Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective To explore whether the biopsy rate and the positive rate of biopsy during colonoscopy can serve as effective indicators for evaluating the diagnostic proficiency of endoscopists.Methods Total fifteen endoscopists from the First Affiliated Hospital of Army Military Medical University,Guiqian International General Hospital and No.958 Hospital of PLA Army were enrolled and served as the study subjects.According to their years of experience,gender and working hours,they were divided into a senior group(n=8)and a junior group(n=7),a male group(n=9)and a female group(n=6),and a morning period(08:00-12:00)and an afternoon period(13:00-18:00).The data of all patients examined by the aforementioned endoscopists between January 2023 and December 2023 were collected,including the basic demographics,colonoscopic results,biopsy outcomes and pathological diagnoses of the patients.ANOVA was used to analyze the differences in the biopsy rate and positive rate of biopsy existed among the endoscopists of different years of experience,gender and working at different periods(morning and afternoon).Additionally,multivariate logistic regression analysis was employed to identify the independent risk factors associated with positive rates of biopsy.Results The senior group had significantly lower biopsy rate[(5.73±0.81)%vs(6.89±0.97)%],but obviously higher positive rate of biopsy[(53.52±3.87)%vs(33.70±7.85)%]than the junior group(both P<0.01).The biopsy rate was notably higher during the morning working time period than the afternoon working time period in all the endoscopits[(6.76±1.11)%vs(5.53±1.57)%,P<0.05].Logistic regression analysis showed that the years of experience[(53.52±3.87)%vs(33.70±7.85)%,OR=92.187,95%CI:3.118～2 725.366,P<0.01)and working time[(48.35±10.50)%vs(37.80±10.65)%,OR=20.885,95%CI:1.266～344.602,P<0.05)were influencing factors for positive rate of biopsy.Conclusion The biopsy rate is low and positive rate of biopsy is high among the senior experienced endoscopists,while,opposite results are seen in the junior experienced clinicians,indicating correlation of biopsy rate and positive rate of biopsy with diagnostic proficiency of endoscopists.

Objective:To analyze interobserver variability in endoscopic diagnostic accuracy of chronic atrophic gastritis (CAG) among endoscopists with varying levels of experience.Methods:Endoscopic examination data from 247 patients who underwent endoscopy from January 2021 to June 2024 at Department of Gastroenterology, the First Affiliated Hospital of Army Medical University ( n=154), Renmin Hospital of Wuhan University ( n=35) and Shanxi Provincial Coal Central Hospital ( n=58) were retrospectively collected. The collected images were reviewed by an expert panel of three individuals with the title of deputy chief physician or above. The final endoscopic Kimura-Takemoto classification diagnosis of the expert panel was regarded as the golden standard. Fourteen endoscopists from the above three centers provided their Kimura-Takemoto classification diagnosis. These endoscopists were divided into the junior group ( n=7, with experience of <2 000 procedures) and the senior group ( n=7, with experience of >10 000 procedures). The difference in the accuracy of endoscopic Kimura-Takemoto classification diagnosis between the groups were analyzed. Results:Diagnostic accuracy for Kimura-Takemoto classification ranged from 65.99% (163/247) to 86.64% (214/247) in the senior group with the overall accuracy of 77.27% (1 336/1 729). The junior group exhibited diagnostic accuracy ranging from 36.44% (90/247) to 72.47% (179/247) with the overall accuracy of 62.12% (1 074/1 729). The senior group demonstrated higher overall diagnostic accuracy than that of the junior group ( χ 2=93.27, P<0.001). The diagnostic accuracy of non-CAG in the senior group was higher than that in the junior group [83.73% (463/553) VS 72.33% (400/553), χ 2=20.27, P<0.001]. The diagnostic accuracy of C-type atrophy in the senior group was higher than that in the junior group [90.10% (801/889) VS 82.79% (736/889), χ 2=19.66, P<0.001] .The diagnostic accuracy of O-type atrophy in the senior group was higher than that in the junior group [83.97% (241/287) VS 68.29% (196/287), χ 2=18.56, P<0.001]. Conclusion:Interobserver variability is observed in the diagnostic accuracy of endoscopic Kimura-Takemoto classification for CAG among endoscopists with different experience levels. Experienced endoscopists exhibit higher diagnostic accuracy for CAG compared with their less experienced counterparts.

Objective:To analyze interobserver variability in endoscopic diagnostic accuracy of chronic atrophic gastritis (CAG) among endoscopists with varying levels of experience.Methods:Endoscopic examination data from 247 patients who underwent endoscopy from January 2021 to June 2024 at Department of Gastroenterology, the First Affiliated Hospital of Army Medical University ( n=154), Renmin Hospital of Wuhan University ( n=35) and Shanxi Provincial Coal Central Hospital ( n=58) were retrospectively collected. The collected images were reviewed by an expert panel of three individuals with the title of deputy chief physician or above. The final endoscopic Kimura-Takemoto classification diagnosis of the expert panel was regarded as the golden standard. Fourteen endoscopists from the above three centers provided their Kimura-Takemoto classification diagnosis. These endoscopists were divided into the junior group ( n=7, with experience of <2 000 procedures) and the senior group ( n=7, with experience of >10 000 procedures). The difference in the accuracy of endoscopic Kimura-Takemoto classification diagnosis between the groups were analyzed. Results:Diagnostic accuracy for Kimura-Takemoto classification ranged from 65.99% (163/247) to 86.64% (214/247) in the senior group with the overall accuracy of 77.27% (1 336/1 729). The junior group exhibited diagnostic accuracy ranging from 36.44% (90/247) to 72.47% (179/247) with the overall accuracy of 62.12% (1 074/1 729). The senior group demonstrated higher overall diagnostic accuracy than that of the junior group ( χ 2=93.27, P<0.001). The diagnostic accuracy of non-CAG in the senior group was higher than that in the junior group [83.73% (463/553) VS 72.33% (400/553), χ 2=20.27, P<0.001]. The diagnostic accuracy of C-type atrophy in the senior group was higher than that in the junior group [90.10% (801/889) VS 82.79% (736/889), χ 2=19.66, P<0.001] .The diagnostic accuracy of O-type atrophy in the senior group was higher than that in the junior group [83.97% (241/287) VS 68.29% (196/287), χ 2=18.56, P<0.001]. Conclusion:Interobserver variability is observed in the diagnostic accuracy of endoscopic Kimura-Takemoto classification for CAG among endoscopists with different experience levels. Experienced endoscopists exhibit higher diagnostic accuracy for CAG compared with their less experienced counterparts.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

To investigate the alleviating effect of glycyrrhizic acid(GA)on chronic toxicity of afla-toxin B1(AFB1)in ducklings.Eighty 4-day-old ducklings were randomly divided into 4 groups,with 20 ducklings in each group,including a blank group,a model group(100 μg/kg AFB1),a high-concentration GA group(100 μg/kg AFB1+100 mg/kg GA),and a low-concentration GA group(100 μg/kg AFB1+50 mg/kg GA),with a trial period of 18 days.At the end of the experi-ment,the body weight of the ducklings in each group,AFB1-DNA content in the liver and liver tis-sues index,the biochemical indicators of liver function,and the pathological changes in liver tissues were examined.Additionally,the oxidative damage status of the liver tissues was eval-uated,and the mRNA expression levels of mitochondria-related apoptosis genes was detected.Com-pared with the control group,the body weight of ducklings in the model group decreased signifi-cantly(P＜0.01),AFB1-DNA content in the tissues increased significantly(P＜0.05),liver swell-ing and yellowing were observed,the liver index increased significantly(P＜0.01),as did the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)(P＜0.01).The AST/ALT levels also increased significantly(P＜0.01),while the serum total protein(TP)content de-creased significantly(P＜0.01).The liver tissues showed a large amount of inflammatory cell infil-tration,vacuolar degeneration,fibrotic changes and apoptosis.The activities of catalase(CAT),glutathione S-transferase(GST),the total antioxidant capacity(T-AOC)of the duckling liver all decreased significantly(P＜0.01)and the mRNA expression of mitochondria-related apoptosis genes Bax,Cyt-c,Caspase-3,and Caspase-9 significantly increased(P＜0.01).Compared with the model group,GA treatment significantly increased the body weight of the model ducklings(P＜0.01),reduced AFB1-DNA content in the tissue,significantly reduced their liver index(P＜0.05),visibly restored the liver's apparent status,effectively reversed the abnormal changes in serum liver function indicators,improved the pathological changes in liver tissue histology,enhanced liver an-tioxidant function,significantly decreased expression of Bax,Cyt-c,Caspase-3,and Caspase-9 mR-NA(P＜0.05).Further correlation analysis showed that mRNA expression levels of Bax,Cyt-c,Caspase-3,and Caspase-9 in duck liver tissues were positively correlated with liver index,AFB1-DNA content,AST content,ALT content,AST/ALT ratio,and MDA content,and negatively cor-related with body weight,TP content,SOD activity,CAT activity,GST activity,and T-AOC activi-ty in ducklings.In conclusion,GA may alleviate liver damage to relieve duckling AFB1 chronic tox-icity by inhibiting the mitochondrial pathway of apoptosis.

Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.

Objective To evaluates the impact of early application of neuromuscular electrical stimulation(NMES)on muscle strength,clinical outcomes,and long-term quality of life improvements in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS).Methods A total of 75 patients diagnosed with SAP and ARDS admitted in Department of Critical Care Medicine of our hospital from September 2022 to August 2023 were recruited and then randomly divided into NMES group(n=37)and control group(n=38).After 16 patients were excluded,including 8 died during treatment,3 discharged and 5 received palliative care,there were finally 29 patients in the NMES group and 30 in the control group.Within 48 h after ICU admission,the NMES group received NMES 1 h per day,for 7 d in addition to standard rehabilitation intervention.While,the control group were given conventional interventions for rehabilitation.Assessments at baseline and post-treatment included the incidence of ICU-acquired weakness(ICU-AW),Medical Research Council(MRC)score,duration of mechanical ventilation,lengths of ICU and total hospital stays,and activity,thickness and thickening fraction of the diaphragm.Mortality rates and Barthel index(BI)for self-care ability in 1,3 and 6 months after discharge were recorded for follow-up assessments.Results The NMES group had significantly lower incidence of ICU-AW(P＜0.05),higher upper and lower limb MRC scores and overall MRC score at ICU discharge(P＜0.05),shorter durations of mechanical ventilation,ICU stay,and total hospital stay when compared with the control group(P＜0.05).There was no statistical difference in the BI at 1 month post-discharge between the 2 groups,but the indexes at 3 and 6 months were notably higher in the NMES group than the control group(P＜0.05).No obvious differences were observed between the 2 groups in terms of diaphragm activity,thickness,or thickening scores at enrollment,ICU discharge,or hospital discharge,nor in mortality rates at 1,3,and 6 months after discharge.Conclusion Combined NMES and early rehabilitation therapy can improve muscle strength and reduce length of hospital stay in SAP patients complicated with ARDS,and may enhance long-term quality of life.However,it does not significantly affect diaphragm function or mortality rates.

Objective:Care bundles for critically ill patients with early enteral nutrition up to goal was constructed. Its purpose was to improve early enteral nutrition, prognosis and provide reference basis for improving the rate of standard of early enteral nutrition in critically ill patients.Methods:By conducting systematic searching of domestic and foreign Chinese and English databases, related guide websites, relevant documents on early enteral nutrition in critically ill patients up to goal, which were obtained, evaluated, extracted, summarized and graded. After discussion by the research group, the first draft was prepared. Delphi method was used to conduct two rounds of expert correspondence, and the final draft of the proposal was established through the reliability analysis of correspondence results.Results:Twenty experts participated finally, and their opinions tended to be consistent after two rounds of expert inquiry. The authority coefficients were 0.92 and 0.91 respectively. The variation coefficients of the importance and operability of the two rounds of correspondence items were 0.05-0.20 and 0.05-0.21, 0.00-0.17 and 0.00-0.20 respectively. The Kendall concordance coefficients for the importance and operability of the two rounds of correspondence items were 0.16 and 0.13, 0.27 and 0.18 respectively. The differences were statistically significant ( χ2 values were 117.01-228.43, all P<0.05). Finally, the final draft of bundle of care for early enteral nutrition up to goal in critically ill patients was established which included three aspects related to evaluation, implementation, and effectiveness monitoring, besides care bundle included 12 intervention perspectives and 29 specific intervention measures. Conclusions:Based on evidence-based and delphi method constructing care bundles for critically ill patients with early enteral nutrition up to goal was scientific, reliable and practical which could provide theoretical and practical guidance for bundled nursing interventions to meet early enteral nutrition standards in critically ill patients.