Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.

Objective:To investigate the effects of chest pain center construction in basic-level hospitals on treatment time and short-term prognosis in patients with acute ST-elevation myocardial infarction.Methods:A total of 162 patients with acute ST-elevation myocardial infarction who received percutaneous coronary intervention (PCI) in The First People's Hospital of Jiande between November 2014 and November 2018 were included in this study. Among them, 66 patients who received treatment in The First People's Hospital of Jiande between November 2014 and October 2016 were included in the control group. The remaining 96 patients who received treatment between November 2016 and November 2018 were included in the study group. The underlying diseases, PCI success rate, first medical contact-to-balloon time, door-to-balloon time, in-hospital mortality, incidence of heart failure on the next day of PCI, length of hospital stay, hospital medical cost were retrospectively analyzed.Results:There were no significant differences in underlying disease composition ratio and PCI success rate between the two groups (both P > 0.05). There were significant differences in first medical contact-to-balloon time [(185.2 ± 53.7) minutes vs. (108.6 ± 46.4) minutes, t = 6.128], door-to-balloon time [(121.5 ± 23.2) minutes vs. (68.7 ± 14.3) minutes, t = 7.341], length of hospital stay [(10.3 ± 3.5) days vs. (7.2 ± 2.8) days, t = 5.128], hospital medical cost [(43 582.0 ± 7 186.5) yuan vs. (35 479.0 ± 4 213.1) yuan, t = 8.361], in-hospital mortality [6.1% vs. 3.1%, χ2 = 4.784], the incidence of heart failure on the next day of PCI [13.6% vs. 4.2%, χ2 = 8.253] between the control and study groups (all P < 0.05). Conclusion:Establishment of a standardized chest pain center construction in basic-level hospital can greatly shorten the first medical contact-to-balloon time, door-to-balloon time and length of hospital stay, improve the cardiac function and prognosis of patients with myocardial infarction, and reduce medical cost.

Objective To investigate the transport and deposition behaviors of lowdensity lipoproteins (LDL) in the carotid artery and explore their associations with hemodynamic and morphological factors, so as to provide theoretical references for assessing the risk and predisposing regions of atherosclerosis based on the characteristics and associated factors of LDL deposition at the carotid artery wall. Methods Subject-specific computational models of the carotid artery based on medical images from six healthy volunteers were built, and the transport and wall deposition of LDL under pulsatile flow conditions were simulated, and finally the correlations of wall LDL concentration and total area of regions with LDL concentration polarization with flow velocity and morphological parameters of the carotid artery were quantitatively analyzed. Results Regions with significant LDL deposition often appeared in carotid sinus near distal end of the common carotid artery, with the degree and spatial distribution of deposition differing considerably among subjects. The degree of LDL deposition was determined mainly by flow velocity, i.e., the lower the flow velocity was, the higher the degree of LDL deposition and accordingly the larger the area of wall regions with LDL concentration polarization was; whereas the spatial distribution of LDL deposition was significantly affected by morphological characteristics (especially bifurcation eccentricity ratio) of the carotid artery, for example, the distribution patterns could be divided into two typical types (i.e., circular distribution, unilateral distribution) according to bifurcation eccentricity ratio. Conclusions Flow velocity and morphological characteristics of the carotid artery are major factors determining respectively the degree and spatial distribution of LDL deposition, and therefore subject-specifically measuring these parameters will provide useful information for screening individuals at high risk of atherosclerosis or identifying atheroprone regions.

In China,peritoneal metastasis of gastric cancer has main characteristics of high incidence,late staging and poor prognosis.However,the proposal of conversion therapy has brought hope to patients.Conversion therapy of peritoneal metastasis in gastric cancer is a novel concept,which aims at down-staging of the gastric cancer's primary lesion and effectively controlling the peritoneal metastases at the same time through valid chemotherapy and other means.Then the surgeons strive for performing radical gastrectomy and lymph node dissection (D2) to prolong survival time of the patients with advanced gastriccancer and improve their life quality.Systemic chemotherapy is the core of the methods of conversion therapy,while the local intraperitoneal chemotherapy can be used as a supplement.Neoadjuvant intraperitoneal-systemic chemotherapy (NIPS) is the most promising technique as conversion therapy due to the comprehensive advantages of the systemic chemotherapy and local intraperitoneal chemotherapy.In recent years,there were many clinical studies reporting NIPS for conversion therapy of peritoneal metastasis in gastric cancer.Therefore,this paper systematically reviews experiences of clinical application in order to provide references for clinical practice of conversion therapy in gastric cancer.

Objective To explore the effects of Bushen Jiedu Formula combined with auricular pressure by coxherb seeds on cancer pain and quality of life in patients with advanced colorectal canc-er.Methods A total of 120 patients with advanced colorectal cancer admitted to our hospital from June 2019 to May 2023 were included in the study,and were randomly divided into two groups.The control group(60 cases)received routine nursing care and the"three-step"analgesic method to in-tervene pain,while the observation group(60 cases)received treatment with Bushen Jiedu Formula combined with auricular pressure by coxherb seeds on the basis of the control group.Both groups were treated for one month.The Numerical Rating Scale(NRS)score,the therapeutic effect,the quality of life(QOL)score and the occurrence of adverse reactions were compared between the two groups before and after treatment,and the levels of substance P(SP),β-endorphin(β-EP)and prostaglan-din E2(PGE2)of the two groups before and after treatment in serum were detected.Results After treatment,the NRS score and the levels of SP,β-EP and PGE2 in the observation group were(2.23±0.64),(11.51±2.64)ng/mL,(78.64±9.46)ng/L and(41.90±6.32)ng/L,re-spectively,which were lower than(2.87±1.25),(15.64±2.42)ng/mL,(101.29±11.26)ng/L and(78.63±10.17)ng/L,respectively of the control group(P＜0.05).The total effective rate and QOL score of the observation group were 90.00％and(51.92±5.66),which were higher than 75.00％and(43.58±5.12),respectively of the control group(P＜0.05).There was no signifi-cant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclu-sion The combination of Bushen Jiedu Formula and auricular pressure by coxherb seeds can obvi-ously improve the cancer-induced pain of patients with advanced colorectal cancer,improve their quality of life,and have good safety.

Objective To explore the effects of Bushen Jiedu Formula combined with auricular pressure by coxherb seeds on cancer pain and quality of life in patients with advanced colorectal canc-er.Methods A total of 120 patients with advanced colorectal cancer admitted to our hospital from June 2019 to May 2023 were included in the study,and were randomly divided into two groups.The control group(60 cases)received routine nursing care and the"three-step"analgesic method to in-tervene pain,while the observation group(60 cases)received treatment with Bushen Jiedu Formula combined with auricular pressure by coxherb seeds on the basis of the control group.Both groups were treated for one month.The Numerical Rating Scale(NRS)score,the therapeutic effect,the quality of life(QOL)score and the occurrence of adverse reactions were compared between the two groups before and after treatment,and the levels of substance P(SP),β-endorphin(β-EP)and prostaglan-din E2(PGE2)of the two groups before and after treatment in serum were detected.Results After treatment,the NRS score and the levels of SP,β-EP and PGE2 in the observation group were(2.23±0.64),(11.51±2.64)ng/mL,(78.64±9.46)ng/L and(41.90±6.32)ng/L,re-spectively,which were lower than(2.87±1.25),(15.64±2.42)ng/mL,(101.29±11.26)ng/L and(78.63±10.17)ng/L,respectively of the control group(P＜0.05).The total effective rate and QOL score of the observation group were 90.00％and(51.92±5.66),which were higher than 75.00％and(43.58±5.12),respectively of the control group(P＜0.05).There was no signifi-cant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclu-sion The combination of Bushen Jiedu Formula and auricular pressure by coxherb seeds can obvi-ously improve the cancer-induced pain of patients with advanced colorectal cancer,improve their quality of life,and have good safety.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.