Objective:To explore the perioperative dynamic changes of cellular immune function and its clinical significance in patients with chest surgery.Methods:The numbers of CD3、CD4、CD4/CD8、CD8 T lymphocyte and nature killer(NK) cells in peripheral blood were examined in 45 patients with chest surgery before operation and 1、3、5 and 7 days after operation by flow cytometry.45 patients were devided randomly into groups.The perioperative changes of T lymphocyte subsets and NK cells were compared among mediastinal disease,pulmonary operation,esophagus and gastric cardia surgery.Results:CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day in patients with chest surgery.In patients with mediastinal disease,CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day.In patients with pulmonary operation,CD8 decreased at the 1st day and 7th day after surgery.NK cells decreased at the 5th postoperative day CD3 increased at the 5th day after surgery.CD4/CD8 increased at the 7th day after operation.In patients with esophagus and gastric cardia surgery,CD4/CD8 decreased 1 day after operation,CD3 and CD4 increased at the 7th postoperative day.All differences are statistically significant( P

Objective To explore the effect of 1,25-dihydroxyvitamin D3 [1,25-(OH)2VitD3] on insulin resistance and inflammatory response in mice with severe burns under stress. Methods One hundred and thirty mice were randomly divided into healthy group (n=10), experimental groupⅠ(n=40), experimental groupⅡ(n=40) and control group (n=40). The model mice were scalded to 30%of total body surface area (TBSA) burnt (Ⅲ°) in experimental groupⅠ, the experi-mental groupⅡand control group. Mice in experimental groupⅠwere given by gavaging 1,25-(OH)2VitD3 (1μg·kg-1) with 0.6 mL peanut oil at 8 am for every other day. At the same time and by the same way, mice in experimental groupⅡreceived 1,25-(OH)2VitD3 (4μg·kg-1) with 0.6 mL peanut oil, and mice in control group received only 0.6 mL peanut oil. The serum levels of fasting blood glucose (FBG), fasting insulin (FIns), TNF-αconcentration, and the NF-κB positive rate in wound tis-sues were determined respectively on day1, day3, day7 and day14 after burn. Results (1) The values of insulin resistance index (HOMA-IR), serum TNF-αand the NF-κB positive rate in wound tissues were higher at different time points in exper-imental groupⅠ, experimental groupⅡand control group than those in healthy group. (2) The levels of HOMA-IR at the same time points were significantly lower in experimental groupⅠand experimental groupⅡthan those in control group, and the value was significantly lower in experimental groupⅡthan that of experimental groupⅠ(P<0.05). The level of HOMA-IR was the highest at day 3 and then gradually decreased at the different time points in the same group (P<0.05). (3) The se-rum levels of TNF-αand NF-κB positive rate of wound tissues at the same time points were significantly lower in experimen-tal group Ⅰand experimental group Ⅱ than those in control group, and the value was significantly lower in experimental groupⅡthan that of experimental groupⅠ(P<0.05). The serum level of TNF-αand NF-κB positive rate of wound tissues were gradually decreased at the different time points in same group (P<0.05). Conclusion 1,25-(OH)2VitD3 can reduce the insulin resistance and inflammatory response in mice with severe burns under stress.

Objective Study the effect of recombinant human acidic fibroblast growth factor combined suction drainage in the treatment of refractory wound. Methods Fifty-four patients with refractory wound were analyzed from January 2010 to December 2012 and were randomly divided into the treatment group (n=29, treated with rh-aFGF washing dur-ing operation) and control group (n=25, treated with 0.9% NS). Both groups were treated combined suction drainage treatment. Exposed areas of surface and deep tissue were recorded during the treatment, then the rate of deep wound healing and the rate of cavity volume improvement were calculated. Results Wound in the treatment group cured pri-marily, and the area of bone tendons exposure reduced. The rate of deep wound healing and the rate of cavity volume improvement in the treatment group were better than the control group (P<0.05). The treatment group all healed after short time dressing change. However, the control group all healed after long time dressing change or with skin flap transplantation. Conclusion By exogenous long-term supplementing aFGF and it can achieve the purpose of therapy.

OBJECTIVETo observe and evaluate the clinical effects of improved scapula flap in repairing refractory wound.

METHODSTen patients, with refractory wounds (ranging from 11 cm×7 cm to 16 cm×15 cm) on face and extremities combined with bone and tendon exposure as a result of traffic injury, burns, or diabetic feet, were hospitalized from February 2008 to February 2013. The wounds were repaired with improved scapula flap ranging from 12 cm×8 cm to 17 cm×16 cm. Six of them were grafted directly; 4 of them were grafted with bridging. The vessel of flap was freed to the subscapular vessel and its thoraco-dorsal branch, forming the T-shape vessel pedicle with circumflex scapular vessel, and the vessels on two sides of vessel pedicle were anastomosed with vessels in recipient area. The donor sites were sutured directly or covered with autologous medium-thickness skin graft.

RESULTSNine flaps survived after surgery; the wounds were healed. Few blisters and exudation were observed at the distal end of one flap, which was cured after dressing change for 2 weeks. The pedicles of the bridge-like flap were divided 4-6 weeks after surgery. All the patients were followed up for 6 to 12 months. Slight swelling was observed in 2 flaps. The appearance and texture of the other 8 flaps were good, and the function of the recipient area recovered. No obvious hypertrophic scar was observed in donor site on the back, with normal function of shoulder joint and pulsation of named vessels.

CONCLUSIONSRepairing refractory wounds with improved scapula flaps can result in good appearance, texture, and satisfactory function, which should be popularized in clinic.

Burns ; surgery ; Humans ; Scapula ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Wound Healing

Objective: To investigate and analyze the actual intake of protein and energy in adult patients with severe burns during post burn days (PBDs) 3 to 14. Methods: Records of 52 adult patients with severe burns [37 males and 15 females, (37±9) years old], admitted to the Department of Plastic Surgery and Burns of Tianjin First Central Hospital from January 1st 2011 to December 31st 2017 and meeting the study inclusion criteria, were retrospectively analyzed. Nutrition intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations of patients during PBDs 3 to 14 were obtained from critical care records. During PBDs 3 to 7 and PBDs 8 to 14, the personal daily total energy intake and the ratio of it to energy target of patients were calculated and compared; the personal daily intake of carbohydrate, fat, and protein and calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake, and the ratios of non-protein calories to total nitrogen of patients were calculated and compared; the personal daily energy and protein intake of patients from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations were analyzed; the percentages of energy intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total energy intake, and the percentages of protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake of patients were calculated. Vomiting and diarrhea of patients during PBDs 3 to 7 and PBDs 8 to 14 were recorded. Levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, nitrogen balance values of patients on PBDs 7 and 14 were recorded or calculated. Data were processed with paired t test and chi-square test. Results: (1) The personal daily total energy intake of patients during PBDs 3 to 7 and PBDs 8 to 14 were (8 696±573) and (11 980±1 259) kJ respectively, and ratios of them to energy target [(13 290±1 561) kJ] were 65.4% and 90.1% respectively. The personal daily total energy intake of patients during PBDs 3 to 7 was obviously lower than that during PBDs 8 to 14 (t=18.172, P<0.01). (2) The personal daily intake of carbohydrate, fat, and protein of patients during PBDs 8 to 14 were obviously higher than those during PBDs 3 to 7 (t=15.628, 22.231, 10.403, P<0.01). The personal daily calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake of patients were 56.8%, 25.1%, and 18.3% respectively during PBDs 3 to 7 and 54.2%, 27.0%, and 18.7% respectively during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy intake of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ²=0.185, P>0.05). The ratios of non-protein calories to total nitrogen (kJ∶g) of patients during PBDs 3 to 7 and PBDs 8 to 14 were 469∶ 1 and 456∶ 1 respectively. (3) The personal daily energy intake of patients from routes of oral diet and parenteral nutrition preparations during PBDs 8 to 14 [(4 394±978), (5 723±898) kJ] were obviously higher than those during PBDs 3 to 7 [(2 137±453), (4 855±825) kJ, t=26.516, 6.583, P<0.01], while the personal daily energy intake of patients from routes of enteral nutrition preparations during PBDs 8 to 14 was close to that during PBDs 3 to 7 (t=1.922, P>0.05). The constituent ratio of personal daily energy during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ²=4.100, P>0.05). The personal daily protein intake of patients from route of oral diet during PBDs 8 to 14 was (58±22) g, obviously higher than (25±6) g during PBDs 3 to 7 (t=14.514, P<0.01). The personal daily protein intake of patients from routes of enteral nutrition preparations and parenteral nutrition preparations during PBDs 8 to 14 was close to those during PBDs 3 to 7 (t=1.924, 1.110, P>0.05). The constituent ratio of personal daily protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake during PBDs 8 to 14 was close to that during PBDs 3 to 7 (χ²=5.634, P>0.05). (4) There were 3 patients with vomiting and 4 patients with diarrhea during PBDs 3 to 7, and 1 patient experienced both of them during PBDs 8 to 14. The levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, and nitrogen balance values of patients on PBDs 7 and 14 were (29±4) and (30±4) g/L, (132±42) and (171±48) mg/L, (7.4±2.8) and (6.7±2.8) mmol/L, (1.5±0.7) and (1.4±0.7) mmol/L, (30.5±4.3) and (34.5±2.2) g, -(25.1±2.6) and -(23.7±3.9) g, respectively. Conclusions The personal daily total energy intake of patients during PBDs 3 to 7 was lower than that during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14. Energy and protein intake were mostly derived from parenteral nutrition preparations during PBDs 3 to 7, while those during PBDs 8 to 14 were mainly derived from parenteral nutrition preparations and oral diet.

ObjectiveTo investigate the effects of Anmeidan （AMD） on cognitive function， cytochrome C （Cyt C） signaling pathway protein expression， and apoptosis in a geriatric sleep deprivation model. MethodSixty aged C57 mice were randomly divided into a blank group， a model group， AMD high， medium， and low dose （26.26， 13.13， 6.565 g·kg^-1·d^-1） groups， and a melatonin group （1.3 mg·kg^-1·d^-1）， with 10 mice in each group. Continuous sleep deprivation was performed for 4 weeks using a homemade sleep deprivation box. Cognitive function was assessed using the Morris water maze， and morphological changes in pyramidal cells in the CA1 area of the hippocampus were observed by hematoxylin-eosin （HE） staining and Nissl staining. Transmission electron microscopy was used to observe the mitochondrial morphology and structure of hippocampal neurons. Western blot was used to detect Cyt C， cysteine-aspartate protease-3 （Caspase-3）， cysteine-aspartate protease-9 （Caspase-9）， brain-derived neurotrophic factor （BDNF）， mitochondrial transcription factor A （TFAM）， and voltage-dependent anion channel 1 （VDAC1） protein expression. Immunohistochemistry was used to detect protein expression levels of Cyt C， Caspase-3， and Caspase-9， and immunofluorescence was used to detect the protein expression of B-cell lymphoma 2 （Bcl-2） and Bcl-2-associated X protein （Bax）. ResultCompared with the blank group， the model group showed prolonged platform latency （P<0.01）， reduced number of platform crossings， and reduced time and distance in the target quadrant （P<0.01）. The mitochondrial structure was damaged， with disappearance or breakage of cristae， and increased swelling and deformation. The protein expression levels of Cyt C， Caspase-3， Caspase-9， Bax， and VDAC1 were significantly increased （P<0.01）， while BDNF， TFAM， and Bcl-2 protein expression levels were decreased （P<0.01）. Compared with the model group， the AMD high， medium， and low dose groups improved spatial exploration and navigation abilities in geriatric sleep-deprived mice （P<0.05， P<0.01）， alleviated mitochondrial damage， and increased the number of Nissl bodies. Additionally， the expression levels of Cyt C， Caspase-3， Caspase-9， Bax， and VDAC1 proteins were significantly reduced （P<0.05， P<0.01）， while the expression levels of BDNF， TFAM， and Bcl-2 proteins were significantly increased （P<0.05， P<0.01）. ConclusionAMD improved the cognitive function of geriatric sleep-deprived mice， and its effect may be related to the reduction of apoptosis mediated by the Cyt C signaling pathway.