OBJECTIVE: To explore the effectiveness of primary interventional revascularization combined with secondary perforator composite flap in the treatment of peripheral arterial disease (PAD) accompanied by soft tissue defects around the ankle. METHODS: Between January 2022 and January 2025, 12 patients with PAD and soft tissue defects around the ankle were admitted. Among them, there were 9 males and 3 females; their ages ranged from 52 to 82 years, with an average of 68.9 years. The causes of injury included 4 cases of traffic accident, 5 cases of falls, 1 case of falling from height, 1 case of foreign body puncture injury, and 1 case of electric shock injury. The infection duration ranged from 1 month to 35 years, with a median duration of 3.5 months. The wound size ranged from 5.5 cm×3.0 cm to 15.0 cm×9.0 cm. The ankle-brachial index (ABI) was 0.32±0.12. The visual analogue scale (VAS) score for pain was 3.3±0.5. Preoperative vascular stenosis assessment was performed in all patients, with primary intervention to dredge large and medium-sized arteries, followed by secondary repair of the wound using a perforator composite flap. The flap size ranged from 6.5 cm×4.0 cm to 16.0 cm×10.0 cm. The donor sites were sutured directly or repaired with skin grafts. After two stages of treatment, the effectiveness was evaluated by measuring ABI, observing flap survival and wound healing, assessing VAS scores, and American Orthopedic Foot and Ankle Society (AOFAS) scores. RESULTS: All 12 cases completed two stages of treatment; all patients were followed up after the second-stage treatment, with a follow-up period ranging from 7 to 28 months, with an average of 16.8 months. After the first-stage treatment, the skin temperature around the ankle was significantly higher than that before treatment, and the ABI increased to 0.71±0.07, with a significant difference ( t=9.918, P<0.001). After the second-stage treatment, the blisters on the distal end of the skin flap occurred in 3 cases. The flaps survived and the wounds healed, with a healing time ranging from 10 to 14 days (mean, 11.8 days). The incisions at the donor site healed by first intention, and the skin grafts survived. The VAS score was 0.5±0.5 at 3 weeks, which was significantly lower than that before treatment ( t=13.675, P<0.001). No infection recurrence occurred during follow-up. At 6 months after the second-stage treatment, the AOFAS score of the ankle joint ranged from 92 to 97, with an average of 94.7, all reaching excellent. CONCLUSION Interventional revascularization combined with perforator composite flap for staged treatment of PAD with ankle soft tissue defects can obtain good effectiveness, by unclogging the main blood vessels, improving lower limb blood supply, and improving the survival rate of the skin flap.
Humans ; Male ; Female ; Middle Aged ; Aged ; Peripheral Arterial Disease/surgery* ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Aged, 80 and over ; Ankle/blood supply* ; Treatment Outcome ; Ankle Brachial Index ; Skin Transplantation/methods*

Purpose To investigate the diagnostic significance of modified lung ultrasound score(MPUS)for pediatric bacterial and viral pneumonia.Materials and Methods A total of 93 eligible children with suspected community-acquired pneumonia in Quanzhou Maternal and Child Care Hospital(Quanzhou Children’s Hospital)from December 2022 to June 2023 were elected as the study subjects.All these children received lung ultrasound and the MLUS was recorded according to the ultrasound manifestations of A line,B line and lung consolidation.According to the etiological results,the children were divided into a bacterial pneumonia group and a viral pneumonia group.According to disease severity,the children were divided into the mild group and the severe group.The MLUS was used to analyze the diagnostic significance of pediatric bacterial and viral pneumonia.Results The MLUS in the mild pneumonia group was 7(4,13)points and the MLUS in the severe pneumonia group was 20(14,30)points,and MLUS scores of pneumonia in the two groups were different(Z=-5.205,P<0.05).By drawing receiver operating characteristic curve,MLUS score of 14.5 was used as the cut-off point,the sensitivity for diagnosing severe pneumonia was 75.9%,the specificity was 82.8%.Area under the curve was 0.838.There was no significant differences in MLUS of 8.00(4.00,16.00)between the bacterial pneumonia group and 13.00(7.00,21.75)between the viral pneumonia group(Z=-1.981,P>0.05).The MLUS of 10.00(5.25,17.75)in the mild bacterial pneumonia group and 5.00(4.00,9.50)in the mild viral pneumonia group were significantly different(Z=-3.403,P<0.05).There was no significant differences in MLUS between the severe bacterial pneumonia group and the severe viral pneumonia group(t=0.017,P>0.05).In mild pneumonia,the cut-off value for the modified lung ultrasound score of 10.5 predicted moderate diagnostic efficacy of mild bacterial pneumonia,the area under the curve was 0.747,sensitivity was 50%and specificity was 87.5%.Large-area lung consolidation was more common in the bacterial pneumonia group than in the viral pneumonia group(χ2=8.360,P<0.05).Conclusion The modified lung ultrasound score can effectively evaluate the severity of pediatric bacterial pneumonia and viral pneumonia.For the identification of the two,MLUS may be a certain guiding significance.

Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Objective To analyze the use of anticholinergic medications at discharge among elderly patients with chronic heart failure(CHF)and its associated risk factors.Methods Clinical data of 240 elderly CHF patients admitted in our Department of Cardiovascular Diseases between January 1,2020,and December 31,2023 were colloected.Based on ACB score,they were divided into an an-ticholinergic group(ACB score≥1,223 cases)and a non-anticholinergic group(ACB score of 0,17 cases).Using the ACB score,the anticholinergic burden was quantified,and the relationship be-tween anticholinergic burden and various related factors was analyzed using logistic regression.Results The anticholinergic group had significantly younger age[(75.17±7.21)years vs(79.12±8.75)years,P＜0.05],and larger number of discharge medications[8(6,10)vs 5(4,7),P＜0.01]when compared with the non-anticholinergic group.Logistic regression analysis showed that the number of discharge medications was an independent risk factor for increased anticholinergic bur-den in the elderly CHF patients(OR=1.575,95％CI:1.249-1.986,P=0.001).Conclusion The proportion of elderly CHF patients using anticholinergic medications is relatively high.Clinically,special attention should be given to polypharmacy to reduce the incidence of adverse events caused by anticholinergic drugs.

Objective To analyze the use of anticholinergic medications at discharge among elderly patients with chronic heart failure(CHF)and its associated risk factors.Methods Clinical data of 240 elderly CHF patients admitted in our Department of Cardiovascular Diseases between January 1,2020,and December 31,2023 were colloected.Based on ACB score,they were divided into an an-ticholinergic group(ACB score≥1,223 cases)and a non-anticholinergic group(ACB score of 0,17 cases).Using the ACB score,the anticholinergic burden was quantified,and the relationship be-tween anticholinergic burden and various related factors was analyzed using logistic regression.Results The anticholinergic group had significantly younger age[(75.17±7.21)years vs(79.12±8.75)years,P＜0.05],and larger number of discharge medications[8(6,10)vs 5(4,7),P＜0.01]when compared with the non-anticholinergic group.Logistic regression analysis showed that the number of discharge medications was an independent risk factor for increased anticholinergic bur-den in the elderly CHF patients(OR=1.575,95％CI:1.249-1.986,P=0.001).Conclusion The proportion of elderly CHF patients using anticholinergic medications is relatively high.Clinically,special attention should be given to polypharmacy to reduce the incidence of adverse events caused by anticholinergic drugs.

Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Purpose To investigate the diagnostic significance of modified lung ultrasound score(MPUS)for pediatric bacterial and viral pneumonia.Materials and Methods A total of 93 eligible children with suspected community-acquired pneumonia in Quanzhou Maternal and Child Care Hospital(Quanzhou Children’s Hospital)from December 2022 to June 2023 were elected as the study subjects.All these children received lung ultrasound and the MLUS was recorded according to the ultrasound manifestations of A line,B line and lung consolidation.According to the etiological results,the children were divided into a bacterial pneumonia group and a viral pneumonia group.According to disease severity,the children were divided into the mild group and the severe group.The MLUS was used to analyze the diagnostic significance of pediatric bacterial and viral pneumonia.Results The MLUS in the mild pneumonia group was 7(4,13)points and the MLUS in the severe pneumonia group was 20(14,30)points,and MLUS scores of pneumonia in the two groups were different(Z=-5.205,P<0.05).By drawing receiver operating characteristic curve,MLUS score of 14.5 was used as the cut-off point,the sensitivity for diagnosing severe pneumonia was 75.9%,the specificity was 82.8%.Area under the curve was 0.838.There was no significant differences in MLUS of 8.00(4.00,16.00)between the bacterial pneumonia group and 13.00(7.00,21.75)between the viral pneumonia group(Z=-1.981,P>0.05).The MLUS of 10.00(5.25,17.75)in the mild bacterial pneumonia group and 5.00(4.00,9.50)in the mild viral pneumonia group were significantly different(Z=-3.403,P<0.05).There was no significant differences in MLUS between the severe bacterial pneumonia group and the severe viral pneumonia group(t=0.017,P>0.05).In mild pneumonia,the cut-off value for the modified lung ultrasound score of 10.5 predicted moderate diagnostic efficacy of mild bacterial pneumonia,the area under the curve was 0.747,sensitivity was 50%and specificity was 87.5%.Large-area lung consolidation was more common in the bacterial pneumonia group than in the viral pneumonia group(χ2=8.360,P<0.05).Conclusion The modified lung ultrasound score can effectively evaluate the severity of pediatric bacterial pneumonia and viral pneumonia.For the identification of the two,MLUS may be a certain guiding significance.

Vitamin D plays multiple crucial roles in human health, especially in bone meta-bolism and immune modulation. Obese patients generally confront the risk of vitamin D deficiency. Furthermore, bariatric surgery may further intensify the vitamin D deficient condition. The authors, in combination with relevant literature, conduct analysis and induction on the relationship between obesity and vitamin D, the influence of vitamin D deficiency on the immune system, the impacts of different bariatric surgery approaches on the vitamin D status, as well as the supplementation strategies of vitamin D, aiming to offer practical guidance and reference for the management of vitamin D after bariatric surgery.

Vitamin D plays multiple crucial roles in human health, especially in bone meta-bolism and immune modulation. Obese patients generally confront the risk of vitamin D deficiency. Furthermore, bariatric surgery may further intensify the vitamin D deficient condition. The authors, in combination with relevant literature, conduct analysis and induction on the relationship between obesity and vitamin D, the influence of vitamin D deficiency on the immune system, the impacts of different bariatric surgery approaches on the vitamin D status, as well as the supplementation strategies of vitamin D, aiming to offer practical guidance and reference for the management of vitamin D after bariatric surgery.

Objective : To investigate the cross⁃sectional associations of serum interleukin( IL) Ⅳ18 with cartilage volume , cartilage defects , bone marrow lesions ( BML) and biomarkers of cartilage degradation in patients with knee osteoarthritis (OA) , and to provide new ideas and new methods for clinical diagnosis and treatment. Methods: The study included 151 patients with knee OA , a general questionnaire survey was conducted , and the knee strucral was photographed by magnetic resonance imaging (MRI) . The cartilage volume was measured by OsiriX software in 3D⁃FLASH sequence , and cartilage defect and BML were determined in T2⁃weighted sequence. Serum IL-18 and matrix metalloproteinase ( MMP) Ⅳ3 , 13 levels were measured by enzyme⁃linked immunosorbent assay(ELISA) . SPSS software was used for statistical analysis. Results : In multivariable analyses , serum IL⁃18 level was consistent at divided part of joint (femorotibial joint and the patella femoral joint , all P < 0. 05) . Serum IL⁃18 level was positively associated with cartilage defect and BML at media femorotibial area (all P < 0. 01) . Serum IL⁃18 level was positively associated with MMP⁃3 (β = 0. 31 , 95% CI:0. 001 - 0. 010) and MMP⁃13 (β = 0. 86 , 95% CI:0. 08 - 0. 10 , all P < 0. 01) . CI:0. 08 - 0. 10 , all P < 0. 01) . Conclusion Serum IL⁃18 level is negatively associated with cartilage volume and Serum IL⁃18 level is negatively associated with cartilage volume and positively associated with cartilage defect , BML , MMP⁃3 and MMP⁃13 , suggesting IL⁃18 may play a significant role duce the injury of article cartilage in patients with knee OA and delay the progression of disease.