Objective To systematically review the efficacy and safety of cap-assisted endoscopy in the treatment of esophageal foreign bodies. Methods PubMed, Web of Science, The Cochrane Library, EMbase, CNKI and Wanfang databases were searched by computer for relevant literatures on cap-assisted endoscopy and traditional endoscopy for esophageal foreign bodies from inception to November 2022. The quality assessment of the literature was conducted using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4.1. Results Finally, 27 studies were collected, including 17 randomized controlled trials, 2 cohort studies and 8 case-control studies, with a total of 3 619 patients. NOS scores of all studies were ≥7 points. Meta-analysis results showed that compared with traditional endoscopic treatment, the success rate of removing esophageal foreign bodies in the cap-assisted endoscopy group was higher (OR=14.43, 95%CI 10.64 to 19.55, P<0.000 1), postoperative complications were fewer (OR=0.30, 95%CI 0.23 to 0.38, P<0.000 1), patients' tolerance was better (OR=4.07, 95%CI 2.95 to 5.60, P<0.000 1), intraoperative visual field clarity was better (OR=12.00, 95%CI 7.29 to 19.76, P<0.000 1) and operative time was shorter (SMD=−1.83, 95%CI −2.31 to −1.34, P<0.000 1). Conclusion Cap-assisted endoscopy for esophageal foreign bodies is an effective and safe method, worthy of further promotion and application in clinical practice.

Objective To explore the influence of attachment anxiety on subjective well-being of warship officers and soldiers,and reveal the mediating roles of self-esteem and negative emotions between them. Methods A total of 288 warship officers and soldiers were enrolled by convenience sampling method. Adult attachment scale,self-esteem scale,generalized anxiety disorder-7 items scale,patient health questionnaire-9 and Memorial University of Newfoundland scale of happiness were used for questionnaire survey. Pearson correlation analysis,multiple linear regression analysis and structural equation modeling were used to analyze the relationships between attachment anxiety,self-esteem,negative emotions and subjective well-being. Results Correlation analysis showed that attachment anxiety,self-esteem,anxiety,depression and subjective well-being were significantly correlated (all P<0.01). Multiple regression analysis showed that attachment anxiety,self-esteem,depression and anxiety could jointly predict 42.4％ of subjective well-being. The analysis of chain mediating effect (x2/df=0.170,P=0.844,good fit index[GFI]=0.999,adjusted GFI=0.996,normative fit index[FI]=0.999,relative FI=0.997,comparative FI=1.000,root mean square error of approximation=0.000) showed that self-esteem and negative emotions played complete chain mediating roles between attachment anxiety and subjective well-being. Conclusion Attachment anxiety of warship officers and soldiers can affect their subjective well-being not only through the mediation of self-esteem and negative emotions,but also through the complete chain mediation of self-esteem and negative emotions.

Objective:To evaluate the characteristics of vaginal flora between normal and abnormal pregnant women throughout pregnancy.Methods:Vaginal swab specimens were collected from pregnant women in the first (<14 gestation weeks, GW), second (14~28 GW) and third trimester (>28 GW) in Anqing, Anhui Province from February 2018 to February 2020. Pregnant women were divided into normal and abnormal groups according to all clinical diagnosis. The sequences of 16S rRNA gene (V3-V4) from vaginal swabs were analyzed using QIIME2 platform. The differences in the dominance of Lactobacillus, community state type (CST) transition, Alpha diversity and Beta diversity were analyzed. Diversity data after log transition were used in the analysis of linear mixed model. Results:A total of 34 pregnant women (10 normal and 24 abnormal) with 102 samples were included for analysis. The composition of vaginal flora between two groups: the relative abundance of Lactobacillus was the highest at the genus level and Lactobacillus crispatus and Lactobacillus iners was the top two species with high relative abundance. The dominance of Lactobacillus, Alpha diversity and transition of CST were also similar. Both groups had a gradually decreased trend of Alpha diversity with GW, and the Chao1, Observed species and Faith′s PD indexes′ were different in different GW ( P<0.05). All Beta diversity metrics in normal group had descending trend, with lower value of the index of first distance which implied a higher microbiota stability, while Bray-Curtis, Weighted UniFrac distance had ascending trend in abnormal group, indicating lower stability. Jaccard distance′s first distance was statistically differed among GW and Unweighted UniFrac distance′s differed between normal and abnormal groups. Conclusions:The first distance of Unweighte UniFrac distance in abnormal pregnant women is higher than that of normal pregnant women and the vaginal flora in abnormal group has lower stability.

Objective To detect the expressions of interleukin-1β(IL-1β)in peripheral blood and programmed death molecule 1(PD-1)in esophageal cancer tissues and to analyze their influence on clinicopathological features and prognosis of patients.Methods A total of 127 patients with esophageal cancer who underwent surgical treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2018 to May 2020 were collected and divided into two groups:the survival group(n= 95)and the death group(n= 32),based on their survival status 3 years after surgery.Clinical data of the patients were collected.The expressions of PD-1 and programmed death ligand 1(PD-L1)in esophageal cancer tissues were detected through immunohistochemistry,while the levels of IL-6,IL-1β,and tumor necrosis factor-α(TNF-α)in peripheral blood were measured using enzyme-linked immunosorbent assay(ELISA).Cox regression analysis was performed to identify the risk factors for death 3 years after surgery.The 3-year Kaplan-Meier survival curves of patients with different expressions of IL-1βand PD-1 were plotted,and the survival rates among the three groups were compared using the log-rank test.Results In the death group,the proportions of patients with age≥60 years old,lymph node metastasis,infiltration into the muscle layer,tumor diameter>3 cm,IL-1β high level,TNF-αhigh level,and PD-1 positive expression were higher than those in the survival group.Conversely,the proportions of patients with high IL-6 levels were lower than those in the survival group,with statistically significant differences between the groups(P<0.05).Infiltration into the myometrium,tumor diameter>3 cm,high IL-1β level,and PD-1 positive expression were identified as independent risk factors for postoperative death.The 3-year survival rates were 92.4%,13.3%,and 84.2%for patients in the normal IL-1β+PD-1 negative group,high IL-1β+PD-1 positive group,and normal IL-1β+PD-1 positive group/high IL-1β+PD-1 negative group,respectively.Significant differences existed between the groups(χ2=82.318,P<0.01),with the highest survival rate observed in the normal IL-1β+ PD-1 negative group and the lowest in the high IL-1β+ PD-1 positive group.Conclusion Positive expression of PD-1 and a high level of IL-1βwere identified as independent risk factors for death in patients with esophageal cancer.Notably,patients with positive expression of PD-1+high levels of IL-1βexhibited a low survival rate.

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Objective:To study the characteristics and influencing factors of vaginal microbiota in normal pregnant women.Methods:This study was based on a cohort of pregnant women established in Anqing Municipal Hospital Affiliated to Anhui Medical University from February 2018 to February 2020. Vaginal samples of normal pregnant women who met the inclusion and exclusion criteria were ordered by the gestational weeks at sampling. Five samples were randomly selected from each gestational week group and if the samples were less than five, all samples were included. Sequencing of the V3-V4 region of the 16S rRNA gene was performed. Dominant species were analyzed by MicrobiomeAnalyst. Alpha diversity was measured with Chao1, Observed Features, Shannon diversity, Simpson diversity, Faith_pd and Pielou′s Evenness. The dominant status of Lactobacillus was also described and compared. Multiple linear regression and logistic regression were used to analyze the factors influencing vaginal microbiota. Analysis of variance and Kruskal Wallis test were used for statistical analysis of continuous variables, and Chi-square test and Fisher′s exact test were used for categorical data. The differences were considered statistically significant when the P value was less than 0.05. Results:This study enrolled 91 pregnant women (91 vaginal samples) with an average age of (27.37±3.60) years. There were 18, 56 and 17 vaginal samples collected at the median gestational age of 11.93 weeks (the first trimester), 19.43 weeks (the second trimester) and 38.29 weeks (the third trimester), respectively. The relative abundance of Firmicutes and Lactobacillus was 91.30% and 87.67%, respectively. Lactobacillus iners and Lactobacillus crispatus had a relative abundance of 43.95% and 36.33%, respectively. Moreover, Lactobacillus iners-dominated vaginal microbiota was detected in all trimesters. The number of samples with high relative abundance of Lactobacillus iners gradually decreased with gestational age. Lactobacillus crispatus-dominated vaginal microbiota was found in the second and third trimesters and the number of samples with high relative abundance gradually increased during pregnancy. The Alpha diversity of vaginal microbiota had a decreasing trend during the gestation. There were significant differences in Pielou′s Evenness diversity index of vaginal microbiota between different smoking groups ( P<0.05) and in Shannon diversity index between different drinking groups ( P<0.05). There were significant differences in Chao1, Observed Features and Faith_pd diversity index of vaginal microbiota between pregnant women with different education ( P<0.05) and in Shannon and Simpson diversity index between different income groups ( P<0.05). Conclusions:Vaginal microbiota was dominated by Lactobacillus in normal pregnant women. The dominance of Lactobacillus iners gradually decreased, while that of Lactobacillus crispatus increased during gestation. In normal pregnant women, the Alpha diversity of vaginal microbiota was correlated with smoking, drinking, education and family annual income. Smoking cessation and drinking before pregnancy were related to lower Alpha diversity of vaginal microbiota in pregnant women, while lower education and higher family income were associated with higher Alpha diversity.

Objective:To explore the method and effect of repairing fingertip defect and soft tissue defect in donor area by relay flap with suture nerve.Methods:From January 2017 to May 2019, 11 cases of fingertip defects were repaired with reverse island fascial pedicle flap of dorsal digital artery sutured with nerve, with a flap area of 0.6 cm×1.2 cm-1.6 cm×2.0 cm, and the flap donor area was repaired with dorsal metacarpal artery cutaneous branch flap. The patients were followed-up by outpatient, reexamination and WeChat interviews.Results:Twenty-two flaps of 11 cases survived completely and the wound healed in stage I. The postoperative follow-up ranged from 3 to 36 months, with an average of 13 months. The flap and pedicle were not bloated, the shape of finger was satisfactory, the texture was soft, and the skin color was close to the skin of finger. Sensory recovery≥S 3. The TPD of the flap was 6-11 mm, with an average of 8.4 mm. Hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Chinese Medical Association: excellent in 10 cases and good in 1 case. The patients were satisfied with the repair effect and resumed their daily life and work. Conclusion:This operation is simple, does not need to sacrifice the main blood vessels and nerves, can restore the good shape and sensction of the affected finger, with the activity close to normal. It is an effective method to repair the fingertip defect.

Objective:To investigate the effect of free wrist crease flap based on the superficial palmar branch of radial artery in the treatment of compound tissue defect of dorsal finger.Methods:From January 2015 to June 2019, the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital with skin, soft tissue and tendon defects of dorsal fingers, with or without bone exposure, were retrospectively analyzed. The free wrist crease flap based on the superficial palmar branch of radial artery was used. For patients with dorsal finger wounds less than 2.5 cm in length, palmaris longus tendon was used in the flap to repair, and the direction of flap incision and dorsal finger repair was consistent. If the length of dorsal finger defect was more than 2.5 cm, the palmaris longus tendon was not carried in the flap. The wrist crease flap based on the superficial palmar branch of the radial artery was harvested, and the free palmaris longus tendon was used to repair the defect along the same incision. The flap was selected according to the left and right wrist donor site flap and rotated 90° counterclockwise or clockwise to cover the dorsal finger wound. The flap survival and texture were followed up after operation. The total active movement(TAM) of fingers was evaluated according to the trial standard for the evaluation of the upper limb function of the Hand Surgery Society of the Chinese Medical Association.Results:A total of 17 patients were enrolled in this study, including 12 males and 5 females. The mean age was 39.5 years (range, 21-65 years). There were 10 cases of left finger and 7 cases of right finger. The area of dorsal finger skin defects ranged from 1.5 cm×1.3 cm to 3.8 cm×2.0 cm, and the area of flap ranged from 1.8 cm×1.5 cm to 4.0 cm×2.2 cm. The patients were followed up for 3 to 48 months, with an average of 16.5 months. All the flaps survived and healed well. The texture of the flap was good, and no obvious swelling was observed. Venous crisis occurred in 1 case 18 hours after operation. The stitches were removed, the edge of the flap was bled, and the flap survived after 10 days. All wrist donor sites were sutured directly and healed well after operation. There was no abnormality in wrist flexion and extension function. The TAM of fingers was rated as excellent in 12 cases, good in 4 cases, and fair in 1 case.Conclusions:The free wrist crease flap based on the superficial palmar branch of radial artery is an alternative method for repairing compound tissue defect of dorsal finger. The recipient flap has no bloated appearance. Finger extension function could be reconstructed. The wound at the donor site is small and could be closed directly.

Objective:To investigate the effect of free wrist crease flap based on the superficial palmar branch of radial artery in the treatment of compound tissue defect of dorsal finger.Methods:From January 2015 to June 2019, the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital with skin, soft tissue and tendon defects of dorsal fingers, with or without bone exposure, were retrospectively analyzed. The free wrist crease flap based on the superficial palmar branch of radial artery was used. For patients with dorsal finger wounds less than 2.5 cm in length, palmaris longus tendon was used in the flap to repair, and the direction of flap incision and dorsal finger repair was consistent. If the length of dorsal finger defect was more than 2.5 cm, the palmaris longus tendon was not carried in the flap. The wrist crease flap based on the superficial palmar branch of the radial artery was harvested, and the free palmaris longus tendon was used to repair the defect along the same incision. The flap was selected according to the left and right wrist donor site flap and rotated 90° counterclockwise or clockwise to cover the dorsal finger wound. The flap survival and texture were followed up after operation. The total active movement(TAM) of fingers was evaluated according to the trial standard for the evaluation of the upper limb function of the Hand Surgery Society of the Chinese Medical Association.Results:A total of 17 patients were enrolled in this study, including 12 males and 5 females. The mean age was 39.5 years (range, 21-65 years). There were 10 cases of left finger and 7 cases of right finger. The area of dorsal finger skin defects ranged from 1.5 cm×1.3 cm to 3.8 cm×2.0 cm, and the area of flap ranged from 1.8 cm×1.5 cm to 4.0 cm×2.2 cm. The patients were followed up for 3 to 48 months, with an average of 16.5 months. All the flaps survived and healed well. The texture of the flap was good, and no obvious swelling was observed. Venous crisis occurred in 1 case 18 hours after operation. The stitches were removed, the edge of the flap was bled, and the flap survived after 10 days. All wrist donor sites were sutured directly and healed well after operation. There was no abnormality in wrist flexion and extension function. The TAM of fingers was rated as excellent in 12 cases, good in 4 cases, and fair in 1 case.Conclusions:The free wrist crease flap based on the superficial palmar branch of radial artery is an alternative method for repairing compound tissue defect of dorsal finger. The recipient flap has no bloated appearance. Finger extension function could be reconstructed. The wound at the donor site is small and could be closed directly.