We previously showed that adenvirus-mediated lymphotactin (Ltn) gene transfer in vivo could improve the an-titumor efficacy of cytosine deaminase (CD) gene therapy significantly. In the precent study, we investigated the im-munological mechanisms involved in the enhanced antitumor efficacy. Upregulation of CD80 and CD54 on murine CT26 colon carcinoma cells was observed after combined transfection with adenovirus encoding CD (AdCD) and adenovirus encoding murine Ltn ( AdLtn) followed by administration of 5-PC in vitro. IL-2 and IFN-? level secreted by splenocytes increased significantly after the combination therapy. In vivo depletion analysis showed that both CD4~+ and CD8~+ T cells participated in the antitumor effect of the host with CD8~+ T cells being the main T cell subset responsible for the enhanced antitumor immune response. These data suggested that increased irnmunogenicity and efficient induction of antitumor immunity of the host might contribute to the enhanced antitumor effects of the combined Ltn and CD suicide therapy.

Adenovirus harboring E. coli. cytosine deaminase gene (AdCD) and adenovirus encoding with lymphotactin gene (AdLtn) were used for gene therapy in vivo. BALB/c mice were inoculated subcutaneously with CT26 colon adeno-carcinoma cells and 3 days later received combined injection of AdCD and/or AdLtn followed by continuous injection with 5-fluorocytosine(5-FC) 300mg/kg. The results demonstrated that mice received combined therapy developed tumors most slowly and survived longest when compared with mice treated with AdCD/5-FC, AdLtn, AdlacZ/5-FC or PBS. To further explain the immunological mechanism of the antitumor effects by the combined therapy, we found that combined treatment with suicide gene and Ltn gene therapy achieved maximal cytotoxic effects of nature killer cells and specific cy-totoxic T lymphocytes. FACS analysis of the tumor mass demonstrated that AdCD/5-FC in combination with AdLtn therapy increased the expression of H-2K~d and B7-1 expression on tumor cells. The CD4~+ and CD8~+ cells infiltrated in the tumor mass after combined therapy were significantly increased when measured by FACS analysis. Our results demonstrated that combined transfer of suicide gene and lymphotactin gene induce nonspecific and specific antitumor immunity of the host and elicit more potent antitumor effect.

Objective:To explore the effect of neurolysis and tendon transplantation in functional reconstruction of the upper limb with severe thermal crush injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 12 patients with thermal crush injuries of the upper limb admitted to Changhai Hospital of Naval Medical University from January 2014 to December 2018. There were 9 males and 3 females, aged 22-54 years (mean, 38 years). The percentage of total body surface area (TBSA) burn ranged from 3% to 8% [(4.9±1.4)%], and wound depth was III degree. According to the damage condition of nerve/tendon and whether there was any dysfunction of the affected limb after wound healing, 12 patients received 2 to 4 times of neurolysis and tendon transplant-related surgeries, with an average surgery of 2.7 times. Among them, a total of 18 times of neurolysis were performed, including 7 times of radial neurolysis, 6 times of median nerve neurolysis and 5 times of ulnar neurolysis, and 14 times of tendon transplantation were done, including 6 times of anastomosis of superficial flexor tendon and long thumb extensor tendon, 5 times of tendon repair transplantation and 3 times of anastomosis of lateral wrist extensor tendon and long thumb extensor tendon. The time interval of each operation was 3-6 months [(4.5±1.0) months]. The Changhai pain ruler, disability of arm-shoulder-hand table (DASH) and joint activity assessment table were assessed before the first operation, 3 months and 6 months after the last operation.Results:All the patients were followed up for 6-12 months (mean, 9.2 months). The score of Changhai pain ruler in the affected limb improved from 3 (2, 3)points before surgery to 1 (0.5, 1)points 3 months after surgery and 1 (0, 1)points 6 months after surgery ( P<0.01). The score of DASH improved from (69.9±2.7) points before surgery to (35.1±1.7) points 3 months after surgery and (33.8±2.0) points 6 months after surgery ( P<0.01). The range of motion score was improved from (1.3±0.5) points before surgery to (2.4±0.5) points 3 months after surgery and (2.8±0.4) points 6 months after surgery ( P<0.01). Conclusion:Neurolysis and tendon transplantation in the treatment of severe thermal crush injuries of the upper limb can alleviate pain in the affected limbs, improve upper limb dysfunction, increase mobility of the palm and upper limb joints, and enhance the quality of life of the patients.

Objective To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism. Methods This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis. Results NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways. Conclusion The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

Objective To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism. Methods This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis. Results NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways. Conclusion The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

The early accurate diagnosis of burn depth is of great significance in determining the corresponding clinical intervention methods and judging the prognosis quality of burn patients. However, the current diagnostic method of burn depth still relies mainly on the empirical subjective judgment of clinicians, with low diagnostic accuracy. Especially for deep partial-thickness burn wounds, the error of early diagnosis is pretty big. In recent years, with the rapid development of artificial intelligence technology, deep learning algorithm combined with image analysis technology can better identify and analyze the information of medical images. This article reviews the research progress of artificial intelligence technology in the diagnosis of burn depth.

A 25-year-old man with extensive burn due to industrial dust explosion was admitted to the First Affiliated Hospital of Naval Medical University on 16th October, 2018. Four days after the first skin grafting and vacuum sealing drainage surgery, the patient developed signs of uncontrolled severe inflammation and shock. However, several atypical manifestations interfered the diagnosis of septic shock. After giving emergency treatment including fluid resuscitation, broad-spectrum antibiotics, and administration of vasopressor agents, the patient′s condition was alleviated, but quickly relapsed and deteriorated, with acute pulmonary edema appeared in the evening of the same day. Finally, the condition was reversed by completely removing the negative pressure devices on upper limbs and thorough dressing change. This case suggests that the diagnosis and treatment of infection in patients with extensive burn need comprehensive analysis. Timely intervention of the wound is the key to control the exacerbation of sepsis. In addition, the possibility of pulmonary edema in patients with sepsis should be on high alert.

BACKGROUND:For elderly patients with traumatic hip fractures,the related factors of prognosis are very complex,and the integrity of the lateral wall is one of the influencing factors.It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE:To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS:Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation.According to the thickness of the lateral wall,the patients were divided into the lateral wall intact group(n=31)and lateral wall risk group(n=51).The perioperative indexes,weight-bearing time,fracture healing time,hip joint function and range of motion,postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION:(1)The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group(P<0.05),but there was no significant difference in other perioperative indexes.(2)Both groups were able to get down to the ground early after surgery and finally complete weight-bearing,but in the lateral wall risk group,the time of fracture healing was longer;the time of complete weight-bearing was significantly delayed;the Harris score of the last follow-up was lower;the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller(P<0.05).(3)There was no significant difference in the incidence of postoperative complications between the two groups,but the overall incidence of complications in the lateral wall intact group was significantly lower(P<0.05).(4)In summary,after internal fixation of proximal femoral nail antirotation,patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall.