Objective:To compare the clinical outcomes of immediate breast reconstruction using latissimus dorsi flap with implant versus mesh with implant based on BREAST-Q evaluation.Methods:From the clinical database of the First Affiliated Hospital of Nanjing Medical University, the patients who underwent immediate breast reconstruction after total mastectomy from January 2020 to December 2023 were selected as the research subjects. All breast reconstruction surgeries were performed by the same surgeon. Patients were divided into two groups according to surgical methods: the latissimus dorsi muscle flap combined with implant immediate breast reconstruction group (LD group) and the mesh combined with implant immediate breast reconstruction group (mesh group). Patients were followed up in outpatient clinics or by telephone one year after surgery. The BREAST-Q was used to evaluate the surgical outcomes of both groups from four dimensions: psychosocial well-being, sexual well-being, chest-physical well-being, and breast satisfaction. The score range for each dimension was 0-100, with higher scores indicating greater patient satisfaction with quality of life and surgical outcomes. Statistical analysis was performed using SPSS 22.0 software. Normally distributed measurement data were expressed as Mean ± SD, and comparisons between the two groups were performed using independent sample t-test. Count data were expressed as number of cases and percentages, and comparisons between groups were performed using chi-square test or Fisher’s exact test. P<0.05 was considered statistically significant. Results:A total of 123 patients were included, with 59 patients in the LD group and 64 patients in the mesh group. In the LD group, the mean age was (37.7±7.0) years, body mass index (BMI) was (22.6±2.6) kg/m 2, and clinical tumor staging showed 2, 22, 30, and 5 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. In the mesh group, the mean age was (39.1±7.0) years, BMI was (22.6±2.8) kg/m 2, and clinical tumor staging showed 1, 25, 38, and 0 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. There were no statistically significant differences between the two groups in baseline characteristics including age, BMI, and clinical tumor staging (all P>0.05). One year after surgery, the BREAST-Q result showed no statistically significant differences between the LD group and mesh group in psychosocial well-being [(83.0±19.8) points vs. (80.8±19.3) points] and sexual well-being [(62.1±30.4) points vs. (65.8±25.6) points] (all P>0.05). However, the LD group had lower chest-physical well-being scores than the mesh group [(40.6±9.7) points vs. (45.1±9.6) points, P<0.05], while breast satisfaction scores were higher in the LD group than in the mesh group [(68.0±17.8) points vs. (59.8±12.6) points, P<0.01]. Conclusion:Immediate breast reconstruction by both latissimus dorsi flap with implant and mesh with implant can improve patients’ psychosocial and sexual well-being by enhancing breast appearance. However, LD technique provides better breast satisfaction, while the mesh technique offers advantages in physical well-being of the chest wall and upper body. Surgeons should select the most appropriate breast reconstruction technique based on patients’ anatomical conditions, treatment history, and individual needs to optimize postoperative quality of life and satisfaction.

Objective:To compare the clinical outcomes of immediate breast reconstruction using latissimus dorsi flap with implant versus mesh with implant based on BREAST-Q evaluation.Methods:From the clinical database of the First Affiliated Hospital of Nanjing Medical University, the patients who underwent immediate breast reconstruction after total mastectomy from January 2020 to December 2023 were selected as the research subjects. All breast reconstruction surgeries were performed by the same surgeon. Patients were divided into two groups according to surgical methods: the latissimus dorsi muscle flap combined with implant immediate breast reconstruction group (LD group) and the mesh combined with implant immediate breast reconstruction group (mesh group). Patients were followed up in outpatient clinics or by telephone one year after surgery. The BREAST-Q was used to evaluate the surgical outcomes of both groups from four dimensions: psychosocial well-being, sexual well-being, chest-physical well-being, and breast satisfaction. The score range for each dimension was 0-100, with higher scores indicating greater patient satisfaction with quality of life and surgical outcomes. Statistical analysis was performed using SPSS 22.0 software. Normally distributed measurement data were expressed as Mean ± SD, and comparisons between the two groups were performed using independent sample t-test. Count data were expressed as number of cases and percentages, and comparisons between groups were performed using chi-square test or Fisher’s exact test. P<0.05 was considered statistically significant. Results:A total of 123 patients were included, with 59 patients in the LD group and 64 patients in the mesh group. In the LD group, the mean age was (37.7±7.0) years, body mass index (BMI) was (22.6±2.6) kg/m 2, and clinical tumor staging showed 2, 22, 30, and 5 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. In the mesh group, the mean age was (39.1±7.0) years, BMI was (22.6±2.8) kg/m 2, and clinical tumor staging showed 1, 25, 38, and 0 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. There were no statistically significant differences between the two groups in baseline characteristics including age, BMI, and clinical tumor staging (all P>0.05). One year after surgery, the BREAST-Q result showed no statistically significant differences between the LD group and mesh group in psychosocial well-being [(83.0±19.8) points vs. (80.8±19.3) points] and sexual well-being [(62.1±30.4) points vs. (65.8±25.6) points] (all P>0.05). However, the LD group had lower chest-physical well-being scores than the mesh group [(40.6±9.7) points vs. (45.1±9.6) points, P<0.05], while breast satisfaction scores were higher in the LD group than in the mesh group [(68.0±17.8) points vs. (59.8±12.6) points, P<0.01]. Conclusion:Immediate breast reconstruction by both latissimus dorsi flap with implant and mesh with implant can improve patients’ psychosocial and sexual well-being by enhancing breast appearance. However, LD technique provides better breast satisfaction, while the mesh technique offers advantages in physical well-being of the chest wall and upper body. Surgeons should select the most appropriate breast reconstruction technique based on patients’ anatomical conditions, treatment history, and individual needs to optimize postoperative quality of life and satisfaction.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the clinical efficacy of myofascial release in the management of upper limb spastic paralysis after stroke(SPAS)and its impact on the central nervous system.Methods The patients with upper limb spasticity who visited Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into a control group(n=50)receiving conventional treatment and acupuncture,and a treatment group(n=50)receiving conventional treatment and myofascial release.The clinical response rate was assessed by comparing the modified Ashworth Spasticity Scale(MAS)scores between the two groups.Additionally,changes in simplified Fugl-Meyer Assessment(FMA)scores,electromyographic F-waves,and serum gamma-aminobutyric acid(GABA)levels were compared.Results The total effective rate of the treatment group was 96％,while that of the control group was 86％,showing no statistically significant difference(P=0.08).However,the effective rate in the treatment group was significantly higher than that in the control group(P＜0.05).Following treatment,both groups exhibited a significant reduction in MAS scores(P＜0.001),with a notably greater decrease observed in the observation group compared to the control group(P＜0.05).Moreover,after treatment,there was a significant increase in FMA scores for both groups(P＜0.05),and this increase was significantly more pronounced in the observation group than in the control group(P＜0.05).After treatment,both groups exhibited a significant reduction in electromyographic F-waves amplitude and a significant increase in threshold(P＜0.05).Moreover,the observation group demonstrated a significantly greater degree of change compared to the control group(P＜0.05).Following treatment,serum GABA levels significantly decreased in both groups(P＜0.001),with the observation group showing a markedly higher decrease than the control group(P＜0.001).Conclusion In comparison to conventional acupuncture,myofascial release demon-strates superior efficacy in improving muscle tension and limb motor function for the treatment of upper limb SPAS,while also facilitating central nervous system regulation.

Objective To explore the diagnostic value of multi-slice spiral CT combined with vimentin in dedifferentiated liposarcoma(DDL).Methods A total of 88 patients with suspected DDL admitted to No.904 Hospital of Joint Logistics Support Force of PLA from June 2017 to June 2022 were enrolled.Multi-slice spiral CT examination and vimentin detection were performed in all the patients.Pathological results were taken as the golden standard of diagnosis.The consistency of multi-slice spiral CT examination and pathological results was investigated.The expression of vimentin was compared between DDL patients and non-DDL patients.The diagnostic value of multi-slice spiral CT combined with vimentin in dedifferentiated liposarcoma was analyzed.Results Pathological diagnosis showed that 64 patients were diagnosed as DDL and 24 patients were not DDL.The results of multi-slice spiral CT showed that 63 patients were diagnosed as DDL.CT results of 59 patients with DDL and 20 patients with non-DDL were consistent with pathological diagnosis.The multi-slice spiral CT examination and pathological results were generally consistent(Kappa=0.746,P<0.01).The expression of vimentin was positive in 59 DDL patients and negative in 5 DDL patients.The expression of vimentin was positive in 6 non-DDL patients and negative in 18 non-DDL patients.Kappa consistency test showed that and the 2 diagnostic methods were generally consistent(Kappa=0.681,P<0.01).Sixty-three patients were diagnosed as DDL by multi-slice spiral CT combined with vimentin detection.The combined detection of 61 patients with DDL and 22 patients with non-DDL were consistent with pathological diagnosis.Kappa consistency test showed that,the 2 diagnostic methods were well consistent(Kappa=0.866,P<0.01).The sensitivities of multi-slice spiral CT,vimentin detection and their combination were 92.18% ,92.18% and 95.31% ,respectively;the specificities were 83.34% ,75.00% and 91.67% ,respectively;the Youden indexes were 0.755,0.671 and 0.870,respectively.The combined use of multi-slice spiral CT and vimentin detection had higher diagnostic value for DDL.Conclusion The result of multi-slice spiral CT combined with vimentin detection is consistent with pathological diagnosis and this method can be widely used in clinic.

Objective:To investigate the effect of rebiopsy blastocyst on clinical pregnancy and neonatal outcomes in patients with preimplantation genetic testing (PGT) before embryo implantation.Methods:A retrospective cohort study analyzed the clinical pregnancy and neonatal outcomes of one biopsy and rebiopsy patients (453 and 60 patients, respectively) with PGT in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2019 to December 2022. The 2∶1 propensity score matching (PSM) method was used to match the age, body mass index (BMI) and infertility duration of women in the two groups, and the laboratory indexes and related indexes of transplant fertility and neonatal outcomes of PGT patients were compared between the two groups. The rebiopsy patients with PGT were divided into PGT for aneuploidy (PGT-A) subgroup, PGT for structural rearrangements (PGT-SR) subgroup and PGT for monogenic (PGT-M) subgroup according to PGT types, and the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo were compared between each two subgroups.Results:After PSM, there were no significant differences in women's age, female body mass index, infertility type, ovulation induction program, PGT type and laboratory-related indexes between the two groups (all P>0.05). At the same time, the implantation rate, the clinical pregnancy rate and the live birth rate of rebiopsy embryos decreased, and the miscarriage rate increased, but the differences were not statistically significant (all P>0.05). The rate of day 3 available embryo in the rebiopsy PGT group [87.50% (434/496)] was significantly increased, and the number of blastocyst [4.00 (2.25,6.75)] was significantly decreased compared with one biopsy PGT group [82.19% (812/980), P=0.020; 5.50 (3.00,8.00), P=0.028]. Then the chromosomal euploidy rate of the rebiopsy embryo [35.9% (28/78)] decreased and the abnormality rate [9.0% (7/78)] increased in the rebiopsy PGT group compared with one biopsy PGT group [49.3% (226/458), P=0.028; 0.9% (4/458), P<0.001], and the differences were statistically significant. The aneuploidy rate and multi-chromosome mosaic rate in the rebiopsy PGT group were higher than those in the one biopsy PGT group, but the difference was not statistically significant (all P>0.05). There were no significant differences in birth weight, gestational age, sex ratio, low birth weight infants, macrosomia, small-for-gestational-age infants, large-for-gestational-age infants, and incidence of birth defects between the two groups (all P>0.05). There was no significant difference in the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo between the subgroups of the PGT group (all P>0.05). Conclusion:For patients who fail the first biopsy, the clinical pregnancy rate, the live birth rate, the neonatal birth weight, and the birth defect incidence rate after the second biopsy of PGT are comparable to those of the patients with the first biopsy of PGT.

Objective:To investigate the effect of rebiopsy blastocyst on clinical pregnancy and neonatal outcomes in patients with preimplantation genetic testing (PGT) before embryo implantation.Methods:A retrospective cohort study analyzed the clinical pregnancy and neonatal outcomes of one biopsy and rebiopsy patients (453 and 60 patients, respectively) with PGT in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2019 to December 2022. The 2∶1 propensity score matching (PSM) method was used to match the age, body mass index (BMI) and infertility duration of women in the two groups, and the laboratory indexes and related indexes of transplant fertility and neonatal outcomes of PGT patients were compared between the two groups. The rebiopsy patients with PGT were divided into PGT for aneuploidy (PGT-A) subgroup, PGT for structural rearrangements (PGT-SR) subgroup and PGT for monogenic (PGT-M) subgroup according to PGT types, and the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo were compared between each two subgroups.Results:After PSM, there were no significant differences in women's age, female body mass index, infertility type, ovulation induction program, PGT type and laboratory-related indexes between the two groups (all P>0.05). At the same time, the implantation rate, the clinical pregnancy rate and the live birth rate of rebiopsy embryos decreased, and the miscarriage rate increased, but the differences were not statistically significant (all P>0.05). The rate of day 3 available embryo in the rebiopsy PGT group [87.50% (434/496)] was significantly increased, and the number of blastocyst [4.00 (2.25,6.75)] was significantly decreased compared with one biopsy PGT group [82.19% (812/980), P=0.020; 5.50 (3.00,8.00), P=0.028]. Then the chromosomal euploidy rate of the rebiopsy embryo [35.9% (28/78)] decreased and the abnormality rate [9.0% (7/78)] increased in the rebiopsy PGT group compared with one biopsy PGT group [49.3% (226/458), P=0.028; 0.9% (4/458), P<0.001], and the differences were statistically significant. The aneuploidy rate and multi-chromosome mosaic rate in the rebiopsy PGT group were higher than those in the one biopsy PGT group, but the difference was not statistically significant (all P>0.05). There were no significant differences in birth weight, gestational age, sex ratio, low birth weight infants, macrosomia, small-for-gestational-age infants, large-for-gestational-age infants, and incidence of birth defects between the two groups (all P>0.05). There was no significant difference in the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo between the subgroups of the PGT group (all P>0.05). Conclusion:For patients who fail the first biopsy, the clinical pregnancy rate, the live birth rate, the neonatal birth weight, and the birth defect incidence rate after the second biopsy of PGT are comparable to those of the patients with the first biopsy of PGT.

Objective To investigate the clinical efficacy of myofascial release in the management of upper limb spastic paralysis after stroke(SPAS)and its impact on the central nervous system.Methods The patients with upper limb spasticity who visited Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into a control group(n=50)receiving conventional treatment and acupuncture,and a treatment group(n=50)receiving conventional treatment and myofascial release.The clinical response rate was assessed by comparing the modified Ashworth Spasticity Scale(MAS)scores between the two groups.Additionally,changes in simplified Fugl-Meyer Assessment(FMA)scores,electromyographic F-waves,and serum gamma-aminobutyric acid(GABA)levels were compared.Results The total effective rate of the treatment group was 96％,while that of the control group was 86％,showing no statistically significant difference(P=0.08).However,the effective rate in the treatment group was significantly higher than that in the control group(P＜0.05).Following treatment,both groups exhibited a significant reduction in MAS scores(P＜0.001),with a notably greater decrease observed in the observation group compared to the control group(P＜0.05).Moreover,after treatment,there was a significant increase in FMA scores for both groups(P＜0.05),and this increase was significantly more pronounced in the observation group than in the control group(P＜0.05).After treatment,both groups exhibited a significant reduction in electromyographic F-waves amplitude and a significant increase in threshold(P＜0.05).Moreover,the observation group demonstrated a significantly greater degree of change compared to the control group(P＜0.05).Following treatment,serum GABA levels significantly decreased in both groups(P＜0.001),with the observation group showing a markedly higher decrease than the control group(P＜0.001).Conclusion In comparison to conventional acupuncture,myofascial release demon-strates superior efficacy in improving muscle tension and limb motor function for the treatment of upper limb SPAS,while also facilitating central nervous system regulation.

Objective:To investigate the efficacy of Qingruxiao granules combined with tamoxifen in the treatment of breast hyperplasia and its effect on serum hypoxia-inducible factor-alpha (HIF-α), angiopoietin-2 (Ang-2) and prolactin (PRL) levels. Methods:Ninety-eight patients with breast hyperplasia admitted to Xi'an No.3 Hospital from June 2020 to January 2022 were retrospectively included in this study. They were divided into control and observation groups ( n = 49/group) according to different treatments. The control group was treated with tamoxifen alone. The observation group was treated with Qingruxiao granules combined with tamoxifen. Clinical efficacy, symptom score, ultrasound parameters (glandular layer thickness, longest diameter of mass, maximum diameter of hypoechoic area, inner diameter of lactating tube), endocrine hormone levels (estradiol, progesterone, and prolactin), HIF-α, and Ang-2 pre- and post-treatment, as well as the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [93.88% (4/49) vs. 77.55%, χ2 = 5.33, P < 0.05). After treatment, breast mass score, breast pain, systemic accompanying symptom, and nipple discharge in the observation group were (1.34 ± 0.29) points, (1.02 ± 0.36) points, (0.68 ± 0.17) points, (0.97 ± 0.15) points, respectively, which were significantly lower than (1.57 ± 0.23) points, (1.45 ± 0.41) points, (0.95 ± 0.26) points, and (1.28 ± 0.26) points, respectively, in the control group ( t = 4.35, 5.52, 6.08, 7.23, all P < 0.001). The glandular layer thickness, the longest diameter of mass, the maximum diameter of hypoechoic area, and the inner diameter of lactating duct in the observation group were (9.45 ± 1.67) mm, (11.46 ± 3.68) mm, (14.37 ± 4.22) mm, and (1.23 ± 0.39) mm, respectively, which were significantly lower than (11.26 ± 2.51) mm, (16.33 ± 4.01) mm, (19.87 ± 5.01) mm, (1.54 ± 0.48) mm in the control group ( t = 4.20, 2.26, 5.88, 3.51, all P < 0.001). Serum estradiol and prolactin levels in the observation group were (122.35 ± 29.76) ng/L and (205.64 ± 36.42) IU/L, respectively, which were significantly lower than (139.76 ± 30.48) ng/L and (251.49 ± 41.87) IU/L in the control group ( t = 2.86, 5.78, both P < 0.05). Serum progesterone level in the observation group was (9.22 ± 1.57) μg/L, which was significantly higher than (7.18 ± 1.21) μg/L in the control group ( t = -7.20, P < 0.05). Serum HIF-α and Ang-2 levels in the observation group were (0.15 ± 0.05) ng/L and (0.98 ± 0.11) ng/L, respectively, which were significantly lower than (0.24 ± 0.07) ng/L and (1.49 ± 0.22) ng/L in the control group ( t = 7.32, 14.51, both P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Qingruxiao granules combined with tamoxifen can effectively improve clinical symptoms, reduce tumor size, regulate endocrine hormone levels, decrease the expression of angiogenic factors in patients with breast hyperplasia, and is highly safe.