Background Diabetic retinopathy (DR) is a chronic inflammatory disease,with pathological changes of retinal microvessels.Studies demonstrated that sericin has anti-inflammation and anti-oxidation effects,inferring that sericin might play a protective effect on diabetic microangiopathy.Objective This study was to investigate the effects of sericin on intercellular adhesion molecule-1 (ICAM-1),vascular cell adhesion molecule-1 (VCAM-1) and Cx43 expressions in retina and explore the protection of sericin to retinal microangiopathy in diabetic rats.Methods Forty-eight specific pathogen free male SD rats were randomly divided into normal control group,diabetic model group,sericin-treated group and calcium dobesilate-treated group,with 12 rats for each group.The diabetic models were established by intraperitoneal injection of streptozotocin (STZ) for 3 consecutive days and feeding up with high lipid foods.Normal saline solution,2.4 g/(kg · d) sericin solution and 0.2 g/(kg · d) calcium dobesilate were used by gavage administration in the rats of the diabetic model group,sericin-treated group and calcium dobesilate-treated for 3 months group,respectively.The rats were sacrificed and retinal sections were prepared,and the retinal morphology was examined by hematoxylin-eosin staining.The expressions of ICAM-1,VCAM-1 and Cx43 proteins and mRNA in retinas were detected by Western blot assay and reverse transcription PCR.The use and care of the rats complied with Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission and ARVO statement.Results The retinal structure was normal in the normal control group.The swell and rupture of inter limiting membrane (ILM),scatter vascular endothelial cell nuclei breakthrough ILM and decrease of retinal ganglion cells (RGCs) were displayed in the diabetic model group;while in the sericin-treated group and calcium dobesilate-treated group,the mild thickening of ILM and disorder of retinal cells were obtained.The relative expression levels of ICAM-1 and VCAM-1 were significantly raised and those of Cx43 were reduced in the diabetic model group,sericin-treated group and calcium dobesilate-treated group when compared with the normal control group (all at P＜0.05).Compared with the diabetic model group,the expressions of ICAM-1 and VCAM-1 proteins and mRNA in the sericin-treated group were significantly reduced (ICAM-1 protein:0.834 3±0.032 1 vs.0.918 9±0.042 4;VCAM-Ⅰ protein:0.726 4±0.011 2 vs.1.235 0±0.078 9;ICAM-1 mRNA:0.716 3±0.008 6 vs.0.956 8±0.012 5;VCAM-1 mRNA:0.393 7±0.035 0 vs.0.477 9±0.020 6) and those of Cx43 protein and mRNA were evidently elevated (Cx43 protein:0.133 1 ±0.015 3 vs.0.039 2±0.002 0;Cx43 mRNA:0.676 8 ±0.064 8 vs.0.430 8±0.111 3) (all at P＜0.05).Conclusions Sericin can relieve retinal microangiopathy and protect retina against the pathogenesis and development of DR by down-regulating the expressions of ICAM-1,VCAM-1 and upregulating the expression of Cx43 in retinas of diabetic rats.

ObjectiveTo apply the Schwann cell neurilemma channel(SCNC) in promoting the regeneration of injuried spinal cord.MethodsSpinal cords of rats after laminectomy at T8/9 were divided in 3 groups randomly: 10 rats were transplanted with SCNC(Group A);10 rats only made models(Group B);10 rats were as normal control group(Group C).All rats received behaviour survey and inclined plane test every week 8 weeks after operation.6 weeks after operation,they were measured with cortical somatosensory evoked potential(CSEP).And 8 weeks after operation,all specimens were studied histologically.ResultsCSEP could be recorded in group A and C,but not in group B.There were marked differenties between group A or C and group B in behavior survey,inclined plane test.Amount of nerve fibers regenerated through the injury gap in group A was significantly larger than that in group B.ConclusionSCNC could facilitate axonal regeneration and promote the repairing of injuried spinal cord.

OBJECTIVETo analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively.

METHODSA total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test.

RESULTSTwenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001).

CONCLUSIONSSingle application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

Burns ; rehabilitation ; therapy ; Cicatrix ; therapy ; Contracture ; surgery ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Metacarpus ; Orthotic Devices ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin ; Skin Transplantation ; Tendons ; Time ; Traction ; Treatment Outcome

Objective To observe the influence of chitosan on the skin and soft tissue expansion.Methods Twenty-five patients were selected,who were suitable to be embedded soft tissue expanders in the face,a 100-milliliter expander was implanted in one side of the face,and other side was used as control.A 100-milliliter expander was implanted in each group,and a slender silicon duct was embedded between the expander and subcutaneous tissue in the experimental group.About five to seven days after the operation,the negative drainage tube was removed,and then two-milliliter medical chitosan injected with the silicon duct in the experimental group,but not in the control group.Two groups were injected with normal saline in the second day.The center of expanded skin was pressed and skin elasticity and relaxation were compared between the two groups during the injection interval.The time of injection interval,the quantity of normal saline inside the expanders after two weeks and three weeks and the total time of expansion to 100 milliliters were recorded.After injection was completed in the two groups and maintained for two weeks.In the stage Ⅱ operation,the expanders were taken out,1 cm × 1 cm fibropeplos was removed from the center of the expanded skin flap from the two groups,and pathological section was prepared to measure the thickness of fibropeplos,average gray scale of collagen and the quantity of blood capillaries.The fibroblasts,collagen fiber and capillaries were observed and compared under light microscope.A matched-pairs t analysis was used to analyze the data.Results Compared with the control group,the quantity of normal saline inside the expanders in the experimental group was increased at the same time; the water injection period was shorten and tissue expansion was significantly accelerated.The number of fibroblasts in the fibropeplos decreased with the influence of chitosan.The fibroblasts were restrained to mature period and collegan decreased.The fibropeplos became thinner but the capillaries were not affected.Conclusions Chitoson can inhibit fibroblast proliferation and collagen production,and the effect of accelerating tissue expansion is significant and deserves to be recommended.

Objective To explore the method of treatment on ventricular hemorrhage .Methods The clini-cal experience of 70 cases of ventricular hemorrhage with minimally invasive treatment of external ventricular drainage and injection of urokinase with CT stereotactic were summarized .Results Except for 3 cases of death ,67 cases sur-vived(95.7%),Grade Ⅰ-Ⅱwas 37 cases(52.9%),Grade Ⅲ was 21 cases(30.0%),Grade Ⅳ-Ⅴ was 9 cases (12.9%), and there was no complication of infection and bleeding associated with drainage among 70 cases. Conclusion The minimally invasive treatment of external ventricular drainage and injection of urokinase with CT ste -reotactic on ventricular hemorrhage improves the cure rate significantly ,reduces the mortality rate and the incidence of complications ,which has important clinical value .

Objective:To report the clinical, pathological, electrophysiological and genic characteristics of a patient with familial amyloidosis Finnish type.Methods:The clinical characteristic of a 60-year-old female who admitted to Beijing Tiantan Hospital, Capital Medical University in June 2020 was analyzed. Meanwhile, the patient underwent electrophysiological examination, biopsy of labial gland, rectum and skin and gene sequencing analysis.Results:The patient presented left facial paralysis at the age of 50, right facial paralysis and thickening of lips at the age of 55, dysarthria and dysphagia at the age of 56. Physical examination of the patient showed signs of cranial nerves involvement and skin thinning and smoothness. Slit lamp showed corneal lattice dystrophy. Electrophysiological findings of the patient suggested bilateral carpal tunnel syndrome. Latencies were prolonged in bilateral visual evoked potential P100. The deep sensory conduction pathways in bilateral C 7 to biparietal and T 12 to biparietal cortex were abnormal. Pathology of the three biopsies of the patient showed the presence of amyloid deposition in the basement membrane around the glands. The heterozygous mutation of c.654 G>T in exon 4 of gelsolin (GSN) gene in the patient resulted in Asp187 Tyr mutation (p.D187Y). Conclusions:The patient with familial amyloidosis Finnish type was characterized by slowly progressive multiple group cranial neuropathy accompanied by corneal lattice dystrophy and skin changes. Optic nerve and spinal cord posterior funiculus sensory conduction pathway and D187Y mutation of GSN gene were involved.

ObjectiveTo investigate the clinical characteristics and outcomes of drug-induced liver injury (DILI) in children, and to improve the understanding of DILI in children. MethodsOne hundred and eighty-four children with DILI who were under 16 years and hospitalized in our hospital from January 2004 to January 2014 were enrolled as subjects, and their clinical and pathological data were retrospectively analyzed. ResultsDILI might occur at any age in children, even at the infant stage, and the youngest patient was only 2 months old. There were 143 patients (77.7%) with clinical symptoms, including loss of appetite, jaundice, and yellow urine. The drugs causing DILI included traditional Chinese medicine (28.3%), antibiotics (24.5%), and anti-inflammatory drugs (19.6%). The pathological characteristics of DILI in children included eosinophils-based inflammatory cell infiltration (78.7%), mixed hepatic steatosis (73.5%), and cholangiolar cholestasis (38.7%). Four patients (2.2%) developed autoimmune hepatitis; twenty-nine patients(158%) had liver failure, and three of them died of liver failure. After treatment, 177 patients (96.2%) recovered normal liver function and were discharged. ConclusionDILI may occur at any age in children, and a majority of drugs causing DILI are traditional Chinese medicine, antibiotics, and anti-inflammatory drugs. The pathological examination of liver provides an important basis for the diagnosis of DILI in children. In spite of the benign prognosis in most patients, the incidence of liver failure still needs to be taken into account, and regular follow-up is necessary.

Background Endoplasmic reticulum stress (ERS) specific caspase-12 dependent pathway plays a key role in cell apoptosis,and apoptosis is an important characteristic of diabetic retinal neuron degeneration.Sericin is a potentially effective therapy for retinal neuron apoptosis.However,whether sericin has neuroprotection effects on caspase-12 pathway-associated retinal cells in diabetic retinopathy (DR) process is not unelucidated.Objective This study was to investigate the effects of sericin on the inhibition of retinal neuron apoptosis-associated with ERS specific caspase-12 dependent pathway in diabetic rat.Methods The diabetic models were established by feeding high lipid foods and intraperitoneal injection of streptozotocin for 3 consecutive days in 30 SPF SD rats aged 2-3 months.Twenty-four successful model rats were randomized into sericin-treated group and diabetic model group according to computer number allocation,and another 12 matched rats served as normal control group.The normal saline solution and sericin solution dissolved with normal saline solution 2.4 g/(kg · d) was used for 35 days in gavage method in the diabetic model group and sericin-treated group,respectively.The rats were sacrificed and retinal sections were prepared.TUNEL staining was employed to detect retinal neuron apoptosis.The expressions of glucose regulated protein 78 (GRP78),an ERS marker,and caspase-12 and caspase-3 in retinas in protein and transcription levels were detected by Western blot and reverse transcription PCR,respectively.The use and care of the rats complied with Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission and ARVO Statement.Results Diabetic models were successfully established in 24 of total 30 rats,with the successful rate of 80％.Apoptotic cells were found in the rats of various groups,mostly locating in retinal ganglion cell layer and inner nuclear layer.The apoptotic index (AI) was 0.028 4±0.002 3,0.215 1 ± 0.020 9 and 0.115 0±0.018 1 in the normal control group,diabetic model group and sericin-treated group,respectively,and the AI was significantly lower in the sericin-treated group than that in the diabetic control group (P＜ 0.05).Compared with the diabetic model group,the relative expression levels of GRP78,caspase-12 and caspase-3 proteins in rat retinas were significantly elevated in the sericin-treated group (0.523±0.029 vs.0.924±0.039,1.118 ± 0.051 vs.1.468±0.037,0.315±0.024 vs.0.554±0.032) (all at P＜0.05),and the relative expression levels of GRP78,caspase-12 and caspase-3 mRNA in rat retinas were significantly reduced in the sericin-treated group (0.816± 0.022 vs.1.218±0.033,0.216±0.023 vs.0.407±0.012,0.322±0.022 vs.0.531 ±0.029) (all at P＜0.05).Conclusions Sericin can inhibit ERS-related retinal neuron apoptosis by down-regulating the expressions of GRP78,caspase-12 and caspase-3 in ERS specific caspase-12 dependent pathway in diabetic rats.

Objective Retrospectively study of the effects of interferon-α therapy on height and weight of children with chronic hepatitis B (CHB).Methods Total of 116 hospitalized cases of CHB children in Adolescent Liver Centre, 302 Military Hospital of China from January 2010 to December 2011 were respectively studied.Heights and weights of all the subjects at baseline, 24 weeks, 48 weeks, 72 weeks and 96 weeks of treatment, and 24 weeks, 48 weeks and 96 weeks of follow-up were measured.The weight Z score (WAZ), height Z score (HAZ) and body mass index (BMI) Z score of subjects with hepatic fibrosis (S) <3 and S≥3 were compared.The differences of HAZ and WAZ between baseline and treatment or follow-up in groups of subjects aged 1-6 years and 6-16 years were also compared.T test or rank sum test was used for comparison between groups.Results Among the study of all 116 patients studied, median baseline values of HAZ, WAZ and BMI Z score were 0.76, 0.38 and-0.04, respectively.For patients with hepatic fibrosis S<3, the median HAZ and WAZ were 0.83 and 0.32, respectively.For patients with hepatic fibrosis S≥3, the median HAZ and WAZ were 0.52 and 0.15, respectively.The differences were not statistically significant (both P>0.05).At 48 weeks of treatment, the median HAZ was 0.50, and the median WAZ was 0.20;after a follow-up period of 24 weeks, the median HAZ was-0.32, and the median WAZ was-0.18;after a follow-up period of 48 weeks, the median HAZ was 0.09 and the median WAZ was 0.06.All the above median values of HAZ and WAZ were significantly different from those at baseline (all P<0.05).The difference of HAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.74±0.69 vs-0.53±0.35, t=1.85, P<0.05).Also, the difference of WAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.69±0.41 vs-0.17±0.75, t=3.74, P<0.05).The difference of HAZ at baseline and 96 weeks after treatment in group aged 6-16 years was significantly different from that in groups aged 1-6 years (-1.12±0.81 vs-0.05±0.69, t=2.06, P=0.022).Conclusions Interferon-α treatment for children with chronic hepatitis B does have influence on their height and weight, which restores to some degree after the treatment finished.Physicians should pay more attention to the influence of interferon-α treatment on height and weight in children aged 6-16 years.

Dizziness and vertigo are common clinical symptoms,which requires clinicians to timely identify dizziness and vertigo due to acute stroke,so as not to delay diagnosis and treatment.In previous studies,such stroke was usually attributed to subtentorial vascular lesions such as brainstem and cerebellum.With increasing reports of vestibular symptoms caused by supratentorial stroke,researchers have found that vestibular symptoms caused by stroke are not unique to supratentorial lesions.This paper expounds the morbidity,influencing factors,pathogenesis,clinical manifestations,examination methods,treatment and prognosis of vestibular symptoms related to supratentorial stroke,in order to improve the understanding of clinicians to this disease.