Objective To investigate the renal function recovery and perioperative risk factors for chronic kidney disease in patients after acute Stanford type A aortic dissection (ATAAD) repair. Methods A retrospective study was conducted on patients who underwent ATAAD repair at the Xiamen Cardiovascular Hospital, Xiamen University from 2020 to 2021, and their clinical data were analyzed. Results A total of 255 patients were included, with 200 males and 55 females, and an average age of (52.80±12.46) years. The incidence of acute kidney injury (AKI) after ATAAD repair was 43.9%. Dissection involving the renal artery [OR=2.144, 95%CI (1.234, 3.765), P=0.007], intraoperative urine output [OR=0.761, 95%CI (0.625, 0.911), P=0.004], and intraoperative red blood cell transfusion [OR=1.288, 95%CI (1.088, 1.543), P=0.004] were significantly associated with early AKI after ATAAD repair. Long-term renal function follow-up data were available for 232 patients, among whom 40 (17.2%) patients developed chronic kidney disease (CKD). Independent predictors for CKD included lower body mass index [OR=0.827, 95%CI (0.723, 0.931), P=0.003], preoperative cardiac tamponade [OR=5.344, 95%CI (1.65, 17.958), P=0.005], preoperative renal hypoperfusion syndrome [OR=12.629, 95%CI (5.003, 35.373), P<0.001], postoperative peak serum creatinine time>3 d [OR=7.566, 95%CI (2.799, 22.731), P<0.001], and AKI grade [grade 1: OR=4.418, 95%CI (1.339, 15.361), P=0.016; grade 2: OR=8.345, 95%CI (1.762, 40.499), P=0.007; grade 3: OR=9.463, 95%CI (2.602, 37.693), P<0.001]. Conclusion AKI related to ATAAD repair can recover in the early postoperative period, but both the duration and severity of AKI will affect long-term renal function. In addition, patients' nutritional status, preoperative cardiac tamponade, and renal hypoperfusion syndrome are also independent risk factors for long-term renal dysfunction.

Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.

Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.

Objective:Verstaile free superficial circumflex iliac artery perforator flap(SCIAPF) were adopted for various reconstructive scenarios, and its clinical effect and value was evaluated.Methods:Retrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019. Nine patients had injury in the foot, 8 in ankle, 8 in calf, 7 in forearm, 9 in hand, and 1 in the mouth. All of the defects were repaired by SCIAPF, including 28 single soft tissue defect wounds, 8 multiple soft tissue defect, and 6 composite defects. The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm. The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm. The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps, functional recovery and complications.Results:In this series, there were 28 flaps, including 18 pedicled with superficia branch of superficial circumflex iliac artery, 2 pedicled with deep branch of superficial circumflex iliac artery, and 8 pedicled with 2 branches. Six were chimeric flaps. Among them, 4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps, and 2 were superficial iliac circumflex artery flap with sartorius muscle flap. Eight cases were resurfaced with lobulated SCIAPF. Arterial anastomoses: end-to-side in 35 arteries and end-to-end in 7 arteries. Venous anastomosis: end-to-end in 27 veins and end-to-side in 15 veins. Venous return through superficial iliac circumflex vein in 25 flaps, through venae comitantes in 12 flaps and through both in 5 flaps. All flap donor sites were sutured directly. All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding, and survived after re-anastomosis. All flaps and donor sites healed primarily. During the follow-up of 6-24(mean, 11.5) months, the pliable flaps were ruddy in colour and soft in texture, without obvious bloatness and pigmentation. The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases. The donor hip function were normal. Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.Conclusion:New applications of lobulated or chimeric SCIAPF, based on the SCIA vasculature or its branches, can meet most of the clinical repair requirement.

The national health industry standard (WS/T 610-2018), 'the reference of screening for elevated blood pressure among children and adolescents aged 7-to 18-years-old’, plays a significant role in the standardization of the blood pressure evaluation, the early detection of high blood pressure, and the early intervention of hypertension and other chronic non-communicable diseases among Chinese children and adolescents. This standard gives screening thresholds for blood pressure assessment of children and adolescents in different genders, ages, and heights. Given the complexity of applying this standard, it is error-prone and less efficient to evaluate blood pressure one by one or program this procedure. Therefore, this study provides a SPSS package based on the standard for researchers to download and use, combined with specific cases to guide the use of this package to evaluate the blood pressure of children and adolescents step by step, which could empower researchers to accurately and efficiently conduct blood pressure screening for children and adolescents in China.

Objective To investigate the mechanism of pulmonary inflammation induced by influenza virus , and provide reference for the development of effective drugs for viral pneumonia .Methods An influenza PR8 infection mouse model was established .The levels of inflammatory cytokines and complement molecules were determined using RT -PCR and ELISA.The pathological changes were examined using biopsy .The complement inhibitor cobra venom factor ( CVF) was injected intraperitoneally at a dose of 50 μg/( kg· 24 h) , and then body mass .The survival rate and inflammatory factors were examined .Results Compared with the control group , the expressions of complement regulatory molecule Crry and CD59 were significantly decreased (P<0.01), while those of complement C9 and complement receptor C3aR and C5aR were significantly increased in the lungs of influenza model mice (P<0.01).Pro-inflammatory cytokines TNF-α, IL-6 and IFN-γwere highly expressed , but anti-inflammatory cytokine IL-2 was lowly expressed in serum .Treatment with CVF caused a sight body mass loss, a survival rate increase and a lung index decrease (P <0.05).Moreover, an IL-2 expression increase and a decrease of IL-6, TNF -αand INF-γexpression were observed in CVF treatment mice ( P< 0.05).Conclusion Inhibition of complement activation can increase the survival rate of mice with influenza pneumonia and decrease pulmonary indexes .thus delaying the pathogenesis of PR 8.