Clinical efficacy of free deep inferior epigastric artery perforator flap in repair of large wounds in upper limb / 中华显微外科杂志

Objective:To summarise the clinical efficacy of free deep inferior epigastric artery perforator flap (DIEPF) in repairing large wounds in upper limb.Methods:From June 2016 to March 2022, free DIEPF repair surgery were performed for 9 cases with large defects in elbow, forearm and wrist in the Department of Hand Surgery, Xuzhou Renci Hospital. The patients were 3 males and 6 females at 36-65(average 50) years old. The sizes of defect ranged from 6.0 cm×7.0 cm to 25.0 cm×33.0 cm. Seven defects combined with radius-ulnar fracture, 4 with wrist fracture, 4 with metacarpal fracture and 1 with humerus fracture. All defects had various degrees of injuries of tendon, blood vessel and nerve. A total of 10 flaps were harvested, and the size of flaps were 7.0 cm×8.0 cm-12.0 cm×35.0 cm. Vessels in 7 flaps of 6 patients were anastomosed with unilateral vascular pedicles and 3 with bilateral vascular pedicles. End-to-end arterial anastomosis was performed on 1 flap, and the other 9 flaps of 8 patients had end-to-side arterial anastomoses. End-to-end vein anastomoses were performed on all flaps. Umbilical reconstruction was performed at the abdominal donor site for 3 patients, and all donor site wounds were closed in stage I surgery. Scheduled outpatient and WeChat follow-up were made after surgery.Results:Nine flaps in 8 patients survived successfully. Partial skin necrosis occurred in 1 flap and repaired by skin grafting. Follow-up lasted for 6 to 60 months(12 months in average). At the last follow-up, the colour of the flaps was found being similar to the surrounding skin with mildly bloated and soft in texture. Sensation of the flaps recovered to S 2 in 5 patients, and not detected in 4 cases. Conclusion:The free DIEPF has a relatively constant perforator and the flap can be used for repairing a large area of defect. The donor site wound can be closed in Ⅰ stage surgery. Free DIEPF is suitable for repair of large upper limb wounds.

Synergetic effect of temperature and PM2.5 on mortality of cardiovascular and cerebrovascular diseases / 上海预防医学

ObjectiveTo explore the synergetic effect of temperature and PM2.5 on cardiovascular and cerebrovascular diseases. MethodWe collected cardiovascular and cerebrovascular death cases，air pollution and meteorological data during the same period in Pudong New Area from 2013 to 2018.We used generalized additive models （GAMs） with poisson regression including non-stratification model， nonparametric bivariate response model and pollution-stratified parametric model， to assess the interaction between temperature and PM2.5 and on the number of cardiovascular cerebrovascular and cerebrovascular disease deaths. ResultsThe exposure-response relationship between temperature and the number of cardiovascular and cerebrovascular deaths exhibited "U" type and the most comfortable temperature was 18.9 ℃. When the concentrations of PM2.5 increased by 10 μg·m-3， the deaths of total， male， female， ≤75 years and >75 years increased， respectively， by 0.60%（95%CI： 0.30%‒0.91%）， 0.77%（95%CI：0.34%‒1.20%）， 0.46%（95%CI：0.05%‒0.86%）， 0.66%（95%CI：0.03%‒1.30%） and 0.59%（95%CI：0.26%‒0.92%）. With the increase of PM2.5 concentration level， the impact of temperature on cardiovascular and cerebrovascular diseases gradually increased， and the impact was the most significant when the concentration of PM2.5 was more than 150 µg·m-3. There were different sensitive people in different seasons. ConclusionPM2.5 concentration levels of mild pollution and above can exacerbate the negative effects of temperature on cardiovascular and cerebrovascular diseases.

Advance in diagnosis and treatment of drug-resistant tuberculosis in children / 国际儿科学杂志

Tuberculosis is one of the infectious diseases with high mortality throughout the world, and drug-resistant tuberculosis in particular aggravates the global burden of disease.As a special group of tuberculosis patients, children have great difficulties in the diagnosis and treatment of diseases due to atypical clinical symptoms, difficulty in collecting test samples, and low bacterial load of samples.In recent years, based on medical evidence, many new detection techniques and drug treatment protocols for drug resistant tuberculosis have emerged, but there is still a lack of child-related clinical data and guideline consensus.The incidence of tuberculosis in children affects the number of adult tuberculosis patients in the future, and it is important to pay attention to tuberculosis in children for disease control, while for tuberculosis patients in children, rapid and correct diagnosis and early rational treatment are crucial.This article reviews the latest advance in the diagnosis and treatment of drug-resistant tuberculosis in children based on the available evidence.

A meta-analysis of factors influencing the development of gastric cancer in Chinese populations / 预防医学

Objective@# To investigate the factors influencing the development of gastric cancer in Chinese populations, so as provide insights into creating a model for predicting gastric cancer incidence among Chinese populations.@*Methods@#The case-control and cohort studies pertaining to factors affecting the development of gastric cancer were retrieved in electronic Chinese and English databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science and Embase from their inception until September 30, 2021. A meta-analysis was performed using R package version 4.1.0. Sensitivity analysis was performed using the “leave-one-out” evaluation procedure, and the publication bias was evaluated using the Egger regression test and the trim-and-fill procedure. @*Results@# A total of 5 301 publications were screened and 116 eligible studies were included in the final analysis, including 103 case-control studies and 13 cohort studies, which covered approximately 3.23 million study subjects. A total of 45 factors affecting the development of gastric cancer were collected, and there were less than 4 publications reporting 7 factors, which were only qualitatively described. There were 38 factors included in the final meta-analysis. A total of 21 factors were identified as risk factors of gastric cancer, including a history of gastrointestinal diseases (pooled OR=4.85, 95%CI: 3.74-6.29), H. pylori infection (pooled OR=3.18, 95%CI: 2.35-4.32), binge eating and drinking (pooled OR=2.88, 95%CI: 2.09-3.97) and a family history of tumors (pooled OR=2.78, 95%CI: 2.17-3.56), and 10 factors as protective factors, including vegetable intake (pooled OR=0.48, 95%CI: 0.38-0.61), tea consumption (pooled OR=0.55, 95%CI: 0.47-0.64), administration of aspirin (pooled OR=0.53, 95%CI: 0.31-0.92) and administration of statins (pooled OR=0.59, 95%CI: 0.44-0.80). Sensitivity analyses of eating moldy food frequently, white meat intake, favoring spicy food and administration of sulfonylureas were not robust. Following correction with the trim-and-fill procedure, there was still a publication bias pertaining to high income, diabetes, administration of stains, alcohol consumption, tea consumption and white meat intake.@*Conclusions@# The development of gastric cancer is associated with a medical history of gastrointestinal disease, H. pylori infection, family history of tumors and poor dietary habits. Risk and protective factors of gastric cancer are recommended to be included in models used to predict gastric cancer incidence among Chinese populations.

The research progress of transcranial direct current stimulation in the treatment of mild cognitive impairment / 中华行为医学与脑科学杂志

Mild cognitive impairment (MCI) is a pre-clinical stage of Alzheimer's disease (AD). In recent years, transcranial direct current stimulation (tDCS), as a neuromodulation technique, has being applied in the field of cognitive intervention for MCI, but its effect is controversial because of many factors. In order to promote the application of tDCS in intervention for MCI, this study performed a systematic review of the previous studies that used tDCS to improve cognitive functions of MCI individuals. The results indicate that tDCS could improve episodic memory, working memory, and language of individuals with MCI, while there is a lack of strong evidence that supports a positive effect of tDCS on attention of individuals with MCI. The placement of electrodes, time course of treatment, and current intensity all affected the intervention effect of tDCS. Future studies should take brain networks underlying cognitive processes and personalized factors such as age and education level into consideration to design better stimulation protocols, and they should be conducted in combination with neuroimaging technologies to evaluate the intervention effect of tDCS more accurately and objectively and to discover the neural mechanisms of tDCS intervention.

Effects of serum triglyceride level within 48 hours after hospitalization on the complications of acute pancreatitis / 中华消化杂志

Objective:To explore the effects of serum triglyceride (STAG) level within 48 hours after hospitalization on the complications of acute pancreatitis (AP).Methods:From January 2012 to June 2016, 1 006 hospitalized patients diagnosed with AP at the Third People′s Hospital of Chengdu were collected. According to the STAG level within 48 hours after hospitalization, AP patients were divided into normal to mild hypertriglyceridemia (HTG) group(STAG <2.3 mmol/L, 877 cases), moderate HTG group(STAG: 2.3 to <8.5 mmol/L, 82 cases) and severe HTG group (≥8.5 mmol/L, 47 cases). The general clinical data and the incidence of local complications of AP including acute necrotizing pancreatitis, pancreatic necrosis, acute peripancreatic fluid collection (APFC) and acute necrotic collection (ANC) and AP-associated gastrointestinal abnormal changes were compared in the three groups. The severity of the complications of AP was scored by modified-magnetic resonance severity index (M-MRSI). Wilcoxon rank sum test and chi-square test were used for statistical analysis, and multivariate logistic regression analysis was used to analyze the correlation between STAG level and persistent organ failure (POF).Results:Compared with that of the normal to mild HTG group and moderate HTG group, the age of the patients of the severe HTG group was the youngest (52 years old, 19 to 82 years old and 47 years old, 21 to 62 years old vs. 35 years old, 18 to 43 years old), the proportion of male was the highest (46.3%, 406/877 and 64.6%, 53/82 vs. 85.1%, 40/47), and the differences were statistically significant( Z=3.943, 2.841, χ2=26.912, 6.224, all P<0.017). The proportion of body mass index (BMI)≥30 kg/m 2 in severe HTG group was higher than that in normal to mild HTG group (38.3%, 18/47 vs. 20.2%, 177/877), and the difference was statistically significant ( χ2=8.792, P=0.003). The proportions of patients with history of diabetes and severe alcohol intake of moderate HTG group and severe HTG group were all higher than those of normal to mild HTG group (31.7%, 26/82 and 29.8%, 14/47 vs. 15.4%, 135/877; 37.8%, 31/82 and 46.8%, 22/47 vs. 9.6%, 84/877), and the differences were statistically significant ( χ2=14.286, 6.833, 56.613 and 60.844, all P<0.017). Compared with those of the normal to mild HTG group and moderate HTG group, the incidences of pancreatic necrosis, APFC, and the M-MRSI score of the severe HTG group were all the highest (8.2%, 72/877 and 15.9%, 13/82 vs. 38.3%, 18/47; 17.8%, 156/877 and 36.6%, 30/82 vs. 59.6%, 28/47; 2, 0 to 10 and 3, 0 to 10 vs. 5, 0 to 10), and the differences were statistically significant( χ2=45.936, 8.244, 48.842 and 6.381, Z=2.711 and 3.049, all P<0.017). The incidence rates of acute necrotizing pancreatitis and ANC of moderate HTG group and severe HTG group were all higher than those of normal to mild HTG group(28.0%, 23/82 and 48.9%, 23/47 vs. 13.3%, 117/877; 26.8%, 22/82 and 42.6%, 20/47 vs. 13.3%, 117/877), and the differences were statistically significant ( χ2=13.011, 43.965, 11.008 and 30.144, all P<0.017). The incidence rate of POF of severe HTG group was higher than those of normal to mild HTG group and moderate HTG group (46.8%, 22/47 vs.14.8%, 130/877 and 24.4%, 20/82), and the differences were statistically significant ( χ2=33.205 and 6.838, both P<0.017). The results of multivariate logistic regression analysis showed that age ≥ 60 years old (odds ratio ( OR)=1.84, 95% confidence interval ( CI) 1.26 to 3.03), BMI≥30 kg/m 2 ( OR=2.41, 95% CI 1.61 to 3.77), alcohol intake ( OR=3.81, 95% CI 2.09 to 5.47), moderate HTG( OR=1.89, 95% CI 1.78 to 5.23) and severe HTG ( OR=3.65, 95% CI 1.98 to 6.49) were independent risk factors of POF(all P<0.05). Conclusion:The STAG level is related to the complications of AP, and moderate HTG and severe HTG(STAG ≥2.3 mmol/L) are independently associated with the risk of POF.

TMEM43-S358L mutation enhances NF-κB-TGFβ signal cascade in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a genetic cardiac muscle disease that accounts for approximately 30% sudden cardiac death in young adults. The Ser358Leu mutation of transmembrane protein 43 (TMEM43) was commonly identified in the patients of highly lethal and fully penetrant ARVD subtype, ARVD5. Here, we generated TMEM43 S358L mouse to explore the underlying mechanism. This mouse strain showed the classic pathologies of ARVD patients, including structural abnormalities and cardiac fibrofatty. TMEM43 S358L mutation led to hyper-activated nuclear factor κB (NF-κB) activation in heart tissues and primary cardiomyocyte cells. Importantly, this hyper activation of NF-κB directly drove the expression of pro-fibrotic gene, transforming growth factor beta (TGFβ1), and enhanced downstream signal, indicating that TMEM43 S358L mutation up-regulates NF-κB-TGFβ signal cascade during ARVD cardiac fibrosis. Our study partially reveals the regulatory mechanism of ARVD development.

Relationship between serum uric acid level and cerebrovascular stenosis in acute ischemic stroke patients / 中华老年心脑血管病杂志

Objective To study the relationship between serum uric acid (UA) level and cerebrovascular stenosis in acute ischemic stroke (AIS) patients.Methods Five hundred and thirteen patients with AIS or old IS admitted to our hospital from April 2014 to April 2016 were divided into primary IS group (n=236),recurrent IS group (n=136),and old IS group (n=141).Venous blood samples were taken on admission for biochemical testing.The patients were further divided into serum UA≤255 μmol/L group (n=128),serum UA=256-312μmol/L group (n=129),serum UA=313-371 μmol/L group (n=129),and serum UA＞371 μmol/L group (n=127).Their cerebrovascular stenosis was assessed by CT angiography or magnetic resonance angiography after admission.Results The severity of cerebrovascular stenosis,hypertension,diabetes and hyperlipidemia was significantly different in primary IS group,recurrent IS group and old IS group (27.5％ vs 33.8％ vs 12.8％、24.2％ vs 28.7％ vs 46.8％、61.9％ vs 49.3％ vs 40.4％、71.6％ vs 61.8％ vs 46.8％,P=0.000).Logistic regression analysis showed that serum UA≤ 255 μmol/L was an independent risk factor for cerebrovascular stenosis (OR =2.787,95 ％CI:2.209-3.365,P=0.001).The risk of cerebrovascular stenosis decreased gradually with the elevated serum UA level.Conclusion Serum UA level is not directly related with recurrent IS.Low serum UA level is a risk factor for cerebrovascular stenosis in AIS.

Analysis and prediction of influence factors for progressive ischemic stroke / 天津医药

Objective To analyze the related influencing factors of progressive ischemic stroke, and to investigate the value of serum markers for prediction of progressive ischemic stroke. Methods Three hundred and six patients with acute cerebral infarction were divided into progressive ischemic stroke (PIS) group (n=91) and non-progressive ischemic stroke (NPIS) group (n=215). Data of gender, age, past medical history, personal history and serum markers were collected and compared in two groups. Binary Logistic regression was used to analyze the influencing factors of PIS. The receiver operating characteristic (ROC) curves of neutrophils to lymphocytes ratio (NLR), fibrinogen and fasting blood glucose were analyzed in two groups. Results Positive rates of hypertension history, diabetes history, hypercholesterolemia history, incidence of large artery atherosclerotic (LAA) stroke were significantly higher in PIS group than those in NPIS group ( P<0.05). The levels of neutrophils, NLR, fibrinogen and fasting blood glucose were significantly higher, but the level of lymphocytes was significantly lower in patients with PIS than those in patients with NPIS (P<0.05). Logistic regression analysis confirmed that diabetes, LAA stroke, NLR, fibrinogen and fasting blood glucose were independent risk factors for the PIS ( P<0.05). The areas under ROC curve by NLR, fibrinogen and fasting blood glucose were 0.777, 0.560 and 0.574, respectively. The sensitivities of NLR, fibrinogen and fasting blood glucose were 72.5%, 59.8%and 47.3%, respectively;and the specificities were 76.7%, 51.2% and 69.8%, respectively. Conclusion The occurrence of PIS is related with blood pressure, blood lipids, inflammatory cells in peripheral bolld, fibrinogen and fasting blood glucose. The level of NLR in peripheral blood can predict the occurrence of PIS, which can be used as an important reference index for early diagnosis of PIS.

Effect of Activating Blood to Resolve Stagnation on Cells Expressing CD34 and Vascular Endothelial Growth Factor in Rats with Acute Myocardial Infarction / 中国康复理论与实践

@#Objective To explore the effect of Activating Blood to Resolve Stagnation on the expression of CD34 and vascular endothelial growth factor (VEGF) in rats with acute myocardial infarction. Methods 32 Sprague-Dawley rats were randomly divided into sham operation group (A, n=8), model group (B, n=8), Xuesaitong Injection + granulocyte colony- stimulating factor (G- CSF) group (C, n=8) and G-CSF group (D, n=8). Corresponding medicine was given to each group 3 hours after modeling, for 6 days. Pathomorphological changes were observed through HE staining, and the expression of CD34, VEGF and Ki-67 were observed through immunohistochemical staining. Results The expressions of CD34, VEGF and Ki-67 were higher in groups B, C and D than in group A (P<0.05), and were higher in group groups C and D than in group B (P<0.05). The expressions of CD34 and VEGF were higher in group C than in group D (P<0.05). However, there was no significant difference in the expression of Ki-67 between 2 groups (P>0.05). Conclusion The expression of CD34 and VEGF increases with Activating Blood to Resolve Stagnation method, which is superior to using G-CSF only. Activating Blood to Resolve Stagnation may play an important role in the treatment of acute myocardial infarction.

Effect of Activating Blood to Resolve Stagnation on Cells Expressing CD34 and Vascular Endothelial Growth Fac-tor in Rats with Acute Myocardial Infarction / 中国康复理论与实践

Objective To explore the effect of Activating Blood to Resolve Stagnation on the expression of CD34 and vascular endotheli-al growth factor (VEGF) in rats with acute myocardial infarction. Methods 32 Sprague-Dawley rats were randomly divided into sham opera-tion group (A, n=8), model group (B, n=8), Xuesaitong Injection + granulocyte colony-stimulating factor (G-CSF) group (C, n=8) and G-CSF group (D, n=8). Corresponding medicine was given to each group 3 hours after modeling, for 6 days. Pathomorphological changes were observed through HE staining, and the expression of CD34, VEGF and Ki-67 were observed through immunohistochemical staining. Re-sults The expressions of CD34, VEGF and Ki-67 were higher in groups B, C and D than in group A (P0.05). Conclusion The expression of CD34 and VEGF in-creases with Activating Blood to Resolve Stagnation method, which is superior to using G-CSF only. Activating Blood to Resolve Stagna-tion may play an important role in the treatment of acute myocardial infarction.

Value of fetal tricuspid regurgitation in early screening for chromosomal abnormalities / 实用医学杂志

Objective To investigate the clinical significance of fetal tricuspid regurgitation (TR) in the screening of chromosomal abnormalities at the first-trimester. Methods Screening for chromosomal abnormalities was carried out in 1 262 fetuses at 11+0 to 13+6 weeks. Ultrosound was performed to measure crown rump length and nuchal translucency (NT) thickness, and to acquire tricuspid waveform. All the neonates were followed up for 6 months after birth. Results Among the 1 262 fetuses, 68 were found to have TR. TR was present in 54 (4.4%) of the 1 239 chromosomally normal fetuses, and in 14 (61%) of the 23 with chromosomal abnormalities. Cardiac malformations were detectable in 28 fetuses. The prevalence of TR was 64%in those with cardiac malformations and 1.5%in those without cardiac malformations. Conclusions Tricuspid regurgitation is an effective predictor for the detection of fetal chromosomal abnormalities at the first trimester.

Electrocardiographic Characteristics of Myocardial Infarction Evolution in Rats and ;Intervention of Chinese Herbs with Replenishing Qi and Activating Blood / 中国中医药信息杂志

Objective To determine the electrocardiographic (ECG) characteristics of myocardial infarction (MI) evolution in rats and the intervention effect of Chinese herbs, and to provide basis for the establishment of the criteria for ECG diagnosis and assessment of drug therapeutic effects of rats MI. Methods Totally 140 male SD rats were randomly divided into sham operation group, model group, replenishing qi group, activating blood group, replenishing qi and activating blood (1∶2) and (2∶1) group as well as Tongxinluo group, each group with 20 rats. The rat MI model was established by ligating the left anterior descending coronary artery. The treatment groups were administrered with corresponding drugs by gavage from the first day after operation. The sham operation group and model group were given the same volume of distilled water. The 12-lead ECGs were recorded before, immediately after, 1st and 2nd week after operation respectively. The voltage value of ST segment deviation, the time limit of QRS complex and the number of animals with pathologic Q wave were evaluated for statistical analysis. Results Model group showed the elevation of ST segment, significantly prolonged time limit of QRS complex (P0.05). Thus, we proposed the criterion for the ECG diagnosis of rats MI as well as the criterion for the ECG assessment of drug therapeutic effects of rats MI. Conclusion ECG can overall and sensitively evaluate the evolution and drug therapeutic effects of MI in rats, thus providing a relatively objective and available assessment method for the experimental studies of myocardial ischemic diseases.

Change of Capillary Pericapillary Cells in Rats with Myocardial Infarction and Effect of Supplementing Qi and Activating Blood Circulation Herbs / 中国中医药信息杂志

Objective To observe the change of capillary pericapillary cells in rats with myocardial infarction and the influence of supplementing qi and activating blood circulation herbs, and explore its mechanism of improving myocardial perfusion. Methods The rat model was established by ligaturing the left anterior descending coronary artery. On the base of ECG evaluation, successfully modeled rats were randomly divided into the model group, group treated with supplementing qi and activating blood circulation Chinese medicine (activating blood and supplementing qi group), group treated with Perindopril (Perindopril group), group treated with Tongxinluo Capsules (Tongxinluo group). The sham-operation group was taken as the control. There were totally 5 groups. The model group and the sham-operation group were treated with normal saline. The changes of myocardial capillary density (MCD) and number of pericapillary cells on the 7th, 28th day after medicinal administration were observed. Results On the 7th and 28th day, the MCD decreased significantly and the number of capillary pericapillary cells increased significantly in the model group compared with the sham-operation group (P<0.01). The MCD increased significantly in the activating blood and supplementing qi group, Perindopril group and Tongxinluo group compared with the model group (P<0.01). The number of pericapillary cells decreased significantly in the activating blood and supplementing qi group, Perindopril group and Tongxinluo group compared with the model group (P<0.01). Conclusion The supplementing qi and activating blood circulation herbs can improve regional myocardial blood supply by decreasing the number of pericytes and promoting regeneration of capillary.

Effect of Faradization Combined with Pelvic Floor Muscle Exercise on Female Stress Urinary Incontinence / 中国康复理论与实践

@#Objective To explore the effect of faradization combined with pelvic muscle exercise on stress urinary incontinence (SUI) infemale. Methods 40 female patients with mild or moderate SUI respectively were managed with faradization and pelvic floor muscle exercisesimultaneously for 16 weeks. They were assessed with International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)and pad test before and after the treatment. Results All the patients improveed significantly in the score of ICIQ-SF, with the incidence ofimprovement were 100% and 72.5% in mild and moderate patients respectively. Conclusion Faradization combined with pelvic floor muscleexercise is effective on female SUI.