Objective To explore the best way to deal with infection of expanded skin flap during auricle reconstruction. Methods 12 cases (12 ears) of expanded skin flap infection was analyzed and treated with the method of stretching the expanded skin flap during auricle reconstruction during Jan. 2003 to Dec. 2005. Results In 12 cases (12 ears) the infection was controlled well, auricles were reconstructed smoothly and no obvious difference was detected between the infected and normal skin flaps after the reconstruction of auricles. Conclusion Stretching the expanded skin flap is a good method to deal with its infection during auricle reconstruction.

Objective To investigate the best way for the operation of congenital microtia with deformities of external auditory meatus (EAM) and middle ear. Method To analyze retrospectively 305 cases (332 ears) of auricle reconstruction operated in the Plastic Department of Auricle, Plastic Surgery Hospital, PUMC, CAMS during June to October 2005, and 49 cases (58 ears) of reconstructions of EAM and middle ear operated in the Otolaryngology Department, General hospital of PLA from December 1988 to July 2002. Results The patients/families rested content with the reconstructed auricles operated with the 3-stage way. The hearing was improved obviously after reconstruction of the EAM and ossicle for the patients with normal stapes footplate. In those patients, for whom EAM was reconstructed first, the scar developed around the orifice which affected the skin flap for auricle reconstruction later, while in those patients, for whom the auricle was reconstructed first, wrong location of the EAM orifice happened easily. Conclusions For the patients with congenital deformities of EAM and middle ear and with the requirement of recovering the appearance and hearing function, the EAM orifice should be located first according to the results of temporal CT, then the auricle reconstruction was conducted with 3-stage method. A simultaneous reconstruction of EAM and ossicle at the third stage may ensure the improvement of both outward appearance and hearing function.

BACKGROUND:Acupuncture point matching is little reported in the electroacupuncture for cerebral ischemia-reperfusion injury.
OBJECTIVE:To explore the influence of electroacupuncture acupoints selected by orthogonal experiment on rats with cerebral ischemia reperfusion and extracel ular signal regulated kinase (ERK) signal pathway.
METHODS:150 Sprague-Dawley rats were randomly divided into five groups:sham operation group rats were exposed the middle cerebral artery only;models of cerebral ischemia reperfusion were established in the rats in model and orthogonal groups. Then rats in the orthogonal groups 1 (Baihui (DU 20), Quchi (LI 11), Zusanli (ST 36), and Chize (LU 5)), 2 (Baihui (DU 20), Zusanli (ST 36), Chize (LU 5), and Sanyinjiao (SP 6)) and 3 (Hegu (LI 4), Zusanli (ST 36), Chize (LU 5) and Sanyinjiao (SP 6)) were given electroacupuncture at acupoints selected by orthogonal experiment, respectively.
RESULTS AND CONCLUSION:Compared with the model group, in al orthogonal groups, the neurological function deficit scores were decreased, infarct volume was smal er, the number of microvessel density in the ischemia region and the p-ERK expression level in the cortex and hippocampal CA1 region of ischemic hemisphere were increased, and significant changes were found in the orthogonal group 3. These findings indicate that electroacupuncture at points of Hegu (LI 4), Zusanli (ST 36), Chize (LU 5) and Sanyinjiao (SP 6) selected by orthogonal experiment can significantly reduce the infarct volume of cerebral ischemia-reperfusion injury in rats possibly by regulating the ERK signaling pathway.

Objective To explore the role of clinical pharmacist in individualized treatment of hypertension.Methods A patient withH hypertension receiving pharmaceutical care from clinical pharmacists was retrospectively analyzed.Results Patient's MTHFR (C677T) gene type was TT homozygous.Clinical pharmacist suggested doctor modify treatment,and then patient's plasma homocysteine dropped from 61.5 to 16.0 μmol·L-1,and blood pressure dropped from 173/ 111 mmHg(1 mmHg =0.133 kPa) to 130/80 mmHg.Conclusion Clinical pharmacist provides individualized treatment for patient with hypertension to ensure the safety and effectiveness of the drug by genotyping.

Objective To observe the variation of helper T cell (Th)9/regular T cell (Treg cell) balance in the inflammatory process of hepatitis B virus (HBV) infection.Methods Two hundred patients with chronic HBV infection in Zhejiang Hospital of Integrated Traditional and Western Medicine during August 2011 to June 2012 were divided into four groups according to alanine aminotransferase (ALT) levels.:chronic HBV carriers,chronic hepatitis B (CHB) with mildly [upper limit of normal (ULN)＜ALT＜3 × ULN],moderately (3 × ULN＜ALT＜5 × ULN),or significantly (ALT＞5 × ULN) elevated ALT,with 50 subjects in each group.In addition,30 healthy volunteers were enrolled as healthy controls (HC).ALT levels,HBV DNA,and Th9/Treg levels were measured by automatic biochemical analyzing equipment,real-time fluorescent quantitative polymerase chain reaction and flow cytometry,respectively.Th9/Treg levels of each group were observed.Means between groups were compared by t test,means of multiple groups were compared by one-way analysis of variance.Spearman rank correlation was used for correlation analysis.Results Age,sex distribution and HBV DNA levels of the four groups were comparable (P＞0.05).ALT levels of HC were significantly different from those of mildly,moderately,or significantly elevated ALT (t=8.48,18.41,28.93; all P＜0.05).Th9 cell levels,Treg cell levels and Th9/Treg ratio of HBV infected individuals were significantly different from those of HC (P＜0.05).With the increasing degree of inflammation,proportion of Th9 cells increased and Treg cells decreased gradually.The differences among the four groups were of statistical significance (P＜ 0.05).Th9 cell level was positively correlated with ALT (r=0.804,P=0.01),while Treg cell level was negatively correlated with ALT (r=-0.828,P=0.01).Conclusions Th9/Treg is imbalanced in patients with HBV infection,and closely correlated with ALT levels.

Objective To analyze and study the diagnosis of large granular lymphocyte leukemia(LGLL).Methods To report and discuss six cases weth LGLL we have found. Results 2 of T-LGLL and lof NK-LGLL had indolent process, mainly presenting with anemia and splenomegaly and good response to treatment, while; 1 of T-LGLL and 2 of NK-LGLL had aggressive process, their clinical characters are obviously general symptom, hepatomegaly,splenomegaly,these disease develop quickly and have bad prognosis. The immunophenotype of indolent LGLL is distinct from aggressive cases. Conclusion As a group of heterogeneous disease,its diagnosis should be based on clinical manifestation and immunophenotype and differentiated it carefully.

Objective: To evaluate the expression of cytokeratin (CK)7, CK8/18, CK19 and p40 in esophageal squamous cell carcinoma (ESCC) and its significances. Methods: One hundred and ninety cases of surgically resected ESCCs and 154 normal esophageal tissues as control were collected at the First Affiliated Hospital of Zhengzhou University in 2012.Of the 190 ESCC cases including 116 male and 74 female, aged 28-82 (60.3±8.6) years, 88 cases <60 years old and 102 cases ≥60 years old. Tissue sections were immunostained for CK7, CK8/18, CK19 and p40, and the expression was evaluated and correlated with the clinicopathologic findings and outcome. Results: CK19 and p40 were expressed in 190 cases of ESCCs; with 147 cases (77.4%) and 151 cases (79.5%) showing high p40 and CK19 expression, respectively; while 43 cases (22.6%) and 39 cases (20.5%) showed low p40 and CK19 expression, respectively. The low expression groups showed more lymph node metastases and higher pTNM stages compared to the high expression groups. The high CK19 expression group showed better prognosis than the low expression group (P<0.01); p40 expression was not correlated with prognosis(P>0.05). In contrast, CK7 and CK8/18 expression was only seen in 29 cases (15.3%) and 59 cases (31.1%) of ESCCs, respectively, and their expression correlated significantly with the degree of tumor differentiation and lymph node metastasis (P<0.05). The prognosis in the CK7 negative group was better than that in the CK7 positive group. Similar results were found in CK8/18 expression. Multivariate analysis revealed that pTNM stages, low CK19 expression and CK8/18 expression were independent prognostic factors. Conclusions Low p40 expression and the expression of CK7 and CK8/18 cannot exclude poorly-differentiated ESCCs.CK7 and CK8/18 expression and low CK19 and p40 expression in the ESCCs are associated with lymph node metastasis and poor prognosis. Decreased expression of CK19 and positive expression of CK8/18 in ESCCs are independent prognostic markers.

Objective:To evaluate the therapeutic effect of electroacupuncture on acute gastrointestinal injury (AGI) in patients with severe traumatic brain injury (sTBI).Methods:A prospective randomized controlled trial was conducted. 126 consecutively hospitalized patients with AGI after sTBI admitted to intensive care unit (ICU) of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2018 to December 2019 were enrolled. The patients were divided into observation group and control group by random number table. All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days, including the treatments of primary diseases, indwelling nasogastric tube to extract gastric contents every 6 hours to determine gastric residual volume (GRV). When vital signs were basically stable, enteral nutrition (EN) was implemented and EN feeding amount and speed were adjusted according to GRV. On the basis of conventional western medicine treatment, the observation group was treated with electroacupuncture at Zusanli, Tianshu, Shangjuxu, Xiajuxu and Zhongwan, once in the morning and once in the evening, 30 minutes each time. The gastrointestinal function parameters including intra-abdominal pressure (IAP), serum diamine oxidase (DAO) and gastrointestinal failure (GIF) scores were observed before treatment and at day 3 and day 7 of treatment. The incidence of ICU hospital-acquired pneumonia (HAP-ICU), duration of mechanical ventilation (MV), length of ICU stay, 28-day mortality and adverse reactions of electroacupuncture were also observed in the two groups. Kaplan-Meier method was used for 28-day survival analysis.Results:During the 7-day treatment and observation, 26 cases of 126 patients withdrew from the study, and 100 cases were actually enrolled, 50 cases in the observation group and 50 cases in the control group. IAP and DAO at day 3 of treatment in both groups were significantly lower than those before treatment [control group: IAP (cmH 2O, 1 cmH 2O = 0.098 kPa) was 13.75±2.76 vs. 18.11±3.97, DAO (U/L) was 129.88±24.81 vs. 158.01±22.64; observation group: IAP (cmH 2O) was 13.56±2.19 vs. 18.50±3.54, DAO (U/L) was 129.11±29.32 vs. 159.36±28.65; all P < 0.01]. The gastrointestinal function parameters of the two groups improved gradually with the extension of treatment time, and the IAP, DAO and GIF scores at day 7 of treatment in the observation group were significantly lower than those in the control group [IAP (cmH 2O): 11.28±3.61 vs. 12.68±3.23, DAO (U/L): 49.69±17.56 vs. 57.27±20.15, GIF score: 2.02±0.74 vs. 2.40±0.70, all P < 0.05). The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group [duration of MV (days): 15.72±4.60 vs. 18.08±4.54, length of ICU stay (days): 16.76±4.68 vs. 19.26±5.42, both P < 0.05], and the incidence of ICU-HAP and 28-day mortality were significantly lowered (12.0% vs. 30.0%, 22.0% vs. 32.0%, both P < 0.05). Survival analysis showed that the 28-day cumulative survival rate in the observation group was significantly higher than that in the control group (86.4% vs. 76.1%; Log-Rank test: χ 2 = 37.954, P < 0.001). The patients in the observation group had no significant adverse reaction of electroacupuncture treatment. Conclusion:Electroacupuncture at corresponding acupoints can effectively improve gastrointestinal function in patients with AGI after sTBI, which is beneficial to shortening the length of ICU stay, promoting the recovery of the patients, and reducing the 28-day mortality.

Objective To observe the expression and significance of helper T cells 9(Th9),helper T cells 22(Th22)and their ef-fector factors in peripheral blood of drug-induced liver injury(DILI).Methods Fifty-six patients with DILI were selected as DILI group and 15healthy volunteers as healthy control group.The DILI group was divided into four groups:mild liver injury group(15 cases),moderate liver injury group(15 cases),severe liver injury group(15 cases)and acute liver failure group(11 cases).Meanwhile,serum liver function,peripheral blood Th9 and Th22,serum interleukin-9(IL-9)and interleukin-22(IL-22)were detected before and after treatment.To observe and analyze the changes of Th9,Th22,IL-9 and IL-22 in DILI,as well as their relationship with the de-gree and type of liver injury.Results There were significant differences in total bilirubin(TBIL),alanine aminotransferase(ALT),as-partate aminotranferase(AST)and alkaline phosphatase(ALP)before and after treatment in the mild DILI group(t were 5.777,10.347,4.225,2.948;P＜0.05),but no significant differences in international normalized ratio(INR)(t=0.210,P＞0.05).There were significant differences in TBIL,ALT,AST,ALP and INR before and after treatment in moderate liver injury group(t were 7.642,5.842,5.747,3.924,5.206;P＜0.05).There were significant differences in TBIL,ALT,AST,ALP and INR before and after treat-ment in severe liver injury group(t were 6.410,5.369,4.726,3.893,6.487;P＜0.05).There were no significant differences in TBIL,ALP and INR before and after treatment in acute liver failure group(t were 0.669,0.072,0.521;P＞0.05),while there were significant differences in ALT and AST(t were 5.466,7.184;P＜0.05).The levels of Th9 and Th22 in peripheral blood and serum IL-9 and IL-22 of related cytokines in patients with DILI were higher than those in healthy control group,and the differences between the two groups were statistically significant(t were 2.269,2.481,6.014,4.987;P＜0.05).There were statistically significant differ-ences in Th9,Th22,IL-9 and IL-22 before and after treatment in mild and moderate liver injury groups(t were 3.556,-5.906,8.258,-2.219,5.906,-8.500,7.982,-5.403;P＜0.05).There were statistically significant differences in Th9 and IL-9 be-fore and after treatment in the severe liver injury group(t were 8.411,7.250;P＜0.05),but no significant differences in Th22 and IL-22(t were-1.463,-2.038;P＞0.05).There was no significant difference in Th9 and IL-9 before and after treatment in acute liver failure group(t were 1.614,0.504;P＞0.05),but there was significant difference in Th22 and IL-22 before and after treatment(t were-3.825,-2.482;P＜0.05).There were no significant differences in Th9,Th22,IL-9 and IL-22 among different types of liver injury(F were 0.636,0.330,0.051,0.376;P＞0.05).Th9 was positively correlated with ALT(r=0.547,P＜0.001).Th22 was negatively correlated with TBIL(r=-0.657,P＜0.001)and ALT(r=-0.301,P=0.024).Conclusion Peripheral blood Th9,Th22 and related cytokines IL-9 and IL-22 are involved in the pathogenesis of DILI.Th9may play a pro-inflammatory role,while Th22may play an anti-inflammatory role,which may have nothing to do with the type of liver injury.

Inflammation plays an important part in neonatal hypoxic-ischemic brain damage (HIBD). High mobility group box-1 protein (HMGB1), a neuroinflammatory trigger, has a dual effect on HIBD: in the acute stage, it amplifies the ischemic tissue injury; in the later stage, it is involved in the neurovascular repair and reconstruction. The significance of HMGB1 in the pathogenesis of HIBD is still not fully understood. This review summarizes the role of HMGB1 in HIBD, including its effects on neurons, glial cells and blood-brain barrier, and the underlying mechanisms as well as the progress in research on HMGB1 in immature brain, hoping to provide new ideas for neuroprotection in HIBD.