Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective:To evaluate the effect of accelerated rehabilitation surgery (ERAS) under diagnosis-intervention packet (DIP) in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection (ESD).Methods:The 64 patients with early cancer of digestive tract treated with ESD in the Gastroenterology Department of the Second People′s Hospital of Jiaozuo were selected by randomized controlled trial and convenient sampling method. According to random number table method, they were divided into routine group and observation group, 32 patients in each group. All patients in the 2 groups paid their medical expenses by DIP method, the routine group was treated with traditional perioperative nursing, and the observation group was treated with ERAS perioperative management mode. The postoperative complication rate, length of hospital stay, DIP allocation ratio, and patient satisfaction with nursing were compared between the two groups.Results:There were 16 men and women in the routine group, 14 men and 18 women in the observation group.After intervention, the incidence of postoperative complications was 21.88% (7/32) in the routine group and 3.12% (1/32) in the observation group, and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). The length of stay was (10.93 ± 2.87) d in the routine group and (9.01 ± 1.53) d in the observation group, and the difference between the two groups was statistically significant ( t=4.13, P<0.05). The average hospitalization expenses per case was (20 108.23 ± 6 495.49) yuan in the routine group and (18 589.03 ± 4 439.46) yuan in the observation group, and the difference between the two groups was statistically significant ( t=20.57, P<0.05). The DIP allocation ratio of the observation group was 87.98% (303 419.26/344 872.99), and that of the routine group was 69.33% (244 864.99/353 187.65), and the difference between the two groups was statistically significant ( χ2=4.81, P<0.05). The satisfaction of the observation group was 96.88% (31/32) and the routine group was 78.13% (25/32), and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). Conclusions:The accelerated rehabilitation surgical nursing can effectively reduce the postoperative complications, the average length of stay, the average hospitalization expenses per case under DIP in patients with early cancer of digestive tract treated by ESD, improve the DIP allocation ratio of ESD diseases and the patient′s nursing satisfaction, which reflects the value of nursing work and can be applied to the nursing management of other surgical diseases.

Metastasis accounts for 90% of breast cancer deaths, where the lethality could be attributed to the poor drug accumulation at the metastatic loci. The tolerance to chemotherapy induced by breast cancer stem cells (BCSCs) and their particular redox microenvironment further aggravate the therapeutic dilemma. To be specific, therapy-resistant BCSCs can differentiate into heterogeneous tumor cells constantly, and simultaneously dynamic maintenance of redox homeostasis promote tumor cells to retro-differentiate into stem-like state in response to cytotoxic chemotherapy. Herein, we develop a specifically-designed biomimic platform employing neutrophil membrane as shell to inherit a neutrophil-like tumor-targeting capability, and anchored chemotherapeutic and BCSCs-differentiating reagents with nitroimidazole (NI) to yield two hypoxia-responsive prodrugs, which could be encapsulated into a polymeric nitroimidazole core. The platform can actively target the lung metastasis sites of triple negative breast cancer (TNBC), and release the escorted drugs upon being triggered by the hypoxia microenvironment. During the responsiveness, the differentiating agent could promote transferring BCSCs into non-BCSCs, and simultaneously the nitroimidazole moieties conjugated on the polymer and prodrugs could modulate the tumor microenvironment by depleting nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) and amplifying intracellular oxidative stress to prevent tumor cells retro-differentiation into BCSCs. In combination, the BCSCs differentiation and tumor microenvironment modulation synergistically could enhance the chemotherapeutic cytotoxicity, and remarkably suppress tumor growth and lung metastasis. Hopefully, this work can provide a new insight in to comprehensively treat TNBC and lung metastasis using a versatile platform.

As a neurological disorder in the brain, epilepsy is not only associated with abnormal synchronized discharging of neurons, but also inseparable from non-neuronal elements in the altered microenvironment. Anti-epileptic drugs (AEDs) merely focusing on neuronal circuits frequently turn out deficient, which is necessitating comprehensive strategies of medications to cover over-exciting neurons, activated glial cells, oxidative stress and chronic inflammation synchronously. Therefore, we would report the design of a polymeric micelle drug delivery system that was functioned with brain targeting and cerebral microenvironment modulation. In brief, reactive oxygen species (ROS)-sensitive phenylboronic ester was conjugated with poly-ethylene glycol (PEG) to form amphiphilic copolymers. Additionally, dehydroascorbic acid (DHAA), an analogue of glucose, was applied to target glucose transporter 1 (GLUT1) and facilitate micelle penetration across the blood‒brain barrier (BBB). A classic hydrophobic AED, lamotrigine (LTG), was encapsulated in the micelles via self-assembly. When administrated and transferred across the BBB, ROS-scavenging polymers were expected to integrate anti-oxidation, anti-inflammation and neuro-electric modulation into one strategy. Moreover, micelles would alter LTG distribution in vivo with improved efficacy. Overall, the combined anti-epileptic therapy might provide effective opinions on how to maximize neuroprotection during early epileptogenesis.

Objective:To investigate the safety and the efficacy of percutaneous and surgical approach in femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation.Methods:All consecutive patients implanted with femoro-femoral VA-ECMO between January 2018 and December 2020 in Beijing Anzhen Hospital, Capital Medical University. Propensity score matching was used to compare outcomes of percutaneous and surgical groups while controlling for confounders.Results:Among the 276 patients who received femoro-femoral VA-ECMO (62 surgical and 214 percutaneous), propensity-score matching selected 52 pairs of patients with similar characteristics with mean age of(59.6±13.0)years old, in which 26 patients were female. There were a lower ECMO cannulation-associated complication (28.8% vs. 48.1%, P=0.044) and a lower hospital mortality (42.3% vs. 67.3%, P=0.010) in the percutaneous group. The circuit blood flow after ECMO initiation was similar in both groups[(3.3±0.8)L·min -1·kg -1 in percutaneous group vs. (3.2±0.7)L·min -1·kg -1 in surgical group, P=0.738]. The serum lactate was declined in both group after ECMO initiation[(5.4±5.8)mmol/L vs. (9.2±6.9)mmol/L, P<0.001 in percutaneous group; (6.3±6.2)mmol/L vs. (10.5±7.0)mmol/L, P=0.003 in surgical group]. Conclusion:Percutaneous approach is a safe and efficient technique in emoro-femoral VA-ECMO cannulation. Compared with surgical cannulation, percutaneous approach is associated with lower ECMO cannulation-associated complication and lower hospital mortality.

Objective:To explore the effect of staged respiratory training in pulmonary rehabilitation nursing of patients with high spinal cord injury.Methods:A total of 76 patients with high spinal cord injury in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2019 were selected as the study subjects, and were divided into the control group and the observation group with random number table method, 38 cases each. The control group was given conventional respiratory training, while the observation group was given staged respiratory training. Both groups were intervened 6 days a week for 8 weeks. The differences of basic indexes, pulmonary ventilation function, respiratory muscle strength and incidence of pulmonary infection between the two groups before and after intervention were compared.Results:After 8 weeks of intervention, the blood oxygen saturation was 0.95±0.04 in the observation group and 0.90±0.04 in the control group, there was significant difference ( t value was 4.229, P<0.001). The percentages of predicted values of maximal vital capacity, forced expiratory vital capacity, forced expiratory volume in 1s, and maximal ventilation were (69.21±11.38)%, (61.83±11.53)%, (56.50±7.86)%, (51.62±8.73)% in the observation group after 8 weeks of intervention, and (56.70±14.65)%, (49.82±15.06)%, (45.61±10.32)%, (42.30±15.11)% in the control group, there was significant difference ( t values were 3.610-4.967, P<0.001). The inspiratory muscle strength index was (56.12±18.31) cmH 2O(1 cmH 2O= 0.098 kPa) in the observation group after intervention, and (46.61±11.62) cmH 2O in the control group, there was significant different ( t value was 2.806, P<0.01). The incidence of pulmonary infection was 5.26% (2/38) in the observation group and 15.78% (6/38) in the control group, there was no significant difference ( χ2 value was 2.235, P>0.05). Conclusions:Stage respiratory training can promote lung rehabilitation of patients with high spinal cord injury, which is worthy of promotion and application.

Objective:Retrospective analysis of the epidemiological and clinical characteristics of the novel coronavirus pneumonia (COVID-19) in children, to provide suggestions for the clinical diagnosis and treatment of children infected with SARS-CoV-2.Methods:7 COVID-19 children admitted to Xiangyang Central Hospital from January to February 2020 were studied. The epidemiological, clinical, laboratory, radiological characteristics and disease outcome data were obtained from data collection forms and electronic medical records.Results:Among the 7 children, 3 were male and 4 were female, median age was 8 years (2.6-14.0), 2 patients with co-morbidities , 4 patients with family aggregation history, two of them are brothers and sisters, all of the 7 children had a history of high-risk epidemiology. The main clinical symptoms of children with COVID-19 were fever (4 cases), cough and expectoration (5 cases), whereas others were asymptomatic (2 cases). The peripheral blood manifestations of the patients were as follows: abnormal leukocyte count was observed in 1 case, decrease of neutrophil was observed in 2 cases , 1 case with increase of C-reactive protein (CRP) and 3 cases with increase of lactate dehydrogenase, other indexes like the lymphocyte count was normal in all patients. There were no significant changes in serum albumin, AST, CK and SCR in children. Most of the chest CT findings of children were high density lesions of lung lobes, 2 of them had typical ground glass density shadow. The clinical types of 5 children were common type and the rest are subclinical type. All cases were cured by antiviral plus symptomatic treatment(Arbidol), and combination of traditional Chinese medicine prescription treatment.Conclusion:Children COVID-19 were mainly mild and common cases, most of them were familial clusters, the laboratory examination showed no specificity and their prognosis was well.

Objective To analyze the differences in mechanical properties of arterial vessels at different sites and the effects of different test methods on the experimental results. Methods A unique fixtures based on characteristics of artery shape was designed. The porcine thoracic aorta and common carotid arteries were applied with uniaxial tensile tests under 4 different states (tubular vessels in axial and radial direction and sheets in axial and circumferential direction), and data fitting analysis was conducted on their nonlinearity. Results The mechanical properties of aorta vessels under tubular state were stronger than those under sheet state, and the difference in such numerical results became more significant with the diameter of the tube decreasing. Conclusions The experiment results, provide more comprehensive and reliable vascular mechanical parameters to provide data support for constructing finite element model and constitutive relationship of blood vessels, and guide design and manufacture of tissue engineered vascular grafts. At the same time, it is also beneficial to study and analyze the potential pathophysiology of certain vascular diseases, which will help doctors to present better therapeutic effects in clinical treatment.

Objective To observe the relationship between CYP2C19 gene polymorphisms and major adverse cardiovascular events in the patients of acute coronary syndrome (ACS) who accepted percutaneous coronary intervention (PCI) in Han population from Dalian. Methods A total 809 cases with ACS who had undergone PCI in the cardiology department of Dalian Municipal Central Hospital from Janurary 2012 to Janurary 2014 were selected,Among 809 cases of ACS,there were 178 cases of acute ST segment elevation myocardial infarction (STEMI),105 cases of acute non ST segment elevation myocardial infarction (NSTEMI) and 526 cases of unstable angina. The patients were divided into three groups according to their CYP2C19 genotype.CYP2C19 genotype (*1/*1) were classified as extensive metabolizers (EM group), CYP2C19 genotype (*1/*2、*1/*3) were classified as intermediate metabolizers (IM group) and CYP2C19 genotype (*2/*2、*3/*3、*2/*3) were classified as poor metabolizers (PM group). The occurrence of major adverse cardiovascular events at least 24 months was observed. Results Seven hundred and ninety patients finished the follow-up at least 24 months, 19 patients lost in follow-up, 350 cases (43.2%) were CYP2C19 (*1/*1),318 cases (39.3%) were CYP2C19(*1/*2), 42 cases(5.2%) were CYP2C19 (*1/*3),77 cases (9.5%) were CYP2C19 (*2/*2), 21 case(2.2%)were CYP2C19 (*2/*3), and 1 case (0.1%) was CYP2C19(*3/*3), 350 cases (43.2%) were classified as EM group, 360 cases (44.5%) were classified as IM group, and 99 cases(12.2%)were classified as PM group. No significant difference in age, gender, hypertention, diabetes mellitus, smoking was shown among three groups (P > 0.05). The rate of MACE were 3.3% , 8 cases had target lesion revascularization(EM group 3 cases, IM group 3 cases, PM group 2 cases), 2 cases had non-fatal myocardial infarction (IM group 1 case, PM group 1 case), 15 cases were died(EM group 6 cases, IM group 7 cases, PM group 2 cases), 1 case had subacute stent thrombosis in IM group. The rates of MACE were higher in PM group (5.1%) than those in EM group(2.65%) and IM group (3.41%) , but there was no significant difference in three groups (P>0.05). There was no significant difference in the rate of target lesion revascularization , thrombus in stent, non- fatal myocardial infarction and death among three groups(P > 0.05). Conclusions There is no significant correlation between CYP2C19 gene polymorphism and long-term prognosis in patients with ACS who accepte PCI treatment in Han population from Dalian.