Objective:To construct a scientific and systematic indicator system for the ideological and political construction of medical professional courses in military medical universities, and to provide a reference for the teaching management department of military medical universities to guide and manage the ideological and political construction of courses, as well as for medical professional course instructors to carry out the ideological and political teaching of courses.Methods:On the basis of literature research and case studies, a framework of the indicator system was established for the ideological and political construction of medical professional courses in military medical universities, and six experts in the field of military medical education were invited for pre-consultation. A preliminary draft of the indicator system was formed after discussion within the research group. A total of 25 experts, who had intermediate or above professional titles and long-term experience in military medical education, teaching and management, military academy education management, and military ideological and political education in military academies, were invited to conduct two rounds of Delphi expert consultation, and a statistical analysis was performed for the consultation results to determine the indicator system for the ideological and political construction of medical professional courses in military medical universities. The percentage weight method and the product method were used to calculate the weight coefficient of each indicator and combined weight coefficient.Results:In the two rounds of expert consultation, the expert positivity coefficient was 100%, the expert authority coefficient was 0.883, and the Kendall harmony coefficients were 0.254 and 0.268, respectively ( P<0.05). Finally, an indicator system was established for the ideological and political construction of medical professional courses in military medical universities, which consisted of 5 primary indicators, 12 secondary indicators, and 31 tertiary indicators. The 5 primary indicators were the teaching objectives, teaching team, teaching resources, teaching implementation, and teaching effect of curriculum ideology and politics, with a weight coefficient of 0.210, 0.202, 0.197, 0.202, and 0.189, respectively. Conclusions:The indicator system constructed in this study is scientific, reliable, systematic, and comprehensive and has a certain guiding significance for the ideological and political construction of medical professional courses in military medical universities.

Objective:To explore the application of a scenario-based onsite first-aid skills station in objective structured clinical examination (OSCE).Methods:Based on common scenarios and cases in medical practice, an evaluation framework of the OSCE onsite first-aid skills station—containing assessment indicators, exam room setting, examiner training, and assessment process—was designed to evaluate the onsite first-aid competencies of medical graduates of the five-year program for three consecutive years. SPSS 24.0 was used to perform the Kruskal-Wallis test and Pearson correlation analysis to calculate the correlation between course examination scores and OSCE onsite first-aid skills station assessment scores. Excel was used to calculate the difficulty index and discrimination index of test items.Results:The graduates' OSCE onsite first-aid skills station assessment scores were improved year by year, with a mean score of about 80 points. The station assessment items showed a moderate difficulty level (0.7-0.8), a good discrimination level (>0.4), and good internal consistency (Cronbach's α>0.7). The examiners and examinees had a high recognition of the design and effectiveness of this station assessment method. There was a positive correlation between the OSCE scores and corresponding course scores (2016, r=0.245, P=0.001; 2017, r=0.108, P=0.026; 2018, r=0.198, P=0.006). Conclusions:Through scientific scoring and strict examination management, the OSCE scenario-based onsite first-aid skills station can effectively evaluate examinees' injury treatment competencies in different situations, which can provide a reference for course teaching.

Objective:To introduce the application of highly selective arterial indocyanine green angiography (hereinafter referred to as highly selective arterial angiography) in the design of anterolateral thigh free flap.Methods:This study was a retrospective observational study. From November 2023 to April 2024, 29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 26 males and 3 females, aged 16 to 71 years. The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm. During the surgery, highly selective arterial angiography was used to assist in flap design. The fluorescence development range of the source arteries or perforators of flaps was observed. The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin, and the excision position of the flap was adjusted. The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm. During the surgery, the number of highly selective arterial angiography, the type of source artery of perforators for puncture, and changes in the excision position of flaps were observed and recorded. After surgery, the blood supply and survival of flaps, the healing of wounds and the survival of skin grafts in the flap donor sites, and the angiography-related complications were observed.Results:All the 32 flaps of 29 patients were successfully excised. The highly selective arterial angiography was performed 37 times, including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery, 6 cases of puncture of the descending branch, 8 cases of double puncture of the oblique and descending branches, and 2 cases of puncture of arteries from other branches. During the surgery, the excision position of 28 flaps did not change, the excision position of 3 flaps moved towards proximal extremity of the thigh, and the excision position of 1 flap moved towards distal extremity of the thigh. All the flaps survived successfully after the surgery, and there was no partial necrosis of the flaps at the proximal or distal ends. The wounds in the flap donor sites healed, and all skin grafts survived. No angiography-related complications occurred.Conclusions:Highly selective arterial angiography can be used to determine the blood supply range of the source artery and perforators of the anterolateral thigh free flaps during the surgery. It can evaluate the blood supply of flaps more intuitively and objectively. Its application in assisting flap design can avoid partial flap necrosis caused by unreasonable preoperative design to a certain extent, and it is safe and reliable.

Objective:To investigate the correlation between serum hypoxia inducible factor 1 alpha (HIF-1α), vascular endothelial growth factor (VEGF), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and inflammatory factors and incision infection after anal fistula surgery.Methods:A retrospective analysis was conducted on the clinical data of 120 patients who underwent anal fistula thread hanging surgery at the First People′s Hospital of Shuangliu District, Chengdu from June 2022 to April 2023. The patients were divided into an infected group (36 cases) and a non infected group (84 cases) based on their postoperative incision infection status. The differences in serum HIF-1 α, VEGF, sTREM-1 and inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α)] between the infected and non infected groups were compared, and the correlation between CRP, IL-6, TNF-α, HIF-1 α, VEGF, sTREM-1 and postoperative infection of anal fistula was analyzed by Pearson correlation coefficient; The correlation between CRP, IL-6, TNF-α and HIF-1 α, VEGF, sTREM-1. And the efficacy of serum HIF-1 α, VEGF, sTREM-1, inflammatory factors and their individual and combined diagnosis of incision infection after anal fistula surgery was analyzed by receiver operating characteristic (ROC) curve analysis.Results:The levels of serum HIF-1 α, sTREM-1, CRP, IL-6, and TNF-α in the infected group were higher than those before surgery and higher than those in the uninfected group 3 days after surgery; VEGF levels were lower than preoperative levels and lower than those in the non infected group (all P<0.05). Pearson correlation analysis showed that HIF-1α, sTREM-1, CRP, IL-6, TNF-α were positively correlated with postoperative infection in anal fistula ( r=0.456, 0.494, 0.455, 0.510, 0.363, all P<0.05), while VEGF was negatively correlated with postoperative infection in anal fistula ( r=-0.462, P<0.05). CRP, IL-6, TNF-α were positively correlated with HIF-1 α and sTREM-1 ( r=0.574/0.611/0.653, 0.661/0.608/0.610, all P<0.05), while CRP, IL-6, TNF-α were negatively correlated with VEGF ( r=-0.200, -0.207, -0.254, all P<0.05). The area under the curve (AUC) of HIF-1 α, VEGF, sTREM-1, CRP, IL-6, and TNF-α for diagnosing incision infection after anal fistula surgery were 0.716, 0.787, 0.741, 0.678, 0.792, and 0.688, respectively. The AUC of the combined diagnosis of inflammatory factors and 6 data points for postoperative incision infection in anal fistula surgery were 0.836 and 0.921, respectively. Conclusions:Serum levels of HIF-1 α, sTREM-1, CRP, IL-6, and TNF-α are abnormally high in patients with incision infection after anal fistula surgery, while VEGF is abnormally low in expression. HIF-1 α, VEGF, sTREM-1, and inflammatory factors can be used as effective indicators for clinical diagnosis of incision infection after anal fistula surgery, and their combined diagnostic value is better. HIF-1 α and sTREM-1 are positively correlated with inflammatory factors, while VEGF is negatively correlated with inflammatory factors.

The presence of high-level talents plays a crucial role in ensuring the successful establishment of national regional medical centers.It presents the high-level talent management experience of Henan Children's Hospital,aiming to facilitate the coordinated development of pediatrics in Central China.To address the practical challenges and difficulties encountered in high-level talent management within hospitals,lean talent management is achieved by standardizing the management structure,clarifying management objectives,refining the management mechanism,establishing a performance appraisal incentive system,and implementing an integrated'induction and utilization'management approach.These measures effectively facilitate the development of national children's regional medical centers.

Objective:To explore the research hotspot and development trend of ideological and political education of medical courses , analyze the existing problem, and provide a reference for the future development of ideological and political education of medical courses.Methods:The CNKI database was searched for the literature on ideological and political education of medical courses included from 2017 to 2021. Excel and CiteSpace were used for visual analysis of the publication time, publication quantity, main authors, research institutions, keywords, and mutated words of 1 257 articles included in the study.Results:In recent five years, the number of articles on ideological and political education of medical courses was on the rise; Zhao Wenxing, Liu Ruiting, and Yang Hongmei published a relatively large number of papers, while Heze Medical College, Fujian Health College, and Shanghai University of Medicine & Health Sciences published a relatively large number of papers. Keywords with high frequency included "teaching reform, "biochemistry", and "ideological and political education". The keywords with strong mediating centrality included "practical teaching", "ideological and political course", "medical English", and "humanistic quality". The keywords with high mutation intensity included ideological and political education, ideological and political curriculum, and professional quality.Conclusion:The ideological and political education is currently a hotspot of medical education. The current research topics include teaching reform and teaching practice. Clarifying the logic of curriculum ideological and political evaluation and gradually building the evaluation system and mechanism of curriculum ideological and political evaluation will be a hot research topic in the future.

Objective:To investigate the therapeutic efficacy of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers.Methods:A retrospective observational study was conducted. From January 2021 to January 2022, 15 patients with two adjacent wounds of the fingers who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 10 males and 5 females, aged 25 to 51 years. The area of single wound after debridement was from 2.5 cm×2.0 cm to 7.5 cm×2.5 cm. All the wounds were repaired by the bilobated superficial peroneal artery perforator flap from the lower leg. The single lobe area of bilobated flap was from 3.0 cm×2.0 cm to 8.0 cm×3.0 cm. The wounds in all the donor sites were sutured directly. During the operation, the number of resected flaps, the number and type of carried perforators were recorded, and the calibers of perforator and superficial peroneal artery and the length of vascular pedicle were measured. The survival of flap and the wound healing in the donor and recipient sites were recorded after operation. The recovery of donor and recipient sites were recorded during follow-up. At the last follow-up, the repair effect of flap was evaluated by the comprehensive evaluation scale, and the sensory function of flap was evaluated by the sensory function evaluation standard of British Medical Research Association.Results:During the operation, 15 bilobated flaps were successfully resected, carrying 36 superficial peroneal artery perforators, all of which were septocutaneous perforators with the caliber of 0.2-0.8 mm. The caliber of superficial peroneal artery was 0.4-1.1 mm and the length of vascular pedicle was 3-8 cm. After operation, all the flaps survived with no vascular crisis occurred, and the wounds in donor and recipient sites healed well. During the follow-up of 6 to 12 months, the color and texture of flaps were similar to those of normal tissue in the hand and the appearance of flap was good in 10 cases; the other 5 cases underwent the stage Ⅱ flap thinning and plastic surgery 6 months after operation due to the bloated appearance of flaps. There was only linear scar in the donor site of lower leg, with no obvious scar hyperplasia or pigmentation, and there was no obvious adverse effect on the sensation or motor function of the distal limbs in the donor area. At the last follow-up, the repair effect of flap of 15 patients was excellent in 11 cases and good in 4 cases, and the sensory function of the flap was evaluated as grade S 2 in all cases. Conclusions:The bilobated superficial peroneal artery perforator flap has high proportion of septocutaneous perforator, and the blood supply is sufficient and reliable. Using this flap to repair two adjacent wounds of the fingers causes minimal damage to the donor area, only one group of blood vessels is needed to be anastomosed to repair two wounds, the difficulty of microoperation is reduced, and good flap repair effect and sensory function can be obtained.

Objective:To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities.Methods:A retrospective observational study was conducted. From October 2018 to June 2021, Suzhou Ruihua Orthopedic Hospital admitted 12 patients (11 males and 1 female, aged 24-64 years) who met the inclusion criteria, and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection, or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation. The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases. The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm, and the applied flap area was 9 cm×6 cm-25 cm×7 cm. During transplantation, the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area. Subcutaneous beauty suture was performed on all the donor wounds. After operation, the survival of the flap and vascular crisis were observed; and the wound healing at the donor site was observed. During follow-up, the texture of the flap and complications at the donor site were observed. At the last follow-up, the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table.Results:After operation, all the flaps of patients survived without vascular crisis; the wounds in the donor site healed smoothly. During follow-up of 6 to 26 months, the flaps had good texture; only linear scars remained in the donor area without scar contracture, pain or other discomfort. At the last follow-up, the total score of flap repair effect of 12 patients was 75-95, with an average of 87, of which 5 cases were rated as excellent, 6 cases as good, and 1 case as fair, and the proportion of excellent and good patients was 11/12.Conclusions:The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch, oblique branch, or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap. This operation has the advantages of simple operation, small trauma, and others, which effectively ensures the smooth operation.

Objective:To investigate the curative effects of the superficial peroneal artery perforator flap carrying two and more homologous perforators in repairing hand and foot wounds.Methods:A retrospective observational study was conducted. From January to September 2021, 23 patients with hand and foot wounds combined with bone or tendon exposure who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 16 males and 7 females, aged 23 to 68 years. After expansion of the wound, the wound area was 3.0 cm×2.0 cm to 11.0 cm×4.0 cm. All the wounds were repaired with the superficial peroneal artery perforator flap carrying two and more homologous perforators. The area of the resected flap was 4.0 cm×2.0 cm to 12.0 cm×5.0 cm. All the wounds in donor areas were sutured directly. During the operation, the resection of the flap, the number and caliber of carried perforators, the caliber of superficial peroneal artery, the length of vascular pedicle, and the number of accompanying veins of the superficial peroneal artery were recorded. The survival of the flap, the occurrence of complications, and the wound healing in the donor area were observed after operation. The recovery of the donor and recipient areas was followed up. At the last follow-up, the comprehensive evaluation scale was used to evaluate the curative effect of flap repair, and the sensory grading scale was used to evaluate the sensory function of the recipient area.Results:Totally 24 flaps were successfully resected in surgical operations, carrying 56 superficial peroneal artery perforators in total, with the caliber of perforators of 0.20-0.70 mm. The calibers of all perforators carried by 7 flaps were smaller than 0.40 mm. Nineteen flaps carried 2 perforators each, 3 flaps carried 3 perforators each, 1 flap carried 4 perforators, and 1 flap carried 5 perforators. During the operation, the superficial peroneal artery was resected with a caliber of 0.40-1.50 mm, the vascular pedicle was 2-6 cm in length, and each superficial peroneal artery had two accompanying veins. After operation, all the flaps survived smoothly, no vascular crisis or distal necrosis occurred, and the wounds healed well in the donor area. During the follow-up of 6 to 10 months after operation, the color, texture, and elasticity of the recipient area were good. Among them, 6 recipient areas were thinned and reshaped because of bloating. There was only linear scar and no obvious scar hyperplasia or pigmentation in the donor area, without significant change in sensory or motor function. At the last follow-up, the curative effect evaluation of flap repair was excellent in 22 flaps and good in 2 flaps, and the sensory function evaluation of the recipient area was grade S 3 in 1 area and grade S 2 in 23 areas. Conclusions:The superficial peroneal artery perforator flap with two and more homologous perforators has sufficient and reliable blood supply and is effective in repairing hand and foot wounds. It provides an ideal solution for the clinical problem in which the original operation scheme is abandoned due to the existence of only multiple slender perforators of caliber smaller than 0.40 mm, and only a single perforator in the operative field that cannot satisfy the needs of the flap blood supply and recipient area.

Objective:To summarize the morphological characteristics of the transverse branch of lateral femoral circumflex artery (LFCA) using digital subtraction angiography (DSA) and explore its clinical significance.Methods:A retrospective observational study was conducted. From October 2020 to May 2021, 62 patients with soft tissue injuries in the extremities were hospitalized in Suzhou Ruihua Orthopedic Hospital, including 40 males and 22 females, aged from 20 to 72 years. DSA was performed in the lateral femoral region of patients before the anterolateral thigh flap transplantation, and in combination with imaging scale to observe and measure the general condition of the blood vessels and the occurrence (with the occurrence rate being calculated), source artery, location of the origin point, direction of course, and the location of the perforating point of the cutaneous perforator of the transverse branch of LFCA, and in addition to classify the morphological characteristics of the transverse branch.Results:DSA detection showed that the femoral artery, the deep femoral artery, and the branches of LFCA were clearly distinguishable in 62 patients. Transverse branches of LFCA were observed in 59 patients, including 52 cases with a single transverse branch, and 7 cases with double transverse branches. The occurrence rate of transverse branches was 95.2% (59/62). A total of 66 transverse branches of LFCA were observed, of which 3 originated from the deep femoral artery, and 63 originated from the LFCA. The origin point of the transverse branch was 6.5-12.7 cm away from the anterior superior iliac spine. The transverse branch which was approximately perpendicular to the long axis of the body, originated outwards, ran between the ascending branch of LFCA and the oblique branch of LFCA, and branched along the way, with the trunk running under the greater trochanter. The perforating point of the cutaneous perforator of the transverse branch was 8.0-18.0 cm away from the anterior superior iliac spine. In the classification of morphological characteristics of the transverse branch of LFCA, the most common type was the one that originated from the same trunk with other branches of LFCA, accounting for 50.0% (31/62), followed by the one that originated from the singular trunk of LFCA (12 cases) or deep femoral artery (3 cases), accounting for 24.2% (15/62); the special type accounted for 21.0% (13/62), including 7 cases of double transverse branches and 6 cases of the transverse branch originated from the same trunk with multiple other branches of LFCA; those with small/absent transverse branch only accounted for 4.8% (3/62). Among the above-mentioned common trunk relationship of two branches, those with shared trunk of ascending and transverse branches were most frequently observed, accounting for 77.4% (24/31); those with shared trunks of the transverse and oblique branches (5 cases) and the transverse and descending branches (2 cases) accounted for 22.6% (7/31) altogether.Conclusions:A high incidence rate of the transverse branch of LFCA is observed through DSA. The transverse branch originates from the lateral femoral artery approximately perpendicular to the long axis of the body, mainly from the same trunk with another main branch of LFCA, especially the ascending branch. This positioning analysis can provide an important reference for the design and resection of anterolateral femoral flaps.