Objective To analyze of internal strength in patients with chronic disease,make clear the concept development,property,prerequisites,outcome and evaluation index of internal force.Methods To retrieve the relevant research literature in the knowledge service platform of Pubmed,PsycINFO and Chinese CNKI,Wanfang data,using the Rodgers analysis method to analyze the evolution of the concept of internal force.Results The molding process of internal strength of patients with chronic diseases included 4 defining characteristics:self concept,support,development and transcendence.Conclusions Rodgers evolution concept analysis method can help medical workers make clear concept essence of internal strength,deepening their cognition and understanding,so as to provide the basis for the implementation of the related research and clinical interventions.

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years (ranged, 19-65 years). The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A (burst in 12 cases, type B (distraction) in 2 and type C (retortion) in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months (12-86 months). The radiograph showed obvious improvement on the injured body height (from 42.62％ preoperatively to 94.33％ postoperatively, P＜0.01) and the canal encroachment index (from 2.67 preoperatively to 0.14 postoperatively, P＜0.01). Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.

OBJECTIVE To investigate the clinical pathologic features and therapeutic tools of pulmonary cryptococcosis.METHODS The clinical data about 16 cases of pulmonary cryptococcosis which were diagnosed by histopathologic examinations were reviewed.The survey data recorded over a 15-year period,from 1982 to 2007,were summarized.We analyzed their clinical situations,radiographic manifestations,final diagnosis and therapeutic tools.RESULTS The majority of the patients were middle-aged males.The health condition of the most of the patients was good before infection.six months to five years after surgery and antifungal theragy,no relapse,dissemination and death were observed.CONCLUSIONS The majority of primary pulmonary cryptococcosis patients have not underlying diseases,and their radiography manifestations show single or multiple nodular shadows,tumor shadows and infiltrative shadows.The limited pathological change can be excised and applied with the antifungal drugs.Fluconazole is the first-choice drug for curing pulmonary cryptococcosis.

Objective To evaluate upfront common bile duct suturing against T-tube drainage after exploration in the treatment of common bile duct stone.Methods 253 cases of extrahepatic bile duct stones treated at our department from 2008 June to 2012 January were randomly divided into primary suture group and T tube drainage group,by t test or analysis of variance independent sample comparison.Results All operations were successful.Postoperative bile leakage was observed in 2 patients in group A and 4 in group B respectively(P ＞ 0.05),there was no reoperations in the two groups.In group B retrograde biliary tract infection developed in one and was cured by biliary tract flush combined with antibiotics administration.The abdominal drainage was bile tainted fluid about 5-10 ml a day in bile leakage cases in both groups and healed itself in 3-4 days without fever,jaundice symptoms.There was no other severe complications such as pancreatitis.The postoperative biliary complication rate (P =0.802),operative time (P =0.137),intraoperative blood loss (P =0.069) and liver function recovery(ALT P =0.087,AST P =0.752,TBIL P =0.459,DBIL P =0.217,ALP P =0.576,GGT P =0.362) was not significantly different between the two groups.In group A postoperative flatus passing (P =0.037),postoperative fluid volume (P =0.008),postoperative hospital stay(P =0.015) were better than that in T-tube drainage group.At 3 to 12 months follow-up,no patients were found to have residual stones and biliary stricture in group A and group B.Conclusions With the definite indication and proficient surgical technology,primary suture of common bile duct after exploration is a safe and effective way after treatment of choledocholithiasis.

Objective To design a new cancer vaccine by using alpha-galactosylceramide (α-Galcer,α-GC) loaded tumor cells in combination with TLR 9 ligand and to evaluate its therapeutic effects on colon canc-er in mice.Methods MC38 cells were transfected with lentivirus (GFP-CD1d) to prepare CD1d-MC38 cells. The expression of CD1d molecules in CD1d-MC38 cells was detected by fluorescence microscopy , RT-PCR and flow cytometry.The sorted CD1d-MC38 cells were loaded with α-Galcer to prepare CD1d-MC38/α-GC complex. Flow cytometry was performed to evaluate the efficiency of combination .A mouse model of colon cancer was es-tablished to investigate the therapeutic effects of α-Galcer loaded tumor cells in combination with TLR 9 ligand ( CD1d-MC38/α-GC+CpG1826) on colon cancer in mice by analyzing tumor growth and mice survival time .Im-munohistochemical staining was used to detect CD 4+T and CD8+T infiltrating lymphocytes in tumor tissues .Re-sults The MC38 cancer cells that expressed CD 1d and GFP were successfully constructed , among which 98.10%±2.53%were positive for CD1d.Moreover, the CD1d-MC38 cells could combine with α-Galcer effec-tively in a dose and time dependent manner .Compared with PBS treated group ,α-GC treated group and TLR9 ligand treated group , the experimental vaccine strategy was sufficient to inhibit the growth of established tumors and prolong survival of tumor-bearing mice (P<0.01).Immunohistochemistry analysis revealed that levels of CD4+T cells and CD8+T cells in experiment group were significantly higher than those in groups treated with PBS,α-GC and TLR9 ligand (P<0.01).Conclusion CD1d-MC38/α-GC in combination with CpG1826 could efficiently inhibit the growth of established tumors and prolong survival of tumor-bearing mice .Immunohisto-chemistry analysis revealed that CD 4+T cells and CD8+T cells played important roles in anti-tumor immunity.

To study the biological characteristics and mutations of influenza A(H1N1)pdm09 virus isolated from one case of pneumonia of unknown etiology (PUE),which would provide references for clinical treatment and disease control,the throat swab specimen from the PUE case was isolated in the Madin-Darby Canine Kidney (MDCK) cells,and then the antigenicity,pathogenicity and drug resistance of influenza A (H1N1) pdm09 virus were analyzed after sequencing.As a result,one influenza virus strain was isolated from the specimen and named as A/FujianGulou/SWL64/2016(H1N1).The similarities of nucleotide sequences and amino acids sequences compared with the vaccine strain A/California/07/2009 (H1N1) were 96.9％-98.9％ and 96.7％-99.5％,respectively.Eighteen amino acids had mutated in the HA and 4 mutations,K163Q,S185T,S203T and D222N,were involved in 3 different epitopes,which indicated that the antigenic drift had occurred in the influenza virus.The D222N mutation associated with receptor binding site made the virus infect lower respiratory tract more easily.The virus was still amantadine-resistance and oseltamivir-sensitive.In conclusion,the influenza A (H1N1) pdm09 virus in this study have occurred antigenic drift and has the molecular characterization of causing severe pneumonia,so further surveillance should be performed to prevent and control the influenza epidemic.

Objective: To explore the influence of different inner dressings in negative-pressure wound therapy (NPWT) on escharectomy wound of full-thickness burn rabbits. Methods: Eighteen Japanese white rabbits were inflicted with full-thickness burn on unilateral back. They were divided into polymer dressing group (PD), biological dressing group (BD), and silver biological dressing group (SBD), according to the random number table, with 6 rabbits in each group. On 3 days post burn, the wounds were performed with escharectomy, and then wounds of rabbits in group PD were covered with polyurethane foam. Wounds of rabbits in group BD were covered with porcine acellular dermal matrix (ADM) and wounds of rabbits in group SBD were covered with silver porcine ADM. Then continuous NPWT was performed on rabbits of the three groups for 7 days. Immediately after surgery and on post surgery day (PSD) 7, general observation of wound was conducted and tissue around the wound was harvested for determination of dry to wet weight ratio. The content of bacteria was counted and the content of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6 in wound was determined by enzyme-linked immunosorbent assay. Fibroblasts in wound were counted after Masson staining and number of microvessels was counted after CD31 antibody immunohistochemical staining. Data were processed with analysis of variance for repeated measurement, LSD-t test, paired samples t test, and Bonferroni correction. Results: (1) Immediately after surgery, there was no granulation tissue in basal wound of rabbits in the three groups, with rich blood supply and obvious edema. On PSD 7, much granulation tissue was found in basal wound of rabbits in the three groups, with no or mild edema and no obvious redness and swelling in wound edge. (2) There were no significant differences in dry to wet weight ratios of tissue around the wound among and within the three groups immediately after surgery and on PSD 7 (with F values respectively 0.70 and 0.09, t values from 0.17 to 0.52, P values above 0.05). (3) Immediately after surgery, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD was respectively (603.0±146.0) ×10^4, (573.0±63.0) ×10^4, and (590.0±100.0)×10⁴ colony-forming unit (CFU)/g, with no significant difference among them (F=0.13, P>0.05). On PSD 7, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD were respectively (5.4±0.8) ×10^4, (4.6±0.9) ×10^4, and (3.5±0.9)×10⁴ CFU/g. Among them, the content of bacteria in wounds of rabbits in group SBD was lower than that in groups PD and BD, respectively (with t values respectively 3.78 and 2.29, P<0.05 or P<0.01). The content of bacteria in wounds of rabbits in the three groups on PSD 7 was decreased compared with that immediately after surgery (with t values from 10.05 to 21.81, P values below 0.01). (4) There was no significant difference in content of TNF-α, IL-1β, and IL-6 in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values from 0.10 to 1.89, P values above 0.05). The content of TNF-α in wounds of rabbits in the three groups on PSD 7 was significantly higher than that immediately after surgery (with t values from 2.93 to 5.01, P<0.05 or P<0.01). (5) There was no significant difference in amount of fibroblasts in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values respectively 0.01 and 0.81, P values above 0.05). The amount of fibroblasts in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with t values from 4.78 to 11.58, P values below 0.01). (6) There was no significant difference in number of microvessels in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values respectively 2.42 and 2.49, P values above 0.05). The number of microvessels in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with t values from 7.17 to 11.14, P values below 0.01). Conclusions SBD is better at inhibiting the growth of bacteria. PD, BD, and SBD have almost the same effects on reducing tissue edema and inflammatory reaction, and on promoting the accumulation of collagen fibers and tissue vascularization.

OBJECTIVE: To explore the effect of different concentrations of vitamin C on proliferation and apoptosis of C(2)C(12) myoblasts. METHODS: C(2)C(12) cells cultured in vitro were collected by trypsinization to form monoplast suspension, and then centrifuged to float again. The cellular numbers were counted and the cell suspension density adjusted, and the cells were inoculated into 96-shadow mask according to 200 μL per hollow. All cells were cultured in the normal way. While cell fusion ratio arrived 80% and cells did not differentiate, cells were divided into 6 groups: a negative control group (pure DMEM-F12 medium), an H(2)O(2) group (DMEM-F12 medium containing 500 μmol/L H(2)O(2)) and vitamin C group 1 to 4(DMEM-F12 medium containing 500 μmol/L H(2)O(2) and 10, 20, 60, and 100 mg/L vitamin C, respectively). After each group was treated for 0, 6, 24, 36, 48,and 72 h, respectively, MTT was used to detect C(2)C(12) cell proliferation in each group. Annexin V-PI double staining was applied to detect C(2)C(12) cell apoptosis in each group after treatment for 36 h. RESULTS: After the cells were treated for 36 h and 72 h, the absorbance of vitamin C group 1 to 4 were higher than that of H(2)O(2) group (P<0.001). The absorbance of vitamin C group 4 was the highest among all the groups, significantly higher than that of the negative control group when the cells were treated for 36 h (P<0.05). When the cells were treated for 36 h, the C(2)C(12) cells apoptosis rate of vitamin C group 2 to 4 was lower than that of H(2)O(2) group; The C(2)C(12) cells apoptosis rate of vitamin C group 2 and 3 was higher than that of the negative control group, while the C(2)C(12) cells apoptosis rate of vitamin C group 4 was significantly lower than that of the negative control group (P=0.009). CONCLUSION Vitamin C can efficiently inhibit the apoptosis of C(2)C(12) myoblasts induced by H(2)O(2), and after 36 h intervention, high concentration vitamin C may promote C(2)C(12) the proliferation of myoblasts.
Antioxidants ; pharmacology ; Apoptosis ; drug effects ; Ascorbic Acid ; pharmacology ; Cell Line ; Cell Proliferation ; drug effects ; Dose-Response Relationship, Drug ; Humans ; Myoblasts ; cytology ; Oxidative Stress ; drug effects

One 24 years old female patient who suffered extremely severe burn in the third trimester of pregnancy was admitted to the Department of Burns and Skin Repair Surgery of the Third Affiliated Hospital of Wenzhou Medical University on 9th May, 2015. Intrauterine distress occurred after injury and stillbirth was confirmed within 12 hours. In cooperation with the obstetrician, the labor was induced on post injury day (PID) 5. Septic shock and multiple organ dysfunction syndrome occurred on PID 8. Through treatments including anti-infection, ventilator-assisted ventilation, cardiotonic diuresis, and escharectomy and skin grafting, the patient was finally cured. This case indicates that it is crucial to grasp the right time and choose a reasonable induction of labor to deal with stillbirth. The scheme of transvaginal induction of labor after shock is a worthy question to explore. The main characteristics of this patient include the extreme paroxysmal changes in breath, circulation, and urine volume within 24 hours after induced labor, which should be monitored dynamically for effective and timely adjustment of respiratory circulation support. This may be another key point for the rescue of this type of patient. To seize the opportunities to perform escharectomy, cover the wound with xenogenic skin graft, and perform skin grafting in time for wound repair remain the top priority.

Objective:To investigate the clinical efficacy of acellular dermis matrix combined with cervical strap muscle (ADM-CSM) as a composite tissue flap for repairing the laryngeal defect after partial laryngectomy.Methods:The medical records of 33 patients with laryngeal cancer who were diagnosed and treated at the First Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2016 were retrospectively reviewed. The patients consisted of 32 males and 1 female with age range from 39 to 76 years. Laryngeal defects were repaired with ADM-CSM in 14 patients (2 for supraglottic laryngeal cancer, 12 for glottic laryngeal cancer) and with CSM fascial flaps in 19 patients (3 for supraglottic laryngeal cancer, 16 for glottic laryngeal cancer). Kaplan-Meier method was used to calculate the 3-year overall survival and local control rate. The functions of voice and swallowing after operation were evaluated by voice handicap index-30 (VHI-30) and MD Anderson dysphagia inventory. Univariate logistic regression analysis, t-test, and Mann-Whitney U test were used to compare the variables between the two groups. Results:The incidence of laryngeal stenosis was 2/14 in ADM-CSM group and 4/19 in CSM group. In the ADM-CSM group, 3-year overall survival and local control rates were 92.9% and 85.7%, respectively. In the CSM group, 3-year overall survival and local control rates were 78.9% and 84.2%, respectively. The time of operation(3 h vs. 4 h, Z=193.5, P<0.05), time of retaining the feeding tube(14 d vs. 17 d, Z=206.0, P<0.05), and length of stay(18.5 d vs. 22.1 d, t=-2.62, P<0.05) in the ADM-CSM group were significantly less than those in the CSM group. The quality of voice in the CSM group was better than that in the ADM-CSM group (66.85±27.65 vs.45.80±23.19, t=2.19, P<0.05), while swallowing function in the ADM-CSM group was better than that in the ACSM group (80.00[60.00, 80.00] vs.60.00[40.00, 80.00], Z=48.0, P<0.05). Conclusion:ADM-CSM is user-friendly control and safe composite tissue flap for repairing the laryngeal defect after partial laryngectomy, with less scar hyperplasia and higher satisfaction of swallowing function after operation.