OBJECTIVE: To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits. METHODS: From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated. RESULTS: All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal. CONCLUSION The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Plastic Surgery Procedures ; Skin Transplantation ; Finger Injuries/surgery* ; Treatment Outcome ; Soft Tissue Injuries/surgery* ; Fingers/surgery* ; Ulnar Artery/surgery* ; Metacarpophalangeal Joint/surgery*

Objective To analyze the etiological characteristics and the variation of pathogens spectrum in hospitalized children with a-cute respiratory tract infection(ARTI)before and after COVID-19 under"the level B of management for class B"of infectious diseases(Level B for Class B)in Shenzhen,in order to provide reference for the clinical diagnosis,treatment and prevention of ARTI.Meth-ods The ARTI cases from January 8,2022 to July 30,2022 were selected as before"Level B for Class B",and the cases from Janu-ary 8,2023 to July 30,2023 were selected as after"Level B for Class B".The pharyngeal swab samples submitted for analyzing 11 common pathogens,such as COVID-19,influenza virus(Ⅳ),respiratory syncytial virus(RSV)and mycoplasma pneumoniae(MP)in the children with ARTI admitted to Shenzhen Children's Hospital.Results SARS-CoV-2 were detected as positive in 347 cases,a-mong which 225 cases were before"Level B for Class B"including 29 cases combined with other pathogens(12.89％,29/225)and human parainfluenza viruses(HPIV)was the most common(31.03％,9/29).After"Level B for Class B",SARS-CoV-2 were detec-ted as positive in 122 cases,including 28 cases combined with other pathogens(22.95％,28/122),and RSV was the most common(28.57％,8/28).There was a statistical difference between the positive rate of SARS-CoV-2 combined with other pathogens before and after"Level B for Class B"(X2=5.834,P=0.016).After"Level B for Class B",the total pathogen detection rate(positive for at least one pathogen)was 60.82％(2 864/4 709)in the spring(January 8,2023 to April 30,2023),and influenza virus A(IVA)(22.64％,1 066/4 709),rhinovirus(HRV)(19.86％,935/4 709)and RSV(13.29％,626/4 709)were the main pathogens,and there were 301 cases(6.39％,301/4 709)of mixed infections.In the summer(May 1,2023 to July 30,2023),the total detection rate of pathogens was 70.26％(4 012/5 710),among which RSV(21.63％,1 235/5 710),MP(13.91％,794/5 710),HPIV(10.05％,574/5 710)were the main pathogens,and there were 710 cases(12.43％,710/5 710)of mixed infections,all of which were significantly higher than the same period before"Level B for Class B".The difference was statistically significant(P＜0.05).Conclusion After"Level B for Class B"for COVID-19,the detection rate of 11 common pathogens increased significantly and the pathogen spectrum of ARTI changed significantly.

Objective:To explore the mediating effect of social support between adult attachment and family resilience in young and middle-aged patients undergoing peritoneal dialysis, and to provide reference for psychological health care of young and middle-aged peritoneal dialysis patients.Methods:From September 2019 to February 2022, the prospective research method was adopted to investigate a total of 100 young and middle-aged patients undergoing peritoneal dialysis by general information questionnaire, Experiences in Close Relationship Scale-short form, Social Support Rating Scale, Family Resilience Scale, respectively. Multiple linear regression and structural equation model was used to evaluate the mediating effect of social support on adult attachment and family resilience.Results:The scores of attachment avoidance and attachment anxiety in Experiences in Close Relationship Scale-short form were (46.47 ± 10.23) points and (63.67 ± 10.37) points; Social Support Rating Scale scores were (36.40 ± 7.27) points; Family Resilience Scale scores were (94.21 ± 11.40) points. There was a negative correlation of attachment anxiety and attachment avoidance with total score and each dimension score of Social Support Rating Scale and total score and each dimension score of Family Resilience Scale ( r values were -0.844--0.373, all P<0.05). Attachment anxiety and attachment avoidance had a significantly indirect effect on the family resilience of young and middle-aged peritoneal dialysis patients through social support, which showed that the mediating effect of social support accounts for 41.6% and 48.8% of the total effect. Conclusions:Social support plays a mediating role in the relationship between adult attachment and family resilience in young and middle-aged peritoneal dialysis patients, nurses can focus on social support to reduce the adverse effects of adult attachment on family resilience.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective:To effectively express the receptor binding domain (RBD) of SARS-CoV-2 spike protein in Pichia pastoris and to evaluate its immunogenicity. Methods:The gene encoding the RBD protein was synthesized and cloned into the pPICZαA plasmid. After linearization, the plasmid was transferred and integrated into the genome of Pichia pastoris. The expressed RBD protein in culture supernatant was analyzed by Western blot and Biolayer interferometry. After screening, a single clone expressing the RBD protein was selected. The high-level expression of RBD protein was achieved by optimizing the fermentation process, including the salt concentration adjusting of the medium and induction condition optimization (pH, temperature and duration). The immunogenicity of the expressed RBD protein was evaluated in a mouse model. Results:A single clone with a high expression level of RBD protein was obtained and named RBD-X33. The expression level of RBD protein in the fermentation supernatant reached up to 240 mg/L after optimization of the induction condition (HBSM medium, pH=6.5±0.3, 22℃ and 120 h). In the mouse experiment, the recombinant RBD protein was formulated with Alum+ CpG dual adjuvant and injected into mice. The binding IgG antibody levels were up to 2.7×10 6 tested by ELISA and the neutralizing antibody levels were up to 726.8 tested by live virus neutralizing antibody assay (prototype). Conclusions:The RBD protein could be efficiently expressed in Pichia pastoris and induce stronger immune response in animals. This study suggested that the recombinant SARS-CoV-2 RBD protein expressed in Pichia pastoris could serve as a candidate antigen in the development of SARS-CoV-2 vaccine.

Objective: To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic. Methods: This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m²), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone position and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%. Results: A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed. Conclusions The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic, and security is acceptable.

Objective:To summarize experience and effect of the stylized operation step in the neck endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 51 patients who underwent transthoracic breast approach scarless neck endoscopic thyroidectomy (SET) from January 2018 to September 2019 in Tungwah Hospital Affiliated to Sun Yat-sen University were retrospectively analyzed. The operative procedure used stylized operation steps: establishment of operating space, three-step method thyroidectomy, central lymph node dissection (CLND), close operating space.Results:Among 51 patients, 25 cases underwent unilateral thyroidectomy plus isthmic resection, 26 cases underwent total/near-total thyroidectomy, and 16 cases underwent preventive CLND. The recurrent laryngeal nerve (RLN) was exposed in all 51 cases, the external branches of the superior laryngeal nerve (EBSLN) was exposed in 35 cases, no procedure was converted into open neck incision thyroidectomy. Forty-two cases were followed up, 2 cases had postoperative hoarseness and unilateral recurrent laryngeal nerve paralysis, which were recovered 55 and 75 d after operation respectively. There was no bucking, voice blunt or permanent low calcium. One patient had abnormal sensation of neck skin after operation, and recovered gradually 3 months after operation.Conclusions:The stylized operation step in the SET can increase safety of surgery.

Objective: To investigate the effect of lung rehabilitation exercise on cancer-related fatigue and quality of life in patients with non-small cell lung cancer (NSCLC) undergoing chemotherapy. Methods: From October 2016 to October 2018, 82 patients with NSCLC treated in Zhejiang Rongjun Hospital were randomly divided into control group (41 cases) and observation group (41 cases) according to random number table method.The control group was given routine intervention, while the observation group was given lung rehabilitation exercise on the basis of the control group.Both two groups were evaluated after 8 weeks of intervention.The changes of lung function, cancer-related fatigue and quality of life before and after intervention were compared between the two groups. Results: After intervention, the FEV₁% and FEV₁/FVC in the two groups were higher than those before intervention (observation group: t=18.565, 11.207; control group: t=9.363, 6.028, all P<0.05). After intervention, the FEV₁% [(64.38±3.79)%] and FEV₁/FVC (69.47±6.54) in the observation group were higher than those in the control group [(56.74±2.85)% and (60.10±4.25)] (t=10.316, 7.692, all P<0.05). After intervention, the scores of body, cognition, behavior and emotion in the two groups were higher than those before intervention (observation group: t=17.663, 15.167, 12.304, 14.750; control group: t=9.869, 6.617, 7.566, 9.553, all P<0.05). After intervention, the scores of body [(6.57±0.31)points], cognition[(6.15±0.42)points], behavior[(6.32±0.31)points] and emotion [(6.28±0.21)points] in the observation group were higher than those in the control group [(5.78±0.28)points, (5.41±0.48)points, (5.78±0.27)points and (5.82±0.25)points] (t=12.109, 7.429, 8.411, 9.021, all P<0.05). After intervention, the scores of social function, cognitive function, emotional function, role function, physical function and general health in the two groups were higher than those before intervention (observation group: t=14.487, 17.845, 22.025, 16.393, 11.665, 14.533; control group: t=9.880, 9.777, 10.797, 6.231, 6.838, 6.512, all P<0.05). After intervention, the scores of social function[(75.48±8.19)points], cognitive function[(72.43±6.32)points], emotional function [(71.93±5.74)points], role function[(63.25±7.86)points], physical function[(69.45±8.97)points] and general health[(68.39±7.54)points] in the observation group were higher than those in the control group [(67.31±6.74)points, (60.38±5.75)points, (59.64±6.56)points, (51.47±10.29)points, (58.83±7.09)points and (56.82±7.38)points] (t=4.932, 9.030, 9.028, 5.825, 5.947, 7.022, all P<0.05). Conclusion Lung rehabilitation exercise has good clinical effect on patients with NSCLC undergoing chemotherapy.It can alleviate cancer-related fatigue and improve the quality of life of patients.It is worthy of clinical reference.

Objective:To explore the suggestion and key points of implementing community rehabilitation centered on peer education for patients with chronic obstructive pulmonary disease (COPD). Methods:From June, 2016 to June, 2017, 19 doctors, 15 nurses and 27 patients with COPD were selected for semi-structured interviews with the phenomenological research method, and the data were analyzed using the 7-step analysis method of Colaizzi. Results:The points were as follows: establishment and orientation of group leader education, hospital-community-family interaction mode, collective and individual intervention mode and effect and interaction monitoring. Conclusion:There is still lack of unified standards and teaching materials for the application of peer education in the rehabilitation of COPD patients. COPD community rehabilitation implementation strategies with peer education as the core are formulated to provide further reference for the rehabilitation of COPD patients.

Objective: To explore the efficacies of regimens of three-drug induction therapy (ATRA+ATO+anthracyclines) versus two-drug induction therapy (ATRA+ATO) in patients with acute promyelocytic leukemia (APL). Methods: Of 184 patients diagnosed with APL from January 2009 to March 2016, 58 patients underwent three-drug induction therapy, while the rest were treated with two-drug induction therapy. Three-drug induction therapy was of ATRA (20 mg·m^-2·d^-1, d_1-28) + ATO (0.16 mg·kg^-1·d^-1, d_1-28) + Idarubicin (8 mg·m^-2·d^-1, d_3-5) /daunorubicin (40 mg·m^-2·d^-1, d_3-5) , while two-drug induction therapy ATRA+ATO with the same doses and methods as above. Of 184 cases, 69 cases accompanied with WBC counts>10×10⁹/L, 115 cases with WBC counts≤10×10⁹/L at onset. Results: ①Short-term efficacy: After one cycle induction therapy, the rates of hematologic remission, genetic remission, molecular remission and induced differentiation syndrome (DS) in three-drug regimen group were 98.3%, 87.9%, 72.4% and 0 respectively, while those in two-drug regimen group were 87.3%, 65.9%, 51.6% and 12.7% respectively. In patients with WBC >10×10⁹/L, DS rate and early mortality in three-drug regimen group were lower than in two-drug regimen group (0 vs 15.6%, 4.2% vs 15.6%, respectively). In patients with WBC≤10×10⁹/L, DS rate in three-drug regimen group was also lower than in two-drug regimen group (0 vs 12.3%) , but there were no statistical differences in terms of relapse and early mortality. ② Long-term efficacy: The relapse rate, overall survival (OS) and disease free survival (DFS) in three-drug regimen group were 0, 98.5%, 96.6% respectively, while those in two-drug regimen group were 8.6%, 86.5% and 84.1% respectively; the advantages of three-drug over two-drug regimen, especially in cases of WBC >10×10⁹/L were observed. ③ Side effects: the incidences of gastrointestinal reaction, liver dysfunction, myocardial damage and headache in three-drug regimen group hardly increased. Conclusion The efficacies of three-drug induction therapy were superior to two-drug one.