Objective:To explore the factors that promote and hinder exercise adherence in long dialysis duration hemodialysis patients, and to provide a reference for improving their exercise levels.Methods:From March to May 2023, a qualitative research method using phenomenon approach was conducted and 15 patients with peritoneal dialysis for at least 10 years at the People′s Liberation Army Central Command Headquarters Hospital (Hankou Hospital) were selected for in-depth interviews using purposive sampling method. The data were analyzed using Colaizzi 7-step method and the main themes were extracted.Results:Among the 15 interviewers, there were 5 males and 10 females, aged 39-76 years old.Conclusions:The exercise level of long dialysis duration hemodialysis patients is influenced by multiple factors. Medical staff should correct their cognitive biases and change their behavioral attitudes, strengthen external supportive environments and reduce subjective normative pressures, gradually provide more objective support, thereby promoting the exercise training of long dialysis duration hemodialysis patients.

Objective:To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap (ALT) for repairing the circular wound of foot and ankle.Methods:Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed. The perforator was located by color Doppler ultrasound before the operation, and the flap was designed according to the size of the wound. Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected. When all perforating branches in the flap come from the same vascular trunk, two or more perforating branches are carried to cover the wound directly; when the branches come from the different trunks, the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap. All the donor areas were closed primarily. The sensory of flaps were elevated by the British Medical Research Council (BMRC) sensory function assessment standard, and the motor function was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 13 patients were enrolled in this study, including 8 males and 5 females.The age ranged from 21 to 65 years, with an average of 39 years. The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon. 12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap ( ALT) harvested from one thigh, and 1 case was repaired with the combined bilateral ALT flap due to the huge wound. The size of flap was 21.0 cm × 7.0 cm to 35.0 cm×10.0 cm. During the procedure, 14 flaps were successfully harvested, 9 flaps were supplied by two perforators, 4 by three perforators, and 1 by four skin perforators. Each flap had an average of 2.4 perforators. Among them, there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources. All flaps in this group finally survived. One flap suffered the venous crisis 24 hours after the operation and survived after removing the thrombus and re-anastomosing the vessel again. The stitches were removed 2 to 3 weeks after operation when the wound had healed. All wounds in the donor area healed primarily. 9 flaps underwent flap thinning and plastic surgery 6 to 10 months after the operation. Follow-up for 6 to 18 months showed the color and texture of the flap was close to the recipient area, and the sensation of the flap elevated by BMRC sensory function assessment standard was S2-S3. According to the AOFAS ankle and hindfoot scoring system, the function of the recipient area was 72-98 points, with an average of 92 points. Only linear scars were left in the donor area.Conclusions:Because of the advantages of rich blood supply, strong anti-infection ability, and less damage to the donor area, it is an ideal method to repair the circular wound of the foot and ankle with multiple-perforator extra-large anterolateral thigh flap.

Objective:To explore the clinical effects of anterolateral thigh perforator flap with sensory nerves in repairing the plantar skin and soft tissue defects.Methods:From January 2016 to March 2019, 13 male patients with plantar skin and soft tissue defects were admitted to the Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, aged 27 to 73 years. The retrospective cohort study was conducted. The wounds of 4 patients underwent 2 times of debridement. The wounds of 9 patients underwent 1 time of debridement and 1 or 2 time(s) of vacuum sealing drainage. Then all the wounds of patients were repaired with flaps when the wounds were clean and dry with no purulent exudation and were negative in secretion culture. The wound areas of this group of patients after wound debridement were 13.0 cm×5.5 cm to 36.0 cm×10.5 cm, and the wounds were repaired with anterolateral thigh perforator flaps with sensory nerves with area of 14 cm×6 cm to 37 cm×11 cm. The wound of 1 patient was repaired with a bilobed flap. The oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein in the flap were anastomosed with the posterior tibial artery and its accompanying vein or the medial plantar artery and its accompanying vein in recipient sites. The lateral femoral cutaneous nerve in the flap was anastomosed with the recipient saphenous nerve or medial plantar cutaneous nerve. The donor sites were directly sutured. The survival of flaps and the healing of wounds in the donor and recipient areas were recorded, and the ulcers of the plantar repaired flap were followed up for 3 months after operation. The sensory function of the flap was evaluated by the sensory evaluation standard of British Medical Research Council (BMRC), and the ankle and foot function score system of American Orthopedic Foot and Ankle Society (AOFAS) was used for comprehensive functional evaluation at the last follow-up.Results:All the 14 flaps in 13 cases survived, and venous crisis occurred in two cases and the flaps survived smoothly after the venous re-anastomosis. One patient developed deep tissue infection after being discharged and was healed after secondary debridement. The donor and recipient areas of the remaining patients healed well. The patients were followed up for 6 to 18 months, the shape of flaps was slightly bloated in 5 patients, and the shape and texture of flaps in the other 8 patients were good. Six patients had ulcers in flaps at 3 months of follow-up after operation, which were healed after stopping weight-bearing activities. At the last follow-up, little linear scar hyperplasia could be seen in the donor site of patients; the BMRC sensory function evaluation results were S 1 grade in 4 cases, S 2 grade in 7 cases, and S 3 grade in 2 cases; the AOFAS scores were excellent in 3 cases, good in 7 cases, fair in 2 cases, and poor in 1 case. Conclusions:The anterolateral thigh perforator flaps with sensory nerves can repair the plantar skin and soft tissue defects with the donor sites directly sutured and good shape of flaps, which provide a good treatment method for the recovery of plantar proprioceptive sensation and weight-bearing function.

Objective:To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap (ALT) for repairing the circular wound of foot and ankle.Methods:Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed. The perforator was located by color Doppler ultrasound before the operation, and the flap was designed according to the size of the wound. Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected. When all perforating branches in the flap come from the same vascular trunk, two or more perforating branches are carried to cover the wound directly; when the branches come from the different trunks, the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap. All the donor areas were closed primarily. The sensory of flaps were elevated by the British Medical Research Council (BMRC) sensory function assessment standard, and the motor function was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 13 patients were enrolled in this study, including 8 males and 5 females.The age ranged from 21 to 65 years, with an average of 39 years. The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon. 12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap ( ALT) harvested from one thigh, and 1 case was repaired with the combined bilateral ALT flap due to the huge wound. The size of flap was 21.0 cm × 7.0 cm to 35.0 cm×10.0 cm. During the procedure, 14 flaps were successfully harvested, 9 flaps were supplied by two perforators, 4 by three perforators, and 1 by four skin perforators. Each flap had an average of 2.4 perforators. Among them, there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources. All flaps in this group finally survived. One flap suffered the venous crisis 24 hours after the operation and survived after removing the thrombus and re-anastomosing the vessel again. The stitches were removed 2 to 3 weeks after operation when the wound had healed. All wounds in the donor area healed primarily. 9 flaps underwent flap thinning and plastic surgery 6 to 10 months after the operation. Follow-up for 6 to 18 months showed the color and texture of the flap was close to the recipient area, and the sensation of the flap elevated by BMRC sensory function assessment standard was S2-S3. According to the AOFAS ankle and hindfoot scoring system, the function of the recipient area was 72-98 points, with an average of 92 points. Only linear scars were left in the donor area.Conclusions:Because of the advantages of rich blood supply, strong anti-infection ability, and less damage to the donor area, it is an ideal method to repair the circular wound of the foot and ankle with multiple-perforator extra-large anterolateral thigh flap.

To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue de-fect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respec-tively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm.After operation, the patients were followed-up regularly.The time of wound healing, appear-ance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps sur-vived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later.Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally.All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvi-ous limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Or-thopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair.The flap is based on a long vascular pedicle.And the clinical effect is satisfied.

Objective? To understand the situation of disability acceptance, coping style and social support in rectal cancer patients with permanent enterostomy and to explore the correlations among them. Methods? From March 2017 to December 2017, we selected 110 rectal cancer patients with permanent enterostomy in Heilongjiang Provincial Hospital as subjects by convenience sampling. All of the patients were investigated with the Acceptance of Disability Scale (ADS), Simplified Coping Style Questionnaire (SCSQ), Social Support Rating Scale (SSRS). Results? A total of 110 questionnaires were sent out and 101 valid questionnaires were collected. The total score of ADS, the scores of positive coping and negative coping of SCSQ as well as the total score of SSRS, were (79.55±7.42), (1.69±0.37), (1.74±0.24) and (41.35±10.24) respectively among rectal cancer patients with permanent enterostomy. The total score of ADS was positively correlated with the positive coping (P＜0.05), was negatively correlated with the negative coping (P＜0.05), and it also had a positive correlation with the total score of SSRS (P＜ 0.05). Conclusions? The disability acceptance of rectal cancer patients with permanent enterostomy needs to be improved. Health care providers should take targeted intervention based on social support system so as to help patients take positive coping style to improve their disability acceptance.

AIM To study the chemical constituents from Nepeta angustifolia C.Y.Wu.METHODS The ethyl acetate fraction of N.angustifolia 70％ ethanol extract was isolated and purified by silica,Sephadex LH-20,ODS and semi-preparative HPLC column,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Ten compounds were isolated and identified as oleanolic acid (1),betulinic acid (2),ursolic acid (3),3-sitosterol (4),angelicin (5),bakuchiol (6),blumenol C glucoside (7),psoralen (8),methyl rosmarinate (9),hesperidin (10).CONCLUSION Compounds 5-8are isolated from genus Nepeta for the first time,compounds 1,4-10 are first isolated from this plant.

[ABSTRACT]OBJECTIVETo study the effects of Arsenic Trioxide on the growth of human nasopharyngeal carcinoma cell strain CNE-2Z xenograft in nude mice, and explore the possible mechanisms of the antitumor effect. METHODSThe models of human poorly differentiated nasopharyngeal carcinoma in nude mice were established and randomly divided into 4 groups (control group, As2O3 group, DDP group and As2O3+DDP group). The antitumor effect of every group was studied. Pathological changes of tumor tissues dyed by HE staining were observed with light microscope. The pathological changes of the heart, liver, lung and kidney from nude mice were also observed by HE staining. Blood routine test was examined. Expression of PCNA and Ki-67 were detected by immunohistochemistry method.RESULTSThe growth of tumor in As2O3, DDP and As2O3+DDP were obviously inhibited. No pathological changes and metastases were found in heart, liver, lung and kidney of the nude mice. No obvious toxicity of the treatment to the hematopoietic systems in the nude mice was observed. The expression of PCNA and Ki-67 were down-regulated.CONCLUSIONAs2O3 can inhibit the growth of human nasopharyngeal carcinoma cell strain CNE-2Z xenograft in nude mice, the mechanism of which might be related to the down-regulation of PCNA and Ki-67.

Objective To observe the morbidity and clinical characteristics of primary aldosteronism (PA) in newly diagnosed patients with hypertension.Methods 255 patients with newly diagnosed high blood pressure were determined plasma renin activity (PRA),angiotensinⅡ(ATⅡ),aldosterone (PAC),cortisol (COR),adrenocortico-tropic hormone (ACTH)and 24h urinary vanilmandelic acid (VMA).They were examined renal artery color doppler and adrenal 64 row CT scan +enhancement scanning.Results 179 patients (70.20%)were diagnosed essential hypertension (EH).In EH patients,24 cases (13.41%)with hypokalemia.42 patients (16.47%)were diagnosed PA.In PA patients,18 cases (42 .86 %)with hypokalemia,25 cases(5 9 .5 2 % )with unilateral adrenal adenoma. Compared with EH patients,there were higher level of high density lipoprotein (HDL -C)(Z =-2.068,P =0.036),lower level of total cholesterol (TC),low density lipoprotein (LDL -C),fasting plasma glucose (FPG), serum kalium (Z =3.594,P =0.000;Z =2.807,P =0.005;Z =3.499,P =0.000;Z =8.435,P =0.000)in PA patients.The levels of plasma PRA and ATⅡin PA patients were lower than in EH patients(Z =3.673,P =0.000;Z =2.215,P =0.026).The levels of plasma PAC and ARR were higher than in EH patients (Z =8.562,P =0.000;Z =19.871,P =0.000).The minimum value of plasma PAC was 292.1pg/L,the ARR was 376.7 in 42 PA patients. The maximum value of plasma PAC was 311.3pg/L,and the ARR was 291.2.Conclusion There is high detection rate of PA in newly diagnosed hypertension.The unilateral adrenal adenoma is a main cause of PA.Hypokalemia is not common in PA patients.PA has little influence on glucolipid metabolism.ARR has high differential diagnosis accuracy for PA and EH.

OBJECTIVETo investigate the biocompatibility and degradation rate of crosslinking sodium hyaluronate gel with different ratio of molecular weight, so as to choose the effective, safe and totally degraded hyaluronate gel for aesthetic injection.

METHODS(1) Compound colloid was formed by cross-linking the divinyl sulphone and sodium hyaluronate with different molecular weight (4 x 10(5), 8 x 10(5), 10 x 10(5), 12 x 10(5)). (2) Healthy level KM mice was randomly divided into two groups to receive hyaluronic acid gel or liquid injection. Each group was subdivided into three subgroup to receive hyaluronic acid with different molecular weight. The biocompatibility and degradation rate, of hyaluronate were observed at 7, 90, 180 days after injection. At the same time, different molecular weight of sodium hyaluronate gel is sealed or exposed respectively under the low temperature preservation to observe its natural degradation rate. (3) The most stable colloid was selected as aesthetic injector for volunteers to observe the aesthetic effect.

RESULTSThe sodium hyaluronate gel with molecular of 4 x 10(5) was completely degraded 90 days later. The sodium hyaluronate gel with molecular of 8 x 10(5) was completely degraded 180 days later. The sodium hyaluronate gel with molecular of 10 x 10(5) was degraded to 90.0% after 180 days. The sodium hyaluronate liquid can be degraded completely within 7 days. The colloid could be kept for at least 12 months when sealed under low temperature, but was totally degraded when exposed for I d. Sodium hyaluronate gel with molecular 10 x 10(5) was confirmed to be kept for at least 6 months in animal experiment and clinical trials.

CONCLUSIONSUnder the same condition of material ratio, the higher the molecular weight is, the lower the degradation rate is. But the liquidity of gel is not good for injection when molecular weight is too large. It suggests that Sodium hyaluronate gel with molecular 10 x 10(5) maybe the best choice in cosmetic injections.

Animals ; Cross-Linking Reagents ; administration & dosage ; chemistry ; Hyaluronic Acid ; administration & dosage ; chemistry ; Injections, Subcutaneous ; Mice ; Molecular Weight ; Random Allocation