Objective:To compare the clinical effects between the homodigital radial flap of the dorsal cutaneous branch of radial palmar proper digital artery (PPDA) and the homodigital reverse island flap of the ulnar dorsal digital artery (DDA) on reconstruction of defects in thumb-tip or thumb-pulp.Methods:The retrospective case-control study method was used. From January 2016 to August 2022, a total of 65 thumb-tip or thumb-pulp defects were treated in the Department of Hand Surgery of the Second Hospital of Tangshan. Thirty-five defects of thumbs were reconstructed with the homodigital radial flap pedicled with dorsal cutaneous branch of radial PPDA (PPDA group) and the other 30 thumbs were treated by the homodigital ulnar reverse island flap pedicled with ulnar DDA (DDA group). Sizes of the wounds and flaps in PPDA group were 1.9 cm×1.5 cm to 2.9 cm×2.4 cm and 2.1 cm× 1.7 cm to 3.1 cm×2.6 cm, respectively, and the dimensions of the wounds and flaps in DDA group were 2.0 cm× 1.7 cm to 2.9 cm×2.5 cm and 2.2 cm×1.9 cm to 3.2 cm×2.8 cm, respectively. The wounds of donor site in both groups were all directly closed. Survival of the flaps and wound healing of donor sites were observed in both groups. The time of surgery and duration of follow-up of the 2 groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At the final follow-up, record of total active motion (TAM) of the injured thumbs, angle of first web of the affected hands, static TPD of the flaps, patient satisfaction of the appearance of flaps and donor sites were taken. According to the Michigan Hand Function Questionnaire (MHQ) evaluation criteria, the patient satisfaction of the appearance of flaps and donor sites were evaluated. The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test, respectively. P<0.05 was considered statistically significant. Results:All 35 flaps in PPDA group and 26 flaps in DDA group survived primarily, except 4 flaps in the DDA group that showed blisters and healed with dressing changes. The primary survival rate of flap in PPDA group (100%) was higher than that of DDA group (87%), and the difference was statistically significant ( P<0.05). Donor sites of both groups healed primary. The time of surgery and duration of follow-up in PPDA and DDA groups were 59.11 minutes±5.42 minutes and 15.37 months±3.32 months, and 61.27 minutes±5.96 minutes and 16.17 months±3.60 months, respectively. There was no statistically significant difference between the 2 groups ( P>0.05). At the final follow-up, the thumb TAM and angle of thumb web in PPDA and DDA groups were 135.14°±10.04° and 90.29°±4.36° and 132.17°±11.04° and 89.00°±4.81°, respectively. There was no statistically significant differences between the 2 groups ( P>0.05). The static TPD, patient satisfaction of the appearance of flaps and donor sites in PPDA group were 7.11 mm±1.21 mm, 4.69 point±0.47 point and 4.43 point±0.50 point, which were better than DDA group [8.20 mm±1.47 mm, 4.40 point±0.50 point and 4.13 point±0.57 point, respectively] with a statistically significant difference ( P<0.05). Conclusion:The homodigital radial flap of the dorsal cutaneous branch of radial PPDA and the homodigital ulnar reverse island flap of the ulnar DDA are both suitable for reconstruction of defects in thumb-tip or thumb-pulp. Compared with the homodigital reverse island flap with the DDA, a homodigital radial flap with the dorsal cutaneous branch of PPDA has advantages in higher primary survival rate, better flap sensation and appearance at both of recipient and donor sites.

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases which predominantly involve spine and/or peripheral joints. SpA can be disabling and seriously affect the quality of life and function of patients. With the increasing clinical use of targeted drug therapy, precise and standardized use becomes the focus. China's first Consensus on Targeted Drug Therapy for Spondyloarthritis was developed by National Clinical Research Center for Dermatologic and Immunologic Diseases using international norms for consensus development. The consensus addresses 13 important clinical questions, ranging from principles, patient eligibility, pre-treatment screening, treatment initiation, drug selection and switch, co-medication, to adverse event monitoring of targeted drug therapy in SpA, and recommends treatment for specific patients, playing a key role in guiding clinical practices.

Objective:To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection ( treatment excluded) (hereinafter referred to as sixth national consensus) and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment (hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan. Methods:From February 20 to May 7, 2023, a questionnaire survey on the diagnosis and treatment of Helicobacter pylori ( H. pylori) infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province. The questionnaire was drawn up according to the sixth national consensus and the guideline, covering knowledge of 6 sections, induding H. pylori related diseases, detection of H. pylori, eradication, prevention and influence factors of eradication of H. pylori, etc. Chi-square test was used for statistical analysis. Results:A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00%.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments, 264 surgeons and 471 medical technologists and pharmacists). About 78.67%(177/225)of gastroenterologists agreed that the overall infection rate of H. pylori in China was more than 20%, the awareness rate was higher than that of other medical staff (physicians from other departments 65.41%(329/503), surgeons 61.74%(163/264), medical technologists and pharmacists 60.30%(284/471); the following datas were sorted by this position), and the difference was statistically significant ( χ2=30.97, P<0.001). About 51.11%(115/225) of gastroenterologists considered that H. pylori serological antibody test could not be used as a diagnostic method for current infection, the awareness rate was higher than that of other medical staff(22.07%(111/503), 14.02%(37/264), 12.31%(58/471)), and the difference was statistically significant( χ2 =152.66, P<0.001). Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks, and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test, and the awareness rates of gastroenterologists were higher than those of other medical staff (38.67%(87/225) vs. 23.26%(117/503), 19.70%(52/264), 18.47%(87/471); 60.89%(137/225) vs. 26.64%(134/503), 25.76%(68/264), 23.78%(112/471)), and the differences were statistically significant ( χ2 =133.70 and 165.51, both P<0.001). For refractory H. pylori infection, 98.67%(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H. pylori infection should be guided by bacterial culture, antibiotic susceptibility test or drug resistance gene test, and the awareness rate was higher than that of other medical staff (91.85%(462/503), 93.56%(247/264), 93.21%(439/471)), and the difference was statistically significant( χ2=20.55, P=0.002). About 70.67% (159/225) of gastroenterologists recommended a bismuth containing quadruple regimen, 80.44% (181/225) supported a 10 to 14 day H. pylori eradication course, and the awareness rates were higher than other medical staff (46.92%(236/503), 33.33%(88/264), 32.91%(155/471); 67.20%(338/503), 59.09%(156/264), 53.93%(254/471)), and the differences were statistically significant ( χ2=111.25 and 59.99, both P<0.001). The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33% (192/225), which was higher than that of other medical staff (64.21%(323/503), 66.67%(176/264), 57.96%(273/471)), and the difference was statistically significant ( χ2=85.47, P<0.001). Conclusions:Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff. However, there is still a lack of deep understanding of the sixth national consensus and the guideline, and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.

The family readiness for discharge of premature infants in the Neonatal Intensive Care Unit (NICU) is an important index to evaluate the safe discharge of premature infants, and a good family discharge readiness is the basic guarantee for the smooth recovery and healthy growth of premature infants. This article summarizes the concept, influencing factors, and intervention strategies of family discharge readiness for premature infants in NICU, in order to provide reference for the formulation and improvement of discharge readiness measures for premature infants in NICU.

Objectives Building a chest X-ray(CXR)image classification model based on convolutional neural networks in deep learning,providing reliable auxiliary diagnostic techniques for lung diseases.Methods Four kinds of chest X-ray pictures of COVID-19,mild pulmonary infection,viral pneumonia and normal were collected through KAGGLE database,and the data were randomly divided into training set,test set and verification set according to 3∶1∶1 ratio.Building a CXR image classification model based on convolutional neural network architecture,adjusting hyperparameters to strengthen and optimize the model.Subsequently,the model was validated and evaluated using metrics such as confusion matrix,accuracy,sensitivity,and K-fold cross validation results.Results The classification accuracy of this research model for lung imaging images is 0.81,the sensitivity is 0.80,and the loss values of the test and validation sets can be stable at a relatively low level.Compared with models with the same migration algorithm,the accuracy,sensitivity,and F1 score on the test dataset were improved by 1.7%,1.7%,1.3%,and 2.9%,respectively.Conclusion This model has stronger recognition and classification performance for CXR images,and can be more effectively applied to auxiliary analysis and judgment of lung diseases.

Objective To explore the effect of different gravity feeding heights and lying position in preventing gastroesophageal reflux in premature infants. Methods A total of 138 premature infants in the Department of Neonatology in Shengjing Hospital of China Medical University from June to December 2022 were selected as the research objects, and they were randomly divided into control group, the first observation group and the second observation group, with 46 cases in each group. The control group received conventional supine gravity feeding; the first observation group adopted a right lateral position, and raised the syringe to a distance of 20 cm above the lips of the premature infant after confirming there was no residual milk; the second observation group adopted a prone position, and the other measures were the same as the first observation group. Vomiting, milk spilling, apnea, decrease of blood oxygen saturation, gastric residue, times of reduced feeding, times of stopping feeding, growth of body mass, times of defecation, amount of defecation, time of exhausted fetal stool, amount of retention, and esophageal reflux monitoring in 24 hours after 2 weeks of feeding were compared among the three groups. Results The average number of feedings per capita for premature infants in the three groups was 112 times; the incidence rates of vomiting, milk spilling, apnea and decreased blood oxygen concentration in the first observation group and the second observation group were significantly lower than those in the control group (P < 0.05); the gastric residue ratios in the first observation group and the second observation group were significantly lower than that in the control group, while the body weight growth was significantly greater than that in the control group (P < 0.05); the first observation group and the second observationgroup had fewer times of reduced feeding and stopped feeding thanthe control group, and the differences were statistically significant (P < 0.05); the number and amount of defecation in the first observation group and the second observation group were significantly greater than those in the control group, while the time and retention of exhausted fetal stool were significantly less than those in the control group (P < 0.05); the number of times of esophageal pH < 4 and reflux exceeding 5 minutes, the longest single reflux duration, and reflux index in the first observation group and the second observation group were significantly lower than those in the control group (P < 0.05). Conclusion Changes in gravity feeding heights and postures can reduce the incidence rates of vomiting, milk spilling, apnea and decreased blood oxygen concentration, prevent gastroesophageal reflux, and promote the growth and development of premature infants.

Objective:To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods:From April 2018 to May 2021, a total of 55 patients (55 fingers) with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery, the Second Hospital of Tangshan. The patients were randomly divided into 2 groups by the method of drawing lots. The wounds of 29 patients (29 fingers) were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery (propeller group) and that of 26 patients(26 fingers) were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group). Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups. The operation and follow-up time in both groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At final follow-up, the static TPD of the flaps, patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM) of the injured fingers were recorded. The measurement and count data of both groups were compared by independent sample t-test, χ2 tests or Fisher's exact test, respectively. P<0.05 was considered a statistically significant. Results:All the flaps and skin grafts survived primarily in both groups. The operation time in propeller group was 57.55 minutes±4.35 minutes. It was less than what in the vascular chain group (61.12 minutes±4.58 minutes) and with statistically significant difference( P<0.05). The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group. There was no significant difference between the 2 groups( P>0.05). At final follow-up, the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59±0.50, which were better than 7.46 mm±1.27 mm and 4.31±0.47 in the vascular chain group with a statistically significant difference( P<0.05). The patient satisfaction with the appearance of donor sites and ROM of the injured digital joints in propeller group were 4.45±0.57 and 190.86°±8.56°, while what in the vascular chain group were 4.35±0.56 and 185.96°±10.58°. There was no significant difference between the 2 groups( P>0.05). Conclusion:The propeller flap and vascular chain flap are both based on dorsal cutaneous branch of proper palmar digital artery and are both suitable for repair of wounds of fingertip or finger-pulp. Compared with the vascular chain flap, the propeller flap has the advantages in shorter operation time, better flap sensation and appearance.

Objective In this study，we performed two sampie Mendelian Randomization to infer a causal association between Gastroesophageal reflux(GERD) and Atrial fibrillation(AF)，it can effectively avoid the problems such as reverse causation and confounds in traditional epidemiology. Methods We used the Summary data of GERD and AF from published Genome wide association study(GWAS) of European Individuals. Single Nucleotide Polymorphisms (SNPs) were extracted as Instrumental Variables (IVs).The main MR methods include Inverse Variance [] Weighted(IVW)，Weighted Median(WME)，MR-Egger，Simple Mode，and Weighted Mode.In addition，we used the sensitivity analysis such as MR-PRESSO，Cochran's Q test etc. Results The IVW shows a causal association between GERD and AF(P<0.0001，OR=1.16，95%CI:1.10-1.23).The WME shows P＜0.0001，OR=1.20，95%CI:1.11-1.30；Simple Mode shows P=0.01，OR=1.34，95%CI:1.07-1.69；Weighted Mode shows P=0.02，OR=1.33，95%CI:1.06-1.66. Conclusion This study based on genetic data supports the causal association between GERD and AF. The occurrence of GERD could increase the risk of AF.

Hypertension is one of the main factors leading to cardiovascular death.The number of cardiovascular patients were about 330 million in China,and 245 million among them were suffering from hypertensive in 2021.The rates of treatment and control of hypertension were less than 45.8%from 1991 to 2018.Therefore,it is of great clinical significance and social value to carry out hypertension related research.Animal models of hypertension are important tools to explore the pathogenesis of hypertension and evaluate the development of antihypertensive agents.At present,there are many ways to establish animal models of hypertension,by consulting and sorting out the relevant papers of animal models of hypertension at home and abroad,the author summarized and discussed the replication methods,principles,features and applications of commonly used animal models from four aspects,such as genetics,surgical induction,environmental induction and pharmaceuticals induction,in order to provide a reference for the selection and establishment of more scientific animal models of hypertension and lay the foundation for the combined treatment of hypertension with Chinese and Western medicine.

Objective:To evaluate the fetal heart shape and function in tetralogy of Fallot (TOF) by fetal heart quantitative analysis (fetal HQ).Methods:A total of 52 fetuses with TOF diagnosed by fetal echocardiography and 200 normal fetuses matched with their gestational weeks from March 2020 to March 2022 at Sir Run Run Shaw Hospital, Zhejiang University were retrospectively evaluated. The basic parameters of fetal cardiac blood vessels in the two groups were measured by fetal HQ technology and conventional M-mode ultrasound technology: aortic valve diameter(AV), pulmonary artery valve diameter(PV), main pulmonary artery diameter (MPA) and Z-score. The overall morphometric measurements including end-diastolic length diameter, transverse diameter, area, and global spherical index (GSI) of the fetal heart in the 4-chamber view(4CV), area and length of the right and left ventricles and their ratios. Measurements of left and right ventricular function included ejection fraction (EF), fraction area change rate (FAC), tricuspid annular plane systolic excursion (TAPSE), left and right ventricular global longitudinal strain (GLS), and left and right ventricular end-diastolic diameter (ED), spherical index (SI), and fractional shortening rate (FS) of 24-segments. The differences of above parameters between TOF group and control group were compared. In addition, the relationships between the absolute value of left and right ventricular GLS of TOF fetus and PV/AV, PV Z-score and MPA Z-score were analyzed. The optimal critical values of GSI, left ventricular EF and left ventricular FAC of TOF fetus were determined by ROC curve, and their corresponding sensitivity and specificity were obtained.Results:Compared with control group, there were significant differences in 4CV end-diastolic length, area, GSI, left ventricular area, left ventricular length, left ventricular EF, left ventricular FAC and left ventricular GLS in TOF group (all P<0.05). There were significant differences in ED between left ventricular 15-24 segments and right ventricular 1-21 segments (all P<0.05). There were significant differences in SI between left ventricular 1-16 segments, 21-24 segments and all segments of right ventricle (all P<0.05). The differences in FS were statistically significant (all P<0.05) when comparing all segments of the left ventricle and 1-2 segments of the right ventricular, and the remaining parameters were not statistically significant (all P>0.05). The left ventricular GLS absolute value of TOF fetuses was positively correlated with PV/AV, PV Z-score and MPA Z-score( rs=0.338, 0.441 and 0.458, all P<0.05), the right ventricular GLS absolute value of TOF fetuses was positively correlated with PV AV, PV Z-score and MPA Z-score( rs=0.418, 0.368 and 0.338, all P<0.05). The optimal critical values of GSI, left ventricular EF, and left ventricular FAC in the diagnosis of fetal TOF were 1.19, 59.05%, and 44.4%, respectively. At this time, the sensitivities of diagnosis of TOF were 0.78, 0.75, and 0.80, respectively. The specificities were 0.88, 0.88 and 0.83, respectively. The areas under ROC curve were 0.89, 0.88 and 0.89, respectively. Conclusions:Fetal HQ technology can provide a simple and reliable quantitative evaluation of fetal heart shape and function, and provide certain theoretical parameters for the study of fetal heart shape and function.