Objective To study the effect of dexamethasone to protect flaps from an ischemia-reperfusion injury and elucidate its mechanism of regulating the death course of the neutrophils. Methods The rats were randomly divided into 3 groups.The vein of the rat was clamped for 8 h after the flap had formed. Group A: the normal flap; Group B: the saline control flap; Group C: the treatment flap with dexamethasone. The survival area of the flaps was measured at 7 days; the apoptotic and necrotic neutrophils,tumor necrosis factor α (TNF-α), and interleukin 10 (IL-10) concentrations were measured. Results The flap survival are as in Groups A and C were larger than those in Group B. The apoptotic neutrophils in Group B were fewer than those in Groups A and C on the 1st and 3rd days after operation; however, they were more in number in Group B than in groups A and C on the 6th day. The necrotic cells in Group B were more in number than those in Groups A and C. In Group B, the plasma TNF-α concentration reached the maximum level at 1 h,while the IL-10 level reached the lowest 3 h after the reperfusion. In Group C, the TNF-α concentration was lower than that in Group B and decreased dramatically at 6 h. The IL-10 concentration was the lowest at 1 h, and increased rapidly at 3 h.Thus,ischemia-reperfusion could injure the flaps, probably through the abnormal action of the neutrophils, such as the disordered secretion of the cytokines and abnormal death course of the neutrophils. Conclusion Dexamethasone can protect the flap from an ischemia-reperfusion injury by its regulation for the neutrophil function.

Objective To investigate the clinical and electrophysiology features of infantile spinal muscular atrophy,and explore the clinical significance of genetic diagnosis. Methods The clinical data of 13 infants suffering from infantile spinal muscular atrophy were analysed.The serum creatine phosphokinase was examined,and nerve conduction velocity was tested in median nerve,ulnar nerve,tibial nerve and peroneal nerve.The parameters such as distal motor latency,motor nerve conduction velocity and amplitude of compound motor active potential were analysed.Electromyography was performed in no less than four muscles,and the insertion potential,spontaneous potential and motor unit action potential were observed.Deletion of exon 7 in SMN1 gene was detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). Results All these infants were characterized by progressive flaccid paralysis in limbs.In all cases,amplitude of muscle response was significantly decreased,with prolonged distal latency and slowed conduction velocity.Electromyography demonstrated motoneuron degeneration.Deletion of exon 7 in SMN1 gene was detected in all 13 infants. Conclusion There are unique clinical and electrophysiology features for infantile spinal muscular atrophy,and electromyography may play an important role in the diagnosis.Prenatal genetic diagnosis may help to avoid the birth of this kind of infants.

Objective To investigate the risk factors for early hypoglycemia and its relationship with prognosis of patients with cerebral infarction.Methods A total of 273 patients with cerebral infarction were divided into the normal blood glucose(NBG) and severe hypoglycemia (SHG)and mild hypoglycemia(MHG) groups in our hospital.Biochemical indicators,the National Institute of Health stroke scale(NIHSS)and mortality were compared between the three groups.According to prognosis,patients were divided into death group and survival group.The NIHSS score,blood glucose concentration and incidence of hypoglycemia were compared between death and survival groups.Pearson relationship between hypoglycemia and NIHSS score,and spearman rank correlation between hypoglycemia severity and mortality were analyzed.Results Levels of lactic acid (6.3 ± 2.8) mmol/L,creatinine(268.7 ± 63.9) mmol/L,urea nitrogen (13.8 ± 3.7) mmol/L,albumin (25.6 ±4.9) g/L,alanine aminotransferase (150 ± 19.7) U/L,NIHSS (22.3 ± 9.2) scores,and mortality rates (38.1 ％)were higher in severe hypoglycemia group than in both NBG group and severe hypoglycemia group[(lactic acid:4.7±2.3 mmol/L and 3.3±1.5 mmol/L),(creatinine 134.8±51.3 mmol/L and 78.7±40.8 mmol/L),(urea nitrogen 7.9±4.2 mmol/L and 7.7±3.3 mmol/L),(albumin 36.9±3.8 g/L and 35.6±4.3 g/L),(alanine aminotransferase 85.8± 18.3U/L and 46.3± 13.8U/L),(NHISS 14.6±5.9 scores and 10.5 ± 5.4 scores)and(mortality rates 20.8％,11.0％)] (all P＜0.01).There was a negative correlation between hypoglycemia and NIHSS score(r=-0.45,P＜＜0.05).There was a positive correlation between hypoglycemic severity and mortality (r =0.41,P ＜ 0.05).Multiple Logistic regression showed that creatinine and alanine aminotransferase were correlated with hypoglycemia and prognosis of patients with cerebral infarction(both P＜0.05).Conclusions Early hypoglycemia in patients with severe cerebral infarction is closely correlated with the liver and kidney insufficiency,and a severe cerebral infarction combined with hypoglycemia often indicate a poor prognosis.

Objective To study the mechanism of glutamine dipeptide on wound healing after operations on bums. Methods Totally, 30 burned patients were randomly divided into study group and control group (15 cases in each group). All patients received parental nutrition support after operation. Study group patients were supplemented with glutamine dipeptide at a dose of 0. 5 g · kg±1 · d±1. The plasma free hydroxyproline level was measured by a standard amino acid analyzer 1 day before operation and 7 days after operation and the wound healing time was recor± ded. Results The plasma free hydroxyproline levels of both groups were higher than the normal values before opera± tion but without significant difference [control group: (2. 24 ±0. 84) fig/ml, study group: (2. 32 ±0.92) μg/ml, normal value: (1.27 ±0.44) μg/ml]. On the post±operative 7 day, the plasma free hydroxyproline level of study group [ (4. 31 ±1. 05) μg/ml] was significantly higher than that of control group [ (3. 04± 1. 01) μ/ml] (P = 0.002). The wound healing time of study group [ (29. 7±5.3) d] was shorter than that of control group but with± out significant difference [ (33. 3 ±7.5) d, P = 0. 14 ]. Conclusion The intravenous supplementation of glutamine dipeptide may increase the plasma hydroxyproline level after operation and thus promote wound healing.

Objective To explore the repair of the open compound wounds in lower extremities caused by multiple factors. Methotis Transplantation of cutaneous.musculo-cutaneous or greater omentum flaps were applied to 155 patients of open compound lower extremity wounds. Results The wound healing rate following first operation was 50% and that following two operations was 14.8%.While the wounds were healed in 7.7% of patients after three operations. Conclusion Transplantations of cutaneous,musculo-cutaneous or greater omentum flaps ale effective to repair and reconstruct the open compound lower extremity wounds.

Objective:To investigate the relationship between the down-regulation expression of sodium taurocholate cotransporting polypeptide (NTCP) in proliferating hepatocytes and the response to antiviral therapy of chronic hepatitis B (CHB) patients.Methods:Sixty-eight hepatitis B e antigen (HBeAg)-positive CHB patients admitted to the Fifth Medical Center of PLA General Hospital from January 2011 to March 2015 were included. Basic information and laboratory data were collected. Based on the baseline (before antiviral treatment) inflammatory activity (G), the patients were divided into ≤G2 group and >G2 group. Twelve liver puncture tissue samples were selected from each group for NTCP and Ki67 immunofluorescence staining.The proportion of Ki67-positive cells was calculated, and the staining of NTCP was scored. Five pairs of tissue specimens of patients who had hepatitis B virus (HBV) infection were diagnosed with focal nodular hyperplasia (FNH) and underwent nodular resection surgery from March 2014 to March 2017 were collected.Immunohistochemical staining was used to detect the expressions of Ki67, NTCP and hepatitis B surface antigen (HBsAg) in each tissue specimen, and the proportion of staining positive cells or the staining intensity was calculated. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Spearman correlation analysis. Results:The proportion of Ki67-positive cells (6.75%(6.20%, 8.16%))in five liver FNH tissues with HBV infection was significantly higher than that in adjacent non-FNH tissues (0.75%(0.66%, 1.20%)), while the immunohistochemical scores of NTCP and HBsAg (3.00 (1.00, 3.00) and 2.00 (1.00, 2.00), respectively) were both significantly lower than those in adjacent non-FNH tissues (8.00 (8.00, 9.00) and 8.00 (6.00, 8.00), respectively), the differences were all statistically significant ( Z=-2.611, -2.424 and -2.635, respectively, P=0.009, 0.015 and 0.008, respectively). There were 37 patients in >G2 group, and 31 patients in ≤G2 group. After six months of antiviral treatment, CHB patients with persistent inflammation in >G2 group obtained a better virological response, with serum HBV DNA and HBeAg showing a greater decline ((0.71±0.14) lg IU/mL and (0.92±0.13) lg IU/mL, respectively) than those in ≤G2 group ((0.54±0.30) lg IU/mL and (0.49±0.65) lg IU/mL, respectively) ( Z=-3.048 and -2.666, respectively, P=0.002 and 0.008, respectively). The proportion of Ki67-positive cells in the specimens of >G2 group (4.34%(1.84%, 8.77%)) was significantly higher than that of ≤G2 group (0.34%(0, 0.80%)) ( Z=-3.640, P<0.01), and the immunohistochemical staining score of NTCP (1.00 (0, 3.25)) was significantly lower than that of ≤G2 group (6.00 (4.00, 8.00)) ( Z=-3.012, P=0.003). Spearman correlation analysis showed that the NTCP immunohistochemical score was negatively correlated with the proportion of Ki67-positive cells ( r=-0.512, P=0.01). Conclusions:CHB patients with persistent inflammationare often accompanied by more active hepatocyte proliferation and low membrane NTCP expression, which is not conducive to HBV reinfection. It may facilitate these patients to obtain better virological response.

Objective:To investigate the clinical and diagnostic value of liver stiffness measurement (LSM) for the evaluation and comparison of aspartate aminotransferas/platelet ratio index (APRI), fibrosis 4 indexes (FIB-4) and NAFLD fibrosis score (NFS) with liver fibrosis staging in relation to nonalcoholic fatty liver disease (NAFLD).Methods:103 cases with NAFLD who met the inclusion criteria confirmed by liver biopsy were selected for retrospective analysis. The results of serological tests and LSM were recorded. The APRI, FIB-4 and NFS were calculated. The accuracy and applicability of four liver fibrosis models in the diagnosis of liver fibrosis in NAFLD patients were compared with the receiver operating characteristic curve (ROC), and the diagnostic cut-off value of LSM was established.Results:Varying degrees of LSM, APRI, FIB-4 and NFS had shown positive correlations with the increasing degree of liver fibrosis. Among them, LSM was positively correlated with the degree of liver fibrosis, and the correlation coefficient was r = 0.727, P < 0.0001. Consistent with this, the area under the receiver operating characteristic curve, sensitivity, and specificity of LSM diagnosis of liver fibrosis in different stages was significantly higher than APRI, FIB-4 and NFS. Area under receiver operating characteristic curve of LSM was 0.862 and 0.928 for significant liver fibrosis ( f ≥ 2), and advanced liver fibrosis ( f ≥ 3). Conclusion:LSM has a good diagnostic exclusion value for NAFLD-induced fibrosis, and its sensitivity and specificity are better than APRI, FIB-4 and NFS.

Objective To evaluate the effect of "health education mobile classroom " in the outpatient department of children's hospital, and to analyze the needs of the outpatient and family members on health education. Methods Through the retrospective analysis of the information of the outpatient and emergency patients in the children's specialist hospital to determine the content, the venue and the time period of the "health education mobile classroom". Selection and training the health educator to implement the health education. At the same time, push the training content through the mobile APP to the patient's family, to expand the education audience. To compare and analyze the patient satisfaction of the hospital and the satisfaction with the dimensions of the project. In the evaluation of the effect of health education and the influencing factors, the relationship between income, occupation and children is positively related, and age is negatively related to it. Results After the implement of this project, the satisfaction of the patient had increased for 3.65%(P=0.001). Overall assessment of the audience was very satisfied with (3.94 ± 0.25) points. In each dimension analysis, the satisfaction of the "training method"was the highest, at (3.94 ± 0.26) points. Satisfied with the attitude of the trainers and comprehensive ability were more than 3.80 points. Conclusions The "health education mobile classroom" can improve patient satisfaction in the outpatient department and emergency of children's specialist hospital. Audience has a certain degree of acceptance and satisfaction with this health education mode.

Objective To explore the effect of sequential and comprehensive preventative measures on the development of premature infants' intelligence.Methods A cohort of 120 premature infants was randomly divided into an observation group and a control group,each of 60.Both groups were given routine premature infant care,but the observation group was additionally provided with sequential and comprehensive preventive intervention.It included neonatal screening,inpatient-outpatient link-up,and their parents' watching CDs explaining early childhood education and health education.All of the infants were followed up from birth to 3 years old.Their adaptive capacity,fine motor skills,language acquisition,gross motor skills and social communication were evaluated at 12,24 and 36 months old using a child intelligence developmental scale for neurological development.Development intelligence quotients (DQs) were calculated and compared.Results After 12 months,significant inter-group differences were observed in adaptability and fine motor control.At 24 and 36 months old there were also significant differences in language skills.At one,two and 3 years old the average DQ of the observation group was significantly higher than that of the control group.Significant within-group differences in average DQ were observed in both groups between 1 and 2 years old,but not between 2 and 3.Conclusion Intervention within two years after birth is critical for premature infants.Timely,sequential,integrated,preventive intervention can promote the development of intelligence and better life quality for premature infants.

Purpose: This study aims to evaluate the efficacy and safety of a new combination treatment of vinorelbine and pyrotinib in human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (MBC) and provide higher level evidence for clinical practice. Materials and Methods: This was a prospective, single-arm, phase 2 trial conducted at three institutions in China. Patients with HER2-positive MBC, who had previously been treated with trastuzumab plus a taxane or trastuzumab plus pertuzumab combined with a chemotherapeutic agent, were enrolled between March 2020 and December 2021. All patients received pyrotinib 400 mg orally once daily plus vinorelbine 25 mg/m2 intravenously or 60-80 mg/m2 orally on day 1 and day 8 of 21-day cycle. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included the objective response rate (ORR), disease control rate (DCR), overall survival, and safety. Results: A total of 39 patients were enrolled. All patients had been pretreated with trastuzumab and 23.1% (n=9) of them had accepted trastuzumab plus pertuzumab. The median follow-up time was 16.3 months (95% confidence interval [CI], 5.3 to 27.2), and the median PFS was 6.4 months (95% CI, 4.0 to 8.8). The ORR was 43.6% (95% CI, 27.8% to 60.4%) and the DCR was 84.6% (95% CI, 69.5% to 94.1%). The median PFS of patients with versus without prior pertuzumab treatment was 4.6 and 8.3 months (p=0.017). The most common grade 3/4 adverse events were diarrhea (28.2%), neutrophil count decreased (15.4%), white blood cell count decreased (7.7%), vomiting (5.1%), and anemia (2.6%). Conclusion Pyrotinib plus vinorelbine showed promising efficacy and tolerable toxicity as second-line treatment in patients with HER2-positive MBC.