Protein Nanotubes as Advanced Material Platforms and Delivery Systems

Protein nanotubes (PNTs) as state-of-the-art nanocarriers are promising for various potential applications both in the food and pharmaceutical industries. Derived from edible starting sources like α-lactalbumin, lysozyme, and ovalbumin, PNTs bear properties of biocompatibility and biodegradability. Their large specific surface area and hydrophobic core facilitate chemical modification and loading of bioactive substances, respectively. Moreover, their enhanced permeability and penetration ability across biological barriers such as intestinal mucus, extracellular matrix, and thrombus clot, make it promising platforms for health-related applications. Most importantly, their simple preparation processes enable large-scale production, supporting applications in the biomedical and nanotechnological fields. Understanding the self-assembly principles is crucial for controlling their morphology, size, and shape, and thus provides the ground to a multitude of applications. Here, the current state-of-the-art of PNTs including their building materials, physicochemical properties, and self-assembly mechanisms are comprehensively reviewed. The advantages and limitations, as well as challenges and prospects for their successful applications in biomaterial and pharmaceutical sectors are then discussed and highlighted. Potential cytotoxicity of PNTs and the need of regulations as critical factors for enabling in vivo applications are also highlighted. In the end, a brief summary and future prospects for PNTs as advanced platforms and delivery systems are included.

A deep-learning model using enhanced chest CT images to predict PD-L1 expression in non-small-cell lung cancer patients

AIM

To develop a deep-learning model using contrast-enhanced chest computed tomography (CT) images to predict programmed death-ligand 1 (PD-L1) expression in patients with non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

Preoperative enhanced chest CT images and immunohistochemistry results for PD-L1 expression (<1% and ≥1% were defined as negative and positive, respectively) were collected retrospectively from 125 NSCLC patients to train and validate a deep-learning radiomics model (DLRM) for the prediction of PD-L1 expression in tumours. The DLRM was developed by combining the deep-learning signature (DLS) obtained from a convolutional neural network and clinicopathological factors. The indexes of the area under the curve (AUC), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were used to evaluate the efficiency of the DLRM.

RESULTS

DLS and tumour stage were identified as independent predictors of PD-L1 expression by the DLRM. The AUCs of the DLRM were 0.804 (95% confidence interval: 0.697-0.911) and 0.804 (95% confidence interval: 0.679-0.929) in the training and validation cohorts, respectively. IDI analysis showed the DLRM had better diagnostic accuracy than DLS (0.0028 [p<0.05]) in the validation cohort. Additionally, DCA revealed that the DLRM had more net benefit than the DLS for clinical utility.

CONCLUSION

The proposed DLRM using enhanced chest CT images could function as a non-invasive diagnostic tool to differentiate PD-L1 expression in NSCLC patients.

[Effects of rapid drug sensitivity testing for multidrug-resistant bacteria on the prognosis of patients with severe intra-abdominal infection]

Objective: To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection. Methods: This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results: The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group (Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant (Z=-1.686, P=0.093). Conclusions: GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

[Treatment of open abdomen combined with entero-atmospheric fistula: A retrospective study]

Objective: The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric fistulas in open abdomen treatment. Methods: In this retrospective observational study, we collected data on 214 patients with open abdomen complicated by entero-atmospheric fistulas admitted to Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School from January 2012 to January 2021. We collected their basic characteristics, aetiology, treatment plan, and prognosis, including the durations of hospitalization and open treatment, time to resumption of enteral nutrition, duration and prognosis of definitive surgery, and overall prognosis. Results: Of the 214 patients with open abdomen complicated with entero-enteral fistulas, 23 (10.7%) died (11 of multiple organ failure caused by abdominal infection, five of abdominal cavity bleeding, four of pulmonary infection, one of airway bleeding, one of necrotizing fasciitis, and one of traumatic brain injury). The remaining 191 underwent definitive surgery at our hospital. The patients who underwent definitive surgery were predominantly male (156 patients, 81.7%); their age was (46.5±2.5) years. Trauma and gastrointestinal tumors (120 cases, 62.8%) predominated among the primary causes. The reasons for abdominal opening were, in order, severe abdominal infection (137 cases, 71.7%, damage control surgery (29 cases, 15.2%), and abdominal hypertension (25 cases, 13.1%). Temporary abdominal closure measures were used to classify the participants into a skin-only suture group (104 cases) and a skin-implant group (87 cases). Compared with the skin-implant group, in the skin-suture-only group the proportion of male patients was lower (74.7% [65/87] vs. 87.5% [91/104], χ2=5.176, P=0.023), the mean age was older ([48.3±2.0] years vs. [45.0±1.9] years, t=-11.671, P<0.001), there were fewer patients with trauma (32.2% [28 /87] vs. 58.7% [61/104), χ2=13.337, P<0.001), intensive care stays were shorter ([8.9±1.0] days vs. [12.7±1.6] days, t=19.281, P<0.001), total length of stay was shorter ([29.3±2.0] days vs. [31.9±2.0] days, t=9.021,P<0.001), there was a higher percentage of colonic fistulas (18.4% [16/87] vs. 8.7% [9/104], χ2=3.948, P=0.047), but fewer multiple fistulas (11.5% [10/87] vs. 34.6% [36/104], χ2=14.440, P<0.001). As to fistula management, a higher percentage of fistula sealing methods using 3D-printed intestinal stents were implemented in the skin-only suture group (60.9% [53/87] versus 43.3% [45/104], χ2=5.907, P=0.015). Compared with the implant group, the skin-only suture group had a shorter mean time to performing provisional closure ( [9.5±0.8] days vs. [16.0±0.6] days, t=66.023, P<0.001), shorter intervals to definitive surgery ( [165.0±10.7] days vs. [198.9±8.3] days, t=26.644, P<0.001), and less use of biopatches (56.3% [49/87) vs. 71.2% [74/104], χ2=4.545, P=0.033). Conclusions: Open abdomen complicated with entero-enteral fistulas is more common in male, and is often caused by trauma and gastrointestinal tumor. Severe intra-abdominal infection is the major cause of open abdomen, and most fistulae involves the small intestine. Collection and retraction of intestinal fluid and 3D-printed entero-enteral fistula stent sealing followed by implantation and skin-only suturing is an effective means of managing entero-enteral fistulas complicating open abdominal cavity. Earlier closure of the abdominal cavity with skin-only sutures can shorten the time to definitive surgery and reduce the rate of utilization of biopatches.

[Membrane anatomy-based splenic hilar lymph node dissection for gastric cancer]

There is a consensus that selectively perform splenic lymph node dissection is necessary for high-risk patients with proximal gastric cancer to achieve radical treatment. However, there are still some outstanding issues that need to be solved during the practice of splenic lymph node dissection. These include poorly defined boundaries, technical difficulties, and blurred boundaries in No. 10 and No. 11 lymph nodes, etc. Membrane anatomy has achieved successful applications in the field of gastric and colorectal surgery in recent years. The study of membrane anatomy in the splenic hilum region is controversial due to the special location of the splenic hilum, which involves multiple organs and affiliated mesentery undergoing complex rotation, folding, and fusion during embryonic development. In this manuscript, we summarize the following points based on existing research and personal experience regarding membrane anatomy. 1. There is a membrane anatomical structure that can be used for lymph node dissection in the splenic hilum region. 2. The membrane structure in the splenic hilum region can be divided into two layers: the superficial layer is composed of the dorsal mesogastrium, and the deep layer is composed of Gerota fascia, the tail of the pancreas, and the mesentery of the transverse colon (from head to tail). 3. There is a loose space between the two layers that can be used for separation during surgery. The resection of the dorsal mesogastrium belongs to D2 dissection. The No. 10 lymph node in the deeper layer belongs to the duodenal mesentery, and the resection of the No.10 lymph node exceeds D2 dissection. The complete excision of the gastric dorsal mesentery is consistent with the D2+CME surgical mode proposed by Gong Jianping's group.

[Application value of serum protein indicators in constructing the early prediction model for the prognosis of patients with pulmonary tuberculosis]

Objective: To analyze the clinical significance of laboratory examination indicators as the key prognostic factors and to construct an early prediction model for prognosis assessment of pulmonary tuberculosis patients. Methods: The basic information, biochemical indexes and blood routine items of 163 tuberculosis patients (144 males and 19 females, aged 41-70 years, with an average age of 56 years) and 118 healthy persons who underwent physical examination (101 males and 17 females, aged 46-64 years, with an average age of 54 years) in Suzhou Fifth People's Hospital from January 2012 to December 2020 were retrospectively collected. According to the presence of Mycobacterium tuberculosis after six months of treatment, the enrolled patients were divided into a cured group (96 cases) and a treatment failure group (67 cases). To analyze the baseline levels of laboratory examination indicators between these two groups, we screened the key predictors and the binary logistic regression method in SPSS statistics software was used to construct the prediction model. Results: The baseline levels of total protein, albumin, prealbumin, glutamic-pyruvic transaminase, erythrocyte, hemoglobin and lymphocyte were significantly higher in the cured group than in the treatment failure group. After 6 months of treatment, the indexes of total protein, albumin and prealbumin increased significantly in the cured group, but remained at the low levels in the treatment failure group. Receiver operating characteristic (ROC) curve analysis showed that total protein, albumin and prealbumin as independent predictors for forecasting the prognosis of pulmonary tuberculosis patients had the highest prediction accuracy. Logistic regression analysis showed that the combination of these three key predictors could construct the best early prediction model for assessing the prognosis of pulmonary tuberculosis patients, with a prediction accuracy of 0.924 (0.886-0.961), sensitivity of 75.0%, specificity of 94%, showing an ideal prediction accuracy. Conclusions: The routine test indexes of total protein, albumin and prealbumin show good application value in the construction of early prediction model for prognosis evaluation of pulmonary tuberculosis treatment. The combined prediction model consisting of total protein, albumin and prealbumin is expected to provide a theoretical basis and reference model for precision treatment and prognosis assessment of tuberculosis patients.

[Relationship between cadmium exposure and pulmonary function level and chronic obstructive pulmonary disease]

Objective: To analyze the levels and distribution characteristics of blood cadmium and urinary cadmium in American adults, to analyze the relationship between blood cadmium and urinary cadmium and pulmonary function dose response, and to explore the effect of this index on the risk of chronic obstructive pulmonary disease. Methods: In March 2022, 3785 patients from 2007 to 2012 in NHANES database were selected as the subjects. Collect demography data such as gender and age, and test data such as lung function, blood cadmium concentration and Urine cadimium concentration. The relationship between blood and urine cadmium levels and lung function and pulmonary function and chronic obstructive pulmonary diease (COPD) was analyzed by Mann-Whitney U test or Kruskal-Wallis H test, multivariate linear regression and restricted cubic spline method. Results: The geometric mean of blood cadmium and urine cadmium in American adults was 0.37 g/L and 0.28 g/L, FEV(1) and FEV(1)/FVC among different cadmium exposure groups was statistically significant, and there was a negative linear dose-response relationship between serum Cd and urine Cd concentrations and FEV(1)/FVC levels (P(overall)<0.001, P(non-linear)=0.152; P(overall)<0.001, P(non-linear)=0.926). Compared with the lowest quartile concentration (Q1), the highest quartile blood cadmium concentration (Q4) (OR=1.934, P(trend)=0.000) and urinary cadmium concentration (OR=1.683, P(trend)=0.000) may increased the risk of chronic obstructive pulmonary disease. Conclusion: There is a negative correlation between blood cadmium, urinary cadmium levels and lung function in American adults, and cadmium may increase the risk of chronic obstructive pulmonary disease.

[Regulatory effects of bio-intensity electric field on microtubule acetylation in human epidermal cell line HaCaT]

Objective: To investigate the regulatory effects of bio-intensity electric field on directional migration and microtubule acetylation in human epidermal cell line HaCaT, aiming to provide molecular theoretical basis for the clinical treatment of wound repair. Methods: The experimental research methods were used. HaCaT cells were collected and divided into simulated electric field group (n=54) placed in the electric field device without electricity for 3 h and electric field treatment group (n=52) treated with 200 mV/mm electric field for 3 h (the same treatment methods below). The cell movement direction was observed in the living cell workstation and the movement velocity, trajectory velocity, and direction of cosθ of cell movement within 3 h of treatment were calculated. HaCaT cells were divided into simulated electric field group and electric field treatment 1 h group, electric field treatment 2 h group, and electric field treatment 3 h group which were treated with 200 mV/mm electric field for corresponding time. HaCaT cells were divided into simulated electric field group and 100 mV/mm electric field group, 200 mV/mm electric field group, and 300 mV/mm electric field group treated with electric field of corresponding intensities for 3 h. The protein expression of acetylated α-tubulin was detected by Western blotting (n=3). HaCaT cells were divided into simulated electric field group and electric field treatment group, and the protein expression of acetylated α-tubulin was detected and located by immunofluorescence method (n=3). Data were statistically analyzed with Kruskal-Wallis H test,Mann-Whitney U test, Bonferroni correction, one-way analysis of variance, least significant difference test, and independent sample t test. Results: Within 3 h of treatment, compared with that in simulated electric field group, the cells in electric field treatment group had obvious tendency to move directionally, the movement velocity and trajectory velocity were increased significantly (with Z values of -8.53 and -2.05, respectively, P<0.05 or P<0.01), and the directionality was significantly enhanced (Z=-8.65, P<0.01). Compared with (0.80±0.14) in simulated electric field group, the protein expressions of acetylated α-tubulin in electric field treatment 1 h group (1.50±0.08) and electric field treatment 2 h group (1.89±0.06) were not changed obviously (P>0.05), while the protein expression of acetylated α-tubulin of cells in electric field treatment 3 h group (3.37±0.36) was increased significantly (Z=-3.06, P<0.05). After treatment for 3 h, the protein expressions of acetylated α-tubulin of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 300 mV/mm electric field group were 1.63±0.05, 2.24±0.08, and 2.00±0.13, respectively, which were significantly more than 0.95±0.27 in simulated electric field group (P<0.01). Compared with that in 100 mV/mm electric field group, the protein expressions of acetylated α-tubulin in 200 mV/mm electric field group and 300 mV/mm electric field group were increased significantly (P<0.01); the protein expression of acetylated α-tubulin of cells in 300 mV/mm electric field group was significantly lower than that in 200 mV/mm electric field group (P<0.05). After treatment for 3 h, compared with that in simulated electric field group, the acetylated α-tubulin of cells had enhanced directional distribution and higher protein expression (t=5.78, P<0.01). Conclusions: Bio-intensity electric field can induce the directional migration of HaCaT cells and obviously up-regulate the level of α-ubulin acetylation after treatment at 200 mV/mm bio-intensity electric field for 3 h.

[Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle]

Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

[Systematic review of gut microbiota changes in patients with chronic heart failure]

Objective: To analyze the changes on gut microbiota and metabolic products in patients with chronic heart failure. Methods: By searching the Pubmed, EMBASE, Cochrane Library, and CNKI, Wanfang, and CMB databases from the day of built up to December 2019, we screened related literature exploring the intestinal flora of chronic heart failure patients, and systematic review was performed to study changes in intestinal flora composition, function, and metabolites among chronic heart failure patients. Results: A total of 10 articles were included to study the gut microbiota of patients with chronic heart failure in this analysis. The systematic review showed significant changes in β-diversity in patients with heart failure. The abundance of faecalibacterium, blautia, bacteroides, prevotella and anaerostipes was decreased, while the abundance of streptococcus, escherichia/shigella, veillonella, and enterobacte was increased. The increased microbial gene function in patients with heart failure included tryptophan metabolism, lipid metabolism, LPS synthesis,and so on, especially, bacterial genes related to trimethylamine oxide production increased significantly, while genes related to key enzymes producing the beneficial metabolite butyrate decreased significantly, and harmful metabolite trimethylamine oxide levels increased in chronic heart failure patients. Conclusion: There are significant changes in the structure, function and metabolites of intestinal flora in patients with chronic heart failure.

[Effects and molecular mechanism of histone deacetylase 6 inhibitor Tubastatin A on the prolifera- tion and movement of human skin fibroblasts]

Objective: To explore the effects and possible molecular mechanism of histone deacetylase 6 (HDAC6) inhibitor Tubastatin A on the proliferation and movement of human skin fibroblasts (HSFs). Methods: The experimental research method was used. HSFs in logarithmic growth phase were taken and divided into negative control group, 1 μmol/L Tubastatin A group, 5 μmol/L Tubastatin A group, and 10 μmol/L Tubastatin A group according to the random number table. The HSFs in negative control group were added with Dulbecco's modified eagle medium with the final volume fraction of 0.1% dimethyl sulfoxide (hereinafter referred to as the complete medium), and the other three groups were added with the complete medium with the corresponding final molarity of Tubastatin A. After 24 h of conventional culture, the cell proliferation activity was detected using cell counting kit 8 (CCK-8) method and 5-ethynyl-2'-deoxyuridine (EdU) staining; the range of motion of cells within 3 h was observed under the living cell workstation, and the curve movement velocity of the cells was calculated. The protein expressions of extracellular signal-regulated kinase 1/2 (ERK1/2) and phosphorylated ERK1/2 (p-ERK1/2) were detected by Western blotting, and the ratio of p-ERK1/2 to ERK1/2 was calculated to represent the activity of ERK1/2. The sample number in cell proliferation activity detection with CCK-8 method was 6, while the sample numbers in other experiments were 3. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results: After 24 h of culture, CCK-8 method and EdU staining showed that compared with negative control group, the cell proliferation activities in 1 μmol/L Tubastatin A group, 5 μmol/L Tubastatin A group, and 10 μmol/L Tubastatin A group were significantly decreased (P<0.01). After 24 h of culture, CCK-8 method showed that compared with 1 μmol/L Tubastatin A group, the cell proliferation activity in 10 μmol/L Tubastatin A group was significantly decreased (P<0.05); EdU staining showed that compared with 1 μmol/L Tubastatin A group, the cell proliferation activities in 5 μmol/L Tubastatin A group and 10 μmol/L Tubastatin A group were significantly decreased (P<0.05 or P<0.01). Within 3 h of observation, the ranges of cell motion in 1 μmol/L Tubastatin A group, 5 μmol/L Tubastatin A group, and 10 μmol/L Tubastatin A group were obviously reduced compared with that in negative control group. Within 3 h of observation, the curve movement velocity of cells in negative control group was (0.780±0.028) μm/min, which was obviously faster than (0.594±0.023), (0.469±0.028), and (0.391±0.021) μm/min of 1 μmol/L Tubastatin A group, 5 μmol/L Tubastatin A group, and 10 μmol/L Tubastatin A group (P<0.01); the curve movement velocity of cells in 1 μmol/L Tubastatin A group was obviously faster than those in 5 μmol/L Tubastatin A group and 10 μmol/L Tubastatin A group (P<0.01); the curve movement velocity of cells in 5 μmol/L Tubastatin A group was obviously faster than that in 10 μmol/L Tubastatin A group (P<0.05). After 24 h of culture, compared with negative control group, the activities of ERK1/2 of cells in 1 μmol/L Tubastatin A group, 5 μmol/L Tubastatin A group, and 10 μmol/L Tubastatin A group were decreased significantly (P<0.01); compared with 1 μmol/L Tubastatin A group, the activities of ERK1/2 of cells in 5 μmol/L Tubastatin A group and 10 μmol/L Tubastatin A group were decreased significantly (P<0.01); compared with 5 μmol/L Tubastatin A group, the activity of ERK1/2 of cells in 10 μmol/L Tubastatin A group was decreased significantly (P<0.05). Conclusions: HDAC6 inhibitor Tubastatin A may mediate the inhibitory effect on proliferation and movement of HSFs by inhibiting the activity of ERK1/2.

[Surveillance and genetic characteristics of imported cases of measles virus of D8 genotype in Hebei province]

Objective: To understand the epidemiological and genotypic characteristics of imported cases of measles virus of D8 genotype in Hebei province. Methods: Epidemiological investigation of measles cases in surveillance was carried out. The throat swabs of the measles cases in acute phase were collected for real time RT-PCR identification, measles virus culture and genotype identification. Results: A total of 36 imported measles cases of genotype D8 were detected. The cases were mainly distributed in 8 counties of Handan city. Number of confirmed measles cases in Cheng'an county was the highest, accounting for 58.33% (21/36) of all the reported cases. All patients had fever and rash, and 55.55% (20/36) of the cases were under 2 years old and 86.11% (31/36) of the cases had no immunization history. The children with pneumonia accounted for 44.12% (15/34) of the total children with D8 genotype measles virus infection. The nucleotide and amino acid homologies between the imported measles virus genotype D8 and the WHO reference strain of D8 genotype (D8-Manchester.UNK/30.94) were 98.4%-98.6% and 97.3%, respectively. Compared with the strains of H1 genotype in China, the nucleotide and amino acid homologies were 92.8%-93.1% and 93.3%, respectively. Conclusions: The imported cases of measles virus of D8 genotype might have caused local transmission in Hebei province. Molecular epidemiological surveillance for measles virus needs to be further strengthened. It is necessary to detect and control the epidemic early and improve the coverage rate and timely rate of measles vaccination. It is also important to prevent cross infection in hospitals.

[CART therapy followed by allo-HSCT for patients with B-cell acute lymphoblastic leukemia relapsing after the first hematopoietic stem cell transplantation]

目的

观察嵌合抗原受体T细胞（CART）序贯二次异基因造血干细胞移植（allo-HSCT）治疗移植后复发急性B淋巴细胞白血病（B-ALL）的疗效。

方法

回顾性分析2015年10月至2020年6月在河北燕达陆道培医院接受二次allo-HSCT的41例B-ALL患者的临床资料，入选患者均为移植后骨髓形态学或髓外复发且二次移植前接受CART治疗。

结果

全部41例患者中男21例、女20例，二次移植时中位年龄为16（3～46）岁。移植后骨髓复发31例（75.6％）、髓外复发5例（12.2％）、骨髓和髓外复发5例（12.2％）。复发后接受CD19-CART治疗35例（85.4％）、CD22-CART治疗2例（4.9％）、CD19-CART联合CD22-CART治疗4例（9.8％）。二次移植后预期3年总生存（OS）率为48.9％（95％ CI 23.0％～70.6％）、无白血病生存（LFS）率为41.8％（95％ CI 17.3％～64.9％），累积复发率（RI）为8.8％（95％ CI 2.9％～26.4％），非复发相关死亡率（NRM）为51.1％（95％ CI 31.2％～83.6％）。首次移植后复发时间≤6个月组（10例）二次移植后1年OS率低于复发时间>6个月组（31例）［45.0％（95％ CI 12.7％～73.5％）对75.0％（95％ CI 51.4％～88.8％），P＝0.017］。

结论

CART序贯二次allo-HSCT可使部分造血干细胞移植后复发B-ALL患者获得长生存，但NRM较高，移植方案有待进一步改进。

[Comparison of the clinical outcomes of haploidentical and matched-sibling donor stem cell transplantation for T cell acute lymphoblastic leukemia in complete remission]

目的

比较亲缘单倍型造血干细胞移植（HIDT）和同胞相合造血干细胞移植（MSDT）治疗完全缓解期（CR）急性T淋巴细胞白血病（T-ALL）的疗效。

方法

回顾性分析2012年5月至2017年5月间在河北燕达陆道培医院接受HIDT（81例）和MSDT（17例）的CR期T-ALL患者的临床特点和预后。

结果

HIDT组、MSDT组移植后100 d Ⅱ～Ⅳ度急性GVHD发生率分别为51.9％（95％CI42.0％～64.0％）、29.4％（95％CI 14.1％～61.4％）（P＝0.072），Ⅲ/Ⅳ度急性GVHD发生率分别为9.8％（95％CI 5.1％～19.1％）、11.8％（95％CI 3.2％～43.3％）（P＝1.000），巨细胞病毒（CMV）血症发生率分别为53.1％（95％CI 43.3％～65.2％）、29.4％（95％CI 14.1％～61.4％）（P＝0.115），EB病毒（EBV）血症发生率分别为35.8％（95％CI 26.8％～47.9％）、11.8％（95％CI 3.2％～43.3％）（P＝0.048）。HIDT、MSDT两组移植后5年总生存（OS）率分别为60.5％（95％CI 5.4％～49.0％）、68.8％（95％CI 11.8％～40.0％）（P＝0.315），无白血病生存（LFS）率分别为58.0％（95％CI 5.5％～46.5％）、68.8％（95％CI11.8％～40.0％）（P＝0.258），累积复发率分别为16.1％（95％ CI 9.8％～26.4％）、11.8％（95％ CI3.2％～43.3％）（P＝0.643），非复发死亡率（NRM）分别为25.9％（95％CI 17.9％～37.5％）、19.4％（95％CI6.9％～54.4％）（P＝0.386）。

结论

对于CR期T-ALL患者，当缺乏合适供者时，HIDT可作为替代选择。

[Investigation and clinical analysis of a family with germline CEBPA mutations in acute myeloid leukemia]

目的

探讨伴CEBPA基因突变的家族性急性髓系白血病（AML）的临床特征、病因及转归，提高对家族性白血病的认识。

方法

调查一个伴CEBPA基因突变AML家系患者的发病年龄、临床特征、转归及预后并绘制家系谱。对先证者采集骨髓及口腔黏膜细胞，与先证者有血缘关系的亲属，采集外周血，通过基因测序技术检测基因突变。

结果

该家系共有10人诊断为AML，其中男4例，女6例，中位年龄9（3～48）岁。10例患者中，6例死亡，其中4例未进行治疗，1例患者化疗后生存3年复发死亡，1例采取中药及支持治疗生存2年后死亡。4例患者生存，1例接受化疗患者生存达15年，3例患者接受化疗联合造血干细胞移植，至随访截止，生存时间分别为6、9、28个月。对先证者及8名与先证者有血缘关系的亲属进行基因测序，发现5例存在胚系CEBPA TAD p.G36Afs*124突变，其中4例确诊为AML，1例随访至今未发病。

结论

伴CEBPA基因突变的家族性AML多在儿童及青壮年期发病，具有完全或接近完全的外显率，通过积极治疗，大多预后良好。

Relationships between resilience and quality of life in parents of children with cancer

CLINICALTRIALS.GOV ID

NCT03631485.

[Analysis of the effect of transgluteal percutaneous drainage in the treatment of deep pelvic abscess]

Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) μg/L, 122.2 (55.8, 226.0) μg/L, 59.2 (29.0,203.5) μg/L and 64.1 (30.0,88.4) μg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.

CXCL-10/CXCR3 in macrophages regulates tissue repair by controlling the expression of Arg1, VEGFa and TNFα

Macrophages have been reported to participate in inflammation, tissue homeostasis and tissue repair. The detailed mechanism of macrophage-mediated tissue repair is not clear. CXCL-10, secreted by monocytes, endothelial cells and fibroblasts, mediates immune response and angiogenesis by binding to CXCR3. In this study, the expression of CXCL-10 and CXCR3 in porcine lung injury induced by porcine reproductive and respiratory syndrome virus (PRRSV) infection was firstly examined. The results showed that the expression of both CXCL-10 and CXCR3 increased in the infected pig lungs. In addition, the increased expression of CXCL-10 and CXCR3 in macrophage treated by poly (I:C) was also observed, suggesting the autocrine system existed in macrophages. Furthermore, CXCL-10 treatment induced upregulation of Arg1 and VEGFa, and downregulation of TNFα in macrophage, and CXCR3 antagonist AMG487 treatment presented the contrary effects on the expression of Arg1, VEGFa, and TNFα. CXCL- 10-stimulated effects were dependent on PI3K/Akt signaling pathway. Wound-healing assay showed that CXCL-10 treatment macrophage conditioned medium promoted the healing process of endothelial cells. Our results suggested that CXCL-10/CXCR3 in macrophage may mediate tissue repair by regulating the macrophage expression of Arg1, VEGFa and TNFα. Modulation of CXCL-10/CXCR3 axis in macrophage may be a potential therapeutic strategy for tissue injury and repair.

[Prognostic analysis of allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in complete remission in the era of tyrosine kinase inhibitors]

目的

探讨在酪氨酸激酶抑制剂（TKI）时代Ph染色体阳性急性淋巴细胞白血病（Ph⁺ALL）在完全缓解（CR）状态下行异基因造血干细胞移植（allo-HSCT）的预后和影响因素。

方法

回顾性分析2012年5月至2017年5月河北燕达陆道培医院收治的116例在CR状态下行allo-HSCT的Ph⁺ALL患者的预后及其影响因素。

结果

116例患者中男72例，女44例。中位年龄20（4～64）岁。同胞全相合移植21例，亲缘单倍型移植77例，非血缘移植18例。5年总生存（OS）率为73.2％（95％CI 63.8％～80.5％），其中诊断至移植间隔时间<180 d的亚组5年OS率为87.5％。5年无病生存（DFS）率为61.4％（95％CI 51.8％～69.7％）。5年细胞形态及分子学水平复发累积发生率为18.5％（95％CI 12.6％～27.3％）。5年移植相关死亡率（TRM）为19.9％（95％CI 13.8％～28.7％）。多因素分析显示，15～39岁（HR＝2.730，P＝0.044）、诊断至移植间隔时间≥180 d（HR＝4.534，P＝0.010）、发生Ⅲ～Ⅳ度急性移植物抗宿主病（aGVHD）（HR＝7.558，P＝0.000）是影响患者OS的不利因素；发生局限型慢性移植物抗宿主病（cGVHD）是影响患者OS的有利因素（HR＝0.300，P＝0.034）。而性别、起病时WBC（<30×10⁹/L，≥30×10⁹/L）、BCR-ABL融合基因类型、体细胞突变类型、移植前状态（CR₁，>CR₁）、移植前微小残留病（MRD）水平（MRD阴性，MRD阳性）、预处理方案（全身照射方案，白消安为基础方案）、预处理方案强度、移植类型、GVHD预防方案（环孢素A，他克莫司）、抗胸腺细胞免疫球蛋白的种类、巨细胞病毒和EB病毒血症的有无对OS的影响无统计学意义。

结论

TKI时代Ph⁺ALL在CR状态下行allo-HSCT时，影响生存的因素有年龄、诊断至移植间隔时间和发生重度aGVHD。

[Application of membrane anatomy in key technologies during gastric cancer surgery: guidance and compromise]

Different from classical surgical anatomy which only pays attention to the morphology and structure of human organs, modern membrane anatomy focuses on not only the relationship between morphology and structure, but also the biological behavior characteristics of tumors. Membrane antomy is a theoretical system with interpretation on both the structural and disease function, so it has been accepted by more and more gastrointestinal surgeons. However, the theoretical system of gastric membrane anatomy is not mature yet. The stomach and its mesentery have undergone complex rotation and fusion in the process of embryonic development, so that surgeons have different understandings of the gastric membrane anatomy. Therefore, it is easy to cause various confusion and misunderstanding, resulting in deviations between the theory of membrane anatomy and the practice of surgery. In the present study, the mesentery of the stomach is divided into different regions, and the embryonic development process is traced back. The application and compromise encountered in the radical gastrectomy of gastric cancer will be expounded according to the membrane anatomy theory combined with the author's experience of operation.

[Depletion of PRDM9 inhibited the osteogenic differentiation potential of periodontal ligament stem cells]

Objective: To investigate the effect of PR domain zinc finger protein 9 (PRDM9), one of the histone methylated transferases, on osteogenic differentiation ability of periodontal ligament mesenchymal stem cells (PDLSC). Methods: PDLSC with PRDM9 gene knocked down by PRDM9 shRNA using recombinant lentiviral vector were allocated into the PRDM9sh group, and the transfected shRNA was as the control group. The gene expression efficiency was evaluated by reverse transcription polymerase chain reaction (RT-PCR). Alkaline phosphatase activity (ALP), alizarin red staining, mineralization and osteocalcin, which belongs to osteogenic differentiation markers detected by RT-PCR and Western blotting to detect the osteogenic differentiation ability of stem cells from periodontal ligaments in vitro. In vivo, PRDM9sh and control group cells was transplanted into the dorsal dermal to explore the osteogenesis. The area percentage of new osteogenic tissue was calculated by image pro software and statistically analyzed. Results: RT-PCR results showed that the relative expression of PRDM9 gene in PRDM9sh (0.460±0.017) was significantly lower than that in control group (1.000±0.107) (P<0.05). The results of ALP activity determined at 5 days postinduction in a significant decrease in PRDM9sh cells (0.762±0.063) compared with control group (1.225±0.058) (P<0.01). Alizarin red staining induced by osteogenesis at 2 weeks and 3 weeks showed that the staining of PRDM9sh was significantly lighter than that in control group. Quantitative calcium analysis results showed that the calcium ion concentration induced by osteogenesis at 2 weeks and 3 weeks [(0.071±0.004), (0.075±0.001)] in PRDM9sh was significantly lower than that in control group at 2 weeks and 3 weeks [(0.282±0.006), (0.485+0.004)] (P<0.01). RT-PCR results showed that the relative expression of osteocalcin mRNA in PRDM9sh (1.059±0.148) was significantly lower than that in control group at 2 weeks (2.542±0.190) (P<0.01). Western blotting results showed that osteocalcin expression in PRDM9sh was significantly lower than that in control group at 1 and 2 weeks after osteogenesis induction. Animal transplantation experiments results indicated that PRDM9 significantly inhibited the osteogenesis of PDLSC in vivo, and the proportion of osteogenic area calculated showed that the osteogenic capacity of PRDM9sh [(3.8±2.41)%] was significantly lower than that in control group [(24.54±7.06)%](P<0.05). Conclusions: Depletion of PRDM9 repressed the osteogenic differentiation of stem cells from periodontal ligament in vitro and in vivo.

Reduced c-Fos expression in orexin neurons of the lateral hypothalamic area and the locus coeruleus following injection of spinosin into mice

BACKGROUND

Spinosin, a major component of Samen Ziziphi spinosae, has been shown to modulate sedation and hypnosis; however, the underlying neuronal mechanisms of its stimulatory effects remain unclear.

MATERIALS AND METHODS

In the present study, we injected spinosin (15 mg/kg) or saline into mice, which were killed after 90 min. We isolated the brains, which were immunohistochemically stained for c-Fos as a biomarker for neuronal activation and assessed the expression profile of c-Fos in various sleep-arousal brain areas.

RESULTS

Our findings revealed that there were no statistically significant differences in the expression of c-Fos in the nucleus accumbens and ventrolateral preoptic area, the vertical limb of the diagonal band nucleus, horizontal limb of the diagonal band nucleus, ventral tuberomammillary nucleus, ventral tegmental area, and dorsal raphe nucleus relative to saline between saline and spinosin-treated mice. Unlike saline, spinosin markedly decreased c-Fos expression in the lateral hypothalamic area (LHA) as well as the locus coeruleus (LC). Compared to the saline injection, the application of spinosin also resulted in a marked decrease in c-Fos expression in the LHA orexin neurons.

CONCLUSIONS

These findings suggest that spinosin administration results in a restricted pattern of c-Fos expression within the LHA orexin neurons and the LC, suggesting that this particular neuronal inactivation contributes to sedation and hypnosis.

[Practical membrane anatomy of en bloc mesogastrium excision in lymph node dissection of gastric cancer]

Gastric cancer is a common malignant tumor of digestive system. D2 procedure is recognized as the standard operation for advanced gastric cancer at present. However, controversies still exist in the standardization and quality control of surgical procedures. Total mesorectal excision (TME) and complete mesocolic excision (CME) based on the membrane anatomy perfectly solve these problems in the treatment for colorectal cancer. However, the complexity of mesogastrium determines that TME and CME cannot be easily transplanted to the treatment of gastric cancer. The practical membrane anatomy in gastric cancer surgery is just emerging and its impact on the treatment of gastric cancer is immeasurable. By reviewing the evolution and embryonic development of digestive system, and combining with actual operation, this paper analyzes and redefines several key issues such as traditional Toldt space, Gerota fascia and complete mesenteric excision. On this basis, we propose a novel and feasible surgical procedure named regional en bloc mesogastrium excision (rEME) for distal gastric cancer. The concept of en bloc mesogastrium excision (EME) based on membrane anatomy may have some influences on the lymph node grouping from the 'Japanese Classification of Gastric Carcinoma'. Performance of EME may reduce the controversies about the group of lymph nodes and their borders. EME in the infra-pyloric region weakens the significance of subdivision of No.6 lymph nodes into No.6a, No.6v and No.6i. More studies are needed in the construction of a mature theoretical system for practical membrane anatomy in gastric surgery.

A chemical kinetic model for Ca2+ induced spontaneous oscillatory contraction of myocardium

The Ca²⁺ induced Spontaneous Oscillatory Contraction (Ca-SPOC) of cardiac myofibrils oscillate with a period similar to resting heartbeat of several animal species, and its auto-oscillatory properties set the basic rhythm of cardiac contraction. To explain the dynamics of Ca-SPOC, the present paper constructs a novel chemical kinetical model based upon the cooperative behavior between the two heads of myosin II dimer, also considering the reaction-diffusion effect of ATP inside myocardial fibers. The simulation results show that the concentration of ATP inside myocardial fibers oscillates over time under some special conditions, together with the proportions of myosin II dimers in different states periodically changing with time, which contributes to produce the sustained oscillations of contractive tension. These results indicate that the SPOC of muscles may be partly due to chemical oscillation involved in the actomyosin ATPase cycle, which has been ignored by the previous theoretical studies.

[Clinical characteristics and prognosis of 34 cases of acute myeloid leukemia with FLT3 internal tandem duplication and MLL gene rearrangement]

目的

探讨同时伴FLT3-ITD突变及MLL基因异常的急性髓系白血病（AML）患者的临床特征及转归。

方法

回顾性分析34例同时伴FLT3-ITD突变及MLL基因异常的AML患者的临床资料，比较化疗、化疗加靶向药物治疗及allo-HSCT的疗效及影响因素。

结果

34例同时伴FLT3-ITD突变及MLL基因异常的AML患者占同期住院AML患者的2.02%。入院时WBC>30×10⁹/L的患者占63.6%，其中WBC>50×10⁹/L者占39.4%。FAB亚型中以M₅比例最高，占35.3%，染色体核型异常者达63.6%，其中复杂异常占12.1%。34例患者中仅有FLT3-ITD及MLL基因异常（双基因异常）者11例（32.4%），具FLT3及MLL以外的1种及1种以上的基因异常（多基因异常）者23例（67.6%）。34例患者2个疗程完全缓解（CR）率为29.4%，7例（20.6%）化疗≥3个疗程后CR，CR患者的早期复发率为52.9%。WBC>50×10⁹/L以及多基因异常的患者2个疗程CR率较低（7.7%、5.4%），其中具有3种以上基因异常的患者无一例CR。34例患者2年总生存（OS）率为28.8%（95%CI 13.5%~46.0%），2年无病生存（DFS）率为27.1%（95% CI 12.5%~44.0%）。18例仅使用化疗或化疗加靶向药物治疗的患者，17例在2年内死亡，1例放弃治疗后失访。接受allo-HSCT治疗的患者3年OS率为43.4%（95%CI 13.7%~70.4%），3年DFS率为42.7%（95% CI 13.4%~69.7%）。

结论

同时伴FLT3-ITD突变及MLL基因异常的AML患者FAB分型以M₅多见，常伴高白细胞血症、细胞遗传学异常及多基因异常。患者化疗缓解率低，早期复发率高，长期生存率低。高白细胞血症、多基因异常可能是此类患者疗效差的重要原因，allo-HSCT可改善患者的转归。

[Multicenter epidemiological investigation of hospitalized elderly, young and middle-aged patients with severe burn]

Objective: To compare and analyze the epidemiological characteristics of hospitalized elderly, young and middle-aged patients with severe burn in recent years, so as to provide reference for the prevention and treatment of elderly patients with severe burn. Methods: Relying on the entry system of epidemiological case data and biological sample of severe burn from multicenter in clinic, medical records of patients with severe burn, aged above 18, hospitalized in 8 burn wards from January 2012 to December 2015 were collected. Six hundred and fifteen patients who were more than 18 years old and less than or equal to 65 years old were included in young and middle-aged group (YM). Eighty-two patients aged more than 65 years old were included in elderly group (E). Data of age, gender, residence, education level, cause of injury, location of injury, season of injury, total burn area, occurrence and area of full-thickness burn injury, wound site, inhalation injury incidence and severity, post burn admission time, proportion of delayed resuscitation, proportion of escharectomy or tangential excision and skin grafting, preinjury systemic disease, system complication during hospitalization, length of hospital stay, outcome of treatment, and reason of abandoning treatment of patients were analyzed. Data were processed with chi-square test and Mann-Whitney U test. The odds ratios of preinjury systemic disease, system complication during hospitalization, and adverse outcome of patients in group YM were compared with those in group E. Results: (1) The majority of patients in the two groups were male, but the proportion of male patients in group YM was higher. There was statistically significant difference in gender distribution of patients between the two groups (χ(2)=18.727, P<0.001). The majority of patients in the two groups were from rural areas, but the proportion of rural patients in group E was higher. There was statistically significant difference in residence distribution of patients between the two groups (χ(2)=9.306, P=0.002). Patients in group YM mainly had secondary education, while patients in group E mainly had primary education. There was statistically significant difference in distribution of education level of patients between the two groups (χ(2)=146.797, P<0.001). (2) The most common causes of injury of patients in the two groups were both flame, but the proportion of patients with flame burn injury in group E was higher. There was statistically significant difference in distribution of cause of injury of patients between the two groups (χ(2)=25.063, P<0.001). The main locations of injury of patients in groups YM and E were respectively public place and private residence. There was statistically significant difference in location distribution of injury of patients between the two groups (χ(2)=46.313, P<0.001). The main seasons of injury of patients in groups YM and E were respectively summer and winter. There was statistically significant difference in season distribution of patients between the two groups (χ(2)=23.143, P<0.001). There was statistically significant difference in distribution of total burn area of patients between the two groups (χ(2)=25.799, P=0.002). The occurrences of full-thickness burn injury of patients in the two groups were similar (χ(2)=2.685, P=0.101), while there was statistically significant difference in area of full-thickness burn injury of patients between the two groups (χ(2)=26.702, P=0.002). There was no statistically significant difference in distribution of wound site of patients between the two groups (χ(2)=3.954, P=0.785). There were no statistically significant differences in incidence and severity distribution of inhalation injury of patients between the two groups (with χ(2) values respectively 0.425 and 0.672, P values above 0.05). (3) There was statistically significant difference in distribution of admission time of patients between the two groups (χ(2)=6.632, P=0.036), but there was no statistically significant difference in proportion of delayed resuscitation of patients between the two groups (χ(2)=1.261, P=0.261). The proportion of escharectomy or tangential excision and skin grafting of patients in group YM was 72.0% (443/615), which was significantly higher than 35.4% (29/82) of group E (χ(2)=44.498, P<0.001). The incidence of preinjury systemic disease of patients in group YM was 13.2% (81/615), which was significantly lower than 61.0% (50/82) of group E (χ(2)=108.337, P<0.001). The risk of preinjury systemic disease of patients in group E was 10.30 times of that of patients in group YM [with 95% confidence interval (CI) of 6.24-17.01, P<0.001]. During hospitalization, 59.8% (49/82) of patients in group E suffered from system complications, which was significantly higher than 36.6% (225/615) of group YM (χ(2)=16.282, P<0.001). The risk of system complication of patients in group E was 2.57 times of patients in group YM (with 95% CI of 1.61-4.12, P<0.001). The length of hospital stay of patients in group E was significantly shorter than that of group YM (U=36 735, P<0.001). There was statistically significant difference in treatment outcome of patients between the two groups (χ(2)=106.251, P<0.001). The risk of adverse outcome of patients in group E was 7.52 times of group YM (with 95% CI of 4.40-12.88, χ(2)=67.709, P<0.001). The proportion of abandoning treatment of patients in group E was significantly higher than that of group YM (χ(2)=150.670, P<0.001). The risk of abandoning treatment of patients in group E was 15.86 times of that of group YM (with 95% CI of 9.36-26.88, P<0.001). There was no statistically significant difference in distribution of reason of abandoning treatment of patients between the two groups (χ(2)=4.178, P=0.243). Conclusions: There were significant differences in the epidemiological characteristics of patients in groups E and YM. In elderly burn patients, the proportion of rural population was higher and the education level was lower. Flame burn was common and burns mostly occurred in private residences and in winter. The total burn area was slightly lower but the area of full-thickness burn injury was larger. The length of hospital stay was shorter and the proportion of surgical treatment was lower. The incidences of preinjury systemic disease and system complication during hospitalization were higher, and therefore the risks of adverse outcome and abandoning treatment were higher.

[National experts consensus on application of silver-containing dressings in wound therapy (2018 version)]

New silver-containing dressings developed in recent years have brought new and powerful means for the prevention and treatment of wound infection, which promote development and progress of wound therapy. There are many kinds of silver-containing dressings, however, misunderstanding and even misapplication exist in how to choose and use these dressings. Based on literature evidence, we propose this national expert consensus on clinical application of silver-containing dressings, particularly in terms of kinds and mechanisms, indications, contraindications, rational selections in different wounds, and cautions in the clinical application of silver-containing dressings. This consensus would be helpful for medical and nursing personnels to use silver-containing dressings in wound repair field in clinic correctly and professionally.

[Comparison of three different types of donor hematopoietic stem cell transplantation for intermediate and high-risk myelodysplastic syndrome]

目的

比较半相合移植（Haplo-HSCT）、无关供者移植（MUD-HSCT）及同胞相合移植（MSD-HSCT）治疗中高危骨髓增生异常综合征（MDS）的疗效及其预后影响因素。

方法

回顾性分析2001年8月至2015年5月接受异基因造血干细胞移植（allo-HSCT）治疗的167例中高危MDS患者病例资料，比较不同移植方式下患者的预后特征及预后影响因素。

结果

存活患者中位随访60（12~177）个月。5年实际累积无病生存（DFS）率为67.8%（95% CI 60.0%~75.6%），其中MSD-HSCT组为68.0%（95% CI 54.1%~81.9%），MUD-HSCT组为77.4%（95% CI 62.1%~92.7%），Haplo-HSCT组为64.0%（95% CI 52.4%~75.6%），三组比较差异无统计学意义（P=0.632）。单因素分析结果显示移植前病程>12个月者累积DFS率明显低于≤12个月者（P=0.018）。5年累积复发死亡率和移植相关死亡率（TRM）与上面危险因素均无明显相关性。

结论

Haplo-HSCT治疗MDS疗效显著，可以作为重要的替代供者，特别是在缺乏MSD而病情紧急没有时间去等待搜索MUD的情况下，可以主动选择；移植前病程是影响DFS的重要因素。

[Evaluation of quality of life on children with cochlear implants]

Objective:To provide theoretical basis for developing comprehensive and individualized rehabilitation programs,we evaluate the quality of life on children with cochlear implants（CI）and explore the influencing factors.Method:One hundred and three children with CI using the Mandaren children with cochlear implants: parental perspectives questionnaire were rated from communication, basic functions,independence ability, well-being,social relations, education, effect and influence of cochlear implants,and the support for children.The comparison was made according to different groups between duration of cochlear implants and age at assessment.Result:With the increasing of age at evaluation and the duration of cochlear implants,the scores of children in each dimension were also increased gradually.Four important factors affecting the quality of life of children with cochlear implants were the age at implantation,the duration of cochlear implants,the level of education with parents and the place of residence.Conclusion:The children with hearing impairment should use the cochlear implants as early as possible.While paying attention to the effect of postoperative hearing and speech rehabilitation,we should pay more attention to the evaluation of the quality of life,so that the children with cochlear implants can return to the mainstream society better.

[Relationship between inflammatory indexes of amniotic fluid and pregnancy outcome of women with cervical incompetence]

Objective: To investigate the relationship between the level of amniotic fluid inflammatory factor and the pregnancy outcome in patients with cervical incompetence. Methods: A retrospective case-control study was conducted. Totally 110 cases of pregnant women were diagnosed as cervical incompetence for cervical dilation at the medical examination in Sun Yat-sen Memorial Hospital of Sun Yatsen University, from January 1st, 2015 to December 31th, 2016. A total of 32 patients (29.1%, 32/110) were performed cervical cerclage. According to their neonatal outcomes, they were divided into live infant group (23 cases, 72%) and dead infant group (9 cases, 28%) . The demographic and clinical data of two groups were analyzed and compared. Results: The mean peripheral blood leucocyte counts, the median amniotic tumor necrosis factor-α (TNF-α) and the median interleukin-8 (IL-8) level of two groups were (10.5±2.8) ×10(9)/L vs (13.6±3.1) ×10(9)/L, 23.80 ng/L (14.9-85.5 ng/L) vs 379.00 ng/L (70.2-418.5 ng/L) , and 3 354 ng/L (1 020-7 500 ng/L) vs 7 500 ng/L (4 210-7 500 ng/L) respectively. The differences were statistically significant (all P<0.05) . The amniotic fluid IL-1β, IL-2 receptor, IL-6, IL-10, C-reactive protein and procalcitonin were not significantly different (all P>0.05) between two groups. Conclusions: The peripheral blood leucocyte counts, amniotic fluid TNF-α and IL-8 level are the factors affecting the pregnancy outcome in women with cervical incompetence before cervical cerclage. When IL-8 is higher than 3 580 ng/L and TNF-α is higher than 105 ng/L, the death of perinatal infants could be predicted.

[Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

[Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。

方法

回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR₁）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。

结果

①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD<1%，10例MRD为1%~3%。②2年总体无病生存（DFS）率为80.0%（95% CI 68.5%~92.3%）。与MRD阴性组比较，MRD阳性组DFS率低[62.9%（95% CI 50.6%~75.2%）对88.9%（95%CI 76.6%~100.0%），P<0.001]、复发率高[11.4%（95%CI 4.1%~29.0%）对3.3%（95%CI 0.6%~20.9%），P=0.003]、非复发死亡率（NRM）高[25.7%（95%CI 8.1%~43.3%）对7.9%（95%CI 1.3%~26.5%），P=0.001]。继发性AML组DFS率低（P=0.004），NRM高（P=0.003）。③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565（95%CI 2.918~9.482），P<0.001]、复发[HR=5.854（95% CI 1.538~22.288），P=0.010]及非复发死亡[HR=3.379（95%CI 1.361~8.391），P=0.009]的独立危险因素。

结论

预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR₁-AML独立危险因素，MFC监测MRD可用于AML allo-HSCT的预后评估。

[Advances in the research of antibacterial composite dressings based on bacterial cellulose]

Bacterial cellulose (BC) is a promising material for wound dressing due to its predominant water binding capacity, mechanical property, biodegradability, and histocompatibility. Whereas BC itself exhibits no antimicrobial activity. To gain antimicrobial activity, several kinds of antibacterial agents have been introduced into BC. However, all of the antibacterial composite dressings are still in the stage of experimental research. In this paper, the types, antibacterial mechanism, and shortcomings of antibacterial composite dressings based on BC are summarized, in order to make prospects of the research trends of antibacterial composite dressings based on BC in future.

[An analysis of electrocochleography in patients with OSAHS]

Objective:To investigate the values of electrocochleograph（ECochG）in patients with OSAHS. Method:ECochG was performed in 31 (62 ears) OSAHS patients (moderately 5 cases, severely 26 cases) and 28 healthy adults (56 ears). AP latency ，AP amplitude and SP/AP were measured and analyzed. Result:There was no difference between the two groups in SP/AP amplitude ratio（P>0.05） while both AP latency（P<0.05） and AP amplitude（P<0.05） were significantly different. Conclusion:ECochG can confirm the damage of cochlear and auditory nerve near the cochlear segment in patients with moderate to severe OSAHS.

[Research on activity evolution of cerebral cortex and hearing rehabilitation of congenitally deaf children after cochlear implant]

Objective:There is a significant difference in the hearing rehabilitation between the congenitally deaf children after cochlear implant(CI). The intrinsic mechanism that affects the hearing rehabilitation in patients was discussed from the perspective of evoked EEG source activity.Method:Firstly, we collected the ERP data from 23 patients and 10 control group children during 0, 3, 6, 9 and 12 months after CI. According to the hearing rehabilitation during 12 months after CI, the patients were divided into two groups: rehabilitation of "the good" and "the poor". Then we used sLORETA to show the changes in the groups of patients' cerebral cortex and compared with the control group.Result:Cross-modal reorganization of cerebral cortex exists in the congenitally deaf children. The cross-modal reorganization gradually degraded and the activity of the relevant cortex followed by normally after CI. There was a statistically significant difference(P < 0.05) in the temporal lobe and the associated cortex around parietal lobe between "the good" and "the poor" groups after 12 months.Conclusion:The normalization of the cross-modal reorganization in patients reflects the hearing rehabilitation after CI, especially the normalization of the activity of the temporal lobe and the associated cortex around parietal lobe, which influences the rehabilitation effect of the auditory function to some extent. This research demonstrated the detection of the mechanism has important significance for the hearing recovery training and evaluation of the hearing rehabilitation after CI.

[Evaluation of endometriosis fertility index in follow-up treatment of endometriosis combined with infertility patients after laparoscopic surgery]

Objective: To explore the application of endometriosis fertility index (EFI) in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods: A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results: (1) The 5 years overall pregnancy rate was 89.0% (130/146). The pregnancy rate was 95.7% (45/47) in EFI≥9 group, 92.8% (77/83) in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate; the rate of the first two groups had no statistically significance (P=0.498), but had significant difference with the last group (P<0.01). (2) In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation; in EFI≥9 group, the pregnancy rate was 66.7% (30/45), and EFI 5-8 group was 50.6% (39/77). (3) EFI≥9 group had the highest natural pregnancy rate [83.6% (46/55)], natural pregnancy rate was significant statistical different in different EFI groups (P=0.001). Conclusions: EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could significantly improve the pregnancy rate of endometriosis patients with infertility.

[Diagnosis and surgical reconstruction results for 14 cases of patients with congenital ossicular chain malformation]

Objective:To investigate the diagnosis of common congenital ossicular chain malformation and the efficacy of ossicular chain reconstruction. Method:Fourteen cases with 15 ears of congenital ossicular chain malformation were included, consisting of 10 cases unilateral conductive hearing loss(10 ears), 1 case bilateral conductive hearing loss (2 ears) and 3 cases unilateral mixed hearing loss with significant conductive hearing loss(3 ears). Tympanoplasty was proceed on all 15 ears, 1 ear was proceed by loosen the cartilage fixation of ossicular chain and tympanic cavity wall. Fourteen ears were proceed with ossicular chain reconstruction, including 3 ears with TORP,10 ears with PORP and 1 ear with artificial stapes operation. The efficacy was measured by comparing the values of air bone gap(ABG) before and after the operation. Result:The average ABG of pre-operation was 39.9 dB, the ABG for 3 week and 6 to 8 months after operation were 22.3 dB and 19.6 dB, which were 17.6 dB and 20.3 dB improve respectively(t=22.10, P<0.01 and t=12.813，P<0.01). Conclusion:Operation is the first choice for those conductive hearing loss causing by simple congenital ossicular chain malformation, relevant ossicular chain reconstruction due to particular situation of the surgery can significantly improve hearing.

[The prevalence and clinical features of fulminant type 1 diabetes]

Objective: To characterize the clinic features of fulminant type 1 diabetes mellitus(FT1DM). Methods: It was a retrospective study analyzing the clinical and laboratory data of patients diagnosed as FT1DM and type 1 diabetes in the Department of Endocrinology in China-Japan Friendship Hospital from January 2011 to November 2015. Results: A total of 125 newly diagnosed type 1 diabetic patients were included in the study, 14 of them (11.2%) met with the criteria of FT1DM. The age at onset was (35.8±8.3) years. The time from onset to ketosis was 2(0-7) days. The plasma glucose levels were extremely high[ (33.79±14.13)mmol/L], while glycosylated hemoglobin A1c[HbA1c, (6.9±0.7) %]and serum glycosylated albumin [(21.8±4.5)%] levels were only slightly above the normal range. Moreover, the C-peptide levels were extremely low and the situation kept after one month to two years' follow-up. Four (28%) patients were glutamic acid decarboxylase antibody (GADA) positive at the onset with two turned negative. One patient was GADA negative at the onset and turned positive after one month. The levels of serum transaminases increased with enlargement of liver in one of the patients after insulin therapy, who was diagnosed as glycogenic hepatopathy. Conclusions: FT1DM is an extremely rapidly progressing type of diabetes and life threatening disease. Causations have to be taken in medical practice.

[Multicenter epidemiological investigation of hospitalized children with severe burn]

Objective: To analyze the epidemiological characteristics of hospitalized children with severe burn from several regions in China during 3 years, so as to provide evidence for prevention of burns in children. Methods: Relying on the entry system of epidemiology data and biological sample of severe burn from multicenter in clinic, medical records of children with severe burn, aged 18 and under, hospitalized in 6 burn wards from February 2012 to February 2015 were collected. The children were divided into 5 age brackets: less than or equal to 1 year old, more than 1 year old and less than or equal to 3 years old, more than 3 years old and less than or equal to 6 years old, more than 6 years old and less than or equal to 12 years old, more than 12 years old and less than or equal to 18 years old. Meanwhile the children were divided into rural and urban children according to their residences. Data of gender and residence of children in the 5 age brackets, cause of injury, location of injury, total burn area, wound site, inhalation injury and combined injury, and source of hospitalization expenses of children in the 5 age brackets and two types of residence, and outcome and length of hospital stay of the children were analyzed. The cause of injury of children in different location of injury was analyzed. In addition, they were divided into 2 age brackets: less than or equal to 6 years old and more than 6 years old and less than or equal to 18 years old, and then incidences of hand and foot burn injury were compared. Data were processed with chi-square test, and the correlation between age and total burn area was processed with Spearman correlation analysis. Results: Four hundred and forty out of 1 106 inpatients with severe burn were children, accounting for 39.8% who were included in the system. (1) The majority of children were male (270, 61.4%). The number of children more than 1 year old and less than or equal to 3 years old ranked the first (222, 50.5%) in the 5 age brackets. The ratio of children from rural areas to that from urban areas was 2.9∶1.0. There were no statistically significant differences in both gender and residence of children among the 5 age brackets (with χ² values respectively 7.649 and 9.399, P values above 0.05). (2) Scald was the most common cause of burn. There was statistically significant difference in injury cause of children among the 5 age brackets (χ²=136.307, P<0.001). There was no statistically significant difference in injury cause of children among the two types of residence (χ²=5.164, P>0.05). (3) Private house was the most common location of injury. There was statistically significant difference in location of injury of children among the 5 age brackets (χ²=124.930, P<0.001). There was no statistically significant difference in location of injury of children among the two types of residence (χ²=3.364, P>0.05). There was statistically significant difference in injury cause of children in different location of injury (χ²=118.284, P<0.001). (4) Most of children were with total burn areas from 10% to 39% total body surface area. There was statistically significant difference in total burn area of children among the 5 age brackets (χ²=103.568, P<0.001). There was positive correlation between age and total burn area (r=0.177, P<0.001). There was no statistically significant difference in total burn area of children among the two types of residence (χ²=16.213, P>0.05). (5) Trunk, lower extremity, and upper extremity were the most common wound sites, respectively. There was statistically significant difference in wound site of children among the 5 age brackets (χ²=45.674, P=0.019). There was statistically significant difference in incidence of hand and foot burn between children less than or equal to 6 years old and children more than 6 years old and less than or equal to 18 years old (with χ² values respectively 29.188 and 14.612, P values below 0.01). There was no statistically significant difference in wound site of children among the two types of residence (χ²=8.515, P>0.05). (6) Twenty-seven children suffered inhalation injury. The main age bracket was more than 12 years old and less than or equal to 18 years old (8 children). The main residence was rural area (18 children). The main cause of inhalation injury was flame burn (23 children). Nine children suffered combined injury, among which the children more than 12 years old and less than or equal to 18 years old accounted for the highest ratio (5 children), and the urban children accounted for higher ratio (5 children). (7) Among the 437 children, most of their hospitalization expenses were at their own expense. There was statistically significant difference in the source of hospitalization expenses of children among the 5 age brackets (χ²=17.917, P=0.001). There was no statistically significant difference in the source of hospitalization expenses of children among the two types of residence (χ²=0.749, P>0.05). (8) Among the 437 children, 34 children abandoned treatment and were discharged from hospital, attributed to lack of funding. Seventy-eight children were discharged with a better health condition and 347 were cured. The condition of 6 children worsened and 6 children died. Mean length of hospital stay was 28.6 days for all the children, and 8.8 days for the deteriorated and dead children. Conclusions: Children were the major group of patients with severe burn in China. Male children less than or equal to 6 years old were common with scald as the major cause of injury, private house as the major location of injury, and trunk, lower and upper extremity as the most common wound sites, their own expenses as the major source of hospitalization expenses. There were statistically significant differences in cause of injury, location of injury, total burn area, wound site, and hospitalization expenses source of children among the 5 age brackets.

[Clinical randomized controlled trial on the feasibility and validity of continuous blood purification during the early stage of severe burn]

OBJECTIVE

To observe and primarily evaluate the feasibility and validity of continuous blood purification (CBP) during the early stage of severe burn.

METHODS

Forty-one patients with severe burn admitted to our ward from January 2013 to July 2015, conforming to the study criteria, were divided into conventional treatment group (CT, n=21) and blood purification group (BP, n=20) according to the random number table and patient's personal consent. Patients in group CT received CT conforming to the traditional resuscitation principle for severe burn, while patients in group BP received CT and blood purification treatment in the mode of continuous venous-venous hemodiafiltration in addition up to post injury hour (PIH) 72. On post injury day (PID) 1, 2, 3, the vital signs, volume of fluid input, and volume of the urine output were observed and recorded; femoral artery blood was drawn to determine lactate, bicarbonate radical, and base excess, and oxygen index was calculated. At PIH 12, 24, 48, 72, femoral vein blood was drawn to determine white cell count, platelet count, neutrophils, creatine kinase-MB, creatine kinase, lactic dehydrogenase, aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine, urea nitrogen, and blood glucose (the ratio of AST to ALT was calculated). The incidence of infection, sepsis, and multiple organ dysfunction syndrome (MODS) and the mortality of patients were recorded during 2 months after injury. Data were processed with chi-square test, analysis of variance for repeated measurement, t test and Wilcoxon test, and the values of P were adjusted by Bonferroni.

RESULTS

The observation was completed in the 41 patients without exclusion. (1) There were no statistically significant differences in vital signs, volume of fluid input, and volume of the urine output of patients between two groups on PID 1, 2, 3 (with t values from -1.64 to 1.48, P values above 0.05). (2) Compared with that in group CT, the level of lactate of patients in group BP declined significantly on PID 2 and 3 (with Z values respectively -2.37 and -2.46, P values below 0.05). Compared with those in group CT, the levels of bicarbonate radical and base excess of patients in group BP declined significantly on PID 3 (with t values both as -2.51, P values below 0.05). The oxygen index of patients in group BP on PID 3 was (370±98) mmHg (1 mmHg=0.133 kPa), which was significantly higher than that in group CT [(305±81) mmHg, t=2.27, P<0.05]. (3) There were no statistically significant differences in white cell count, platelet count, neutrophils, creatine kinase, lactic dehydrogenase, AST, ALT, and AST to ALT ratio of patients between two groups at PIH 12, 24, 48, 72 (with t values from -1.47 to 1.19, Z values from -1.58 to -0.03, P values above 0.05). At PIH 24, 48, 72, the levels of creatine kinase-MB and blood glucose of patients in group BP were respectively (81±43), (55±34), (58±40) U/L and (7.9±2.0), (6.7±0.9), (6.9±1.8) mmol/L, which were significantly lower than those in group CT [(179±184), (124±71), (103±57) U/L and (10.1±3.8), (9.1±2.4), (8.8±4.1) mmol/L, with Z values from -3.73 to -2.02, P<0.05 or P<0.01]. Compared with those of patients in group CT, creatinine at PIH 48 and urea nitrogen at PIH 24, 48, 72 were obviously lower in group BP (with t values from -4.23 to -2.44, P<0.05 or P<0.01). (4) During the two months after injury, the infection rate of patients in group BP was 60.0% (12/20), which was significantly lower than that in group CT [95.2% (20/21), χ(2)=5.51, P<0.05]. The incidence of sepsis and MODS and the mortality of patients in group BP were all lower than those in group CT, but there were no statistically significant differences (with χ(2) values from 0.22 to 2.93, P values above 0.05).

CONCLUSIONS

Conducting CBP in the early stage of severe burn is safe and feasible, which does not obviously affect the vital signs, volumes of fluid input and urine output, or platelet count of patients, additionally, it could help protect the function of vital organs, eliminate stress hyperglycemia, and reduce infection rate. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-TRC-12002616.

Lack of clinical significance of the ImmuKnow(TM)-Cylex assay for the detection of cellular immune function in patients with renal cell carcinoma

This study aimed to explore the clinical value of the CD4(+) T cell ATP levels in patients with renal cell carcinoma through the application of the ImmuKnow(TM)-Cylex(®) assay. We recruited 104 patients with renal cancer who had undergone surgery at Fuzhou General Hospital from March 2009 to June 2012, and were subsequently treated by dendritic cell and cytokine-induced killer cell bio-therapy or interferon-α therapy. The changes in CD4(+) T cell ATP levels were detected at the perioperative period and at 10 days, 1 month, 3 months, and 1 year after the surgery using the ImmuKnow assay. In addition, the differences in ATP levels in different therapy groups were compared and the prognosis conditions were analyzed. Our results demonstrated that no significant difference in the ATP levels occurred at different time points; furthermore, there were no obviously different ATP levels between the different therapy groups, and the ATP levels were found to have no clinical significance for the assessment of renal cancer prognosis. Overall, this study suggested that CD4(+) T cell ATP levels as detected by the ImmuKnow assay have no obvious clinical value in patients with renal cancer.

Genetic diversity and taxonomic status of Gymnocypris chilianensis based on the mitochondrial DNA cytochrome b gene

In order to study the genetic diversity and taxonomic status of Gymnocypris chilianensis on a molecular level, the mitochondrial DNA cytochrome b gene was sequenced for 74 individuals of G. chilianensis from two locations (Heihe River and Shule River) and 42 individuals of its affinis species Gymnocypris przewalskii. Analyses of genetic diversity and sequence differences were conducted for these samples, combined with the analysis of 30 homologous sequences of another affinis species Gymnocypris eckloni, which were downloaded from GenBank. The results showed that both the haplotype diversity (h = 0.9820) and nucleotide diversity (π= 0.0039) of the Shule River G. chilianensis were lower than the other populations, thus, the Shule River G. chilianensis should be prioritized for protection because of its lower genetic diversity level. The results of sequence analysis showed that the genetic distance between the Heihe River G. chilianensis population and the Shule River G. chilianensis population was 0.0064, and the genetic distance between these two populations and the G. przewalskii population was 0.0838 and 0.0810, respectively. The genetic distance between the two G. chilianensis populations and the G. eckloni population was 0.0805 and 0.0778, respectively. Analysis of sequence differences indicates that G. chilianensis is sufficiently diverged from G. przewalskii and G. eckloni to the extent that it has reached species level, thus, G. chilianensis can be considered an independent species of Gymnocypris.