OBJECTIVE: To explore the feasibility and effectiveness of repairing surgical defect in pharyngo-laryngeal malignant tumor with free rectus femoris flap. METHODS: The clinical data of 34 patients with surgical defects in pharyngo-laryngeal malignant tumor who met the selection criteria between July 2014 and August 2024 were retrospectively analyzed. There were 25 males and 9 females, aged 25-82 years, with a median age of 54 years. The disease duration ranged from 2 months to 2 years, with a median of 7 months. The tumor locations included the oropharynx, hypopharynx, cervical esophagus, and larynx. Pathological types included squamous cell carcinoma (29 cases), myoepithelial carcinoma (2 cases), adenoid cystic carcinoma (1 case), and diffuse large B-cell lymphoma (2 cases). TNM staging: 16 cases of T ₄N ₁M ₀, 3 cases of T ₄N ₂M ₀, 3 cases of T ₄N ₀M ₀, 10 cases of T ₃N ₁M ₀, and 2 cases of T ₃N ₀M ₀. The 2017 American Joint Committee on Cancer (AJCC) staging was stage Ⅲ in 2 cases and stage Ⅳ in 32 cases. The blood supply of the proximal rectus femoris muscle was observed by enhanced CT of the lower limb vessels before operation, and the surgical defects ranged from 3.0 cm×2.0 cm to 12.0 cm×8.5 cm. The blood supply and perforators of rectus femoris muscle were explored during operation, and the free rectus femoris flap pedicled with the direct vascular stem of rectus femoris muscle was used to repair the defect. For the patients with pharyngeal fistula or obvious neck swelling after operation, the blood supply of the flap was analyzed by vascular enhanced CT to determine the corresponding strategies of nutritional support, anti-infection, dressing change and drainage. Radiotherapy and chemotherapy were supplemented in 27 patients with lymph node metastasis after operation. RESULTS: All the 34 patients were followed up 1-10 years, with an average of 3 years. The flap was found to be necrotic by fibrolaryngoscopy at 1 week after operation in 2 cases, and the incision healed after dressing change and nutritional support, and no reoperation was performed. The flap was in good condition at 1 week after operation in 4 cases, and the signs of gradual necrosis of the flap were found within 1 month after operation, of which 2 cases were healed after dressing change, 1 case was removed the necrotic tissue by reoperation, and 1 case was healed after pectoralis major myocutaneous flap was used to repair the pharyngeal tissue defect. The flaps survived in 28 cases, including 4 cases of pharyngeal fistula, which healed by dressing change. Twenty-two cases achieved satisfactory results in swallowing or phonation. Two patients with total laryngectomy and voice reconstruction underwent reoperation to seal the voice tube because of postoperative aspiration. During the follow-up, 1 case had tracheal stomal recurrence, 2 cases had bone metastasis, and 1 case had bone and lung metastasis. CONCLUSION The free rectus femoris flap has good flexibility, the volume of the flap is easy to adjust, and the incision of the donor site is concealed, which is expected to become a new choice for the repair of the surgical defect in pharyngo-laryngeal malignant tumor.
Humans ; Male ; Middle Aged ; Female ; Aged ; Adult ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Laryngeal Neoplasms/pathology* ; Aged, 80 and over ; Pharyngeal Neoplasms/pathology* ; Free Tissue Flaps/blood supply* ; Quadriceps Muscle/transplantation* ; Surgical Wound/surgery* ; Treatment Outcome

Objective To explore the early detection value of estimated glucose disposal rate(eGDR)for non-alcoholic fatty liver disease(NAFLD),providing a simple tool for precise clinical intervention.Methods A cross-sectional analysis was conducted on totally 3 262 participants with complete data from the National Health and Nutrition Survey Database of the United States from 2007 to 2018.Univariate regression and multivariate logistic regression analyses were used to explore the correlation between the estimated glucose treatment rate and the incidence of non-alcoholic fatty liver disease.Subgroup analysis,restricted cubic spline and threshold effect analysis were conducted to investigate the potential factor influences and nonlinear relationships.Result Among all the included populations,948 cases(25.29%)were diagnosed with NAFLD,and the number gradually decreased with the increase of the estimated glucose treatment rate(P<0.001).Multivariate logistic regression showed that the estimated grape processing rate was negatively correlated with non-alcoholic fatty liver disease(OR=0.86,95%CI:0.83～0.88,P<0.001),and when the estimated glucose processing rate was≥10.246,it could significantly reduce the risk of non-alcoholic fatty liver disease(OR=0.20,95%CI:0.10～0.39,P<0.001),and stratified analysis further confirmed this result.Conclusion The eGDR is significantly associated with the incidence risk of NAFLD.A higher eGDR indicates a lower risk of NAFLD.This implies that in clinical practice,the risk of disease detection can be quantified through this indicator,thereby identifying potential patients earlier and initiating intervention.Countermeasures As decision-makers,they should strengthen public health education on non-alcoholic fatty liver disease,reduce health risks by promoting healthy diets and lifestyle interventions,and pay attention to the cardiovascular health of high-risk groups for non-alcoholic fatty liver disease.At the same time,promote the research and application of drugs,and dynamically adjust policies through continuous disease monitoring to comprehensively reduce the burden of non-alcoholic fatty liver disease.

Objective Using Meta-analysis to systematically evaluate the incidence and risk factors of pulmonary infection occurring in patients with acute ischemic stroke(AIS)after receiving mechanical thrombectomy.Methods A computerized retrieval of academic papers concerning the case-control study and cohort study of lung infection in patients with AIS after mechanical thrombectomy from the databases of PubMed,Web of Science,Embase,Cochrane Library,China Knowledge Network,Wanfang Data Knowledge Service Platform,and Wipro.com databases was conducted by two independent investigators.The retrieval time period was from the establishment of the database to December 2023.STAT A 16.0 software was used to make the Meta-analysis of the extracted literature.Results A total of 10 literature were included,with a combined sample size of 6 149 cases and 2 076 cases occurring lung infections.Meta-analysis revealed that the pulmonary infection in patients after mechanical thrombectomy for AIS showed a high degree of heterogeneity in the included studies(I2=97.87％,P＜0.001),and a random-effects model yielded an incidence of 31.8％for pulmonary infection.Risk factors for the occurrence of postoperative lung infection included atrial fibrillation(OR=1.33,95％CI:1.10-1.6,P=0.004),dysphagia(OR=3.83,95％CI:2.43-6.05,P＜0.001),high NIHSS score(OR=1.43,95％CI:1.05-1.94,P=0.023),impaired consciousness(OR=2.29,95％CI:1.38-3.81,P＜0.001),and intraoperative use of sedative drugs(OR=3.21,95％CI:2.91-3.54,P＜0.001).Conclusion The existing evidences indicate that patient's age ≥60 years,atrial fibrillation,dysphagia,impaired consciousness,high NIHSS score,and intraoperative use of sedative drugs are risk factors for the occurrence of pulmonary infection in AIS patients after receiving mechanical thrombectomy.In clinical practice,these risk factors should be highly valued,and these risk factors should be included in the postoperative comprehensive assessment and intervention strategies for patients so as to reduce the incidence of pulmonary infection.

Objective To evaluate the risk factors for pulmonary infection in patients with acute ischemic stroke after receiving mechanical thrombectomy and to construct a risk prediction model based on machine-learning algorithm technology.Methods A total of 315 patients with acute ischemic stroke,who received mechanical thrombectomy at the Kunming Yan'an Hospital and Kunming Municipal First People's Hospital,were enrolled in this study.The 315 patients who were admitted to the hospital between January 2019 and December 2023 were collected as the modeling group,and other 73 patients who were admitted to the hospital between January 2024 and September 2024 were collected as the validation group.The demographic materials and the clinical diagnosis and treatment data were collected within 24 h after admission,and the risk factors for pulmonary infection after mechanical thrombectomy were analyzed.A total of seven machine learning algorithms were employed to establish a predictive model for pulmonary infection in patients with large-vessel occlusive stroke after receiving mechanical thrombectomy.Based on the accuracy,recall,precision,F1 index,and area under the receiver operating characteristic curve(AUC),the performance of model was evaluated.Results The comprehensive performance in accuracy,recall,precision,F1 index and AUC of the gradient boosting classifier in both the modeling group and the validation group are all excellent.Conclusion The risk prediction model constructed on the basis of machine-learning algorithm technology can early identify lung infection and discover the risk factors in patients with acute ischemic stroke after receiving mechanical thrombectomy,therefore,the prevention and control measures can be promptly taken,the incidence of lung infection can be effectively decreased.

Objective To analyze the effect of topical recombinant human acidic fibroblast growth factor(rh-aFGF)on wound healing in burn and scald patients.Methods A total of 240 burn pa-tients were selected as the study subjects and divided into observation group and control group,with 120 cases in each group.The control group was treated with compound polymyxin B ointment,while the observation group received rh-aFGF combined with compound polymyxin B ointment.The wound healing time,wound healing rate,positive detection rate of wound pathogens and wound inflammatory response were compared between the two groups after treatment.Results After 28 days of medication,the wound healing time of patients in the observation group was significantly shorter,and the wound healing rate was significantly higher than that in the control group(P＜0.05).The detection rate of pathogens in the burn wounds of the observation group was significantly lower than that of the control group at 7,14,21,and 28 days after treatment(P＜0.05).There was a statistically significant differ-ence in wound inflammatory response between the two groups(P＜0.05).Conclusion The rh-aFGF is effective in treatment of burn and scald wound,and it is conductive to promoting wound healing,shortening healing time,and reducing wound inflammatory responses.

Objective: To investigate the effects and mechanisms of Astragalus Polysacharin(APS) on the proliferation and metastasis of breast cancer cells by regulating miR-107 and miR-346-mediated macrophage polarization in breast cancer-derived exosomes. Methods: Forty 8-week-old female BALB/c mice were selected and breast cancer xenograft models and 4T1 transplanted tumor models were established. The mice were divided into the control group and the APS group. The APS group mice received daily intragastric administration of APS for 25 days, while the control group mice were given the same amount of normal saline. After all treatments were completed, the mice were euthanized, and tumor tissues were isolated. Western blot and flow cytometry were used to detect the expressions of proliferating cell nuclear antigen(PCNA), Ki-67, CD206, CD163, inducible nitric-oxide synthase(iNOS), and CD86. The apoptosis of single-cell suspensions in tumor tissues was analyzed. Human breast cancer cell line MDA-MB-231 was cultured and stimulated with APS, and exosomes from the cell culture medium were collected. The proliferation, migration, and invasion of cells were detected by CCK-8 assay, scratch assay, permeability chamber cell invasion assay, and qRT-PCR. Differentially expressed genes were screened by bioinformatics. Results : By measuring the expressions of molecules related to breast cancer cell proliferation and metastasis, it was shown that APS treatment reduced the expressions of proliferation-related proteins(PCNA and Ki-67) and metastasis-related proteins(Vimentin) in MDA-MB-231 xenograft tumor tissues; and the polarization of tumor-associated macrophages was observed. APS treatment of 4T1 transplanted tumor tissues could reduce the number of M2 macrophages and increase the number of M1 macrophages, resulting in a decrease in the ratio of M2/M1 macrophages and an increase in cell apoptosis in 4T1 transplanted tumor tissues. The expressions of related proteins iNOS and CD86 increased, and CD206 and CD163 decreased. After APS treatment, the exosomes produced by MDA-MB-231 reduced the polarization of M2 macrophages and affected the expressions of miR-107 and miR-346. Conclusion APS inhibits the polarization of M2 macrophages by regulating the expression of miR-107 or miR-346 in breast cancer cell-derived exosomes, ultimately inhibiting the proliferation and metastasis of breast cancer cells.

OBJECTIVE To establish a clinical pharmaceutical pathway of anti-infective therapy for high-risk populations of antibiotic-associated encephalopathy （AAE）， and analyze its application effects. METHODS Clinical pharmacists developed the “AAE High-Risk Population Screening Form” and “Antibiotic AAE Risk Comparison Form” based on literature and expert opinions， and established the “Clinical Pharmaceutical Pathway of Anti-infective Treatment for AAE High-Risk Population” in our hospital. A prospective， non-randomized controlled study was conducted from May 2023 to April 2024， including 50 cases in the observation group and 50 cases in the control group among patients with pulmonary infections admitted to the Dept. of Internal Medicine in our hospital. The observation group was involved in the development of an anti-infective treatment following the clinical pharmaceutical pathway by clinical pharmacists， while the control group received routine anti-infective treatment by clinical physicians. The occurrence of AAE， the rational antibiotic drug use， and the effectiveness of initial anti-infective treatment in the two groups were observed， and the intervention measures and outcomes of AAE cases were summarized. RESULTS The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population was preliminarily established in our hospital. The analysis of the application effects showed that there was 1 case of AAE in the observation group and 8 cases in the control group， with a significantly lower incidence of AAE in the observation group than in the control group； the rational antibiotic drug use and the effectiveness of initial anti-infective treatment in the observation group were both significantly superior to those in the control group （P＜0.05）. Drug withdrawal and dressing change were the preferred effective intervention measures for AAE， and encephalopathy treatment drugs could be used as auxiliary measures for symptom relief. Timely and effective intervention was conducive to rapid symptom relief， with a total improvement rate of AAE of 88.89%. CONCLUSIONS The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population can effectively prevent the occurrence of AAE as well as contribute to promoting rational drug use and the effectiveness of initial anti-infection plans and strengthening treatment outcomes.

Objective To investigate the difference of facial soft tissue changes in patients with different vertical bone facial types after orthodontic treatment.Methods A total of 137 female patients with class Ⅱ malocclusion aged 18 to 30 years old were selected for retrospective analysis using facial soft tissue 3D model data.According to the mandibular plane angle(FH-MP)angle,they were divided into high angle group,average angle group and low angle group.The EinScan Pro 2X 2020 handheld high-precision 3D scanner was used to capture facial soft tissue images of patients before treatment(T0)and at 6 months during treatment(T1)and after treatment(T2).The patients'facial images were overlapped using reverse engineering software Geomagic Wrap 2021,and the differ-ences within and between groups were statistically analyzed using SPSS 26.0 statistical software.Results Before and after orthodontic treatment,the average overall facial changes in the high angle group were(-3.25±0.22)mm,in the average angle group was(-3.28±0.30)mm,and in the average low angle group was(-3.69±0.36)mm.Compared with the other two groups,the changes in the low angle group decreased more,and the difference was statistically significant(P＜0.05).The mandibular angle area and temporal area decreased the most in the low angle group,which were(-2.78±0.18)mm and(-2.27±0.35)mm,respectively,and the differ-ence was statistically significant compared with the other two groups(P＜0.05),while there was no statistically significant difference among the other groups(P＞0.05).Conclusion The whole face and all facial regions of the three groups had some negative changes,but the collapse in the mandibular angle area and the temporal muscle ar-ea of the low angle group was more obvious than that of the other two groups.

Chinese materia medica has a wide range of clinical applications， but it has many active ingredients with different physicochemical properties， and the target organs， action pathways and mechanisms for different ingredients to exert their efficacy are not the same. Therefore， it is difficult to design and develop a co-delivery system loading multiple components of Chinese materia medica to maximize the synergistic therapeutic efficiency. Based on the characteristics of effectiveness and functionality of active ingredients， the strategies for multi-component co-delivery of Chinese materia medica can be categorized into two types：firstly， based on the effectiveness of active ingredients， new carriers such as liposomes， nanoparticles can be constructed to load multi-components of Chinese materia medica. secondly， based on the functionality of some active ingredients of Chinese materia medica， they are employed in the construction of co-delivery system， which can give play to the dual characteristics of their own efficacy and preparation functions. In this paper， we summarized the relevant research progress of the above two types of multi-component co-delivery strategies， and mainly discussed the pharmaceutical functions of the active ingredients in co-delivery systems， in order to find a more suitable multi-component co-delivery strategy， promoting the design and development of new delivery systems of Chinese materia medica.

Objective:To explore the effectiveness of the Shewhart control chart-based assessment and early warning system in prevention of medical device-related pressure injury(MDRPI).Methods:152 critically ill patients admitted to Hebei Central Hospital from January 2020 to December 2021 were selected and divided into a control group and an observation group based on different methods of assessing MDRPI risk,with 76 cases in each group.The control group adopted the Braden scale to assess the risk of MDRPI.The observation group adopted a safety early warning system based on Shewhart control charts to assess the risk of MDRPI in patients.Nursing measures were undertaken according to MDRPI risk grade in both groups.The occurrence of adverse events of MDRPI,nursing safety quality and nursing comprehensive quality were compared between the two groups.Results:The incidence rate of head,neck and face adverse events of MDRPI and the total incidence of adverse events of MDRPI of the patients in the observation group were lower than those in the control group(x2=4.802,5.758,P<0.05).The safety quality and comprehensive quality of nursing of 20 nurses in the observation group were higher than those in the control group(t=6.654,7.172,P<0.05).Conclusion:The application of assessment and early warning system based on Shewhart control chart in clinical nursing management can effectively reduce the incidence of MDRPI adverse events and improve the quality of nursing safety and comprehensive nursing.