Objective To introduce an improved method of continuous intradermal suture,and to evaluate its clinical efficacy for the closure of surgical incisions.Methods Eighty-two patients were enrolled in this study,including 37 cases of nevus,10 cases of basal cell carcinoma,16 cases of sebaceous cyst,6 cases of lipoma,8 cases of seborrheic keratosis,3 cases of dermatofibroma and 2 cases of depressed scar.All the patients were managed by simple surgical excision with the shortest length of postoperative incisions being 0.8 cm and the longest length being 12 cm.An improved method of continuous intradermal suture was used for the closure of all the postoperative incisions.Specifically,an absorbable thread with a small triangle needle in both ends was inserted through and pulled out from the dermal layer at one side of the incision,and then inserted through and pulled out from the dermal layer at the opposite side of the incision,which was repeated until the incision was entirely closed.Results Among the 82 patients,80 achieved primary healing,and 2 developed erythematous painful swelling at the incision site 2 days after the operation,which disappeared after symptomatic treatment for 5 days.During 3-6 months of follow-up,the incisions closed leaving a flat and smooth surface in 78 patients,and proliferative scar formed in 4 patients,which was obviously improved after local injection with glucocorticoids.No disruption of incisions was observed.Conclusion The improved method of continuous intradermal suture can be applied to the closure of skin defects in the face,neck,trunk and extremities with a favorable healing outcome and cosmetic result.

Objective To explore the growing development and community succession of main sarcos-aphagous insects on pig carcasses in summer indoor and outdoor environment in Shenzhen area and to estimate the postmortem interval (PMI). Methods From early May to August in 2013, in Forensic Med-ical Examination Center of Shenzhen Public Security Bureau, the main insect species and the decomposi-tion process were observed in two adult pig carcasses of simulative indoor and outdoor environment. The different decomposition stages and the community succession of insects were recorded. Results The indoor and outdoor pig carcasses showed skeleton 412.5 and 325 hours after death, respectively. The main species of flies on pig carcasses were Chrysomya megacephala, Chrysomya rufifacies and Chrysomya chani. The main species of beetles were Crecphilus maxillosus, Necrobia ruficollis, Saprinus splendens and Dermestes maculatu. The dominant species of flies in the outdoor pig carcasses obviously produced the second generations due to the effect of mass rainfall, nor in the indoor pig carcasses. Conclusion There are regular patterns on the community succession of insects on pig carcasses in summer indoor and out-door environment in Shenzhen area. The activity patterns of seven typical insects and their larva show important value for estimating PMI.

Medical ethics is an important constitutes of medicine project. The medical ethics of military has its particularity and realism meaning. Combined with the spirit of anti-SARS and the actuality of military medicine ethnics,we must adopt some availability measure to promote the education of military medicine ethnics.

Objective To detect the changes of microbial community functional diversity of corpses with different postmortem interval(PMI)and to evaluate forensic application value for estimating PMI. Methods The cultivation of microbial community from the anal swabs of aSusscrofaand a human corpse placed in field environment from 0 to 240 h after death was performed using the Biolog-Eco Mi-croplate and the variations of the absorbance values were also monitored. Combined with the technology of forensic pathology and flies succession, the metabolic characteristics and changes of microbial commu-nity on the decomposed corpse under natural environment were also observed.Results The diversity of microbial metabolism function was found to be negatively correlated with the number of maggots in the corpses. The freezing processing had the greatest impact on average well color development value at 0 h and the impact almost disappeared after 48 h. The diversity of microbial metabolism of the samples be-came relatively unstable after 192 h. The principal component analysis showed that 31 carbon sources could be consolidated for 5 principal components(accumulative contribution ratio >90%). The carbon source tsquare-analysis showed thatN-acetyl-D-glucosamine andL-serine were the dominant carbon sources for estimating the PMI(0=240 h)of theSusscrofaand human corpse.Conclusion The Biolog-Eco method can be used to reveal the metabolic differences of the carbon resources utilization of the microbial community on the corpses during 0-240 h after death, which could provide a new basis for estimating the PMI.

Objective To establish a rapid method for the clinical detection and identification of fungi in clinical urine samples.Methods DNA was extracted from clinically collected urine sample,and the fungal ribosomal internal transcribed spacer was amplified by polymerase chain reaction (PCR) and followed by pyrosequencing.The fungal species were identified by sequence alignment.Results The identification results were compared between PCR-pyrosequencing and conventional culture method.Among the 1320 urine samples,180 were detected positive by conventional method with the positive rate of 13.6％,while 192 were positive by the pyrosequencing based method with the positive rate of 14.5％.The overall coincidence rate of the two methods was 99.09 ％,with the positive coincidence rate of 100 ％ and the negative coincidence rate of 98.95 ％.The Kappa value was 0.963,suggesting a good consistency.The results of 13 standard strains were consistent with the actual results.Conclusions A rapid culturefree method for the detection of fungi in urine sample has been successfully established.This method is based on PCR-pyrosequencing technology with highly accuracy,sensitivity and reproducibility.It is highly automated,cost effective and with high throughput (96 samples per run).The fungal pathogen in urine is identified by single step test within 3 hours without conventional culture.Thus,it is applicable in the clinical laboratory.

Objective To analysis the relationship of primary aldosteronism to insulin resistance and abnormal glucose metabolism in patients with primary aldosteronism.Methods One hundred and three patients were diagnosed as aldosterone-producing adenoma(APA),75 cases as idiopathic hyperaldosterenism(IHA),56 patients as metabolic syndrome(MS)in Peking Union Medical College Hospital from September 2003 to December 2005.All patients were accepted 3 h oral glucose tolerance test and calculated HOMA-insulin resistance index (HOMA-IR)by Homeostasis Model.Results The Insulin area under curve[INS_(AUC) 270.8(192.7,370.4)mU?L~(-1)?h~(-1)]、HOMA-IR[3.2(2.4,4.7)]and prevalence of insulin resistance(64.3%)were significantly higher in patients with MS as compared with APA[113.2(81.5,193.6)mU?L~(-1)?h~(-1),1.4(1.0,2.2),16.5%]and IHA[186.9(116.6,243.3)mU?L~(-1)?h~(-1),2.0(1.4,3.1),32.0%]groups (all P＜0.01);The INS_(AUC), HOMA-IR and prevalence of insulin resistance were significantly higher in patients with IHA than those with APA (P＜0.05 or P＜0.01).There was no difference between the prevalence of impaired glucose regulation(41.7%, 34.7%),diabetes mellitus(15.5%,16.0%)in patients with APA,IHA and those with MS(41.1%, 26.8%).Conclusion Insulin resistance is present in primary aldosteronism patients,and the prevalence of insulin resistance is higher in patients with IHA.

Objective We have summarized the clinical characteristics of inappropriate antidiuresis(SIAD).Methods We adopted retrospective analysis to analyze the clinical and lab data of 40 cases.Results The most common causes of SIAD were malignant tumor,lung disease,and central nervous system disease.The five major abnormal lab data were:hypochloraemia,hypouricemia,hyponitremia,hypocalcemia,and low hematocrit.Conclusion It is important to diagnose SIAD as soon as possible,and patient presented hyponatremia combined with hypouricemia must be suspected to have SIAD.

Developing new therapeutic agents for cancer immunotherapy is highly demanding due to the low response ratio of PD-1/PD-L1 blockade in cancer patients. Here, we discovered that the novel immune checkpoint VISTA is highly expressed on a variety of tumor-infiltrating immune cells, especially myeloid derived suppressor cells (MDSCs) and CD8⁺ T cells. Then, peptide C1 with binding affinity to VISTA was developed by phage displayed bio-panning technique, and its mutant peptide VS3 was obtained by molecular docking based mutation. Peptide VS3 could bind VISTA with high affinity and block its interaction with ligand PSGL-1 under acidic condition, and elicit anti-tumor activity in vivo. The peptide DVS3-Pal was further designed by d-amino acid substitution and fatty acid modification, which exhibited strong proteolytic stability and significant anti-tumor activity through enhancing CD8⁺ T cell function and decreasing MDSCs infiltration. This is the first study to develop peptides to block VISTA/PSGL-1 interaction, which could act as promising candidates for cancer immunotherapy.