Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Objective To analyze correlation between T-wave parameters and life-threatening arrhythmia(LTA)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods A total of 232 AMI patients admitted to Huzhou No.1 People's Hospital from May 2021 to March 2023 and treated with PCI were selected as subjects.They were divided into LTA group(n=36)and non LTA group(n=196)based on the presence of LTA within 72 hours after PCI.General information,clinical data,and T-wave parameter of two groups of patients were compared,and multivariate Logistic regression were used to analyze influencing factors.Results There were statistically significant difference in age,resting heart rate(RHR),Tp-Te/QT,and Tp-Tec between two groups(P＜0.05).The difference in anterior wall myocardial infarction,creatinine,and high-sensitivity cardiac troponin T(hs-cTnT)between two groups were statistically significant(P＜0.05).Age,RHR,Tp-Te/QT,Tp-Tec and hs-cTnT were the influencing factors of LTA in AMI patients after PCI(P＜0.05).Multivariate Logistic regression showed that age,Tp-Te/QT and hs-cTnT were independent influencing factors of LTA in AMI patients after PCI(P＜0.05).Conclusion AMI patients have a higher risk of life-threatening arrhythmia after PCI.Age,Tp-Te/QT and hs-cTnT are independent influencing factors of LTA after PCI.

Objective To design a tabletop exercise teaching toolkit for emergency rescue training for mass wounded at sea.Methods Guided by the competency-based education(CBE)theory,a preliminary tabletop exercise teaching toolkit was constructed by combining field research and literature analysis.The toolkit was tested and modified through expert meetings.Results A set of tabletop exercise teaching toolkit including tabletop exercise scheme,casualty pool,teaching aids and teaching evaluation tools was formed.Conclusion The tabletop exercise teaching toolkit developed in this study can be used for the training of medical personnels on large surface warships,and it provides new ideas for our military medical training.

Objective To explore the efficacy of 4R technology combined with prone five-direction cer-vical muscle strength training for neck type cervical spondylosis.Methods A total of 112 patients with neck and shoulder pain who visited the Affiliated Shapingba Hospital of Chongqing University and the Shapingba District Traditional Chinese Medicine Hospital in Chongqing from January to November 2024 were selected as research subjects.They were randomly assigned using a random number table method into an observation group and a control group,with 56 patients in each group.The observation group received 4R technology com-bined with prone five-direction cervical muscle strength training,while the control group received conventional rehabilitation treatment.Both interventions lasted for 4 weeks.Differences in Visual Analogue Scale(VAS)scores,Neck Disability Index(NDI)scores,and cervical range of motion in flexion,extension,lateral bending,and rota-tion were assessed before treatment and at 1 and 6 months after treatment for both groups.Results At 1 and 6 months of treatment,VAS scores in both groups decreased compared to before treatment,with the observation group lower than the control group,and the difference was statistically significant(P<0.05).At 1 and 6 months of treatment,NDI scores in both groups decreased compared to before treatment,with the observation group lower than the control group,and the difference was statistically significant(P<0.05).At 1 and 6 months of treatment,cervical flexion,cervical extension,and cervical lateral flexion in both groups increased compared to before treatment,and cervical rotation in the observation group increased compared to before treatment.Cervical extension and cervical rotation in the observation group were greater than those in the con-trol group,and only at 6 months of treatment was cervical lateral flexion in the observation group greater than in the control group,with all differences statistically significant(P<0.05).Conclusion The 4R technology combined with prone five-direction cervical muscle strength training can effectively improve cervical-type cer-vical spondylosis.

Objective:To explore risk factors for delayed onset of lactogenesis in prenatally overweight women and construct risk prediction models based on machine learning for early identification of high-risk individuals.Methods:Convenience sampling was adopted to select 338 prenatally overweight women who delivered in the Obstetrics Departments of four ClassⅢ Grade A hospitals in Hengyang City from October 2023 to June 2024 for the study. Delivery women were randomly divided into training set and test set in the ratio of 7∶3. The survey was conducted with the General Information Questionnaire, Breastfeeding Self-efficacy Scale Short Form, Edinburgh Postnatal Depression Scale, LATCH Scale and Pittsburgh Sleep Quality Index. One-way analysis and LASSO regression were used to screen predictors using delayed onset of lactogenesis as the outcome variable. Risk prediction models were constructed based on three machine learning algorithms of Logistic regression, support vector, and random forest, respectively. The models were tuned by ten-fold cross-validation to filter out the best models.Results:Delayed onset of lactogenesis occurred in 140 of 338 prenatally overweight women, an incidence of 41.4%. Among the three predictive model performances, the random forest model had the highest area under the receiver operating characteristic curve, accuracy, precision, recall, and F1 value. The importance of each predictor was ranked according to the fandom forest algorithm, and in descending order of importance, they were breastfeeding 1 h after the birth of the newborn, number of previous deliveries, age, feeding mode 3 d postpartum, pregnancy complications, mode of delivery, number of breastfeeding 24 h postpartum, and monthly household income.Conclusions:Risk prediction models for delayed onset of lactogenesis in prenatally overweight women are constructed based on three machine learning algorithms, aiming to help provide a scientific basis for clinical healthcare professionals to take relevant decisions.

Objective:To explore risk factors for delayed onset of lactogenesis in prenatally overweight women and construct risk prediction models based on machine learning for early identification of high-risk individuals.Methods:Convenience sampling was adopted to select 338 prenatally overweight women who delivered in the Obstetrics Departments of four ClassⅢ Grade A hospitals in Hengyang City from October 2023 to June 2024 for the study. Delivery women were randomly divided into training set and test set in the ratio of 7∶3. The survey was conducted with the General Information Questionnaire, Breastfeeding Self-efficacy Scale Short Form, Edinburgh Postnatal Depression Scale, LATCH Scale and Pittsburgh Sleep Quality Index. One-way analysis and LASSO regression were used to screen predictors using delayed onset of lactogenesis as the outcome variable. Risk prediction models were constructed based on three machine learning algorithms of Logistic regression, support vector, and random forest, respectively. The models were tuned by ten-fold cross-validation to filter out the best models.Results:Delayed onset of lactogenesis occurred in 140 of 338 prenatally overweight women, an incidence of 41.4%. Among the three predictive model performances, the random forest model had the highest area under the receiver operating characteristic curve, accuracy, precision, recall, and F1 value. The importance of each predictor was ranked according to the fandom forest algorithm, and in descending order of importance, they were breastfeeding 1 h after the birth of the newborn, number of previous deliveries, age, feeding mode 3 d postpartum, pregnancy complications, mode of delivery, number of breastfeeding 24 h postpartum, and monthly household income.Conclusions:Risk prediction models for delayed onset of lactogenesis in prenatally overweight women are constructed based on three machine learning algorithms, aiming to help provide a scientific basis for clinical healthcare professionals to take relevant decisions.

Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Objective To analyze correlation between T-wave parameters and life-threatening arrhythmia(LTA)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods A total of 232 AMI patients admitted to Huzhou No.1 People's Hospital from May 2021 to March 2023 and treated with PCI were selected as subjects.They were divided into LTA group(n=36)and non LTA group(n=196)based on the presence of LTA within 72 hours after PCI.General information,clinical data,and T-wave parameter of two groups of patients were compared,and multivariate Logistic regression were used to analyze influencing factors.Results There were statistically significant difference in age,resting heart rate(RHR),Tp-Te/QT,and Tp-Tec between two groups(P＜0.05).The difference in anterior wall myocardial infarction,creatinine,and high-sensitivity cardiac troponin T(hs-cTnT)between two groups were statistically significant(P＜0.05).Age,RHR,Tp-Te/QT,Tp-Tec and hs-cTnT were the influencing factors of LTA in AMI patients after PCI(P＜0.05).Multivariate Logistic regression showed that age,Tp-Te/QT and hs-cTnT were independent influencing factors of LTA in AMI patients after PCI(P＜0.05).Conclusion AMI patients have a higher risk of life-threatening arrhythmia after PCI.Age,Tp-Te/QT and hs-cTnT are independent influencing factors of LTA after PCI.

Aim To explore the effect of total flavonoid extract(TFE)of Ampelopsis megalophylla on the pro-liferation and apoptosis of human breast cancer cells and its mechanism in autophagy inhibition.Methods For human cervical cancer cell Hela,human lung cancer cell A549,human liver cancer cell SMMC-7721,human breast cancer cell MCF-7,MDA-MB-231 and human normal liver cell L-02,MTT method was used to select sensitive cell lines.The inhibitory effect of TFE combined with autophagy inhibitor 3-methylade-nine(3-MA)on sensitive cell proliferation was detec-ted using MTT assay.The morphological changes of cells were observed using transmission electron micros-copy and Hoechst 33258 single staining method.The changes in cell apoptosis rate were detected using An-nexin V-FITC/PI dual staining method.The expression levels of apoptosis related proteins and pathway pro-teins(death receptor pathway,mitochondrial pathway,endoplasmic reticulum stress pathway)were detected uisng Western blot.The expression of the key protein Cyt-c in mitochondrial pathway was determiend by im-munofluorescence,and the autophagy agonist rapamy-cin was selected for reverse validation.Results TFE could inhibit the proliferation of human breast cancer cells in a concentration-dependent manner,and MCF-7 cells were sensitive cell lines.Compared with the TFE group,the TFE+3-MA group significantly increased the inhibition rate of MCF-7 cells at 24,48,and 72 h(P＜0.01).The number of cells decreased,the gap increased,the number of apoptotic bodies increased,and the apoptosis rate increased(P＜0.01).The ex-pression levels of Bax/Bcl-2(P＜0.01),cleaved-caspase3(P＜0.01),Cyt-c(P＜0.05),FADD,and cleaved-caspase-12 all increased,and the expres-sion of apoptotic protein Cyt-c in nucleus increased.The fluorescence of the TFE+RA group decreased,re-versing the mitochondrial pathway apoptosis induced by TFE.Conclusions TFE can significantly inhibit the proliferation of human breast cancer cells.When inhib-iting autophagy,it may promote the apoptosis of MCF-7 cells through the mitochondrial pathway,and activa-ting autophagy can reverse apoptosis.

Objective To establish a sensitive,accurate and simple method for the determination of methotrexate and methotrexate polyglutamates(MTXPG2 and MTXPG3)in human erythrocytes.Methods A dual three element gradient liquid chromatograph with a fluorescence detector was used,the C18-WP column(20 mm ×4 mm,5μm)was used as the online SPE column,and the Athena C18-WP column(150 mm x4.6 mm,3 μm)was used as the analytical column.Erythrocyte lysate was precipitated with zinc sulphate-10％formic acid methanol(100:90,v/v),and postcolumn photo-oxidation of MTXPGs to fluorescent analytes using H2O2.The fluorescence excitation wavelength was 274 nm,the emission wavelength was 470 nm,the column temperature was 40 ℃,and the injection volume was 100 μL.The specificity,standard curve,lower limit of quantitation,precision,recovery and stability of the method were investigated.Results MTX,MTXPG2 and MTXPG3 had good linearity in the range of 12.5-400.0 nmol·L-1.The standard curve of MTX was y=763.8x-2 961.1(R2=0.999 5),and the extraction recovery rate was 60.7％-66.1％;the standard curve of MTXPG2 was y=1 017.8x-239.8(R2=0.998 4),and the extraction recovery rate was 67.2％-67.3％;the standard curve of MTXPG3 was y=1 069.1x-819.6(R2=0.999 4),the extraction recovery rate was 62.9％-70.1％.Intra-day precision RSD＜8.8％,inter-day precision RSD＜10.8％.Conclusion This method is accurate and reproducibility,and the online solid-phose extraction enrichment and separation of target compounds simplify the sample pretreatment steps,improve the analysis efficiency,and is suitable for detecting the concentration of MTX,MTXPG2 and MTXPG3 in erythrocytes of patients with rheumatoid arthritis.