Under the trend of increasing aging， integrated elderly care and medical services is an important measure to optimize the supply of elderly care services and promote the good death of the elderly. Using the cooperative production theory and the classical grounded theory， a qualitative analysis was conducted on 38 cases of elderly palliative care and 25 cases of hospital-based palliative care under the integrated elderly care and medical services model from a hospital in Nanning City using Nvivo 20.0 software. This paper found that the integrated elderly care and medical services mode emphasized the deep integration of medical and elderly care services by integrating resources and improving service efficiency， to achieve the basic experience of comprehensive health care for the elderly. The promotion of these experiences has a positive significance for building a multi-agent cooperative production system， strengthening personnel training， perfecting the performance distribution mechanism， and further promoting the development of the national palliative care pilot.

Objective:To explore the feasibility and clinical effects of unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap in repairing huge pressure ulcers in the sacrococcygeal region.Methods:The study was a retrospective observational study. From June 2020 to April 2023, 15 patients with stage Ⅳ pressure ulcers with sacrococcygeal defect area greater than 10.0 cm×10.0 cm who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 8 males and 7 females, aged from 30 to 86 years. The pressure ulcers before debridement were all accompanied by different degree of infection and necrosis. Debridement and negative pressure sealing and irrigation treatment were performed in stage Ⅰ. After debridement, the skin and soft tissue defect area was 12.0 cm×10.5 cm to 20.0 cm×17.0 cm. After the wound bed infection was controlled, unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap was used to repair the pressure ulcer wounds in stage Ⅱ. The perforator flap area was 12.0 cm×7.0 cm to 16.0 cm×10.5 cm. The donor area wound was sutured directly. After operation, the survival, complications, and wound healing of flap donor area were observed. During regular follow-up, the recurrence of pressure ulcers, the appearance and texture of the flap, and the scars in the donor site were observed.Results:After operation, 1 patient had fluid accumulation under the flap and survived after drainage and dressing change. The flaps of the other patients survived well without infection, local necrosis, and sinus formation under the flap. The wounds in the donor area healed well. All patients were followed up for more than 6 months, and there was no recurrence of pressure ulcers. The appearance of the flap was not bloated, the texture was soft, and the compression resistance and elasticity were good. The donor site wound healed well without obvious scar.Conclusions:The surgical method of repairing giant sacrococcygeal pressure ulcers with unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap is simple and easy to operate. It can repair large defect area with the donor area being sutured directly, which is worthy of clinical promotion.

The deep tissue defects of extremities are prone to cause the exposure of tendons, blood vessels, nerves, and bones, which are commonly repaired with free flaps in clinical practice. However, for special parts such as fingers, toes, posterior ankles, anterior tibias, and dorsum of feet, the appearances are usually bulky after being repaired with free flaps and need lipectomy operations, which bring great physiological, psychological, and economic burden to patients. As the fascia flap is soft and thin with reliable blood supply and strong anti-infection ability, the free fascia flap combined with skin grafting offers some advantages in repairing the above-mentioned wounds. However, its clinical application is severely limited due to the complexity of surgical operation and the difficulty in observing blood supply after operation. In recent years, our team has carried out a lot of work and accumulated rich experience in repairing deep tissue defects of special parts of extremities with free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting. From the clinical perspective, this paper mainly introduces the anatomy and harvesting method of free superficial temporal fascia flap/anterolateral femoral fascial flap, as well as the advantages, difficulties, and precautions of clinical application, for reference of peers.

Objective To investigate the changes of CD4+ CD25+ regulatory T lymphocyte (Treg) and expressions of folkhead helix transcription factor 3 (FoxP3) in intestinal mucosa in human immunodeficiency virus (HIV) infected patients. Methods Twenty-one HIV infected patients and 17 control subjects without HIV infection were included in this study. The expression of FoxP3, which was considered as a specific marker of CD4+ CD25 + Treg, was detected in intestinal mucosa specimens from HIV infected patients by immunohistochemistry. Meanwhile, the in situ expression of CD4+ T lymphocyte was also determined by immunohistochemistry. The data were analyzed by t test. Results The positive labeling index of CD4+ T lymphocyte in intestinal mucosa was significantly lower in HIV infected patients compared to the controls (11. 56%±4. 44% vs 43. 49% ±8. 90% ,t=-11. 86,P<0. 01). The positive labeling index of FoxP3 in intestinal mucosa was also significantly lower in HIV infected patients compared to the controls (0.46% ± 0.20% vs 1. 18% ± 0. 44% ,t= - 5. 98,P<0.01). Conclusion The depletion of CD4+ CD25+ Treg is accompanied with the depletion of CD4 + T lymphocyte and the reduction of FoxP3 expression in intestinal mucosa of HIV infected patients.

Objective To express nonstructural protein 2 transactivated protein (NS2TP) of hepatitis C virus (HCV) in the prokaryotic expression system and prepare polyclonal antibody,and to study the expressions in different liver tissues.Methods NS2TP gene was amplified by polymerase chain reaction (PCR) technique and cloned into the prokaryotic expression vector pET-32a(+),which was transformed into E.coli BL21.The protein was induced by isopropyl thiogalactose (IPTG) and analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and confirmed by Western blotting assay.The recombinant protein were expressed and purified in a large amount.The rabbit was immunized with the purified protein to prepare polyelonal antibody.The liver tissues of patients with chronic HCV infection and healthy controls were detected by immunohistochemistry method.Results The recombinant NS2TP protein (relative molecular mass:33×103 ) and polyclonal antibody with high titer and specificity were successfully prepared.NS2TP expressions in the liver of patients with chronic HCV infection were higher than those of healthy controls,and were mainly distributed in the nucleus of hepatocytes.Conclusions The NS2TP expression level and intracellular location in liver tissue of patients with chronic HCV infection are understanded,which could bring new clues for further study of the biological function of NS2TP and the pathogenesis of HCV infection.

Objective To prepare polyclonal antibody of transactivated protein 5 of hepatitis C virus nonstructural 5A (NA5ATP5) and to explore its expression in the liver tissues. Methods In Escherichia coil BL21, the prokaryotic expression vector pET32a(+)-NS5ATP5 was induced by isopropyl-β-D-thiogalactoside (IPTG), and it was analyzed with sodium dodecyl sulfate-polyaerylamide gel electrophoresis (SDS-PAGE) and Western blotting. And the purified protein was used to immunize the rabbit to prepare polyelonai antibody, with which we studied the function of NSSATP5 by determining the different liver tissues with the streptavidin-perosidase (SP) immunohistochemistry method. Results Recombinant NS5ATP5 (molecular weight: 65 kD) and polyclonal antibody were successfully prepared. NS5ATP5 expression in the liver of patients with chronic HCV infection was much higher than that of a normal person, and it was detected mainly in the cytoplasm. Conclusion The findings of the expression difference between HCV patients and normal people led to a novel diagnostic marker to detect HCV infection.

The existence of HBV-DNA in the mononuclear cells of peripheral blood and in the serum of 61 patients with HBV infection was determined with southern blot and dot blot hybridization,and that in the liver tissue of 31 patients out of the 61 with southern blot and in situ hybridization.The positive rate of HBV-DNA in the serum,mononuclear cells and hepatocytrs was 26.2% (16/61),24.6% (15/61) and 44.8% (13/31) respectively.There was no concordance of the existence of HBV-DNA in the serum,peripheral mono-nuclear cells and hepatocytes in an individual.For example,HBV-DNA was absent in the serum but present in mononuclear cells and hepatocytes in 11 cases.In fact,peripheral mononuclsar cells can serve as the reservoir for HBV to replicate.It cannot be denied that HBV can replicate in an individual even though HBV-DNA is negative in the serum.

Nine cases with serious chronic active hepatitis and 19 cases with severe viral hepatitis were treated with glucocorticoids in the past four years, the former were all recovered while 12 cases of the later achieved marked clinical improvement. Since no specific treatment for severe viral hepatitis was available, the effective rate of 63.2% of glucocorticoids on the disease was considered satisfactory.According to the clinical data, we think that the mechanism of treatment of glucocorticoids on viral hepatitis can not be definitely attributed to their anti-inflammatory and immunosuppressive activities but it would more likely be due to their potential effect on regulating the physiological functions of the liver cells.

In order to evaluate the acid-hase disorders(ABD)in patients with severe viral hepatitis correctly,274 parameters of blood gas and electrolyte were analyzed.According to the combined analysis on the pre-estimated compensatory formula(PCF).anion gap(AG).and potential bicarbonate and chlorine,there were only 78 times of single ABD(28.5%),101 times of double ABD(36.7%),and 95 times of triple ABD(34.6%),which indicates that multiple ABD was quite common in patients with severe viral hepatitis.Among various forms of ABD.respiratory al-kalosis(222 times and 81.0%)was the commonest.then metabolic alkalosis(188 times and 68.6%).metabolic acidosis(136 times and 49.3%),and respiratory acidosis(20 times and 7.3%)occupied the 2nd.3rd.and 4th position on the list.The ratio between alkalemia and acidemia was 2.43 '?1.The incidences of complications and mortality were significantly higher in patients with mixed ABD than in those with simple ABD.

Antibodies against LSP in the sera of 168 patients with various types of viral hepatitis were determined with SPA-RIA. The sera of another group of 178 patients (109 of them were from the first group) with viral hepatitis were studied with ELISA for the same antibodies, which were further divided into three categories, that is, IgG, IgM and IgA classes. The results of 109 patients examined with both of the two methods, indicated that anti-LSP antibodies measured by SPA-RIA might mainly represent anti-LSP IgG class. It was found that circu-lating anti-LSP antibodies could easily be detected in most patients with either acute or chronic hepatitis. After analyzing the-results, the authors suggest that the humoral immune response against LSP might not be the sole initiating factor in the pathogenesis of viral hepatitis, they are more likely the result of the antigen variation of the injured liver cells.