Gastrointestinal tract is the main site of human immunodeficiency virus (HIV) infection. Intestinal flora and its metabolites can affect the physicochemical properties, nutritional status and immune function of the intestinal tract. Improving the state of intestinal flora of AIDS patients can improve the immune function of patients and suppress the damage caused by HIV virus to the body. Moringa oleifera combined enteral nutrition can improve the intestinal microecology of AIDS patients and effectively improve the nutritional status of the patients, but there is the possibility of interaction with antiviral drugs, garlic, hypericum perforatum and other herbs. The microbial ecological agents have a weak regulation effect on the intestinal flora of AIDS patients, but it can improve the immune function of patients to a certain extent. Fecal microbiota transplantation does not significantly change the diversity of intestinal flora in AIDS patients, and the long-term complications are still to be clarified, but it can improve the immunity of patients to some extent. The preservation of microbial ecological agents, dietary regulation of intestinal flora and nursing after fecal microbiota transplantation in AIDS patients are still to be studied.

Objective:To explore the advantages and value for clinical application of clavicle segment osteotomy approach with pectoralis major muscle pedicle in surgical resection of posterior brachial plexus tumour.Methods:From April 2010 to December 2020, 6 patients with brachial plexus tumour behind the clavicle were treated. Two patients had the tumour on the left brachial plexus and 4 on the right. Two patients had the tumours located in the upper trunk of brachial plexus, 2 in the middle trunk, 1 in the medial plexus and 1 in the posterior bundle. The neurological function evaluation were grade II in 3 cases and grade III in 1 case preoperatively. The tumours sized from 3.0 cm× 3.0 cm×2.0 cm to 11.0 cm×8.0 cm×6.0 cm. The clavicular segment osteotomy approach with the pedicle of the pectoralis major was applied in order to expose the surgical field and remove the nerve tumour. All patients underwent regular postoperative outpatient clinic follow-up to record the sensation of the affected limb and the recovery of muscle strength, tumour recurrence and fracture healing.Results:In the operation, it was found that there was still a little glial-like tissue in the nerve sheath after complete dissection of the tumours in 2 patients. Postoperative pathological examination reported that there were 4 schwannoma, 1 malignant peripheral schwannoma and 1 neurolipoma. The postoperative follow-up lasted for 6 to 34 months, with an average of 12.8 months. All patients showed no symptoms of brachial plexus injury or tumour recurrence. The clinical symptoms were relieved or disappeared. The neurological function evaluation reached grade III in 5 patients and grade IV in 1 case. At the same time, the internal fixation of the clavicle was satisfactory and achieved bone union in all cases. Fracture healing time was 2.5 to 4.5 months, with an average of 3.2 months. The internal fixation was removed from 3 patients after operation in 1 year. No obvious limb movement disorder and periarthritis of shoulder and other complications occurred.Conclusion:The transclavicular osteotomy approach with the pedicle of the pectoralis major can fully expose the anatomical alignment of the brachial plexus and the relationship adjacent and between the tumour and the surrounding tissues in the surgery for a brachial plexus tumour behind the clavicle, which is helpful for a complete tumour resection. It is a feasible method to treat brachial plexus tumour behind the clavicle by finding residual tumour-like tissue, reducing the risk of surgery and tumour recurrence, and providing excellent blood supply to the osteotomy segment of the clavicle to promote fracture healing.

Objective:To investigate feasibility and clinical effect of free anterolateral thigh flap(ALTF) with reversed arterial flow in repair of foot and ankle wounds in children.Methods:From October 2014 to February 2021, the free ALTF with reversed arterial flow was used to repair the wounds in 7 children with severe soft tissue injury and main blood vessel injury in the Department of Hand & Foot Surgery of the Second Affiliated Hospital of University of South China. Of the 7 injured children, 5 were caused by traffic accident, 1 by mechanical strangulation and 1 by heavy object. The size of wounds ranged from 6.0 cm×8.0 cm to 9.0 cm×11.0 cm. ALTF were designed to be anastomosed with the blood vessels at the recipient sites by retrograde blood supply. The size of flaps ranged from 6.0 cm×8.0 cm to 10.0 cm×11.0 cm. All flap donor sites were pulled together and directly sutured. Follow-ups were conducted through outpatient clinic visits, telephone call and WeChat reviews in the 1st, 3rd, 6th, 12th and 24th months after surgery. The major contents in follow-up were the shape, colour, texture, sensation of flap and function of ankles.Results:All donor sites healed at I stage. A total of 5 flaps survived successfully; One flap had venous occlusion after surgery, and the flap survived after surgical exploration; One flap had partial necrosis after surgery, and repaired with artificial dermis after further debridement. Postoperative follow-up lasted for 6-24 months, with an average of 10.5 months. All flaps appeared in similar colour and texture to the surrounding soft tissues. Two children underwent flap repair after half a year due to bloated flaps. The Ankle-hind foot Function Score of American Orthopedic Foot Ankle Society(AOFAS) was used to evaluate the ankle function. AOFAS achieved 84-94 points, with 5 children in excellent and 2 in good. The sensation recovered to S 3+ in 5 children, S 3 in 1 child and S 2 in 1 child, according to the standard of British Medical Research Council (BMRC). Conclusion:For the children with severe soft tissue injury combined with main vascular injury in foot and ankle, free ALTF with reversed arterial flow can repair the defect and effectively secure the blood supply. It is a feasible method for wound repair.

Objective:To screen for preoperative frailty risk factors in elderly patients with spinal degenerative diseases and construct a risk prediction model.Methods:From September 2021 to August 2022, convenience sampling was used to select 324 elderly patients who underwent spinal surgery in the Department of Neurosurgery at Xuanwu Hospital, Capital Medical University as research subjects. The patients were surveyed using the General Information Questionnaire, Barthel Index, Nutritional Risk Screening 2002, Mini-mental State Examination, Geriatric Depression Scale-15, Generalized Anxiety Disorde-7, Athens Insomnia Scale, Charlson Comorbidity Index (CCI), and Modified Frailty Index. Binary Logistic regression analysis was used to explore the influencing factors of preoperative frailty in elderly patients with spinal degenerative diseases and establish a risk prediction model. Receiver Operating Characteristic (ROC) curve was used to assess the discriminative power of the model, and Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Results:A total of 324 questionnaires were distributed, and 308 valid questionnaires were collected, with a valid response rate of 95.06% (308/324). Among 308 elderly patients with degenerative spinal diseases, 56 patients experienced preoperative frailty. Binary Logistic regression analysis showed that falls within one year, CCI, serum albumin, activities of daily living, and self-rated health status were the influencing factors for preoperative frailty in elderly patients with spinal degenerative diseases ( P<0.05). The area under the ROC curve of the prediction model was 0.851, with a sensitivity of 0.786 and a specificity of 0.778. Hosmer Lemeshow test indicated that the predictive model had a good fit (χ 2=3.764, P=0.709) . Conclusions:Falls within one year, CCI, serum albumin, activities of daily living, and self-rated health status are influencing factors for preoperative frailty in elderly patients with spinal degenerative diseases. The risk prediction model constructed can identify preoperative frailty early and has good predictive performance, which is worthy of clinical promotion.