Objective:To investigate clinical curative effect of multiple composite tissues replantation with microsurgical technique in single hand.Methods:From May 2008 to December 2021, the clinical data of patients who underwent multiple composite tissue replantation in single hand in Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences and Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, were retrospectively analyzed. According to the severed site, anatomical level, the injury cause, the severity of injury, the size of severed tissue, and replantation conditions (such as blood vessels for anastomosis), the severed tissue was evaluated and carried out modified classification (type Ⅰ-Ⅳ) before the operation, and the surgical plan was designed. The severed composite tissue was debrided in emergency, the severed bone and muscle tissue were fixed, and the arteries, veins and nerves were anastomosed by microsurgical technique under a high-power microscope. The ratio of arteries to veins was 1∶1-1∶2. If enough arteries and veins could not be found, arteriovenous shunt could be used to form arterial venous flap or venous arterialized flap, or form artery flap by just artery anastomosis, or form venous flap by just vein anastomosis. Then skin tissue was sutured after recanalization. After the operation, the patients received specialized treatment and guided rehabilitation exercise. The wound healing of hand, skin color, skin quality, swelling degree, sensation, pain degree of joint, and activity function were followed up after the operation. At the last follow-up, the patient’s self-evaluation of the treatment effect was divided into three levels: satisfactory, average, and unsatisfactory. One chief physician and one doctor-in-charge were responsible for the comprehensive evaluation of curative effect, according to the assessment standard for upper limb function issued by Chinese Medical Association of Hand Surgery. 80-100 points were excellent, 60-79 points were good, 40-59 points were fair, and <40 points were poor.Results:A total of 94 severed composite tissues in 35 patients, including of 20 male patients and 15 female patients were enrolled. The average age was 36.4 years (range, 16-65 years). Fifty severed tissues in 18 cases were classified into type Ⅰ, 40 severed tissues in 15 cases type Ⅱ, 4 severed tissues in 2 cases type Ⅲ. Among the 35 cases, 1 case of thumb pulp severed tissue was necrotic at the edge (0.3 cm×0.5 cm) due to local contusion, 1 case of index finger lateral severed tissue was necrotic at the edge (0.3 cm×0.8 cm) due to local avulsion injury, and healed after dressing change, and the other replanted composite tissue survived. The patients were followed up for 3 to 65 months (average, 18.5 months). The wounds were completely healed, and the color, elasticity, and quality of the replanted tissue was close to the surrounding normal skin. There was no obvious swelling or atrophy deformity of the hands. According to the patients’ self-assessment, 31 cases were satisfied and 4 cases were average. Comprehensive evaluation of hand function and appearance: excellent in 23 cases, good in 9 cases, fair in 3 cases, excellent and good rate was about 91.4% (32/35).Conclusion:Though multiple composite tissues replantation with microsurgical technique in single hand is difficult, and vascular anastomosis technical requirement is high, once surgery succeeds, the function and appearance can get good recovery, and patient satisfaction is also relatively high.

Objective:To investigate clinical curative effect of multiple composite tissues replantation with microsurgical technique in single hand.Methods:From May 2008 to December 2021, the clinical data of patients who underwent multiple composite tissue replantation in single hand in Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences and Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, were retrospectively analyzed. According to the severed site, anatomical level, the injury cause, the severity of injury, the size of severed tissue, and replantation conditions (such as blood vessels for anastomosis), the severed tissue was evaluated and carried out modified classification (type Ⅰ-Ⅳ) before the operation, and the surgical plan was designed. The severed composite tissue was debrided in emergency, the severed bone and muscle tissue were fixed, and the arteries, veins and nerves were anastomosed by microsurgical technique under a high-power microscope. The ratio of arteries to veins was 1∶1-1∶2. If enough arteries and veins could not be found, arteriovenous shunt could be used to form arterial venous flap or venous arterialized flap, or form artery flap by just artery anastomosis, or form venous flap by just vein anastomosis. Then skin tissue was sutured after recanalization. After the operation, the patients received specialized treatment and guided rehabilitation exercise. The wound healing of hand, skin color, skin quality, swelling degree, sensation, pain degree of joint, and activity function were followed up after the operation. At the last follow-up, the patient’s self-evaluation of the treatment effect was divided into three levels: satisfactory, average, and unsatisfactory. One chief physician and one doctor-in-charge were responsible for the comprehensive evaluation of curative effect, according to the assessment standard for upper limb function issued by Chinese Medical Association of Hand Surgery. 80-100 points were excellent, 60-79 points were good, 40-59 points were fair, and <40 points were poor.Results:A total of 94 severed composite tissues in 35 patients, including of 20 male patients and 15 female patients were enrolled. The average age was 36.4 years (range, 16-65 years). Fifty severed tissues in 18 cases were classified into type Ⅰ, 40 severed tissues in 15 cases type Ⅱ, 4 severed tissues in 2 cases type Ⅲ. Among the 35 cases, 1 case of thumb pulp severed tissue was necrotic at the edge (0.3 cm×0.5 cm) due to local contusion, 1 case of index finger lateral severed tissue was necrotic at the edge (0.3 cm×0.8 cm) due to local avulsion injury, and healed after dressing change, and the other replanted composite tissue survived. The patients were followed up for 3 to 65 months (average, 18.5 months). The wounds were completely healed, and the color, elasticity, and quality of the replanted tissue was close to the surrounding normal skin. There was no obvious swelling or atrophy deformity of the hands. According to the patients’ self-assessment, 31 cases were satisfied and 4 cases were average. Comprehensive evaluation of hand function and appearance: excellent in 23 cases, good in 9 cases, fair in 3 cases, excellent and good rate was about 91.4% (32/35).Conclusion:Though multiple composite tissues replantation with microsurgical technique in single hand is difficult, and vascular anastomosis technical requirement is high, once surgery succeeds, the function and appearance can get good recovery, and patient satisfaction is also relatively high.

Objective To analyze the epidemiological characteristics of syphilis in Yichang City from 2011 to 2020, and provide a scientific basis for developing effective control measures. Methods The data of syphilis cases reported in Yichang City from 2011 to 2020 were collected and analyzed by descriptive epidemiological methods. Results A total of 8 107 cases of syphilis were reported in Yichang City from 2011 to 2020, with an average annual reported incidence rate of 19.76 per 100 000.The reported incidence of syphilis increased from 17.39/100 000 in 2011 to 24.49/100 000 in 2018 （APC=6.82%，95%CI：2.34%~11.49%， P＜0.05）, from 24.49/100 000 in 2018 Decline to 17.55/100 000 in 2020（P＞0.05）. Recessive syphilis is the main type, with 5 837 cases (72.00%), and the annual reported incidence rate is 14.23 per 100 000. The number of cases peaked in July, at 836 (10.31%), and 433 (5.34%) of the lowest in February . The top 3 counties with annual average reported incidence rates were Zigui County (28.51/100 000) , Xiling District (25.01/100 000), and Dangyang City (23.73/100 000). There were a statistically significant differences in reported incidence between counties (2 =933.92, P＜0.01). Gender ratio was 0.72. Cases mainly concentrated in people over 20 years old, 7901 cases (97.46%). The occupation distribution is mainly farmers, housework, unemployed, and retired people. Conclusion The incidence of syphilis in Yichang City has been on the rise in recent ten years, and there is still a long way to go to prevent and control syphilis. We suggested to continue to strengthen the prevention and control of syphilis and comprehensively prevent and control the spread of syphilis.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.

Objective To analyze the changes of CD4⁺ T cell numbers at different periods of antiviral therapy in HIV-infected and AIDS patients (HIV/AIDS) in Yichang City. Methods The relevant information was retrieved from the National AIDS Comprehensive Prevention Information System-Antiretroviral Treatment Management Database. Changes in the number of CD4⁺ T cells were analyzed in HIV/AIDS patients who started receiving highly active antiretroviral therapy (HAART) and continued the treatment for 3 years from January 1, 2003 to December 31, 2017 in Yichang. Results The number of CD4⁺T lymphocytes in 550 HIV/AIDS cases increased significantly at various time points within 3 years after treatment, and increased with the increase of treatment time（F=100.20，P<0.001）. The CD4+T cell counts of different baseline level groups were statistically different before and after treatment（F=8.57，P<0.01）. The CD4+ T cell counts of patients who started treatment at age of 15-30 years old increased faster than those who started treatment at age of over 30 years old（F=1.27，P<0.05）. Conclusion HAART has a significant effect on the increase of CD4+T cells, and the early treatment is more effective. Early detection, diagnosis and treatment should be promoted, and anti-viral treatment should be actively carried out.

Subthreshold depression is common in the elderly. It is also one of the neuropsychiatric symptoms that frequently affect patients with mild cognitive impairment (MCI). MCI patients with subthreshold depression may suffer from more severe cognitive impairment and an increased risk of dementia. In recent years, more attention has been paid to the relationship between subthreshold depression and cognitive impairment. This article reviews the research progress on the epidemiology and neuroimaging of subthreshold depression in the elderly with MCI.

Subthreshold depression is common in the elderly. It is also one of the neuropsychiatric symptoms that frequently affect patients with mild cognitive impairment (MCI). MCI patients with subthreshold depression may suffer from more severe cognitive impairment and an increased risk of dementia. In recent years, more attention has been paid to the relationship between subthreshold depression and cognitive impairment. This article reviews the research progress on the epidemiology and neuroimaging of subthreshold depression in the elderly with MCI.

OBJECTIVE: To evaluate the clinical and radiological results of patients with thoracic and lumbar fracture and dislocation treated by posterior transforaminal decompression and interbody fusion. METHODS: From June 2010 to June 2017, posterior transforaminal decompression, interbody fusion combined with pedicle screw fixation were performed in 21 patients with thoracic and lumbar fracture and dislocation. Their clinical and radiological data were collected and retrospectively analyzed, including 15 males and 6 females, aged from 25 to 58 years with an average of 45 years old. According to the criterion of American Spinal Injury(ASIA), preoperative neurological function was graded A in 3 cases, B in 7 cases, C in 6 cases, D in 4 cases and E in 1 case. Operative time and intraoperative blood loss and correlative complications were recorded. And VAS score, ODI and Cobb angle were evaluated before and after surgery. The improvement of neurological function was also analyzed at the final follow-up. Intervertebral bony fusion was observed during the follow-up by CT three-dimensional reconstruction. RESULTS: The operative time was 150 to 240 min with an average of (192±47) min. The intraoperative blood loss was 380 to 750 ml with an average of(603±120) ml. Dura sac tearing and cerebral fluid leakage occurred in 3 cases and were repaired during operation; superficial wound infection occurred in 1 case, and got healing after dressing change. The postoperative follow-up duration was 24 to 45 months with an average of(37.0±9.5) months. VAS score was improved from preoperative 8.9±0.4 to immediately postoperative 4.2±1.3(<0.05). At the final follow-up, VAS score decreased further to 3.6±0.8. ODI was decreased from preoperative (95.30±3.52)% to (32.51±6.30)% at the final follow-up (<0.05). Cobb angle was corrected from preoperative (21.2±8.8)° to immediately postoperative(2.3±3.1)° (<0.05). At the final follow-up, Cobb angle was (3.2±2.5)°, showing no significant difference with immediately postoperative value. The neurological function was grade A in 3 cases, B in 3 cases, C in 5 cases, D in 6 cases and E in 4 cases at the final follow-up. All the patients got solid intervertebral bone fusion in 8 to 13 months after operation, with an average fusion time of (10.3±2.5) months. CONCLUSIONS For the patients with thoracic and lumbar fracture and dislocation mainly involving intervertebral disc and endplate plane, posterior transforaminal decompression and interbody fusion not only is less invasive, but also can effectively reconstruct spinal three column and obtain good biomechanical stability. And, it is beneficial for the good recovery of neurological function.
Adult ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome