Objective To evaluate the performance of surgical approaches in the treatment of linear scleroderma of the head and face. Methods Forty-three patients with stable linear scleroderma of the head and face were included in this study. Surgical approaches, which included direct suture,skin flap translocation, soft-tissue augmentation and filling operation with dermal tissues, were selected and utilized alone or in combination according to the size, location and degree of atrophy and depression of lesions. Results After surgical treatment, wound dehiscence developed in one of these patients, but the wound healed after two sessions of suture. During one year of follow up, all the patients achieved favorite color, feeling and blood supply in the filling areas as well as good facial profile and visual appearance with no obvious convexity and concavity. Skin flaps matched well with surrounding tissues, incision lines were inconspicuous, and hairline looked naturally with well-distributed hairs in these patients after treatment. Patients were satisfied with treatment results. Conclusion Satisfied cosmetic outcomes can be achieved by using surgical approaches in patients with stable linear scleroderma of the head and face.

Objective To investigate the effects of autophagy on lipopolysaccharide (LPS)-induced vascular hyper-permeability. Methods ① In vitro: Human umbilical vein endothelial cells (HUVECs) were randomly divided into blank group, LPS group (5 mg/L LPS stimulation), autophagy inhibitor 6-amino-3-methyl purine (3-MA) + LPS group (5 mmol/L 3-MA pretreatment for 30 minutes + 5 mg/L LPS stimulation) and autophagy revulsive Rapamycin (RAP) + LPS group (10 nmol/L RAP pretreatment for 30 minutes + 5 mg/L LPS stimulation). After LPS simulation for 60 minutes in four groups, endothelial permeability was detected by trans-endothelial electrical resistance (TER) determination. The protein expressions of autophagy marker protein microtubule-associated protein 1 light chain 3 (LC3 Ⅱ/Ⅰ) and autophagy related gene Beclin-1 were detected by Western Blot. Cell apoptosis was evaluated by using flow cytometry. Caspase-3 activity was detected by fluorometric assay kit. ② In vivo: 24 Sprague-Dawley (SD) rats were randomly assigned to four groups according to random number table, with 6 rats in each group. The rats in control group received no treatment; rats in model group were tail intravenous injected 10 mg/kg of LPS. The rats in 3-MA pretreatment and RAP pretreatment groups were tail intravenous injected 10 mg/kg of 3-MA or 2 mg/kg of RAP pretreatment for 30 minutes before 10 mg/kg LPS injection. The extravasation of FITC-albumin in mesenteric post-capillary venules was observed by fluorescence microscope. Then the change in fluorescence intensity of FITC-albumin between the intravascular and extravascular space (ΔI) were measured to reflect vascular permeability. Results ① In vitro, compared with blank group, the LC3 Ⅱ/Ⅰ protein, Beclin-1 protein, caspase-3 activity and rate of cell apoptosis in LPS group were increased, and the TER was decreased. Compared with LPS group, the LC3 Ⅱ/Ⅰ, Beclin-1, caspase-3 activity and rate of cell apoptosis in 3-MA+LPS group were decreased, and the TER was increased [LC3 Ⅱ/Ⅰ protein: (288.2±33.3)% vs. (420.5±39.4)%, Beclin-1 protein: (185.3±26.4)% vs. (293.3±36.1)%, caspase-3 activity: (196.6±28.5)% vs. (339.5±25.4)%, rate of cell apoptosis: (9.50±0.99)% vs. (15.40±1.55)%, TER: 0.88±0.09 vs. 0.63±0.05, all P < 0.05]. Compared with LPS group, the LC3 Ⅱ/Ⅰ, Beclin-1, caspase-3 activity and rate of cell apoptosis in RAP+LPS group were further increased, and the TER was further decreased [LC3 Ⅱ/Ⅰ protein: (519.6±45.2)% vs. (420.5±39.4)%, Beclin-1 protein: (359.0±38.3)% vs. (293.3±36.1)%, caspase-3 activity: (449.1±31.0)% vs. (339.5±25.4)%, rate of cell apoptosis: (19.30±1.72)% vs. (15.40±1.55)%, TER: 0.54±0.05 vs. 0.63±0.05, all P < 0.05]. ② In vivo, the albumin extravasation and vascular permeability were increased in model group as compared with those of control group (ΔI: 0.54±0.07 vs. 0.13±0.03, P < 0.05). The albumin extravasation and vascular permeability were obviously decreased in 3-MA pretreatment group as compared with those of model group (ΔI: 0.25±0.05 vs. 0.54±0.07, P < 0.05). The albumin extravasation and vascular permeability were obviously increased in RAP pretreatment group as compared with those of model group (ΔI: 0.67±0.07 vs. 0.54±0.07, P < 0.05). Conclusions Inhibition of autophagy can reduce the LPS-induced vascular hyper-permeability, and enhanced autophagy can further increase vascular permeability. The mechanism of autophagy mediate vascular permeability may be related to the endothelial cells apoptosis.

Objective:To analyze clinicopathological characteristics of trauma-related melanoma and their relationship with the prognosis of patients.Methods:Clinical data were collected from 87 cases of trauma-related melanomas in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from 2009 to 2020, and their clinicopathological characteristics were retrospectively analyzed. Mann-Whitney test was used to analyze the difference in Breslow thickness of tumors between patients of different ages or genders; Spearman rank correlation analysis was used to analyze the correlation between the time from trauma to the notice of melanoma and Breslow thickness, Kaplan-Meier survival analysis and Log-Rank test were employed to analyze the relationship between clinicopathological characteristics of melanoma and the prognosis of patients; Cox regression model was used to analyze risk factors for survival duration of patients with trauma-related melanoma.Results:Among the 87 patients with trauma-related melanoma, 47 (54.02%) were males and 40 (45.98%) were females. Among them, melanoma occurred in 50 (57.47%) cases after sharp injuries, and in 37 (42.53%) after blunt injuries. In addition, 31 (35.63%) cases presented with primary lesions on the hands, and 48 (55.17%) on the feet. The Breslow thickness of the primary tumors was significantly higher in the group aged > 55 years than in the group aged ≤ 55 years ( U= 623.500, P= 0.010) , but there was no significant difference between patients of different genders ( P= 0.138) . The time from trauma to the notice of melanoma was negatively correlated with the Breslow thickness of tumors ( r=-0.203, P= 0.037) . The age of patients, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor significantly affect the survival duration of patients with trauma-related melanoma ( P= 0.011, 0.031, 0.002 and 0.031, respectively) ; the gender, type of trauma and ulceration of tumor mass did not significantly affect the survival duration of patients ( P= 0.618, 0.114 and 0.379, respectively) . Cox regression model analysis showed that the Ki67 proliferation index and Breslow thickness were independent risk factors affecting the prognosis of trauma-related melanoma (risk ratio [ RR] and 95% confidence interval [ CI] were 1.946 (1.234, 4.217) and 1.839 (1.014, 3.332) , P= 0.039 and 0.045, respectively) . Conclusion:The Breslow thickness of trauma-related melanoma is related to the age of patients and time from trauma to the notice of melanoma; the age, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor all affect the survival duration of patients with melanoma, and Ki67 proliferation index and Breslow thickness are independent risk factors affecting prognosis.

Objective: To compare clinical efficacy and safety of microwave therapy versus suction-curettage through small incisions in the treatment of axillary osmidrosis. Methods: Totally, 60 patients with axillary osmidrosis were enrolled from Department of Dermatology, Xijing Hospital, Fourth Military Medical University from January 2017 to February 2018. Every patient received miraDry microwave therapy on the left axillary (microwave therapy group) and suction-curettage through small incisions on the right axillary (suction-curettage group) , and operation duration was recorded. After follow-up of half a year, clinical efficacy and complications were compared between the two groups. Results: After 6-month follow-up, no significant differences were observed in the response rate or recurrence rate between the microwave therapy group (93.33%[56/60], 6.67%[4/60] respectively) and suction-curettage group (96.67% [58/60], 3.33% [2/60] respectively; both P > 0.05) . However, the incidence rate of postoperative complications was significantly lower in the microwave therapy group (0) than in the suction-curettage group (6.67% [4/60], χ² = 4.138, P = 0.042) . Conclusion Compared with suction-curettage through small incisions, microwave therapy has advantages of being non-invasive and less postoperative complications.

Objective To explore the application of radiofrequency lipolysis combined with line-ar lifting in fine lipolysis ,facial rejuvenation and treatment of common complications .Methods From February 2016 to October 2018 ,237 patients were treated by radiofrequency lipolysis combined with linear lifting .According to the patient's face shape ,skin laxity and fat accumulation ,the thickness of fat was measured by B-mode ultrasonography before operation ,and the operative plan was formulated after sufficient communication with the patients .Then ,we marked the range of lipolysis ,the orienta-tion of serrated line and the position of puncture point ,followed by the adjustment of the treatment parameters .Subsequently ,we placed FaceTite handle after swelling anesthesia ,moving slowly and fixing the treatment point ,as well as monitoring the temperature and swelling status of the skin .Im-mediately after the completion of lipolysis ,the treatment area of skin was ice compressed ,with the trocar needles inserted and serrated lines introduced for linear lifting operation .Neck-jaw sleeves were put on after operation .Results 237 patients had different degrees of post-operative edema ,of which the period ranged from 2 to 7 days .168 patients were followed up for 6 to 24 months ,and 8 patients had subcutaneous sclerosis that then gradually disappeared within 2 months after operation .Folliculitis occurred in 5 cases of scalp puncture ,and recovered after topical antibiotics .Facial skin relaxation and sagging ,fat accumulation ,facial shape ,pouch and wrinkles of 160 patients were improved in varying degrees ,and the outcomes of facial rejuvenation were obvious .However ,the self-reported treatment outcomes of 7 patients were not obvious .One patient was reported that the sagging of the skin after sacrificial lipolysis was worse than before ;48 patients underwent autologous fat transplantation ,botu-linum toxin injection ,hot pull ,E-light ,and water-light injection during the follow-up period ,and were not included in the evaluation of efficacy ;21 patients were lost to follow-up .Conclusions Radio-frequency lipolysis combined with linear lifting is an effective method for facial rejuvenation ,and it has obvious effect in fining lipolysis and facial rejuvenation by avoiding the disadvantage of single approach . Post-operative edema should be controlled and avoided to improve patients'satisfaction .

Objective:To explore surgical treatment strategies and prognosis of early-stage nail apparatus melanoma.Methods:A total of 115 patients with early-stage nail apparatus melanoma receiving surgical treatment were collected from Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from July 2011 to December 2019, and surgical treatment strategies and outcomes were analyzed retrospectively.Results:According to the modified ABCDEF criteria and clinical manifestations (such as deformation of the nail plate, ulcers, nodules) , 73 patients with early-stage nail apparatus melanoma received extended surgical resection based on the resection principles of melanoma in situ, 22 based on the resection principles of stage I and II melanoma, 20 based on the resection principles of stage I and II melanoma with invasion risks. During the follow-up period of 6 months to 9 years, there was no recurrence of the primary tumors in any patients; no abnormalities were observed by the ultrasound examination of lymph nodes in 101 patients; metastases occurred in 2 patients receiving finger amputation, 1 of whom died; 12 patients were lost to follow-up. Conclusion:To select extended surgical resection strategies for early-stage nail apparatus melanoma based on clinical manifestations, can ensure adequate treatment and preserve the normal function of the extremities to the greatest extent without recurrence of the primary tumors.

Objective To explore the distribution of sex, month of onset and type of infection virus in children with hand, foot and mouth disease of different TCM syndromes in Heilongjiang province. Methods A total of 2 688 hospitalized children who met the admission criteria in the Infectious Disease Department of Harbin Infectious Disease Hospital from September 1, 2014 to August 31, 2016 were selected. The TCM syndrome differentiation according to the clinical manifestations of children on the day of admission. The distribution of sex, month of onset and type of infection virus in children with different syndrome types were analyzed by SPSS 19.0 software. Results Hand, foot and mouth disease (HFMD) was more common in males than females in Heilongjiang, with a ratio of 1.58:1. Children of all sexes with hand, foot and mouth disease in Heilongjiang were predominantly with lung-defense syndrome. The incidence of lung-defense syndrome, lung-stomach heat syndrome, damp-heat syndrome and heart-spleen heat syndrome were the majority among the children aged 1-4 years, and the lung-defense syndrome was the highest proportion. From July to September, most of the cases occurred, especially in the case of lung-defense syndrome. Pathogenic tests showed that 1 456 cases were enterovirus universal RNA positive, 203 cases were enterovirus 71 positive and 108 cases were coxsackievirus A16 positive. The most common pathogens of the three pathogens were pathogenic lung-defense syndrome. Conclusions herewere some differences in age, time and virus infection among 2 688 children with hand, foot and mouth disease of different TCM syndromes in Heilongjiang, which may be related to region and climate.

Objective:To compare the dose and image quality of selected photon shield (SPS) technique, organ-based tube current modulation (OBTCM) technique and the combination of these two techniques for reducing the organ dose in head CT examination for infants.Methods:Two anthropomorphic head phantoms (CIRS 1-yr-old and 5-yr-old) were scanned by using Reference mode, Reference + OBTCM mode, SPS mode and SPS + OBTCM mode, respectively. Radiation doses to the lens of the eye, the anterior of the brain, the posterior of the brain, noise level and CNR of orbit and brain in different phantoms were measured and compared by using different scanning modes.Results:Compared with Reference mode, the doses to the lens of the eye in 1-yr-old and 5-yr-old phantom decreased by (21.89 ± 0.01)% and (28.33 ± 0.34)%, respectively. In SPS mode, the reduction in doses to the lens of the eye in 1-yr-old and 5-yr-old phantom were (71.38 ± 1.30)% and (53.72 ± 2.42)%, respectively. In SPS + OBTCM mode, the reduction was (71.12 ± 2.54)% and (55.73 ± 1.90)%, respectively. There was significant difference in the noise level of orbit and brain in different phantoms under various scanning modes ( F=5.67-85.47, P< 0.05). The noise level in OBTCM mode compared with reference mode increased slightly (<1.45 HU) in various phantoms. SPS and SPS + OBTCM mode resulted in a small noise increase (<2.58 HU). There was no significant difference in CNR of different phantoms under various scanning modes ( P>0.05). Conclusions:SPS and SPS + OBTCM mode can significantly reduce the radiation dose of lens and the whole image plane in the head CT scan for infants, with maintaining the image quality.

Objective:To understand the current status of nurses' awareness and needs for the Employee Assistance Program (EAP), as to provide basis for the hospital to formulate EAP.Methods:Using the purpose sampling method, 352 ICU nurses from the Nanjing Drum Tower Hospital Affiliated of Nanjing University Medical School were selected as the research subjects from December 2019 to January 2020. Finally, 350 valid questionnaires were obtained. Use the EAP demand questionnaire to investigate the ICU nurses' awareness and demand for EAP.Results:Among the 350 nurses in the intensive unit, 214 cases (61.14%) had never understood EAP, only 8 (2.29%) had understood and experienced the EAP, and 332 cases (94.86%) believed that the hospital′s implementation of EAP was a benefit provided to nurses. The top two service requirements were: "Relief of work pressure" and "mental health consultation", and hope to receive mixed-mode EAP services; in ICU and CCU, nurses hope EAP can help resolve work-family conflicts; in EICU, they need to provide Specific job skills training services.Conclusions:ICU nurses have insufficient cognition of EAP and urgently need to obtain EAP implementation knowledge; at the same time, it is necessary to formulate an implementation plan that meets ICU nurses′ needs for EAP, that is, to relieve work pressure and carry out psychological counseling to ensure that EAP is launch successfully in ICU nurses.

Objectives To determine the contents of heavy metals lead, cadmium, mercury, arsenic, and chromium in water and sediment samples from Luoyang River in Quanzhou City, Fujian Province, and to understand the temporal and spatial distribution of heavy metal pollutants. Methods In 2018, 231 water and sediment samples were collected from 43 sampling points in 6 representative areas in Luoyang River during normal, rainy and dry seasons. The presence of heavy metals in the samples was then determined. Results Pb, Cd, Hg, As and Cr⁶⁺ were not detected in the water samples. Pb, Cd, Hg, As and Cr were detected in the sediments were 10.33,0.33,0.029,5.18 and 23.3 mg/kg , but the contents were low. Conclusion The water and sediments of Luoyang River in 2018 had good quality, both of which met Class I standards according to the environmental quality standards for surface water and for marine sediment quality, respectively.