Skin flaps are frequently employed in plastic and reconstructive surgery to address tissue defects.However,their low survival rates remain a challenge,attributed to vascular crisis and necrosis.Despite numerous studies investigating drugs to alleviate flap necrosis,a comprehensive analysis of the research trend in this critical area is lacking.To gain a deeper understanding of the current status,research focal points,and future trends in drugs aimed at enhancing flap survival,a thorough retrospective analysis is imperative.This study aims to employ bibliometric methods to scrutinize the evolution,mechanisms,and forthcoming trends of drugs targeting flap survival improvement.Using VOSviewer software,we quantitatively and visually depict 1)annual temporal trends in the number of documents and citations;2)national/regional publications and their collaborations;3)institutional and authors'contribution;4)journal contribution and relevance;and 5)analysis of research hotspots and directions derived from keywords.Ultimately,we discussed the prospects and challenges of future advances and clinical trans-lation of drugs designed to enhance skin flap survival.In conclusion,the field of pharmacology dedicated to improving skin flap survival is expanding,and this study aims to offer a fresh perspective to promote the advancement and clinical application of such drugs.

Objective To evaluate the efficacy of the bacterial lysate Broncho-vaxom on chronic obstructive pulmonary disease(COPD)in elderly patients.Methods A total of 150 patients with stable COPD were randomized into the Broncho-vaxom group(n=78)treated with Broncho-vaxom as add-on to conventional treatment and the control group(n=72)treated with conventional treatment.The number of acute exacerbation of COPD per patient per year,quality of life,lung function,T cell subsets were evaluated for the therapeutic effects.Results After one year of treatment,the number of acute exacerbation per patient per year was lower in Broncho-vaxom group than in control group[(1.44 ± 1.05) times/y vs.(1.82 ± 0.61) times/y,t =2.754,P =0.007].The proportions of acute exacerbationfree patients were higher in Broncho-vaxom group than in control group(20.5％ or 16/78 vs.4.2％ or 3/72,x2 =9.043,P =0.003).There were significant differences in the forced vital capacity(FVC),forced expiratory volume in one second(FEV1),and forced expiratory volume in one second/predicted value ratio(FEV1 ％)between the two groups at 5 different time points(before,at 3,6,9 and 12 months after treatment) (Broncho-vaxom group:F =90.819,50.674 and 51.233,P =0.000;control group:F =84.928,90.654 and 86.117,P =0.000).After treatment,the symptom scores were lower in Broncho-vaxom group than in control group,and the ratios of CD4/CD8 T-cell were increased and level of CD8 T-cell was decreased in Broncho-vaxom group(all P ＜ 0.05).The rate of adverse reactions had no significant difference between Broncho-vaxom group and control group(3/78 or 3.8％ vs.2/ 72 or 2.8％,x2 =0.132,P=0.717).Conclusions The oral administration of Broncho-vaxom for six months can modulate and enhance immune functions,significantly decrease acute exacerbation frequency,improve quality of life and delay the deterioration in lung function in elderly patients with stable COPD.

Objective To investigate the protective effects of a Yiqi Huatan Quyu formulation on liver injury in chronic intermittent hypoxia rats.Methods Thirty healthy male Sprague-Dawley rats of SPF grade were randomly divided into 3 groups:Group A(normoxia and normal saline gavage),Group B(chronic intermittent hypoxia and normal saline gavage)and Group C(chronic intermittent hypoxia and Yiqi Huatan Quyu formulation gavage)(n =10 in each group).After 8 weeks of treatment,the liver tissue was extracted for protein and RNA.Western blot was used to test the protein levels of B-cellymphoma-2 associated X protein (BAX) and B-cellymphoma-2 (BCL-2),and Realtime PCR was used to test gene expression of BAX and BCL-2.Transferase-mediated dUTP nick end-labeling(TUNEL)was used to assay the apoptotic rate of liver cells.Results The expression of the BAX protein and BAX gene was higher and the expression of the BCL-2 protein and BCL-2 gene was lower in Group B than in Group A(t =13.490 and 16.480,P =0.005 and 0.002;t =5.142 and 9.776,P =0.036 and 0.001,respectively).The levels of the BAX protein and BAX gene were lower and the levels of the BCL-2 protein and BCL-2 gene were higher in Group C than in Group B(t =6.088 and 15.240,P =0.026 and 0.005;t =5.296 and 16.380,P =0.034 and 0.004,respectively).The apoptosis rate of hepatocytes was higher in Group B than in Group A(t =7.698,P =0.002),and was lower in Group C than in Group B(t=4.345,P =0.012).Conclusions The Yiqi Huatan Quyu formulation may alleviate the apoptosis of liver cells in chronic intermittent hypoxia rats by upregulating BCL-2 and down-regulating BAX levels,thus exerting protective effects on the liver.

Objective To investigate the appropriate age of primary and secondary school students for cardiopulmonary resuscitation (CPR) training.Methods A total of 437 students aged 9-15 years at 3 to 6 grade in the primary schools or 1 to 2 grade in the secondary schools were selected from 2 Yuyao primary and secondary schools by stratified random sampling between March 2017 and January 2018.The numbers of students with the age of 9,10,11,12,13,14 and 15 y were 61,62,66,64,63,63 and 58,respectively.All students received chest compression training provided by Yuyao emergency department People's Hospital according to the 2015 Cardiopulmonary Resuscitation Guidelines.The training included 30 min theoretic teaching and 6 min practice in the simulator.The quality of chest compression performed by students was assessed;the depth,rate,position and retention of chest compression were recorded.Results The mean depth of chest compression in the students aged 9-15 years was 3.8,4.1,4.6,5.1,5.2,5.6 and 5.6 cm,respectively;the accuracy rate was 24.6％(14/61),25.8％ (16/62),50.2％ (33/66),70.5％ (45/64),79.4％(50/63),88.9％(56/63) and 91.4(53/58),respectively.Compared with the students aged 9-11 years,the mean depth of chest compression was significantly increased and accuracy rate was significantly improved in the students aged 12-15 years (Compared with 9-y students,t=-8.936,-9.502,-10.640 and-11.370;x2=35.019,47.599,63.013 and 65.671;compared with 10-y students,t=-6.927,-8.179,-10.70 and-11.047;x2=24.977,35.967,50.916 and 52.727;compared with 1 1-y students,t=-3.095,-4.177,-6.785 and-6.995;x2=5.586,12.114,22.786 and 24.870;all P＜0.05).The mean rate of chest compression was 110-116/min and its accuracy rate was 86.4％-95.2％;the accuracy rate of chest compression position was 90.9％-96.8％ in all students,there were no significant differences among the 7 groups.The mean retention rate of chest compression in the 7 groups was 81.3％(122/150),67.3％(101/150),64.7％ (94/150),48.0％(72/150),48.7％(73/150),33.3％(50/150) and 27.3％(41/150),respectively.Compared with the students aged 9-11 years,the mean retention rate of chest compression was significantly decreased in the students aged 12-15 years (compared with the 9-y students,x2=36.472,35.179,70.64 and 119.92;compared with 10-y students,x2=11.483,10.728,34.682 and 72.150;compared with 11-y students,x2=6.528,5.927,25.855 and 59.11;all P＜0.05).Correlation analysis showed that the depth (r=0.96,0.89,0.91 and 0.86;P＜0.01) and retention rate (r=-0.99,-0.90,-0.93 and-0.86;all P＜0.01) of chest compression were significantly associated with the age,body weight,height and body mass index of students.Conclusion The students with an age of 12 years or more are able to effectively perform chest compression;thus,12 years and above might be the appropriate age for CPR training.

Objective To investigate the effects of the third-generation mechanical chest compressor on outcomes of cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest.Methods The patients with out-of-hospital cardiac arrest from October 2015 to September 2017 in the Yuyao peoples' hospital were included and divided randomly into 2 groups:manual chest compression group and mechanical chest compression group.The duration of resuscitation,the rate of restoration of spontaneous circulation (ROSC),4-h survival rate and the rate of survival getting to hospital discharge with favorable neurological status of two groups were analyzed.Results A total of 95 patients with out-of-hospital cardiac arrest were included.The rate of ROSC and 4-h survival was significantly increased in the mechanical chest compression group compared with the manual chest compression group (P＜0.05).There was no remarkable difference in the duration of resuscitation and the rate of survival getting to hospital discharge with favorable neurological status between 2 groups.Conclusions The thirdgeneration mechanical chest compressor significantly improves the rate of ROSC and the shout-term survival in patients with out-of-hospital cardiac arrest.

The research findings published by National Surgical Adjuvant Breast and Bowel Project have continued to change the clinical practice of early-stage breast cancer over the past decade.Sentinel lymph node biopsy has become the new surgical operation standard.The aromatase inhibitor adjuvant endocrine therapy cycle has been extended from 5 years to 10 years, which benefits the patients with high risk and reactivity.Chemotherapy combined with trastuzumab has become the standard adjuvant therapy strategy of human epidermal growth factor receptor-2-positive invasive breast cancer.In addition, the research progress is also related to the optimization of the fields including the postoperative adjuvant chemotherapy and neoadjuvant chemotherapy.

Objective To explore the clinical significance of application of critical patient tracking system in traumatic patient treatment in resuscitation room.Methods A total of 1860 traumatic patients treated in the resuscitation room from September 2013 to August 2014, before critical patients tracking system was applied, were selected as control group, and another 1824 cases, treated from September 2014 to August 2015, after the implementation of this system in resuscitation room of Emergency Department in Yuyao People's Hospital, as observation group. Treatment efficiency, quality, and satisfaction of the patients' relatives were compared between the two groups.Results In the observation group, admission time, rescue time and length of staying in the resuscitation room were (10.00±4.23), (36.70±12.93) and (70.26±24.03) min, shorter than those in the control group [(21.46±11.38), (59.92±22.90), (90.69±25.66) min](P<0.01). Rate of missed diagnosis in the observation group was lower than the control group (2.8% vs. 7.1%), successful rescue rate was higher (97.4% vs. 94.2%), and overall satisfaction of the patients' relatives higher (94.9% vs. 84.5%) (P<0.01). Conclusions Application of critical patient tracking system helps to shorten rescue time of traumatic patients in the resuscitation room, improve treatment effect and satisfactions of the patients' relatives.

Objective To investigate the effect of β-lactam antibiotics on the false positive rate of the serum Aspergillus galactomannan (GM) assay in patients with lung diseases.Methods We selectively recruited 77 lung disease patients who did not meet the diagnostic criteria of invasive pulmonary Aspergillosis (IPA) and received different β-lactam antibiotics,while 41 patients without IPA who did not receive any antibiotic treatment were recruited as the control group.Serum samples for GM detection were collected from all participants.The rate of false-positive Aspergillus galactomannan was compared between the two groups.Results False-positive serum results were found in patients who received piperacillin-tazobactam (30.8％ or 8/26) and cefoperazone sulbactamand (27.8％ or 5/18).The rate of false-positive Aspergillus galactomannan in patients who receive β-lactam antibiotics were significantly higher than that in the control group (24.7％ or 19/77vs.7.3％ or 3/41,x2 =5.315,P=0.025).Taking false-positive serum Aspergillus galactomannan as the dependent variable and β-lactam antibiotic treatment as the independent variable,univariate logistic regression analysis showed that the rate of false-positive Aspergillus galactomannan in patients who received β-lactam antibiotics were 4.149 times more than that in the control group (OR=4.149,P=0.030).Conclusions The administration of β-lactam antibiotics may increase the occurrence of false-positive serum Aspergillus galactomannan,and physicians should be aware of this possible interference.

Objective To explore if Ulinastai reverses hepatofibrosis in rats.Method Rat hepatofibrosis models were induced by TAA subcutaneously injection.18 rats with hepatofibrosis were divided into 2 groups,Ulinastai treatment group (9 rats),normal saline control group (9 rats).AST,ALT,HA,SOD,MDA,LN level were measured and compared between the 2 groups and that of healthy rats (3 rats).Rats liver morphology was observed using HE,Masson stain and type-B ultrasonic.TGF-β1、caspase-3 were detected by immunohistochemistry.Result After 3 weeks Ulinastai treatment,elastic index and SSS score in Ulinastai group decreased significantly compared to pretreatment (t =2.472,P ＜0.05).ALT,AST,SOD,MDA,HA and LN level significantly improved (F =3.862,5.774,3.442,4.157,4.173,3.674,P ＜ 0.05).Compared with NS treatment group HE and Masson staining showed fewer inflammatory cells infiltration in central vein,ballooning degeneration of liver cells,collagen proliferated,hepatic lobules degradation and pseudolobule arise after 3 weeks intervenion.Also in Ulinastai group,TGF-β1、caspase-3 positive cells were much less than that in NS treatment group.Conclusions Ulinastai can reverse rat hepatic fibrosis and alleviate fibrosis degree and collagen fiber deposit.

Objective To appraise and compare protein expression profiles in sera of patients without or with recurrence following liver transplantation for hepatocellular carcinoma (HCC) using SELDI-TOF-MS technique,and establish the diagnostic and predictive model. Methods A total of 76 sera (41 from disease free survival patients and 35 from recurrence individuals) were collected pretransplantation and differentially expressed proteins were identified by SELDI-TOF-MS. The intensity values for each peak were analyzed by Biomarker Wizard Software to screen serum proteome biomarkers related to the recurrence post-transplantation. By using Biomarker Patterns Software, the classification trees were generate. from randomly selected samples (30 fingerprints obtained from each group). The sensitivity and specificity of best decision tree were then chosen for blind test with 16 samples (5 from recurrence individuals and 11 from recurrence-free survival patients). Results There were significant differences only in tumor size and the presence of vascular invasion between recurrence group and recurrence-free survival group (P＜0.05). According to serum protein fingerprints, a total of 368 protein peaks were identified at the mass-to-charge ratio (M/Z) value ranging from 2000 to 300 00. There were 22 significant differential proteins between two groups. Among them, 9 proteins were up-regulated and 13 proteins were down-regulated -espectively in recurrence group. The intensity values of differential proteins were input into BPS for classification tree analysis and the best performing tree could distinguish two groups successfully. As a result of blind assessment for this model,a sensitivity of 80.0 % (4/5) and specificity of 72.7 % (8/11) were obtained. Conclusion Some of differential proteins screened by SELDI-TOF-MS technique in the serum may be correlated with the prognoses of liver transplantation patients with HCC. The decision tree may be useful for the clinical application of formulating the indication for liver transplantation, detecting extrahepatic micrometastasis and setting up the diagnostic and treatment strategies.