Objective:To explore the effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with severe wrist electric burn.Methods:A retrospective observational study was conducted. From January 2017 to December 2020, 4 patients with wrist high-voltage electric burn admitted to the Department of Burns of the First People's Hospital of Zhengzhou and 4 patients with wrist high-voltage electric burn admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital met the inclusion criteria, including 6 males and 2 females, aged 12 to 52 years. They were all classified as type Ⅱ wrist high-voltage electric burns with median nerve defect. In the first stage, the wounds were repaired with free anterolateral thigh femoral myocutaneous flap. In the second stage, the free gracilis muscle flap combined with sural nerve transplantation was used to reconstruct the digital flexion and sensory function of the affected hand in 3 to 6 months after wound healing. The cut lengths of muscle flap and nerve were 32 to 38 and 28 to 36 cm, respectively. The muscle flap donor area and nerve donor area were both closed and sutured. The survival condition of gracilis muscle flap and sural nerve, the wound healing time of recipient area on forearm, the healing time of suture in muscle flap donor area and nerve donor area were observed and recorded after operation, and the recovery of donor and recipient areas was followed up. In 2 years after operation, the muscle strength of thumb and digital flexion and finger sensory function after the hand function reconstruction were evaluated with the evaluation criteria of the hand tendon and nerve repair in the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association.Results:All the gracilis muscle flap and sural nerve survived successfully after operation. The wound healing time of recipient area on forearm was 10 to 14 days after operation, and the healing time of suture in muscle flap donor area and nerve donor area was 12 to 15 days after operation. The donor and recipient areas recovered well. In the follow-up of 2 years after operation, the muscle strength of thumb and digital flexion was evaluated as follows: 4 cases of grade 5, 3 cases of grade 4, and 1 case of grade 2; the finger sensory function was evaluated as follows: 4 cases of grade S3 +, 2 cases of grade S3, and 2 cases of grade S2. Conclusions:For patients with hand dysfunction caused by severe wrist electric burn, free gracilis muscle flap combined with sural nerve transplantation can be used to reconstruct the digital flexion and sensory function of the affected hand. It is a good repair method, which does not cause great damage to thigh muscle flap donor area or calf nerve donor area.

Objective:To explore the curative effects of ultrathin anterolateral femoral flap in one-stage split-finger repair of palmar combined with multiple finger wounds.Methods:A retrospective observational study was conducted. From October 2016 to June 2018, 20 patients with wounds on palms and multiple fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 15 males and 5 females, aged 18 to 77 years. After debridement, the wound area was 8 cm×4 cm-17 cm×12 cm. The wound was repaired by ultrathin anterolateral femoral flap with area of 9 cm×5 cm to 19 cm×13 cm. According to the wound condition of finger, the finger division was performed in one stage, and the length-to-width ratio of the split-finger flap was 2.0:1.0-2.5:1.0. During the surgery, the descending branches of lateral circumflex femoral artery and accompanying vein of flap were anastomosed end-to-end to the radial artery and vein in the recipient area, respectively, and the anterolateral femoral cutaneous nerve of flap was bridged with the superficial branch of radial nerve in the recipient area. The wounds in the donor area of flap in 14 patients were sutured directly, the wounds in the donor area of flap in 3 patients were repaired by relay superficial iliac circumflex artery perforator flap, and the wounds in the donor area of flap in 3 patients were covered by free trunk medium-thick skin graft. The survival of flap, occurrence of vascular crisis and other complications, and healing of wounds in the donor area of flap were recorded. The appearance of flap, scar hyperplasia in the donor and recipient areas and the patients' satisfaction with the shape and function of the donor and recipient areas were followed up. In 1 year after surgery, the two-point discrimination distance of the flap was measured, and the recovery of hand function was evaluated by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:The flaps of 17 patients survived without vascular crisis or other complications after surgery. The flap of 1 patient had poor blood circulation and partial necrosis, and the wound was healed 14 days after dressing change and grafting of split-thickness skin graft from head. Two patients had mild cyanosis at the margin of flap after surgery, which disappeared spontaneously 5 days later. Incisions at donor site, relay flaps, and skin grafts of all patients survived well. After surgery, the color and texture of flap were basically the same as that of the normal skin of hand, and linear scars were observed in the donor and recipient areas. The patients were satisfied with the recovery of appearance and function of donor and recipient areas. After 1 year of follow-up, the patients' hand sensory function recovered well, the two-point discrimination distance of flap was 4-6 mm, and the recovery of hand function was evaluated as excellent in 18 cases and good in 2 cases.Conclusions:The ultrathin anterolateral femoral flap in repairing the palmar combined with multiple finger wounds in one-stage split-finger can significantly reduce the number of surgeries and improve the function and beauty of the hand, so it is worthy of clinical promotion.

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.

Objective:To investigate the correlation between CD133 expression and clinicopathological features in triple negative breast cancer (TNBC) patients, and the impact of CD133 on prognosis in these patients.Methods:Data of 70 patients who received surgical treatment in our center from Jan. 2008 to Dec. 2012 were collected. Immunohistochemistry was used to examine the expression of CD133. Patients were divided into two groups according to CD133 expression. Univariate analysis, Cox and Logistic regression multivariate analysis were used in order to investigate the correlation between CD133 expression and clinicopathological features. Kaplan-Meier curve and Log-rank analysis were used to evaluate DFS (disease-free survival) and OS (overall survival) .Results:CD133 was expressed in cytomembrane and cytoplasm with expression rate of 95.71% (67/70) . Of which, 64.29% (45/70) of patients were low CD133 expression and 35.71% (25/70) were high expression. High CD133 expression was significantly correlated with younger age (≤50) ( P=0.007) and larger tumor size (>2 cm) ( P=0.020) . Tumor size ( P=0.035) , axillary status ( P=0.001) , Ki67 ( P=0.005) and CD133 expression ( P=0.014) were independent predictors of recurrence and metastasis in TNBC patients. Axillary status was independent predictor of death event ( P=0.008) . Increased CD133 was associated with poor prognosis. Compared with high expression, patients with low CD133 expression had better DFS ( P=0.002) and OS ( P=0.088) , while OS did not reach significant difference. Conclusion:CD133 expression was correlated with age and tumor size in TNBC patients. High expression was associated with recurrence, metastasis and poor prognosis. Thus, CD133 may be a potential biomarker in predicting prognosis in TNBC.

Objective: To examine sleep quality and related factors among middle school students,and to provide a scientific reference for making the relevart interventional measures. Methods: A cross-sectional questionnaire anonymous survey was conducted among 9 560 students randomly selected from Shanxi province using multi-stage stratified cluster sampling. Pittsburgh Sleep Quality Index (PSQI) was used to collect information on sleep quality. Results: Among all the participants, 2 255 (23.6%) middle school students were reported poor sleep quality. The prevalence of poor sleep quality was significantly higher in girls (24.5%) than in boys (22.4%)(χ2=5.93, P<0.05). Significant differences were observed in the prevalence of poor sleep quality between junior middle school (12.9%), senior middle school (36.6%) and vocational school students (24.6%) (χ2=636.07, P<0.01). The global PSQI, sleep duration and sleep disturbance scores were higher in girls than in boys (t=3.76，8.38，3.47，P<0.01). There were significant differences between students with different school stages in global PSQI, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medication, and daytime dysfunction scores (F=727.43,83.69,1 670.07,8.24,26.19,4.20,609.80,P<0.05). Multivariable Logistic regression analysis showed that gender, school stage, academic pressure, parental marital state, relationship with teachers, physical activity, smoking and drinking were associated with poor sleep quality among middle school students in Shanxi. Conclusion Sleep problems are common among middle school students, and appropriate intervention should be taken to improve sleep quality of students from individual, school-and family level.

Breast Neoplasms ; metabolism ; pathology ; Female ; Humans ; Ki-67 Antigen ; genetics ; metabolism

Objective To investigate the awareness of osteoporosis and its influential factors in middle-aged and older people. Methods By using self-designed questionnaire, 354 middle-aged and old people were investigated as to their awarness of osteoporosis in Chajiao street community in Guangzhou. Among them, 58 people were measured the bone density in the calcaneal bone by Ultrasound. Results The average score of the questionnaire was 9.46 ± 5.13, and the accuracy was 39.4%. In the diagnosis and treatment, the accuracy was just 17.8%. The diet (the accuracy in 54%) and sport (the accuracy in 50.3%) were good. The statistical analyses showed the linear relationship between the T value of bone density and the age (P = 0.021), between the T value and the score (P = 0.047). Wilcoxon rank sum test found that the T value between female and male was significantly different (Z = -3.749, P < 0.000). With multiple linear regression analysis, the T value had a linear correlation with the score (F = 4.224, P = 0.045) positively. Conclusions Currently, the awareness of osteoporosis in the middle-aged and old people was inadequate. To better prevent osteoporosis, the propogation of knowledge and guidance provided by clinicians in osteoporosis should be improved necessarily and emergently.

BACKGROUND: Gallium is a non-essential trace element in the human body. In vivo experiments have confirmed that gallium can directly inhibit bone osteelysis, prevent bone calcium release, increase bone calcium content, serves as a new drug treatment of metabolic bone disease, its anti-bone transformation mechanism remains unclear. OBJECTIVE: To observe the effects of gallium nitrate on collagen and bone calcium protein in osteeporotic rat model. METHODS: Ninety female SD rats were divided into control group (n = 20) and osteoporosis group (n = 70) at random. Control group rats were sutured to close abdominal cavity after bilateral ovarian was exposed. Osteoporosis group rats received the bilateral ovariectomy to produce osteoporotic rat models, which then were assigned into 4 groups by random digits table: osteoporotic control group (n = 16) by intraperitoneal injection of saline, 3 times per week; Low-dose gallium salt group (n = 16) by intrapedtoneal injection of I mg/kg of galfium nitrate, 3 times per week; High-dose gallium salt group (n = 15) by intraperitoneal injection of 2 mg/kg ofgallium nitrate, 3 times per week; Estrogen group (n = 15) by intraperitoneal injection of estradiol, 3 times per week. After 12 weeks of the treatment, the bone collagen, osteocalcin protein and hydroxyproline levels in bone specimens were detected. RESULTS AND CONCLUSION: Compared with control group, the content of collagen in osteoporosis control group was reduced (P < 0.05), the contents of aminohexose and hydroxyproline increased (P < 0.05), no significant differences were observed in the content of sulfate-base for both groups. Following gallium and estradiol treatment, the collagen contents enhanced (P < 0.05), while the contents of aminohexose and hydroxyproline reduced (P < 0.05). High-dose gallium salt group had a remarkable curative effect compared with low-dose gallium salt group (P < 0.05), and was similar to estradiol group (P > 0.05). it is indicated that gallium nitrate can improve bone metabolism status with osteoporosis through increasing the content of collagen and decreasing the content of hydroxyproline, 2 mg/kg gallium nitrate are similar to estrogen treatment.

Objective To study the clinicopathologic characteristics of triple-negative breast cancer (TNBC) and its value in the prediction of prognosis. Method In this study,500 cases of female breast cancers were examined immunohistochcmically for the TNBC. The clinicopathologic characteristics of the 243 TNBC cases were inspected. Results TNBC accounted for 17.6% (88/500) of the 500 breast cancers. The histological types of the TNBC included mainly infihrative ductal carcinoma, metaplastic carcinoma and medullar carcinoma. Among those, histological grade Ⅲ accounted for 72.7% (64/88) of all the TNBC and was more common than that in hormone receptor positive breast cancers (HR+ group ) and Her-2 overexpression breast cancers (Her-2 group)(P=0.000). The positive rates of CK5/6 and EGFR in the TNBC were 30.7% (27/88) and 34.1% (30/88), respectively. The positive rates of ERCC1 and KIT in the TNBC were 28.4% (25/88) and 34.1% (30/88), respectively, Both of which were higher than those in the HR + group and Her-2 group, respectively (P=0.032 and P=0.026). 3-year survival rate of the TNBC was 71.5% and it was lower than that of HR group (P=0.021) and not significantly different from that of Her-2 group (P=0.474). Conclusions TNBC is the breast cancer with high aggressive pathologic futures and poor prognosis. EGFR and ERCC1 expression were positive in a portion of TNBC cases.

Objective To explore the operative therapy of young and middle-age patients with femoral collum fracture to improve the therapeatic efficacy. Methods 25 cases of femoral collum fracture were treated with opening and internal fixation, and circumflex iliac vascular pedicle bone graft of ilium with monitoring skin flap. After operation, The blood supply of femoral collum was observed by the monitoring skin flap. Results The blood supply of the monitoring skin flap in 23 cases was good, and in 2 cases the monitoring skin flap's color chang indicated that the crisis occurred in the circulation of the grafted bone. The grated bone recovered the blood supply through removing thrombosis by operation. All the patients were cured early, and no femoral head nercosis occured. Conclusion The transplantation of iliac lamella of circumflex ilium profound artery with monitoring skin flap for the treatment of femoral collum fracture could monitor the blood supply of femoral head, improve the fracture healing, and decrease the incidence of femoral head necrosis.