Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap transplantation.In this group,the skin and soft tissue defects size were 4.5 cm ×4.0 cm-13.5 cm × 6.5 cm,Focused on analyzing the features of forefoot skin and soft tissue defects,the design and harvesting of lateral leg peroneal artery perforator flap,and vascular anastomosis and vessel matching,meanwhile,follow-up the survival condition and appearance of the flap,the function of foot and ankle after operation.Results In the 9 cases,the larger myocutaneous perforator arising from peroneal artery,accompanying 2 vena comitans,were found slightly above the midpoint of the line between fibula head and lateral malleolus in lateral leg.The flaps transfered to repair forefoot defects,artery end-end anastomosis:in 5 cases cutaneous branch of peroneal artery to dorsal artery of foot,in 4 cases by cutaneous branch of peroneal artery to dorsal metatarsal artery;vein end-end anastomosis:in 1 case 2 accompanying veins of peroneal artery cutaneous branch to 2 accompanying veins of dorsal artery of foot,in 5 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,in 3 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,simultaneously,the another accompanying vein of peroneal artery cutaneous branch to 1 dorsal superficial vein of the foot.All the 9 flaps survived,and no vessel articulo happened.The venous return of flaps had no significant difference between repairing 1 vein and 2 veins in gross appearance.All wounds healed in one-period.Followed-up 2-6 months postoperative,1 patient was performed flap reshaping due to flap fat and clumsy at 5 months postoperative,others,the skin texture and appearance of the flaps were good and satisfactive.Conclusion Free transplantation of the lateral leg peroneal artery perforator flap broke away from the bondage of pedicled flap,had more freedom in flap design,and effectively controlled the trauma of donor and recipient site.The flap have the merits,blood vessel anatomy is relatively stable,blood supply is reliable,harvesting is simple,skin texture is similar to the forefoot and the effect is better,operation of the donor and recipient sites can accomplish under a identical anaesthesia and tourniquet.Thus,the lateral leg peroneal artery perforator free flap is an effective metheod in reparation of the forefoot defects.

Objective To evaluate the use of nasojejunal tube in early enteral nutrition in severe traumatic brain injury (STBI) patients under mechanical ventilation.Methods STBI patients requiring mechanical ventilation in intensive care unit (ICU) of the First Affiliated Hospital of Bengbu Medical College admitted in 2013 were randomly divided into the jejunal tube group (n =15) and gastric tube group (n =19).We compared the 2 groups in terms of the tolerable beginning time of enteral nutrition (EN),the time before reaching target feeding volume,the incidences of gastrointestinal complications and ventilator-associated pneumonia (VAP) during EN,mechanical ventilation time,ICU hospital stay,and 28-day mortality rate.Results The tolerable beginning time of EN [(51.73 ± 9.16) hours vs.(81.11 ± 11.82) hours,t =7.920,P ＜0.05] and the time required to reach target feeding volume [(87.27 ± 9.99) hours vs.(152.05 ± 28.74) hours,t =8.320,P ＜ 0.05] in the jejunal tube group were significantly shorter than those in the gastric tube group.In the process of EN,compared with the gastric tube group,the incidences of gastric retention (6.7％ vs.57.9％,x2 =10.937,P ＜ 0.05),reflux (0％ vs.36.8％,x2 =9.566,P ＜ 0.05),vomiting (20.0％.vs.63.2％,x2 =6.642,P＜0.05),aspiration (6.7％ vs.42.1％,x2 =6.087,P＜0.05),VAP (33.3％ vs.73.7％,x2 =5.536,P ＜ 0.05) in the jejunum tube group were significantly lower.The mechanical ventilation time [(10.73 ± 4.68) days vs.(15.74 ± 2.54) days,t =3.730,P＜0.05] and the ICU hospital stay [(13.60 ± 4.80) days vs.(17.42 ± 4.05) days,t =2.497,P ＜0.05] of the jejunum tube group were significantly shorter than those of the gastric tube group.Comparison of 28-day mortality rate between the two groups revealed no statistically significant difference.Conclusion Early implementation of EN via nasojejunal tube in mechanically ventilated STBI patients can alleviate feeding intolerance,shorten the beginning time of EN and the time required to reach target feeding volume,reduce the incidence of complications,and shorten mechanical ventilation time and hospital stay in ICU.

Objective To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT)and to evaluate a new criterion.Methods A retrospective analysis was performed on 81 consecutive patients with HCC who underwent LT.The survival rates of the patients who met different criteria such as Milan.UCSF(University of California San Francisco UCSF).and Pittsburgh(Pitt)modified TNM criteria were calculated by KaplanMeier method,and the value of different criteria was evaluated.The Long-Rank test and COX proportional hazards regression model were performed to analyze the prognostic factors.the model of criteria was established according the most important prognostic factors.Using the Kaplan-Meier method,the suitable cut-offs of every variable ifl the model were found by comparing the survival and the number of the patients who met the cut-off,and considering the significant difference between the patients who met and exceed the cut-off at the same time.Resuits The 1,2,3-year accumulative survival rates of the 19 patients who met Milan criteria were 87.7%,87.7%,and 52.6%respectively:the 1,2,3-year disease free survival rates of them were 88.9%,72.7%,and 72.7%respectively.The 1,2.3-year accumulative survival rates of the 26 patients who met UCSF criteria were 87.2%,80.5%,and 55.2%respectively;the 1,2,3-year disease free survival rates of them were 84.1%,68.4%,and 68.4%respectively.With our new expanded criterion as of solitary tumor≤8 cm in diameter.or no more than 3 tumors,with the largest≤6 am,and a total tumor diameter≤10 cm.there was no significant difierence in 1,2,3-year sunrival rates and disease free survival rates(89.0%,81.8%,71.8%,and 81.9%,72.4%,72.4%.)as compared with Milan or UCSF criteria.but with this new criterion more patients(a=41)would be eligible for transplantation with a comparable long term survival.and the difference of the accumulative survival rates and disease free survival rates of the patients who met and exceed the new criteria was significant(P＜0.05).Conclusion The new indication is acceptable because the criteria does not adversely impact survival.

Objective:To design a Checklist for quality control in intensive care unit and observe the effect of clinical application.Methods:By consulting guidelines and literature, such as Critical care medicine professional medical quality control index (2015 edition), the quality control Checklist of intensive care unit was designed. It included four parts: quality control data collection, medical record quality verification, special diagnosis and treatment, and hospital infection prevention and control supervision. Every month, a doctor with a senior professional title served as the quality control director, and was responsible for the quality control of the department's medical care, including collecting data of the past 24 hours during the morning handover, discussing and registering special diagnosis and treatment behaviors that would be performed on the day, and coordinating with the nursing team leader, controlling the quality of the whole department throughout the day, such as supervising each medical staff if they had unreasonable behaviors, checking the running and discharge medical records, and inspecting the status of the staff on duty. The data in 2018, 2019 (Checklist implemented) and 2017 (Checklist not implemented) were retrospectively analyzed, including the status of admitted patients, department management information, length of intensive care unit (ICU) stay, and the incidence of three-tube infection [ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI)], and standardized mortality, etc. Results:From 2017 to 2019, the number of patients admitted was 373, 446, and 480, with annual growth of 19.57% and 7.62% in 2018 and 2019, respectively, and an increase of 28.69% in 2019 compared with 2017. There was no statistically significant difference in the average age and acute physiology and chronic health evaluationⅡ (APACHEⅡ) of patients in the three years. Compared with 2017, the length of ICU stay of patients in 2018 and 2019 were significantly shortened (days: 8.99±6.12, 9.14±7.02 vs. 10.20±7.21), and the incidence of VAP, CRBSI and CAUTI were significantly reduced [VAP (cases/1 000 ventilation days): 12.97±3.60, 9.62±3.14 vs. 17.48±4.89, CRBSI (cases/1 000 catheter days): 3.75±2.19, 3.87±1.87 vs. 6.19±3.13, CAUTI (cases/1 000 catheter days): 3.29±2.18, 3.28±1.87 vs. 5.61±3.18]. The standardized mortality were also significantly reduced [(77.27±7.24)%, (70.61±7.49)% vs. (84.41±9.05)%], the number of non-compliance with hospital infection prevention per month decreased significantly (person times: 54.00±6.30, 41.08±10.76 vs. 72.08±19.68), and the number of special diagnosis and treatment per month increased significantly (person times: 1 056.67±235.27, 1 361.75±278.48 vs. 722.25±145.96), the rate of etiology submission before antimicrobial treatment [(93.21±3.68)%, (96.59±2.49)% vs. (87.86±5.28)%] and deep vein thrombosis (DVT) prevention rate [(91.13±6.36)%, (96.23±2.99)% vs. (85.58±7.68)%] were significantly improved, and all the differences were statistically significant (all P < 0.05). All medical records in the three years were Grade A, but the average scores in 2018 and 2019 were higher than those in 2017 (96.82±2.84, 96.73±2.94 vs. 93.70±3.33, both P < 0.01). Compared with 2018, the incidence of VAP, the rate of etiology submission before antimicrobial treatment, the DVT prevention rate, and the standardized mortality rate in 2019 were further improved, and the number of non-compliance with hospital infection prevention per month decreased and the number of special diagnosis and treatment per month increased, and the differences were statistically significant (all P < 0.05). Conclusion:The application of quality control Checklist in intensive care unit can build an effective quality control system, reduce the incidence of three-tube infection, standardized mortality and length of ICU stay, improve the quality control awareness and execution of medical staff, and promote the improvement of medical quality.

Objective To retrospectively analyze clinical features,treatment methods and efficacy of giant cell tumor of bone in proximal tibia,and to investigate risk factors affecting tumor recurrence and functional outcomes.Methods A total of 250 patients with giant cell tumor of bone in proximal tibia confirmed by pathology,who had undergone surgical treatment from March 2000 to July 2014,were enrolled in this study.There were 132 males and 118 females,with an average age of (34.59±12.86) years.A total of 140 patients who were followed up for more than 3 years were included in this study,and there were 72 males and 68 females,with an average age of (34.46± 11.96) years.There were 11 cases of Campanacci grade Ⅰ,58 cases of grade Ⅱ,71 cases of grade Ⅲ and pathological fracture of 47 cases.According to surgical methods,they were divided into bone grafting group (49 cases),bone cement filling group (34 cases),prosthesis group (46 cases) and others group (11 cases).The epidemiology,clinical and radiographic features and risk factors affecting tumor recurrence and functional outcomes were analyzed.Results A total of 140 patients were followed up,the follow-up period was 36-324 months,with an average of 95.4 months,and the median follow-up time was 88 months.Recurrence was found in 26 cases,and recurrence rate was 18.57％,with an average recurrence interval of 25.85 months.Recurrence was found in 17 cases in the first 2 years.The 5-year free survival rate was 77.60％.The recurrence rates were 18.37％ in bone grafting group,20.59％ in bone cement filling group,15.22％ in prosthesis group and 27.27％ in the others group,no statistically difference was found on recurrence rate and free survival rate (P=0.805,P=0.558).Recurrence was not related to all kinds of factors.A variety of related factors affecting postoperative recurrence were analyzed,sex,the first diagnosis of the original recurrence,left and right side,whether the eccentricity,fracture,cortical bone destruction,soft tissue mass,surgical methods,high-speed grinding,auxiliary application,and there was no significant correlation between recurrence and these factors.The MSTS 93 score was 25.26±4.31.Function of the primary patients was better than that of recurrence (P=0.044).Function of the patients treated with curettage with or without internal fixation was better than that with segmental resection (P=0.011).Function of the patients treated with grafting or bone cement filling was better than that with prosthesis or allograft-prosthesis reconstruction (P=0.004).There were no significant correlation between MSTS function score and gender,left and right side,whether the eccentricity,whether fractures,cortical bone destruction (Campanacci grade),whether there is soft tissue mass,whether the use of assisted inactivation,whether the use of grinding or internal fixation.Conclusion Various surgical methods had no significant effect on the recurrence of proximal tibial GCT,as for GCT in proximal tibia,there is no relation between recucrrence and related factors.Whether primary tumor and surgical methods are two important factors affecting limb function.

Objective To detect the expression of Beclin1 and Bcl2 in invasive pituitary adenomas and to explore the relationship of Beclin1 and Bci2 in invasive pituitary adenomas and the relativity between the 2 genes.Methods 61 specimens were classified into invasive group (32 cases) and non-invasive group (29 cases) according to the comprehensive evaluation of invasive pituitary adenomas.lmmunofluorescence analysis and RT-PCR were adopted respectively to detect the protein and mRNA expressions of Beclinl and Bcl2.The difference and relativity of Beclin1 and Bcl2 expression in invasive group and non-invasive group were analyzed.Results 32 specimens of pituitary adenoma were invasive and 29 were non-invasive.Beclin1 protein and mRNA expressions were lower in the invasive group than in the non-invasive group (P ＜0.01 ).Bcl2 protein and mRNA expressions were higher in the invasive group than in the non-invasive group (P ＜0.01 ).Pearson related analysis showed that Beclin1 mRNA expression was negtively correlated with Bcl2 mRNA expression in the invasive group ( r =-0.42,P =0.028 ).Conclusions Beclinl expression is decreased in invasive pituitary adenomas.The invasiveness of pituitary adenoma is closely related to the high expression of Bcl2 protein and mRNA,and the low expression of Beclin1 protein and mRNA.The inhibition of the autophagy may lead to the enhancement of the invasiveness of pituitary adenomas and that inhibition may come from the interaction of Beclin1 and Bcl2.

Colorectal cancer (CRC) is one of the most common malignant tumors.Accumulating evidences suggests that gut microbiota play an important role in CRC initiation and progression.Chinese herbal medicine has certain regulation effects on disorders of gut microbiota.In current review,we discuss the changes of gut microbiota in CRC patients,and summarize the effects of gut microbiota on CRC progression and their underlying mechanisms through barrier function,inflammation,bacterial enzymes,toxic metabolites,as well as the effects of Chinese herbal medicine on gut microbiota.This review provides a basic scientific and clinical application of gut microbiota in CRC.

Objective: To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support. Methods: A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected. Results: ① At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7 088.38±559.41, 6 751.34±558.72 vs. 7 553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7 553.44±645.55 vs. 6759.21±668.14, 7 088.38±559.41 vs. 6 759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6 751.34±558.72 vs. 6 759.21±668.14, 6 568.03±760.19 vs. 6 759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6 089.55±560.70 vs. 6 759.21±668.14, 5 992.55±501.82 vs. 6 759.21±668.14, 5 860.84±577.59 vs. 6 759.21±668.14, all P < 0.01). ② After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. ③ The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P < 0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24% vs. 24.14%, P > 0.05). Conclusions Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.

Objective To investigate the safety and efficacy of embolization of inferior phrenic artery as nonbronchial systemic artery(NBSA) for hemoptysis.Methods Imaging and clinical data of 1 1 patients with inferior phrenic artery as NBSA were analyzed retrospectively, and complications and hemoptysis recurrence rate were recorded.Results Seven patients underwent enhanced CT examination and 4 patients underwent plain CT examination before embolization.Six of those patients who underwent enhanced CT examination were found abnormal arteries,and were confirmed as NBSA by angiography.The other 5 patients were found unmatch of lesion distribution and bronchial arteries during procedure,and inferior phrenic artery as NBSA were found by expanding angiography.All procedure were successfully performed,3 cases occurred hiccup and need not treatment.No serious complications occurred,such as incontinence and paraplegia.During (1 8.7 ± 1 3.8)months follow-up,only 1 patient recurrence of hemoptysis,and successful after conservative treatment,and the other 10 patients had no recurrence of hemoptysis.Conclusion The inferior phrenic artery as NBSA can induce hemoptysis.It is safe to embolization of the inferior phrenic artery,which can reduce the recurrent rate of hemoptysis.

Objective:To analyze the relationship between the expression of microRNA-126 (miR-126) in peripheral blood lymphocytes with apoptosis and prognosis in patients with sepsis, and to explore its potential regulatory mechanism.Methods:Thirty patients with general infection and 20 patients with sepsis admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of Bengbu Medical College from January to December 2019 were enrolled. Peripheral blood was taken to separate lymphocytes, and the expressions of miR-126 and caspase-3 were detected by reverse transcription-polymerase chain reaction (RT-PCR). At the same time, the liver and kidney function and other laboratory indexes were measured, and the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores were calculated. The 28-day prognosis was observed. Pearson method was used to analyze the correlation between miR-126 and caspase-3, APACHEⅡ score. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of miR-126 on prognosis; at the same time, according to the best cut-off value of miR-126 in predicting prognosis, the patients were divided into two groups, and the 28-day Kaplan-Meier survival curve was drawn.Results:The expression of miR-126 in peripheral blood lymphocytes of patients with sepsis was lower than that of patients with general infection [miR-126 mRNA (2 -ΔCt): 1.239±0.134 vs. 1.599±0.110, P < 0.01], while the expression of caspase-3 and APACHEⅡ score were significantly increased [caspase-3 mRNA (2 -ΔCt): 1.172±0.132 vs. 0.901±0.143, APACHEⅡ: 19.75±3.74 vs. 12.63±3.94, both P < 0.01]. Pearson correlation analysis showed that the expression of miR-126 was negatively correlated with the expression of caspase-3 ( r = -0.678, P < 0.001) and APACHEⅡ score ( r = -0.581, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting the prognosis by miR-126 expression in peripheral blood lymphocytes was 0.823 ( P < 0.001). When the best cut-off value was 1.395, the sensitivity was 75.0%, the specificity was 71.4%, the positive predictive value was 81.1%, the negative predictive value was 63.6%, the positive likelihood ratio was 2.622, and the negative likelihood ratio 0.350. In addition, the patients were divided into high miR-126 group (miR-126 > 1.395, n = 31) and low miR-126 group (miR-126 ≤ 1.395, n = 19) according to the best cut-off value of miR-126. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate of high miR-126 group was higher than that of low miR-126 group (Log-Rank: χ 2 = 11.702, P = 0.001). Conclusion:miR-126 in peripheral blood lymphocytes of patients with sepsis may affect immune status by promoting apoptosis of lymphocytes, and its expression level can reflect the severity and prognosis of sepsis.