Objective To investigate the clinical efficacy and safety of emergency microsurgery repair for retrograde avulsion injury of hand skin.Methods 36 patients with retrograde avulsion injury of hand skin were randomly divided into research group and control group,18 cases in each group.The control group was treated with flap free re-implantation,and the research group was treated with emergency microsurgical repair.The clinical efficacy of the two groups was compared.Results The effective rate of the research group was 94.44%,which was higher than 66.67% of the control group(x2=4.433,P<0.05).The duration of operation,bleeding and hospitalization time in the study group were better than those in the control group(t=-5.523,-4.889,-3.690,all P<0.05).The survival rate of the research group was (95.54±4.21)%,which was higher than (73.22±6.44)% of the control group(t=12.308,P<0.05).The proportion of beautiful skin recovery of the research group was 88.99%,which was higher than 66.67% of the control group(x2=4.985,P<0.05).Conclusion Emergency microsurgery repair for patients with retrograde avulsion injury of hand skin can improve the efficacy of treatment and the survival rate of skin,which is beneficial to the recovery of skin,and can improve the function and appearance of the patients.The effect is remarkable,and it is worthy of popularization and application.

Objective To compare the effect of two different time for intravenous dexmedeto-midine alleviates shivering during parturients cesarean undercombined spinal-epidural anaesthesia. Methods One hundred and twenty parturients delivery under combined spinal-epidural anaesthesiawere equally randomized into three groups.The parturients were intravenously injected with dexmedetomidine 0.4 μg/kg (15 min)at 15 min before the beginning of anesthesia (group A)or the time immediately after delivery of fetus (group B)respectively.Moreover,group C was the control group.Parturientsin group C were given equal volume of normal saline.Mean arterial pressure (MAP),heart rate(HR),pulse oxygen saturation (SpO 2 )and ear temperature were recorded respec-tively.Apgar scores of the fetus at 1 min and 5 min,the incidence and grade of shivering response, Ramsay sedative grade and adverse responses such as nausea,vomiting and traction reaction were re-corded as well.Results By 30 min after operation,2 parturients (5%)in group A,8 parturients (20%)in group B and 19 parturients (47.5%)in group C experienced shivering.Traction reaction was observed in 2 parturients (5%)in group A,in 3 parturients (7.5%)in group B and in 10 parturi-ents (25%)in group C respectively.Compared with group C,the incidence rate and degree of shive-ring were significantly lower in groups of A and B (P <0.05),as well as the traction reaction (P <0.05).The incidence rate and degree of shivering in group A were significantly lower than that in group B (P <0.05),but the incidence rates of traction reaction were not statistically different between the two groups.Conclusion Dexmedetomidine administered before combined spina-epidural anesthesia could prevented shivering response in parturients undergoing cesarean section better than being injected immediately after the birth offetus.

Filamentous fungi are important industrial microorganisms that play important roles in the production of bio-based products such as organic acids, proteins and secondary metabolites. The development of metabolic engineering and its enabling techniques have greatly promoted the design, construction and application of filamentous fungal cell factories. This article systematically reviews the development of filamentous fungal cell factories constructed through metabolic engineering, and discusses the challenges and future perspectives for systems metabolic engineering of filamentous fungi.
Fungi/genetics* ; Metabolic Engineering