Objective To investigate the association between the genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and ulcerative colitis (UC) of Han ethnic population in Zhejiang, China. Methods Two hundred and seventy-four consecutive patients with UC and 726 healthy controls (HC) were studied. The genetic polymorphisms of MTHFR (C677T and A1298C) were genotyped using PCR-RELP methods. Results The frequencies of variant allele and genotype in MTHFR A1298Cgene were higher in UC patients than in the HC (35.77% vs 29. 96%, P =0. 013; 52. 19% vs 44. 90%,P=0.039; respectively). However, there were no significant discrepancies of the allele and genotype frequencies in the MTHFR C677T gene between the UC patients and the HC (P ＞ 0. 05 ). In addition, the MTHFR 677Tr homozygote, T allele and 677CT/1298AC compound genotype were more prevalent in patients with extensive colitis than in those with distal colitis (37. 66% vs 14. 72% ,P = 0. 0002; 49. 35% vs 32.99% ,P =0. 0004; 29. 87% vs 15.23% ,P =0. 006; respectively). Furthermore,the variant allele in the MTHFR A1298C gene (C) in severe UC patients was significantly lower than in mild and moderate UC patients (18.97% vs 33. 88% ,P =0. 022). Conclusion The genetic polymorphisms of MTHFR C677T and A1298C are obviously associated with Han ethnic population with UC in Zhejiang province.

Objective:To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19).Methods:Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as ± s, and measurement data distributed abnormally were expressed as M( P25, P75). Results:(1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10 9/L, (17.2±3.4)×10 9/L, (13.3±3.1)×10 9/L, and (11.1±1.6)×10 9/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10 9/L, (0.65±0.24)×10 9/L, (0.91±0.34)×10 9/L, and (1.23±0.42)×10 9/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions:During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Objective To explore the association between death receptor (DR) 4 gene polymorphism and the predis-position of ulcerative colitis(UC). Methods DR4(rs20575)genotypes were determined by direct sequencing in a total of 147 UC patients and 244 healthy controls. Logistic regression analysis was employed to assess the relationship be-tween DR4 (rs20575)gene polymorphism and UC. Results Compared to the controls, the frequencies of variant allele(G)and genotype(CG+GG) of DR4(rs20575)were significantly increased in UC patients(5.78% vs 1.23%,P=0.001,OR=4.930,95%CI1.192-12.651;7.48% vs 2.46%,P=0.025,OR=3.208,95%CI1.161-8.869). According to the Tru-elove &Witt Activity Index, the severity of UC was further stratified into the mild, moderate and severe disease. In re-sult, variant allele (G)and genotype(CG+GG)in DR4(rs20575)were significantly higher in patients with moderate and severe UC than those with mild UC (10.64% vs 3.50%,P=0.020,OR=3.282,95%CI1.208-8.916; 14.89% vs 4.00%,P=0.028,OR=4.200,95%CI1.165-15.146). DR4(rs20575) mutant allele and genotype frequencies between extensive colitis and distal colitis were no statistical difference(P>0.05). Conclusion The genetic polymorphism of DR4(rs20575)is significantly related with the susceptibility to UC, as well as severity of the disease in this cohort of Chinese pa-tients.

Objective:To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns.Methods:A retrospective observational study was conducted. From May 2016 to September 2022, 17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 13 males and 4 females, aged 23 to 55 years, with 3 patients having degree Ⅱ cervical contracture, 14 patients having degree Ⅲ cervical contracture, and 12 patients having facial scar contracture deformity. In the first stage, 34 rectangular skin and soft tissue expanders (hereinafter referred to as expanders) with rated capacity of 100-600 mL were inserted into the face, chest, shoulder, and abdomen, and then the normal saline was injected for expansion. In the second stage, the scar tissue was removed and the contracture was released to correct the deformity. Two expanded facial flaps were transplanted in local fashion, 17 expanded flaps were transplanted in pedicled fashion, and 15 expanded flaps were freely transplanted to repair the secondary wounds after release, with artery pressurization was performed in 7 flaps. Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation. The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm. The wounds of 31 flap donor sites were closed by direct suture, and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation. The skin condition of inserted place, expansion time, and total amount of normal saline injection of expanders, complications of skin and soft tissue expansion surgery, and survival of flap after the second stage surgery were observed and recorded. The long-term face and neck reconstruction effect and recovery of flap donor area were followed up. At the last follow-up, the 5-level Likert scale was used to evaluate the efficacy satisfaction of patients.Results:Of the 34 expander inserted places in 17 patients, 22 places were superficial scar skin after deep partial-thickness burns, 8 places were superficial scar skin after multiple skin donations, and 4 places were normal skin. After 4 to 15 months of expansion, the total normal saline injection volume was 238 to 2 000 mL, with no complications occurred. After the second stage surgery, the distal part of 2 pedicled flaps was partially necrotic, and the necrotic wounds were healed after flap dressing and free transplantation of contralateral expanded triangular flaps, respectively; the other flaps survived completely. During 6 to 18 months of follow-up, except for 2 expanded paraumbilical flaps and 1 expanded groin flap, which were bloated and improved by flap thinning, the appearance and texture of the other flaps were good, and all the flap donor sites recovered well. At the last follow-up, the face and neck scar contracture deformities were significantly improved in all patients, and the satisfaction of curative effect of patient was very satisfactory in 8 patients and relatively satisfactory in 9 patients.Conclusions:The expanded flaps of chest, abdomen, and other parts, combined with local advance, pedicled, and free transplantation, can effectively reconstruct scar contracture deformities in the face and neck after extensive burns, restore the function of operative area and improve the appearance simultaneously, with high degree of patient satisfaction, which is worthy of promotion in clinic.