28 days. The overall SOFA score ranged from 7 to 15 points, with an average of 10.9 (10.0, 12.0) points. The SOFA score of non-survival group was significantly higher than that of the survival group [points: 11.0 (10.0, 12.0) vs. 9.5 (9.0, 10.0), P < 0.05]. This difference between SOFA score mainly caused by the neurological and cardiovascular systems. After excluding neurological factors, the SOFA score of the non-survival group was still significantly higher than that of the survival group [points: 8.0 (6.0, 8.0) vs. 6.5 (6.0, 7.0), P < 0.05]. SOFA score was found to be an independent risk factor for 28-day mortality in PCAS patients by multifactorial Logistic regression analysis [odds ratio ( OR) = 1.97, 95% confidence interval (95% CI) was 1.24-3.04]. The correlation between neurological score and mortality was the highest in subgroups ( OR = 3.47, 95% CI was 1.04-11.52). The area under the ROC curve (AUC) predicted by SOFA score was 0.81 (95% CI was 0.73-0.89). When SOFA score cut-off value was 10.5 points (10 or 11 points), the sensitivity and specificity of SOFA score for predicting 28-day mortality in patients with PCAS were 67.0% and 82.1%, respectively. Conclusions:The SOFA score is quite accurate in predicting 28-day mortality in patients with PCAS.

Objective:To investigate the clinical effect of free superficial circumflex iliac artery flap combined with anterolateral thigh flap in repairing large skin defect of the hand.Methods:A retrospective case series study was conducted to analyze the clinical data of 9 patients with large skin defect of the hand admitted to Ningbo No.6 Hospital from January 2016 to December 2019，including 7 males and 2 females，aged 31-63 years［（45.3±5.6）years］. The area of skin defect reanged from 20 cm×15 cm to 25 cm×20 cm. One side of the superficial circumflex iliac artery flap and the contralateral anterolateral thigh flap were used for repair. Both recipient and donor sites were sutured at the first stage. The ilioinguinal region and thigh donor region were sutured directly. The area of superficial circumflex iliac artery flap was from 19 cm×6 cm to 23 cm ×10 cm and that of anterolateral thigh flap was 19 cm×9 cm to 23 cm×8 cm. The flap survival，healing of donor and recipient area and complications were observed. At 1，6 and 12 months after operation，the function of the flap was evaluated by the late functional evaluation criteria of the flap，hand function by the upper limb functional evaluation criteria of the Chinese Medical Association，and scar condition of the donor site by Vancouver Scar Scale（VVS）. At the last follow-up，the color，elasticity，appearance and scar of the donor site were observed.Results:All patients were followed up for 6-18 months［（12.5±2.3）months］. All flaps survived successfully. All patients achieved donor-site healing at the first stage，except that one patient experienced incision dehiscence in the thigh donor site after operation and healed after the second stage suture. The texture and appearance of the flaps were good. The flap in 5 patients was obviously bloated. Therefore，the secondary skin flap repair was selected，and the appearance was significantly improved after operation. Scores for function of the flap and the hand were improved over time（ P<0.05）. At 12 months after operation，the function of the flap was excellent in 3 patients，good in 4 and fair in 2，with the excellent and good rate of 78%；the result of hand function was excellent in 3 patients，good in 3 and fair in 3，with the excellent and good rate of 67%. The VVS score of the donor site decreased from（9.7±1.3）points at postoperative 1 month to（5.7±0.9）points at postoperative 6 months and（3.4±0.8）points at postoperative 12 months（ P<0.05）. At the latest follow-up，the color and elasticity of the flap was similar to that of the surrounding skin tissue，only with slight bloating；the scar of the donor site was small. Conclusions:The free superficial circumflex iliac artery flap combined with anterolateral thigh flap can cover large skin defect of the hand at one time，with good appearance and texture of the flap. The appearance and function of the wounded hand are good after operation，leaving only linear scar in the donor site.

Objective:To investigate the clinical application and effect of end-to-side anastomosis in personalised free ilioinguinal flap transfer.Methods:From March, 2015 to July, 2020, 88 patients with soft tissue (bone) defect of limbs were treated. Different ilioinguinal flaps were designed according to the wound condition of patients, which were 48 cases of free superficial circumflex iliacartery perforator flap, 7 cases of free superficial epigastric artery perforator flap, 19 cases of composite tissue flap with iliac bone, 8 cases of combined flap of superficial circumflex iliac artery and superficial abdominal wall artery, and 6 cases of superficial circumflex iliac artery and superficial abdominal wall artery lobulated flap. The area of the flap was 4.0 cm×6.0 cm-10.0 cm×30.0 cm. The artery and recipient artery were anastomosed end-to-side: 36 cases to radial artery; 12 cases to ulnar artery; 18 cases to dorsalis pedis artery; 15 cases to anterior tibial artery; 7 cases to posterior tibial artery. Venous anastomosis of skin flap: 42 cases were anastomosed with 2 veins, which were superficial vein of the same name and accompanying vein; 46 cases were anastomosed with 1 superficial vein of the same name. The accompanying vein of the flap was anastomosed end-to-side with the accompanying vein of the main artery of the recipient area, and the superficial vein of the same name was anastomosed end-to-end with the accompanying vein or subcutaneous superficial vein of the recipient artery. Follow-up includes flap blood supply, blood supply to the distal limbs, appearance of both the donor site and the recipient area, and patient satisfaction.Results:There were 83 cases of flaps survived successfully, and 5 cases of crisis. Among them, 2 cases had artery crisis at 48 h after surgery. After exploration, it was found that 1 case caused by arterial thrombosis, and 1 case compressed by the stapler that anastomoses the vein. The other 3 cases had venous crisis at 72 h after surgery: after exploration, it was found that caused by thrombosis at the venous anastomotic site. The average follow-up period was 10 (range, 3-24) months. All flaps survived after re anastomosis or vascular transposition. The donor site and recipient site of the flap healed well. The blood supply of the flap was good and the texture was soft. There was no blood supply disorder in the distal limb.Conclusion:The end-to-side anastomosis technique is suitable for all kinds of free flap transplantation in ilioinguinal region, with high vascular patency rate. It can not only solve the problem of thin vascular pedicle of donor site flap, but also retain the main artery of recipient limb without affecting the distal blood supply.

Objective:To establish a competing risk model to predict the cumulative hazard risk probability of the outcomes (unhealed or hyperthyroidism recurrence) of Graves disease (GD) treated with 131I. Methods:From January 2020 to May 2021, 61 GD patients (13 males, 48 females; age (46.0±13.8) years) who received 131I treatment in Zhangzhou Affiliated Hospital of Fujian Medical University were enrolled. The outcomes of treatment were recovery, unhealed or hyperthyroidism recurrence (event 1), and hypothyroidism (event 2). Follow-up was started 1 month after 131I treatment and ended 1 year later. It was terminated in the following conditions: one of the two events occurred; no event occurred after 1 year of follow-up; the research deadline was up. The Fine-Gray test was used to analyze the factors related to event 1, and then the competitive risk model was established. Results:Thirty-nine patients had hypothyroidism, 17 patients were unhealed or had hyperthyroidism recurrence, 2 patients lost follow-up, and 3 patients had normal thyroid function after 1 year follow-up. Multivariate analysis showed that effective half-life (hazard ratio ( HR)=1.74, 95% CI: 1.10-2.75, β=0.55, P=0.019) and thyroid volume ( HR=1.12, 95% CI: 1.07-1.17, β=1.12, P<0.001) were risk factors for event 1, while the elasticity of thyroid was a protective factor ( HR=0.17, 95% CI: 0.06-0.54, β=-1.76, P=0.003). The C index of the nomogram constructed based on the multi-factor competitive risk model was 0.784(95% CI: 0.633-0.935). Conclusions:Thyroid volume, elastic value, and effective half-life are associated with treatment outcomes of 131I. The competitive risk model can predict the therapeutic outcomes of GD patients treated with 131I.

Objective To analyze the situation and changing trend of free medication service in Beijing from 2013 to 2020, and to propose policies and service improvement measures. Methods A retrospective survey was conducted in Beijing to collect and analyze the service subjects, service process, drug catalog, fiscal investment and patient participation of free medication in each district in recent years. Results Among the 16 districts of Beijing, 81.25% of the districts included the patients listed in Item (2) of Paragraph 2 of Article 30 of the Mental Health Law into the scope of free medication, and 75% of the districts broke the restriction that the service targets were registered residents in Beijing. 56.25% of the districts provided a variety of free medication modes, and 81.25% of the districts provided a mode of nearby community service. The catalog of free medications in various areas was still based on the Beijing catalog, and only 18.75% of the districts supplemented the list. In 2020, the total investment of free medicines and subsidies was 88.3768 million RMB, and the per capita investment was 1 616.02 RMB. The total cost showed an increasing trend year by year. From 2013 to 2020, the difference of per capita annual financial investment in drugs and subsidies was statistically significant (F=9.248, P<0.001). The per capita cost basically showed an increasing trend year by year except for individual years. In 2020, 54,688 patients participated in the free medication service in Beijing, and the participation rate was 67.23%. From 2013 to 2020, the difference of annual participation rate of patients was statistically significant (χ²=37098.759, P<0.001), and the number and proportion of patients increased year by year. Conclusion The practice of the district level has proved feasible to expand the scope of free medication service and to optimize the service process, which should be paid more attention in the future. With the continuous advancement of policies and services, the level of patient participation in various areas will tend to be relatively balanced after rising year by year.