Objective:To explore the clinical application value of multimodal"one-stop"CT in assessing acute ischemic stroke(AIS).Methods:A total of 98 patients who were diagnosed as AIS and underwent the treatment of intravenous thrombolysis in Department of Neurology of Huainan Chaoyang Hospital from December 2019 to July 2023 were selected.In them,the degree of vascular stenosis of 49 patients was<30%(mild stenosis),and that of 39 patients was 30%～69%(moderate stenosis),and that of 10 patients was 70%～99%(severe stenosis)and 100%occlusion(severe group).All subjects underwent multimodal"one-stop"CT scan,and the changes of perfusion parameters included time to peak(TTP),mean transit time(MTT),cerebral blood flow(rCBF)and cerebral blood volume(rCBV)of them were analyzed.Results:All 98 patients existed stenosis at different locations and degrees,and CT examination showed existed respectively 5 cases of suspicious low density foci in frontal lobe and parietal lobe.Post-processing pseudo-color map showed that all 98 cases had abnormal hypoperfusion.The responsible vessel of 25 cases with occlusion and 20 cases with stenosis was the cerebral middle artery,and that of 3 cases with occlusion and 7 cases with stenosis was posterior artery,and that of 7 cases was internal carotid artery,and that of 3 cases with occlusion and 5 cases with stenosis was basilar artery,and that of 7 cases with occlusion and 18 cases with stenosis was vertebrobasilar artery.In addition,3 cases existed arteriosclerosis.There were significant differences in the average levels of rCBF,rCBV,MTT and TTP among patients with different degrees of stenosis,and the differences were all statistically significant(F=66.689,46.751,3.401,41.565,P<0.05),respectively.The area under curve(AUC)values of the receiver operating characteristic(ROC)curves of rCBF,rCBV,MTT and TTP were all>0.5 in assessing AIS,and the AUC value of the combined examination of above indicators was higher than the AUC value of each single indicator of the above indicators.Conclusion:Brilliance iCT multimodal"one-stop"CT scan can comprehensively understand the vascular morphology and stenosis location of the head and neck,and effectively assess responsible vessels,and provide perfusion parameters of whole brain.This technique can improve the accuracy of diagnosis and treatment decision,which has important impact in improving the efficacy of cerebral stroke.It can provide the basis for the selection of subsequent treatment plan and the prognosis judgment.

Objective:To investigate the effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy.Methods:This study was a retrospective non-randomized clinical controlled study. A total of 32 patients (20 males and 12 females, aged (58±11) years) who met the inclusion criteria and underwent closure with antibacterial absorbable sutures (hereinafter referred to as direct closure surgery) admitted to Guangdong Provincial People's Hospital of Southern Medical University (hereinafter referred to as our hospital) from October 2017 to December 2021 were included in direct closure group. A total of 39 patients (27 males and 12 females, aged (59±11) years) who met the inclusion criteria and received bilateral pectoralis major muscle flap packing repair admitted to our hospital from January 2015 to January 2020, were included in muscle flap packing group. In the two groups, sternal infected wounds were thoroughly debrided during stage Ⅰ surgery, followed by wound repair during stage Ⅱ surgery. The width of sternal cross-section defects after debridement was less than 1 cm for patients in the two groups. For patients in direct closure group, stage Ⅱ wound repair involved intermittent sutures to the anterior sternal plate or full-thickness sternum with a total of 6 or 7 double sternal sutures. Relevant data including the duration of the stage Ⅱ wound repair surgery and the volume of blood loss during surgery, length of hospital stay, and bacterial wound infection of patients in the two groups were recorded. The postoperative complications and wound healing of patients in the two groups were recorded. During follow-up, the wound infection or recurrence of patients in the two groups and the sternal healing of patients in direct closure group were observed.Results:Compared with those in muscle flap packing group, the duration of stage Ⅱ wound repair surgery and length of hospital stay of patients in direct closure group were significantly shorter (with t values of 13.61 and 6.25, respectively, P<0.05), and there was no statistically significant difference in intraoperative blood loss volume of the stage Ⅱ wound repair surgery between the two groups ( P>0.05). The main bacterial infection in the two groups was Staphylococcus. In direct closure group, one patient had exudation in the wound two weeks post-operation, however the wound healed well after two weeks of conservative dressing changes; the wounds of the other patients healed well. In muscle flap packing group, 5 patients had postoperative complications, of which one patient died, and the wounds of 4 patients healed after dressing change or reoperation; the wounds of the other patients healed well. There was no statistically significant difference in complication incidence of patients between the two groups ( P>0.05). During the follow-up of 22-45 months, there was no re-infection or recurrence in the wound of patients in direct closure group and surviving patients in muscle flap packing group, the sternum of patients in the direct closure group achieved anatomical union. Conclusions:Direct closure surgery can not only effectively repair sternal cross-sectional defects with width below 1 cm due to deep sternal wound infections after median thoracotomy, but can also significantly shorten the operation time and duration of hospitalization.

Objective:To recognize the characteristics of necrotizing fasciitis patients complicated with sepsis and summarize the experience the treatment.Methods:A retrospective study was conducted. The clinical data of 57 patients with necrotizing fasciitis complicated with sepsis admitted to Guangdong Provincial People's Hospital from July 2009 to December 2019 was analyzed by collecting such factors as gender, age, complications, infection sites, pathogens, surgery information, treatment options and outcome. The patients were divided into debridement group ( n = 14) and control group ( n = 43) according to whether the debridement was completed within 48 hours of admission, and the mortality during hospitalization between the two groups was compared. A telephone follow-up had been done to record the long-term outcome of these patients. Results:Among 57 patients with necrotizing fasciitis complicated with sepsis, there were 43 males and 14 females with the average age of (57.9±12.1) years old. Most of the underlying diseases were diabetes mellitus (70.17%), other diseases included hypertension (8.77%), tumor chemotherapy (7.02%), liver disease (hepatitis, cirrhosis, 7.02%), coronary artery heart disease (3.51%), systemic lupus erythematosus (3.51%), etc. Most of the infection site was lower limbs (71.93%). There were 78 pathogens cultured in 57 patients, in which 52 were non-drug resistant bacteria (66.67%), and 26 were drug resistant bacteria (33.33%). There were 40 Gram positive (G +) bacteria (51.28%), 29 Gram negative (G -) bacteria (37.18%), 8 fungi (10.26%) and 1 mixed bacteria (1.28%). Finally, of 57 patients, 46 patients were cured, and 11 patients died with hospital mortality of 19.30%. Among 57 patients, the hospital mortality in the debridement group was significantly lower than that in the control group [0% (0/14) vs. 25.58% (11/43), P < 0.05]. Among the 46 cured patients, 11 had accepted amputations, accounting for 23.91%. In December 2020, 43 patients who were cured (3 patients were lost to follow-up) were followed up by telephone. Twenty-three patients were completely self-care, 9 patients were partly self-care, 8 patients were completely unable to take care of themselves, and 3 patients died. Conclusions:Necrotizing fasciitis with sepsis mostly occurs in people with weakened immunity, and has a high mortality and disability rate. Early identification and active surgical debridement may be the key to improve the treatment effect.

Objective:To analyze the effects of noise exposure on the hearing at different frequencies in workers from the automobile manufacturing industry.Methods:A total of 4723 noise workers in a large automobile manufacturing company in Guangzhou were chosen as the research object by using judgment sampling method between April and July, 2018, and carried out 0.5, 1.0, 2.0, 3.0, 4.0 and 6.0 kHz pure tone audiometry threshold to analyze the characteristics of the status of hearing loss at different frequencies and its relationship with the noise exposure time.Results:The detection rate of hearing loss in noise-exposed workers was 29.8% (1406/4723) . Among them, the binaural hearing loss was 21.2% (999/4723) , and single unilateral hearing loss accounted for 8.6% (407/4723) . The hearing loss detection rate of right ear was higher than that of the left ear ( P<0.05) , especially in the 6.0 kHz ( P<0.001) . The detection rate of increased speech frequency hearing threshold was 1.9% (90/4723) , and the detection rate of increased high-frequency hearing threshold was 28.9% (1366/4723) . The detection rate of increased threshold in both the left and the right ear increased with the increase of frequency ( P<0.001) , the increased hearing threshold was the highest at the frequency of 6.0 kHz. The auditory threshold of left ear in 0.5 kHz were higher than that of right ear at the same frequency ( P<0.05) . The detection rate of hearing loss increased with the increase of noise exposure time ( P<0.001) , and the increased threshold of 3.0, 4.0 and 6.0 kHz from workers increased with the increase of noise exposure time ( P<0.001) . Conclusion:There is a significant increased threshold in workers exposed to noise frequency of 6.0 kHz, right ear is more easily damaged than left ear, there is a dose-response relationship for the noise exposure time and high-frequency hearing loss.

Objective:To explore the annexin A2 (ANXA2) expression and distribution in dorsal root ganglion (DRG) after chronic compression of DRG (CCD) in rat models.Methods:One hundred and two adult male Wistar rats were randomly divided into control group ( n=24), CCD model group A (7 d after modeling, n=30), CCD model group B (14 d after modeling, n=24), and CCD model group D (28 d after modeling, n=24). Rats in the later 3 groups were established CCD models with the help of "U" rod screw. Mechanical withdrawal threshold (MWT) and thermal radiation paw withdrawal latency (TWL) were measured by mechanical pain stimulator and thermal pain stimulator. The ANXA2 protein expression in the DRG was detected by Western blotting and immunofluorescent staining. The distributions of ANXA2 and class III β-tubulin (TUBB3) positive cells in DRG were detected by immunofluorescence double staining. Results:As compared with those in the control group, MWT and TWL in the CCD model group A and CCD model group B were significantly decreased ( P<0.05). Western blotting showed that ANXA2 protein expression in the DRG of CCD model group A was statistically increased as compared with that in the control group ( P<0.05). Immunofluorescent staining showed that the immunoreactivity of ANXA2 in DRG of CCD model group A was enhanced as compared with that in control group. Immunofluorescence double staining showed that ANXA2 was mainly expressed in the cell membrane of neurons in the DRG of CCD model group A. Conclusion:The mechanical and thermal pain thresholds are decreased, while the ANXA2 protein expression at the pressure side of DRG is up-regulated and the immunoreactivity is increased in CCD models; ANXA2 may be involved in the occurrence and development of pathological neuralgia after CCD.

Objective:To analyze the effects of noise exposure on the hearing at different frequencies in workers from the automobile manufacturing industry.Methods:A total of 4723 noise workers in a large automobile manufacturing company in Guangzhou were chosen as the research object by using judgment sampling method between April and July, 2018, and carried out 0.5, 1.0, 2.0, 3.0, 4.0 and 6.0 kHz pure tone audiometry threshold to analyze the characteristics of the status of hearing loss at different frequencies and its relationship with the noise exposure time.Results:The detection rate of hearing loss in noise-exposed workers was 29.8% (1406/4723) . Among them, the binaural hearing loss was 21.2% (999/4723) , and single unilateral hearing loss accounted for 8.6% (407/4723) . The hearing loss detection rate of right ear was higher than that of the left ear ( P<0.05) , especially in the 6.0 kHz ( P<0.001) . The detection rate of increased speech frequency hearing threshold was 1.9% (90/4723) , and the detection rate of increased high-frequency hearing threshold was 28.9% (1366/4723) . The detection rate of increased threshold in both the left and the right ear increased with the increase of frequency ( P<0.001) , the increased hearing threshold was the highest at the frequency of 6.0 kHz. The auditory threshold of left ear in 0.5 kHz were higher than that of right ear at the same frequency ( P<0.05) . The detection rate of hearing loss increased with the increase of noise exposure time ( P<0.001) , and the increased threshold of 3.0, 4.0 and 6.0 kHz from workers increased with the increase of noise exposure time ( P<0.001) . Conclusion:There is a significant increased threshold in workers exposed to noise frequency of 6.0 kHz, right ear is more easily damaged than left ear, there is a dose-response relationship for the noise exposure time and high-frequency hearing loss.

Objective:To evaluate the association of abdominal obesity and obesity types with carotid intima-media thickness (cIMT) in children and provide scientific evidence for the prevention of abnormal vascular structure.Methods:Based on the "Children’s Cardiovascular Health Cohort" conducted in Huantai county of Zibo, Shandong province from November 2017 to January 2018, a total of 1 240 children, including 657 boys (53.0%), who had completed data of sex, age, physical examinations, blood biochemical indices and lifestyle variables (collected by questionnaires) were included for the analysis. Covariance analysis was used to compare the levels of cIMT in groups with normal waist circumference, pre-abdominal obesity and abdominal obesity. Logistic regression analysis was used to evaluate the association of pre-abdominal obesity and abdominal obesity with high cIMT, and the association of combined effect of general overweight or obesity and abdominal obesity or pre-abdominal obesity with high cIMT.Results:The levels of cIMT in children with pre-abdominal obesity (0.47±0.03) mm and abdominal obesity (0.50±0.04) mm were higher than that in children with normal waist circumference (0.45±0.05) mm, the difference was significant ( P<0.001). The detection rates of high cIMT in children with pre-abdominal obesity(20.8%) and abdominal obesity (49.5%) were higher than that in children with normal waist circumference (8.8%), the difference was significant ( P<0.001). Compared with normal waist circumference, pre-abdominal obesity and abdominal obesity were significantly associated with high cIMT (pre-abdominal obesity: OR=2.53, 95 %CI: 1.67-3.84; abdominal obesity: OR=8.56, 95 %CI: 5.97-12.29) after adjustment for potential covariates. Compared with normal body mass index and normal waist circumference, abdominal obesity or pre-abdominal obesity alone ( OR=2.24, 95 %CI: 1.36-3.69), and mixed overweight and obesity ( OR=6.94, 95 %CI: 4.87-9.90) were significantly associated with high cIMT. Conclusions:The association between abdominal obesity and high cIMT was significant in children, and the association was stronger between mixed overweight or obesity and high cIMT, suggesting that we should consider mixed overweight and obesity in the prevention of abnormal vascular structure.

Objective:To analyze the trends in blood pressure (BP) values and the elevated BP based on the measurements at three occasions in different days and its relationship with obesity in children and provide scientific evidence for the identification and prevention of hypertension in children.Methods:A public primary school in Huantai county of Zibo, Shandong province, was selected as the investigation field by using a convenient cluster sampling method. The baseline survey of "Children’s Cardiovascular Health Cohort" was carried out from November 2017 to January 2018. All the students with willingness and informed consent in this school were included in the survey, and the valid sample size was 1 505 children (aged 6-11 years). Children with elevated BP at the measurement of the first occasion should had a second measurement 2 weeks later, and a third measurement was given 2 weeks later if BP was still high at the measurement of the second occasion. Hypertension was confirmed if elevated BP was detected in the measurements at all the three occasions in different days. Multivariate linear regression model was used to assess the trend in BP values in children in the measurements at three occasions in different days, Cochran-Armitage trend analysis was used to evaluate the trend of elevated BP, and logistic regression model was used to analyze the relationship of elevated BP with obesity at three occasions in different days.Results:In this study, with the increase of follow-up visits, the BP levels continued to rise (trend P<0.05). The elevated BP rates at three occasions were 15.5%, 4.0% and 1.9%, respectively, showing a significantly downward trend (trend P<0.05). Compared with both normal weight and normal waist circumference, the association between obesity types (general obesity only, abdominal obesity only, and mixed obesity) and elevated BP at three occasions increased (the first occasion: OR=3.62, 95 %CI: 2.65-4.96; the second occasion: OR=9.50, 95 %CI: 4.95-18.22; and the third occasion: OR=8.94, 95 %CI: 3.48-22.96; all P<0.05). Stratified analysis by gender showed similar results. Conclusions:The elevated BP rates based on the measurements at three occasions in different days in children aged 6-11 years showed a significant decrease trend. The association between different types of obesity (especially mixed obesity) and elevated BP in children became stronger gradually with the progress of the follow up.

Objective To investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] level and the risk of metabolic syndrome ( MS) and its components in patients with type 2 diabetes mellitus. Methods Clinical data of 796 type 2 diabetic inpatients in the Department of Endocrinology, the Ninth People' s Hospital, Shanghai Jiaotong University School of Medicine, from January 2017 to December 2018 were enrolled. These patients were divided into MS group (n=541) and non-MS group (n=255). The association of serum vitamin D level and metabolic syndrome was investigated. Results The level of 25( OH) D in MS group was significantly lower than that in non-MS group (P<0.05). According to 25(OH)D 20 ng/ml as the borderline of vitamin D deficiency, the rate of 25(OH)D deficiency in MS group was significantly higher than that in non-MS group (P<0.01). Serum 25(OH)D levels in patients with type 2 diabetes were negatively correlated with smoking, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, triglyceride, and low density lipoprotein-cholesterol levels ( all P<0.05) . Multiple logistic regression analysis showed that 25( OH) D was an independent protective factor for MS in patients with type 2 diabetes. These patients were divided into 4 subgroups according to 25( OH) D levels [ Q1:0-10 ng/ml (n=24), Q2:10-20 ng/ml (n=417), Q3:20-30 ng/ml (n=117), Q4≥30 ng/ml(n=18)]. Logistic regression showed that the risk ratios (OR) of the metabolic syndrome in the Q2, Q3, and Q4 groups were 0.471, 0.389, and 0.211 respectively, compared with Q1 group (P<0.05).Conclusion Serum 25(OH)D level in type 2 diabetic patients was negatively correlated with the risk of MS.

To investigate the effect of venous super drainage applying in free flaps. Methods From June, 2017 to December, 2018, 7 cases who had severe soft tissue injuries were treated with free flap. Cause of injury: 1 electric injuries, 2 tumor-related wounds, 1 deep burns, 2 mechanical trauma, and 1 necrotizing fasciitis. All patients were underwent free flap transplantation. There were 5 cases of anterolateral thigh artery perforator flap, 1 case of superficial circumflex iliac artery perforator flap, and 1 case of first dorsal metatarsal artery perforator flap.The application of venous super-drainage technology was carried out according to needs and specific conditions. Two sets of venous passages were prepared in both recipient and donor site to form a double set of venous reflux super-drainage mode. Blood supply, swelling, exudation, secondary exploration and survival rate of the flap were observed after operation, and regularly followed-up. Results All 7 flaps survived. Venous super drainage technique was ap-plied in 7 cases. No arteriovenous crisis occurred after the operation. The flaps had good blood circulation, slight swelling, less exudation, rapid edema regression and no secondary surgical exploration. Followed-up for 2-18 (average 10.5) months, there was no infection recurred. Flaps survived well, and the donor sites healed well without sensory loss.The flexion and extension function of joint was normal. Conclusion The technique of venous super-drainage prepares 2 sets of venous systems for the free flap in the treatment of vascular pedicle in the free flap repair operation, which is conducive to reducing the venous crisis after flap surgery, reducing flap edema, reducing exudation, reducing secondary surgical exploration and improving the survival rate of the flap.