ObjectiveTo observe the effectiveness of collagen sponge for reducing volume of drainage after surgery for lumbar spinal stenosis. MethodsOne hundred and eighty-six patients who suffered from lumbar spinal stenosis were divided into two groups by random digits table method. The test group(96 cases) used collagen sponge to cover dura mater before placing drainage tube,the control group (90 cases) was treated without collagen sponge. The volume of drainage at 1,12,24 h after surgery were observed, the blood routine test was carried out at before and 48 h after surgery and the volume and ratio of blood transfusion after surgery was also measured and compared between the two groups. ResultsThe volume of drainage were significantly decreased in the test group compared with the control group at 1,12,24h after surgery [( 106.11 ± 20.02 ) ml vs. ( 127.02 ± 25.09) ml, (236.12 ± 34.06) ml vs. (327.31 ± 51.21 )ml, (355.16 ± 49.03 ) ml vs.( 506.36 ± 85.29 ) ml](P ＜ 0.05 ). The volume and the ratio of blood transfusion in the test group were ( 176.27 ± 21.37) ml and 10.42％(10/96) ,which were greatly lower than those in the control group[(445.94 ±24.56) ml and 32.22％ (29/90)](P ＜0.05). The number of RBC and the concentration of Hb were (2.96 ± 0.45 ) × 1012/L and ( 106.75 ± 7.30) g/L, differently in the test group at 48 h after surgery,which were increased significantly compared with the control group[(2.35 + 0.57) × 1012/Land (90.45 ± 5.10) g/L](P ＜ 0.05 ). ConclusionsCollagen sponge provides rapid ,effective and durable hemostasis and decreases the leak of cerebrospinal fluid after surgery for lumbar spinal stenosis. It can be used as an effective and economic method to reduce the volume of drainage after surgery.

[Abstract ] Objective To investigate the present situation and demand of nurses training in the different level hospitals of a suburb,so as to provide reference to the building of nursing team.Methods Stratified random sampling was taken in 764 nurses in 20 different level hospitals of a suburb of Beijing.Results In recent 3 years, 31.9% of nurses went out to short -term training and 15.58% of nurses went out to further study for a longer time. The continuous education scores came mainly from own hospital(88.22%),suburb training center(77.75%)and networks(42.54%).About training needs,over half of nurses chose training inside themselves areas,58.38% of nurses chose special short duration training,53.66% of nurses chose further study,48.04% of nurses chose WeChat network platform.About the training content,the first need of training for nursing administrators was nursing safety management (4.65 ±0.54)points,the first need of training for clinical nurses was emergency techniques training (4.41 ±0.69)points.89.14% of nurses would like to have two -way feedback.Conclusion The present situation of nurses training should be improved.Integrating resources and flexible and multiple training methods should be adopted to satisfy nurses training demand.

Objective To investigate the expression of transit receptor potential ankyrin 1 (TRPA1) and 5-hydroxytryptamine (5-HT) in the colonic mucosa of patients with slow transit constipation (STC).Methods The clinical data of 10 patients with STC and 10 patients with sigmoid cancer who were respectively admitted to the Daping Hospital of the Third Military Medical University from March 2013 to March 2014 and from December 2013 to May 2014 were retrospectively analyzed.Ten and 10 surgical specimens of descending colon from patients with STC and sigmoid cancer (tumor edge measuring in controls ＞ 10 cm) were allocated into the STC group and the control group,respectively.The expressions of TRPA1 and 5-HT in the colonic mucosa in the control group and in the 2 groups were detected by immunofluorescence and immunochemistry staining,respectively.The expression of TRPA1 in the colonic mucosa was observed by Western blot test.The measurement data with normal distribution was presented as x ± s,and the comparison between groups were analyzed using the t test.Results The results of immunofluorescence showed that TRPA1 and 5-HT were co-expressed in the colonic mucosa of controls.The results of immunochemistry staining showed that the integrated optical density (IOD) of expressions of TRPA1 and 5-HT in the STC group and in the control group were 3 619 ± 1 702,55 721 ±28 613 and 9 894 ± 3 325,12 949 ± 2 200,respectively,showing significant differences between the 2 groups (t =-5.312,4.713,P ＜ 0.05).The results of Western blot test showed that the relative expressions of TRPA1 in the STC group and in the control group were 0.8 ± 0.3 and 1.5 ± 0.5,showing a significant difference between the 2 groups (t =-2.379,P ＜ 0.05).Conclusions TRPA1 is expressed in the enterochromaffin (EC) cells of colonic mucosa.High expression of 5-HT and low expression of TRPA1 in the colonic mucosa are closely related with the pathogenesis of STC.

Objective To investigate the effects of pelvic nerve transection on the colonic motility and the expression of transit receptor potential ankyrin 1 (TRPA1) in the colon mucosa.Methods Ninety-six Sprague-Dawley rats were divided into 3 groups based on a random number table:(1) 18 rats in the control group remained untreated and were fed regularly;(2) 39 rats in the sham operation group received laparotomy,and the pelvic nerves were stripped;(3) 39 rats in the operation group received laparotomy with pelvic nerve transection before abdominal closure.Colonic transit was assessed respectively at postoperative day 1,3,and 7 by injecting and calculating the geometric center (GC) of the distribution of 51Cr after 3 hours of propagation.The expression of TRPA1 in the colonic mucosa was determined by Western blot at postoperative day 1,3,7.Data with normal distribution were expressed by (x)± s,and were analyzed using the repeated measures ANOVA or LSD test.Results The GC values of the distribution of 51Cr in the sham operation group at postoperative day 1,3,7 were 5.8 ± 0.9,7.5 ± 0.5,7.3 ± 0.5,with a significant difference (F =9.508,P ＜ 0.05).The GC values of the distribution of 51Cr in the operation group at postoperative day 1,3,7 were 4.9 ± 0.4,5.6 ± 0.4,6.4 ± 0.8,with a significant difference (F =11.689,P ＜ 0.05).There were significant differences in the GC values of the distribution of 51 Cr at postoperative day 1 and 3 between the sham operation group and the operation group (t =2.227,7.144,P ＜ 0.05),while no significant difference was detected at postoperative day 7 (t =2.162,P ＞ 0.05).The results of Western blot showed that the relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 1.00 ± 0.05,1.00 ± 0.07,1.00 ± 0.06 in the control group,with a significant difference (F =0.055,P ＞ 0.05).The relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 0.78 ± 0.09,0.94 ± 0.08,0.95 ± 0.12 in the sham operation group,with a significant difference (F =5.651,P ＜ 0.05).The relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 0.37 ± 0.12,0.89 ± 0.10,0.92 ± 0.14 in the operation group,with a significant difference (F =41.005,P ＜0.05).There was significant difference in the relative expressions of TRPA1 in the proximal part of the colon among the 3 groups at postoperative day 1 (F =73.497,P ＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group and the operation group at postoperative day 1 (t =4.224,11.954,P ＜ 0.05),and significant difference between the operation group and the sham operation group was also observed (t =7.730,P ＜ 0.05).There was no significant difference in the relative expression of TRPA1 in the proximal part of the colon among the 3 groups between day 3 and day 7 (F =2.087,0.656,P ＞ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7 were 1.00 ± 0.05,1.00 ± 0.07,1.00 ± 0.06 in the control group,with no significant difference (F =0.055,P ＞ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7were 0.68 ±0.11,0.98 ±0.12,1.11 ±0.16 in the sham operation group,with a significant difference (F =16.975,P ＜ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7 were 0.39 ± 0.12,0.78 ± 0.10,1.06 ± 0.13 in the operation group,with a significant difference (F =50.417,P ＜ 0.05).There were significant differences in the relative expression of TRPA1 in the distal part of the colon among the 3 groups between day 1 and day 3 (F =58.773,8.680,P ＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group and the operation group at postoperative day 1 (t =5.706,10.837,P ＜ 0.05),and significant difference was also detected between the operation group and the sham operation group (t =5.131,P ＜ 0.05).There was no significant difference in the relative expression of TRPA1 in the distal part of the colon between the control group and the sham operation group at postoperative day 3 (t =0.166,P ＞ 0.05),while significant differences were respectively detected between the control group and the operation group and between the sham operation group and the operation group at postoperative day 3 (t =3.694,3.528,P ＜ 0.05).There was no significant difference in the relative expression of the TRPA1 in the distal part of the colon between the 3 groups at postoperative day 7 (F =1.319,P ＞ 0.05).Conclusions Injury to pelvic nerves adversely affects colonic transit and expression of TRPA1 in mucosa.With a compensatory mechanism from the intestinal itself,these alterations in intestinal motility function normalize over time suggesting expression of TRPA1 in mucosa plays a crucial role in the recovery of intestinal motility function.

ObjectiveTo observe the clinical efficacy of electroacupuncture plus constraint-induced movement therapy (CIMT) in recovering neurologic function of patients with spastic hemiplegia.MethodSixty patients with post-stroke spastic hemiplegia were randomized into an electroacupuncture group, a CIMT group, and an electroacupuncture+CIMT (integrated) group to receive corresponding intervention in addition tothe ordinary rehabilitation treatment, 20 cases in each group. Before treatment and after 4-week treatment, the modified Ashworth Scale, Clinical Neurologic Deficit Scale, Short-form Fugl-Meyer Assessment Scale (FMA), and Berg Balance Scale (BBS) were adopted for evaluation and comparison.ResultAfter 4-week treatment, the Ashworth score and neurologic deficit score were significantly reduced in the three groups (P<0.01), and the scores in CIMT group were significantly lower than that in the electroacupuncture group (P<0.05), and the scores in the integrated group were markedly lower than that in the other two groups (P<0.05); the FMA and BBS scores were significantly increased after intervention in the three groups (P<0.01), and the scores in CIMT group were higher than that in the elctroacupuncture group (P<0.05), and the scores in the integrated group were higher than that in the other two groups(P<0.05).ConclusionElectroacupuncture plus CIMT can reduce the muscular tension of the affected limb in patients with spastic hemiplegia, and improve the neurologic function, motor function, and the quality of life of the patients.

Objective　The effects of nitric oxide(NO) on the endotoxin-induced tissue damage,especially intestinal injury and bacterial translocation are still poorly known, although its involvement in vasodilatation and hypotenion in shock is much clear. So, the intestinal damage and bacterial translocation were observed in this study in endotoxemic rats after treatment with Nω-nitro-L-arginine(LNNA),the special inhibitor of NO synthase(NOS),and L-arginine,the substrate of NOS.Methods　The endotoxemia was conducted with administration of lipopolysaccharide(O111B4,10mg/kg,i.p.),animals were treated with LNNA(4mg/kg,i.p.)or L-arg(40mg/kg,i.p.).Intestinal molondialdehyde(MDA) content and Diamine oxidase(DAO) activity were determined,and mesenteric lymph nodes were cultured.Results　The results showed that endotoxin decreased intestinal DAO acitivity but increased MDA content and incidence of bacterial translocation to mesenteric lymph nodes.These effects of endotoxin were aggregated by inhibition of NO production with LNNA, but attenuated by L-arg.Conclusion　We concluded that inhibition of NO formation might enhance endotoxin-induced intestinal damage and bacterial translocation,which suggested that NO might play a protective role in this endotoxemia model.

According to the GenBank sequences (GenBank Accession No. AF539467), one pair of primers was designed to amplify hly gene of Aeromonas hydrophila by PCR. After sequencing, homology analysis indicated that a DNA fragment of 1485 bp was amplified from isolated DNA from Aeromonas hydrophila, and it shared more than 99% homology in nucleotide sequence compared with other reference strains in GenBank. The gene was cloned in pET-28a vector to construct a recombinant plasmid pET-28a-hly, which was transformed into Escherichia coli BL21 (DE3), and the recombinant strain BL21(DE3)(pET-28a-hly) was obtained. The hemolysin was highly expressed when the recombinant strain BL21 (DE3) (pET-28a-hly) was induced by IPTG. The expressed protein was 56 kD as estimated by 15% SDS-polyacrylamide gel electrophoresis (SDS-PAGE). The immunogenicity of the expressed Hly protein was confirmed by Western blotting. Mice were immunized with inactivated whole bacteria vaccine and the genetic engineering vaccines showing promise that all these vaccines have a high protective ability. The results showed that the recombinant strain BL21 (DE3)(pET-28a-hly) could be candidate of hemolysin toxoid vaccine to provide protective immunity against diseases caused by Aeromonas hydrophila.
Aeromonas hydrophila ; genetics ; Animals ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Female ; Hemolysin Proteins ; genetics ; metabolism ; Immunization ; Mice ; Molecular Sequence Data ; Random Allocation ; Recombinant Proteins ; genetics ; immunology ; metabolism ; Sequence Homology ; Toxoids ; immunology ; Vaccines, Synthetic ; immunology

OBJECTIVETo investigate the quality of life of rectal cancer patients after anterior resection and the role of 5-hydroxytryptamine(5-HT) in the pathogenesis of anterior resection syndrome (ARS).

METHODSBetween November 2012 and October 2014, 90 rectal cancer patients who underwent Dixon procedure in the Institute of Surgery Research, Daping Hospital, Third Military Medical University, and developed ARS postoperatively were enrolled in the study. By clinic interview and telephone follow-up, they were investigated according to the 4 questionnaires, including gastrointestinal quality of life index(GIQLI), Wexner constipation and incontinence score(WCS, WIS), and 36-item short form health survey(SF-36). Associated clinical data and above parameters were compared between postoperative 0-6 months and 7-24 months. Expression of 5-HT in rectal mucosa was determined by immunohistochemistry preoperatively and postoperatively.

RESULTSThe GIQLI, WCS and WIS were significantly improved in 7-24 months group compared with those in 0-6 months group(all P<0.05). Furthermore, the SF-36 test result also showed significant improvement in the terms of physical function, physical role, vitality, social function, emotional role and health changes spheres in 7-24 months group(P<0.05). 5-HT expression in rectal mucosa(upper anastomosis 3402.95±1876.24, lower anastomosis 3045.35±1373.59 of ARS patients was significantly down-regulated compared with the preoperative expression(rectal margin mucosa 7176.60±3927.61)(P<0.05).

CONCLUSIONSPatients with ARS experience a significant trend toward recovery in their whole long-term quality of life. The down-regulation of 5-HT expression in rectal mucosa after surgery may be related with the pathogenesis of ARS.

OBJECTIVETo explore the availability of Da Vinci robotic-assisted transanal total mesorectal excision(taTME) for lower rectal cancer, which have been regarded as challenging situations in rectal cancer surgery.

METHODSThe medical records of a patient who underwent robotic-assisted transanal total mesorectal excision, coloanal anastomosis and ileostomy for lower rectal cancer on May 31st 2017 were reported.

RESULTSThe case was a sixty-three year-old male patient with a body mass index of 19.1 kg/m. Preoperative examinations showed the tumor size was 4 cm×4 cm×3 cm. With a distance from the anal verge of 4 cm.The tumor was moderately differentiated and staged as cT3N2M0.taTME was performed successfully and the patient recovered quickly without any complications. The histological report showed a complete mesorectal excision with freee distal and circumferential margins.

CONCLUSIONRobotic-assisted taTME is available. Robotics may help to overcome technical difficulties.

Keloids are benign skin tumors resulting from the excessive proliferation of connective tissue in wound skin. Precise prediction of keloid risk in trauma patients and timely early diagnosis are of paramount importance for in-depth keloid management and control of its progression. This study analyzed four keloid datasets in the high-throughput gene expression omnibus (GEO) database, identified diagnostic markers for keloids, and established a nomogram prediction model. Initially, 37 core protein-encoding genes were selected through weighted gene co-expression network analysis (WGCNA), differential expression analysis, and the centrality algorithm of the protein-protein interaction network. Subsequently, two machine learning algorithms including the least absolute shrinkage and selection operator (LASSO) and the support vector machine-recursive feature elimination (SVM-RFE) were used to further screen out four diagnostic markers with the highest predictive power for keloids, which included hepatocyte growth factor (HGF), syndecan-4 (SDC4), ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2), and Rho family guanosine triphophatase 3 (RND3). Potential biological pathways involved were explored through gene set enrichment analysis (GSEA) of single-gene. Finally, univariate and multivariate logistic regression analyses of diagnostic markers were performed, and a nomogram prediction model was constructed. Internal and external validations revealed that the calibration curve of this model closely approximates the ideal curve, the decision curve is superior to other strategies, and the area under the receiver operating characteristic curve is higher than the control model (with optimal cutoff value of 0.588). This indicates that the model possesses high calibration, clinical benefit rate, and predictive power, and is promising to provide effective early means for clinical diagnosis.
Humans ; Keloid/genetics* ; Nomograms ; Algorithms ; Calibration ; Machine Learning