Objective To investigate the application value of procalcitonin(PCT),neutrophil-to-lym-phocyte ratio(NLR)and C-reactive protein to albumin ratio(CAR)in the short-term prognosis of the pa-tients with severe community acquired pneumonia(SCAP).Methods A total of 225 patients with communi-ty-acquired pneumonia(CAP)treated in this hospital from July 2021 to December 2022 were selected as the study subjects and divided into the SCAP group and non-SCAP group.Then the patients with SCAP were di-vided into the survival group and death group according to their survival state in 28 d.The general data and re-lated laboratory indexes were collected.NLR and CAR were calculated.The binary logistic regression was a-dopted to analyze the risk factors of death on 28 d for the SCAP patients.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the predictive value of relevant indicators.Results The age,levels of PCT,NLR,CAR,WBC and NEU,and the proportion of cor-onary heart disease in the SCAP group were higher than those in the non-SCAP group,while the levels of LYM and ALB were lower than those in the non-SCAP group,and the differences were statistically significant(P＜0.05).The age,levels of PCT,NLR,CAR,WBC and NEU,and the proportion of COPD in the death group were higher than those in the survival group,while the levels of LYM and ALB were lower than those in the survival group,and the differences were statistically significant(P＜0.05).The binary logistic regres-sion analysis showed that the age(OR=1.069,95％CI:1.020-1.120),chronic obstructive pulmonary dis-ease(OR=5.633,95％CI:2.019-15.712),PCT(OR=1.045,95％CI:1.002-1.090)and CAR(OR=2.170,95％CI:1.616-2.915)were the independent influencing factor for the death on 28 d in the patients with SCAP.The ROC curve analysis indicated that AUC,sensitivity and specificity of PCT,NLR and CAR combined detection were superior to those of detection alone,having good predictive value.Conclusion PCT,NLR and CAR have a certain predictive value for death within 28 d in the patients with SCAP.The combined detection has better predictive efficiency.

Objective:To explore the application strategies and clinical effects of superior gluteal artery perforator tissue flaps in repairing stage Ⅳ pressure ulcers in the sacrococcygeal region.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 89 patients with stage Ⅳ pressure ulcers in the sacrococcygeal region who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 59 males and 30 females, aged 21 to 84 years. There were 89 sacrococcygeal pressure ulcers, with an area of 5.0 cm×4.0 cm-21.0 cm×21.0 cm after debridement. According to the shape, size, and depth of the wounds after debridement, combined with the elasticity and texture of the skin around the wounds, and the principle of minimizing damage to the donor area, the appropriate forms of superior gluteal artery perforator tissue flaps were cut for wound repair in the following three conditions. (1) For wounds with a round shape, an area of 5.0 cm×5.0 cm-21.0 cm×21.0 cm, and a depth of 1.0-3.5 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, bilobed superior gluteal artery perforator relay flap, and bilateral superior gluteal artery perforator rotational flap were used. (2) For wounds with an oval shape, an area of 5.0 cm×4.0 cm-18.5 cm×10.5 cm, and a depth of 1.0-3.0 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, unilateral superior gluteal artery perforator propeller flap combined with contralateral superior gluteal artery perforator V-Y advanced flap or keystone flap were used. (3) For wounds with a fusiformis shape, an area of 7.0 cm×4.0 cm-17.5 cm×6.0 cm, and a depth of 1.5-5.0 cm, the unilateral or bilateral superior gluteal artery perforator V-Y advanced flap, superior gluteal artery perforator keystone flap, or superior gluteal artery perforator keystone flap combined with gluteus maximus muscle flap were used. In this group of patients, a total of 40 superior gluteal artery perforator propeller flaps (with an resection area of 11.0 cm×6.0 cm-17.0 cm×11.0 cm), 22 superior gluteal artery perforator propeller myocutaneous flaps (with an resection area of 10.0 cm×5.0 cm-14.0 cm×8.0 cm), 7 bilobed superior gluteal artery perforator relay flaps (with a main flap resection area of 5.5 cm×5.5 cm-18.0 cm×11.5 cm and a side flap resection area of 4.5 cm×3.0 cm-11.0 cm×6.5 cm), 5 bilateral superior gluteal artery perforator rotational flaps (with a total resection area of 20.0 cm×16.0 cm-26.0 cm×21.0 cm on both sides), 14 superior gluteal artery perforator V-Y advanced flaps (with an resection area of 12.0 cm×10.0 cm-18.0 cm×18.0 cm), 13 superior gluteal artery perforator keystone flaps (with an resection area of 13.0 cm×6.5 cm-19.0 cm×18.0 cm), and 3 gluteus maximus muscle flaps (with an resection area of 8.0 cm×3.0 cm-15.0 cm×4.5 cm). The donor area wounds were all directly sutured. The survival of tissue flaps was observed and the incidence rate of delayed wound healing in the reception area was calculated, and wound healing in the donor area was observed. The appearance and texture of tissue flaps and recurrence of pressure ulcers were followed up.Results:After surgery, all bilateral superior gluteal artery perforator rotational flaps, superior gluteal artery perforator V-Y advanced flaps, superior gluteal artery perforator keystone flaps, and gluteus maximus muscle flaps survived well. There were 6 cases of delayed wound healing in the reception area after surgery, with an incidence rate of 6.7% (6/89). Two patients had incision dehiscence in the donor area wounds due to postoperative bleeding, the wounds healed after debridement, vacuum sealing drainage, and dressing change. The wounds in the donor area of the remaining patients healed well. Six patients were lost to follow-up. Eighty-three patients were followed up for 3-48 months, of whom 4 patients died. Among the remaining 79 patients, 3 cases had pressure ulcers recur due to improper nursing, while the rest of the patients had tissue flaps with good appearance and soft texture and no recurrence of pressure ulcers.Conclusions:Based on the characteristics of wound shape, size, and depth after debridement of stage Ⅳ pressure ulcers in the sacrococcygeal region, individualized selection of flap, myocutaneous flap, or a combination of flap and gluteus maximus muscle flap based on the perforating branch of the superior gluteal artery perforator can achieve good clinical repair results. The postoperative tissue flap survived well, with a good appearance, soft texture, and less recurrence of pressure ulcers.

Objective:To explore the application strategies and clinical effects of superior gluteal artery perforator tissue flaps in repairing stage Ⅳ pressure ulcers in the sacrococcygeal region.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 89 patients with stage Ⅳ pressure ulcers in the sacrococcygeal region who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 59 males and 30 females, aged 21 to 84 years. There were 89 sacrococcygeal pressure ulcers, with an area of 5.0 cm×4.0 cm-21.0 cm×21.0 cm after debridement. According to the shape, size, and depth of the wounds after debridement, combined with the elasticity and texture of the skin around the wounds, and the principle of minimizing damage to the donor area, the appropriate forms of superior gluteal artery perforator tissue flaps were cut for wound repair in the following three conditions. (1) For wounds with a round shape, an area of 5.0 cm×5.0 cm-21.0 cm×21.0 cm, and a depth of 1.0-3.5 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, bilobed superior gluteal artery perforator relay flap, and bilateral superior gluteal artery perforator rotational flap were used. (2) For wounds with an oval shape, an area of 5.0 cm×4.0 cm-18.5 cm×10.5 cm, and a depth of 1.0-3.0 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, unilateral superior gluteal artery perforator propeller flap combined with contralateral superior gluteal artery perforator V-Y advanced flap or keystone flap were used. (3) For wounds with a fusiformis shape, an area of 7.0 cm×4.0 cm-17.5 cm×6.0 cm, and a depth of 1.5-5.0 cm, the unilateral or bilateral superior gluteal artery perforator V-Y advanced flap, superior gluteal artery perforator keystone flap, or superior gluteal artery perforator keystone flap combined with gluteus maximus muscle flap were used. In this group of patients, a total of 40 superior gluteal artery perforator propeller flaps (with an resection area of 11.0 cm×6.0 cm-17.0 cm×11.0 cm), 22 superior gluteal artery perforator propeller myocutaneous flaps (with an resection area of 10.0 cm×5.0 cm-14.0 cm×8.0 cm), 7 bilobed superior gluteal artery perforator relay flaps (with a main flap resection area of 5.5 cm×5.5 cm-18.0 cm×11.5 cm and a side flap resection area of 4.5 cm×3.0 cm-11.0 cm×6.5 cm), 5 bilateral superior gluteal artery perforator rotational flaps (with a total resection area of 20.0 cm×16.0 cm-26.0 cm×21.0 cm on both sides), 14 superior gluteal artery perforator V-Y advanced flaps (with an resection area of 12.0 cm×10.0 cm-18.0 cm×18.0 cm), 13 superior gluteal artery perforator keystone flaps (with an resection area of 13.0 cm×6.5 cm-19.0 cm×18.0 cm), and 3 gluteus maximus muscle flaps (with an resection area of 8.0 cm×3.0 cm-15.0 cm×4.5 cm). The donor area wounds were all directly sutured. The survival of tissue flaps was observed and the incidence rate of delayed wound healing in the reception area was calculated, and wound healing in the donor area was observed. The appearance and texture of tissue flaps and recurrence of pressure ulcers were followed up.Results:After surgery, all bilateral superior gluteal artery perforator rotational flaps, superior gluteal artery perforator V-Y advanced flaps, superior gluteal artery perforator keystone flaps, and gluteus maximus muscle flaps survived well. There were 6 cases of delayed wound healing in the reception area after surgery, with an incidence rate of 6.7% (6/89). Two patients had incision dehiscence in the donor area wounds due to postoperative bleeding, the wounds healed after debridement, vacuum sealing drainage, and dressing change. The wounds in the donor area of the remaining patients healed well. Six patients were lost to follow-up. Eighty-three patients were followed up for 3-48 months, of whom 4 patients died. Among the remaining 79 patients, 3 cases had pressure ulcers recur due to improper nursing, while the rest of the patients had tissue flaps with good appearance and soft texture and no recurrence of pressure ulcers.Conclusions:Based on the characteristics of wound shape, size, and depth after debridement of stage Ⅳ pressure ulcers in the sacrococcygeal region, individualized selection of flap, myocutaneous flap, or a combination of flap and gluteus maximus muscle flap based on the perforating branch of the superior gluteal artery perforator can achieve good clinical repair results. The postoperative tissue flap survived well, with a good appearance, soft texture, and less recurrence of pressure ulcers.

Objective:To explore the clinical effect of a pedicled gracilis musculocutaneous flap on reconstruction of chronic sinus wounds in inguinal region.Methods:From September 2015 to June 2023, 10 patients with chronic inguinal sinus wounds were treated in Medical Centre of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University. The patients were 6 males and 4 females, aged 15-72 years old with an average age of 45 years old. Causes of injury: 4 patients were of non-healed wound after inguinal lymph node dissection for external genital or penile cancer, 2 of chronic radiation ulcers formed in the inguinal area after radiotherapy, 2 of femoral artery angiography site non-healing after lower limb artery balloon angioplasty, 1 of wound non-healing after resection of inguinal protuberant skin fibrosarcoma, and 1 of non-healing ulceration after repeated scratching due to inguinal pruritus. The wounds were all chronic in the groin region, all with a course over 30 days and sinus formation. Soft tissue defects on the surface of wounds ranged from 2.0 cm × 3.0 cm to 5.0 cm × 7.0 cm, and the depth of the sinus was from 2.0 cm to 5.0 cm. After debridement, ipsilateral gracilis musculocutaneous flaps were taken for defect reconstruction. Size of the flaps was 3.5 cm × 4.0 cm - 8.0 cm × 9.0 cm, the length of the gracilis musculocutaneous composite flaps was 16.0 - 24.0 cm, and the volume of the flap was 96.0 - 180.0 cm 3. The gracilis tissue of the flap was filled into the sinus tract and the wound was covered by the cutaneous tissue of the flap. Donor sites of the flap were pulled together and directly sutured. After surgery, hip movements were avoided and appropriately raised the affected limb, observed the survival of gracilis musculocutaneous flap as well as the healing of donor site. Scheduled postoperative follow-ups were conducted through the visits of outpatient clinic and interviews via WeChat or Internet hospital. Results:All the flaps survived. One flap had bleeding at the edge of flap within 24 hours after surgery and resulted in suture dehiscence. After bedside haemostasis, debridement and re-suture, it was healed. All donor sites achieved primary healing. All of the 10 patients were included in the postoperative follow-up for 6-21 months, with an average of 13 months. The flaps were in good colour and appearance, and the patients were satisfactory with the appearance. Scars were seen in the donor sites, but there was no obvious functional impairment. During the follow-up, no flap rupture occurred.Conclusion:The pedicled gracilis musculocutaneous flap is used to reconstruction of chronic inguinal sinus wounds, which can fully fill the sinus tract and simultaneously reconstruct the soft tissue defect of wound. This surgery is simple, practical and with good clinical efficacy.

Objective:To explore the feasibility and clinical efficacy of reconstruction of the soft tissue defect after keloidectomy and/or cicatricial ulcers excision caused by sternotomy with the 5th intercostal perforator flap of the internal thoracic artery.Methods:From September 2016 to August 2023, 10 patients with sternal keloids and/or sternal scar ulcers caused by sternotomy were treated in the Medical Centre of Burn Plastic Surgery and Wound Repair, the First Affiliated Hospital of Nanchang University. The soft tissue defect after resection reconstructed by the pedicled 5th intercostal perforator flap of the internal thoracic artery. The patients were 7 males and 3 females, aged 17-65 years, with an average age of 43 years. The history of sternal scar was 2-15 years, with an average of 5.5 years. And the sizes of sternal scars were 2.0 cm×6.5 cm-5.5 cm×10.0 cm. After admission, the patients firstly received surgery to remove sternal keloids and/or scar ulcers. The defects of soft tissue were found from 2.5 cm×7.0 cm to 6.0 cm×10.5 cm in size after surgery. Then one-stage reconstructive surgery were performed on all of the patients with a transposition of the pedicled 5th intercostal perforator flap of the internal thoracic artery. Flaps were harvested in surgery at 3.5 cm×7.5 cm-6.0 cm×11.0 cm in size. The donor sites of flaps were pulled and directly sutured. After the surgery, wound healing and flap survival were observed, through regular follow-ups at outpatient clinics, and via internet hospitals or WeChat reviews to monitor the colour and appearance of the flaps, recurrence of keloids and/or ulcers, the appearance of donor sites and the secondary dysfunction of surgery.Results:All incisions healed well after surgery, and all the pedicled 5th intercostal perforator flaps of the internal thoracic artery survived. All 10 patients were included in the postoperative follow-up for a period of 6-31 months, with an average of 15 months. During follow-up, the colour and appearance of the flaps were found good, and the patients were satisfied. There was no recurrence of keloid and/or scar ulcer in the reception sites. Two patients had linear scar hyperplasia at the incision sites over the period of follow-up, due to the failure of adherence to regular scar prevention and treatment after wound healing. Appearances of the donor sites were good without functional impairment.Conclusion:The pedicled 5th intercostal perforator flap of the internal thoracic artery has a better clinical effect in reconstruction of the soft tissue defect after keloidectomy and/or cicatriciad ulcers excision caused by sternotomy and without a postoperative recurrence of a keloid and/or scar ulcer, with a good colour and appearance in the affected area and in a good appearance without a secondary functional impairment at the donor site.

Objective:To explore the feasibility and clinical efficacy of reconstruction of the soft tissue defect after keloidectomy and/or cicatricial ulcers excision caused by sternotomy with the 5th intercostal perforator flap of the internal thoracic artery.Methods:From September 2016 to August 2023, 10 patients with sternal keloids and/or sternal scar ulcers caused by sternotomy were treated in the Medical Centre of Burn Plastic Surgery and Wound Repair, the First Affiliated Hospital of Nanchang University. The soft tissue defect after resection reconstructed by the pedicled 5th intercostal perforator flap of the internal thoracic artery. The patients were 7 males and 3 females, aged 17-65 years, with an average age of 43 years. The history of sternal scar was 2-15 years, with an average of 5.5 years. And the sizes of sternal scars were 2.0 cm×6.5 cm-5.5 cm×10.0 cm. After admission, the patients firstly received surgery to remove sternal keloids and/or scar ulcers. The defects of soft tissue were found from 2.5 cm×7.0 cm to 6.0 cm×10.5 cm in size after surgery. Then one-stage reconstructive surgery were performed on all of the patients with a transposition of the pedicled 5th intercostal perforator flap of the internal thoracic artery. Flaps were harvested in surgery at 3.5 cm×7.5 cm-6.0 cm×11.0 cm in size. The donor sites of flaps were pulled and directly sutured. After the surgery, wound healing and flap survival were observed, through regular follow-ups at outpatient clinics, and via internet hospitals or WeChat reviews to monitor the colour and appearance of the flaps, recurrence of keloids and/or ulcers, the appearance of donor sites and the secondary dysfunction of surgery.Results:All incisions healed well after surgery, and all the pedicled 5th intercostal perforator flaps of the internal thoracic artery survived. All 10 patients were included in the postoperative follow-up for a period of 6-31 months, with an average of 15 months. During follow-up, the colour and appearance of the flaps were found good, and the patients were satisfied. There was no recurrence of keloid and/or scar ulcer in the reception sites. Two patients had linear scar hyperplasia at the incision sites over the period of follow-up, due to the failure of adherence to regular scar prevention and treatment after wound healing. Appearances of the donor sites were good without functional impairment.Conclusion:The pedicled 5th intercostal perforator flap of the internal thoracic artery has a better clinical effect in reconstruction of the soft tissue defect after keloidectomy and/or cicatriciad ulcers excision caused by sternotomy and without a postoperative recurrence of a keloid and/or scar ulcer, with a good colour and appearance in the affected area and in a good appearance without a secondary functional impairment at the donor site.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.