Objective:Investigation of the relationship between variant angina pectoris syncope and coronary artery spastic targeted location, arrhythmias, and coronary artery stenostic lesion.Methods:This study combined retrospective and prospective registry approaches. Data were sourced from the case database of Henan province "Multicenter Clinical Observation Study of Variant Angina Pectoris". A total of 507 patients with variant angina pectoris who had complete records from June 1980 to December 2022 were consecutively enrolled. Select patients among them who experienced syncope, and analyze the target vessel sites of coronary artery spasm, arrhythmias during variant angina pectoris attacks, and the degree of stenosis in coronary artery lesions.Results:Among 507 variant angina pectoris patients, 88 experienced syncope. Age was (53.9±9.7) years and 66 patients (75.0%) were male. Forty patients (45.5%, 40/88) were aged 50-59 years. The incidence of syncope in variant angina pectoris caused by left anterior descending artery (LAD) spasm, right coronary artery (RCA) spasm, and multivessel coronary artery spasm was 7.4% (15/202), 22.7% (42/185), and 23.6% (25/106), respectively. The latter two were significantly higher than those in the LAD group ( P all<0.05). Among 77 patients with variant angina pectoris syncope, definitive electrocardiogram recordings were available during syncope episodes. All patients exhibited arrhythmias during syncope: 34 cases involved tachyarrhythmias and 43 cases involved bradyarrhythmias. The incidence of rapid arrhythmias in patients with LAD, RCA, and multi-vessel spasm syncope was 72.7% (8/11), 24.3% (9/37), and 54.2% (13/24), respectively, with P<0.05 for the first two. Bradyarrhythmias occurred in 27.3% (3/11) of LAD, 75.7% (28/37) of RCA, and 45.8% (11/24) of multivessel coronary artery spasm syncope cases, with the first two showing P<0.05. Coronary angiography analysis of 56 syncope patients revealed target vessel locations and stenosis severity: 12 patients had LAD lesions and 41 had RCA lesions, stenosis ≥50% occurred in 66.7% (8/12) and 43.9% (18/41) of these lesions, respectively ( P>0.05). Conclusions:Variant angina pectoris syncope predominantly affects middle-aged males. Bradyarrhythmias triggered by RCA spasm are a common cause, while the incidence of syncope shows no significant correlation with the degree of coronary artery stenostic lesion, whether in the LAD or the RCA.

Objective:Investigation of the relationship between variant angina pectoris syncope and coronary artery spastic targeted location, arrhythmias, and coronary artery stenostic lesion.Methods:This study combined retrospective and prospective registry approaches. Data were sourced from the case database of Henan province "Multicenter Clinical Observation Study of Variant Angina Pectoris". A total of 507 patients with variant angina pectoris who had complete records from June 1980 to December 2022 were consecutively enrolled. Select patients among them who experienced syncope, and analyze the target vessel sites of coronary artery spasm, arrhythmias during variant angina pectoris attacks, and the degree of stenosis in coronary artery lesions.Results:Among 507 variant angina pectoris patients, 88 experienced syncope. Age was (53.9±9.7) years and 66 patients (75.0%) were male. Forty patients (45.5%, 40/88) were aged 50-59 years. The incidence of syncope in variant angina pectoris caused by left anterior descending artery (LAD) spasm, right coronary artery (RCA) spasm, and multivessel coronary artery spasm was 7.4% (15/202), 22.7% (42/185), and 23.6% (25/106), respectively. The latter two were significantly higher than those in the LAD group ( P all<0.05). Among 77 patients with variant angina pectoris syncope, definitive electrocardiogram recordings were available during syncope episodes. All patients exhibited arrhythmias during syncope: 34 cases involved tachyarrhythmias and 43 cases involved bradyarrhythmias. The incidence of rapid arrhythmias in patients with LAD, RCA, and multi-vessel spasm syncope was 72.7% (8/11), 24.3% (9/37), and 54.2% (13/24), respectively, with P<0.05 for the first two. Bradyarrhythmias occurred in 27.3% (3/11) of LAD, 75.7% (28/37) of RCA, and 45.8% (11/24) of multivessel coronary artery spasm syncope cases, with the first two showing P<0.05. Coronary angiography analysis of 56 syncope patients revealed target vessel locations and stenosis severity: 12 patients had LAD lesions and 41 had RCA lesions, stenosis ≥50% occurred in 66.7% (8/12) and 43.9% (18/41) of these lesions, respectively ( P>0.05). Conclusions:Variant angina pectoris syncope predominantly affects middle-aged males. Bradyarrhythmias triggered by RCA spasm are a common cause, while the incidence of syncope shows no significant correlation with the degree of coronary artery stenostic lesion, whether in the LAD or the RCA.

Based on the research results of aspiration in patients with dysphagia after ischemic stroke at home and abroad, this paper reviews the definition, detection methods, and risk factors of aspiration and emphasizes the incidence rate and severity of this disease. The authors conclude that preventing aspiration can decrease the incidence rate of aspiration pneumonia, change the clinical outcome of patients, and thereby save medical resources.

Objective:To analyze the molecular epidemiological characteristics of the Corona virus disease 2019 (COVID-19) cases in Shijiazhuang, which can reveal the origin of the outbreak and provide a scientific basis for COVID-19 prevention and control.Methods:From January 2 to January 8, 2021, a total of 404 samples from 170 COVID-19 cases were collected from the Shijiazhuang Fifth Hospital. The consensus sequence of 2019 novel Coronavirus(2019-nCoV) was obtained through multiplex polymerase chain reaction-based sequencing. The sequences of 170 COVID-19 cases were analyzed by the PANGOLIN, and the data were statistically analyzed by T-test.Results:Among the 404 COVID-19 samples, a total of 356 samples obtained high quality genome sequences (>95%,100×sequencing depth). The whole genome sequences of 170 COVID-19 cases were obtained by eliminating repeated samples. All 170 sequences were recognized as lineage B1.1 using PANGOLIN. The number of single nucleotide polymorphism arrange from 18-22 and most of the single nucleotide polymorphism were synonymous variants. All of 170 genomes could be classified into 48 sub-groups and most of the genomes were classified into 2 sub-groups (66 and 31, respectively).Conclusions:All cases in this study are likely originated from one imported case. The viruses have spread in the community for a long time and have mutated during the community transmission.

Objective:To investigate the technique and clinical effect of repairing 2 soft tissue defects on the same finger with a pedicled tandem flap of the first dorsal metatarsal artery and the second toe tibial artery.Methods:From March, 2018 to May, 2020, 8 patients, which were 5 males and 3 females, with 2 soft tissue defects in the same finger, were repaired with the first dorsal metatarsal artery flap in series with the second toe tibial flap. The causes of injury: 4 by crush, 2 by heavy object, and 2 by thermal press. There were 4 defects on index fingers, 2 on middle fingers and 2 on ring fingers. The defects ranged from 2.0 cm×2.5 cm to 2.5 cm×3.0 cm. All defects had exposed bone or tendon at varying degrees and 3 with phalanx fractures. Three patients underwent emergency surgery, the other 5 had sub-emergency surgery which were performed 3 to 5 days after the injury. The size of the flaps was 2.0 cm×2.5 cm to 3.0 cm×3.5 cm. The donor sites were sutured directly in 3 patients and 5 patients received skin grafting. The regular follow-up was performed. The survival of flaps, character, feeling and Total active motion(TAM), recovery of the foot donor area and complications were observed.Results:The operation time ranged from 2.0 to 5.5 hours, with an average of 3.5 hours. No vascular crisis occurred and all flaps survived after the surgery. All patients entered follow-up for 3-20 months, with an average of 8 months. The flaps had a good plump appearance, soft texture, good elasticity, and with a high similarity to the surrounding skin. The TPD of the flaps was 6-15 mm, with an average of 8 mm. The fingers had good flexion and extension functions. The incision in the donor site of the foot healed by first intention. The walking, running and jumping were normal without pain or discomfort.Conclusion:The first dorsal metatarsal artery-second toe tibial artery tandem flap has been used to repair 2 soft tissue defects in same finger. It simplifies the revascularisation of the flap together with exact surgical curative effect.

Objective To discuss the clinical effect of transplantation of slice nail bed flap of great toe with vascular anastomosis in repair of partial nail-bed and soft tissue defect at fingers.Methods From January,2015 to March,2018,16 cases (16 fingers) of partial nail-bed defect at fingers were repaired with transplantation of slice nail bed flap of great toe with vascular anastomosis.All cases were combined with palmar soft tissue defect at distal segment fingers.The area of nail bed defects were from 0.8 cr×0.5 cm to 1.2 cm×1.0 cm.The area of soft tissue defects were from 1.2 cm×1.0 cm to 2.5 cm×1.5 cm.The average time from injury to operation was 3.6 hours after injuries (ranging from 1 hour to 8 hours).The area of slice nail bed flap incised during operation were from 2.5 cm×1.2 cm to 3.2 cm×1.8 cm,and the donor site was sutured directly.All patients were followed-up regularly for nail appearance,function and donor healing.Among them,11 cases were followed-up by clinic,4 cases by WeChat,and telephone follow-up was performed in 1 case.Results The nail-bed flap after transplantation survived successfully.The followed-up time were from 6 to 18 months,the average time was 9 months.Longitudinal spine and rough appearance occurred in 1 case.Others were flat,smooth,complete attachment of nail body and nail bed.The flaps had good appearance,texture and elasticity at 6 months after surgery,and two-point discrimination was 6-12 mm(average,8 mm).The toenails at donor sites grew well.No walk-associated pain after long-term following-up.Six months after surgery,according to standard for efficacy evaluation of nail regeneration,12 cases were excellent,3 cases were good and 1 case was acceptable.Conclusion Transplantation of slice nail bed flap of great toe with vascular anastomosis in repair of partial nail-bed and soft tissue defect at fingers is one of the effective methods for repairing nail-bed defect at fingers.

Objective To explore the clinical effect of using hallux-nail flap with the distal part of phalanx combined with iliac bone for reconstruction of thumb with Ⅲ degree defect.Methods From June,2011 to June,2016,7 patients with thumb Ⅲ degree defect were treated with the hallux-nail flaps with distal phalanx combined with iliac bone to reconstruct thumbs.According to the thumb defect indexing method reported by Cheng Guoliang,the type 1 of thumb Ⅲ degree defect was 4 cases,and the type 2 of Ⅲ degree defect was 3 cases.The donor site was covered with skin grafting in 1 case,free superficial iliac artery graft in 5 cases and free peroneal artery perforator flap in 1 case.All patients kept the number and length of donor toes.Regular follow-up was performed after operation to observe the function,shape,feeling of finger reconstruction,the survival condition of flaps or skin graft in donor site,etc.It was also observed if the pain by walking actually exists in the long-term effect.Results All of the reconstructed thumbs survived.One patient suffered the necrotic in the donor site repaired by superficial iliac artery flap,which was successfully covered with the skin graft.All patients were followed-up from 3 months to 18 months (mean,8 months).The reconstructed thumb with smooth nail had fine textile and good elasticity,good flexion and extension function of the palm,fingers and the metacarpophalangeal joint.The donor sites recovered with fine texture,and there were no difficulties in walking and running and no complaint about the pain and discomfort.According to the Trial Criteria of Upper Limb Functional Evaluation of Chinese Medical Association Hand Surgery Society,5 cases resulted in excellent,and 2 cases resulted in good.Conclusion The hallux-nail flap with the distal phalanx combined with iliac bone is an excellent option to reconstruct thumb with Ⅲ degree defect with the outcome of good function and appearance.The trauma of the donor site is small and the number and length of the toes are remained.The clinical effect is good.

Objective To discuss the clinical effect of partial nail-bed flap at second toe with blood-vessel anastomosed in repair of different types of nail-bed defects at finger.Methods From July,2010 to July,2015,25 cases of partial nail-bed flap at second toe with blood-vessel anastomosed were treated,including 14 males and 11 females,with an age range from 18 to 45 years old (average 25 years old).Eleven cases at index finger,6 cases at middle finger,5 cases at ring finger and 3 cases at little finger.According to the classification of nail bed defect site,9 cases at lateral,5 cases at nail root and 11 cases at distal.All cases were combined skin and soft tissue defect.The area of defects were from 1.1 cm × 2.0 cm to 2.5 cm × 3.2 cm.The time from injury to admission were from 1 hour and 12 minutes to 3 hours and 12 minutes,the average time was 2.1 hours.The area of incised nail flap during operation were from 1.2 cm × 2.2 cm to 2.6 cm × 3.5 cm.The donor site was sutured directly or repaired with free skin graft.The toe length in all cases were retained.The nail shape,nail gloss,fine function of finger such as pinch,grip,grasp and restoration of the donor toes were compared in the follow-up.All patients were followed-up at regllar intervals.Results The nail-bed flap after transplantation and skin graft at donor site survived successfully,and primary healing of the wounds occured in all cases.The follow-up time were from 6 to 26 months(average 9 months).Longitudinal spine or transverse groove occurred in 3 cases at the nail-bed boundary between toe and finger,nail thickened and distal tilted occurred in 1 case,flat,smooth,no deformity nail and glossy deck occurred in others.The flap had good appearance,texture and elasticity.Two-point discrimination was 5-9 mm,averageal of 6 mm.The donor toe had no shortening and no pain after long-term following.According to effectiveness standard for fingernail regeneration:19 cases were excellent and 6 cases were good.Conclusion Partial nail-bed flap at second toe wih bloodvessel anastomosed in repairing nail-bed defects at finger,nail appearance is realistic and function recovered well postoperatively.

Objective To investigate the replantation and postoperative rehabilitation methods for simultaneous amputation of 10 fingers and both forearms.Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September,2014.The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels,nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery.Results All the amputated arms and fingers revived after the surgery.After 14 months follow-up,function of wrist flexion and expansion was normal,superficial and deep sensory functions on hands were good,function of thumb and finger grip,pinch and opposition had partially recovered,the two-point discrimination was 8-10 mm,and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association.Conclusion For the case of simultaneous amputation of both forearms and 10 fingers,it is very likely to carry out successful replantation as well as achieve satisfactory function restoration with excellent teamwork and accurate vessel and nerve anastomosis under microsurgery as well as rehabilitation treatment afterwards.

Objective To investigate the prothetic effect of free grafting of microvascular anastomotic peroneal artery perforator flap when used to repair the donor tissue defects of wrap-around flap of toe.Methods From January 2008 to March 2013,twenty-six cases thumb avulsion at proximal and distal phalanx level with skin and nail bed defect caused by trauma were admitted to our hospital.After incising wrap-around flap of toe to repair the thumb defects,microvascular anastomotic peroneal artery perforator flap was transplanted freely to repair the donor site of it.Results The skin flaps of 26 cases all successfully survived.After a followed-up of 3 months to 4 years,the length of donor toes were the same as before.The appearance of skin flaps were no fat and clumsy and the abradability of their skin were well.Algesia,thalposis and thigmesthesia were partially recovery.Two point discrimination reached to 5-10 mm.There were no obvious uncomfortableness in donor feet when standing and walking except wearing flip-flops.Conclusion Free grafting of peroneal artery perforator flap is a good method to repair the donor defect caused by incising wrap-around flap of toe.