Objective: To compare the therapeutic effects between the needling method by identification of deficient and excessive patterns and the needling method by routine meridian differentiation in the treatment of soft tissue injuries. Methods: 380 cases of the patients with soft tissue injuries were randomly divided into pattern identification group (200 cases, with the needling method by identification of deficient and excessive patterns) and meridian identification group (180cases, with the needling method by routine meridian differentiation), to observe and compare the therapeutic effects in the two groups. Results: The curative effect was 86% in the pattern identification group and 31.11% in the meridian identification group, with a significant difference (P＜ 0.01). In comparison with the total average treatment times in the cured and improved cases,the pattern identification group was 8.8 days and the meridian identification group was 15.6 days,with a remarkable significant difference (P＜ 0.01). The pattern identification group was better than the meridian identification group. Conclusion: In the treatment of soft tissue injuries, the needling method by identification of deficient and excessive patterns was better than the needling method by routine meridian differentiation.

Objective To provide references for the plan-making of mental intervention on new recruits through the exploration of the comprehensive psychological behavior training influences on psychological stress and health and relevant factors.Methods 436 new recruits in training period were divided into comprehensive psychological behavior training group (intervention group) and non intervention group (control group).By randomly selected 2 (intervention group,control group) × 2 (Before training and after training) matching design,the questionnaire survey was carried out using stress-reaction questionnaire (SRQ),symptom checklist 90 (SCL-90),eysenck personality questionnaire(EPQ),trait coping style questionaire(TCSQ) at the 15th day and 75th day.t-test between group and matched t-test within group and multiple stepwise regression analysis were carried out.Results (1) The SCL-90 total point of new recruits in intervention group (125.26±36.52)and control group(124.92± 34.79) before the training and the difference of SRQ and TCSQ factor scores had no statistical significance(P＞ 0.05).The difference after the comprehensive psychological behavior training had no statistical significance (P＞ 0.05) as the total points of SCL-90 of intervention group(125.63±36.74) and other factors' score were compared with before.Except for the somatization and force,the total points of SCL-90 (131.21 ± 39.98)and other factor scores of the control group were all higher than what they were in the early period of the training significantly (P＜ 0.01 or P＜0.05).In the later period of group training,from the parallel controlled study among groups we found that except for the somatization and force,the total points of SCL-90 and other factor scores of the control group are all lower than the control group (P＜0.0 or P＜0.05).(2)The total points of intervention group's SCL-90 and SRQ had significant positive correlation with negative coping and stability(r=0.313-0.698,P＜0.01) while it had negative correlation with introversion and extroversion(r=-0.293--0.207,P＜0.01) as well as dissimulation at the later period of group training,however,it did not have significant correlation with positive coping method (P＞0.05).(3) The regression analysis showed that factors significantly affected the total score of SCL-90 respectively was:SRQ total score,negative coping method,stability,introversion-extroversion and psychoticism (P＜ 0.01).Five variables'coefficient of determination R 2 =0.665,F=247.82,P＜ 0.01.Conclusion The comprehensive psychological behavior training could reduce the over psychological stress of new recruits,promote their positive coping attitude and protecting their psychological health.Coping method and personality characteristics are important mediating variable between new recruits' psychological stress and mental health.

With the change of disease spectrum and the progress in the aging of society, chronic wound has gradually become one of the major diseases that threaten human health, and also one of the major economic burdens of family and society. According to the different etiology, the pathogenesis of chronic wound is different, including both systemic factors and local factors. The treatment of chronic wound is a multi-disciplinary integrated treatment process, including internal medicine treatment, surgical treatment, vascular interventional therapy, platelet-rich plasma treatment, and biological therapy, etc. Each treatment regimen has its own indications and pros and cons. To make a treatment regimen, a combination of a variety of options should be chosen according to the patient′s wound conditions. The traditional chronic wound treatment mode is multi-disciplinary team (MDT) treatment mode, which requires the participation of surgeons from multiple departments such as intervention department, plastic surgery department, orthopedics department, etc., and it is also the mainstream mode for treating chronic wound in western countries. According to the domestic medical situation and the experience of our department, we put forward the integrated surgical wound treatment (ISWT) mode, that is to integrate multiple surgical techniques of wound treatment. Compared with the traditional MDT treatment mode, to apply the ISWT mode can make a more reasonable treatment plan, improve the efficiency of diagnosis and treatment, shorten the hospitalization period, and improve the diagnosis and treatment ability of the team. With the increasing incidence of chronic wound, the ISWT mode needs to be further explored and improved, and the team needs more specialized experts to join in.

Objective To explore the occurrence and influencing factors of delayed cerebral ischemia(DCI)after clipping surgery in patients with anterior circulation aneurysms.Methods A retrospective analysis was conducted on 248 patients with anterior circulation aneurysms who underwent clipping surgery in our hospital from May 2018 to May 2023.The patients were divided into the DCI group and the non-DCI group based on the occurrence of DCI after surgery.A1∶1 propensity score matching method was used to match 54 patients in the DCI group with 54 patients in the non-DCI group.The random forest algorithm was employed to rank the importance of factors influencing DCI.Multivariable Logistic regression analysis was performed to identify independent risk factors for DCI,and the E-value method was used to assess the sensitivity of model parameters.A DCI risk prediction model was constructed,and the discriminative ability and accuracy of the model were evaluated using ROC curve and Hosmer-Lemeshow test.Results After matching,no statistically significant differences were observed between the two groups in terms of gender,age,body mass index(BMI),smoking history,alcohol consumption,history of cerebral infarction,history of subarachnoid hemorrhage,aneurysm location,and maximum aneurysm diameter(all P＞0.05).Compared to the non-DCI group,the DCI group had a higher proportion of modified Fisher grade 3-4 and Hunt-Hess grade IV patients,higher levels of D-dimer(D-D),total bilirubin(TBIL),TNF-α,high-sensitivity C-reactive protein(hs-CRP),IL-6,and glutamate,and lower levels of immunoglobulin(Ig)G,IgM,and IgA(all P＜0.05).The random forest analysis showed that including Hunt-Hess grade,modified Fisher grade,D-D,glutamate,TB1L,IgA,and IL-6 in the multivariable regression analysis achieved the lowest out-of-bag error rate.Multivariable analysis revealed that Hunt-Hess grade Ⅳ,modified Fisher grade 3-4,D-D,glutamate,TBIL were independent risk factors for DCI,while IgA was a protective factor(all P＜0.05).The risk prediction equation was as follows:P=1/[1+e(3.142+1.307 Hunt-Hess grade+1.086 modified Fisher grade+0.976 D-D+0.748 glutamate+0.552 TBIL-0.524 IgA+0.487 IL-6)].A patient with a risk probability P＞0.65 was considered to have a postoperative occurrence of DCI.The ROC curve results showed that after internal validation,the AUC of the model was 0.869(95％CI:0.836-0.897),with sensitivity and specificity of 81.08％and 97.34％,respectively,indicating good discrimination of the model.The Hosmer-Lemeshow test results showed that after internal validation,the goodness of fit of the model wasx2=4.219,P=0.561,indicating good fit of the model.Conclusions Hunt-Hess grade Ⅳ,modified Fisher grade 3-4,D-D,glutamate,TBIL,and IL-6 are identified as independent risk factors for DCI,while IgA is a protective factor.The predictive model constructed using these factors demonstrates high accuracy and discriminative ability.A risk probability P＞0.65 indicates a postoperative occurrence of DCI in patients.

In the 60th anniversary of Chinese burn medicine,I am honored to review the development of Department of Burns and Plastic Surgery in the Affiliated Hospital of Zunyi Medical College.The Affiliated Hospital of Dalian Medical college was relocated to Zunyi in 1969 to support the development of southwestern China and renamed Affiliated Hospital of Zunyi Medical College.Only a few medical workers stayed in Zunyi when the State Council decided to reestablish Dalian Medical University in 1978.In the last 30 years,our department made great progress in the field of burns treatment with Chinese and Western medicine and complex wounds repair with flap,especially with perforator flap.We also took the lead to achieve the integrated treatment model,including peripheral vascular intervention,autogenous adipose cells/adipose-derived stem cells transplantation,platelet-rich plasma/platelet-rich fibrin,flap grafting,vacuum sealing drainage,Ilizarov technology,and functional active dressing for the treatment of chronic and ischemic wounds.Our department has become one of the national key clinical subject with certain influence from low ebb.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) protein system, as an emerging gene editing system, can be divided into class 1 and class 2 systems according to the number of Cas protein. The CRISPR/Cas9 in class 2 system can cleave target nucleic acid only with the help of Cas9 protein and single-stranded guide RNA, which is currently the most widely used CRISPR/Cas system. In addition to gene editing in the treatment of genetic diseases, a variety of CRISPR/Cas system derived technologies have vast application prospect in the fields of disease-related gene screening, gene expression regulation, and rapid detection, prevention, and control of pathogens. This article summarizes the discovery process of CRISPR/Cas system and applications of several major CRISPR/Cas derived technologies, aiming to provide a reference for researchers in the field of life science.

Objective:To explore the carrier status of carbapenems-resistant Klebsiella pneumoniae (CRKP) plasmids in burn patients and analyze the correlation of these plasmids with the transmission of CRKP. Methods:A retrospective observational study was conducted. A total of 26 CRKP strains, which were isolated from the clinic-related samples of 22 burn patients (with 20 males and 2 females, aged (42±16) years) admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January to December 2017, were collected and individually numbered. The plasmids of the strains were extracted by alkali lysis. After determination of the plasmid concentration by a nucleic acid concentration detector, the agarose gel electrophoresis was used to visualize the bands, and rough plasmids typing was performed. The plasmid of the smallest numbered CRKP in each plasmid type was transformed into competent Escherichia coli ( E. coli) strain Top10 (hereinafter referred to as TOP10 strain). The growth of each transformed strains and a Top10 strain cultivated in ampicillin containing Luria-Bertani (LB) agar medium overnight was observed, and the proportion of successful transformation was calculated. The plasmids from the smallest numbered plasmid carrying CRKP strain of successfully transformed Top10 strains (hereinafter referred to as the smallest successfully transformed strain) and correspondingly numbered CRKP were extracted, and then, the agarose gel electrophoresis was used to visualize the bands. Aforementioned successfully transformed strains and a TOP10 strain were used for the antimicrobial susceptibility testing with 17 antibiotics commonly used in clinic. The plasmid from the smallest successfully transformed strain was sequenced using the next-generation sequencing technology. Bioinformatics analyses such as protein-coding gene prediction and protein sequence alignment were performed successively. The sequence was subsequently named pKP03-NDM1 according to the carrying of drug resistance gene. According to the whole genome sequence of the plasmid carried by the smallest successfully transformed strain, the polymerase chain reaction, agarose gel electrophoresis, and gene sequencing were used to detect the New Delhi metallo-beta lactamase-1 ( blaNDM-1) of plasmids in the remaining 25 strains of CRKP. The ST typing in multilocus sequence typing of 26 strains of CRKP was analyzed based on the literature. Results:Plasmids were successfully extracted from 26 CRKP, with mass concentrations ranging from 19.3 to 189.8 ng/μL. Each of the 26 CRKP carrying plasmids showed at least one band longer than 2 500 bp in the agarose gel electrophoresis, which were roughly divided into 6 patterns of A, B, C, D, E, and F. After overnight cultivation, no growth of strains was observed in LB agar medium containing ampicillin inoculated with the TOP10 strain or TOP10 strains transformed by the plasmid of CRKP patterning A, B, D, or E. In contrast, TOP10 strains transformed by the pattern C plasmid from NO.3 CRKP and the pattern F plasmid from NO.15 CRKP resulted in numerous colony growths, and those transformed strains were named as TOP10-pKP03 and TOP10-pKP15, respectively. The proportion of successful transformation was 1/3. The plasmid carried by TOP10-pKP03 showed a single band in the agarose gel electrophoresis, which was the same size as the largest band of the plasmid from NO.3 CRKP. The TOP10 strain was sensitive to the 17 antibiotics commonly used in clinic. TOP10-pKP03 and TOP10-pKP15 were resistant to penicillins, cephalosporins, and carbapenems but remained sensitive to monocyclic β-lactam, aminoglycosides, quinolones and tigecycline. The full length of the plasmid carried by TOP10-pKP03 was 41 190 bp. In addition to blaNDM-1, this plasmid carried bleMBL, T4SS, bleomycin resistance gene, conjugation transfer elements, and relaxase, etc. The plasmid showed 99% nucleotide identity similarity and the same length to the plasmid pJN24NDM1 extracted from an E. coli isolate JN24. Totally 16 (61.5%) CRKP were confirmed to carrying blaNDM-1 gene, among the ST typing of the 16 strains, 11 strains were ST11, while ST215, ST260, ST395, ST2230, and new ST had 1 strain each. Among the ST typing of 10 blaNDM-1-negative CRKP, 8 strains were ST11, while ST395 and ST2230 had 1 strain each. Conclusions:A blaNDM-1 gene carrying plasmid pKP03-NDM1 was extracted and sequenced from CRKP isolated from burn patients, with a high plasmid carrying rate. Meanwhile, this plasmid may mediate inter-CRKP and CRKP- E. coli horizontal transfer of blaNDM-1, leading to transmission of antimicrobial resistance.

Objective:To explore the clinical application value of MRI in quantitative evaluation of anterior cruciate ligament mucoid degeneration (ACL-MD).Methods:From March to July 2020, 40 patients who were scheduled to undergo arthroscopic treatment were prospectively collected in the First Affiliated Hospital of Kunming Medical University.The anterior cruciate ligament tissue from the lateral edge of the tibial end was taken during the operation. Based on the pathologicalre sults, the patients were divided into the ACL-MD group ( n=19) and the normal group ( n=21). The sagittal plane three-dimensional steady-state rapid precession (3D-FIESTA), T 1 mapping, T 2 mapping, and T 2* mapping were performed before the knee joint surgery, and the scanned images were post-processed and analyzed to measure the T 1, T 2, and T 2* values of the tibial end of the anterior cruciate ligament.The relaxation time of the ACL-MD group and the normal group was compared using independent sample t test. The ROC curve was drawn using each parameter and the areas under the curve (AUC) for the diagnosis of ACL-MD were obtained.DeLong test was used to compare the differences of AUCs. Results:The T 1 [(1 291.9±273.4) ms], T 2 [(54.8±10.6) ms], and T 2* values [(30.6±6.4) ms] of anterior cruciate ligaments in the ACL-MD group were significantly higher than those in the normal group [ (1 087.0±121.0), (44.8±7.1), (20.4±4.8) ms; t=3.011, 3.473, 5.658, all P<0.001]. The AUCs of T 1, T 2, T 2* were 0.747, 0.764, 0.912, sensitivity of 63.2%, 63.2%, 100%, and the specificity of 100%, 95.2%, 76.2% in diagnosing ACL-MD. The AUC of the T 2* value was higher than those of the T 1 and T 2 values, and the differences were statistically significant ( Z=1.734, 2.162, P=0.043, 0.031). Conclusion:T 1, T 2, T 2*values measured by MRI quantitative imaging have high performance in assessing knee joint ACL-MD, and T 2* value has the largest AUC and the highest diagnostic efficiency.

BACKGROUND: Vaccination has been shown effective in controlling the global coronavirus disease 2019 (COVID-19) pandemic and reducing severe cases. This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis (RA). METHODS: A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status. Each of them was examined every 3 to 6 months. In the vaccination group, disease activity was compared before and after vaccination. The rates of flare defined as disease activity scores based on 28-joint count (DAS28) >3.2 with ΔDAS28 ≥0.6 were compared between vaccination and non-vaccination groups. RESULTS: A total of 202 eligible RA patients were enrolled. Of these, 98 patients received no vaccine shot (non-vaccination group), and 104 patients received two doses of vaccine (vaccination group). The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days, respectively. The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar. At enrollment, gender, RA disease course, seropositivity, and disease activity were comparable across the two groups. Flare was observed in five (4.8%) of the vaccination group patients and nine (9.2%) of the non-vaccination group patients at post-vaccination assessment ( P  = 0.221). In terms of safety, 29 (27.9%) patients experienced adverse events (AEs) after vaccination. No serious AEs occurred. CONCLUSIONS COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity. Patients with stable RA should be encouraged to receive the COVID-19 vaccination.
Humans ; Arthritis, Rheumatoid ; Cohort Studies ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; East Asian People ; Prospective Studies ; Vaccination/adverse effects*

With the long-term and widespread use of antibiotics,drug resistance of bacteria has become a major problem in the treatment of burn infection.For treating multidrug resistant bacteria,phage therapy has become the focus of attention.Development of phage therapy to fill the blank of this field in China is extremely urgent.