Objective:To explore the clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers (DFUs) under a multi-disciplinary team (MDT) cooperation model.Methods:The study was a retrospective observational study. From June 2018 to December 2022, 49 DFU patients who met the inclusion criteria were admitted to the Department of Hand and Foot Microscopy and Wound Repair Surgery of Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), including 28 males and 21 females, aged from 47 to 68 years, with type 2 diabetes history period ranging from 6 months to 21 years. Under a MDT cooperation model, the physicians from department of endocrinology comprehensively assessed the patients, stabilized the patients' general condition, and controlled their complications, the surgeons from department of vascular surgery assessed and improved the patients' lower limb blood supply, the physicians from department of infectious diseases provided anti-infection treatment plans, the physicians from department of anesthesiology and perioperative medicine assessed the patients' perioperative risk and ensured their perioperative safety, and according to the patients' condition, the physicians from departments such as cardiology, neurology, nutrition, and rehabilitation actively and timely participated in the treatment. The surgeons from department of hand and foot microscopy and wound repair surgery prepared the wound base and used free anterolateral thigh perforator flaps to repair the wounds. After once or multiple debridement in the first stage, the wound area ranged from 5.0 cm×4.5 cm to 17.0 cm×10.0 cm. After once or twice vacuum sealing drainage treatment, the free anterolateral thigh perforator flaps were used to repair the wounds with incision area of 6 cm×5 cm to 18 cm×11 cm in the second stage. The descending branches of lateral circumflex femoral artery and the accompanying veins of flaps were anastomosed to the arteries and veins in the recipient sites, respectively. The wounds in the flap donor sites were sutured directly. After surgery, whether the patient's perioperative period was stable, the survival of flaps, the healing of wounds in the flap donor and recipient sites were observed. During the follow-up, the texture and appearance of flaps, whether there was a new ulcer, and the patient's walking ability were observed.Results:All the patients had stable perioperative period. Among them, the flaps in 46 patients survived successfully; the flaps in 2 patients developed complete necrosis, including 1 case whose ulcer was healed after repair of pedicled flap from the lower leg, and 1 case who underwent amputation of the lower leg; the flap in 1 patient developed partial necrosis, which was healed after dressing change and skin grafting. The wounds in the flap donor and recipient sites healed well. During the postoperative follow-up of 6-24 months, the flaps had good texture and appearance with no new ulcers, and the patients had no obvious impairment in daily walk.Conclusions:The MDT cooperation model can sufficiently ensure the perioperative safety of DFU patients. The free anterolateral thigh perforator flaps can repair the DFU wounds achieving good clinical effects with high flap survival rate and decreased amputation rate.

Objective:To analyze the status of first viral load (VL) suppression for newly diagnosed HIV/AIDS on antiretroviral therapy (ART) from 2014 to 2016 in Shandong province, to provide theoretical evidence for improvement of ART effectiveness.Methods:Based on a retrospective cohort study, logistic regression model was used to identify influencing factors about VL suppression.Results:There were 4 833 newly diagnosed HIV/AIDS cases who received ART from 2014 to 2016 in Shandong province, and 3 449 cases achieved VL suppression at the first VL testing. The rate of first VL suppression was 71.36%. The possibilities of first VL suppression among patients on ART with education at junior high school, junior college and above were higher than those with education at primary school and below, with OR values at 1.75 and 2.00, separately. The possibilities of first VL suppression for patients treated at medical institutions was higher than those by CDC, with OR value 1.29. The possibilities of first VL suppression among patients whose CD4 count level at 201-350, 351-500 and ≥501 cells/μl were higher than that of the patients whose CD4 count level at ≤200 cells/μl, with OR values at 2.36, 2.11 and 2.66, respectively. The possibilities of first VL suppression among patients who missed doses was lower than those who did not miss doses, with OR value at 0.55. All the Pvalues for the above comparisons was <0.05. Conclusions:The suppression of viral load for HIV/AIDS on ART was influenced by culture level, CD4 count level at the entry of ART, treatment institutions and adherence to the therapy. Earlier diagnosis, treatment services provided by medical institutions and improvement of drug adherence can enhance ART effectiveness.

To explore the incidence and grade of acute gastrointestinal injury（AGI）in patients with acute stroke，and the influence of gastrointestinal disorders on the mortality of stroke. Methods A total of 103 patients were recruited. According to the National Institutes of Health Stroke Scale（NIHSS）scores，they were divided into two groups：severe stroke patients（n=52）and mild to moderate stroke patients（n=51）.The incidence of gastrointestinal complications in the two groups are calculated. AGI classification was performed according to gastrointestinal symptoms. Binary logistic analysis was used to analyze the influencing factors of gastrointestinal failure in stroke patients，and KM curve was used to evaluate the effect of AGI classification on 28-day mortality in stroke patients. Results The incidence of gastrointestinal complications was 91.3%. There was no significant difference in the incidence of gastrointestinal disorders in the mild to moderate stroke and severe stroke groups（74.5% vs 75.0%，P>0.05）；The severe stroke group showed a higher incidence of gastrointestinal failure（7.8% vs 25.0%，P<0.05）. Multivariate logistic regression analysis showed：elevated NIHSS score was a risk factor for gastrointestinal failure after stroke（P<0.05）.Combining gastrointestinal failure significantly increased the 28-day mortality of stroke patients（χ2=53.08，P<0.001）. Conclusion Gastrointestinal complications are common in patients with acute stroke. NIHSS score is positively correlated with gastrointestinal failure. And patients with gastrointestinal failure have a worse prognosis.

Objective:To analyze the status of follow-up and its correlation with highly active antiretroviral therapy (HAART) for newly diagnosed HIV/AIDS patients from 2014 to 2016 in Shandong province, then to provide theoretical evidence for the improvement of follow-up and HAART.Methods:Based on retrospective cohort study, logistic regression model was used to identify influencing factors of follow-up for HIV/AIDS, and chi-square test was used to do correlation analysis.Results:There were 6253 newly diagnosed HIV/AIDS cases from 2014 to 2016 in Shandong province, and 6011 cases accepted follow-up service. The cumulative follow-up rate was 96.13%, and timely follow-up rate was 94.51%. Higher prevalence of follow-up was found among those aged 15-24 years at diagnosis, diagnosed by VCT, with education level of college and above, lived in east of Shandong province and infected with homosexual sex behaviors. HIV/AIDS cases who received follow-up service within 1 year of diagnosis were more likely to receive HAART ( OR=5.28, 95% CI: 3.51-7.95) and meet the level of viral load (VL) suppression ( OR=4.30, 95% CI: 2.89-6.40) than those who received follow-up service later. Conclusions:The status of follow-up of HIV/AIDS in Shandong province was influenced by age at diagnosis, sample resource, cultural level, address and transmission route. Timely follow-up can improve the proportion and effect of HIV/AIDS treatment.

OBJECTIVE To observe and analyze the characteristics of tinnitus in perimenopausal women. METHODS To do sleep quality assessment, pure-tone test, tinnitus frequency and loudness match, tinnitus questionnaire investigation and FSH testfor 248 subjective tinnitus women with perimenopausal syndrome. RESULTS There was more single tinnitus than double tinnitus, the difference was statistically significant (P＜0. 05); The incidence of tinnitus on left and right ears was basically the same, the difference was not statistically significant;High frequency tinnitus accounted for 62. 73％, medium frequency was 2. 80％, low frequency was 34. 47％; There was no significant correlation between the frequency of tinnitus and hearing loss, There was no significant correlation between loudness and severity of tinnitus; Tinnitus THI loudness rating is mainly grade 2 and 3, accounting for 72. 18％, followed by gradel and grade 4, accounting for 24. 60％, grade 5 is very few, only 3. 22％; There was significant correlation between the FSH and severity of tinnitus, but there was no significant correlation between the FSH and loudness of tinnitus. The incidence of sleep disorders was 58. 06％. With the degree of tinnitus increased, the incidence of sleep disorders increased, and the degree of tinnitus was positively correlated with the quality of sleep. CONCLUSION The characteristics, etiology and pathogenesis of tinnitus in perimenopausal women are different from that of tinnitus happened in auditory system, mainly relate to FSH level. Otologists should pay attention to differential diagnosis, comprehensive analysis and treatment.

Since the fecal bacteria transplantation (FMT) had been exist for a long time, it attracted more attention in recent years because this therapy could adjust the bacteria disturbance rapidly in clinical settings. Recent studies demonstrated that fecal microbiota transplantation (FMT) has great clinical value in the treatment of Clostridium difficile infection, inflammatory bowel disease, Intractable functional constipation and other diseases. But the FMT is not as perfect as we expect, so we did this article to review the history and terminology of FMT, and summarized the progress in nursing methods of FMT.

OBJECTIVE:To investigate therapeutic efficacy and safety of edaravone and nimodipine in the treatment of acute large area cerebral infarction. METHODS:101 patients with acute large area cerebral infarction were analyzed retrospectively and divided into control group (53 cases) and observation group (48 cases) according to drug use. After admission,control group re-ceived routine treatment as relieving cerebral edema,anticoagulant and antiplatelet agglutination. Observation group was additional-ly given Edaravone injection 30 mg added into 0.9%Sodium chloride injection 100 mL intravenously,within 30 min,twice a day+Nimodipine injection 12 mg added into 0.9%Sodium chloride injection 500 mL intravenously,once a day,at dripping speed of 0.5μg/(kg·min),for 10 days,and then given Nimodipine tablet 60 mg orally instead,3 times a day,for 5 d,on the basis of control group. Treatment course of 2 groups lasted for 15 d. Clinical efficacies of 2 groups were observed as well as SpO2,hemoglobin (Hb),total hemoglobin (HBT),reduced hemoglobin (MHb),NIHSS score and the occurrence of ADR before and after treat-ment. RESULTS:Total response rate of observation group was significantly higher than that of control group,with statistical signifi-cance(P<0.05). Before treatment,there was no statistical significance in the levels of SpO2,Hb,HBT,MHb and NIHSS score between 2 groups (P>0.05). After treatment,the levels of SpO2,HBT and MHb in 2 groups were significantly higher than be-fore,and the observation group was significantly higher than the control group;NIHSS score of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;Hb level of 2 groups were significantly low-er than before,with statistical significance(P<0.05),but there was no statistical significance in Hb level between 2 groups(P>0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:On the basis of conventional therapy,edara-vone combined with nimodipine in the treatment of acute large area cerebral infarction has significant therapeutic efficacy,can im-prove neurological impairment,but doesn't increase the occurrence of ADR.

Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.

OBJECTIVE To investigate the effects of recombinant human epidermal growth factor (rhEGF) on wound healing of chronic sinusitis patients after functional endoscopic sinus surgery. METHODS A total of 110 patients with chronic sinusitis underwent functional endoscopic sinus surgery with both sides of their nose. The right side of their nasal cavity (control group) treated by nasal irrigation and steroid nasal spray, the left side of their nasal cavity (study group) treated by nasal irrigation and the nasal spray of steroid hormones and rhEGF. Surgical effect was evaluated under nasal endoscope at 2, 4, 12 and 24 weeks after surgery, while subjective symptom was evaluated depending on visual analogue scale (VAS). Both the score of endoscopic examination and VAS, also the rates of epithelization of the two groups were compared. RESULTS The score of endoscopic examination of the study group at 2 weeks after surgery was better than that of the control group, which had statistical significance, while the score of VAS had no statistical difference. The score of endoscopic examination and VAS, the rate of epithelization in study group at 4 and 12 weeks after surgery were better than those in control group, and the difference was statistically significant, but they were no statistical difference at 24 weeks after surgery. CONCLUSION The using of rhEGF nasal spray on chronic sinusitis patients with functional endoscopic sinus surgery can shorten the time of epithelization, improve the situation of nasal mucosa and patients' subjective symptoms, it is worthy of clinical application.

Objective To evaluate the clinical value of microvascular anastomotic devices in free anterolateral thigh flap in the recon-struction of oral carcinoma defects.Methods From September 2013 to September 2014,52 patients with oral cancer were treated by func-tional neck cleaning,primary tumors resection,and free anterolateral thigh flap in the reconstruction.Of which 27 patients received free of femoral anterolateral flap to repair veins by using microsurgical line end to end anastomosis.And 25 pieces of microvascular anastomotic ad-vices were applied in 25 patients with oral carcinoma defects.The length of anastomosis time,flap survival rate,and complications were recor-ded.Results In 52 patients,microvascular anastomotic devices were applied in 25 veins with shorter anastomosis time,(6.3 ±1.9)min vs. (12.3 ±1.4)min,and the difference was significant(P =0.001).The flap survival rate and vascular anastomosis patency rate was 100%.No intra-and post-operative complications such as blood leak,stapling,excessive tension and tear,thrombosis in flap vein crisis associated with microvascular anastomotic devices were observed.Twenty-seven patients with 40 root vein received manual microsurgical anastomosis,2 of them showed vein crisis.Conclusion The microvascular anastomotic devices used in repairing the soft tissue defects by anterolateral thigh flap with venous anastomosis for patients of oral cancer after surgery has the advantage of higher quality,shorter time and less complications.