Objective:To investigate the different types of renal artery involvement in Stanford type B aortic dissection (TBAD) and the comparison of clinical effecacy after thoracic endovascular aortic repair (TEVAR).Methods:This is a retrospective cohort study included 330 patients with TBAD and renal artery involvement treated with TEVAR from June 2002 to September 2021 in General Hospital of Northern Theater Command of the PLA. According to aortic CTA image, unilateral renal artery involvement conditions were divided into 5 types: the true lumen type (renal artery opening completely from the true lumen), false lumen type (renal artery opening completely from the false lumen), double lumen type (renal artery opening from the true and false double lumen), compression type (renal artery opening connected with the true lumen, but the renal artery opening was extremely squeezed by the inner membrane), open type (renal artery opening with intimal tear). There were seven types of bilateral renal artery involvement: true-true type (true lumen-true lumen type), true and false type (true lumen-false lumen type), true-double type (true lumen-double lumen type), true-opening type (true lumen-opening type), false-false type (false lumen-false lumen type), false-compression type (false lumen-compression type), double-double type (double lumen-double lumen type). The primary observation index of this study was the comparison of postoperative renal function and the incidence of clinical adverse events of different types of renal artery involvement. One-way ANOVA test, Kruskal-Wallis H test and paired sample rank sum test were used to compare postoperative renal function between different types of bilateral renal artery involvement. The Chi-square test or Fisher′s exact probability test were used to compare the near and long term adverse events between different types of bilateral renal artery involvement. Kaplan-Meier method was used to compare the all-cause mortality of patients with severe renal functional injury and non-severe renal functional injury before surgery. Results:The average age of the patients included in this study was (53±11) years, including 276 males (83.6%) and 54 females (16.4%). There were statistical difference in the level of serum creatinine (preoperative: H=18.686, P=0.005, postoperative: H=18.101, P=0.006) and cystatin C (preoperative: H=17.566, P=0.007, postoperative: H=10.433, P=0.016), pre-and post-operative, between the seven groups of TBAD patients with different renal artery involvement types ( P<0.05), and the false-false type group shown the worst kidney function. However, no statistically significant differences were shown when comparing their pre- and post-operative change values ( P>0.05). The 30-day follow-up result showed that there were statistically significant differences in the incidence of postoperative acute kidney injury ( χ2=15.623, P=0.007), aorta-related adverse events ( χ2=15.523, P=0.010), and intraoperative endoleak ( χ2=17.935, P=0.004) among the seven groups, and the false-false group was the highest (2/9, 5/9 and 5/9, respectively). In terms of long-term follow-up results, there were statistically significant differences in all-cause death ( χ2=14.772, P=0.011) and non-aortic death ( χ2=15.589, P=0.008) among the seven groups. Kaplan-Meier survival analysis showed that patients with worse pre-operative renal function showed higher long-term all cause death (17.7% vs. 4.8%, P=0.009). Conclusions:For TBAD patients with renal artery involvement, there were differences in renal function among different types, and TEVAR showed no significant effect on renal function in TBAD patients. The long-term all cause death was higher in patients with worse renal function pre-operative.

【Objective】 To establish the reference interval of Thromboelastography(TEG)of healthy adult in Hainan, compare with the interval provided by the manufacturers, and analyze the influencing factors. 【Methods】 A total of 308 healthy adult volunteers were included according to the inclusion and exclusion criteria. The TEG was analyzed based on adequate quality control, and the reference interval of each parameter was calculated with 95% CI. 【Results】 The reference interval of these volunteers were R 4.27~9.20 min, K 1.60~3.83 min, Angle 44.22°~67.78°, MA 47.82~64.17 mm, CI -5.63~1.12 and G 4.58~9.03. 14.94% (46/308) of these volunteers had at least one index exceeded the reference interval provided by manufacturers. A total of 74 healthy volunteers were diagnosed with coagulation disorder, with the specificity at 79.22%. Significant differences of R, K, Angle, MA, CI, G were observed between males and females (P<0.05). Hypercoagulability was not associated with the age. 【Conclusion】 This study established a reference interval of TEG of healthy adults in Hainan, which provided reference for related clinical and basic science study.

【Objective】 To investigate the correlation between preoperative thromboelastography (TEG) parameters and routine coagulation tests of malignant tumor patients. 【Methods】 A total of 79 patients with malignant tumors, receiving preoperative TEG tests and routine coagulation tests between January 2019 and June 2020, were included. The correlation and regression between coagulation indexes and TEG parameters were analyzed. 【Results】 In patients with malignant tumors, the coagulation time(K) was negatively correlated with Plt and fibrinogen (FIB), while Angle, Ma, and G were respectively positively correlated with Plt and FIB. 【Conclusion】 There is a correlation between preoperative TEG parameters and routine coagulation tests in patients with malignant tumors. There is complementarity but not reciprocal substitutability between these two tests.

Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To present the authors’experience using a deep inferior epigastric artery perforator (DIEP) flap for the salvage of tissue expander implantation failed breast reconstruction.Methods:A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019. Flap survival, breast shape, wound healing and abdominal wall function were reviewed.Results:A total of 13 patients, female, 28 to 53 years old, were included in this study. All the patients had undergone modified mastectomy and failed tissue expander implantation before, and the expanders were removed because of infection in 3 cases, the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases. Unilateral reconstruction was performed in all cases, 8 cases of left breast and 5 cases of the right. Thirteen free DIEP flaps were harvested. The length, width and thickness of DIEP flap were (25.5 ± 0.6) cm, (12.6 ± 0.4) cm and (5.9 ± 0.7) cm respectively, and the length of vascular pedicle was (11.3 ± 0.4) cm. The average weight of the flap was 435 g (390-510 g). The average operation time was 440 min (390-560 min). The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases, the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases, the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case. All flaps survived successfully. The average follow-up period was 16.5 months (range, 12-39 months). The appearance and texture of reconstructed breast were good, and there was no flap contracture and deformation. Only concealed linear scar was left in the donor site. The motor function of abdominal wall was not limited.Conclusions:Salvaging failed tissue expander implantation breast reconstruction using DIEP flap is safe and efficient, with satisfying breast appearance and low complication rate.

Objective:To explore the diagnostic value of Caprini score for acute pulmonary embolism(APE).Methods:Totally 2 764 patients with suspected APE admitted to Yuncheng Central Hospital were enrolled from January 2012 to January 2019, and 312 patients were diagnosed APE and assigned to APE group finally.Among the patients without APE, 312 patients(control group) were matched with the patients in APE group according to age, gender, weight, blood pressure, surgical history, etc.The general clinical data of the two groups were collected, and the Caprini score of each patient was recorded.The differences between the two groups in clinical data and Caprini score were compared.The area under curves(AUC) of receiver operating characteristic(ROC) was calculated to predict the diagnostic efficacy of Caprini scale for patients with APE.Results:The Caprini score of the APE group was significantly higher than that of the control group[(5.41±2.47)points vs.(2.16±1.28)points, t=1.180, P=0.004]. The Caprini score had a favorable diagnostic efficacy for patients with suspected APE(AUC=0.915, 95% CI: 0.878-0.995, P<0.001), and when the 3.5 cutoff value of Caprini score was determined, the specificity and sensitivity were 87.76% and 95.24%, respectively, with 7.778 of positive likelihood ratio, 0.054 of negative likelihood ratio, and 0.83 of Youden index. Conclusion:Caprini score has strong diagnostic efficacy in patients with APE.

Objective:To explore the occurrence of symptoms in postoperative patients with oral cancer, and to explore the types and number of symptom groups.Methods:The Anderson symptom assessment scale for head and neck cancer was used to conduct a questionnaire survey on 345 patients after oral cancer surgery. The results of two exploratory factor analysis methods were compared, and the cluster analysis and Spearman rank correlation analysis were combined to determine the symptom group of patients after oral cancer surgery.Results:There were 4 symptom groups in patients with oral cancer, including oral and pharynx symptoms group, dietary and digestive symptoms group, gastrointestinal and emotional symptoms group, and rest activity symptoms group.Conclusions:There are many symptom groups that affect the life of patients with oral cancer in the rehabilitation process after surgery, so the medical staff should carry out targeted intervention mode to achieve better intervention effect.

Objective:To explore the clinical application of conjoined bipedicle deep inferior epigastric perforator flap (DIEP) in reconstruction of unilateral breast for patients with breast cancer.Methods:From August, 2007 to Feburary, 2017, 41 cases of breast cancer patients received conjoined bipedicle DIEP to reconstruct breasts at the same time of radial operation of mastocarcinoma or in the second phase. Their age ranged from 27 to 49 (34.5±2.7) years old. Twenty-two cases had one-staged and other 19 had two-staged breast reconstruction. All patients were in scheduled followed-up.Results:In this study, 41 conjoined bipedicle DIEP were harvested, including 12 of lateral branch type, 9 of medial branch type, and 20 of combined lateral and medial branch type. The length of flap was (24.5±0.5) cm, the width of flap was (10.8±2.8) cm, and the thickness of flap was(5.5±0.4) cm. The length of flap pedicle was (12.5±0.6) cm. The average weight of flap was 565 (ranged 365-1 050) g. The vascular combinations in the receiving area included: ①Eighteen cases of proximal and distal thoracic vessels. ②Eleven cases proximal ends of internal mammary vessels and lateral thoracic vessels. ③Eight cases of proximal ends of internal mammary vessels and thoracodorsal vessels. ④Four cases thoracodorsal vessels and lateral thoracic vessels. In 3 patients, in order to further promote the venous outflow of the flap, the superficial inferior epigastric vein of the flap was anastomosed with the thoracoacromial vein of the recipient area. All flaps were successful and completely survived without marginal necrosis or infection. The shape, texture and elasticity of the reconstructed breasts were good without flap contractive deformity. There were only linear scars left in the donor sites, and function of abdomen was not affected. All 41 patients were followed-up for 12 to 50 months, with an average of 15.8 months with satisfied results. No local recurrence happened. Only linear scar was left in the donor site of abdomen, and the function of abdominal wall was not affected. In all cases bilateral rectus abdominis muscle strength was level 5.Conclusion:The conjoined bipedicle DIEP could be a safe and valuable option as an alternative method for autologous breast reconstruction.