ObjectiveThe aim of this study is to investigate whether oral administration of collagen Ⅱ peptide (250-270)[C Ⅱ (250-270)]-cholera toxin B subunit (CTB)complex could effectively set up oral immune tolerance to collagen-induced arthritis (CIA) in mice. MethodsDBA/1 mice were divided into Ⅰ, Ⅱ, Ⅲ and Ⅳgroups. Group Ⅰ was normal control group. Collagen type Ⅱ emulsified in Freund's complete adjuvant were injected to mice of groups Ⅱ , Ⅲ and Ⅳ twice from the base of the tail. Mice of group Ⅲ were fed with C Ⅱ (250-270)-CTB covalent complex twice after the arthritis was developed. Mice of group Ⅳ were fed with C Ⅱ(250-270) and CTB mix at the 14th day after primary immunization. Visual scores and histopathologic scores of arthritis were recorded. The frequencies of arthritis between the groups were compared usingFisher's exact test. The clinical and histological severity of arthritis were analyzed by ANOVA.Results The frequencies of arthritis in groups Ⅰ , Ⅱ , Ⅲ and Ⅳ were 0, 100％, 100％ and 25％ respectively. Average accumulative scores of arthritis were 0, 5.0±1.7, 10.8±2.8 and 1.0±2.0 respectively. Average accum-ulative histopathological scores of arthritis were 0, 16±8, 32±13 and 7±6 respectively. Conclusion Oral administration of C Ⅱ (250-270) and CTB mix in arthritis mice after C Ⅱ immunization can suppress the onset and severity of arthritis. Oral administration of C Ⅱ (250-270)-CTB covalent complex in the acute stage of arthritis can accelerate arthritis.

Objective:To analyze the pay for performance related costs and provide suggestions for further stud-y. Methods:Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers ( performance appraisal, performance improvement and incentive per-formance) . Results:A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions:(1) Differences in costs could be found from home and overseas experience which per-haps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities’ hidden costs. (3) Most available researches fo-cus on pay for performance cost-effectiveness from the society and service purchase but not the providers’ perspective and the hidden costs were also ignored.

PurposeTo explore the gemstone CT with low tube voltage and low concentration contrast medium in evaluating renal artery imaging of preoperative living renal transplantation donor.Materials and Methods Fifty cases of living kidney donor underwent spiral CT angiography of renal artery before operation. The patients were randomly divided into double-low group (25 patients) with 100 kV and Visipaque (270 mg/ml), and control group (25 patients) with 120 kV and Iopromide (370 mg/ml). Image reconstruction of 40% ASiR was used in both groups. The image quality score, CT values of renal arteries, contrast-to-noise ratio (CNR), noise, radiation dose and the amount of contrast agent of the two groups were recorded and compared.ResultsKappa coefifcient analysis showed that the consistency in evaluating image quality between two radiologists was excellent (Kappa=0.82). The CT value of the renal arteries and image quality did not show signiifcant difference between the two groups (t=1.05, 0.07 and 1.62,P>0.05). The CNR, noise and average radiation dose were statistical different between the two groups (t=2.92,-6.95 and-2.21,P<0.05). The contrast medium dosage of double-low group was decreased by 27% when compared with that of the control group.Conclusion Satisfied image quality of renal artery CTA can be obtained with low tube voltage (100 kV) and low concentration contrast medium (270 mg/ml) combined with iterative reconstruction algorithm. It can be used as a routine method in preoperative examination of living renal donors.

Objective:To examine the occurrence of seizures and perioperative risk factors in children after obtaining cardiopulmonary bypass (CPB).Methods:Electroencephalograph (EEG) and cerebral oxygen saturation (ScO 2) were monitored in 87 patients (aged 3 days-110 months, with the median at 4.4 months) and they were admitted to the Cardiac Intensive Care Unit (CICU) from May 2018 to April 2019, with 77 patients for 72 h after CPB and 10 cases with clinical seizures after CICU discharge for 8-180 h. Clinical data were recorded every 4 hours, including blood pressure, central venous pressure (CVP), temperature, arterial blood gases, lactate, doses of Dopamine, Milrinone, and Adrenalin, and daily C-reaction protein (CRP) and N-terminal pro-brain natriuretic peptide(NT-proBNP). Demographic data, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery(STAT) mortality classification and clinical outcomes (duration of mechanical ventilation, CICU and hospital stay, and death) were recorded. Results:Seizures occurred in 24 patients (27.6%) within 48 h after CPB.EEG seizures appeared in 7 patients, both EEG and clinical seizures in 7 patients, and clinical seizures in 10 patients.Three patients developed epilepsy.There were 2 hospital deaths and both had EEG seizures.Patients with seizures had higher STAT categories, longer operative time and worse clinical outcomes (all P<0.05). Univariate regression revealed that the occurrence of seizures was positively related to adrenalin, temperature, lactate level (all P<0.01), blood pressure, CVP (all P<0.05) and CRP ( P<0.1), and negatively correlated with arterial carbon dioxide tension[ pa(CO 2)], ScO 2 and dose of Milrinone (all P<0.05). In multivariate regression, only dose of Adrenalin ( P<0.001) and lactate level ( P<0.01) remained significant. Conclusions:The incidence of seizures was high in children after CPB.Numerous perioperative factors that were related to seizures were identified.The most significant risk factors were higher dose of adrenaline and lactate level.Studies on neurological injury after CPB are urgently needed in China in order to reduce brain injury and improve neurodevelopmental outcomes.

Objective: To investigate effects of clinical strategy on repair of pressure injury on ischial tuberosity based on the histopathological type. Methods: From January 2014 to January 2018, 33 patients with 33 pressure injuries on ischial tuberosity were admitted to our department. There were 25 males and 8 females aged 35 to 87 years. Pressure injuries on ischial tuberosity were repaired with different methods according to pathological types of denatured tissue on basal parts of wounds and tissue defect volumes. Areas of wounds after thorough debridement ranged from 2.0 cm×1.0 cm to 14.0 cm×12.0 cm. Pressure injuries of necrosis type with tissue defect volumes of 6.5-9.5 cm³ were sutured directly after debridement at the first stage. Tissue defect volumes of 3 patients with pressure injuries of granulation type ranged from 56.0 to 102.5 cm³. According to situation around wounds, the above mentioned 3 patients were respectively repaired with posterior femoral Z-shaped reconstruction, posterior femoral advanced V-Y flap, and posterior femoral propeller flap. Tissue defect volumes of 5 patients with pressure injuries of infection type ranged from 67.5 to 111.0 cm³. Among the patients, 2 patients were repaired with posterior femoral propeller flaps, 2 patients were repaired with posterior femoral advanced V-Y flaps, and 1 patient was repaired with posterior femoral Z-shaped reconstruction. Among patients with pressure injuries of synovium type, wounds of 14 patients with tissue defect volumes 6.4-9.5 cm³ were sutured directly after debridement, and tissue defect volumes of another 8 patients were 97.0-862.5 cm³. Among the 8 patients, 7 patients were repaired with gluteus maximus myocutaneous flaps and continued vacuum sealing drainage was performed for 7 to 14 days according to volume of drainage, and 1 patient was repaired with posterior femoral propeller flap. Areas of flaps or myocutaneous flaps ranged from 3.5 cm× 2.5 cm to 14.0 cm×12.0 cm. The donor sites of flaps were sutured directly. Operative areas after operation and healing of wounds during follow-up were observed. Results: The sutured sites of 33 patients connected tightly, with normal skin temperature, color, and reflux. During follow-up of 12 months, wounds of 25 patients healed well with no local ulceration, and 8 patients were admitted to our department again due to recurrence of pressure injuries on or near the primary sites. Pathological types of pressure injuries of the 8 patients were synovium types. After complete debridement, the tissue defect volumes were 336.8-969.5 cm^3, wounds with areas ranged from 8.0 cm×7.0 cm to 14.0 cm×12.0 cm were repaired with gluteus maximus myocutaneous flaps or posterior femoral propeller flaps which ranged from 8.0 cm×7.0 cm to 14.0 cm×12.0 cm. Eight patients were discharged after wound healing completely. During follow-up of 12 months, operative sites of the patients healed well, with no recurrence. Conclusions Appropriate and targeted methods should be chosen to repair pressure injuries on ischial tuberosity based on the pathological types. Direct suture after debridement is the first choice to repair pressure injury of necrosis type. Pressure injuries of granulation type and infection type can be repaired with posterior femoral propeller flap, Z-shaped reconstruction, or advanced V-Y flap according to situation around wounds. Gluteus maximus myocutaneous flap is the first choice to repair pressure injury of synovium type. In addition, recurrence-prone characteristics of pressure injury of synovium type should be taken into consideration, plan should be made previously, and resources should be reserved.

The purpose of this study is to prepare galactosyl modified lipid bilayer-coated mesoporous silica nanoparticles (GPEM) to enhance the antitumor efficacy against hepatocellular carcinoma cells. The irinotecan (CPT-11) loaded mesoporous silica nanoparticles (MSNs) was coated with the Gal-P123 modified functional lipid bilayer by thin-film dispersion method. Nanoparticles were characterized with particle size, zeta potential, morphology and drug release in vitro. Afterwards, the cell uptake, intracellular concentration of CPT-11, cell apoptosis rate and cytotoxicity were evaluated on human hepatocellular carcinoma cell line Huh-7. The results showed that MSNs were coated with intact lipid bilayers and the nanoparticles had clear core-shell structure. GPEM is stable with the mean particle size of (78.01 +/- 2.04) nm. The low leakage rate in normal physiological conditions in vitro is contributed to the protection of stable lipid bilayer, and the fast drug release in acid environment due to the destruction of the lipid bilayer. On the cell level, the vector could improve the intracellular CPT-11 concentration by 4 times because of the functional lipid bilayer. The high CPT-11 concentration led to the increasement of apoptosis rate by 48.6%, and the reduction of half maximal inhibitory concentration (IC50) values of CPT-11 by 2 times, indicating stronger cell cytotoxicity.

Cold injury is very damaging. This article summarizes the mechanism, types, and rehabilitation of cold injury, focusing on the degree and clinical treatment of frostbite. Frostbite can mainly cause damage of microcirculation and capillary structure, while burn injury can mainly cause damage of cutaneous tissues. Based on this, the key point of management of frostbite is to improve microcirculation and appropriate rewarming, while that of burn injury is wound repair. Up to date, the rate of amputation caused by frostbite is still high, and the rehabilitation for sequela caused by frostbite remains a big challenge in modern medicine. It is worth paying more attention to.

Bacteria usually colonize, reproduce, and grow aggressively on chronic wounds in the form of biofilm. Different from free bacteria, bacteria in biofilm exhibit unique mechanism in epigenetics and biological behavior, especially in resistance to antibiotics and host immunity. In this article, we introduce the composition and structural function of bacterial biofilm, expound the drug-resistance mechanism of bacterial biofilm, discuss the clinical characteristics of bacterial biofilm infection wound and the diagnosis method of biofilm, and analyze the treatment strategy for bacterial biofilm. It is suggested that clinicians should pay more attention to bacterial biofilm infection and advocate in-depth study of bacterial biofilm in order to improve the quality of managing chronic wounds.

Objective:To evaluate the relationship between changes in Golgi apparatus morphological structure and endotoxin-induced acute lung injury (ALI) in mice.Methods:Twenty healthy male C57BL/6J mice, weighing 18-20 g, aged 6-8 weeks, were divided into 2 groups ( n=10 each) using a random number table method: sham operation group (group Sham) and endotoxin-induced ALI group (group ALI). Lipopolysaccharide (LPS) 10 mg/kg was injected intravenously in group ALI, while the equal volume of normal saline 0.5 ml was given instead in group Sham.The animals were sacrificed at 12 h after LPS injection and the lung tissues were taken for detection of the content of reactive oxygen species (ROS) and wet to dry weight ratio (W/D ratio), for observation of the pathological changes (using HE staining) and Golgi apparatus morphological structure (with a transmission electron microscope) and for determination of expression of Golgi matrix protein 130 (GM130), Golgin97 and mannosidase alpha class II member 1 (MAN2A1) and its mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with group Sham, ROS content and the W/D ratio in lung tissues were significantly increased, GM130, MAN2A1, Golgin97 protein and its mRNA expression were down-regulate ( P<0.01), the pathological changes of lung tissues were accentuated, the Golgi cisternae was swollen, and Golgi fragments were dispersed in the cytoplasm in group ALI. Conclusion:The mechanism of endotoxin-induced ALI may be related to the changes in Golgi apparatus morphological structure.

Objective: To explore the effects of recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) gel on treatment of thefull-thickness frostbite wounds on foot and hand. Methods: From November 2013 to April 2017, a total of 45 patients of 71 full-thickness frostbite wounds on foot and hand meeting the inclusion criteria were admitted to the First Hospital of Jilin University and the prospective randomized controlled study was done. The patients were divided into rhGM-CSF group of 24 patients with 35 wounds and control group of 21 patients with 36 wounds according to the random number table. There were 20 males and 4 females, aged (38±13) years among patients in rhGM-CSF group, and there were 19 males and 2 females, aged (36±14) years among patients in control group. Patients in 2 groups were performed with the same systemic treatment of rewarming, anti-inflammation, pain relief, anti-infection, anti-coagulation, and thrombolysis. Wounds of patients in rhGM-CSF group and control group were respectively treated with rhGM-CSF gel and aloe vera gel for external usage with 10 mg for every square centimeter and dressing change once every 24 hours, until wounds healed completely. The wound inflammatory response was scored on treatment day (TD) 1, 3, 7, 14, wound secretion was collected for bacteria culture and positive bacteria detection rate was calculated before treatment and on TD 6 and 12, adverse drug reaction after drug use was observed, and the complete wound healing time was recorded. Data were processed with Fisher′s exact probability test, analysis of variance for repeated measurement, t test, and Bonferroni correction. Results: The scores of wound inflammatory response of patients in 2 groups on TD 1 and 3 were close (t=0.37, 2.93, P>0.05). The scores of wound inflammatory response of patients on TD 7 and 14 in rhGM-CSF group were significantly higher than those in control group (t=5.77, 5.83, P<0.01). The results of bacteria culture of wound secretion of patients in 2 groups before treatment were negative. The positive bacteria detection rates of wound secretion of patients in rhGM-CSF group on TD 6 and 12 were 5.71% (2/35) and 22.86% (8/35), which were slightly lower than 13.89% (5/36) and 30.56%(11/36) in control group respectively, but there was no significantly statistical difference (P>0.05). No adverse drug response occurred in patients in rhGM-CSF group, while 1 patient in control group had adverse drug response, with symptoms of redness and swelling of wounds and patchy erythema on skin around wounds, which were alleviated by irrigating with normal saline. The complete wound healing time of patients in rhGM-CSF was (12.3±0.5) d, which was significantly shorter than (16.5±0.8) d in control group (t=24.89, P<0.05). Conclusions The topical rhGM-CSF gel has effects of shortening time of wound healing and reducing inflammatory response of wound on treatment of full-thickness frostbite wounds on foot and hand, which is safe in clinical application.