Objective:To explore the application effect of rotating skin flap in the repair of skin and soft tissue defects in the perineum.Methods:A retrospective analysis was conducted on the data of 9 patients with perineal soft tissue defects treated in the Department of the First Affiliated Hospital, Wenzhou Medical University from January 2022 to March 2024. Among them, 8 cases were soft tissue defects after extensive resection of Paget′s disease in the perineum, and 1 case was soft tissue defects after treatment of severe urethral stricture. The defect area ranged from 4 cm×1.5 cm to 30 cm×35 cm, and all wounds were repaired with rotating skin flaps, For patients with excessive area, rotating skin flaps were used to cover important areas, combined with autologous skin and artificial skin to cover the remaining wounds. Patients with urethral stricture were treated with free oral mucosal reconstruction of the urethra combined with rotational skin flap coverage. The donor site was directly sutured or autologous skin was transplanted.Results:After surgery, the recipient skin flaps of 9 patients survived and the donor area healed. After a follow-up of 9-15 months, the skin flap survived well, with skin color approaching normal, and the donor site wound healed well. Eight patients with Paget′s disease did not show any recurrence, among which one patient with extensive wound expansion had good recovery of the perineal skin flap coverage area, and small-scale chronic ulcers appeared in the skin graft area. The skin flap of the patient with urethral stricture had recovered well, and the shape of the penis was good, without any urethral stricture, urinary fistula, sinus tract, etc.Conclusions:The rotational skin flap has a clear therapeutic effect on perineal soft tissue defects and is suitable for repairing perineal skin and soft tissue defects.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

AIM: To investigate the effect of ezetimibe combined with statins on residual lipoprotein-cholesterol (RLP-C) levels and major cardiovascular adverse events (MACE) in patients with acute coronary syndrome (ACS) after emergency intervention (PCI). METHODS: A total of 90 hospitalized patients with ACS and undergoing emergency PCI were randomly divided into two groups: 48 patients in the control group received atorvastatin, and 42 patients in the study group were additionally treated with ezetimibe. RLP-C level before and after treatment was detected. The occurrence of MACE events and adverse drug events during the treatment were obtained through regular follow-up. RESULTS: Compared with the control group, the level of RLP-C in the study group was significantly decreased (P<0.05), the incidence of MACE were significantly decreased (P<0.05), and adverse drug events were not increased. CONCLUSION: The combination therapy of ezedemibe and statins can reduce RLP-C level and MACE in ACS patients undergoing emergency PCI with less adverse reactions, which is worthy of promotion and application.

Objective:To detect the expression of ALG3 in human bladder cancer and analyze its clinical significance.Methods:Bioinformatics was conducted to analyze the mRNA level of ALG3 in bladder cancer tissues and normal tissues, and to analyze the relationship between its expression and the survival rate of bladder cancer patients. The clinical and pathological data of 87 patients with bladder cancer who underwent surgical treatment were retrospectively analyzed. Immunohistochemical method was used to detect the expression level of ALG3 protein in bladder cancer tissues and healthy tissues adjacent to the cancer, and to analyze its relationship with clinicopathological characteristics of bladder cancer patients.Results:The results of bioinformatics analysis showed that ALG3 mRNA was highly expressed in bladder cancer tissues, and was significantly correlated with the overall survival rate and disease-free survival rate of patients. Immunohistochemical results showed that ALG3 was mainly localized in the cytoplasm and was highly expressed in bladder cancer tissues, but low or no expression in healthy tissues adjacent to the cancer. The high expression of ALG3 in bladder cancer tumor tissue was related to tumor stage and tumor recurrence (all P<0.05), but not related to age, gender, tumor grade and lymph node metastasis (all P>0.05). Conclusions:ALG3 plays an important role in the occurrence and development of bladder cancer, and it is expected to become an important therapeutic target and prognostic marker for bladder cancer.

Objective:To detect the expression of CCNB2 in human renal clear cell carcinoma and analyze its clinical significance.Methods:Bioinformatics was conducted to analyze the mRNA level of CCNB2 in renal clear cell carcinoma tissues and normal tissues, and to analyze the relationship between its expression and the survival rate of renal clear cell carcinoma patients. The clinical and pathological data of 98 patients with renal clear cell carcinoma who underwent surgical treatment were retrospectively analyzed. Immunohistochemical method was used to detect the expression level of CCNB2 protein in renal clear cell carcinoma tissues and healthy tissues adjacent to the cancer, and to analyze its relationship with clinicopathological characteristics of renal clear cell carcinoma patients.Results:The results of bioinformatics analysis showed that CCNB2 mRNA was highly expressed in renal clear cell carcinoma tissues, and was significantly correlated with the overall survival rate and disease-free survival rate of patients. Immunohistochemical results showed that CCNB2 was highly expressed in renal clear cell carcinoma tissues, but low or no expression in healthy tissues adjacent to the cancer. The high expression of CCNB2 in renal clear cell carcinoma tumor tissue was related to tumor stage and tumor size (all P<0.05), but not related to age, gender and tumor grade (all P>0.05). Conclusions:CCNB2 plays an important role in the occurrence and development of renal clear cell carcinoma, and it is expected to become an important therapeutic target and prognostic marker for renal clear cell carcinoma.

From November 2014 to July 2017,637 patients with acute coronary syndrome (ACS) were included in the analysis,among whom there were 48 cases with prior ischemic stroke (7.5％).The risk factors,history,severity of coronary artery disease,medication status,and incidence of adverse cardiovascular and cerebrovascular events (cardiac death,re-infarction,heart failure,stroke) were analyzed.Compare with patients without prior ischemic stroke (control group) patients with prior ischemic stroke (study group) had lower rates in administration of beta blockers [50.00％(24/28) vs.69.78％(411/589),x2=8.02,P＜0.05]and interventional therapy[56.67％(17/30) vs.81.86％(334/408),x2=11.15,P＜0.05].However,there were no significant differences in medication of dual antiplatelet,statins and angiotensin converting enzyme inhibitors or angiotensin receptor blocker between two groups (P＞0.05);and there was no significant difference in major adverse cardiovascular events between two groups (P＞0.05).In the future,more studies are needed for clinical management of this group of patients.

Objective:To investigate the correlation of serum hs-CRP,D-dimmer and Lp-PLA2 with vulnerable plaque of coronary artery atherosclerosis in patients with coronary heart disease.Methods:Selected 106 cases of patients in our hospital from January 2014 to December 2015,all taken coronary angiography and intravascular ultrasound.Divided into three groups according to the results of the examination,the levels of serum hs-CRP,D-dimmer and Lp-PLA2 were examined and compared,and the correlation with fiber cap thickness,plaque eccentricity index,and vascular remodeling index were tested by Pearson correlation analysis.Results:Serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group and stable plaque group were significantly higher than that of the control group (P＜0.05),and the serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group were significantly higher than that of stable plaque group (P＜0.05);hs-CRP was negative correlated with the thickness of fibrous cap (r=-0.712,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.813,0.756;D-,P＜0.05),D-dimmer was negative correlated with the thickness of fibrous cap (r=-0.654,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.912,0.853,P＜0.05);Lp-PLA2 was negative correlated with the thickness of fibrous cap (r=-0.796,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.836,0.729,P＜0.05).Conclusion:Hs-CRP,D-dimmer and Lp-PLA2 have high correlation with vulnerable plaque in coronary artery disease,can be used as reference indexes for assessing the instability of coronary atherosclerotic plaque.

Objective To study the correlation between aldosterone/renin ratio (ARR) and heart rate variability (HRV),QT interval in patients with essential hypertension.Methods A total of 179 people were divided into two groups according to median number of ARR,and 24 h Holter,24 h ambulatory blood pressure,ECG,serum potassium,serum sodium were monitored,then HRV and QT interval index were compared between the two groups.Results There were significant differences between the two groups in SDNN,SDNN index,SDANN index,RMSSD,QTc,blood potassium,sodium (P ＜ 0.05),while gender,age,diabetes,smoking,BMI,average heart rate,heart rate standard deviation showed no significant difference.At the same time,correction factors showed that ARR was still negatively correlated with SDNN,SDNN Index,SDANN Index,RMSSD,serum potassium (r =-0.444,-0.677,-0.381,-0.623,-0.432,P ＜ 0.05),andwaspositivelycorrelated with QTc,serum sodium (r =0.391,0.379,P ＜ 0.05).Multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN Index were the independent factors related to ARR (P ＜0.05).Conclusion High aldosterone is closely related to heart rate variability reduction.

Objective To study the correlation between aldosterone/renin ratio (ARR) and heart rate variability (HRV),QT interval in patients with essential hypertension.Methods A total of 179 people were divided into two groups according to median number of ARR,and 24 h Holter,24 h ambulatory blood pressure,ECG,serum potassium,serum sodium were monitored,then HRV and QT interval index were compared between the two groups.Results There were significant differences between the two groups in SDNN,SDNN index,SDANN index,RMSSD,QTc,blood potassium,sodium (P ＜ 0.05),while gender,age,diabetes,smoking,BMI,average heart rate,heart rate standard deviation showed no significant difference.At the same time,correction factors showed that ARR was still negatively correlated with SDNN,SDNN Index,SDANN Index,RMSSD,serum potassium (r =-0.444,-0.677,-0.381,-0.623,-0.432,P ＜ 0.05),andwaspositivelycorrelated with QTc,serum sodium (r =0.391,0.379,P ＜ 0.05).Multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN Index were the independent factors related to ARR (P ＜0.05).Conclusion High aldosterone is closely related to heart rate variability reduction.

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
Cerebral Angiography ; Facial Nerve ; pathology ; Female ; Hemifacial Spasm ; surgery ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; etiology ; surgery ; Vertebral Artery Dissection ; diagnostic imaging ; surgery ; Vestibulocochlear Nerve ; pathology