Objective:To investigate the predictive effect of postoperative blood lipid metabolism and C-reactive protein/albumin ratio (CAR) on anastomotic fistula after radical resection of esophageal cancer.Methods:A retrospective case-control study was conducted on 256 patients with esophageal squamous cell carcinoma (all aged >50 years) who underwent radical esophagectomy in the thoracic surgery of the Second Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. Total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), ratio of C-reactive protein to albumin (CAR) and hemoglobin test index were collected. According to whether there was anastomotic fistula after operation, the patients were divided into anastomotic fistula group and non-anastomotic fistula group. The measurement data of normal distribution were compared by t-test, the measurement data of non-normal distribution were expressed by M( Q 1, Q 3), the comparison between groups was expressed by Mann-Whitney U test, and the counting data were expressed by (case(%)).The comparison between groups was performed by χ 2 test. Logistic regression model was used for multivariate analysis. ROC curve and Kappa value were used to evaluate the predictive value of total cholesterol and CAR in postoperative anastomotic fistula. Results:The preoperative body mass index (BMI) ((18.71±1.90) kg/m 2) in anastomotic fistula group was higher than that in non-anastomotic fistula group ((20.59±2.88) kg/m 2), and the difference was statistically significant ( t=3.48, P=0.001). The postoperative total cholesterol ((5.44±1.09) mmol/L), LDL-C ((3.82±1.15) mmol/L) and CAR(0.64(0.41, 0.95)) in anastomotic fistula group were higher than those in non-anastomotic fistula group ((4.54±0.94) mmol/L, (2.92±0.76) mmol/L, 0.27(0.13,0.45)). There were significant differences between the two groups (the statistical values were t=4.84, t=5.69, Z=5.16, all P<0.001)). The hemoglobin concentration of 103.20 (84.94,110.48) g/L was lower than that of non anastomotic fistula group (107.68 (99.20,125.20) g/L), the difference was statistically significant ( Z=2.82, P=0.005). Lower BMI( OR=0.652,95% CI 0.482-0.882), higher total cholesterol( OR=3.240,95% CI 1.430-7.340), lower hemoglobin ( OR=0.837,95% CI 0.777-0.902) and higher CAR( OR=2.161,95% CI 1.597-2.925) were the risk factors of anastomotic fistula in esophageal squamous cell carcinoma( P values were 0.006, 0.005, <0.001 and <0.001,respectively). ROC curve analysis showed that the areas under the curve of total cholesterol and CAR were 0.742 (95% CI:0.643-0.841, P<0.001) and 0.790 (95% CI:0.690-0.890, P<0.001) respectively. The cutoff values were 4.915 mmol/L and 0.605, the sensitivity were 80.0% and 80.0%, the specificity were 82.3% and 92.5%, respectively, and the Kappa values were 0.418 and 0.625 respectively (all P<0.001). Conclusion:Total cholesterol and CAR after radical resection of esophageal cancer have a certain predictive value for postoperative anastomotic fistula in patients with esophageal squamous cell carcinoma. The predictive result of CAR is better than that of total cholesterol.

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot.Methods From March 2013 to December 2015,eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study.They were seven males and one female,with age range of 18-51 years (mean,34.5 years).The foot skin defect area ranged from 18 cm × 12 cm to 13 cm × 10 cm.All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively.The CTA data were entered into Mimics 15.0 software in DICOM format.Based on perforating condition of descending branch of lateral fenoral circunflex artery and the size of foot defect,one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap.The flap size ranged from 24 cm× 9 cm to 19 cm × 7 cm.All reconstructive surgeries were performed secondarily.Patients were all at Ⅱ stage recovery.The survival of flaps and healing status of flap donor sites were observed in one month after surgery.The number of debulking flaps was recorded.The appearance of flaps,shoe wearing,gait and related complications were recorded.Results The follow-up was 10-21 months (mean,15.5 months.All flaps survived uneventfully,and all donor sites were sutured directly.Three patients had twice debulking procedures,three patients had one debulking procedure,and two patients had no debulking.At the last visit in follow-up,the color and texture of flaps were good.All patients were able to wear shoes normally,two patients remained mild abnormal gait,and one patient presented superficial ulcer at the medial of the forefoot.Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications.Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot,which makes precise preoperative planning and intraoperative accurate cutting.

Acute cerebral infarction （ACI）， also known as ischemic stroke， is a disease with a high disability rate， which brings heavy burdens to society and families. Its pathogenesis is related to many factors， of which the inflammatory theory is one of the important mechanisms. In the early stage of ACI， microglia are activated， and the inflammatory mediators， such as interleukins and tumor necrosis factor-α （TNF-α）， released by them induce vascular endothelial cells to express adhesion molecules. The circulating leukocytes （neutrophils， monocyte-macrophages， etc.） are promoted to roll and adhere to the injured vascular endothelium， migrate and cross the blood-brain barrier， penetrate and infiltrate the brain parenchyma， and further expand the local inflammatory response by releasing a variety of proinflammatory mediators， thus exacerbating the tissue injury at the injury site and ischemic penumbra. Traditional Chinese medicine （TCM） has advantages in treating the disease. TCM believes that the occurrence of stroke is related to blood stasis caused by various reasons， which block the brain vessel. This article reviewed the research progress on the effect of activating blood therapy on inflammatory factors in patients with ACI in recent years and discussed its regulation of inflammatory factors in ACI such as interleukin-1 （IL-1）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， TNF-α， C reactive protein （CRP）， and monocyte chemotactic protein-1 （MCP-1）， hoping to elucidate the scientific connotation of TCM treatment of ACI and lay the foundation for further research.

ObjectiveTo analyze the clinical characteristics of 151 local COVID-19 patients in Shanghai， 2022. MethodsThe clinical data of 151 COVID-19 patients admitted to a district-level designated hospital in Shanghai from April 13 to May 10， 2022 were reviewed， and their clinical manifestations， laboratory tests， lung imaging， treatment and outcomes were analyzed. ResultsThe 151 patients ranged from 3 to 97 years old， with a median age of 72 years. Most of them were clustered cases in the communities and families. The main clinical types were mild （95 cases， 62.9%） and general （47 cases， 31.1%）. Most of the 9 severe/critical patients （6.0%） were elderly and complicated with multiple comorbidities. The proportion of people who had not been vaccinated was as high as 66.9%， and the proportion of those among severe/critically ill patients who had not been vaccinated was even higher. The most common first symptoms were expectoration in 71 cases （47.0%）， fever in 51 cases （33.8%） and dry cough in 30 cases （19.9%）. The counts of white blood cells and neutrophils in mild or general group were mostly normal or decreased， and in the severe/critical group increased significantly （P<0.001）. Increase of troponin， D-dimer， creatinine， and myoglobin； and decrease of lymphocytes in severe/critical group were more common than the other clinical types （P<0.05）. The proportions of use of antibiotics， antiviral drugs， thymalfasin and heparin in severe/critical and general patients were significantly higher than those in mild patients （P<0.05）. Among the cured and discharged patients （138 cases， 91.4%）， the median number of days for COVID-19 viral nucleic acid to turn negative after treatment was 12 days. The negative conversion days of mild patients were significantly shorter than those of general patients and severe/critical patients （P<0.01）. Four （2.6%） death patients were all over 80 years old， unvaccinated， combined with multiple comorbidities， and eventually died of those serious comorbidities. ConclusionCOVID-19 patients at the district-level designated hospital are mainly clustered cases， and the proportion of patients who do not receive COVID-19 vaccine is high. Most of the hospitalized patients are mild， but advanced age， multiple underlying diseases， and lack of vaccination are high-risk factors for developing severe disease. Early assessment and comprehensive treatment are the key to improve prognosis.