Objective:To evaluate the relationship between the mechanism of promoting wound healing by modified autologous blood transfusion and metastasis-associated lung adenocarcinoma transcript 1 ( MALAT1) in diabetic mice. Methods:Twenty SPF ICR mice, weighing 21-25 g, in which the diabetic model was successfully established, were divided into 2 groups ( n=10 each) using a random number table method: modified preservation group (group I) and ordinary preservation group (group O). Peripheral venous blood samples were collected and stored in the corresponding preservation solution for 7 days.The platelet aggregation rate, blood glucose, serum glycosylated hemoglobin (GHB) and phosphodiesterase (DPG) concentrations and WBC were measured.Autologous blood was transfused back immediately after the wound model was established.The percentage of wound healing area was calculated at 7, 10 and 14 days after autologous blood transfusion.The expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, β-actin, type Ⅰ collagen (Col Ⅰ), Col Ⅲ protein and mRNA and MALAT1 was determined by Western blot, immunohistochemistry and quantitative real-time polymerase chain reaction respectively, at 14 days after transfusion. Results:Compared with group O, the blood glucose, serum concentrations of GHB and DPG, and WBC were significantly decreased, platelet aggregation rate was increased, the percentage of wound healing area was increased, the positive staining rate of Col Ⅰ and Col Ⅲ was increased, and the expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, ColⅠ, Col Ⅲ and β-actin protein and mRNA and MALAT1 was up-regulated in group I ( P<0.05). Conclusion:The mechanism by which modified autologous blood transfusion promotes wound healing may be related to up-regulating MALAT1 expression in diabetic mice.

Objective To explore the potential mechanism of Fasudil hydrochloride pharmacologic postconditioning that alleviated acute myocardial ischemia/reperfusion injury (MI/RI) in rats,narrowed the scope of infacted myocardium,and inhibited cell apoptosis.Methods Ninety rats were randomly and averagely divided into 5 groups:sham group,ischemia/reperfusion (I/R) group,ischemic postconditioning (IPost) group,fasudil hydrochloride (FH) group,and FH and PI3K inhibitor (LY294002) (FH + I) group.The expressions of Rho associated coiled-coil forming protein kinase-1 (ROCK-1),Bcl-2,Bax,Caspase-3,Akt,and P-Akt in rat myocardial cells were determined.Results Compared to I/R group (ROCK1:2.94 ± 0.13),ROCK1 expression was not changed in IPost group (ROCK1:2.79 ± 0.11),FH group (ROCK1:2.83 ± 0.10),and FH + I group (ROCK1:2.85 ± 0.26).Compared to I/R group (Bcl-2:1.11 ± 0.12,P-Akt:1.09 ± 0.06,Bax:1.74 ± 0.06,and caspase-3:1.32 ± 0.12),the expressions of Bcl-2 and P-Akt in FH group (Bcl-2:1.76 ± 0.08,and P-Akt:1.73 ± 0.05) and IPost group (Bcl-2:1.74 ± 0.06,and P-Akt:1.37 ± 0.05) were all significantly higher than those in I/R group (P ＜ 0.05),while the expressions of Bax and caspase-3 in FH group (Bax:0.98 ±0.14,and caspase-3:0.97 ±0.06) and IPost group (Bax:0.97 ±0.11,and caspase-3:1.07 ±0.08) were all significantly lower than those in I/R group (P ＜0.05).Compared to FH group,the expressions of Bcl-2 and P-Akt in FH + I group (Bcl2:1.05 ±0.12,and P-Akt:1.21 ±0.06) were decreased (P ＜0.05),while the levels of Bax and caspase-3 (Bax:1.61 ±0.11,and caspase-3:1.42 ± 0.11) were increased (P ＜ 0.05).Conclusions The mechanism of FH postconditioning was associated with the inhibition of ROCK activity,and the activation of PI3K-Akt pathway.

On October 23, 2017, a 52-year-old male patient with 3 recurrences of dermatofibrosarcoma protuberans in the left shoulder and chest was admitted to the Department of Burns and Plastic Surgery of Dali Bai Autonomous Prefecture People′s Hospital. Dermatofibrosarcoma protuberans on the skin were completely resected, leaving wound defect of 10 cm×10 cm. The wound was planned to be repaired by the transplantation of right anterolateral thigh perforator free flap. However, the anterolateral thigh perforator branch was absent during flap removal, and only one small perforating branch was found. Moreover, it was difficult to separate. Therefore, this flap cutting was given up. The anteromedial thigh perforator was explored through the same incision, and a thicker perforator was found, which was supplied by an independent iatrogenic artery. The length and diameter of the vascular pedicle matched with the blood vessels in the receiving site. An anteromedial thigh perforator flap (10 cm×10 cm) was cut to repair the defect. The postoperative 9-month follow-up revealed that the color, texture, and thickness of the flap were good, the two-point discrimination distance was 30 mm, and the linear scar remained at the donor site of right thigh.

OBJECTIVESTo investigate the clinical value of combined dye-isotope technique in detecting sentinel lymph node (SLN) and to examine whether the characteristics of SLN accurately predict cervical lymph node metastasis in lingual carcinoma.

METHODSThirty patients with lingual carcinoma without lymph metastasis were injected with a dose of about 18.5 MBq of (99m)Tc-SC (sulfur colloid), around the tumor tissues before surgery, and lymphoscintigraphy was performed 5, 10, 30, 60 minutes, and 6 hours after injection. In the following day, all patients were injected with isosulfan blue dye around the primary tumor during surgery to trace SLN and underwent standard cervical lymph node dissection after SLN dissection. The pathological results of SLN were compared with standard lymph node dissection for their ability to accurately predict the final pathological status of the cervical lymph nodes.

RESULTSSLN was successfully identified in 100% of the patients. Both positive and negative predictive values of SLN were 100%. The accuracy rate was 100%, and there were no false negatives.

CONCLUSIONSThe detection of SLN using combined dye-isotope technique could accurately predict cervical lymph node metastasis in lingual carcinoma.

Adult ; Aged ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck ; Radiopharmaceuticals ; Rosaniline Dyes ; Technetium Tc 99m Sulfur Colloid ; Tongue Neoplasms ; pathology

Objective To analyze the early outcomes of heart transplantation in critical patients and its significance in donor allocation decision. Methods Clinical data of 449 recipients undergoing heart transplantation were retrospectively analyzed. According to preoperative status, all patients were divided into the critical status group (n=64) and general status group (n=385). The incidence of critical status was summarized. Clinical data of recipients were statistically compared between two groups. Postoperative survival and causes of death in recipients between two groups were analyzed. Perioperative results of critical recipients undergoing different mechanical circulation support as a bridge to heart transplantation were compared. Results Critical patients accounted for 14.3% of the total number of transplant recipients. The proportion of critical patients gradually increased in recent 5 years. Compared with the general status group, the recipients in critical status group had a lower proportion of smoking history, a higher proportion of cardiac surgery history, a higher serum level of creatinine, and a higher proportion of primary diseases of heart failure before heart transplantation(all P≤0.01). The proportion of undergoing mechanical circulation support was higher, the incidence of complications was higher, the stay time in intensive care unit (ICU) was longer and the in-hospital fatality was higher after heart transplantation in the critical status group (all P≤0.01). The 1-year survival rate of recipients in critical status group was significantly lower than that in general status group (83% vs. 95%, P < 0.01). The fatality of recipients due to infection and multiple organ failure in critical status group was higher than that in general status group. Among 64 critical recipients, 1 recipient received ventilator alone, and 63 recipients underwent mechanical circulation support devices as a bridge to heart transplantation. Among them, intra-aortic balloon pump (IABP) alone was applied in 49 cases (77%), 8 cases (13%) of extracorporeal membrane oxygenation (ECMO) combined with IABP, 4 cases (6%) of ECMO alone, and 2 cases (3%) of left ventricular assist device (LVAD) alone. Critical patients who received preoperative ECMO and ECMO combined with IABP bridging to heart transplantation have a higher proportion of postoperative complications, a longer ICU stay time, a longer mechanical ventilation time, and a higher proportion of hospital deaths. Conclusions The overall prognosis of critical patients undergoing heart transplantation is relatively poor. Effective preoperative management may reverse the high-risk status of critical patients in a certain extent. The limited quantity of donor heart should be allocated to the most urgent patients who can obtain the greatest benefit from heart transplantation.

From November 2015 to July 2017, six patients with skin and soft tissue defects of vulva, vagina, and buttock after resection of vulvar tumors were hospitalized in our unit. All patients were female, aged 45-70 years. Among them, four patients had bilateral defects, and two patients had unilateral defect. The defect area on each side ranged from 6 cm×4 cm to 12 cm×6 cm. Internal pudendal artery perforator " angel wing" island flaps were used to repair and reconstruct the defects. The area of flaps ranged from 7 cm×5 cm to 14 cm×7 cm. The donor sites were sutured directly. All 10 flaps of 6 patients survived. Two patients had local incision infection 3 days after operation. One of the two patients was healed 2 weeks after dressing change, and the other one underwent debridement and suture 1 week after dressing change and was healed 1 week after surgery. Follow-up for 6-12 months after surgery showed no recurrence of tumors, no eversion of vagina, better shape of vulva in bilateral reconstruction cases, and slightly worse symmetry in unilateral reconstruction cases. The skin of the reconstructed area was soft, with sensations of pain, temperature, and touch recovered in varying degrees. The distance of a two-point discrimination was 20-30 mm. Linear scars were left in the flap donor sites, with no impact on squatting or striding. In vaginal examination, 1.5 to 2.0 fingers could be inserted in bilateral reconstruction cases, while 2.0 to 3.0 fingers could be inserted in unilateral reconstruction cases. The anus functioned well during defecation.

In recent years, mental disability estimation are more than ever in the practice of forensic psychiatric expertise. The standards about mental disability estimation in the Disability Evaluation Criteria of Traffic Accident Injury are ambiguous and difficult to operate, it cause to different understanding in one case. This article discuss some common questions through 3 aspects in mental disability expertise according to some typical cases, there are the first, we should compare the IQ score before and after injurious in intelligence estimate. The second, the mental disability estimation should be done at least one year after the end of medicine treatment. The third, mental estimate scale should be used in mental disability estimation.
Accidents, Traffic ; Adolescent ; Craniocerebral Trauma/psychology* ; Disability Evaluation ; Expert Testimony/standards* ; Female ; Forensic Psychiatry/legislation & jurisprudence* ; Humans ; Intelligence ; Male ; Persons with Mental Disabilities ; Wechsler Scales ; Young Adult

Objective To study the occurrence of acute gastrointestinal injury under different critical status in Pediatric Intensive Care Unit,and to assess the connection between citrulline and acute gastrointestinal injury.To ana-lyze the correlation among serum citrulline and C-reaction protein(CRP),procalcitonin(PCT),creatinine,urea nitro-gen,bilirubin,lactate,albumin.To study the role of citrulline in evaluating the children condition,prognosis and changes in critically ill children.Methods Ninety-six pediatric patients who were critically ill at the Pediatric Intensive Care Unit of the Second Hospital of Lanzhou University were selected,excluding those with primary gastrointestinal diseases and chronic kidney disease.Clinical features were recorded and CRP,PCT,creatinine,urea nitrogen,bilirubin,lactate, and albumin were measured.Serum citrulline concentrations were measured by high performance liquid chromatography in 65 patients with gastrointestinal injury,and sensitivity,specificity and area under the receiver operating characteristic (ROC)curve were calculated.Results The incidence of acute gastrointestinal injuries in non-critical group,critical group,reorganization critical group were 47.06%(16/34 cases),75.00%(36/48 cases),92.86%(13/14 cases) (χ2=11.848,P=0.003).The serum citrulline concentrations of gastrointestinal injury group and non- gastrointesti-nal injury group were(14.655 ± 8.231)μmol/L,(23.522 ± 11.079)μmol/L(t=4.398,P<0.05).The area under ROC of citrulline was 0.079 8.Serum citrulline concentrations increased significantly in infants with very severe gastro-intestinal injury after 3 days of treatment compared with admission[(26. 40 ± 16. 10)μmol/L vs.(14. 40 ± 6.82)μmol/L,t=5.524,P=0.029].The lower serum citrulline levels the children had,the higher mortality was. There were negative correlations among serum citrullin and CRP,PCT and length of hospital stay(r = -0. 319,-0.299,-0.364,P=0.003,0.006,0.001).There were no correlations among serum citrullin and blood urea nitro-gen,lactic acid,albumin,and bilirubin levels.Conclusion The more critically ill children have a higher incidence of acute gastrointestinal injury and the worse the prognosis.Serum citrulline levels may well reflect the extent of acute gas-trointestinal injury and the outcome.Perhaps it can be one of the reliable markers to evaluate the function of gastrointes-tinal and participate in assessing critical condition and prognosis in critical ill children ness.

Objective:To detect the infection and subtype status of human papilloma virus (HPV) for patients with head and neck squamous cell carcinoma (HNSCC) treated in a single center in Chaoshan area of Guangdong Province.Methods:The primary lesion samples from 167 HNSCC patients in Cancer Hospital of Shantou University Medical College between December 2014 and December 2016 were collected. The expression of p16 protein in tumor tissues was detected by using immunohistochemistry (IHC), and the positive rate of tumor cell p16 protein≥ 76% was used as a diagnostic standard to judge HPV in HNSCC; the relationship between p16 protein and the clinicopathological factors was analyzed. The status of HPV 16/18 DNA in tumor tissues was tested by using in situ hybridization(ISH). RNA scope was used to detect the RNA expression of 18 kinds of common high-risk HPV subtype (HPV HR 18), and the positive status of HPV HR 18 in tumor tissues with the positive cell proportion ≥ 50% of p16 protein was analyzed.Results:The strong expression rate of p16 protein was 7.2% (12/167). The strong expression rate of p16 protein in the younger group (< 50 years old) was higher than that in the older group (≥ 50 years old) [17.2% (5/29) vs. 5.1% (7/138), χ 2=5.321, P=0.021]. The strong expression rate of p16 protein in the oropharyngeal carcinoma group was higher than that in the non-oropharyngeal carcinoma group [29.4% (5/17) vs. 4.7% (7/150), χ 2=14.019, P < 0.01]. The strong expression rate of p16 protein in the gender, smoking and alcohol consumption, tumor staging and stratification among different patients was not statistically different (all P > 0.05). HPV 16/18 DNA was not found in all HNSCC primary lesions by using ISH, which showed the same result after repeated examination. RNAscope method showed that 3 cases (15.8%) out of the 19 patients with p16 protein positive rate≥50% were HPV HR 18 RNA positive. Conclusions:The positive rate of HPV for HNSCC patients in Chaoshan area is low, while the patients with oropharyngeal carcinoma have the highest rate and tend to be younger. The main carcinogenic viruses of HPV for HNSCC patients in Chaoshan area are other subtypes of HPV including HPV HR 18 rather than HPV 16/18.

Objective To evaluate the role of high-mobility group box 1 protein ( HMGB1)∕Toll-like receptor 4 ( TLR4) signaling pathway in myocardial ischemia-reperfusion ( I∕R) injury in rats. Meth-ods Fifty-four clean-grade healthy male Sprague-Dawley rats, aged 7-8 weeks, weighing 200-250 g, were divided into 3 groups ( n=18 each ) using a random number table method: sham operation group ( group Sham) , myocardial I∕R group ( group I∕R) and specific HMGB1 antibody group ( group H) . Myo-cardial I∕R was produced by 30-min occlusion of left anterior descending branch of coronary artery followed by 180-min reperfusion in anesthetized rats. Specific HMGB1 antibody 2 mg∕kg was injected through the femoral vein at 30 min of reperfusion in group H. Twelve rats in each group were randomly selected at 180 min of reperfusion, and blood samples were collected from the femoral vein for determination of plasma in-terleukin-6 ( IL-6) , IL-8, IL-12, tumor necrosis factor-alpha ( TNF-α) and cardiac troponin I ( cTnI ) concentrations. The rats were then sacrificed, hearts were removed and myocardial tissues were obtained forexamination of the pathological changes and for determination of the expression of intercellular adhesion mol-ecule 1 ( ICAM-1) and E-selectin ( by immunohistochemistry) , expression of TLR4 and NF-κB mRNA and protein (by quantitative real-time polymerase chain reaction or by Western blot), activities of glutathione peroxidase ( GSH-PX) , superoxide dismutase ( SOD) and myeloperoxidase ( MPO) and MDA content. Six rats were selected for measurement of the myocardial infarct volume, and the percentage of myocardial in-farct volume was calculated. Results Compared with group Sham, the serum concentrations of IL-6, IL-8, IL-12, TNF-α and cTnI, MPO activity and MDA content were significantly increased, the expression of ICAM-1, E-selectin, TLR4 and NF-κB protein and mRNA was up-regulated, activities of GSH-PX and SOD were decreased, and the percentage of myocardial infarct volume was increased in group I∕R ( P<0. 01) . Compared with group I∕R, the serum concentrations of IL-6, IL-8, IL-12, TNF-α and cTnI, MPO activity and MDA content were significantly decreased, the expression of ICAM-1, E-selectin, TLR4 and NF-κB protein and mRNA was down-regulated, activities of GSH-PX and SOD were increased, and the percentage of myocardial infarct volume was decreased in group H ( P<0. 01) . Conclusion HMGB1∕TLR4 signaling pathway is involved in myocardial I∕R injury in rats.