[Analysis of distribution characteristics of specific immunoglobulin E in 8 092 children with eczema and urticaria in a hospital of pediatric in Tianjin City]

To investigate the common specific immunoglobulin E(sIgE) in children with eczema and urticaria, compare the allergies in children with different diseases, genders and ages, and provide the scientific basis for the prevention, diagnosis and treatment. A retrospective study was conducted to analyze the children who were suspected of eczema and urticaria and tested for serum sIgE in the Tianjin Children's Hospital from December 2019 to August 2021. A total of 8 092 serum samples were tested for ten food allergens and ten inhaled allergens. The method was the enzyme-linked immune capture assay. The allergen epidemiological characteristics were statistically analyzed by Chi square test based on the children's characteristics and factors such as different sexes and ages and by the mass data. The results showed that the positive rate of eczema was 64.42%(5 213/8 092), and the urticaria was 35.58%(2 879/8 092). The positive rate of specific IgE was 66.65%(5 393/8 092), the food allergens was 61.74%(4 996/8 092), and the inhaled allergens was 34.85%(2 820/8 092). The top three positive rates of food allergens were egg 46.65%(3 775/8 092), milk 32.64%(2 641/8 092) and wheat flour 15.08%(1 220/8 092). The top three positive rates of inhaled allergens were house dust 21.40%(1 732/8 092), Alternaria 11.78%(953/8 092) and Dermatophagoides farinae 7.33%(593/8 092). The positivity of food allergens and inhaled allergens was significantly different in different age groups. The positive rates of food allergens in different age groups were 48.92%(947/1 936) in<1 year old, 72.28%(2 680/3 708) in 1-3 years old, 64.58%(919/1 423) in 4-6 years old and 43.90%(450/1 025) in>6 years old. The positive rates of inhaled allergens in different age groups were 17.67%(342/1 936) in<1 year old, 36.35%(1 348/3 708) in 1-3 years old, 46.38%(660/1 423) in 4-6 years old and 45.85%(470/1 025) in>6 years old. The top six positive rates of allergens of eczema were the same with urticaria, which were egg, milk, house dust, wheat flour, Alternaria and Dermatophagoides farinae. The allergens (greater than or equal to grade 4) differed in children with eczema and urticaria. Moreover, there were significant differences in the positive rates of Alternaria, egg, wheat flour, crab and shrimp. In conclusion, this study can reflect the epidemic characteristics of allergens in children with eczema and urticaria to a certain extent. There were significant differences in the positive rates of allergens between different age groups. It is necessary to reasonably avoid the high-risk allergens according to the epidemiological characteristics and clinical symptoms, which provide valuable information for the prevention, diagnosis and treatment of allergic diseases.

[Exploration of functional reconstruction and rehabilitation strategies for patients with destructive electric burns]

Electric burn is a kind of three-dimensional destructive damage. It is necessary to attach great importance to the functional reconstruction and rehabilitation of patients with destructive electric burns. Wound repair and limb salvage are not the end of the treatment of destructive electric burns, but functional rehabilitation and reintegration into society of patients are the goals of treatment. This paper systematically discusses the early wound repair, late functional reconstruction and rehabilitation, limb salvage and amputation, minimized damage of donor area, psychological rehabilitation, and multi-disciplinary cooperation of destructive electric burns. Only by attaching great importance to the functional reconstruction and rehabilitation, and embedding these concepts in people's brains, perfect repair and rehabilitation of destructive electric burns can be realized.

[Clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist]

Objective: To investigate the clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist. Methods: A retrospective observational study method was used. From September 2016 to October 2021, thirteen male patients (aged 20-43 years) with annular high voltage (10-100 kV) electrical burns on the wrist were admitted to the Beijing Jishuitan Hospital. At the early stage after injury, the patient's wrist was subjected to incision, tension reduction and debridement, with the wound area after debridement being 27 cm×16 cm-32 cm×19 cm; in 12 patients with vascular injury, the radial or ulnar artery was reconstructed by great saphenous vein transplantation, with the length of 15-25 cm; the wrist wound was repaired by free transplantation of the deep inferior epigastric artery paraumbilical perforator flap (if the wound was giant, the lower abdominal flap carrying other perforators was used), with the area of 30 cm×19 cm-35 cm×20 cm. The donor site was repaired by direct suture+skin grafting or relay flap transplantation. After surgery, the survival of flap in recipient area, as well as survival of the skin or flap in donor site were observed. During follow-up, the appearances of the flap in recipient area and the recovery of hand function, as well as the healing of donor site, occurrence of abdominal wall hernia, and scar in skin graft area were observed. Results: After surgery, all the 13 patients' paraumbilical perforator flaps survived. Among them, 3 patients had subcutaneous fat necrosis at the distal end of the wrist flap, and the wound had mild infection, which healed after re-expansion and dressing change. All the skin grafts in the donor site of 10 patients survived, and the flaps in the donor site of 3 patients survived well. The patients were followed up for 6 months to 3 years. The flaps in recipient area were in good shape, 8 cases had partial recovery of hand function, and 5 cases had loss of finger flexion function; the donor site of abdominal flap healed well with no abdominal hernia occurred, and the skin graft site had no obvious scar hyperplasia and was soft in texture. Conclusions: Early vascular reconstruction after injury, together with free transplantation of the giant deep inferior epigastric artery paraumbilical perforator flap are effective in repairing circular high-voltage electrical burn wounds on the wrist.

[Repeated stellate ganglion blockade for the treatment of ventricular tachycardia storm in patients with nonischemic cardiomyopathy: a new therapeutic option for patients with malignant arrhythmias]

Objectives: This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade (R-SGB) as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy (NICM). Methods: This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1, 2021 and January 31, 2022. Lidocaine (5 ml, 1%) was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound, once per day for 7 days. Data including clinical characteristics, immediate and long-term outcomes, and procedure related complications were collected. Results: The mean age was (51.5±13.6) years. All patients were male. 5 patients were diagnosed as dilated cardiomyopathy, 2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy. The left ventricular ejection fraction was 37.8%±6.6%. After the treatment of R-SGB, 6 (75%) patients were free of electrical storm. 24 hours Holter monitoring showed significant reduction in ventricular tachycardia (VT) episodes from 43.0 (13.3, 276.3) to 1.0 (0.3, 34.0) on the first day following R-SGB (P<0.05) and 0.5 (0.0, 19.3) after whole R-SGB process (P<0.05). There were no procedure-related major complications. The mean follow-up was (4.8±1.1) months, and the median time of recurrent VT was 2 months. Conclusion: Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.

[Application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing destructive wounds]

Objective: To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds. Methods: The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed. Results: Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site. Conclusions: Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

[Factors affecting long-term survival of advanced high-grade serous ovarian cancer]

Objective: To identify the factors associated with long-term survival and guide the decision for primary surgery in patients with advanced high-grade serous ovarian cancer(HGSOC). Methods: In this case-control study, clinical parameters, including surgical and non-surgical associated factors, were collected and compared between the patients with short-term (<2 years) and long-term (>5 years) survival who all underwent primary debulking surgery (PDS) followed by carboplatin and paclitaxel chemotherapy from January 2004 to December 2016. Univariate analysis was examined by chi-square test and multivariate analysis was performed by logistic regression analysis. Results: There were 95 cases long-term survival (LTS group) and 77 cases short-term survival (STS group) in 698 newly diagnosed HGSOC patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅲc and Ⅳ who met include and exclude criteria. (1) Univariate analysis showed that the proportion of complete cytoreduction with no visible residual disease (R0) at PDS and platinum sensitivity in LTS group were significantly higher than those in STS group (P<0.01). The surgical complexity score (SCS), the preoperative serum CA₁₂₅ level and the ascites volume in the LTS group were significantly lower than those of the STS group (all P<0.05). In the LTS group, the preoperative incidence of lesions in retrograde peritoneum of the bladder, serosal and mesangial membrane of the small intestine, upper abdominal peritoneum and liver parenchyma were significantly lower than those in the STS group (all P<0.05). Multivariate logistic regression analysis showed that platinum sensitivity (OR=0.016, 95%CI: 0.004-0.063, P<0.01), ascites volume >500 ml (OR=3.193, 95%CI: 1.285-7.930, P=0.012), and SCS ≥8 (OR=17.433, 95%CI: 2.281-133.25, P=0.003) were independent factors affecting long-term survival (P>0.05). (2) Totally 37 of 95 in long-term survival and 16 of 77 in short-term survival achieved R0 cytoreduction at PDS. Univariate analysis showed that preoperative serum CA₁₂₅ level, preoperative lesion score, preoperative lesion (DS) score, ascites volume, platinum sensitivity,and SCS were significantly correlated with the R0 PDS (all P<0.05). Multivariate analysis showed that ascites volume >500 ml (OR=5.199, 95%CI: 2.015-13.409, P=0.001), DS >2 (OR=15.264, 95%CI: 5.843-39.874, P<0.01) and SCS ≥4 (OR=4.176, 95%CI: 1.618-10.777, P=0.003) were independent factors associated with R0 cytoreduction. In patients with DS ≤2 or SCS <4, but not those with DS >2 or SCS ≥4, R0 cytoreduction was significantly associated with long-term survival. Conclusion: The intrinsic biology of tumor is the factor influencing long-term survival of advanced HGSOC patients, and those who present with wide intraperitoneal metastases and need to remove multiple organs may not benefit from R0 cytoreduction.

[Consistency of peripheral whole blood and venous serum procalcitonin in children: a multicenter parallel controlled study]

Objective: To explore the consistency of peripheral whole blood and venous serum procalcitonin (PCT) levels, and the value of peripheral whole blood PCT in evaluating pediatric bacterial infection. Methods: This multicenter cross-sectional parallel control study was conducted in 11 children's hospital. All the 1 898 patients older than 28 days admitted to these hospitals from March 2018 to February 2019 had their peripheral whole blood and venous serum PCT detected simultaneously with unified equipment, reagent and method. According to the venous serum PCT level, the patients were stratified to subgroups. Analysis of variance and chi-square test were used to compare the demographic characteristics among groups. And the correlation between the peripheral blood and venous serum PCT level was investigated by quantitative Pearson correlation analysis.The PCT resultes were also converted into ranked data to further test the consistency between the two sampling methods by Spearman's rank correlation test. Furthermore, the ranked data were converted into binary data to evaluate the consistency and investigate the best cut-off of peripheral blood PCT level in predicting bacterial infection. Results: A total of 1 898 valid samples were included (1 098 males, 800 females),age 27.4(12.2,56.7) months. There was a good correlation between PCT values of peripheral whole blood and venous serum (r=0.97, P<0.01). The linear regression equation was PCT_{venous serum}=0.135+0.929×PCT_{peripheral whole blood}. However, when stratified to 5 levels, PCT results showed diverse and unsatisfied consistency between the two sampling methods (r=0.51-0.92, all P<0.01). But after PCT was converted to ordinal categorical variables, the stratified analysis showed that the coincidence rate of the measured values by the two sampling methods in each boundary area was 84.9%-97.1%. The dichotomous variables also showed a good consistency (coincidence rate 96.8%-99.3%, Youden index 0.82-0.89). According to the severity of disease, the serum PCT value was classified into 4 intervals（<0.5、0.5-<2.0、2.0-<10.0、≥10.0 μg/L）, and the peripheral blood PCT value also showed a good predictive value (AUC value was 0.991 2-0.997 9). The optimal cut points of peripheral whole blood PCT value 0.5、1.0、2.0、10.0 μg/L corresponding to venous serum PCT values were 0.395, 0.595, 1.175 and 3.545 μg/L, respectively. Conclusions: There is a good correlation between peripheral whole blood PCT value and the venous serum PCT value, which means that the peripheral whole blood PCT could facilitate the identification of infection and clinical severity. Besides, the sampling of peripheral whole blood is simple and easy to repeat.

[Staged repair strategy for chronic sacrococcygeal radiation ulcer]

Objective: To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer. Methods: The retrospective cohort study method was applied. Twelve patients with chronic sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020, including 7 males and 5 females, aged 38-74 years. The thorough debridement was performed in the first stage, with wounds area after debridement ranging from 8 cm×6 cm to 22 cm×14 cm, and continuous vacuum sealing drainage (VSD) was performed after the debridement operation. In the second stage, personalized surgery scheme was formulated according to the patient's age, systemic condition, vascular condition, and the position, size, and depth of wound. Six cases were reconstructed with superior/inferior gluteal artery perforator flaps, 4 cases were repaired with gluteus maximus myocutaneous flaps, 1 case was repaired with pedicled latissimus dorsi myocutaneous flap, and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap. The area of flaps or myocutaneous flaps ranged from 10 cm×8 cm to 25 cm×18 cm. Donor sites of the flaps were sutured primarily in 9 patients and in the other 3 patients were repaired with intermediate split-thickness skin graft in back. The survival of flap or myocutaneous flap after operation, recurrence of tumor, and the appearance and texture of flap or myocutaneous flap, and wound healing were observed during follow-up. Results: Flaps or myocutaneous flaps in 11 patients survived after operation, and superior gluteal artery perforator flap in 1 patient had partial distal necrosis, which was covered again with flap pushed to the distal after debridement and resection of the necrotic tissue. The wounds in 8 patients achieved primary healing, 1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection, 1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap, and 1 patient repaired with gluteus maximus myocutaneous flap had hematoma under myocutaneous flap, and 1 patient repaired with retrograde latissimus dorsi myocutaneous flap had incision exudation and dehiscence, which were all healed after dressing change, etc. There was no recurrence of tumor after the operation. The wounds healed well during follow-up of 2-52 months after discharge, with no recurrence of infection, and the flaps were soft in texture, with satisfactory appearance and well healed donor sites. Conclusions: On the basis of thorough debridement and VSD in the first stage, superior/inferior gluteal artery perforator flap, gluteus maximus myocutaneous flap, or pedicled/free latissimus dorsi myocutaneous flap with abundant blood supply is applied to repair chronic sacrococcygeal radiation ulcer in the second stage. The staged operation is reliable, with minimal injury to the donor site of flap and satisfactory therapeutic effect.

[Strategies on the prevention and treatment of surgical site infection and the resulting wound]

With the increase in various trauma patients and the number of surgeries and the worsening of population aging, more and more surgical site infection (SSI) and the resulting wounds were seen, bringing great pressure and burden to medical staff and patients. This article focuses on the risk factors, prevention, and treatment strategies related to SSI and the resulting wounds, especially their common treatments, hoping to raise the significant attention of everyone.

[Epidemiological investigation of 169 inpatients with high-voltage electrical burns on the wrist]

Objective: To analyze the epidemiological characteristics of inpatients with high-voltage electrical burns on the wrist in Beijing Jishuitan Hospital (hereinafter referred to as the author's unit), so as to provide reference for the prevention and treatment of high-voltage electrical burns on the wrist. Methods: The medical records of inpatients suffered from high-voltage electrical burns on the wrist in the author's unit from January 2008 to December 2019 were collected. The patients' gender, age, population category, injury situation, injury season, total burn area, electrical burn type on the wrist of the affected limbs, the time from injury to first flap/myocutaneous flap transplantation, vascular reconstruction and flap/myocutaneous flap transplantation of the affected limbs, the total amputation rate of the affected limbs and the amputation rate of the affected limbs with type Ⅲelectrical burns on the wrist, the number of operation, postoperative infection rate of flap/myocutaneous flap, length of hospital stay, hospitalization expense, and treatment outcome were retrospectively analyzed. Comparison of the aforementioned statistical items between patients admitted from January 2008 to December 2013 (hereinafter referred to as the pre-stage) and January 2014 to December 2019 (hereinafter referred to as the post-stage) except gender, the total amputation rate of the affected limbs, treatment outcome were performed. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Wilcoxon rank-sum test. Results: During the 12 years, a total of 169 patients with high-voltage electrical burns on the wrist were admitted to the author's unit, including 162 males and 7 females, aged (35±13) years, and 75.15% (127/169) of patients were 21-50 years old. The top three groups in population category from high to low were workers, migrant workers, and primary and secondary school students, accounting for 48.52% (82/169), 28.99% (49/169), and 9.47% (16/169), respectively. At work of non-electric power accounted for 47.93% (81/169) and ranked the first in the proportion of injury situation. The injury occurred mostly in summer and autumn, accounting for 39.05% (66/169) and 28.99% (49/169), respectively. About 65.09% (110/169) of the patients were with total burn area less than 10% total body surface area. There were totally 216 affected limbs with high-voltage electrical burns on the wrist, of which the numbers of wrist with type Ⅲ and type Ⅳ injury were 25 (11.57%) and 21 (9.72%), respectively. The time from injury to first flap/myocutaneous flap transplantation was 6.00 (3.75, 8.00) d. There were 45 affected limbs operated with vascular reconstruction, 75 affected limbs transplanted with pedicled axial flap, and 86 affected limbs transplanted with free flap/myocutaneous flap. The total amputation rate of affected limbs was 12.96% (28/216), and the amputation rate of the affected limbs with type Ⅲ electrical burns on the wrist was 28% (7/25). The number of operation was 4 (3, 5) times, the postoperative infection rate of flap/myocutaneous flap was 7.18% (13/181), the hospitalization time was 39.00 (25.00, 50.00) d, and the hospitalization cost was 123 553.00 (50 656.50, 216 003.00) yuan. Compared with those of the pre-stage, the time from injury to first flap/myocutaneous flap transplantation was significantly shortened (Z=-4.038, P<0.01), the ratio of free flap/myocutaneous flap transplantation on affected limbs was significantly increased (χ(2)=13.478, P<0.01), the ratio of pedicled axial flap transplantation on affected limbs was significantly decreased (χ(2)=10.242, P<0.01), the number of operation was significantly reduced (Z=-5.903, P<0.01), the postoperative infection rate of flap/myocutaneous flap was significantly decreased (χ(2)=4.492, P<0.05), the length of hospital stay was significantly shortened (Z=-2.723, P<0.01), and the hospitalization expense was significantly decreased among patients hospitalized in the post-stage (Z=-2.121, P<0.05). The other items were close between patients hospitalized in the pre-stage and those in the post-stage. Conclusions: Men were more likely than women to suffer from high-voltage electrical burns on the wrist in the author's unit. Young workers and migrant workers may be the key groups for the prevention of high-voltage electrical burns on the wrist. It is very important to strengthen the management of high voltage safety education for non-electric power staff, warn and protect the surrounding area of high voltage environment, and prohibit non staff for entering the high voltage environment, especially in summer and autumn. In the last 6 years, the patients with high-voltage electrical burns on the wrist may benefit from the active vascular reconstruction at early stage and free flap/myocutaneous flap repair in the author's unit.

[Clinical application of self-made drainage tubes in different layers of soft tissue for negative-pressure wound therapy in 33 patients]

From January 2014 to June 2018, 28 patients with different types of deep soft tissue injury or infection were admitted to the Affiliated Jiangyin Hospital of Medical College of Southeast University; 5 patients were admitted to the Zhengzhou First People's Hospital. There were 24 males and 9 females, aged 18-89 (40±20) years. Disposable suction tubes with holes cut on side walls were used as self-made drainage tubes. The authors placed the self-made drainage tubes on different deep soft tissue layers and wound surfaces after debridement. The effective drainage sections of the wound surface drainage tubes were wrapped with silver ion antimicrobial functional active dressings. Bio-permeable membrane was used to close the operative area. The drainage tubes in the deep layer of wound and wound surface were connected in parallel by a tee and connected to wall-hanging medical negative-pressure suction device to conduct negative-pressure wound treatment at -20.0 to -10.6 kPa. The deep drainage tubes were usually removed or changed 4 or 5 days after surgery.The drainage tubes in the wound surface were synchronously replaced when removing or replacing he drainage tubes in the deep layer of wound. On 4 to 15 days after surgery, the deep drainage tubes were removed. On 8 to 25 days after surgery, the wound surface drainage tubes were removed. Then the treatment was changed to a conventional dressing change until the wounds were completely healed or the wound bed was ready for skin grafts or tissue flaps. The indwelling time of deep drainage tubes in this group of patients was (6.2±2.8) days, and the indwelling time of wound surface drainage tubes was (12.0±3.0) days. The wound healing time was (22±5) days, the hospital stay time was (29±7) days, and wound bacteria were reduced from 6 species and 11 strains before treatment to 3 species and 4 strains after treatment. No adverse events such as wound bleeding, irritative pain, and chronic sinus occurred during treatment. Twenty-three patients were followed up for 13 to 28 months, no treatment-related complications were observed.

[Effect of axial flap of adjacent artery perforator with vascular pedicle in repairing facial and cervical scar deformity in patients]

Objective: To explore the effect of axial flap of adjacent artery perforator with vascular pedicle in repairing scar deformity of face and neck in patients. Methods: From January 2010 to June 2018, 38 patients with cicatricial deformity of face and neck after deep burn were admitted to author's unit, including 22 males and 16 females, aged 5-56 years. The time of admission was 7 months to 19 years after burn injury. The size of wounds ranged from 7.0 cm×4.0 cm to 20.0 cm×10.0 cm after scar tissue was released. Nineteen patients were treated by upper thoracic internal artery perforator flap with size ranged from 7.0 cm×5.0 cm to 18.0 cm×8.5 cm. Among them, 16 cases were preexpanded with expanders at thorax whose rated capacity ranged from 300 to 500 mL and times of water injection of 1.8 to 3.1, and 3 cases were directly used. Twelve patients were treated by transverse carotid artery perforator flap with size ranging from 7.0 cm×4.5 cm to 11.0 cm×8.5 cm, of which 8 patients were preexpanded and 4 cases were directly used. The rated capacity of expander placed at the supraclavicular region ranged from 200 to 350 mL with times of water injection from 1.5 to 2.0. Seven patients were treated by preexpanded superficial temporal frontal branch artery perforator flap with size of 5.5 cm×3.8 cm to 8.0 cm×5.0 cm. The rated capacity of expanders placed at forehead was 150 to 300 mL with times of water injection of 1.5 to 2.0. Donor sites were directly sutured or reversely repaired by pedicled skin tube plasty. After operation, operation times and treatment time were recorded. The survival condition and complications of flaps and follow-up were observed. Results: The patients each received 1 to 4 operation (s) with treatment time of 5 to 11 months. All flaps survived after operation. Among them, three flaps with perforating branches of internal thoracic artery had slight blood circulation disturbance at the distal end and were healed after conservative dressing change, etc. Pigment changes were observed at the distal end of thoracic internal artery perforator flaps in two patients in the later stage and was resected and repaired in the second stage. The patients were followed up for 5 to 18 months. The appearance and function of operation area were good with high satisfaction of patient. Conclusions: The axial flap of adjacent artery perforator with vascular pedicle for repairing scar deformity of face and neck used directly or preexpanded can solve the problem of lack of normal skin around scar deformity without vascular anastomosis during the operation and with better appearance and function after operation. The donor site often can be directly sutured, but many operations often need to be completed for finishing whole treatment.

[Limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation]

Objective: To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. Methods: From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded. Results: All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function. Conclusions: Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

[Comparison between hybrid surgery and transabdominal preperitoneal surgery in treatment of irreducible inguinal hernia: A case-control study]

Objective: To compare the effects between hybrid surgery and transabdominal preperitoneal surgery in treatment of irreducible inguinal hernia. Methods: A total of 60 patients who underwent laparoscopic inguinal hernia repair between June 2011 and December 2017 were included in the study. Patients were divided into two group: hybrid surgery group (observation group, n=30) and transabdominal preperitoneal group (control group, n=30). The operation time, intraoperative bleeding, hospital stay, hospital cost and complications were analyzed. Results: The operative time of observation group and control group was 45 (35-65) minutes and 50(35-70) minutes, respectively. Intraoperative blood loss of two groups was 10(5-15) ml and 5(2-10) ml. The length of postoperative hospital stay was 2(1-4) days and 2(1-3) days in the two groups, respectively. And the hospitalization cost of two groups was 9 646 (9 066-11 560) yuan and 9 494(8 989-10 660) yuan, respectively. The intraoperative complications occurred in 4 cases in control group, including 1 case of vas deferens injury, 2 cases of spermatic vessel injury and 1 case of inferior epigastric artery injury. No intraoperative complications occurred in observation group. Perioperative complications in observation group and control group included dysuria (6.7% vs 10.0%), scrotum hematoma (3.4% vs 0%), wound pain (46.7% vs 6.7%) and fever (16.7% vs 20.0%). Twelve months of follow-up was completed in all the patients, and no recurrence or infections occurred in the two groups. The incidence of seroma in observation group and control group was 26.7%, 33.3%, respectively. One case of foreign body sensation and one case of chronic pain occurred in control group. The incidence of perioperative wound pain in patients undergoing hybrid surgery was higher than those undergoing transabdominal preperitoneal surgery (P<0.05), but no statistical differences were observed for other variables between the two groups (all P>0.05). Conclusion: Hybrid surgery is safe and feasible for the treatment of irreducible inguinal hernia. Though with a higher incidence of postoperative acute pain, it may have advantages of avoiding injuries of the vas deferens and spermatic vessels.

[Effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns]

Objective: To explore the clinical effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities after severe burns. Methods: From January 2008 to January 2018, 72 patients (53 males and 19 females, aged 5 to 63 years) with hypertrophic scar contracture deformities and functional disorder in the large joints of extremities after severe burns were admitted to the Department of Burns of Beijing Jishuitan Hospital. Scar hyperplasia and contracture deformity were located at shoulder joints of 28 patients, elbow joints of 15 patients, hip joints of 7 patients, knee joints of 17 patients, and ankle joints of 5 patients. The wound area of patients after the scars were excised and released ranged from 7 cm×6 cm to 34 cm×12 cm. The wounds were repaired with corresponding unexpanded perforator flaps or expanded perforator flaps according to the joint location and existing soft tissue conditions. The size of flaps ranged from 7 cm×6 cm to 35 cm×14 cm. The donor sites of 51 patients were sutured directly; the donor sites of 21 patients were repaired by segmented grafts or mesh grafts. The adopted surgeries, the survival of flaps after surgery, and the functional recovery of the joints during follow-up were recorded. Results: Among the 72 patients, 53 patients had perforator flap repairing surgery only; 19 patients had perforator flap repairing surgery and skin grafting. Among them, 12 patients had expanded perforator flaps, 60 patients had unexpanded perforator flaps. The perforator flaps were performed free transplantation in 9 patients, pedicled transplantation in 61 patients, and groin transplantation in 2 patients. At last, 67 flaps survived completely, while 5 flaps had distal-end necrosis which were healed after dressing change or skin grafting after debridement. During follow-up of 6 months to 3 years, the joint function of all the patients was obviously improved. The abduction angles of shoulder joints were over 110°; the hip, knee, and elbow joints could reach the straight position, and the flexion was normal; the foot drop deformity was corrected, and the appearance of flaps was good with obvious extension compared with the original state. Conclusions: Perforator flaps are suitable for reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns. They can restore the joint function to the greatest extent as well as repair the wounds.

RGD peptide-decorated micelles assembled from polymer-paclitaxel conjugates towards gastric cancer therapy

Development of polymer-drug conjugate capable of controlled drug release is urgently needed for gastric cancer therapy. Herein, arginine-glycine-aspartic acid (RGD)-decorated polyethylene glycol (PEG)-paclitaxel (PTX) conjugates containing disulfide linkage were synthesized. The amphiphilic PEG-PTX conjugates were found to assemble into micelles (RGD@Micelles), which would be decomposed under the reduction of glutathione (GSH) and finally release PTX in weakly acidic conditions characteristic of intracellular environment. The RGD@Micelles were spherical nanoparticles with an average hydrodynamic size of ˜50 nm, which were stable in physiological environment. The release of PTX from the micelles in response to GSH was investigated. In vitro cell assay suggested that the RGD@Micelles could target the gastric cancer cells and inhibit cell proliferation by inducing apoptosis. In vivo experiments indicated that the RGD@Micelles could be delivered to the tumor site and inhibit the tumor growth efficiently by releasing PTX inside the tumor cells. This type of micelles exhibited high therapeutic efficacy and low side effects, providing new insights into targeted drug delivery for gastric cancer therapy.

Syntheses of chiral C2-symmetric bidentate ligands having different ring sizes of cyclic amines and their catalytic abilities on enantioselective cyclopropanation of styrene catalysed by copper(I) triflate

A series of chiral bidentate ligands having different ring sizes of cyclic amines have been synthesized. Their catalytic abilities on chiral inductions have been examined in the asymmetric cyclopropanation of styrene catalysed by copper(I) triflate.

The Reactions of Dmso with Arylaldehydes in the Presence of Sodium Hydride

Dimethyl sulfoxide (DMSO) reacted with arylaldehydes under basic conditions to afford sulfide 1, β-(benzyloxy)styrene 2 and dialkyl sulfoxide 3, while the reaction of benzophenone with DMSO gave 1,1-diphenylethylene 4, 1,1-diphenyl-2-methylthioethylene 5 and sulfoxide 6 at the same time under the same conditions.

[Analysis of effects of discipline cooperation on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident]

Objective: To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored. Results: Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)(-1)·kg(-1) electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA(-1)·kg(-1) electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally. Conclusions: After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.

[Sixty years of classics and sixty years of fulfilling mission]

The Department of Burns of Beijing Jishuitan Hospital has gone through 60 years of glorious course as well as Chinese burn surgery. Over the past 60 years, our department developed from scratch, from weak to strong, with continuous innovation. Under the efforts of several generations, remarkable achievements have been made one after another. This article mainly introduces the contribution of our department to burn medicine from five aspects as follows: critical burn treatment, wound repair, electric burn treatment, flap transplantation, and emergency rescue.

[Experience of wound treatment on extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident]

Objective: To explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test. Results: The size of residual wound of patients in Meek skin graft group on 28 days post injury was (59±13)% total body surface area (TBSA), which was obviously smaller than that in microskin graft group [(70±14)%TBSA, t=4.379, P<0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum (4 patients), vola (10 patients), and toe or finger web (8 patients). Conclusions: Meek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

[DeSUMOylation of protein kinase B1 inhibits cell proliferation and metastasis of hepatocellular carcinoma]

Objective: To investigate the effect of AKT1 deSUMOylation induced by Ubc9 silencing on the proliferation and metastasis of hepatocellular carcinoma (HCC) cells. Methods: The Ubc9 gene was silenced using RNA interference, and the expression levels of Ubc9, SUMO1 and AKT1 protein were detected by Western blot. Cell proliferation and cell cycle was analyzed by MTT and flow cytometry. Wound healing and transwell assays were used to detect the cell migration ability. Furthermore, the xenograft model was established, and tumor growth curves were drawn. The in situ apoptotic rates was measured using TUNEL Apoptosis Assay. The expression of proliferating cell nuclear antigen (PCNA), matrix metalloproteinase (MMP)-2 and MMP-9 were evaluated by immunohistochemical staining. Results: Knockdown of Ubc9 gene significantly decreased the protein expression levels of Ubc9, conjugated SUMO1, free SUMO1 and AKT1 in HCC cells (P<0.05 for all). In control, siR-neg and siR-Ubc9 groups, the cell proliferation indexes were 53.19%, 54.25% and 39.17%, respectively. Moreover, cell migration distance and migrating cells per low power field for all these three groups were (59.47±4.66) μm and 89.44±8.36, (56.56±5.37) μm and 93.84±8.79, as well as (34.57±6.61) μm and 41.67±5.39, respectively. In the xenograft model, the weights of subcutaneous tumors for these three groups were (3.78±0.69) g, (3.72±0.72) g and (2.09±0.61) g, respectively. The corresponding apoptotic cell rates were (7.79±2.21)%, (6.45±2.48)% and (33.59±5.44)%, respectively. The expression levels of PCNA, MMP-2 and MMP-9 protein were significantly decreased in siR-Ubc9 group (P<0.05). Conclusions: Ubc9 silencing in HCC cells induces AKT1 deSUMOylation, and then inhibits the proliferation and metastasis. These results provide a new therapeutic strategy for liver cancer in the future.

[Effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients]

Objective: To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. Methods: From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients' general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. Results: The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. Conclusions: The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.

Controllable release of nitric oxide and doxorubicin from engineered nanospheres for synergistic tumor therapy

NaYF₄:Yb,Er upconversion nanoparticles (UCNPs) capped with long-chain carboxylic acid were synthesized and then conjugated with chitosan (CS) in the aid of N-hydroxysuccinimide. The resultant nanocompound was integrated with doxorubicin (DOX) and Roussin's black salt (RBS), a photosensitive nitric oxide (NO) donor to produce stimuli-responsive UCNPs(DOX)@CS-RBS nanospheres as nanocarriers for controllable drug delivery. On the one hand, the encapsulated UCNPs can efficiently absorb NIR photons and convert them into visible photons to trigger NO release. On the other hand, the entrapped DOX can be released at lowered pH from the swollen nanospheres caused by stretched oleoyl-CS chains under acidic conditions. The UCNPs(DOX)@CS-RBS nanospheres exhibit great therapeutic efficacy, which is attributable to the combination of NO and DOX releases based on NO dose-dependent mechanisms. This study highlights the controllable release of NO and DOX from the same nanocarriers and the synergistic therapeutic effect on tumors, which could give new insights into improving cancer nanotherapeutics.

STATEMENT OF SIGNIFICANCE

In this paper, core-shell structured UCNPs(DOX)@CS-RBS nanospheres have been designed and synthesized via a step-by-step procedure. The stimuli-responsive UCNPs(DOX)@CS-RBS nanospheres act as nanocarriers for controllable drug delivery towards cancer therapy. The encapsulated UCNPs can efficiently absorb NIR photons and convert them into visible light to trigger NO release. Meanwhile, the entrapped DOX can be released from the swollen nanospheres caused by stretched oleoyl-CS chains at lowered pH typical of intracellular environment. Synergistic cancer therapy will be achieved through the combination of NO and DOX releases based on NO dose-dependent mechanisms. This study provides new drug nanocarriers with high antitumor efficacy for synergistic cancer therapy.

Chitosan-based core-shell nanomaterials for pH-triggered release of anticancer drug and near-infrared bioimaging

As a naturally-abundant biopolymer, chitosan (CS) exhibit pH-sensitive structural transformation within a narrow pH range. Integrating hydrophobic groups to CS molecules gives modified CS polymers with more adjustable pH responsiveness. In this paper, near-infrared (NIR) photoluminescent Ag₂S QDs capped by long-chain carboxylic acid were synthesized and then conjugated with CS via esterification reaction. The anticancer drug doxorubicin (DOX) has an affinity for the hydrophobic oleoyl groups and was entrapped by them to produce Ag₂S(DOX)@CS nanospheres. A variety of experiments were performed to characterize the nanospheres. In vitro and in vivo experiments showed that the nanospheres can release DOX at lowered pH in tumor cells and have high antitumor efficacy. In addition, the strong NIR signal derived from the encapsulated Ag₂S QDs makes real-time monitoring of the nanosphere distribution in a body possible. This study provides a new CS-based nanocomposite drug carrier for efficient cancer therapy.

Design and synthesis of fluorescence-labeled nucleotide with a cleavable azo linker for DNA sequencing

A cleavable azo linker was synthesized and reacted with 5-(6)-carboxytetramethyl rhodamine succinimidyl ester, followed by further reactions with di(N-succinimidyl) carbonate and 5-(3-amino-1-propynyl)-2'-deoxyuridine 5'-triphosphate [dUTP(AP3)] to obtain the terminal product dUTP-azo linker-TAMRA as a potential reversible terminator for DNA sequencing by synthesis with no need for 3'-OH blocking.

[Model and enlightenment from rescue of August 2nd Kunshan explosion casualty]

On August 2nd, 2014, a massive dust explosion occurred in a factory of Kunshan, resulting in a mass casualty involving 185 burn patients. They were transported to 20 medical institutions in Jiangsu province and Shanghai. More than one thousand of medical personnel of our country participated in this emergency rescue, and satisfactory results were achieved. In this paper, the characteristics of this accident were analyzed, the positive effects of interdisciplinary cooperation were affirmed, and the contingency plan, rescue process and pattern, and reserve, organization and management of talents during this rescue process were reviewed retrospectively.

[Discussion of laparoscopic transabdominal preperitoneal repair for recurrent inguinal hernia]

OBJECTIVE

To explore the surgical techniques and the clinical efficacy of laparoscopic transabdominal preperitoneal repair (TAPP) for recurrent inguinal hernia.

METHODS

Clinical data of 367 patients with recurrent inguinal hernia who underwent TAPP repair from Mar. 2009 to Mar. 2015 in Beijing Chao-Yang Hospital of Capital Medical University were analyzed retrospectively.

RESULTS

Laparoscopic operations were completed successfully in 365 cases, however, 2 cases were converted to open surgery.The operation time was (55.7±19.3) min (30-100 min) and the hospital stay was (4.9±2.7) d (2-12 d). The incidences of postoperative pain, hydrocele, and urinary retention were 4.1%(15/367), 13.1%(48/367), and 1.3%(5/367) respectively.Other complications such as foreign body sensation, wound infection, and intestinal obstruction.All cases were followed up from 3 to 72 months ((36.5±14.7) months), 2 recurrent cases was observed and no mesh infection and long-term chronic pain were observed.

CONCLUSIONS

Laparoscopic TAPP repair has advantages of minimal invasion and few complications, which is safe and effective for recurrent inguinal hernia.

Synthesis and evaluations of an acid-cleavable, fluorescently labeled nucleotide as a reversible terminator for DNA sequencing

An acid-cleavable linker based on a dimethylketal moiety was synthesized and used to connect a nucleotide with a fluorophore to produce a 3'-OH unblocked nucleotide analogue as an excellent reversible terminator for DNA sequencing by synthesis.

Synthesis and micellization of redox-responsive dynamic covalent multi-block copolymers

Multi-block copolymers, which are composed of two or more covalent interconnected polymeric segments of different types, offer unparalleled opportunities for designing new nanostructured materials with enhanced functionality and properties.

Reductive triblock copolymer micelles with a dynamic covalent linkage deliver antimiR-21 for gastric cancer therapy

Triblock copolymer micelles with a double disulphide linkage in the backbone directed by H-bonding association were synthesized and evaluated as an antimiRNA delivery carrier.

Design and synthesis of new acid cleavable linkers for DNA sequencing by synthesis

A new kind of acid sensitive tetrahydrofuranyl (THF) linker was synthesized and then reacted with 5-(6)-carboxytetramethylrhodaminesuccinimidyl ester (5(6)-TAMRA, SE), followed by di(N-succinimidyl) carbonate (DSC) and modified 2'-deoxyuridine triphosphate (dUTP); the final product, as a reversible terminator for DNA sequencing by synthesis (DNA SBS), was given obtained and confirmed by 1H-NMR, 31P-NMR, and HRMS with purity of up to 99%. The synthesized dye-labeled terminator incorporated into DNA strand successfully, and the fluorophore was cleaved completely under acidic conditions. The preliminary results encourage us to explore more acid-sensitive linkers for DNA SBS to increase the cleavage efficiency under weakly acidic conditions.

Chitosan oligosaccharide copolymer micelles with double disulphide linkage in the backbone associated by H-bonding duplexes for targeted intracellular drug delivery

Folic acid conjugated block copolymer micelles with H-bonding associated double disulphide linkage in the backbone were developed.

Asian Foxtail (Uraria crinita), a New Host for Sclerotium rolfsii from Taiwan

Asian foxtail (Uraria crinita (L.) Desv. ex DC.) is an herb cultivated for the use of roots and stems in Taiwanese cuisine. In September 2013, symptoms of leaf blight and basal rot were observed on U. crinita in a commercial field in Longjing District, Taichung, Taiwan, at an incidence of approximately 20%. White mycelia and brown sclerotia formed on the surfaces of the basal stems. The infected plant gradually wilted and eventually died. Diseased lower stem tissues were surface sterilized in 0.6% NaOCl, rinsed with sterile distilled water, and transferred to potato dextrose agar plates. The cultures were incubated at 25°C in the dark. The radial mycelial growth was 9.0 mm/day during the first 4 days, and the diameter of mature sclerotia was 1.76 mm following 3 weeks of incubation. The internal transcribed spacer (ITS) sequence of the isolate was amplified by PCR using the primers ITS5 and ITS4 (2). The amplicon was cloned, sequenced, and deposited in GenBank (Accession No. KJ677121). The sequence similarity was 99% compared with that of Sclerotium rolfsii Sacc. from Spain (GU080230) (1). Based on the characteristics, the fungus was identified as S. rolfsii. The fungal isolate (BCRC FU30230) was deposited in the Bioresource Collection and Research Center, Hsinchu, Taiwan. Pathogenicity tests were conducted on six 2-month-old potted U. crinita plants in a greenhouse. Prior to infesting the plant, fungal inoculum of S. rolfsii BCRC FU30230 was prepared by inoculating the isolate on autoclaved rice (rice/water/dextrose = 50:50:1) in a flask. After 20 days incubation at room temperature, rice colonized by S. rolfsii was placed near the base of the plants (approximately 30 g/plant) in the greenhouse. Sterile rice applied to an equal number of plants served as negative controls. All inoculated plants developed blight symptoms with mycelia and sclerotia produced near the bases of each seedling 1 week after inoculation at an average temperature of 26°C. The control plants remained healthy. The pathogen re-isolated from the inoculated plants was morphologically identical to the original isolate. The pathogenicity test was repeated by inoculated healthy plants with reduced inoculum (five granules/plant). A delay of symptom development was observed and similar results were obtained. To our knowledge, this is the first report of Sclerotium rot on U. crinita in Taiwan, and the first report on U. crinita as a host for S. rolfsii. References: (1) E. Remesal et al. Plant Dis. 94:280, 2010. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.

First Report of Downy Mildew Caused by Plasmopara obducens on Impatiens in Taiwan

In February 2013, single and double flowered impatiens (Impatiens walleriana Hook. f.) affected by downy mildew were observed in nurseries (cv. Accent) and in the wild in central Taiwan. More than 90% of the plants were infected in areas where the disease broke out. Symptomatic leaves showed yellowing, with white, fungal-like structure covering the lower leaf surfaces, causing the plants to become wilted and defoliated. Under microscopic observation, hyaline, thin-walled sporangiophores branched monopodially and had slightly swollen bases. Three apical branchlets were at right angles to the main axis, measuring 4.3-15.0 μm (average 8.5 μm). Sporangia were hyaline, ovoid, with an average length and width of 14.2 (10.0 to 18.0) × 12.1 (9.3 to 15.0) μm. For molecular categorization, PCR amplification of the 5' end of the large ribosomal subunit gene was performed with primers NL1 and NL4 (2). The amplicons were cloned, sequenced, and deposited in GenBank (Accession Nos. KC905620 and KC905621). The sequence similarities were 99% compared with that of Plasmopara obducens (J. Schröt.) J. Schröt from Florida (JX217746) (3). Based on morphological and molecular characters, the pathogen was identified as P. obducens. Three voucher specimens (TNM Nos. F0026644, F0026645, and F0026646) were deposited in the herbarium of the National Museum of Natural Science, Taichung, Taiwan. Pathogenicity was confirmed by inoculation of five young, potted impatiens plants with a suspension containing 1 × 10⁵ sporangia/ml in 0.05% Tween 20 (approximately 8 ml/plant). An additional five plants sprayed with 0.05% Tween 20 served as negative controls. The plants were maintained in an outdoor ambient environment. After 2 weeks incubation at an average temperature of 20°C and approximately 80% relative humidity, the inoculated plants exhibited typical downy mildew symptoms, while the control plants remained healthy. The pathogenicity test was repeated in a dew chamber under 20°C with similar results. In the Asia-Pacific region, impatiens downy mildew was recently confirmed in Korea and Japan (1,4). To our knowledge, this is the first report of downy mildew on impatiens in Taiwan. Our further surveys indicated the disease has spread to other parts of the island and will become a potential problem requiring prevention. References: (1) Y. J. Choi et. al. Plant Pathol. J. 25:433, 2009. (2) K. O'Donnell. Curr. Genet. 22:213, 1992. (3) A. J. Palmateer et. al. Plant Dis. 97:687, 2013. (4) M. Satou et. al. J. Gen. Plant Pathol. 79:205, 2013.

16,17-dihydroxycyclooctatin, a new diterpene from Streptomyces sp. LZ35

Genome sequence analysis of Streptomyces sp. LZ35 has revealed a large number of secondary metabolite pathways, including a complete gene cluster for the biosynthesis of cyclooctatin. This cluster contains four genes, cotB1-4, located in a 5-kb region. Optimization of fermentation medium for LZ35Δheng (SR107) led to the identification of cyclooctatin (1) and 16,17-dihydroxycyclooctatin (2), a new diterpene. The structures of these substances were elucidated on the basis of 1D-, 2D-NMR, and HRESIMS data. Cytotoxicity against MDA-MB-231 and A549 cell lines was also evaluated. Results demonstrated that gene cluster and pathway analysis are key to guided isolation of new natural products.

A new phenoxazine derivative isolated from marine sediment actinomycetes, Nocardiopsis sp. 236

During screening of marine actinomycetes for anti-mycobacterial activity, a new phenoxazine derivative (1) was isolated, along with 6-phenazinediol (2), 6-methoxy-1-phenazinol (3), nocardamin (4), and 3-pyridinecarboxylic acid (5), from a culture of Nocardiopsis sp. 236 collected from the west Pacific. The chemical structure of 1 was established on the basis of 1D-, 2D-NMR, and HRQ-TOF MS data. All compounds were evaluated for their anti-mycobacterial activity in vitro, and only compounds 2 and 3 exhibited weak activity.

First Report of Bacterial Spot Caused by Xanthomonas arboricola pv. pruni on Japanese Plum in Taiwan

Prunus salicina Lindl., also known as Japanese plum, is a temperate-zone fruit tree grown in mountainous areas of Taiwan. The planted area in Taiwan is approximately 3,000 ha. In June 2011, more than 20% of plum fruits harvested in an orchard in Lishan (elevation about 2,000 m) showed black, mostly circular, sunken necrotic lesions. Leaves with a shot-hole appearance and cankered branches were found when investigating the orchard. Bacteria were isolated from symptomatic fruits, leaves, and branches. Isolation on nutrient agar detected colonies that were yellow, mucoid, gram-negative, Xanthomonas-like, and induced hypersensitive responses on tomatoes. Three voucher isolates, BCRC80476, BCRC80478, and BCRC80481, obtained from the fruit, leaf, and branch, respectively, were deposited in the Bioresource Collection and Research Center, Hsinchu, Taiwan. Molecular analyses were conducted for species identification. Sequences of the gyrB gene of the three voucher isolates (GenBank Accession Nos. KC202288, KC202289, and KC202287) were 100% identical to that of Xanthomonas arboricola pv. pruni pathotype strain ICMP51 (2). In addition, DNA fragments of the xopE3 gene (an X. arboricola pv. pruni specific T3E gene, approximately 381 bp) were PCR amplified using the primer pair fw-5'CCGACATTGCCGTCAGCGATCACG3' and rv-5'AGCGTTCTTGGGTGTGTTGAGCATTTG3' (1). The bacterial isolates were identified as X. arboricola pv. pruni on the basis of the colony characteristics, sequence homology, and the specific PCR assay. Pathogenicity was confirmed by inoculation of greenhouse-potted P. salicina plants with strains BCRC80476, BCRC80478, and BCRC80481 using bacterial suspensions (6.7 × 10⁸ CFU per ml) in 0.01% Tween 20. Five plants were evenly sprayed with inoculum of each bacterial isolate and covered with plastic bags for 3 days. One week post inoculation, at an average temperature of 19°C, the 15 inoculated plants produced brown-purple spots delimited by a chlorotic margin on the leaves. Three weeks post inoculation, the necrotic leaf spots completely deteriorated, leaving a shot-hole appearance, and the branches showed lesions similar to those observed in the fields. The pathogen was reisolated from the symptomatic tissues, fulfilling Koch's postulates. Control plants sprayed with 0.01% Tween 20 remained symptomless. To our knowledge, this is the first record of X. arboricola pv. pruni causing bacterial spot on P. salicina in Taiwan. References: (1) A. Hajri et al. Appl. Environ. Microbiol. 78:371, 2012. (2) J. M. Young et al. Syst. Appl. Microbiol. 31:366, 2008.

Synthesis and 188Re radiolabelling of dendrimer polyamide amine (PAMAM) folic acid conjugate

Folic acid receptors (FR) are usually over expressed in many cancer cells and are considered as potential targeted therapy agent. Generation of five polyamido amine (PAMAM) dendrimer folic acid conjugate was synthesised and radiolabelled with (188)Re, furthermore the in vitro/in vivo stability was evaluated accordingly. The labelling yield of the conjugate G5-FA-DTPA-(188)Re was 67.1% and its radiochemical purity exceeded 95%. The conjugate also showed high in vitro stability and potential value for further structure modifications and evaluations.

Topoisomerase IIα, rather than IIβ, is a promising target in development of anti-cancer drugs

DNA topoisomerase II (TOP2) is a well-known anticancer target. Its inhibitors are among the most effective anticancer drugs currently in clinical use. TOP2-targeting agents fall into two major classes of "Topo poisons" and "Topo inhibitors" based on their mechanisms of action. Mammalian cells possess two genetically distinct TOP2 isoforms, TOP2α and TOP2β, that are differentially regulated and play different roles in living cells. Compared to TOP2β, TOP2α may be an efficacious and safe chemotherapeutic target for cancer treatment. This review discusses the advantage of targeting TOP2α over TOP2β and action of various agents on TOP2α.

Anti-inflammatory activities of fractions from Geranium nepalense and related polyphenols

Geranium nepalense Sweet is a common Chinese herbal medicine and has been used as influenza, dysentery, antiphlogistic and analgesic tonic, hemostatic, stomachic, and antidiabetic drugs. The anti-inflammatory effects of G. nepalense on tetradecanoyl phorbol acetate (TPA)-induced mouse ear edema were studied in this work. The results showed that ethyl acetate fraction of the water extract of G. nepalense possessed significant activity at 2.5 g/kg (p < 0.01) with aspirin as a positive control (0.6 g/kg). Six polyphenolic compounds, including three flavonoids, i.e. kaempferol, kaempferol-7-O-β-D-glucopyranoside, and quercetin-7-O-α-rhamnopyranoside, and two tannins, i.e. pyrogallol and gallic acid, and one lignin, i.e. epipinoresinol, were isolated and characterized from ethyl acetate fraction. The isolation of polyphenols provides a clue for beneficial effects of G. nepalense in the demonstrated anti-inflammatory activity.