[Objective] To investigate the factors associated with alanine aminotransferase (ALT) abnormalities in multi-ethnic blood donors across five Zang autonomous prefectures in the plateau regions of Qinghai Province, and to provide evidence for ensuring blood safety and formulating screening strategies. [Methods] A retrospective analysis was performed on the ALT abnormal test results of blood donors in the Zang autonomous prefectures of Qinghai from 2022 to 2024. The correlations between ALT levels and factors including gender, age, altitude, and infectious markers were investigated. [Results] The overall ALT unqualified rate among blood donors in this region was 9.01%. Significant differences in ALT levels were observed across genders and age groups (P<0.05). Variations in ALT abnormality rates were also noted among different plateau regions (P<0.05). Overall, ALT values exhibited an increasing trend with rising altitude. The average ALT unqualified rates were 11.19% in Zang donors, 7.96% in Han donors, and 4.79% in donors from other ethnic groups (P<0.05). No statistically significant association was observed between ALT abnormality and the presence of HBV/HCV infectious markers (P>0.05). [Conclusion] In the plateau areas of Qinghai, multi-ethnic blood donors have a relatively high ALT levels and ALT unqualified rates, showing distinct regional characteristics. ALT elevation in voluntary blood donors is related to non-pathological factors such as gender, age, and dietary habits, but not to infectious indicators.

Objective:To evaluate the design and application of the superior thyroid artery perforator flap (STAPF) for reconstruction after head and neck oncological resection.Methods:A retrospective analysis was performed on 24 consecutive patients (22 men, 2 women; age 40-72 years) treated at Hunan Cancer Hospital between June 2018 and December 2023. Their primary tumors included buccal carcinoma ( n=7), tongue carcinoma ( n=8), oropharyngeal carcinoma ( n=2), floor-of-mouth carcinoma ( n=3), laryngeal carcinoma ( n=3), and hypopharyngeal carcinoma ( n=1). Flap design, venous drainage strategy, and postoperative outcomes were assessed. SPSS 19.0 software was used for statistical analysis. Results:Flap dimensions were length of 9.4±0.5 cm, width of 3.3±0.6 cm, thickness of 0.5±0.2 cm, and pedicle length of 7.3±0.6 cm. Fifteen flaps were based on a single perforator (diameter ≥0.5 mm), whereas, nine fascial flaps incorporated multiple perforators (capillary diameter ≤0.5 mm). Venous drainage routes were as follows: superior thyroid vein ( n=12, retrograde in 3), facial vein ( n=5, all retrograde), anterior jugular vein ( n=4, retrograde in 1), and external jugular vein ( n=3, retrograde in 2). All 24 flaps survived completely. Donor sites were closed primarily and all cervical wounds healed. No flap-related complications, inculding orocutaneous, pharyngocutaneous, laryngocutaneous fistula and wound infection, were observed. Final pathologic stages were T1N0M0 ( n=2), T2N0M0 ( n=16), T2N1M0 ( n=3), and T3N0M0 ( n=3). With follow-up of 12-46 months, aside from one patient with tongue cancer died of contralateral cervical and parapharyngeal lymph-node metastases at 6 months, others remained disease-free. Patients with laryngeal or hypopharyngeal carcinoma had their tracheostomy tubes removed within 4 weeks postoperatively. Conclusion:STAPF offers flexible design, with minimal donor-site morbidity and low functional impairment. It is particularly advantageous for reconstruction of small-to-moderate defects following head and neck tumor ablation.

Objective:To evaluate the design and application of the superior thyroid artery perforator flap (STAPF) for reconstruction after head and neck oncological resection.Methods:A retrospective analysis was performed on 24 consecutive patients (22 men, 2 women; age 40-72 years) treated at Hunan Cancer Hospital between June 2018 and December 2023. Their primary tumors included buccal carcinoma ( n=7), tongue carcinoma ( n=8), oropharyngeal carcinoma ( n=2), floor-of-mouth carcinoma ( n=3), laryngeal carcinoma ( n=3), and hypopharyngeal carcinoma ( n=1). Flap design, venous drainage strategy, and postoperative outcomes were assessed. SPSS 19.0 software was used for statistical analysis. Results:Flap dimensions were length of 9.4±0.5 cm, width of 3.3±0.6 cm, thickness of 0.5±0.2 cm, and pedicle length of 7.3±0.6 cm. Fifteen flaps were based on a single perforator (diameter ≥0.5 mm), whereas, nine fascial flaps incorporated multiple perforators (capillary diameter ≤0.5 mm). Venous drainage routes were as follows: superior thyroid vein ( n=12, retrograde in 3), facial vein ( n=5, all retrograde), anterior jugular vein ( n=4, retrograde in 1), and external jugular vein ( n=3, retrograde in 2). All 24 flaps survived completely. Donor sites were closed primarily and all cervical wounds healed. No flap-related complications, inculding orocutaneous, pharyngocutaneous, laryngocutaneous fistula and wound infection, were observed. Final pathologic stages were T1N0M0 ( n=2), T2N0M0 ( n=16), T2N1M0 ( n=3), and T3N0M0 ( n=3). With follow-up of 12-46 months, aside from one patient with tongue cancer died of contralateral cervical and parapharyngeal lymph-node metastases at 6 months, others remained disease-free. Patients with laryngeal or hypopharyngeal carcinoma had their tracheostomy tubes removed within 4 weeks postoperatively. Conclusion:STAPF offers flexible design, with minimal donor-site morbidity and low functional impairment. It is particularly advantageous for reconstruction of small-to-moderate defects following head and neck tumor ablation.

Objective:To investigate the feasibility, safety and effectiveness of colonic interposition with vascular anastomosis in reconstructing the entire esophagus and hypopharynx after resection of hypopharyngeal cancer with esophageal cancer.Methods:We conducted a retrospective analysis of 4 male patients with simultaneous multiple primary cancers of the hypopharynx and esophagus, aged 47 to 58, treated in the Department of Head and Neck Surgery at the Hunan Cancer Hospital from February to August 2019. All cases underwent total hypopharyngectomy and total esophagectomy, of whom, three cases presented with total laryngectomy and one case with larynx preservation. Colonic interposition was performed using the left colic artery as a pedicle, with an average colonic length of 48.5 cm. The colon was elevated through the esophageal bed to the neck, and the branch of the colonic mesenteric artery was anastomosed to one of the neck arteries, including the inferior thyroid artery in one case, the transverse cervical artery in two cases, and the superior thyroid artery in one case, and all venous anastomoses were performed with the internal jugular veins.Results:The postoperative neck and abdominal wounds healed well without anastomotic leakage, and all patients were able to resume a regular oral diet within 21-30 days postoperatively. During the follow-up of 48-52 months, two cases died due to tumor recurrence, while the remaining two cases were disease-free survivals.Conclusion:Colonic interposition with vascular anastomosis is a safe and reliable reconstruction method suitable for repairing long-segment upper digestive tract defects after resection of hypopharyngeal cancer with esophageal cancer.

Wilson's disease （WD） is a copper metabolism disorder caused by mutations in the ATP7B gene， with diverse phenotypes and complex pathogenesis. It is one of the few rare diseases that can achieve good clinical efficacy through standardized treatment. Since there are few systematic reviews of this disease， we summarize the pathogenesis and treatment methods of WD from traditional Chinese and western medicine by reviewing the literature related to WD. In western medicine， ATP7B gene mutation is considered as the root cause of WD， which affects copper transport and causes copper metabolism disorders. The excessive copper deposited in the body will result in oxidative stress， defects in mitochondrial function， and cell death. Western medicine treatment of WD relies mainly on drugs， and copper antagonists are the first choice in clinical practice， which are often combined with hepatoprotective and antioxidant therapy. Surgery is a common therapy for the patients with end-stage WD， and gene therapy provides an option for WD patients. According to the traditional Chinese medicine （TCM） theory， WD is rooted in constitutional deficiency and copper accumulation and triggered by dampness-heat accumulation or phlegm combined with stasis. The patient syndrome varies in different stages of the disease， and thus the treatment should be based on syndrome differentiation. The TCM treatment method of nourishing the liver and kidneys and warming the spleen and kidneys can address the root cause. The methods of clearing heat and drying dampness， resolving phlegm and dispelling stasis， and soothing liver and regulating qi movement can be adopted to treat symptoms. On the basis of syndrome differentiation， special prescriptions for the treatment of WD have been formulated， such as Gandou decoction， Gandouling， and Gandou Fumu decoction， which have been widely used in clinical practice. TCM and western medicine have their own advantages and shortcomings. The integrated Chinese and western medicine complementing with each other demonstrates great therapeutic potential. This paper summarizes the pathogenesis and treatment of WD with integrated Chinese and western medicine， aiming to provide a reference for the clinical diagnosis and treatment of this disease.

Objective To investigate the safety and feasibility of peripheral vascular intervention via the ipsilateral transulnar access(TUA)due to failure of transradial access(TRA)puncture.Methods The clinical data of 2546 peripheral vascular interventions via TRA,which were performed at authors'hospital between January 2019 and December 2021,were retrospectively analyzed.Among the 2546 interventions,TRA puncture failed in 37 procedures,and in 27 of these patients the ipsilateral TUA puncture had to be adopted.The puncture success rate,surgical success rate and puncture approach-related complications of TUA of the 27 patients receiving ipsilateral TUA puncture were analyzed.Results The success rate of ipsilateral TUA puncture after TRA puncture failed was 96.3％(26/27),and in one patient transfemoral access(TFA)puncture had to be substituted because of the ulnar artery spasm.The total success rate of interventional procedures was 96.3％(26/27).No serious complications occurred,and the incidence of minor complications was 19.2％(5/26).Conclusion Preliminary results indicate that for the experienced TRA operators,using ipsilateral TUA puncture due to failure of TRA puncture is a safe and feasible strategy choice.

For muscle-invasive bladder cancer (MIBC) patients, preoperative neoadjuvant chemotherapy (NAC) can reduce the tumor stage, treat micrometastases, prolong the median survival, and improve the prognosis.However, NAC is associated with side effects such as renal impairment, thromboembolism and drug toxicity.NAC itself suffers from deficiencies such as renal function impairment, thromboembolism, and drug toxicity.Its therapeutic efficacy is affected by factors such as tumor pathology type, DNA repair gene defects, whether it is primary MIBC, and TNM staging, so there are certain limitations in its use.Based on the cisplatin treatment regimen, more and more studies are exploring the limitations and shortcomings of NAC in MIBC treatment regimen.Therefore, this paper provides an overview and outlook of the application of NAC in MIBC treatment.

Passing the hospital grading evaluation, establishing a tertiary-A specialized hospital for occupational diseases, enhancing hospital's internal quality and sustainable development, and continuously improving medical service quality are important measures to promote the high-quality development of hospitals. The evaluation standards for occupational disease specialized tertiary-A hospital require standardized, scientific, and sustainable management of medical equipment. Guangdong Province Hospital for Occupational Disease Prevention and Treatment is the first tertiary-A hospital for occupational diseases specialized in Guangdong Province. Relative regulation on medical equipment management was systematically reviewed based on the requirement of tertiary-A specialized hospital for occupational diseases during hospital grading evaluation process. Building and completing the medical equipment management system, standardizing and strengthening government procurement management, completing the configuration management and safety management of large-scale medical equipment, strengthening the effectiveness analysis and evaluation of large equipment, enhancing training on medical equipment usage, establishing emergency allocation systems for first-aid and life support medical equipment, and forming a medical equipment quality and safety management team is the measure to systematically improve and implement each item in various regulation for the full lifecycle management of medical equipment. It provides vital support in passing the tertiary-A hospital evaluation for hospitals. During the hospital grading evaluation process, each issue identified in medical equipment management was addressed and improved. This process continuously enhanced the hospital's medical equipment management level, ensured the safe and effective use of medical equipment, and improved the quality of medical services, laying a solid foundation for the hospital to become a high level specialized medical institution for occupational diseases.

Objective To investigate the clinical effect and safety of endoscopic inlay butterfly cartilage tympanoplasty(BCT)by day surgery mode.Method 120 patients with tympanic membrane perforation from June 2021 to June 2022 were randomly divided into two groups,the observation group of 60 patients underwent endoscopic inlay BCT,the control group of 60 patients underwent endoscopic tympanic membrane repair with tragus cartilage membrane.Both groups of patients completed all preoperative examinations in the outpatient department and completed the steps of admission,surgery,and discharge within 24 h.The surgical conditions(operation time and intraoperative blood loss),pure tone average(PTA)after 6 months,air-bone gap(A-B gap)after 6 months,tympanic membrane healing rate,and complications were compared between the two groups.Results There was no statistical significance in the operation time and intraoperative blood loss between the observation group and the control group(P>0.05).After 6 months,the PTA and A-B gap of both groups were lower than those before the surgery(P<0.01),the observation group had a significantly lower PTA(23.40±4.40)dB HL and A-B gap(9.11±3.13)dB HL than the control group(29.12±3.33)dB HL and(14.86±3.20)dB HL,with statistically significant differences(P<0.05).There was no statistical significance in the tympanic membrane healing rate between the two groups after surgery(P>0.05),but the incidence of complications in the observation group was 5.0%(3/60),significantly lower than that in the control group(21.7%,13/60),with a statistically significant difference(P<0.05).Conclusion Endoscopic inlay BCT is safe and effective in the treatment of tympanic membrane perforation,with better hearing recovery than tragus cartilage membrane repair surgery,fewer complications,and more suitable for day surgery mode.It is worthy clinical application.

Objective To observe the changes in the symptoms and relevant physiological indicators in subjects after inhaling the hypoxic air produced by a hypoxic air generator at a low altitude prior to their entry into high-altitude environment,and to explore its early warning effect for acute mountain sickness(AMS)among the subjects upon their subsequent entry into high-altitude environment.Methods A total of 50 subjects who were going to visit high-altitude regions were enrolled.All subjects were men,with an average age of(22.00±1.52)years.They continuously inhaled for 30 minutes hypoxic air(which simulated the air at the altitude of 5200 m,with an oxygen content 10.80％)generated by a hypoxic air generator.During this period fingertip oxygen saturation,heart rate,blood pressure,and symptoms of discomfort were observed and recorded.On the fourth day after living at an altitude of 4020 m,the subjects completed the evaluation for the symptom scores of acute mild altitude disease(AMAD).The subjects were divided into a maladjusted group(18 cases)and a well-adjusted group(32 cases)according to whether they experienced discomfort(including drowsiness,dizziness,chest tightness,cold sweating of the hands,etc.)during the inhalation of hypoxic air at a low altitude.After entry into the high-altitude environment,they were divided into an AMS group(28 cases)and a non-AMS group(22 cases)according to whether they experienced AMS after entering the he high-altitude environment.The primary indicator was the incidence of AMS,including the incidence of AMAD and severe acute mountain sickness(SAMS),and the incidence of AMS in the maladjusted group and the well-adjusted group after entering high-altitude environment.The secondary indicator was the relationship between the changes in fingertip oxygen saturation after inhaling hypoxic air at a low altitude and the incidence of AMS and the AMAD symptom scores.Results All 50 subjects traveled by air to the target altitude of 4020 m above sea level at the same time.The AMS incidence among them was 56.0％(28/50),with the incidence of AMAD being 54.0％(27/50)and the incidence of SAMS being 2.0％(1/50).In the single case of SAMS,the patient had high-altitude pulmonary edema.The incidences of AMS after entering high-altitude environment in the maladjusted and well-adjusted groups were 88.9％(16/18)and 37.5％(12/32),respectively,and the difference was statistically significant(P＜0.01).In the 50 subjects,fingertip oxygen saturation decreased rapidly in the first 11 minutes into the inhalation of hypoxic air at a low altitude,with a more pronounced decrease in the AMS group than that in the non-AMS group,and the differences between the groups were statistically significant after 5,9,and 11 minutes(P＜0.05).Fingertip oxygen saturation plateaued in the 50 subjects from the 12th to the 30th minute,with no significant differences between the AMS and non-AMS groups.The mean value of fingertip oxygen saturation within 30 minutes of hypoxic air inhalation was negatively correlated with the AMAD symptom scores after subjects'entry into high-altitude environment(r=-0.300).Conclusion Those who experience symptoms of discomfort after exposure to hypoxic air produced by a hypoxic air generator at a low altitude are more likely to develop AMS and close attention should be paid to the decrease in fingertip oxygen saturation within the first 11 minutes.