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 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 analyze the epidemic characteristics of pneumoconiosis in Jingmen City from 2011 to 2022, and to provide theoretical basis for formulating the occupational disease prevention plan of the ^“14th Five-Year Plan^” in Jingmen City. Methods The data of pneumoconiosis cases in Jingmen City from 2011 to 2022 were collected from the Occupational Disease and Health Hazard Factors Monitoring Information System, and the information of disease classification, enterprise economic type, scale distribution, regional distribution, job distribution, dust exposure years and so on was statistically analyzed. Results A total of 260 cases of pneumoconiosis were reported in Jingmen City from 2011 to 2022, with an average of 13.81 years of exposure to dust, including 164 cases of coal workers' pneumoconiosis, 90 cases of silicosis and 6 cases of other pneumoconiosis. The cases were mainly distributed in Dongbao District with 160 cases (61.54%), Zhongxiang City with 72 cases (27.69%), and Duodao District with 18 cases (6.92%). The difference was statistically significant（χ²=217.846，P<0.05）. The cases were mainly distributed in private enterprises (76.54%, 199 cases). The enterprise sizes were mainly medium-sized (28.46%, 74 cases) and small (61.15%, 159 cases) enterprises, and the difference was statistically significant (χ²=46.025，P<0.05). Conclusion Coal workers' pneumoconiosis and silicosis are the main types of occupational pneumoconiosis in Jingmen area, which will become the key prevention and control targets in Jingmen City for a long time and should be paid attention to. The cases are mainly concentrated in joint-stock, private economic type enterprises and small and medium-sized enterprises, which should be monitored intensively.

[Objective]To investigate the effects of Kuanxiong aerosol(KXA)on pyroptosis and inflammatory response in isoproterenol(ISO)-induced myocardial infarction(MI)rats,and its effect on the key pathway of pyroptosis Toll-like receptor 4(TLR4)/myeloid differentiation primary response gene 88(MyD88)/NOD-like receptor pyrin domain containing 3(NLRP3)/cysteinyl aspartate specific proteinase-1(caspase-1).[Methods]Thirty male Wistar rats were randomly divided into five groups,6 rats in each group,as control group(0.9％sodium chloride solution),model group(ISO 120 mg·kg-1),isosorbide mononitrate(IMSN)group(ISO 120 mg·kg-1+IMSN 5 mg/kg·d),KXA low dose group(ISO 120 mg·kg-1+KXA 0.1 mL/kg·d),and KXA high dose group(ISO 120 mg·kg-1+KXA 0.3 mL/kg·d),gave continuous intragastric administration for 14 days,and intraperitoneal injection of ISO on the 13th and 14th day.After the last intervention,collected heart tissues and blood under anesthesia.Enzyme-linked immunosorbent assay(ELISA)was performed to investigate the expression of creatine kinase-MB(CK-MB)and cardiac troponin T(cTnT),as well as serum inflammatory indicators such as interleukin-1β(IL-1β),interleukin-18(IL-18),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α).The histopathological changes in heart tissue were evaluated using hematoxylin-eosin(HE)staining,and RNA-sequencing was used to detect the differential expression genes among groups.And the expression of the pyroptosis relevant protein was detected by Western blot.[Results]The results of the ELISA showed that CK-MB and cTnT expression in model group were significantly higher than those in control group(P＜0.01),which meant successful model construction.Pathological staining results showed disordered and fractured muscle fibers were significantly improved after KXA and IMSN intervention.RNA-seq results showed there were 2 646 different genes between model group and control group,while 714 other genes were in KXA and model group.After analyzing these two compared groups,it found that there were 130 up-regulated genes and 7 down-regulated genes;among them,inflammation related TLR4 pathway was significantly enriched.Furthermore,compared with model group,the expression of inflammatory factors IL-1β,IL-18,IL-6 and TNF-α decreased significantly in KXA groups and IMSN group(P＜0.01,P＜0.05),and Western blot showed that the protein expression of TLR4,MyD88,phospho-nuclear factor-KB(p-NF-KB)p65,NLRP3,cleaved cysteinyl aspartate specific proteinase-1(cleaved caspase-1)and Gasdermin D-N(GSDMD-N)increased significantly in model group while significantly down-regulated in KXA groups and IMSN group(P＜0.05,P＜0.01).[Conclusion]KXA can improve myocardial ischemia,reduce cardiac damage,and inhibit cardiomyocyte pyroptosis and inflammatory response,the mechanism may be related to regulating the TLR4/MyD88/NLRP3/caspase-1 signaling pathway.

Objective:To investigate the ultrasonographic features of internal jugular venous vein pseudo-aneurysm.Methods:The ultrasonographic and clinical features of a patient with internal jugular venous vein pseudo-aneurysm in Union Hospital Affiliated to Huazhong University of Science and Technology were retrospectively analyzed. These characteristics of this patient combined with cases from literatures were summarized.Results:Ultrasound showed that the 38.6 mm×14.0 mm×29.9 mm anechoic area in the soft tissue layer of the left neck communicated with the left internal jugular vein through the 3.8 mm wide breach, and a 12.9 mm×6.6 mm slightly hyperechoic mass was found in the anechoic area. Color Doppler flow imaging showed that the internal jugular vein communicated with the anechoic area through the crevasse. There was no obvious blood flow signal in slightly hyperechoic mass. The bidirectional burr-like blood flow signal could be detected by pulse-wave Doppler. Contrast enhanced ultrasound showed that the contrast agent flowed into the mass from the internal jugular vein through the breach, and the slightly hyperechoic mass appeared the contrast filling defect, and contrast agent was well filled in the rest of the anechoic area. Ultrasound diagnosis: left internal jugular vein pseudoaneurysm with thrombosis. 35 cases of cervical vein pseudo-aneurysm patients were finally included in 23 documents, including 12 males, 23 females, 15 cases on the left side, 20 cases on the right side, 6 cases of the internal jugular vein, 27 cases of the external jugular vein; one case only describes the neck veins and supraclavicular vein in another one case. Among them, 34 cases showed subcutaneous anechoic masses on ultrasound, 1 case showed slightly hyperechoic masses, and 35 cases showed venous wall breaches.Conclusions:Ultrasound examination has high diagnostic value for vein pseudo-aneurysm owing to its convenience, fast and serial observation. Therefore, it is the preferred method and can be widely used in clinical practice. Contrast-enhanced ultrasound can clearly show the blood perfusion, and help to improve the diagnostic confidence of the operator.

Objective:To study the size difference of bilateral axillary vein in adults, and to provide basis for the design of interventional surgical treatment.Methods:From December 2017 to December 2018, 145 inpatients (117 cases of hypertension, 28 cases of heart failure) and 87 healthy volunteers were selected from the Second People's Hospital of Lianyungang as study objects.The size of bilateral axillary vein of each study object was measured and the difference was statistically analyzed.Results:Among the 232 subjects, the dominant hand was the right hand, accounting for 95.7% (222/232). There were no statistically significant differences in the size of left and right axillary veins (all P>0.05). There were no statistically significant differences in the other indicators except age between the two groups (all P>0.05). The diameter of axillary vein was (0.67±0.15)cm in male and (0.53±0.13)cm in female, the difference is statistically significant( P=0.000). In the healthy control group, the dominant, non-dominant and large cross-sectional areas were (0.54±0.17)mm 2, (0.54±0.15)mm 2, (0.60±0.16)mm 2, respectively, which in the hypertension group were (0.55±0.14)mm 2, (0.54±0.14)mm 2, (0.59±0.14)mm 2, respectively, which in the heart failure group were (0.54±0.16)mm 2, (0.56±0.19)mm 2, (0.59±0.1)mm 2, respectively, there were no statistically significant differences among the three groups (all P>0.05). Conclusion:The difference is not obvious in the size of bilateral axillary vein, and there is no correlation between the size of bilateral axillary vein and dominant hand.The size of axillary vein in adults of different genders is different, and the size of axillary vein can be estimated by the gender of subjects, but not by the dominant hand or other data.

Objective To assess the morphological changes of tricuspid annulus in patients with functional tricuspid regurgitation(FTR)by real-time three-dimensional echocardiography.Methods Seventy-five FTR patients were divided into 4 groups according to the tricuspid regurgitation and transverse diameter of tricuspid annulus,which were group A(regurgitation more than moderate and dilated transverse diameter,n=21),group B(regurgitation less than moderate and dilated transverse diameter,n =18), group C(regurgitation more than moderate and normal transverse diameter,n = 1 9),group D (regurgitation less than moderate and normal transverse diameter,n =17).And 21 healthy controls were chosen to be group E.The 3D parameters including annular anterior-posterior diameter(AP),annular left-right diameter(SM),sphericity index(SI),non-planar angle(NPA),anterior annular length(Ant Ann), posterior annular length(Post Ann),annular circumference(Ann)and annular area(Area)were analyzed. Results SM,AP,Post Ann,Ann and Area of group A and B were larger than those in group E,whereas SI and Ant Ann only larger in group A(P<0.05).There were positive correlations between SM,AP,Post Ann,Ann,Area and the degree of regurgitation in group A(P <0.05).The patients of group C showed larger SM,Ant Ann,Post Ann,Ann and Area compared with patients in group E(P <0.05).There were no significant difference in all 3D parameters between group D and E(P >0.05).Conclusions FTR patients with regurgitation more than moderate or dilated transverse diameter are accompanied with changes of 3D annular parameters. The real-time three-dimensional echocardiography is helpful to judge morphological changes of tricuspid annulus in patients with FTR.

Objective To explore the changes of vascular endothelial growth factor (VEGF) and high-sensitivity C-reactive protein (hs-CRP) levels in the patients with coronary heart disease (CHD), and its clinical significance.Methods Nighty cases with CHD in our hospital from January 2015 to February 2016 were selected as study group, while 30 cases healthy persons underwent physical examination were selected as control group, and the study group were divided into stable angina pectoris ( SAP) group, acute myocardial infarction ( AMI) group and unstable angina pectoris ( UAP) group.The serum VEGF and hs-CRP levels were detected by ELISA.Results The serum VEGF and hs-CRP levels in study group were higher than those in control group (P<0.05).The serum VEGF and hs-CRP levels in AMI group were higher than those in SAP group and UAP group, the serum VEGF and hs-CRP levels in UAP group were higher than SAP group (P<0.05).There was positive correlation between serum level of VEGF and hs-CRP(r=0.626,P<0.05).The ROC showed a higher diagnostic value of VEGF and hs-CRP on CHD.Conclusion The serum levels of VEGF and hs-CRP has a higher diagnostic value and accuracy on CHD, which could evaluate the patient’s condition and predict the progress of cardiovascular events.

Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group( 25 cases for each group ). Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre-dilation,stenting,while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation,stenting were recorded. The blood flow slowed down,the incidence of side branch occlusion or stent placement,and the incidence of postoperative 24 h troponin I( cTnI) levels were measured. Results Nine cases(36%)in A group occurred lower branch blood flow,which due to 4 cases(16% )with significantly narrow branch stenting,2 cases(8%)with complete occlusion. There were only 2 cases(8%)with decrease branching blood flow in B group,and the difference was significant(P=0. 041, 0. 022). The cases with higher cTnI after 24 h in A group were 11( 39%),significantly higher in group B (3(12 %);P =0. 027 ). Conclusion Compared with the traditional protection guidewire,the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.