Objective To examine the levels of plasma tissue factor pathway inhibitor (TFPI) in patients with acute pancreatitis (AP) to assess the clinical value of diagnosis for severe acute pancreatitis ( SAP).Methods Sixty-eight patients were divided into mild acute pancreatitis (MAP)group (n=36) and SAP group (n=32), and twenty volunteers were chosen into normal group ( n=20 ) .Clinical data of these patients were collected, including APACHEⅡscore and Ranson score.Plasma levels of TFPI were measured by ELISA.Results The plasma levels of TFPI in SAP group, MAP group and control group were (4274.25 ±639.83),(3026.81 ±465.76) and (2468.73 ±262.39)pg/ml, respectively(P<0.05).There were significant positive correlations between TFPI and WBC, AST, ALT, TBIL, Cr, PT, APTT, PCT, APACHEⅡscore and Ranson score (P<0.05).The area under the curve (AUC) of TFPI for SAP was 0.902(95%CI=0.845 -0.959, P<0.05 ) .The cutoff value was 4028.83 pg/ml for plasma TFPI with a sensitivity of 87% and a specificity of 78%.Conclusion Plasma levels of TFPI in patients with SAP are significantly increased, which maybe help diagnose SAP.

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb.Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed.There were 7 males and 4 females,aged from 16 to 56 years,with an average age of 31.5 years.The soft tissue defect of the affected finger ranged from 3.0 cm×1.3 cm to 6.3 cm×2.0 cm,and the bone defect ranged from 1.3 cm×0.8 cm×0.4 cm to 2.8 cm×1.3 cm×0.8 cm.All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area.The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue.The flap area ranged from 4.0 cm×1.5 cm to 7.0 cm×3.0 cm and the bone flap size ranged from 1.5 cm×1.0 cm×0.5 cm to 3.0 cm× 1.5 cm× 1.0 cm.The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association.Results All 11 cases of wrist transverse bone flap survived.The average healing time of the bone flap was 1.6 (range,1.5-3) months,and the bone graft was not absorbed.The function and appearance of the finger was good with only a linear scar;6 months after surgery,the two-point discrimination on average was 7.1 mm (range,5.5-9.0 mm).At the latest follow-up according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association,finger function were excellent in 9 cases,good in 1 case,with the excellent rate of 90.9％ (10/11).Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin,soft tissue and bone defects of thumb simultaneously.It has the advantages of simple operation,safe blood supply,speeding up fracture healing,good functional recovery and concealed scar in donor area.It is a new choice to repair the complex tissue defect of thumb.

Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area.Methods From March,2015 to March,2017,12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery.All digital arteries defective with soft tissue defect,the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm.The wound of the wrist donor site was sutured directly.Postoperative followed-up was performed to review if the flap survival.Results There was 1 case of venous reflux disorder.After removal of some sutures,the symptoms were relieved.All other fingers survived successfully,and the flap survived completely.The donor site incision healed at Ⅰ stage.The followed-up period was 12-18 (average,13.5) months.The appearance of the thumb and flap was satisfactory,and the scar in the donor site was not obvious.The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery.Eight cases were excellent,3 cases were good,and 1 case was medium.Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply.It can reconstruct the defect vessels and repair the wound at the same time.It is a new method for replantation of complicated severed thumb.

Objective To explore the clinical effect of free chimeric bone flap based on the superficial pal-mar branch of radial artery to repair finger composite tissue defects. Methods From July, 2013 to January, 2016, 9 cases of finger composite tissue defect were repaired by free chimeric bone flap from the wrist crease area. The flap and bone flap were taken with the superficial palmar branch of the radial artery during the operation. The area of the flap was 1.5 cm×4.0 cm to 3.5 cm×6.5 cm, and the size of the bone flaps were 0.5 cm×1.0 cm×1.5 cm to 1.0 cm × 2.5 cm × 3.5 cm. Regular followed-up was done after the operation. Results Nine cases of chimeric bone flap survived well, and the average healing time of bone flap was 1.6(1.5-3.0) months. The function and appearance of the patients recovered well. The scars on the donor area was slight. The average two-point discrimination of flap was 6.6 (5.3 to 8.6) mm at 6 months after operation. According to the Evaluation Criteria of Thumb and Finger Reconstructive Function Assessment of the Upper Limb of the Chinese Medical Association, 7 cases were superior, 1 was good, 1 was medium. Conclusion The free chimeric bone flap pedicled with superficial palmar branch of radial artery can si-multaneously repair soft tissue and bone defects. It helps shorten the course of disease and speed up the recovery of finger function.It is a new choice to repair finger tissue defects.

Objective To construct a three-dimensional finite element model to investigate the biomechanical mechanism of carotid blast injuries.Methods Based on the head and neck CT angiography data of a healthy male volunteer,the 3D geometric model was extracted by Mimics software.The 3D solid model was obtained by fitting the geometric model to the non-uniform rational B-splines (NURBS) by Geomagic Studio software.The mesh of blood vessels,blood and soft tissue was divided by HyperMesh software to obtain the three-dimensional finite element model of the carotid artery.The material parameters and boundary conditions were set,and the vessel wall rupture damage threshold was 1 MPa.The dynamic process of carotid injury caused by MK3A2 grenade explosion shock wave at the distance of 60,70 and 80 cm to the neck was simulated using the LS-DYNA,generating the shock waveform and peak overpressure.The stress cloud map was used to analyze the stress distribution and damage morphology,and the stress curve was used to analyze the mechanical changes.Results The peak values of shock wave overpressure were 0.45,0.63 and 0.96 MPa at the distance of 80,70 and 60 cm away from the explosion center,respectively.At 80 cm,the peak stress of vessel wall was 0.43 MPa,and the vessel wall was not ruptured;at 70 cm,the peak stress of anonyma was greater than 1 MPa,which resulted in small rupture;at 60 cm,the peak stress of both anonyma the ascending aorta were greater than 1 MPa,leading to obvious rupture.The root part of the common carotid artery,anonyma and the arch of the aorta were high stress concentration areas,manifested as high-prevalence areas of damage and rupture.Conclusions The finite element model of explosive carotid artery injury is successfully constructed,which can be used to analyze the mechanical response and damage mechanism of carotid blast injuries.The main cause of injury and rupture is that the sudden change of stress in the process of explosion shock reaches or exceeds the threshold of vascular wall injury.Carotid artery rupture will occur when the vessel wall stress peak is greater than 1 MPa at 60 and 70 cm away from the explosion center,providing references for the clinical treatment and injury prevention.

Objective:To investigate the clinical effect of free chimeric bone flap pedicled with superficial palmar branch of radial artery in reconstruction of partial finger with composite tissue defect.Methods:From July, 2018 to January, 2020, 9 cases of compound tissue defect of fingers were reconstructed by free transfer of chimeric bone flap pedicled with superficial palmar branch of radial artery. The wrist transverse striated flap and distal radius bone flap pedicled with superficial palmar branch of radial artery were harvested in operations. The size of flap were 2.0 cm × 4.0 cm -3.0 cm × 6.5 cm, and the length of bone flaps were 1.5-2.5 cm. All patients entered monthly follow-up by clinic visit in 6 months after the surgery, and thereafter by WeChat interviews.Results:All of the 9 chimeric bone flaps survived well. The average healing time of bone flap was 1.7 months, and the average length of reconstructed finger was 2.4(1.8-3.0) cm; The appearance of the affected fingers restored well, the scars of the donor sites were mild, and average of the TPD of the flaps was 6.6(5.3-8.6) mm at 6 months after the surgery. The function of the affected finger was evaluated according to the Trial Standard of the Upper Limb Function Evaluation proposed by the Hand Surgery Society of the Chinese Medical Association: excellent in 7 cases, good in 1 case and medium in 1 case.Conclusion:Free chimeric bone flap pedicled with superficial palmar branch of radial artery can be used in reconstruction of the soft tissue and bone defects of fingers at the same time. It restores the functional length of fingers, improves the function and appearance of fingers, with less damage to the donor site. It is a simple method for reconstruction of finger defects.

Objective To analyze the spatial distribution characteristics of tuberculosis in rural areas of Nanning City from 2010 to 2018, and explore the clustering areas, and to provide evidence for tuberculosis prevention and treatment. Methods The database of tuberculosis epidemics in rural areas of Nanning City from 2010 to 2018 was established by ArcGIS 10.8. The spatial distribution map was drawn, and global autocorrelation, local autocorrelation and hotspot analysis were conducted. Results The spatial distribution map of the average annual reported incidence rates in rural areas of Nanning from 2010 to 2018 showed that the towns with high average annual incidence rates were Jinchai Town and Yangqiao Town. Global autocorrelation analysis showed that the Moran's I index from 2010 to 2018 was 0.18 (Z=2.33, P=0.02), suggesting that tuberculosis in rural areas of Nanning had spatial clustering in the regional distribution. Local autocorrelation analysis showed that tuberculosis in rural areas of Nanning had high-high clustering, low-low clustering, high-low clustering and low-high clustering patterns. Among them, Jinchai Town and Lidang Yao Township were high-high clustering areas. Litang Town, Xinfu Town and Taoxu Town were low-low clustering areas. Local hotspot analysis showed that ^“hotspot^” areas included Jinchai Town, Yangqiao Town and Lidang Yao Township. Conclusion There is a spatial clustering of tuberculosis epidemics in rural areas of Nanning. The high-incidence areas include Jinchai Town, Yangqiao Town and Lidang Yao Township, and the low-incidence areas include Litang Town, Xinfu Town and Taoxu Town.

Objective: To explore the clinical effect of the flap from the rasceta area to repair the hand wound, with relayed superior carpal perforator flap of the ulnar artery to repair the donor site. Methods: During July 2015 to July 2016, 11 cases of hand skin and soft tissue defects from 3.0 cm × 5.5 cm to 5.0 cm × 7.5 cm were treated. and the rasceta flap was used to repair the wound. The superior carpal perforator flap of ulnar artery was used to repair the donor site. Results: All the 22 flaps survived after operation in 11 cases.Followed up for 6-12 months (average 8.5 months). The area of the superior carpal branch of ulnar artery skin flap is 4.0 cm ×6.5 cm to 6.5 cm× 8.5 cm. The skin flap appearance was good and the scar of the donor area was minimal. After 6 months of operation, the function of the affected limbs was evaluated according to the criteria of functional evaluation of the upper limb of the Chinese Medical Association, 8 cases were excellent, 3 were good, and the excellent rate was 88.9%. Conclusions Relayed superior carpal perforator flap of ulnar artery. Not only expands the repair area of the island flap, but also avoids the skin grafting in donor site. It is applicable to the recovery of the function and appearance of the affected limbs.

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.