Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry,and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus.Methods By the convenience sampling method,a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15,2024.The survey was conducted using the instrument for evaluating clinical applicability of guide-lines(version 2.0)and a self-compiled questionnaire on the clinical implementation of the restraint consensus.Results A total of 7,844 valid questionnaires were collected,with a valid questionnaire recovery rate of 93.78％.The results of clinical applicability scoring showed that the consensus had the lowest availability score(64.72％)and the highest acceptability score(76.74％).The results showed that nurses' receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions(P＜0.05).4,774 participants(87.42％)believed that the application of consensus could enhance the standardization of nurses' restraint operations.The safety rate of the restraint consensus was 79.51％,and the economic ratio was 76.87％.Among the evaluators,1,739(22.17％)believed that there were implementation obstacles in the consensus.Conclusion The clinical applicability of the consensus is relatively good,and the application of the consensus helps to improve the standardization of clinical operations.In the future,efforts should be made to strengthen the promotion and training of the consensus,develop hierarchical promotion strategies according to the characteristics of medical institutions,and improve the quality of evidence for the consensus,so as to further enhance the clinical application effect of the consensus.

Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry,and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus.Methods By the convenience sampling method,a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15,2024.The survey was conducted using the instrument for evaluating clinical applicability of guide-lines(version 2.0)and a self-compiled questionnaire on the clinical implementation of the restraint consensus.Results A total of 7,844 valid questionnaires were collected,with a valid questionnaire recovery rate of 93.78％.The results of clinical applicability scoring showed that the consensus had the lowest availability score(64.72％)and the highest acceptability score(76.74％).The results showed that nurses' receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions(P＜0.05).4,774 participants(87.42％)believed that the application of consensus could enhance the standardization of nurses' restraint operations.The safety rate of the restraint consensus was 79.51％,and the economic ratio was 76.87％.Among the evaluators,1,739(22.17％)believed that there were implementation obstacles in the consensus.Conclusion The clinical applicability of the consensus is relatively good,and the application of the consensus helps to improve the standardization of clinical operations.In the future,efforts should be made to strengthen the promotion and training of the consensus,develop hierarchical promotion strategies according to the characteristics of medical institutions,and improve the quality of evidence for the consensus,so as to further enhance the clinical application effect of the consensus.

Objective:To compare the difference and effect of fat grafting assisted by adjustable external volume expansion (EVE) and fat grafting only in female patients who chose autologous fat grafting for breast reconstruction after a breast cancer operation.Methods:A retrospective analysis was carried out in 17 patients in the past four years. The patients in the experimental group wore EVE 10 hours daily for four weeks before surgery, and the negative pressure value was -60 mmHg. From the second week after the operation, they continued to wear EVE 10 hours every day, and the initial negative pressure value was -40 mmHg. After one week, the negative pressure was adjusted to -20 mmHg, and the EVE was worn for four weeks after surgery. Both the experimental group and the control group chose classical Coleman fat for breast reconstruction.Results:The number of operations in the experimental and control groups was 3.0±0.8 and 3.9±1.2, respectively ( t=2.193; P<0.05). The single fat injection volume of the experimental group and the control group was (228.60±15.34) ml and (198.20±12.01) ml, respectively ( t=4.861; P<0.01). The single fat volume preservation rate of the experimental group and the control group was (31.6±5.8)% and (25.8±6.2)%, respectively ( t=2.226; P<0.05). For postoperative complications, there were 3 cases in the experimental group (10 cases in total) and 3 cases in the control group (7 cases in total). Conclusions:For breast cancer patients who choose autologous fat grafting for breast reconstruction, wearing EVE can reduce the number of operations, improve the single fat injection volume and postoperative fat preservation rate, and reduce postoperative complications.

Objective:To investigate the clinical effect of using perforator flaps with the microsurgical technique in repairing secondary wounds after resecting superficial malignant tumors.Methods:A retrospective observational study was conducted in patients with superficial malignant tumors admitted to the Yulin NO.1 People’s Hospital from January 2018 to January 2021. After comprehensive examinations and multidisciplinary consultations, tumors were completely or palliatively resected based on results of the preoperative diagnosis and the intraoperative fast pathological test of cutting edge. Perforator flaps were used to repair the secondary wounds with microsurgical technique. The type of perforator flaps, including the lateral femoral circumflex artery perforator flap, the thoracodorsal artery perforator flap, the inferior epigastric artery perforator flap, the superficial iliac circumflex artery perforator flap, were decided by the intraoperative position, the defect size, the caliber and length of the blood vessel, etc. Postoperative conditions of the patients were observed.Results:Twenty-nine cases were included, with 19 males and ten females, aged from 28 to 69 years. Locations of the tumors included head and face (13 cases), upper extremity (four cases), lower extremity (six cases), and chest wall regions (six cases). The pathological type included 12 cases of squamous cell carcinoma, four of basal cell carcinoma, nine of sarcoma, and four of advanced breast cancer. The size of the wound after tumor resection ranged from 9.0 cm×7.5 cm to 22.0 cm×17.0 cm. There were 20 cases repaired with the lateral femoral circumflex artery perforator flap, four with the thoracodorsal artery perforator flap, four with the inferior epigastric artery perforator flap, and one with the superficial iliac circumflex artery perforator flap. The size of the flap ranged from 10.0 cm×9.0 cm to 24.0 cm×18.0 cm. One case had venous reflux obstruction and survived after exploringa bridging vein. One case suffered from the arterial crisis. Since this patient refused the exploration surgery, the skin-grafting was used to repair after flap necrosis. In addition, the other flaps survived successfully. Twenty-five patients achieved R0 resection. No recurrence was observed, and the appearance of the tumor was smooth after half a year to two years of follow-up. Four cases of advanced breast cancer were treated with palliative resection. The wounds were repaired and showed no recurrence. The quality of life was improved in the survival period. The donor site was closed directly in 13 cases, and thick skin grafting was used to cover the remaining 16 cases. No dysfunction was left.Conclusions:Using perforator flaps with microsurgical technique can repair the large and composite wound after extensive resection of malignant tumors. It is an essential guarantee for surgical treatment of body surface malignant tumors.

Objective:To investigate the clinical effect of using perforator flaps with the microsurgical technique in repairing secondary wounds after resecting superficial malignant tumors.Methods:A retrospective observational study was conducted in patients with superficial malignant tumors admitted to the Yulin NO.1 People’s Hospital from January 2018 to January 2021. After comprehensive examinations and multidisciplinary consultations, tumors were completely or palliatively resected based on results of the preoperative diagnosis and the intraoperative fast pathological test of cutting edge. Perforator flaps were used to repair the secondary wounds with microsurgical technique. The type of perforator flaps, including the lateral femoral circumflex artery perforator flap, the thoracodorsal artery perforator flap, the inferior epigastric artery perforator flap, the superficial iliac circumflex artery perforator flap, were decided by the intraoperative position, the defect size, the caliber and length of the blood vessel, etc. Postoperative conditions of the patients were observed.Results:Twenty-nine cases were included, with 19 males and ten females, aged from 28 to 69 years. Locations of the tumors included head and face (13 cases), upper extremity (four cases), lower extremity (six cases), and chest wall regions (six cases). The pathological type included 12 cases of squamous cell carcinoma, four of basal cell carcinoma, nine of sarcoma, and four of advanced breast cancer. The size of the wound after tumor resection ranged from 9.0 cm×7.5 cm to 22.0 cm×17.0 cm. There were 20 cases repaired with the lateral femoral circumflex artery perforator flap, four with the thoracodorsal artery perforator flap, four with the inferior epigastric artery perforator flap, and one with the superficial iliac circumflex artery perforator flap. The size of the flap ranged from 10.0 cm×9.0 cm to 24.0 cm×18.0 cm. One case had venous reflux obstruction and survived after exploringa bridging vein. One case suffered from the arterial crisis. Since this patient refused the exploration surgery, the skin-grafting was used to repair after flap necrosis. In addition, the other flaps survived successfully. Twenty-five patients achieved R0 resection. No recurrence was observed, and the appearance of the tumor was smooth after half a year to two years of follow-up. Four cases of advanced breast cancer were treated with palliative resection. The wounds were repaired and showed no recurrence. The quality of life was improved in the survival period. The donor site was closed directly in 13 cases, and thick skin grafting was used to cover the remaining 16 cases. No dysfunction was left.Conclusions:Using perforator flaps with microsurgical technique can repair the large and composite wound after extensive resection of malignant tumors. It is an essential guarantee for surgical treatment of body surface malignant tumors.

Objective:To explore the clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound.Methods:From July 2015 to May 2019, 19 patients with complex refractory wounds were hospitalized in Yulin NO.1 People′s Hospital of Guangxi Zhuang Autonomous Region, including 12 males and 7 female, aged 13-67 years. There were 5 patients with multiple tissue defects, 7 patients with large area of wounds, and 7 patients with wounds in special areas. The sizes of wounds after complete debridement were 8 cm×5 cm-23 cm×7 cm. According to the repair demand, the wounds in 5 patients were repaired with anterolateral thigh flaps and flow-through, the wounds in 7 patients were repaired with anterolateral thigh flaps chimed with lateral thigh muscle flaps, with vascular anastomosis in 2 patients, the wounds in 6 patients were repaired with unilateral anterolateral thigh lobulated flaps, and the wound in 1 patient was repaired with bilateral anterolateral thigh flap in series connection. The sizes of flaps were 10 cm×7 cm-25 cm×9 cm. The donor sites were sutured directly or repaired with thin split-thickness skin graft of head. The survival of the flaps, the appearance of the donor sites, and wounds repair after the operation and during follow-up were observed.Results:The lobulated flap in 1 patient had local necrosis after the operation and finally healed by debridement, dressing change, and transplanting medium split-thickness skin graft in groin. The flaps in 18 patients survived with good blood supply, and the lobulated flap tissue was swollen in 1 of 18 patients. The donor sites which were directly sutured in 18 patients only had linear scar, and the donor site which was repaired with thin split-thickness skin graft of head in 1 patient had flaky scar. Follow-up of 1-12 months showed that all the wounds healed well, the flap thinning operations were performed in 5 patients in 3 months post operation because the flaps were slightly bloated. The CT angiography after the operation showed that the anastomosed blood vessels were unobstructed in 7 patients with reconstructed local blood supply.Conclusions:The special forms of anterolateral thigh flap, such as lobulation, series connection, and chimerism can be designed according to the anatomical characteristics of the descending branch of the lateral femoral artery to meet individualized repair demand for complex refractory wounds, and achieve the double purposes of making full use of the donor site tissue and good repair of the recipient site.

AIM:To investigate the expression of C/EBP homologous protein (CHOP) and its correlation with proliferative/apoptotic ratio (PAR) in colorectal adenoma-carcinoma sequence under the same genetic background .ME-THODS:Four kinds of tissue samples under the same genetic background from 23 patients, including normal colorectal tissue, adenoma with low-grade intraepithelial neoplasia , adenoma with high-grade intraepithelial neoplasia and colorectal adenocarcinoma samples , were collected .TUNEL method and Ki-67 immunohistochemistry were applied to determine the PAR.The expression of CHOP was detected by immunohistochemistry SABC method .RESULTS: ( 1 ) Under the same genetic background , the level of CHOP expression is significantly higher in colorectal adenocarcinoma than that in the ade -noma with high-grade intraepithelial neoplasia , the adenoma with low-grade intraepithelial neoplasia and the normal muco-sa.The level of CHOP expression was significantly higher in the adenoma with high -grade intraepithelial neoplasia than that in the adenoma with low-grade intraepithelial neoplasia and the normal mucosa .The level of CHOP expression was signifi-cantly higher in the adenoma with low-grade intraepithelial neoplasia than that in normal mucosa .(2) Under the same ge-netic background , PAR was significantly higher in the colorectal adenocarcinoma than that in the adenoma with high -grade intraepithelial neoplasia , the adenoma with low-grade intraepithelial neoplasia and the normal mucosa .PAR was significant-ly higher in the adenoma with high-grade intraepithelial neoplasia than that in the adenoma with low-grade intraepithelial neoplasia and the normal mucosa .PAR was significantly higher in the adenoma with low-grade intraepithelial neoplasia than that in the normal mucosa.(3) CHOP levels were positively correlated with PAR in the adenoma with low-grade intraepi-thelial neoplasia , adenoma with high-grade intraepithelial neoplasia and colorectal adenocarcinoma .CONCLUSION:CHOP expression and PAR continuously increased and positively correlated along the adenoma -carcinoma sequence , indica-ting that endoplasmic reticulum stress mediates the carcinogenesis of colorectal adenomas .