Objective To evaluate combined buccal mucosa and lingual mucosa grafts for urethroplasty in a dog model. Methods Seven female mongrel dogs were selected.After a segment of proximal urethra mucosa (4 cm×1 cm) was excised and onlayed,urethroplasty was performed by using the combined free buccal mucosa (2 cm×1 cm)graft which had been harvested from the inferior cheek and free lingual mucosa graft(2 cm×1 cm)harvested from the inferior lateral surface of the tongue.A 12 F urethral catheter was kept for 7 d.Retrograde urethrography was done and urethra diameter was calibrated with a 10 F catheter before animals were sacrificed at week 12.Then the grafted areas excised and evaluated grossly and histopathologically. Results All dogs survived during the procedure and there was no tongue or bueeal complications.One dog developed a severe urethral stricture at the proximal anastomosis site.The remaining 6 dogs voided spontaneously with no difficulty.Retrograde urethrography showed that no stricture or fistula formed.The combined buccal mucosa graft and lingual mucosa graft shortened from a mean (SD) of 4.00(0.15)to 3.75(0.23)cm (statistically.significant,P＜0.05).No stricture was found in the connection of the buccaI mucosa and lingual mucosa grafts.Histological examination showed that the combined buccal mucosa and lingual mucosa grafts were well-incorporated into the urethral walls and covered by a keratinized squamous epithelium.Neovascularization was evident beneath the grafts. Conclusion Combined buccal mucosa graft and lingual mucosa graft could be an option for urethral substitution.

Objective To explore the effect of in utero exposure to inlfammation on innate immune response in preterm infants. Methods Forty-seven premature infants with gestational age<35 weeks were recruited in this study. According to his-tological evidence of placental infection, all neonates were divided into intrauterine inlfammation positive group and negative group. Mononuclear cells and monocytes were isolated from umbilical cord blood, and were cultured in vitro in the presence or absence of LPS (100 ng/ml). The levels of interleukin 1β(IL-1β), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and interleukin 10 (IL-10) in cord blood plasma and monocyte cultural supernatants were measured by ELISA respectively. The level of IL-1β, TNF-α, IL-6 and IL-10 mRNA were detected by Real-time PCR. Expression of HLA-DR on surface of CD14+monocytes and ratio of CD3+CD4+/CD3+CD8+T was analyzed by lfow cytometry. Results (1) The level of cord plasma IL-6 in intrauterine inlfammation positive group was signiifcantly higher than in negative group. (P=0.02). (2) After stimulation of LPS, levels of IL-1β, IL-6, TNF-α, IL-10 in supernatants were increased signiifcantly, in consistence with their mRNA expression (P<0.05) in both groups. (3) Expression of HLA-DR on surface of monocytes was signiifcantly decreased after stimulation with LPS in intrauterine inlfammation positive group (P=0.012), but was signiifcantly increased in negative group (P=0.0305). Con-clusions In utero exposure to inlfammation does not suppress the response of monocytes to LPS in preterm neonates, but impairs the antigen presenting function in monocytes.

OBJECTIVETo explore the inhibitory effect of combined administration of bear bile powder (BBP) and cyclophosphamide (Cytoxan, CTX) on colorectal cancer liver metastasis by regulating tumor promotion inflammation microenvironment.

METHODThe CRC liver metastasis mode in mice was established through in situ spleenic injection of SL4 tumor cells into spleens. The mice were randomly divided into 5 groups: the model group, the CTX (80 mg x kg(-1)) treatment group, the CTX + BBP high dose (300 mg x kg(-1)) group, the CTX + BBP middle dose (150 mg x kg(-1)) group and the CTX + BBP low dose (75 mg x kg(-1)) group. Mice were orally administered with drugs for 12 days, and sacrificed on the 13'h day for weighing their spleens and lives, HE staining, and immunofluorescence analysis. Their peripheral blood, and metastatic tumor in spleens and lives were analyzed with flow cytometry.

RESULTSpleen and liver weights of the: CTX treatment group and other doses groups were significantly lower than that of the model group. HE staining and immunofluorescence analysis showed that lymphocyte infiltration was detected in normal tissues, and macrophages infiltration was observed around the tumor tissues. Flow cytometry analysis showed that the number of T-lymphocytes in peripheral blood of different doses groups were much higher than that of the CTX treatment group (P < 0.05), with the rise in the ratio of CD4/CD8; the total number of lymphocytes in spleen cell suspension increased in different doses groups, compared to the CTX treatment group, with notable increase in B cells (P < 0.05) and significant decrease in CD11b, F4/80 cells (P < 0.05). The combined treatment showed less monocyte macrophages in liver metastasis than that of the CTX treatment group.

CONCLUSIONThe combined treatment of bear bile powder and cyclophosphamide has the effect in not only protecting liver and increase immunity, but also in anti-inflammation and antitumor by regulating tumor microenvironment and reducing the collection of mononuclear macrophages. Particularly, the combined administration of low dose of bear bile powder and CTX shows the most significant effect in reducing inflammatory cell infiltration.

Animals ; Bile ; chemistry ; Colorectal Neoplasms ; drug therapy ; mortality ; pathology ; Combined Modality Therapy ; Cyclophosphamide ; administration & dosage ; Humans ; Liver Neoplasms ; drug therapy ; mortality ; physiopathology ; secondary ; Male ; Mice ; Mice, Inbred C57BL ; Tumor Microenvironment ; drug effects ; Ursidae

Objective:To develop and validate a model to predict the risk of malnutrition in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy. Methods:From April 2022 to August 2023, 430 patients with nasopharyngeal carcinoma who were admitted to the department of radiotherapy of the first affiliated hospital of Guangxi medical university in Nanning were conveniently selected as the study subjects, and they were divided into the modelling group (300 cases) and the internal validation group (130 cases) in the internal validation group in the ratio of 7:3, and 61 patients with nasopharyngeal carcinoma admitted to the affiliated cancer hospital of Guangxi medical university in Nanning City were selected as the external validation group. Logistic regression was used to establish the risk prediction model and draw nomograms,Hosmer-Lemeshow, calibration curve and ROC were used to verify the goodness of fit and predictive power of the model, and clinical decision curve was used to assess the clinical utility. Results:Logistic regression analysis showed that skeletal muscle mass index, self-rated anxiety scale score, Pittsburgh sleep quality questionnaire score, Chinese diet pagoda score, regular exercise, and digestive symptom groups were the influencing factors for malnutrition in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy. In the modelling group, the area under the ROC curve was 0.853 (95％CI:0.81 ～ 0.89), the maximum Youden was 0.600, and the corresponding specificity was 0.764 and the sensitivity was 0.836. The Hosmer-Lemeshow test=4.040 and P=0.853 indicated that the model had good predictive ability. Calibration curve of the calibration showed that the predictive effect of the model matched actual probability well, with an average absolute error was 0.024. When the threshold probability of the clinical decision curve is 0.05 ～ 0.85, the clinical response rate is higher. The area under the operating curve of the subjects in the internal validation group was 0.891, the sensitivity was 77.36％, the specificity was 89.61％, and the practical application accuracy was 84.62％. The area under the operating curve of the subjects in the external validation group was 0.886, the sensitivity was 76.00％, the specificity was 83.33％, and the overall accuracy was 80.33％. Conclusion:The risk prediction model constructed in this study has a good effect, which can effectively predict the incidence of malnutrition in patients receiving concurrent radiotherapy and chemotherapy for nasopharyngeal carcinoma, and provide a reference for clinical staff to formulate and implement nutritional interventions.

BACKGROUNDThe hypothalamus plays a central role in the regulation of metabolism by sensing metabolic demands and releasing regulatory neurotransmitters. This study investigated the response of the hypothalamus to glucose ingestion in rats by blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and immunohistochemical techniques to determine the role of the hypothalamus in glyco-regulation during disturbances in carbohydrate metabolism.

METHODSThe signal intensity of the hypothalamus was monitored by fMRI for 60 minutes after oral glucose intake in 48 healthy rats (age 14 months), which included 24 normal weight rats (weighing (365 +/- 76.5) g) and 24 overweight rats (weighing (714 +/- 83.5) g). Then, 12 rats (6 normal, 6 overweight) underwent a repeat fMRI scan after consuming an equivalent amount of water without glucose on a separate day. The procedure for fMRI with water intake was the same as for glucose ingestion. fMRI data was processed using time cluster analysis and intensity averaging method. After fMRI, the expression of neuropeptide Y (NPY) and 5-hydroxytryptamine (5-HT) in the hypothalamus of all rats was determined by immunohistochemistry. Positive cells for NPY or 5-HT were counted.

RESULTSThere was a transient, but significant, decrease in fMRI signal intensity in all rats (mean (3.12 +/- 0.78)%) in the hypothalamus within 19.5 - 25.5 minutes of oral glucose ingestion. In overweight rats, the decrease in signal intensity in response to the glucose ingestion was more markedly attenuated than that observed in normal weight rats ((2.2 +/- 1.5)% vs (4.2 +/- 0.7)% inhibition, t = 2.12, P < 0.05). There was no significant response in the hypothalamus after oral water ingestion. The percentage of NPY positive cells in obese rats were slightly lower than those in control group (21% vs 23%, t = 0.71, P > 0.05); but there was no significant difference between the two groups; the percentage of 5-HT positive cells in obese rats were significantly lower than those in the control group (22% vs 31%, t = 3.25, P < 0.01).

CONCLUSIONSThere is a transient, but significant, decrease in BOLD signal intensity in the hypothalamus following glucose ingestion, which is similar to that observed in humans. The response of the hypothalamus to glucose ingestion was different in overweight and normal weight rats. The percentage of NPY positive cells in obese rats were lower than those in the control group, although this difference was not statistically significant. The percentage of 5-HT positive cells in obese rats was significantly lower than those in the control group.

Animals ; Glucose ; metabolism ; Hypothalamus ; physiology ; Immunohistochemistry ; Magnetic Resonance Imaging ; methods ; Neuropeptide Y ; analysis ; Obesity ; metabolism ; Oxygen ; blood ; Rats ; Serotonin ; analysis

Objective To evaluate the clinical effects of multiple rewarming interventions in adult hypothermia trauma patients.Methods A systematic search of Cochrane Library,PubMed,EMBASE,Scopus,CINAHL,Chinese Biomedical Literature Database (CBM),Chinese Knowledge Infrastructure (CNKI),VIP and Wan Fang Database was carried out to identify all randomized controlled trials(RCTs) and controlled clinical trials(CCTs) that explored the effects of rewarming interventions in adult hypothermia trauma patients.The quality of the literature was evaluated using JBI 2008 RCT and quasi-experimental study evaluation criteria.Data and network plot were analyzed and drawn by ADDIS 1.16.7 software.Results Totally 6 RCTs and 1 quasi-experimental design were included,involving 10 interventions and 619 patients.There was statistically significant difference in body temperature after rewarming between the warm blankets and the forced-air blankets in all rewarming measures.The results of the top three interventions were carbon-fiber heating blanket(set to 42℃),forced-air blankets,warmed intravenous fluids plus blanket which resulted from the primary outcome indicators.The incidence of chills and cold discomfort decreased with the use of forced-air blankets and chemical heat pad as compared with traditional warm blankets,while the heart rate of the patients who used chemical heating pads and continuous heating of carbon fiber blanket were declined more than those used normal blankets.Conclusion The effects of carbon-fiber heating blanket which set to 42°C was the best method in all rewarming interventions.But this conclusion still requires randomized controlled trials with larger sample size to further verify.

Background and Objectives: Virtual learning has been utilized in residency programs to continue training amid the COVID-19 pandemic. This study aimed to determine the knowledge, skills, and attitudes of faculty members and residents of the Department of Rehabilitation Medicine of the Philippine General Hospital towards virtual learning. Method: This is a descriptive cross-sectional study. Respectively, residents and faculty members answered the Online Learning Readiness Scale (OLRS) and Faculty Readiness to Teach Online (FRTO) through Google Forms. Results: Twenty (20) residents and 19 faculty members participated in the study. The majority of the residents preferred asynchronous learning (50%), while faculty members preferred the hybrid mode (74%). Residents’ readiness for online learning was generally high, though problems with easy distractibility (60%) and time management (40%) were revealed. Female residents had higher online communication self-efficacy compared to males (p = 0.0367). Faculty members’ perceived attitude was significantly higher than ability in course design (p = 0.00102), time management (p = 0.00159), and technical competence (p < 0.0001). Males had higher perceived ability in course design (p = 0.0320). Older age groups had lower perceived abilities in course design (p = 0.0301) and technical competence (p = 0.0371). Conclusion This study revealed the levels of readiness of residents and faculty for virtual learning. Finding indicate the need to address both issues by developing programs to enhance faculty’s online teaching abilities and observing best practices to minimize problems such as distractibility. Large-scale studies with longer time frames are also recommended.
Physical and Rehabilitation Medicine ; Internship and Residency ; Education, Distance ; Education, Distance

In this study,the immunological characteristics of the PhoP protein were explored with a two-component system of Mycobacterium tuberculosis(Mtb).Bioinformatics was used to predict the B and T cell epitopes of the PhoP protein.A re-combinant expression plasmid was constructed by PCR analysis of the phoP sequence and cloning into the prokaryotic expres-sion vector pET-28a(+).Competent Escherichia coli BL21 cells were transformed with the recombinant plasmid and expres-sion was induced with IPTG.The recombinant PhoP protein was purified by affinity chromatography.Serum levels of PhoP-specific antibodies in Mtb-infected mice and tuberculosis(TB)patients were analyzed with an ELISA.BALB/c mice were im-munized with the PhoP recombinant protein by intramuscular injection.Sera of mice were collected and antibody titers were detected with an ELISA and specificity was assessed by West-ern blot analysis.Mouse splenocytes were isolated and the pro-portions of IFN-y-positive cells and cytokine levels were detec-ted with an ELISpot and ELISA,respectively.Bioinformatics i-dentified 24 B cell and 11 T cell epitopes of the PhoP protein.A prokaryotic recombinant vector of PhoP was successfully con-structed and the recombinant PhoP protein was obtained by purification.Specific antibody levels to PhoP in sera of Mtb in-fected mice and TB patients increased significantly,with preci-sion of 99.9％and 82.5％,and specificity of 100％,respectively.PhoP protein immunization successfully induced production of specific antibodies in mice.Stimulated by antigens in vitro,IL-2 and IFN-γ levels were significantly increased in the splenocytes of immunized mice.Immunization with the PhoP protein induce a humoral immune response and Thl-dominated cellular immu-nity,indicating that the PhoP protein was immunogenic with diagnostic efficacy for TB.These results lay a foundation to clari-fy the role of PhoP in Mtb infection and application for diagnosis and prevention of TB.

Objective To investigate the protective effect of sodium butyrate on the neonatal mouse model of necrotizing enterocolitis and analyze its possible mechanism.Methods Sixty c57BL/6 neonatal mice were randomly divided into two groups (n=30):PBS group and butyric acid group.At the third day after birth,mice in both groups were respectively given PBS and sodium butyrate solution by gavage once a day for 7 days,and neonatal necrotizing enterocolitis (NEC) model was established by hypoxia,cold stimulation and artificial feeding.The newborn mice were sacrificed overnight after modeling.HE staining and double-blind pathological score were performed to observe the pathological changes of ileocecal intestinal tissue.The mRNA expressions of IL-6,IL-10,TGF-β1 and TNF-a were tested by quantitative real-time PCR.The levels of IL-10 and TGF-β1 in intestine tissues were evaluated using ELISA.Flow cytometry was used to analyze the ratio of regulatory T cells (Treg) on CD4+ T cells in both groups.Results When mice were sacrificed overnight after NEC modeling,the body weight was significantly higher in butyric acid group (4.50 ± 0.42g) than in PBS group (4.16 ± 0.60g,P＜0.05);No significant difference (P＞0.05) existed in survival rate of butyric acid group (76.34％) and PBS group (67.95％).The pathological damage score of intestinal tissue showed that the median score of intestinal injury was significantly lower in butyric acid group [1.33(1.33-1.67)] than in PBS group [2.00(1.67-2.25),P＜0.05].qPCR demonstrated that the expressions of IL-6 and TNF-α mRNA were obviously lower in butyric acid group than in PBS group (0.85 ± 0.30 vs.1.77 ± 0.49 and 0.41 ± 0.25 vs.0.96 ± 0.56,respectively,P＜0.05);and the expressions of IL-10 and TGF-β1 mRNA were markedly higher in butyric acid group than in PBS group (1.91 ± 0.82 vs.0.94 ± 0.43 and 1.46 ± 0.57 vs.0.88 ± 0.29,respectively,P＜0.05);Intestinal tissue ELISA results showed that the expressions of IL-10 and TGF-β1 were higher in butyric acid group than in PBS group (68.60 ± 15.06 vs.37.25 ± 5.81 and 424.93 ± 19.34 vs.127.31 ± 60.83,respectively,P＜0.05);Flow cytometry revealed that the proportion of regulatory T cells (Treg) of CD4+ T cells was higher in butyric acid group than in PBS group (12.68％ ± 6.79％ vs.3.57％ ± 0.88％,P＜0.05).Conclusions Butyric acid plays a protective effect in the intestinal injury of neonatal mouse model of necrotizing enterocolitis.The possible mechanism is that butyrate can down-regulate the expressions of cytokines IL-6 and TNF-o,up-regulate the expressions of cytokines IL-10 and TGF-β1,and promote the differentiation of T cells into Treg cells.