Objective To investigate the epidemiological trends,temporal and spatial distribution characteristics of pulmonary tuberculosis in Lanping County.Methods Based on tuberculosis management data and basic information systems from the"China Disease Prevention and Control Information System,"pulmonary tuberculosis data from Lanping County for 2018-2023 were obtained.Descriptive epidemiology,concentration method,circular distribution method,and spatial autocorrelation analysis were used to conduct epidemiological and spatial analyses of the pulmonary tuberculosis data.Results A total of 2836 TB cases were reported in Lanping County from 2018 to 2023,with an average annual incidence rate of 233.26 per 100000,showing a declining trend.The male-to-female ratio was 1.95∶1,with the highest incidence among individuals aged 60 and above(932 cases,32.86%).Cases were predominantly among farmers(91.01%)and the Lisu ethnic group(52.68%).TB incidence showed weak seasonality with a bimodal distribution,with primary peak occurring from October to March and secondary peak from June to August.Tu'e Township(324.74 per 100,000),Shideng Township(307.42 per 100000),and Jinding Town(260.98 per 100,000)had the highest incidence rates,accounting for 1,284 cases or 45.28%of the county's total cases.In 2020,the incidence of pulmonary tuberculosis in Lanping County showed a spatial clustering distribution(global Morans's I value<0,P value<0.05),with Shideng Township consistently showing high-low aggregation characteristics.Conclusion Between 2018-2023,while the tuberculosis incidence rate in Lanping County has declined,it still falls short of Yunnan Province's tuberculosis prevention and control targets,and the prevention and control work continues to face significant challenges.Strengthening screening of high-risk populations and providing medical support to remote areas will be key measures for future prevention and treatment.

Objective:To investigate the clinical effect of free posterior tibial artery perforator flap in repair of forefoot soft tissue defect.Methods:From January 2017 to January 2021, a retrospective study was conducted on 13 patients with forefoot soft tissue defect, metatarsal head exposed, and forefoot transverse arch integrity, including 9 males and 4 females. The age was (40.0±13.0) years old. Cause of injury: 8 cases of traffic accident injury, 5 cases of heavy object smashing injury. Seven cases had forefoot skin defect and toe damage, and 6 cases had forefoot skin avulsion injury, open toe fracture with tendon, blood vessel and nerve injury. The wound area was 4.5 cm×3.0 cm-8.0 cm×6.0 cm. VSD treatment was performed in the first stage, and free posterior tibial artery perforator flap was used for the second stage. The flap area was 5.5 cm×4.0 cm-9.0 cm×7.0 cm. Outpatient reviews scheduled at 1, 2, 3, and 6 months after surgery, through outpatient clinic, telephone or WeChat. The flaps were evaluated according to appearance, texture, sensory recovery, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot function scoring system.Results:All 13 flaps survived. The follow-up lasted for 6 to 24 months. The feet were in good shape, walking with weight beries, and the flaps had satisfactory appearance without wear and tear. Five cases were S 3, 6 were S 2, and 2 were S 1. According to AOFAS ankle-hindfoot function score, 4 had excellent scores, 7 were in good, and 2 in fair. Conclusion:The free posterior tibial artery perforator flap has relatively constant perforators, and the pedicle of the middle and upper perforators is longer, and the flap can build part of the sensation. Posterior artery perforator flap is a good flat for repairing the soft tissue defects of the metatarsal head of the forefoot.

Objective: To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. Methods: This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. Results: A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.

Objective To investigate the safety and short-term effectiveness of the hybrid operation for the treatment of intracranial complex ruptured aneurysms.Methods From December 2014 to March 2017,14 consecutive patients with complex ruptured aneurysm treated with hybrid operation at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University were enrolled retrospectively,including 13 with acute spontaneous aneurismal subarachnoid hemorrhage and 1 with hemorrhage in the recurrent aneurysm embolization.Twelve aneurysms were treated with shape clipping.Digital subtraction angiography (DSA) was used to evaluate the clipping effect of aneurysms.Two patients with aneurysm were treated with extracranial-intracranial (EC-IC) bypass and aneurysm trapping.Endovascular balloon occlusion for trapping aneurysms was performed after DSA evaluation of the patency of bridge vessel.Results Of the 14 patients,11 were treated with emergency hybrid operation after angiography,2 were treated with elective surgery,and 1 with emergency surgery for rescue because of bleeding during embolization.DSA revealed that the aneurysm clips in 3 of 12 patients needed to be adjusted,including 2 parent artery stenosis and 1 with incomplete clipping.After adjustment,the clipping was satisfactory.In intracranial and extracranial bypass surgery,angiography revealed that the blood vessels were patent.Trapping of the aneurysms was performed in the one-stage operation.One patient discharged voluntarily after procedure because of serious vasospasm.Onepatient had perfusion pressure breakthrough after surgery and received hematoma evacuation and decompression.The Glasgow outcome scale (GOS) score was 3 at discharge.Other patients had no new neurological dysfunction after operation.Thirteen patients were followed up for 3-24 months after operation.There were no new neurological dysfunction,including GOS 5 in 8 cases and 4 in 5 cases.Six patients underwent DSA examination,in 4 of them the aneurysm clipping did not show aneurysm recurrence,and the parent arteries were patent.Two patients treated with vascular bypass.There were no recurrence of aneurysms,and the parent arteries and anastomotic vessels were patent.Conclusion After preliminary observation,using hybrid operation for the treatment of complicated intracranial ruptured aneurysms was safe and effective.

Objective To investigate the relationship betweenthe stability of carotid artery plaque and cystatin C,homocysteine. Methods A total of 1 50 cerebral infarction patients with carotid artery plaque treated in Hospital of the First Electricity Authority in Guangdong were selected as the research subjects.According to Color Doppler ultrasound scanning,the patients were divided into the observation group (86 unstable plaque patients)and control group(64 stable plaque patients).Peripheral venous blood from the patients of both groups were collected for the detection of cystatin C,homocysteine,serum total cholesterol and fibrinogen levels and the results of detection were compared between the two groups.Results The levels of cystatin C,homocysteine,serum total choles-terol and fibrinogen in the observation group were significant higher than those of the control group(t =48.760,20.530,29.860, 33.720,P <0.05).The level of cystatin C was weak positive correlated with homocysteine(r =0.21,P <0.003).Multivariate lo-gistic regression analysis showed cystatin C,homocysteine,serum total cholesterol and fibrinogen were independent risk factors for carotid artery plaque instability in patients with cerebral infarction.Conclusion Cystatin C,homocysteine,serum total cholesterol and fibrinogen are important risk factors for carotid plaque instability,the cerebral infarction is closely related to the carotid artery plaque stability,so controlling the risk factors is the focus of prevention and treatment of cerebral infarction.

Objective To observe the therapeutic effect ofYiqi-Fumai injection andShenshao capsule in the treatment of angina pectoris and the influence on vascular endothelial cell function and serum MPO. Methods 90 cases of angina pectoris of coronary heart disease were randomly divided into a treatment group and a control group. 50 cases in the treatment group were treated withYiqi-Fumai injection and Shenshao capsule; 40 cases in the control group were treated with Plavix and metoprolol; clinical symptoms were observed before and after treatment, the indexes of endothelial cell function and electrocardiogram blood serum nitric oxide (NO), endothelin (ET), NOS and serum MPO, SOD, GSH changes were compared.Results The content of nitric oxide (NO), 6-keto-PGFLa and NOS of the treatment group were increased than the control group, while ET was reduced. In the treatment group, NO was (78.09 ± 88.71)μmol/L 6-keto-PGFL was 32.04 ± 25.82 pg/ml and NOS was 27.88 ± 9.08 U/MI before the treatment,; after the treatment, the NO was 127.11 ± 103.60μmol/L, 6-keto-PGFLa was 50.03 ± 60.87 pg/ml and NOS was 35.12 ± 22.18 U/MI. In the control group, NO was 96.98 ± 82.45μmol/L, 6-keto-PGFLa was 40.31 ± 51.92 pg/ml and NOS was 28.12 ± 5.11 U/MI before the treatment; After the treatment, NO was 95.62 ± 6.31μmol/L, 6-keto-PGFLa was 29.09 ± 42.01 pg/ml and NOS was 30.11 ± 7.51 U/MI. In the treatment group, ET was 58.81 ± 33.18 pg/ml before the treatment and 42.47 ± 40.5 pg/ml. after the treatment. In the control group, ET was 56.81 ± 32.76 pg/ml before the treatment and 60.67 ± 12.81 pg/ml after the treatment. In terms of resistance to oxidative stress and MPO, the SOD ,GSH and MPO improvement rate of the treatment group was significantly better than the control group (P<0.05). In the treatment group, SOD was 48.36 ± 17.38 U/MI, GSH was 126.68 ± 19.93 g/L and MPO was 57.33 ± 8.34 mmol/L before the treatment, after the treatment, SOD was 62.45 ± 15.76 U/MI, GSH was 135.98 ± 28.99 g/L and MPO was 17.11 ± 3.60 mmol/L. In the control group, SOD was 48.44 ± 19.37 U/MI, GSH was 29.44 ± 21.66 g/L and MPO was 56.35 ± 14.44 mmol/L before the treatment, after the treatment, SOD was 57.35 ± 14.44 U/MI, GSH was 28.56 ± 24.06 g/L and MPO was 48.62 ± 6.31 mmol/L.ConclusionYiqi-Fumai injection combined with Shenshao capsule has curative effect on angina pectoris of coronary heart disease, being worth of clinical use.

Spontaneous complete thrombosis with parent artery occlusion of giant intracranial aneurysms is rare.We report a patient with a rare giant vertebral artery aneurysm with spontaneous complete thrombosis and parent artery occlusion,and review the related literature,discuss its incidence,clinical presentation,pathogenesis,diagnosis,and treatment.

OBJECTIVE: To determine features of the clinical manifestation in patients with primary biliary cirrhosis (PBC), and to provide a scientific basis for diagnosis of PBC.
 METHODS: A total of 102 patients with PBC treated in the Second Xiangya Hospital, Central South University, from January 2013 to January 2015 were retrospectively analyzed. The patients' general condition, clinical manifestations, serum biochemical and immunological parameters were detected.
 RESULTS: Of the 102 PBC patients, 91 (89.21%) patients were female. The main symptoms in these patients were fatigue, poor appetite, dry mouth, nausea, vomiting, pruritus, stomachache, and abdominal distension. The major signs were jaundice, splenomegaly, hepatomegaly, edema, and ascites. The main features of serum biochemical parameters in these patients included the increase of alkaline phosphatase and gamma glutamyltranspeptidase (GGT), especially the GGT. The anti-mitochondrial antibodies-M2 (AMA-M2) in 81 and 21 patients was positive and negative, respectively. The differences between the AMA-MA positive and negative groups were not statistically significant (P>0.05). According to clinical manifestation, 102 patients were classified into 2 groups: A non-cirrhosis group (n=56) and a cirrhosis group (n=46). The positive rates in these 2 groups, such as ANA, AMA-M2, anti-gp210, anti-Sp100, anti-Ro52, anti-PML, were 54.35%, 89.13%, 41.30%, 13.04%, 43.38% and 10.87% vs 57.14%, 71.43%, 42.86%, 12.5%, 51.79% and 3.71%, respectively, with no significant difference between them (P>0.05). However, there was significant difference in the positive rate of anti-3E-EPO between the above 2 groups (86.78% vs 58.93%, P<0.05). The positive rates of AMA-M2 and anti-3E-EPO in 30 patients diagnosed by hepatic histopathological examination were higher than those of other antibodies.
 CONCLUSION PBC mainly affects middle-aged women, and its clinical manifestation is various. The autoantibody tests play an important role in diagnosis of PBC. Checking for AMA-A2 and anti-3E-BPO can improve the positive rate of PBC. Liver histopathological examination may provide useful information on disease severity, which can determine the histological stage when the patient's serum autoantibodies are negative.
Alkaline Phosphatase ; metabolism ; Autoantibodies ; blood ; Female ; Humans ; Liver Cirrhosis, Biliary ; diagnosis ; pathology ; Male ; Mitochondria ; Retrospective Studies ; gamma-Glutamyltransferase ; metabolism

Objective To explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA). Methods We retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients' records were reviewed including all computed tomographic scans and angiograms. Results Twelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping;44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were:absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients;death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment due to recanalization in only one patient. Conclusion Correct localization of the rupture aneurysm based on a comprehensive diagnosis is key to MIA treatment. All the aneurysms should be treated in one session whenever possible to protect the patient from rebleeding.

Objective To explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA). Methods We retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients' records were reviewed including all computed tomographic scans and angiograms. Results Twelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping;44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were:absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients;death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment due to recanalization in only one patient. Conclusion Correct localization of the rupture aneurysm based on a comprehensive diagnosis is key to MIA treatment. All the aneurysms should be treated in one session whenever possible to protect the patient from rebleeding.