Objective: To detect drug-resistant phenotype and abaR gene of Acinetobacter baumannii (AB) and investigate influences of abaR gene on biofilm formation of AB. Methods: From February to July 2014, 159 strains AB were collected from Department of Clinical Microbiology of Ruijin Hospital of School of Medicine of Shanghai JiaoTong University and numbered starting from 1 according time when they were collected. (1) The above-mentioned 159 strains of AB were identified by detecting gene sequence of 16S ribosomal DNA. According to results of drug sensitivity test, extensively drug-resistant strains and sensitive strains of AB were selected and counted, and their sources were recorded. (2) Extensively drug-resistant strains and sensitive strains of AB were collected to measure biofilm formation (denoted as absorbance value) by methyl thiazolyl tetrazolium method when strains at culture hour 12, 24, 48 and 72. (3) The abaR gene sequence of ATCC 17978 of AB was analyzed through Gene banks of National Center for Biotechnology Information and compared with AqsR gene sequence of LuxR type receptor of Acinetobacter oleivorans DR1. No. 87 and No. 96 AB strains were amplified and sequenced by polymerase chain reaction according to target gene sequence of abaR of ATCC 17978 of AB. The sequencing result was compared with abaR gene sequence of ATCC 17978. (4) No. 87 and No. 96 AB strains were collected and divided into 0.1% dimethyl sulfoxide (DMSO) group, 10 μmol/L N-heptanoyl-L-Homoserine lactone (C7-HSL) group, 10 μmol/L N-(3-Hydroxydodecanoyl)-DL-homoserine lactone (OH-dDHL) group, 1% DMSO group, 100 μmol/L C7-HSL group, and 100 μmol/L OH-dDHL, with 3 wells of each group. AB strains in the above groups were respectively dealt with DMSO of corresponding final volume fraction, C7-HSL and OH-dDHL of corresponding final amount-of-substance concentration. Biofilm formation (denoted as absorbance value) of AB was measured by methyl thiazolyl tetrazolium method at culture hour 12, 24, 48 and 72. Data were processed with analysis of variance of factorial design, one-way analysis of variance, LSD test and Bonferroni correction. Results: (1) There were 18 extensively drug-resistant strains and 5 sensitive strains of AB. Samples of extensively drug-resistant strains were mainly collected from Emergency ICU and Department of Burns and Plastic Surgery of our hospital and were mainly from sputum, blood, and wound exudate. Samples of sensitive strains were collected dispersedly and were mainly from sputum. (2) Absorbance values of extensively drug-resistant strains and sensitive strains of AB at all culture time points were similar (with P values above 0.05). Absorbance value of extensively drug-resistant strains of AB at culture hour 24 was obviously higher than that of these strains at culture hour 12, 48, or 72 (with P values below 0.01). Absorbance value of sensitive strains of AB at culture hour 24 was obviously higher than that of these strains at culture hour 12 (P<0.01). (3) AbaR gene sequence of LuxR type receptor existed in AB. Similarity ratio between abaR gene sequence and LuxR type receptor AqsR gene sequence in Acinetobacter oleivorans DR1 was 87%. Similarity ratios between abaR gene sequence of No. 87 and No. 96 strains and ATCC 17978 of AB were 98% and 99%, respectively. (4) Absorbance values of 0.1% DMSO group of No. 87 strain at all culture time points were similar to those of 1% DMSO group (with P values above 0.05). Absorbance value of 0.1% DMSO group of No. 96 strain at culture hour 12 was obviously lower than that of 1% DMSO group (P<0.01), while that at culture hour 24 was obviously lower than that of 1% DMSO group (P<0.01). Absorbance values of 10 μmol/L C7-HSL group of No. 87 and No. 96 strains at culture hour 24 were obviously lower than those of 0.1% DMSO group (with P values below 0.01). Absorbance values of 100 μmol/L C7-HSL group of No. 87 strain at all culture time points were similar to those of 1% DMSO group, respectively (with P values above 0.05). Absorbance value of 100 μmol/L C7-HSL group of No. 96 strain at culture hour 12 was lower than that of 1% DMSO group (P<0.01). Absorbance values of 10 μmol/L OH-dDHL group of No. 87 and No. 96 strains were similar to those of 0.1% DMSO group (with P values above 0.05). Absorbance values of 100 μmol/L OH-dDHL group of No. 87 strain at all culture time points were similar to those of 1% DMSO group (with P values above 0.05). Absorbance value of 100 μmol/L OH-dDHL group of No. 96 strain at culture hour 12 was obviously higher than that of 1% DMSO group (P<0.01). Absorbance values of 0.1% DMSO group and 1% DMSO group of No. 87 and No. 96 strains at culture hour 24 were obviously higher than those at culture hour 12 and 48 (with P values below 0.01). Conclusions Extensively drug-resistant strains of AB exist commonly. AbaR gene exists in AB has relation with biofilm formation of AB.

G heterozygote carriers.The carrying rate of deafness gene was 26‰(32/1234).In the 32 carriers,there are 5 babies showed 'refer' at the first step of hearing screening.In the 1234 babies,112 babies showed 'refer' at the first step of hearing screening.CONCLUSION Deafness gene screening can make up for the deficiencies of the universal newborn hearing screening,and should be used in this kind screening more widely.

OBJECTIVE: The purposes of this study was to analyse the significant of low frequency air-bone gap in enlarged vestibular aqueduct (EVA) patients according to the pure tone audiogram and the benefit for clinic diagnosis of the EVA. METHOD: The audiology testing include (1) play audiometry or pure tone audiometry, tympanometry, middle ear muscle reflex thresholds and stapedius muscle reflex; (2) High-resolution computed tomography (CT) scan of the temporal bone and magnetic resonance imaging was used for diagnoses the EVA. RESULT: All the 78 patients (154 ears) were diagnosed as the typical EVA by CT or MRI. Inner ear malformations were found in 3 ears otherwise the structures of middle ear in all the patients were absolutely normal. The audiology analysis showed 154 ears were type A tympanogram including 126 ears with typical A, 25 ears with As, 3 ears with Ad type. In the 250 Hz pure-tone test:A-B gap were observed in 126 ears(126/154,81. 8%) with the different hearing loss degree: 1 ear mild, 11 ears moderate, 19 ears moderate severe, 40 ears severe and 53 ears profound. In the 500 Hz pure-tone test: A-B gap were found in 102 ears(102/154, 66. 2%) with the different hearing loss degree: 9. ears moderate, 17 ears moderate severe, 35 ears severe and 41 ears profound. CONCLUSION Our study suggested a 66. 2% -81. 8% possibilities to find the EVA through the pure-tone audiometry firstly in the basis of the normal tympanograms with the significant A-B gap.
Acoustic Impedance Tests ; Adolescent ; Audiometry, Pure-Tone ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Vestibular Aqueduct ; Vestibular Diseases ; physiopathology

Acinetobacter baumannii has emerged as one of the leading bacteria for nosocomial infections, especially in burn wards and ICUs. The bacteria can easily form biofilm and readily attach to abiotic and biotic surfaces, resulting in persistent biofilm-mediated infections. Being surrounded by self-produced extracellular polymeric substance (EPS), the microorganisms in biofilm can acquire protective property against detrimental environment and their tolerance toward antibiotics is increased. Poly-β-1-6-N-acetylglucosamine (PNAG), the common constituent of EPS in Acinetobacter baumannii, acts as the key virulence factor and plays a crucial role in biofilm formation process. This review describes the properties and functions of the PNAG and its influence on biofilm formation and drug resistance of Acinetobacter baumannii.
Acinetobacter Infections ; drug therapy ; Acinetobacter baumannii ; drug effects ; Anti-Bacterial Agents ; therapeutic use ; Biofilms ; drug effects ; growth & development ; Burns ; Cross Infection ; Drug Resistance, Multiple, Bacterial ; beta-Glucans ; metabolism

This study summarizes the construction background, rules and regulations and institutional settings of the MOOC and Micro-course Club in the Second Hospital of Jilin University, discusses the means of teacher training for clinical teachers, and shows the application effect of the club. At the same time, the related problems encountered in the process of club construction are summarized and reflected. The construction of MOOC and micro-course clubs is conducive to improving the information-based teaching level of clinical teachers, and also provides new inspiration and ideas for the construction of medical clubs.

Objective:To explore the clinical effect of free anterolateral thigh flap combined with arterial vascular reconstruction on repairing high-voltage electrical burn wound of type Ⅱ and Ⅲ on the wrist.Methods:From May 2016 to February 2019, 25 patients with deep high-voltage electrical burn wounds on the wrist were admitted to Zhengzhou First People′s Hospital, including 23 males and 2 females, aged 11-63 years. Among them, 4 cases had bilateral electrical burns on the wrist, and 21 cases had unilateral electrical burns on the wrist. There were 29 wounds in 29 affected limbs with depth of full-thickness to full-thickness with tendon and bone exposure, and 17 wounds were type Ⅱ and 12 wounds were type Ⅲ. Twenty-four patients underwent CT angiography of the upper extremities before surgery, while the other one patient did not undergo the examination due to seafood allergy. There were no obvious injury to the ulnar and radial arteries in 7 affected limbs, simple ulnar artery injury in 6 affected limbs, simple radial artery injury in 7 affected limbs, and both ulnar and radial arteries injury in 9 affected limbs. The wound areas after debridement were 10 cm×7 cm-36 cm×17 cm, and the free anterolateral thigh flaps were obtained with area of 11 cm×8 cm-37 cm×18 cm for repairing the wounds. For patients with no damage of ulnar artery and radial artery, the trunk of descending branch of lateral circumflex femoral artery of the flap or combined with the thick muscle perforating branch or lateral branch was anastomosed with the ulnar or radial artery of the wound. For patients with simple ulnar artery or radial artery injury, the trunk, lateral branch, or medial branch was anastomosed with the ulnar artery or radial artery of the wound. For patients with long injury of ulnar artery and radial artery, the ulnar artery or radial artery of the wound was reconstructed with one of the above-mentioned methods, the injured artery that was not anastomosed was reconstructed with great saphenous vein, and the transplanted blood vessel was embedded in the lateral femoral muscle. The accompanying vein of the descending branch of the lateral circumflex femoral artery of the flap was anastomosed with the accompanying vein of the ulnar artery or radial artery of the wound and/or the cephalic vein. The donor sites of flaps were sutured directly or repaired with split-thickness skin graft from the thigh. The survival condition of flap and affected limb after operation and during follow-up was observed, and hand function of the affected limb during follow-up was evaluated according to the evaluation standard after repair of peripheral nerve injury in upper limbs.Results:Fifteen affected limb wounds had tissue liquefaction but healed after second debridement on 14-28 days after flap repair operation. All 29 flaps survived in the end. One patient had long ulnar artery and radial artery injuries in affected limbs and the hand was necrotic due to second embolism of the blood vessel in 1 week post operation, and the remaining affected limbs survived. During the follow-up of 6 to 30 months after operation, the flaps were slightly bloated, the affected limbs were warm with normal blood flow, and finger flexion, wrist flexion, and sensory function of hand recovered to varying degrees. The functions of the survived affected limbs were evaluated as excellent in 8 affected limbs, good in 9 affected limbs, medium in 5 affected limbs, and poor in 6 affected limbs, with an excellent and good rate of 60.71%.Conclusions:The clinical effect of free anterolateral thigh flap combined with arterial vascular reconstruction is good for repairing high-voltage electrical burn wound on the wrist, and the patency restoration of the ulnar artery and/or radial artery of the upper limb in stage Ⅰ is helpful for improving the success rate of limb salvage.

Objective:To explore the clinical effects of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck.Methods:From January 2016 to August 2019, 10 male patients, aged from 20 to 52 years with post-burn facial and cervical scar deformities, were admitted to the First People′s Hospital of Zhengzhou, with the size of scar ranging from 15 cm×7 cm to 23 cm×11 cm. In the first stage, a cylindrical skin and soft tissue expander with rated capacity ranging from 400 to 600 mL was placed in the frontal-parietal region. Another cylindrical expander with rated capacity ranging from 50 to 100 mL was placed in the temporal region of the patient with scars in front of the ear and in cheek. The injection time was 3 to 5 months with the total injection volume being 1.5 to 2.5 times of the rated capacity of expander. In the second stage, the superficial temporal artery frontal branch and its branches were explored, the expander was removed, the scars in the face and neck were conducted resection and contracture relaxation, and the single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region for reconstruction was performed. When the branches of the superficial temporal vessels were difficult to be detected by Doppler ultrasonic blood stream detector, the patient underwent computed tomography (CT) angiography and three-dimensional reconstruction. The donor site in frontal-parietal region was directly sutured, and the wound of the exposed donor site at the pedicle and temporal region was temporarily covered with scar skin. After the suture wound was healed and the hair in expanded flap grew out, hair removal and laser hair removal were performed. Three to four weeks after transplantation of expanded flap, the flap pedicle was cut off, restored, and trimmed in the third stage. The status about the completion of operation, the implantation of expander in the temporal region, CT angiography and three-dimensional reconstruction were recorded. The effective resection area of expanded flap, the length across the midline and the length of the pedicle, and the survival status of the expanded flap and complications after operation were observed. The appearance of donor and recipient sites, the scar recurrence, the appearance and function improvement of patients, and the satisfaction degree of patients were followed up.Results:All the 10 patients successfully completed three stages of operation, of which 6 patients had an auxiliary expander placement in the temporal region, and 5 patients underwent CT angiography and three-dimensional reconstruction. The effective resection area of expanded flap ranged from 18 cm×8 cm to 25 cm×13 cm. The distal end of the flap across the midline extended 4-6 cm to the opposite side, and the length of pedicle was 2-6 cm. All the expanded flaps of patients survived well after formation and transfer. The venous reflux disorder and obvious swelling occurred in 6 patients at the distal end of the flap after operation, and the blood supply recovered after acupuncture bloodletting, etc. Follow-up of 6 to 24 months showed that the color, texture, and thickness of the expanded flaps were similar to those of the facial skin, and no recurrence of scar was observed; the incision in the donor site of the frontal-parietal region was concealed, the hair growth of the temples and head was normal, and the reconstructed hairline was natural; compared with those before operation, the appearance, head-up, mouth-opening, and other functions of patients were significantly improved; the patients were satisfied with the effect of reconstruction.Conclusions:Clinical application of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck can achieve a good appearance and function, and the donor site shows good shape, which enriches the application range of the trans-regional blood supply flap. It is a reliable method for reconstruction of large scar deformities in the face and neck.

Objective:To explore the technique and clinical effects of free medial plantar flap on reconstruction of the severe defect of thumb caused by electric burn.Methods:Surgical techniques and clinical effects were explored in reconstruction with free medial plantar flap for treatment of severe electric burns of thumbs. From July 2016 to July 2021, 18 patients suffered from severe electric burns of thumbs were admitted in the Department of Burn, Zhengzhou First People's Hospital. All the wounds were the entrance of electric burns. After thorough debridement, the arteries, nerves, tendons, phalanges and interphalangeal joints were exposed to various degrees. Damaged digital proper palmar arteries were ligated and defected proper palmar digital nerves were marked and further anastomosed with the nerves carried by the flap. Palmaris longus tendon grafts were employed to reconstruct the defects of flexor pollicis longus tendon. Wounds were closed by transfer of free medial plantar flaps, and the flap donor sites were closed by inguinal skin grafts. Survival of the flap was observed 1 week after surgery, and the survival of the skin graft in the foot donor site 12 days after surgery. Outpatient follow-up including observation of the appearance and texture of the flap, evaluation of sensory function, thumb alignment and finger flexion according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Evaluate the scar hyperplasia in the foot donor site and the standing and walking functions of the donor foot.Results:All flaps survived,at 1 week after surgery. On the 12th day after surgery, all 16 foot flap survived, and 2 patients had local necrosis, and the necrosis healed completely after dressing change for 10 days, the wound healed completely. Among them, 3 patients without tendon transfer experienced a rupture of the flexor pollicis longus tendon at 2 months after surgery, and underwent another palmaris longus tendon transfer. After the surgery, functional exercise was performed with the palm and flexor fingers. After 6-12 months of follow-up, the blood supply, appearance, and texture of the flap were good and similar to that of the palmar skin of the thumb, with varying degrees of recovery in sensation. The TPD was 6-11 mm, and the thumb was restored to varying degrees. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 13 cases in excellent and 5 cases in good. Mild scar hyperplasia remains in the flap site of donor feet, which does not affect the standing and walking functions of the donor foot.Conclusion:The texture of medial plantar skin is similar to that of palmar skin, with good wear resistance and good sensation. Furthermore, it causes a little damage to the donor site and without obvious complication. The medial plantar flap is ideal for reconstruction of a severe wound caused by electric burn in thumb.

Objective:To explore the clinical effects of artificial dermis combined with split-thickness skin for repairing wounds with bone and tendon exposure in hands and feet.Methods:A prospective randomized controlled study was conducted. From October 2018 to February 2020, 82 patients with bone and tendon exposed wounds in hands and feet admitted to the Department of Burns of Zhengzhou First People′s Hospital who met the inclusion criteria were selected. All the patients were divided into flap group (41 cases, including 27 males and 14 females) and artificial dermis+split-thickness skin group (41 cases, including 29 males and 12 females) according to the random number table, with age of (37±7) years. After complete debridement of wounds of patients in the two groups, the wounds of patients in flap group were transplanted with anterolateral femoral free flaps; the wounds of patients in artificial dermis+split-thickness skin group were grafted with artificial dermis with continuous negative pressure suction applied, and then grafted with split-thickness skin from autologous lateral thigh once the vascularization of artificial dermis was completed. One week after autologous skin graft/flap grafting, the survival of wound graft was observed and the graft survival rate was calculated. The complete wound healing time, number of operation, length of hospital stay, hospitalization cost, and the occurrence of surgery-related complications during hospitalization after autologous skin graft/flap grafting were recorded, and the incidence of complications was calculated. Six months after autologous skin graft/flap grafting, the scar hyperplasia of recipient area was evaluated by Vancouver Scar Scale (VSS), while the recovery of hand and foot function was evaluated by Total Action Mobility (TAM) System Rating method and American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Function Scale (AOFAS-AHS), respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and independent sample t test. Results:One week after autologous skin graft/flap grafting, the survival rates of wound grafts were similar in the two groups ( P>0.05). The complete wound healing time and length of hospital stay were (29±5) and (35±5) d for patients in artificial dermis+split-thickness skin group, respectively, which were significantly longer than (22±4) and (28±5) d in flap group ( t=6.96, 6.22, P<0.01). Compared with those in flap group, the number of operations was fewer ( t=7.39, P<0.01), the incidence of surgery-related complications during hospitalization after autologous skin graft/flap grafting was lower ( P<0.01), but there was no significant change in hospitalization cost of patients in artificial dermis+split-thickness skin group ( P>0.05). Six months after autologous skin graft/flap grafting, the VSS scores of recipient area of patients in the two groups were similar ( t=0.32, P>0.05); the TAM score of hand function and AOFAS-AHS score of foot function of patients in artificial dermis+split-thickness skin group were 40±6 and 62±12, respectively, which were significantly higher than 34±6 and 53±11 of flap group ( t=4.66, 3.41, P<0.01). Conclusions:The combined application of artificial dermis and split-thickness skin results in fewer number of operation compared with using flaps in the repair of wounds with bone and tendon exposure in hands and feet, reducing the incidence of surgery-related complications and improving the postoperative hand and foot joint function of patients, without significant scar hyperplasia, although it may also prolong the wound healing time and length of hospital stay accordingly.

Objective:To explore the effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with severe wrist electric burn.Methods:A retrospective observational study was conducted. From January 2017 to December 2020, 4 patients with wrist high-voltage electric burn admitted to the Department of Burns of the First People's Hospital of Zhengzhou and 4 patients with wrist high-voltage electric burn admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital met the inclusion criteria, including 6 males and 2 females, aged 12 to 52 years. They were all classified as type Ⅱ wrist high-voltage electric burns with median nerve defect. In the first stage, the wounds were repaired with free anterolateral thigh femoral myocutaneous flap. In the second stage, the free gracilis muscle flap combined with sural nerve transplantation was used to reconstruct the digital flexion and sensory function of the affected hand in 3 to 6 months after wound healing. The cut lengths of muscle flap and nerve were 32 to 38 and 28 to 36 cm, respectively. The muscle flap donor area and nerve donor area were both closed and sutured. The survival condition of gracilis muscle flap and sural nerve, the wound healing time of recipient area on forearm, the healing time of suture in muscle flap donor area and nerve donor area were observed and recorded after operation, and the recovery of donor and recipient areas was followed up. In 2 years after operation, the muscle strength of thumb and digital flexion and finger sensory function after the hand function reconstruction were evaluated with the evaluation criteria of the hand tendon and nerve repair in the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association.Results:All the gracilis muscle flap and sural nerve survived successfully after operation. The wound healing time of recipient area on forearm was 10 to 14 days after operation, and the healing time of suture in muscle flap donor area and nerve donor area was 12 to 15 days after operation. The donor and recipient areas recovered well. In the follow-up of 2 years after operation, the muscle strength of thumb and digital flexion was evaluated as follows: 4 cases of grade 5, 3 cases of grade 4, and 1 case of grade 2; the finger sensory function was evaluated as follows: 4 cases of grade S3 +, 2 cases of grade S3, and 2 cases of grade S2. Conclusions:For patients with hand dysfunction caused by severe wrist electric burn, free gracilis muscle flap combined with sural nerve transplantation can be used to reconstruct the digital flexion and sensory function of the affected hand. It is a good repair method, which does not cause great damage to thigh muscle flap donor area or calf nerve donor area.