Objective:To study the expression and clinical significance of alpha-1 antitrypsin (A1AT) in the serum of patients with antiphospholipid syndrome (APS).Methods:The study recruited 131 patients with APS, 48 patients with other autoimmune diseases (8 patients with rheumatoid arthritis, 8 with osteoarthritis, and 32 with systemic erythematous sores), and 49 healthy people were recruited. The patients were admitted to Peking University People's Hospital during January 2019 to June 2022. A1AT expression in the serum of patients with APS and its clinical significance were investigated. Blood samples were collected and the concentration of A1AT in the samples was determined by enzyme-linked immunosorbent assay (ELISA). The correlation between A1AT and clinical and laboratory parameters of APS patients was analyzed. Statistical analysis and graphing were performed using GraphPadPrism 10.1.2. The categorical variables were subjected to the χ2 test, and the continuous variables were subjected to the normal distribution test. If the sample were normally distributed, the independent sample t-test (with homogeneity of variance) or the Welch's t-test (with heterogeneity of variance) was used for comparison between the 2 groups, and one-way analysis of variance (ANOVA) was used for comparison among multiple groups; Otherwise, and the variables were described as M( Q1, Q3), the Mann Whitney U-test was used for comparison between 2 groups, and the Kruskal-Wallis U-test was used for comparison among multiple groups. The Kruskal-Wallis H test was used for multiple comparisons. If the samples were normally distributed, Spearman correlation analysis was used to determine the correlation, otherwise, Pearson correlation analysis was used. Results:The serum A1AT concentrations were significantly higher in APS patients than in patients with other autoimmune diseases [2 048.0(670.6, 2 904.0) μg/ml vs. 1 099.0(0, 1 855.0) μg/ml, U=1 990, P<0.001] and healthy people [2 048.0(670.6, 2 904.0) μg/ml vs. 739.5 (0, 1 232.0) μg/ml, U=1 485, P<0.001]. No statistically significant difference was observed between patients with other autoimmune diseases and healthy people [1 099.0(0, 1 855.0) μg/ml vs. 739.5 (0, 1 232.0) μg/ml, U=924, P=0.060]. Mean serum A1AT concentrations were also higher in patients with both a history of adverse pregnancy and thrombosis than in those with morbid pregnancy only [(3 212 ±1 744)μg/ml vs. (1 965 ±1 500) μg/ml, t=2.27, P=0.026] and thrombosis only [(3 212 ±1 744)μg/ml vs. (1 963 ±1745)μg/ml, t=2.01, P=0.048]. Mean serum A1AT concentrations were higher in patients with both arterial and venous thrombosis than in those with only venous thrombosis [(3 390 ±2 286) μg/ml vs. (2 148 ±1 648) μg/ml, t=3.04, P=0.004]. The mean A1AT concentration was higher in patients with recurrent thrombosis than in patients with single thrombosis [(2 709 ±1 941) μg/ml vs. (1 805 ±1 627) μg/ml, t=2.10, P=0.040]. Using the 95% upper limit of A1AT concentration in healthy controls (1 066 μg/ml) as a cut-off value, the risk of recurrent thrombosis was higher in A1AT-positive than negative TAPS patients [51.0%(25/49) vs. 26.1%(6/23), χ2=3.97, P=0.046]. In terms of laboratory indicators, there was a significant positive correlation between serum A1AT concentration and ESR level ( r=0.28, P=0.045), a significant negative correlation with C4 level ( r=-0.24, P=0.025). There was a significant positive correlation with fibrinogen (FIB) concentration( r=0.25, P=0.027). A1AT was an effective diagnostic marker of APS [AUC(95% CI)=0.769(0.699, 0.847), P<0.001], with a sensitivity of 71.8%, a specificity of 73.7%, and Youden index of 0.452. Conclusion:A1AT was is significantly elevated in the serum of patients with APS and may be associated with the severity of thrombotic event.

Objective:To explore the application value of different methods of segmented latissimus dorsi myocutaneous flap in repairing chest wall defects after local advanced breast cancer surgery.Methods:The clinical data of 64 patients with unilateral locally advanced breast cancer admitted to Shanxi Cancer Hospital from Feb. 2019 to Jan. 2020 were selected. All patients underwent modified radical mastectomy for breast cancer. The patients were divided into two groups according to the random number table method. Antegrade (group A, n=32 cases) and retrograde (group B, n=32 cases) were used to design and cut the segmented latissimus dorsi myocutaneous flap to repair the defects. The range of skin island cut was 14 cm×6 cm-19 cm×7 cm; The donor area of the flap was closed directly. The application effects of the two groups of methods were compared. Results:In group A, one antegrade flap was partially necrotic, while in group B, six retrograde flaps were partially necrotic ( P>0.05). The delayed healing rate of donor site incision in group A was 6.25%, significantly lower than that in group B (25.00%) ( χ2=4.267, P=0.039). All the patients in both groups were followed up for 12 to 24 months, and the appearance and texture of the flaps were satisfactory; Only linear scar was left in the donor area, and the shoulder joint activity was not affected. The mean survival time was 20.8 months. Conclusion:The antegrade latissimus dorsi myocutaneous flap can repair the large area defect of chest wall after LABC, which can ensure the blood supply of the flap to the greatest extent, reduce the closing tension of the donor area, the incidence of postoperative complications, and promote the healing of the incision.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.