Continuous deep irrigation combined with vacuum sealing drainage for the treatment of postoperative multidrug-resistant bacterial infections in wounds of patients with major artery injury / 中华创伤杂志

Objective:To compare the efficacy between deep continuous irrigation combined with vacuum sealing drainage (VSD) and routine dressing change in treating multidrug-resistant bacterial infections at the surgical wound site in patients with major vascular injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 28 patients with surgical wound infections by multidrug-resistant bacteria after major vascular injury treated at the First Affiliated Hospital of Henan University of Science and Technology from March 2015 to December 2021. There were 15 males and 13 females, aged 15-65 years [(41.8±12.9)years]. All patients received vascular graft surgery after major vascular injury. Postoperative microbiological culture indicated that the wound infections were caused by Carbapenem-resistant organisms (CRO) or vancomycin- resistant Enterococci (VRE), with no available sensitive antibiotics for treatment. The patients received surgical debridement every five days after vascular graft surgery and were divided into two groups to receive the subsequent treatments including a routine dressing change (routine dressing group, 14 patients) or a deep continuous irrigation combined with VSD (irrigation combined with VSD group, 14 patients). On the first day post-operation and then every 3 days, inflammatory indicators [white blood cell count, neutrophils, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin] were observed in the two groups (repeat tests when a patient′s condition changed). Microbiological cultures were applied with patient samples every 5 days to observe the wound and infection control. Comparisons were made between the two groups regarding the duration to normal levels of inflammatory indicators, duration to negative CRO or VRE cultures, visual analogue score (VAS) before and at 1, 2 and 3 hours after changing the irrigation fluid (changing the dressing), conditions of wound skin grafting or flap repair, and incidences of anastomotic fistula.Results:All patients were followed up for 12-24 months [(14.3±2.4)months], during which no wound redness, rupture, purulent discharge or infection recurrence was noted. The duration to normal levels was (9.4±2.4)days for white blood cells, (9.6±2.8)days for neutrophils, (9.8±3.1)days for CRP, (12.2±3.6)days for ESR, and (7.6±1.9)days for procalcitonin in the irrigation combined with VSD group, significantly shorter than those in the routine dressing group [(15.2±3.1)days, (13.6±3.4)days, (14.2±3.9)days, (19.9±3.3)days, and (12.9±4.1)days, respectively] (all P<0.01). The duration to negative CRO or VRE cultures was (13.9±3.1)days in the irrigation combined with VSD group, significantly shorter than that in the routine dressing group [(19.2±6.9)days] ( P<0.05). The VAS before and at 1, 2 and 3 hours after changing the irrigation fluid was (4.2±0.7)points, (4.1±0.9)points, (4.2±0.9)points and (4.1±0.8)points in the irrigation combined with VSD group, respectively, and was (4.3±0.6)points, (6.9±0.7)points, (5.4±0.9)points and (4.5±0.9)points in the routine dressing group, respectively. The VAS score in the irrigation combined with VSD group was significantly lower than that in the routine dressing group at 1 hour and 2 hours after changing the irrigation fluid (all P<0.01), while no significant differences were found before and at 3 hours after changing the irrigation fluid (all P>0.05). After infection control, 5 patients (35.7%) in the irrigation combined with VSD group required skin grafting or flap repair at the wound site, lower than 11 patients (78.6%) in the routine dressing group ( P<0.01). The incidence of anastomotic fistula was 7.1% (1/14) in the irrigation combined with VSD group, lower than 42.9% (6/14) in the routine dressing group ( P<0.05). Conclusion:When multidrug-resistant bacterial infections occur at the surgical wound site after major vascular injury, deep continuous irrigation combined with VSD performs better than routine dressing change in controlling infection as well as in reducing pain, rate of wound skin grafting or flap repair and incidence of anastomotic fistula, without reliance on antibiotics.

Research Progress in Improving Efficacy of Radiotherapy by Targeting Glutamine Metabolism / 肿瘤防治研究

Radiotherapy is an important treatment method for malignant tumors. Radiation resistance is the main obstacle to the therapeutic effect of radiotherapy. Cellular metabolic reprogramming is one of the main features of cancer, and it may have an important effect on the therapeutic effect of radiotherapy. Glutamine is closely related to tumor cell biosynthesis and growth. It affects radiotherapy sensitivity by producing antioxidants through decomposition. In addition, the expression patterns and functions of two isoenzymes of glutamine, namely, glutaminase (GLS) and glutaminase 2 (GLS2), are different and have an important influence on the sensitivity of radiotherapy. The utilization of glutamine metabolism in the tumor microenvironment has great research value to improve the efficacy of radiotherapy. This review describes the metabolic characteristics of glutamine in malignant tumors and the sensitization effect of glutamine inhibitors on the efficacy of radiotherapy.

Effective constituents of essential oil from Gleditsiae Fructus Abnormalis and anti-cerebral ischemia/reperfusion injury mechanism: based on GC-MS, network pharmacology, and experimental verification / 中国中药杂志

Based on GC-MS and network pharmacology, the active constituents, potential targets, and mechanism of essential oil from Gleditsiae Fructus Abnormalis(EOGFA) against cerebral ischemia/reperfusion(I/R) injury were explored, and the effective constituents were verified by experiment. To be specific, GC-MS was used identify the constituents of the volatile oil. Secondly, the targets of the constituents and disease were predicted by network pharmacology, and the drug-constituent-target network was constructed, followed by Gene Ontology(GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment of the core targets. Molecular docking was performed to investigate the binding affinity between the active constituents and the targets. Finally, SD rats were used for experimental verification. The I/R injury model was established, and the neurological behavior score, infarct volume, and pathological morphology of brain tissue were measured in each group. The content of interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-α) was determined by enzyme-linked immunosorbent assay(ELISA), and the protein expression of vascular endothelial growth factor(VEGF) by Western blot. A total of 22 active constituents and 17 core targets were screened out. The core targets were involved in 56 GO terms and the major KEGG pathways of TNF signaling pathway, VEGF signaling pathway, and sphingolipid signaling pathway. Molecular docking showed that the active constituents had high affinity to the targets. The results of animal experiment suggested that EOGFA can alleviate the neurological impairment, decrease the cerebral infarct volume and the content of IL-1β, IL-6 and TNF-α, and down-regulate the expression of VEGF. The experiment verified the part results of network pharmacology. This study reflects the multi-component, multi-target, and multi-pathway characteristics of EOGFA. The mechanism of its active constituents is related to TNF and VEGF pathways, which provides a new direction for in-depth research on and secondary development of Gleditsiae Fructus Abnormalis.

Clinical characteristics of children infected with SARS-CoV-2 Omicron variant combined with allergic disease / 中华儿科杂志

Objective: To investigate the clinical characteristics of children with allergic diseases suffering from SARS-CoV-2 Omicron variant strains. Methods: This was a cross-sectional study. A total of 43 pediatric patients with allergic diseases infected by SARS-CoV-2 from April 25, 2022 to June 8, 2022 in Shanghai Jiao Tong University School of Medicine were selected as the allergic disease group, while 114 cases without underlying diseases and 16 cases with other underlying diseases were selected as control groups diagnosed at the same period. Clinical data including clinical features, laboratory tests, duration of hospitalization, and the time to negative turn of novel coronavirus nucleic acid were collected and analysed. Kruskal-Wallis H test, chi-square test or Fisher exact test were used for comparison among three groups. Results: Among the 43 patients with allergic diseases, 28 were males and 15 were females, with an age of 4.4 (2.1, 8.2) years on admission, including 32 mild cases and 11 common cases. The allergic disease group included 20 cases (46.5%) of atopic dermatitis and eczema, followed by 14 cases (32.6%) of rhinitis, 8 cases (18.6%) of food allergies, 7 cases (16.3%) of asthma, 4 cases (9.3%) of allergic conjunctivitis and 2 cases (4.7%) of drug allergy. Among the 114 cases without underlying diseases, 57 were males and 57 were females, with an age of 2.8 (1.2, 5.6) years on admission, including 93 mild cases and 21 common cases. Among the 16 cases with other underlying diseases, 9 were males and 7 were females, with an age of 3.0 (2.6, 10.8) years on admission, including 13 cases mild and 3 cases common cases. Children with allergic diseases had higher frequency of sore throat and vomiting than those without underlying diseases (10 cases (23.3%) vs.9 cases (7.9%), 14 cases (32.6%) vs. 11 cases (9.6%), χ²=6.93, 12.24, both P<0.05). The lymphocyte count of patients with allergic disease was lower than those without underlying disease (1.1 (0.7,1.7)×109 vs. 1.6 (1.1,2.7)×109/L, H=-28.00,P=0.005). There were no significant differences in age, gender, typing of SARS-CoV-2, the duration of hospitalization, cycle threshold values of SARS-CoV-2 and the time to negative turn of novel coronavirus nucleic acid among the three groups (all P>0.05). Conclusions: Children with allergic diseases may suffer from sore throat and vomiting more frequently when infected with SARS-CoV-2 Omicron variant. The combination of allergic diseases hardly influenced the disease course of SARS-CoV-2 in children.

Analysis of Gene Recombination between HLA-B and -DRB1, HLA-DQB1 and -DPB1 Loci / 中国实验血液学杂志

OBJECTIVE@#To investigate the recombinations within the human leukocyte antigen (HLA) region in two families.@*METHODS@#Genomic DNA was extracted from the peripheral blood specimens of the different family members. HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1 loci were genotyped using polymerase chain reaction-sequence specific oligonucleotide probing technique (PCR-SSO) and next-generation sequencing technique. HLA haplotype was determined by genetic analysis of the pedigree.@*RESULTS@#The haplotypes of HLA-A*11:01~C*03:04~B*13:01~DRB1*12:02~DQB1*03:01~DPB1*05:01:01G and HLA-A*03:01~C*04:01~B*35:03~DRB1*12:01~DQB1*03:01~DPB1*04:01:01G in the family 1 were recombined between HLA-B and HLA-DRB1 loci, which formed the haplotype of HLA-A*11:01~C*03:04~B*13:01~DRB1* 12:01~DQB1*03:01~DPB1*04:01:01G. The haplotypes of HLA-A *02:06~C*03:03~B*35:01~DRB1*08:02~DQB1*04:02~ DPB1*13:01:01G and HLA-A *11:01~C*07:02~B*38:02~DRB1*15:02~DQB1*05:01~DPB1*05:01:01G in the family 2 were recombined between HLA-DQB1 and HLA-DPB1 loci, which formed the haplotype of HLA-A*02:06~C*03:03~B*35:01~ DRB1*08:02~DQB1*04:02~DPB1*05:01:01G.@*CONCLUSION@#The gene recombination events between HLA-B and -DRB1, HLA-DQB1 and -DPB1 loci were found respectively in two Chinese Han families.

Research Progress of Forensic Diagnosis Approaches of Early Acute Myocardial Infarction / 法医学杂志

The postmortem diagnosis of acute myocardial infarction (AMI), especially the postmortem diagnosis of early AMI that died immediately after onset or within 1 hour, has always been a difficulty in forensic identification. This article reviews the forensic application of diagnosis and analysis methods for AMI postmortem diagnosis including autopsy imaging, histomorphology, immunohisto-chemistry, biochemical marker and molecular biology diagnosis, and explores the feasible scheme of early postmortem diagnosis in AMI.

Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children / 中国当代儿科杂志

OBJECTIVES@#To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children.@*METHODS@#A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups.@*RESULTS@#The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05).@*CONCLUSIONS@#The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.

Effect of miltirone on proliferation and apoptosis of leukemia THP-1 cells / 中国中药杂志

To investigate the toxicity and related mechanism of miltirone to human acute myeloid leukemia THP-1 cells. To be specific, the active components and targets of miltirone were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP), and the target proteins were converted into standard gene names with UniProt. Acute leukemia-rela-ted target genes were screened from GeneCards and DisGeNET. Venn diagram was constructed with Venny 2.1 to yield the common targets of the disease and the drug. The protein-protein interaction(PPI) network was constructed by STRING and Cytoscape 3.8.2. THP-1 cells in the logarithmic growth phase were treated with dimethyl sulfoxide(DMSO), and 2.5, 5, 10, 15, and 20 μmol·L~(-1) miltirone for 24 h, respectively. The proliferation rate of cells was analyzed by carboxyfluorescein diacetate succinimidyl ester(CFSE), apoptosis rate by flow cytometry with Annexin V-PE/7 AAD staining, and cell morphology by acridine orange staining. Real-time quantitative PCR(qPCR) was employed to detect the mRNA levels of nuclear receptor coactivator 2(NCOA2), poly(ADP-ribose) polymerase-1(PARP1), B-cell lymphoma-2(Bcl-2)-associated X protein(Bax), Bcl-2, and cysteine aspartyl protease-3(caspase-3). The effect of miltirone on apoptosis was detected in presence of caspase inhibitor Z-VAD-FMK. A total of 26 targets of miltirone, 1 046 genes related to acute leukemia, and 6 common targets of the two were screened out. Flow cytometry result showed miltirone at 10 μmol·L~(-1) can inhibit proliferation and promote apoptosis of THP-1 cells. The typical manifestations of apoptosis, such as cell shrinkage, nuclear rupture, and chromatin agglomerate were displayed by acridine orange staining. The decreased mRNA levels of NCOA2 and PARP1 and increased Bax/Bcl-2 ratio and the activity of pro-apoptotic protein caspase-3 were observed. Z-VAD-FMK can attenuate the apoptosis-inducing effect of miltirone. This study indicates that miltirone can inhibit the proliferation and promote the apoptosis of THP-1 cells, by down-regulating NCOA2 and PARP1, raising Bax/Bcl-2 ratio, and activating caspase-3.

Molecular design and biological activity analysis of antimicrobial peptide RIKL / 生物工程学报

Natural antimicrobial peptides have strong bactericidal activities. An obstacle of the development of antimicrobial peptides resides in the difficulty of developing peptides with high biocompatibility. In this study, molecular dynamics analysis was employed to assess the structural characteristics and biological activities of peptides. A (RXKY)2(YRY)2 structure was used as a template to design an antimicrobial peptide RIKL of high-efficiency and low-toxicity, where X represents Ile and Y represents Leu. The secondary structure of the antimicrobial peptide was detected by circular dichroism (CD), and the structures of RIKL in water and in POPC/POPG membrane environment were measured using molecular dynamics. The biological activity of RIKL was further studied by assessing its antimicrobial activity, hemolytic activity, eukaryotic cytotoxicity, and salt ion stability. CD results showed that RIKL presented an α-helical structure in a simulated bacterial membrane environment. Molecular dynamics simulation predicted that the secondary structure of RIKL could be partly retained in water and POPG environment, while this secondary structure was weakened in the POPC environment. Antimicrobial test suggested that RIKL had high antimicrobial activities, and the geometric mean of the Minimum Inhibitory Concentration (MIC) was 3.1 μmol/L. The hemolysis indicated that RIKL had no hemolytic activity within the detection range, and cytotoxicity test suggested the cytotoxicity of RIKL was low. Stability test showed that RIKL maintained antimicrobial activities under different pH, serum concentrations and salt environments. Based on the above results, RIKL has high cell selectivity and has the potential as a highly effective antibacterial drug.

Study on the effect of structural authorization on horizontal violence among operating room nurses / 中国实用护理杂志

Objective:To investigate the status of horizontal violence between structural authorization and operating room nurses, and to analyze the influence of structural authorization on horizontal violence among operating room nurses, and to provide reference for improving the occurrence of horizontal violence among nurses in operating room.Methods:From May to June 2019, a convenient sampling method was used to select 198 operating room nurses from 4 third-grade hospitals in Beijing as the research object. The general data questionnaire, structural authorization scale, and horizontal violence questionnaire were used. Questionnaire.Results:The total score of structural authorization scale was (55.37±9.78) points. The total score of horizontal violence among nurses in operation room was (54.69±9.38) points. The structural authorization was negatively correlated with the horizontal violence between nurses in the operating room ( r=-0.786, P<0.05). Conclusion:Structural authorization can affect horizontal violence among nurses in the operating room. The head nurse should construct a positive working environment that is conducive to authorization, thus effectively reducing the occurrence of horizontal violence among nurses.

Role of intestinal microbiota and metabolites in inflammatory bowel disease / 中华医学杂志(英文版)

OBJECTIVE@#The metabolites produced by the gut microbiota are of interest to scientists. The objective of this review was to provide an updated summary of progress regarding the microbiota and their metabolites and influences on the pathogenesis of inflammatory bowel disease (IBD).@*DATA SOURCES@#The author retrieved information from the PubMed database up to January 2018, using various combinations of search terms, including IBD, microbiota, and metabolite.@*STUDY SELECTION@#Both clinical studies and animal studies of intestinal microbiota and metabolites in IBD were selected. The information explaining the possible pathogenesis of microbiota in IBD was organized.@*RESULTS@#In IBD patients, the biodiversity of feces/mucosa-associated microbiota is decreased, and the probiotic microbiota is also decreased, whereas the pathogenic microbiota are increased. The gut microbiota may be a target for diagnosis and treatment of IBD. Substantial amounts of data support the view that the microbiota and their metabolites play pivotal roles in IBD by affecting intestinal permeability and the immune response.@*CONCLUSIONS@#This review highlights the advances in recent gut microbiota research and clarifies the importance of the gut microbiota in IBD pathogenesis. Future research is needed to study the function of altered bacterial community compositions and the roles of metabolites.

Combination of mRNA of Repair-related Genes in Rat Skeletal Muscles for Wound Age Estimation / 法医学杂志

Objective To investigate the estimation of early and mid-term wound age by a combination of four mRNAs, the DNA polymerase delta-interacting protein 3 （POLDIP3） mRNA, regulator of chromosome condensation 1 like （RCC1L） mRNA, proline-rich 5 （PRR5） mRNA, and ribonucleic acid export 1 （RAE1） mRNA in rats skeletal muscles. Methods The model of rat skeletal muscle contusion was established, and then contusion area muscle tissue was extracted 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44 and 48 h after injury. Histomorphological changes during the repair process after rat skeletal muscle contusion were observed. The relative expressions of Poldip3, Rcc1l, Prr5 and Rae1 mRNAs were detected by reverse transcription real-time quantitative polymerase chain reaction （RT-qPCR）. Different stages of wound age were classified by using the expression patterns of four genes at various time points after injury. The accuracy of the results was verified by Fisher discriminant analysis. Results Histomorphological results showed that the repair process after skeletal muscle contusion occurred with the prolonging of time. Through combination of the expression trends of the four kinds of mRNAs, the 48 h after injury could be divided into three periods, 4-12 h, 16-28 h and 32-48 h. The Fisher discrimination method showed that the classification accuracy rates of the three periods were 83.3%, 75.0% and 73.3%, respectively. Conclusion The classification discrimination based on the relative expression of every gene has a higher accuracy, and the accuracy of wound age estimation with combination of mRNA relative expressions is higher than that with a single indicator. By combining with Fisher discrimination method, this method can be used for early and mid-term wound age estimation.

Relationship of Platelet Activation Markers and Vitamin D to Clopidogrel Resistance / 中国康复理论与实践

Objective:To explore the relationship of platelet activation markers and vitamin D to antiplatelet drug resistance in ischemic stroke patients. Methods:From June, 2017 to June, 2018, 190 patients with ischemic stroke were tested their maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA), activation of platelet CD62P and P-selectin vitamin D seven to ten days after dual antiplatelet treatment (aspirin 100 mg/d + clopidogrel 75 mg/d). According to the MPAR induced by ADP and AA, the patients were divided into resistance group and sensitive group. Results:The prevalence of aspirin resistance was 1.2%, while the prevalence of clopidogrel resistance was 24.7% (47 in the resistance group and 143 in the sensitive group). The activation of platelet CD62P (t = -5.232, P < 0.001) and the prevalence of hypertension (χ2 = 4.878, P < 0.05) were more in the resistance group than in the sensitive group, while the vitamin D concentration was less (t = 3.052, P < 0.01). There was no significant difference in P-selectin between the resistance and sensitive groups (t = -0.684, P = 0.253). Logistic regression analyses showed that hypertension (OR = 5.538, 95% CI: 1.204-25.470, P < 0.05), activation of platelet CD62P (OR = 1.082, 95% CI: 1.041-1.092, P < 0.05) and vitamin D (OR = 0.848, 95% CI: 0.755-0.953, P < 0.01) were the independent related factors for clopidogrel resistance. Conclusion:Inhibition of platelet activation and supplementation of vitamin D may help to overcome the resistance of clopidogrel.

Relationship of Platelet Activation Markers and Vitamin D to Clopidogrel Resistance / 中国康复理论与实践

Objective:To explore the relationship of platelet activation markers and vitamin D to antiplatelet drug resistance in ischemic stroke patients. Methods:From June, 2017 to June, 2018, 190 patients with ischemic stroke were tested their maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA), activation of platelet CD62P and P-selectin vitamin D seven to ten days after dual antiplatelet treatment (aspirin 100 mg/d + clopidogrel 75 mg/d). According to the MPAR induced by ADP and AA, the patients were divided into resistance group and sensitive group. Results:The prevalence of aspirin resistance was 1.2%, while the prevalence of clopidogrel resistance was 24.7% (47 in the resistance group and 143 in the sensitive group). The activation of platelet CD62P (t = -5.232, P < 0.001) and the prevalence of hypertension (χ2 = 4.878, P < 0.05) were more in the resistance group than in the sensitive group, while the vitamin D concentration was less (t = 3.052, P < 0.01). There was no significant difference in P-selectin between the resistance and sensitive groups (t = -0.684, P = 0.253). Logistic regression analyses showed that hypertension (OR = 5.538, 95% CI: 1.204-25.470, P < 0.05), activation of platelet CD62P (OR = 1.082, 95% CI: 1.041-1.092, P < 0.05) and vitamin D (OR = 0.848, 95% CI: 0.755-0.953, P < 0.01) were the independent related factors for clopidogrel resistance. Conclusion:Inhibition of platelet activation and supplementation of vitamin D may help to overcome the resistance of clopidogrel.

Clinical research of 3D-CTA in anterolateral thigh perforator flap for reconstruction of extremities / 中华整形外科杂志

Objective@#To investigate the effects of three-dimensional digital technology (3D-CTA) in repairing wounds of the limb with anterolateral thigh perforator flap.@*Methods@#From April 2014 to June 2017, 12 patients with extensive skin and soft tissue defects on extremities were selected from the Yidu Central Hospital of Weifang. Twelve patients were performed anterior femoral perforator flaps. There were 9 males and 3 females, aged from 23 to 52 years old, with the mean age of 32 years. The defects were 8 cm×3 cm to 25 cm×9 cm in size, and all of them were accompanied by bone and/or muscle exposure. Preoperative CT scan of the donor site of the free flap used to achieve the three-dimensional images of arterial blood area, in order to determine the origin, direction, classification, length, diameter and the position of pedicle perforator of the anterolateral thigh perforator flap by 3D-CTA.According to the preoperative condition of lateral circumflex femoral artery, the perforator flaps of anterolateral femoral artery on the contralateral or ipsilateral side were designed to repair the wound.@*Results@#Twelve anterolateral thigh perforator flaps have been transferred using above methods. All the flaps survived well and the donor site was directly closed.All patients were followed up for 1-6 months (mean 3 months). The appearance of flaps was satisfactory. The diameter and location of the perforator artery were measured using pre-operative digital angiography, as well as the actual value of perforator artery. Preoperative digital examination was consistent with the type of perforator found during the operation, with an accuracy of 100%.@*Conclusions@#For the soft tissue reconstruction by anterolateral thigh perforator flaps, preoperative digitization technology can identify the diameter, the type and origin of vessels, optimize the operation plan, reduce the difficulty of flap design, and reduce the risk of operation.

Improvement of thoracic umbilical flap repair the extremity giant soft-tissue defects / 中华整形外科杂志

Objective@#To investigate the clinical outcome of modified thoracic umbilical flap, spanning chest and abdomen, in repairing large soft-tissue defect of limbs.@*Methods@#From April 2012 to March 2017, 7 patients with large soft-tissue defects of limbs were admitted in the Department of Traumatic Osteopathic, Yidu Central Hospital of Weifang. The patients include 5 males and 2 females, aged from 29 to 51 years, with the mean age of 43 years. Four patients had upper limb soft-tissue defect and 3 patients were lower limb. All limbs large soft-tissue defects were treated by ultra-long thoracic umbilical flaps, spanning chest and abdomen. Epigastric artery and intercostal arteries or lateral thoracic artery were included in the flap to provide double blood supply with only one vascular anastomosis.@*Results@#All 7 flaps(30 cm×9 cm-45 cm×13 cm) survived. The followed-up period was 3 months to 1 years. There was no necrosis or infection in tendon and bone observed. The texture of flaps in 5 patients were similar to surrounding skin, or slightly thickened by 2-3 mm. One patient had slightly bloated flap due to obesity, but had no effect on limb function. All patients were satisfied with the outcome.@*Conclusions@#Modified thoracic umbilical flap is an reasonable design for the repairment of large soft-tissue defect of limbs, and easily to carry out.

Role of intestinal microbiota and metabolites in inflammatory bowel disease / 中华医学杂志(英文版)

Objective@#The metabolites produced by the gut microbiota are of interest to scientists. The objective of this review was to provide an updated summary of progress regarding the microbiota and their metabolites and influences on the pathogenesis of inflammatory bowel disease (IBD).@*Data sources@#The author retrieved information from the PubMed database up to January 2018, using various combinations of search terms, including IBD, microbiota, and metabolite.@*Study selection@#Both clinical studies and animal studies of intestinal microbiota and metabolites in IBD were selected. The information explaining the possible pathogenesis of microbiota in IBD was organized.@*Results@#In IBD patients, the biodiversity of feces/mucosa-associated microbiota is decreased, and the probiotic microbiota is also decreased, whereas the pathogenic microbiota are increased. The gut microbiota may be a target for diagnosis and treatment of IBD. Substantial amounts of data support the view that the microbiota and their metabolites play pivotal roles in IBD by affecting intestinal permeability and the immune response.@*Conclusions@#This review highlights the advances in recent gut microbiota research and clarifies the importance of the gut microbiota in IBD pathogenesis. Future research is needed to study the function of altered bacterial community compositions and the roles of metabolites.

Homogeneity of Different Functional mRNA Indicators for Wound Age Estimation / 法医学杂志

OBJECTIVES@#To explore the homogeneity level of four different functional mRNA （PUM2, TAB2, Cx45 and CHRNA1） expressions in rats with skeletal muscle contusion.@*METHODS@#The relative expressions of PUM2, TAB2, Cx45 and CHRNA1 mRNAs were detected by quantitative real-time reverse transcription-polymerase chain reaction （RT-qPCR）. The coefficient of variation （CV） of the relative expressions for different individuals in each injury group was calculated. The extreme value of CV, cumulative variability, and CVCV were compared.@*RESULTS@#A high CV of PUM2 and TAB2 mRNAs appeared on several different time points. However, the CV of Cx45 and CHRNA1 mRNAs was relatively low. The cumulative variability from high to low was PUM2, CHRNA1, TAB2 and Cx45 mRNAs. The relative expression of PUM2 mRNA was significantly higher than that of TAB2, Cx45 and CHRNA1 mRNAs （ P<0.05）. There was no statistical significance （P>0.05） in the CVCV of the relative expression of TAB2, CHRNA1 and Cx45 mRNAs.@*CONCLUSIONS@#As the mRNAs involving in biological process regulation, PUM2 and CHRNA1 mRNAs show a lowest individual homogeneity of the relative expression followed by TAB2 mRNA. As the mRNAs participating in the composition of cellular structure, Cx45 and CHRNA1 mRNAs show a high individual homogeneity of the relative expressions. The functional classification should be considered for the screening of the mRNA indicators used for wound age estimation.

Pediatric idiopathic hypereosinophilic syndrome with pulmonary embolism: a case report and review of literature / 中华儿科杂志

Objective@#To explore clinical features of idiopathic hypereosinophilic syndrome combined with pulmonary embolism.@*Method@#A retrospective analysis of a patient with idiopathic hypereosinophilic syndrome and pulmonary embolism diagnosed and treated in the Respiratory Department of Shanghai Children′s Hospital in September 2016 was performed. A literature search was performed with"Eosinophils increased, thrombosis"as the Chinese keywords in Wanfang database and"idiopathic hypereosinophilic syndrome, deep vein thrombosis"as the English key words in PubMed database. The time interval was from April 1985 to March 2017.@*Result@#The patient was 11-year-old with fever and cough. Computed tomography angiography (CTA) showed pulmonary embolism, inferior vena cava thrombosis. Ultrasound examination of the left leg demonstrated venous thrombosis. Complete blood count showed eosinophilia and thrombocytopenia. Literature found 30 articles, including eighteen case reports, twelve reviews and other types of articles. A total of 23 cases were reported, only three were pediatric cases. According to the literature that eosinophilia can damage the vascular epithelium, leading to multiple arterial and venous thromboses, anticoagulation and glucocorticoid treatments are effective.@*Conclusion@#The diagnosis of idiopathic hypereosinophilic syndrome is complicated. It may cause multiple thromboses. Anticoagulation and glucocorticoids can reduce eosinophil count and decrease its toxins which can injure vascular endothelium. The effectiveness of preventative anticoagulant therapy is unclear and requires further clinical study.

Influence of persistent concept based on strong concept on long-term hope level of patients with breast cancer surgery / 现代临床护理

Objective To investigate the effect of persistent concept based on strong concept on long-term hope of patients with breast cancer undergoing extended-concept nursing.Methods Two hundred and sixty-six patients with breast cancer were randomly divided into control group (n=62) and observation group (n=64) according to the discharge order.The routine health education and instruction were carried out plus strong concept of nursing intervention for three times during hospitalization.About 2 months after discharge the observation group was treated with the strong concept of nursing intervention (1 month,4 times) and the control group without strong concept of nursing intervention.The two groups were assessed with Hirth hope index (HHI) at discharge and six months after discharge.Results There was no significant difference in hope level between the two groups (P ＞ 0.05)at discharge.Six months after discharge,the scores of hope in the observation group were significantly higher than those in the control group (P ＜ 0.05) and with out statistical sigficance when comaparing to who at discharge(P ＞ 0.05).The HHI score of the control group 6 moths after discharge was significantly lower than that of the control group at discharge (P ＜ 0.05).Conclusion The strong concept nursing intervention during hospitalization can effectively improve the hope level of patients with breast cancer surgery.