Clinical teaching plays an important role in the education of medical graduate students.In the clinical teaching of the graduate students of burn and plastic surgery,we based it on clinical practice and guided the students in changing their modes of learning and thinking from examination-orientedness to problem solving,from simple vertical to clinical lateral thinking.We made sure that they all acquired innovative ideas and correct methods of clinical research by various academic activities,and cultivated their practical abilities and medical virtues by strict training and moral education.

OBJECTIVE:To explore the role of clinical pharmacists on pharmaceutical care for allergic reaction caused by ox-aliplatin. METHODS:Clinical pharmacists conducted pharmaceutical care for a patient with oxaliplatin-induced allergic reaction, and suggested stopping taking oxaliplatin,giving Dexamethasone injection 5 mg and then slowing down injection speed. RE-SULTS:Physicians adopted the suggestions of clinical pharmacists. Allergic reaction relieved 5 min after giving Dexamethasone in-jection. The patient didn't suffered from this allergic reaction again under tight supervision. CONCLUSIONS:Oxaliplatin is often used for tumor therapy. Medical staff should be familiar with the prevention,diagnosis and treatment of ADR,evaluate oxaliplatin chemotherapy plan in advance and screen high risk allergy factor. The participation of clinical pharmacists in pharmaceutical care contribute to ADR monitoring and promote safe and rational drug use in the clinic.

BACKGROUND:Chondrocytes co-cultured with bone marrow stromal stem cells on the scaffold of platelet-rich plasma are found to proliferate, and besides proliferative growth, bone marrow stromal cells exhibit a tendency of differentiating into chondrocytes. OBJECTIVE:To study the effect of platelet-rich plasma and human umbilical cord mesenchymal stem cells (hUCMSCs) on cartilage repair. METHODS:Forty healthy New Zealand white rabbits were selected to establish models of cartilage defects, and then randomly divided into normal saline group, platelet-rich plasma group, hUCMSCs group and combination group. Platelet-rich plasma was prepared by using double centrifugations to prepare passage 3 hUCMSCs. After modeling, intra-articular injection of normal saline (0.5 mL), 12.5%platelet-rich plasma (0.5 mL), 1×107 hUCMSCs (0.5 mL), 12.5%platelet-rich plasma+1×107 hUCMSCs (total y 0.5 mL) was done in corresponding groups, respectively. After 12 weeks of modeling, the injured cartilage was grossly observed, and hematoxylin-eosin staining was used to observe cartilage repair under light microscope;according to the O'Driscol histologic standard, histological examination was performed. RESULTS AND CONCLUSION:The repair effect in the normal saline group was significantly better that in the platelet-rich plasma group, hUCMSCs group, combination group (P<0.05), while the platelet-rich plasma group and combination group also exhibit better outcomes than the hUCMSCs group (P<0.05). These findings indicate that both platelet-rich plasma and hUCMSCs can promote cartilage repair;moreover, platelet-rich plasma with or without hUCMSCs is superior to hUCMSCs alone in the cartilage repair.

Objective:To investigate the intervention effects of fracture liaison service (FLS)-based intervention in elderly patients with meniscus injury, to provide reference for clinical rehabilitation.Methods:A total of 86 elderly patients with meniscus injury from February 2018 to October 2019 in the Second Affiliated Hospital of Xi ′an Jiaotong University were divided into experimental group and control group according to random number table method. There were 43 cases in each group.The control group was given routine nursing, and the experimental group implemented FLS-based nursing intervention on the basis of the control group. The clinical effects were compared between the two groups by using knee function, knee joint mobility and degree of frailty. Results:Finally, 38 cases were included in the experimental group and 41 cases in the control group. There was no significant difference in knee function, knee joint mobility and degree of frailty between the two groups at discharge ( P>0.05). At 1, 3 months after discharge, the knee scores and knee joint mobility were (75.37 ± 4.68) points, (90.34 ± 3.02) points and (96.68 ± 8.11)°, (119.11 ± 7.92)° in the experimental group, higher than those in the control group (73.17 ± 3.92) points, (87.76 ± 2.93) points and (91.76 ± 7.75)°, (108.61 ± 7.72)°, the differences were statistically significant ( t values were 2.26-5.96, all P<0.05). The knee function scores and knee joint mobility of the two groups changed with time ( F=264.33, 279.54, both P<0.05). There were interaction effects between groups and time in the knee joint mobility of the two groups ( F=6.12, P<0.05). At 1, 3, 6 months after discharge, the physiological dimension scores and frailty total scores were 5.08 ± 1.34, 4.74 ± 1.10, 4.13 ± 0.88 and 8.32 ± 1.50, 7.82 ± 1.31, 6.82 ± 0.95 in the experimental group, lower than those in the control group 5.68 ± 1.15, 5.22 ± 0.85, 5.02 ± 0.76, 9.05 ± 1.28, 8.40 ± 0.89, 8.18 ± 0.90, the differences were statistically significant ( t values were 2.15-6.57, all P<0.05). At 6 months after discharge, the psychological and cognitive dimension scores were 0.98 ± 0.30 and 0.45 ± 0.24 in the experimental group, lower than those in the control group 1.32 ± 0.37 and 0.59 ± 0.22, the differences were statistically significant ( t=4.49, 2.82, both P<0.05). The physiological and cognitive dimension scores and total scores of the two groups changed with time ( F=30.61, 31.72, 38.50, all P<0.05). There were interaction effects between groups and time in the physiological demension scores and the frailty total scores of the two groups ( F=2.86, 4.03, both P<0.05). Conclusions:FLS-based intervention can promote the rehabilitation of knee joint function and alleviate the degree of frailty of elderly patients with meniscus injury.

Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.

Objective:To investigate the clinical effect of ultrapulse fractional carbon dioxide laser combined with stromal vascular fraction gel (SVF-Gel) transplantation in the treatment of scars.Methods:Retrospective analysis of the clinical data of patients with scars treated at the General Hospital of Jilin Chemical Industry Group from January 2018 to January 2022. Application of ultrapulse fractional carbon dioxide laser for treatment: Scaar FX mode treatment for hypertrophic scars, micro FX energy: 80-150 mJ, frequency: 250 Hz, density: 3%. Deep FX mode treatment for superficial scars and atrophic scars, micro FX energy: 30-50 mJ, frequency: 300 Hz, density: 5%. Manual fractional technology(MFT) mode treatment for hyperplastic scars, atrophic scars with scar contracture site, energy: 150-175 mJ, frequency: 40 Hz, distance between holes: 4-5 mm, treatment time 2-3 s. Superficial scar and atrophic scar were treated 2 times, hypertrophic scar was treated 3 times, and the time interval was 2 months. Transplantation of SVF-Gel for scar treatment around 30 days after the first laser treatment. Thigh fatty tissue was extracted to prepare SVF-Gel. The SVF-Gel was injected into the basal layer and deep layer of inside the scar by multi-point and multi-tunnel injection. All patients were followed up for 6 months to evaluate the therapeutic effect. Assess the Vancouver scar scale (VSS) score and the difference of transepidermal water loss (TEWL) between scar skin and adjacent normal skin was measured after treatment, compared with before treatment. The data were analyzed by SPSS 20.0, data in Mean±SD represents. Paired t-test was used to compare the difference between the VSS score and TEWL before and after treatment. P<0.05 indicates a statistically significant difference. Results:A total of 30 patients were enrolled, including 17 males and 13 females, aged (32.7 ± 11.2) years old. Among the 30 patients, 10 patients were superficial scars, 10 patients were hypertrophic scars, 10 patients were atrophic scars. The scars’ formation time was (17.5 ± 4.5) months. (1) The VSS score of superficial scars after treatment was 1.8±0.7, which was lower than 4.7±0.8 before treatment( t=9.26, P=0.001). The difference in TEWL after treatment was (2.48±0.61) g·m -2·h -1, which was lower than (6.85±1.17) g·m -2·h -1 before treatment( t=13.28, P<0.001). (2) The VSS score of hyperplastic scars after treatment was 3.9±1.1, which was lower than 10.6±1.7 before treatment( t=9.37, P=0.001). The difference in TEWL after treatment was (4.91±0.87) g·m -2·h -1, which was lower than (9.92±0.75) g·m -2·h -1 before treatment( t=18.22, P<0.001). (3) The VSS score of atrophic scars after treatment was 3.5±1.2, lower than 7.7±2.3 before treatment ( t=5.81, P=0.005). The difference in TEWL after treatment was (3.73±1.22) g·m -2·h -1, lower than (6.52±1.51) g·m -2·h -1 before treatment ( t=9.52, P=0.001). Conclusion:Ultrapulse fractional carbon dioxide laser combined with SVF-Gel transplantation is effective in the treatment of scars. It can improve the color, thickness, vascular distribution, softness, and skin barrier function of scars.

Objective:To investigate the clinical effect of ultrapulse fractional carbon dioxide laser combined with stromal vascular fraction gel (SVF-Gel) transplantation in the treatment of scars.Methods:Retrospective analysis of the clinical data of patients with scars treated at the General Hospital of Jilin Chemical Industry Group from January 2018 to January 2022. Application of ultrapulse fractional carbon dioxide laser for treatment: Scaar FX mode treatment for hypertrophic scars, micro FX energy: 80-150 mJ, frequency: 250 Hz, density: 3%. Deep FX mode treatment for superficial scars and atrophic scars, micro FX energy: 30-50 mJ, frequency: 300 Hz, density: 5%. Manual fractional technology(MFT) mode treatment for hyperplastic scars, atrophic scars with scar contracture site, energy: 150-175 mJ, frequency: 40 Hz, distance between holes: 4-5 mm, treatment time 2-3 s. Superficial scar and atrophic scar were treated 2 times, hypertrophic scar was treated 3 times, and the time interval was 2 months. Transplantation of SVF-Gel for scar treatment around 30 days after the first laser treatment. Thigh fatty tissue was extracted to prepare SVF-Gel. The SVF-Gel was injected into the basal layer and deep layer of inside the scar by multi-point and multi-tunnel injection. All patients were followed up for 6 months to evaluate the therapeutic effect. Assess the Vancouver scar scale (VSS) score and the difference of transepidermal water loss (TEWL) between scar skin and adjacent normal skin was measured after treatment, compared with before treatment. The data were analyzed by SPSS 20.0, data in Mean±SD represents. Paired t-test was used to compare the difference between the VSS score and TEWL before and after treatment. P<0.05 indicates a statistically significant difference. Results:A total of 30 patients were enrolled, including 17 males and 13 females, aged (32.7 ± 11.2) years old. Among the 30 patients, 10 patients were superficial scars, 10 patients were hypertrophic scars, 10 patients were atrophic scars. The scars’ formation time was (17.5 ± 4.5) months. (1) The VSS score of superficial scars after treatment was 1.8±0.7, which was lower than 4.7±0.8 before treatment( t=9.26, P=0.001). The difference in TEWL after treatment was (2.48±0.61) g·m -2·h -1, which was lower than (6.85±1.17) g·m -2·h -1 before treatment( t=13.28, P<0.001). (2) The VSS score of hyperplastic scars after treatment was 3.9±1.1, which was lower than 10.6±1.7 before treatment( t=9.37, P=0.001). The difference in TEWL after treatment was (4.91±0.87) g·m -2·h -1, which was lower than (9.92±0.75) g·m -2·h -1 before treatment( t=18.22, P<0.001). (3) The VSS score of atrophic scars after treatment was 3.5±1.2, lower than 7.7±2.3 before treatment ( t=5.81, P=0.005). The difference in TEWL after treatment was (3.73±1.22) g·m -2·h -1, lower than (6.52±1.51) g·m -2·h -1 before treatment ( t=9.52, P=0.001). Conclusion:Ultrapulse fractional carbon dioxide laser combined with SVF-Gel transplantation is effective in the treatment of scars. It can improve the color, thickness, vascular distribution, softness, and skin barrier function of scars.

Objective:To study the transepidermal water loss (TEWL) of scar skin in patients with superficial scars, hypertrophic scars, and atrophic scars, and to explore the correlation between TEWL and scar severity.Methods:A retrospective observational study was conducted. From February 2017 to February 2019, 120 scar patients who met the inclusion criteria were admitted to the General Hospital of Jilin Chemical Industry Group, including 78 males and 42 females, aged (35±14) years. According to the diagnosis on admission, there were 40 cases of superficial scar patients, 40 cases of hypertrophic scar patients, and 40 cases of atrophic scar patients. On admission, the Vancouver Scar Scale (VSS) was used to score the scar of each patient; the TEWL of scar skin and normal skin 1 cm from the edge of scar or the same site of the healthy side (hereinafter referred to as normal skin) of each patient was measured by water loss tester, and the difference value of TEWL between scar skin and normal skin (hereinafter referred to as the TEWL difference) was calculated. Data were statistically analyzed with chi-square test, Kruskal-Wallis rank sum test, paired sample t test, one-way analysis of variance, and Dunnett- t test for comparison, and the correlation between the difference value of TEWL and scar VSS score was analyzed with univariate linear regression analysis. Results:On admission, the scar VSS score of superficial scar patients was significantly lower than that of hypertrophic scar or atrophic scar patients ( t=4.403, 4.768, P<0.01), and the scar VSS score of atrophic scar patients was significantly lower than that of hypertrophic scar patients ( t=4.185, P<0.01). On admission, the TEWL of scar skin of superficial scar, hypertrophic scar, and atrophic scar patients were (18±4), (20±4), and (20±5) g·m -2·h -1 respectively, significantly higher than (12±3), (12±3), and (14±4) g·m -2·h -1 of normal skin ( t=6.889, 10.221, 5.870, P<0.01). The difference values of TEWL of superficial scar, hypertrophic scar, and atrophic scar patients were (5.9±1.7), (8.1±1.7), and (6.4±2.1) g·m -2·h -1 respectively. In comparison among different types of scar patients, only the TEWL difference of hypertrophic scar patients was significantly higher than that of superficial scar patients ( t=6.975, P<0.05). The TEWL difference and the scar VSS score in patients with superficial scars, hypertrophic scars, and atrophic scars were significantly positively correlated ( r=0.805, 0.872, 0.826, P<0.01). Conclusions:The TEWL of scar skin in patients with superficial scars, hypertrophic scars, and atrophic scars is increased compared with normal skin, and the degree of increase was positively correlated with the severity of scars.

Objective: To explore the influences of comprehensive nursing intervention on the caregivers of severely burned children. Methods: Eighty severely burned children, admitted to our department from November 2016 to November 2017 and conforming to the study criteria, were included in this study. They were divided into comprehensive group and control group according to the random number table, with 40 children in each group. One caregiver for each child was included in the same group. Children and caregivers in control group had routine nursing care while children and caregivers in comprehensive group had comprehensive nursing care on the base of routine nursing care, including comprehensive psychological nursing of children and caregivers, guidance of rehabilitation for caregivers throughout the entire recovery process, individualized propaganda and education for caregivers on account of disease of children, perfecting social support system, sustained attention of children during follow-up. Anxiety self-rating scale and social support rating scale were used to assess the levels of anxiety and social support of caregivers of children in the two groups at the time of admission (before intervention) and the second month after discharge (the third time follow-up, after intervention). On the day of discharge, the nursing service satisfaction questionnaire of our department was used to evaluate the nursing service satisfaction of caregivers of children. Data were processed with chi-square test and independent sample t test. Results: (1) Before intervention, the anxiety and social support scores of caregivers of children in control group were respectively (64.5±3.8) and (40.4±2.5) points, similar to (63.5±4.9) and (40.5±2.6) points in comprehensive group (t=0.988, 0.177, P>0.05). After intervention, the anxiety score [(47.2±1.9) points] of caregivers of children in comprehensive group was significantly lower than that of control group [(57.6±4.3) points, t=13.917, P<0.01], and the social support score [(45.3±1.9) points] was significantly higher than (35.9±2.1) points in control group (t=-21.282, P<0.01). After intervention, scores of objective support, subjective support, and social support utilization in the social support evaluation rating of caregivers of children in comprehensive group were significantly higher than those in control group (t=12.678, -11.079, -10.031, P<0.01). (2) At the time of discharge, scores of clinical care, propaganda and education content and form in the nursing service satisfaction questionnaire of caregivers of children in comprehensive group were significantly higher than those of control group (t=-14.757, -15.627, -33.221, P<0.01). Conclusions Comprehensive nursing intervention method can effectively reduce the anxiety of the caregivers of severely burned children, help them to make better use of social support system, and improve the satisfaction of caregivers in nursing services.

Objective:To design and develop a molecular imaging probe of 68Ga-labeled bombesin (BBN) analogue, 68Ga-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA)-polyethylene glycol (PEG) 4-BBN, and investigate its potential to target prostate cancer with high expression of gastrin-releasing peptide receptor (GRPR) while minimizing uptake in pancreatic tissue. Methods:Based on the amino acid sequence of BBN peptides, the precursor DOTA-PEG 4-BBN was designed and prepared, followed by labeling with 68Ga and conducting to quality control analysis. The tumor uptake of 68Ga-DOTA-PEG 4-BBN was assessed by microPET/CT imaging on tumor-bearing nude mice models with PC3 of high GRPR expression or HT29 of low GRPR expression (3 mice per group). 68Ga-DOTA-PEG 4-BBN microPET/CT imaging was also performed on 6 tumor-bearing nude mice models with PC3, among which 3 mice were treated with gastrin-releasing peptide antagonist 1 h prior to injection of the tracer (blocked group). After imaging, the ex vivo tissues of 3 PC3 tumor-bearing nude mice of the non-blocked group were examined for radioactivity counting to evaluation the biodistribution of 68Ga-DOTA-PEG 4-BBN, and the percentage injected dose per gram of tissue (%ID/g) was calculated. Independent-sample t test was used for data analysis. Results:The synthesis of 68Ga-DOTA-PEG 4-BBN took 40 min, with the radiochemical yield of 50%-60% (no decay correction) and the radiochemical purity of over 95%. After incubation in the serum at 37 ℃ for 4 h, the radiochemical purity remained more than 95%. The microPET/CT imaging results indicated that the uptake in the PC3 tumor was 3.2 times higher than the uptake in the tumor after GRPR blockade ((1.34±0.24) vs (0.42±0.03) %ID/g; t=5.47, P=0.005). After the injection of 68Ga-DOTA-PEG 4-BBN at 1 h and following imaging for 15 min, the PC3 tumor-bearing nude mice models of the non-blocked group showed that the pancreatic uptake ((0.150±0.058) %ID/g) was significantly lower than that in kidneys, lungs and liver ((9.452±0.234), (0.720±0.041), (1.572±0.213) %ID/g) with a profound statistical distinction ( t values: 11.28-53.02, all P<0.001). The tumor/pancreas uptake ratio could reach 16.92 in the tumor-bearing nude mice models with high GRPR expression. Conclusion:A novel molecular imaging probe 68Ga-DOTA-PEG 4-BBN demonstrates specific recognition of tumors with high GRPR expression while exhibiting low uptake in the pancreas, which shows its potential in prostate cancer molecular imaging.