OBJECTIVE To investigate the selection strategy for recipient vessels in free flap reconstruction of head and neck defects.METHODS A retrospective analysis was conducted on 96 patients who underwent 99 free flap reconstructions for head and neck defects between January 2020 and December 2024.Recipient vessel selection,flap survival,and postoperative complications were analyzed based on defect location and flap type.RESULTS In 99 cases microvessel anastomosis,the recipient arteries were superior thyroid artery in 49 branches,facial artery in 28 branches,superficial temporal artery in 14 branches,lingual artery in 5 branches.external carotid artery in 1 branch,transverse cervical artery in 1 branch,and superior laryngeal artery in 1 branch.Venous anastomosis was performed in 104 branches,with 94 cases in 1 venous anastomosis and 5 cases in 2 venous anastomoses.The recipient veins selected were facial vein in 62 branches,external jugular vein in 21 branches,superficial temporal vein in 12 branches,retromandibular vein in 3 branches,middle thyroid vein in 2 branches,internal jugular vein in 2 branches,middle temporal vein in 1 branch,and superior thyroid vein in 1 branch.Complete flap necrosis occurred in 5 cases,and partial necrosis occurred in 4 cases.When the recipient vessels were deficient,the lingual artery was chosen in 3 cases,the facial artery in 1 case,the external jugular vein in 3 cases,the internal jugular vein with end-to-side anastomosis in 1 case,and the common facial vein with end-to-side anastomosis in 1 case.CONCLUSION In free flap reconstruction for head and neck defects,the superior thyroid artery,facial artery,and superficial temporal artery are commonly used as recipient arteries,while the facial vein,external jugular vein,and superficial temporal vein are frequently selected as recipient veins.When recipient vessels are scarce,the ipsilateral lingual artery,transverse cervical artery,and main trunk of the internal jugular vein can serve as alternative recipient vessels.

Given the increasing concern regarding antibacterial resistance, the antimicrobial properties of naphthoquinones have recently attracted significant attention. While 1,4-naphthoquinone and its derivatives have been extensively studied, the antibacterial properties of 5,8-dihydroxy-1,4-naphthoquinone derivatives remain relatively unexplored. This study presents a comprehensive in vitro and in vivo analysis of the antibacterial activity of 35 naturally sourced and chemically synthesized derivatives of 5,8-dihydroxy-1,4-naphthoquinone. Kirby-Bauer antibiotic testing identified three compounds with activity against methicillin-resistant Staphylococcus aureus (MRSA), with one compound (PNP-02) demonstrating activity comparable to vancomycin in minimum inhibitory concentration, minimum bactericidal concentration (MBC), and time-kill assays. Microscopic and biochemical analyses revealed that PNP-02 adversely affects the cell wall and cell membrane of MRSA. Mechanistic investigations, including proteomic sequencing analyses, Western blotting, and RT-qPCR assays, indicated that PNP-02 compromises cell membrane integrity by inhibiting arginine biosynthesis and pyrimidine metabolism pathways, thereby increasing membrane permeability and inducing bacterial death. In an in vivo mouse model of skin wound healing, PNP-02 exhibited antibacterial efficacy similar to vancomycin. The compound demonstrated low toxicity to cultured human cells and in hemolysis assays and remained stable during serum incubation. These findings suggest that PNP-02 possesses promising bioactivity against MRSA and represents a potential novel antibacterial agent.
Methicillin-Resistant Staphylococcus aureus/genetics* ; Anti-Bacterial Agents/chemistry* ; Naphthoquinones/administration & dosage* ; Animals ; Microbial Sensitivity Tests ; Mice ; Humans ; Staphylococcal Infections/microbiology* ; Molecular Structure

Objective:To explore the status and influencing factors of participation in cardiac rehabilitation of cardiovascular nurses.Methods:This is a cross-sectional study. From January to February 2022, a total of 3 047 cardiovascular nurses in members of China Cardiovascular Health Alliance were selected as research objects by convenience sampling method. General data questionnaire and Cardiovascular Nurses Participated in the Cardiac Rehabilitation Questionnaire (CNPCRQ) were used to investigate cardiovascular nurses. Multiple linear regression analysis was used to investigate the influencing factors of participation in cardiac rehabilitation of cardiovascular nurses. A total of 3 047 questionnaires were distributed in this study, and 2 704 valid questionnaires were effectively received, with an effective recovery rate of 88.74%.Results:The total score of CNPCRQ of cardiovascular nurses was (93.23±31.58), which was at a moderate level. Multiple linear regression analysis results showed that age, education, professional title, hospital location, hospital level, position type and hospital type were the influencing factors of participation in cardiac rehabilitation of cardiovascular nurses.Conclusions:The status of participation in cardiac rehabilitation of cardiovascular nurses in China needs to be improved. Role and job content of cardiovascular nurses should be further clarified, and cardiac rehabilitation knowledge and skills training should be strengthened in the future, so as to promote the profession development of cardiac rehabilitation and improve patients' health outcomes.

In recent years,the effective management of patients with chronic kidney disease(CKD)is gaining growing attention.In 2014,our hospital established the CKD generalist-specialist combination management model,which incorporates a set of CKD management processes.The generalist component incorporates the following,general practitioners from 6 community health centers in the surrounding areas(with about 650 000 permanent residents in the region)joining hands,setting up a management team composed of doctors and nurses,and formulating management protocols for patient follow-up,patient record management,screening,risk assessment,examination and treatment,nutrition and exercise,and two-way referrals.The specialist component of the model incorporates the following,providing trainings for general practitioners in the in the community in the form of lectures on special topics and case discussion sessions,and organizing 7 national-level workshops for continuing medical education in the past decade,covering about 1 400 participants.In addition,regular meetings of the support groups of patients with renal diseases were organized to carry out information and education activities for patients.We have set up 4 community-based training centers and 6 specialized disease management centers,including one for diabetic nephropathy.We have retrospectively analyzed the risk factors of elderly CKD patients by establishing the elderly physical examination database(which has a current enrollment of 26 000 people),the elderly community CKD cross-sectional survey database,and the elderly CKD information management system.After 10 years of management practice,the level of institutionalization and standardization of CKD specialty management in our hospital has been improved.Moreover,we have expanded the management team and extended the management base from the hospital to community.We have improved the level of CKD management in community health centers and improved the specialty competence of the general practitioners in the communities.The generalist-specialist combination management model makes it possible for CKD patients to receive early screening and treatment,obtain effective and convenient follow-up and referral services,and improve their quality of life.Patients with complications such as diabetes,hypertension,and sarcopenia could access treatments with better precision.It is necessary to carry out the generalist-specialist integrated management of CKD,which is worthy of further development and improvement.

Objective:To compare the consistency between bioelectrical impedance analysis(BIA)and dual-energy X-ray absorptiometry(DXA)in skeletal muscle mass assessment in elderly patients with advanced chronic kidney disease(CKD), and to provide a basis for accurate clinical diagnosis of sarcopenia.Methods:Elderly patients with advanced CKD at the Department of Nephrology of Shanghai Sixth People's Hospital were included.Parameters for physical performance included handgrip strength and gait speed, and body muscle mass was measured by DXA and multifrequency BIA.The consistency between the two methods was assessed by the intraclass correlation coefficient, Bland-Altman analysis and kappa coefficient test.Results:This study included 67 elderly patients with advanced CKD with a mean age of(70.7±6.1)years and an average BMI of(24.6±3.5)kg/m 2.The proportion of enrolled male patients was 61.2% and the mean estimated glomerular filtration rate was(27.7±12.7)ml·min -1·1.73m -2.The intraclass correlation coefficients of muscle mass and appendicular skeletal-muscle mass index(ASMI)measured by BIA and DXA ranged from 0.81 to 0.90.Bland-Altman analysis showed that BIA overestimated muscle mass against DXA, and the mean difference in ASMI was(0.44±0.13)kg/m 2.In addition, there was a moderate agreement between the two measurement methods for determining muscle loss(Kappa=0.47). Conclusions:BIA and DXA offer a fair level of consistency in the assessment of muscle mass in elderly patients with advanced CKD.However, compared with DXA, BIA overestimates muscle mass in elderly patients with CKD.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Objective:To investigate the clinical characteristics and related risk factors of sarcopenia in elderly patients undergoing maintenance hemodialysis.Methods:This was a retrospectively study involving 135 elderly hemodialysis patients aged(70.6±7.7)years, with 46(34.1%)females and a mean hemodialysis duration of(3.2±2.9)years, at Shanghai Sixth People's Hospital.The incidence of sarcopenia in patients was examined by measuring handgrip strength, walking speed and muscle mass of the limbs using bioelectrical impedance analysis.Related risk factors were analyzed with univariate and multivariate logistic regression analysis.Results:Among 135 elderly hemodialysis patients, the incidence of sarcopenia was 62.9%(85 cases), and severe sarcopenia cases accounted for 44.4%(60 cases). Compared with the non-sarcopenia group, patients with sarcopenia were older, had lower body mass index(BMI)and handgrip strength, walked more slowly and had less muscle mass in their limbs.Advanced age, low BMI and long dialysis duration were correlated with the high incidence of sarcopenia in elderly dialysis patients.The odds ratio( OR)for sarcopenia increased by 12% per year, and the OR decreased by 32% with an increase of 1.0 kg/m 2 in BMI.Advanced age and lower BMI were also correlated with a high incidence of severe sarcopenia( OR=1.12, 95% CI: 1.05~1.18; OR=0.84, 95% CI: 0.74~0.95; all P<0.01). Conclusions:The incidence of sarcopenia is high in elderly hemodialysis patients and is closely related to advanced age and low body weight.Improving nutritional status and avoiding low body weight will help reduce the occurrence and development of sarcopenia in elderly hemodialysis patients.

Objective: As the prevention and control of COVID-19continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China. However, the false-positive rate of positive results in the screening has not been reported up to now. But to clearify the false-positive rate during screening is important in COVID-19 control and prevention. Methods: Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present. The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings. Results: When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19.67%, in contrast, the false-positive rate of positive results was 80.33%. The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47%. Conclusions In the close contacts of COVID-19 patients, nearly half or even more of the 'asymptomatic infected individuals’ reported in the active nucleic acid test screening might be false positives.

The flipped class model is student-centered,which turns the traditional "teaching firstlearning behind" into the "learning first-teaching behind".The flipped class model can improve students' autonomous learning ability and other abilities.This article introduces the application of the flipped class in the course of medical immunology,including the course content selection,building QQ group learning platform,the production and release of independent learning resources,enactment of the task order and learning requirements,the design and implementation of classroom teaching activities and so on.The review and reflection of the formative assessment is also carried out.Through the reflection of the problems in the teaching,it is expected to lay the foundation for the promotion of the overturned class.