OBJECTIVETo observe the changes in serum contents of interleukin-6 (IL-6) and interleukin-10 (IL-10) in patients with severe burn injury, and to investigate their relation with occurrence of sepsis and prognosis of patients.

METHODSOne-hundred and sixty adult patients admitted into our hospital (1.0 ± 6.0) h after injury during March 2007 to March 2011 with massive and severe burns were enrolled in the investigation. Patients were divided into non-sepsis group (NS, n = 112), sepsis-survival group (SS, n = 36), and sepsis-deceased group (SD, n = 12) based on the occurrence of sepsis and death. Sepsis occurred on post burn day (PBD) 9 ± 5 in patients in the latter two groups. Patients died on PBD 18 ± 4 in SD group. Twenty healthy adult volunteers were chosen as healthy control group (HC). The age of subjects for observation among four groups, and total burn area and full-thickness burn area of patients among NS, SS, and SD groups were compared. Serum was isolated from blood samples collected from each patient every day from day of admission till PBD 20 to determine the contents of IL-6 and IL-10 by ELISA, and the same determinations were done in HC group. Data of trial subjects were processed with one-way analysis of variance. Data of IL-6 and IL-10 contents were processed with analysis of variance of repeated measure data and SNK method (q test).

RESULTS(1) There was no significant statistical difference among four groups in age (F = 2.090, P > 0.05). Total burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05), and total burn area of patients in SD group was obviously larger than that in SS group (q test, P < 0.05). Full-thickness burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05). (2) Serum contents of IL-6 of patients in NS, SS, and SD groups from PBD 1 to 20 were obviously higher than that of volunteers in HC group. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 7 (with F value from 0.188 to 2.897, P values all above 0.05). Serum content of IL-6 of patients in NS group decreased from PBD 4. Serum content of IL-6 of patients in SS group decreased gradually from PBD 13, but that in SD group increased continuously at the same time points. Serum contents of IL-6 of patients in NS group [(262 ± 25) pg/mL on PBD 8] were lower than those in SS group [(287 ± 38) pg/mL on PBD 8, q test, P < 0.05] and SD group [(299 ± 22) pg/mL on PBD 8, q test, P < 0.05] from PBD 8. Serum contents of IL-6 of patients in SS group [(300 ± 33) pg/mL on PBD 13] were obviously lower than those in SD group [(338 ± 22) pg/mL on PBD 13, q test, P < 0.05] from PBD 13. (3) Serum contents of IL-10 of patients in NS, SS, and SD groups were higher than that in HC group at each time point. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 5 (with F values from 1.802 to 2.538, P values all above 0.05). Serum content of IL-10 of patients in NS group was obviously lower than that of patients in SD group from PBD 6 (q test, P values all below 0.05). On PBD 8, serum content of IL-10 of patients in SS group [(54 ± 19) pg/mL] was obviously lower than that in SD group [(91 ± 23) pg/mL, q test, P < 0.05]. The sum of sensitivity (83.33%, 10/12) and specificity (91.67%, 33/36) minus 1 was maximum when the critical value of IL-10 content was set at 77 pg/mL based on the comparison between SS group and SD group in serum content of IL-10 on PBD 8.

CONCLUSIONSThe occurrence and outcome of sepsis is related to burn area and depth when the patients are in similar age. Serum contents of IL-6 and IL-10 play important roles in the pathogenesis of sepsis after burn. IL-6 content in early stage shall not be used in predicting the prognosis of patients with sepsis. IL-10 continuously higher than 77 pg/mL in early stage forecasts unfavorable prognosis of patient.

Adult ; Burns ; blood ; complications ; diagnosis ; Case-Control Studies ; Female ; Humans ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Male ; Prognosis ; Sepsis ; diagnosis ; etiology ; Serum ; metabolism ; Young Adult

Objective:To design a tracheotomy cannula cuff filling device for hyperbaric oxygen therapy, which is convenient for clinical operation, improves work efficiency and reduces the incidence of aspiration pneumonia.Methods:This study was a randomized controlled trial. From July 2020 to June 2022, 90 patients with tracheotomy who were treated with hyperbaric oxygen in the First Hospital of Jiaxing were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 45 cases in each group. In the experimental group, the cuff pressure was maintained by the tracheotomy cannula cuff filling device, and in the control group, the traditional water injection method was used to maintain the cuff pressure. The operation time, infection index and incidence of aspiration pneumonia were compared between the two groups.Results:The operation time in the experimental group was (6.33 ± 1.31) s lower than that in the control group (40.96 ± 3.70) s, and the difference was statistically significant ( t=-59.11, P<0.05). Body temperature, C-reactive protein and procalcitonin after treatment in the experimental group were (36.91 ± 0.83) ℃, (34.59 ± 16.25) mg/L, (1.57 ± 0.82) μg/L, respectively, lower than those in the control group (37.42 ± 0.72) ℃, (44.18 ± 18.10) mg/L, (2.45 ± 0.92) μg/L, the differences were statistically significant ( t=-3.09, -2.64, -4.73, all P<0.05). The difference of white blood cell count post-treatment between the two groups was not statistically significant ( P>0.05). The incidence of aspiration pneumonia in the experimental group was 11.11%(5/45) lower than 31.11%(14/45) in the control group, and the difference was statistically significant ( χ2=5.17, P<0.05). Conclusions:The application of tracheotomy cannula cuff filling device can simplify the operation process, reduce the incidence of infection and aspiration pneumonia, and optimize the clinical work.

Objective: To understand sexual and reproductive health knowledge, access to sexuality education and associated factors among secondary vocational school students in Shanghai Municipality and Shaanxi Province, so as to provide a scientific basis for conducting sexuality educaiton in vocational schools. Methods: A crosssectional survey was conducted among 3 180 students in grades 1-3 selected by cluster sampling during April to June 2021 in six secondary vocational schools from three cities of Shanghai and Shaanxi (Shangluo, Ankang, Baoji). Participants were investigated through online questionnaire survey, inlcuding demographic characteristics, household information, sexual health at home and school, knowledge on sexual and reproductive health. Both t test and Chisquare test were used for group comparisons, and multivariate ordial Logistic regression was used to explore possible risk factors for sexual and reproductive health score in quartiles. Results: Respondents average score was (51.36±21.61), with the highest score on sexual harassment/sexual abuse (66.45±42.27) and the lowest score on reproduction and physiology (47.67±31.94) and contraception (43.85±26.81). Although significant differences were observed between two study sites, the primary source of knowledge in both sites was schools/teachers, followed by the Internet or friends; the main theme of school sexuality education was puberty development and health care (more than 80%); the most frequently reported topic between respondents and their parents in both sites was interpersonal relationships (more than 55%), and there were significant differences in the reporting rates of secondary vocational school students between the two regions(χ2=28.56，32.02，P<0.05). The results of multivariable Logistic regression analysis showed that residential area, gender, grade, registered residence, number of sexual related topics communicated with parents, number of subjects received from school sexuality education, and reported information sources from classmates/friends, books/magazines/newspapers, internet and communities were related to knowledge level of respondents (OR=1.62, 0.72, 1.20, 1.58, 2.09, 1.17, 1.18, 1.66, 1.62, 1.69, 1.22, P<0.05). Conclusions Vocational students of Shanghai and Shaanxi have poor sexual and reproductive health knowledge and limited access to school and family sexuality education. It is necessary to strengthen sexuality education for secondary vocational school students.

OBJECTIVETo explore a better approach to resect the advanced oropharyngeal carcinoma.

METHODSFrom 1995 to 2005, 17 patients underwent mandibular swing procedure for excision of advanced oropharyngeal carcinoma including: 13 tonsillar cancers, 2 soft palate carcinomas and 2 lingual root cancers. Surgical procedure was selected according to the lesion. All tumors were resected through the mandibular swing approach or its combined approaches. Immediate reconstruction of the surgical defect was done using tongue flap, pectoralis major myocutaneous flap, sternohyoid myofascial flap, temporalis myofascial flap and forehead flap, respectively. After surgical resection of the tumors, all patients received postoperative radiotherapy.

RESULTSAll patients' advanced oropharyngeal carcinoma were successfully resected as planned through the mandibular swing procedure or its combined procedures without severe complications. Functions of deglutition, respiration and speech were well restored. The 3- and 5-year survival rate was 54. 5% and 40%, respectively.

CONCLUSIONThe mandibular swing procedure and its combined approach is safe and effective in the surgical resection of the advanced oropharyngeal carcinoma, which can provide a good exposure for the oropharynx, supraglottic region, hypopharynx, the parapharyngeal space and the base of the skull.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Female ; Humans ; Male ; Mandible ; radiation effects ; surgery ; Middle Aged ; Neoplasm Staging ; Oropharyngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Postoperative Period ; Radiotherapy, Adjuvant ; Survival Analysis ; Tonsillar Neoplasms ; pathology ; radiotherapy ; surgery

OBJECTIVETo objectively evaluate the efficacy and safety of Yimusake Tablet in the treatment of premature ejaculation (PE) through a multi-centered large-sample trial.

METHODSWe conducted a multi-centered, open, fixed-dose, and self-compared clinical trial among 300 patients with diagnosed PE. The trial lasted 12 weeks, including 4 weeks without any medication and 8 weeks of treatment with Yimusake Tablet, 2 pills (1 g) per night. We observed the intravaginal ejaculation latency time (IELT) before and after treatment, evaluated the safety of medication, and performed a questionnaire investigation on the patients' satisfaction.

RESULTSOf the 300 PE patients, 288 accomplished the clinical trial. The patients ranged in age from 22 to 60 years, averaging at 31.6 years. The mean IELT of the patient was 62.5 seconds at baseline, 168.9 seconds after 4 weeks of treatment with Yimusake Tablet, and 222.2 seconds after 8 weeks of medication. Among the 157 patients with normal erectile function (IIEF >21), the mean IELT was 71.4 seconds before treatment, 147.4 seconds after 4 weeks of medication, and 172.5 seconds after 8 weeks of medication. The patients' satisfaction was significantly increased after treatment. Those complicated by mild to moderate erectile dysfunction achieved different degrees of improvement in the IIEF-5 score, with a mean increase of 3.8. Only a few patients experienced mild adverse events, including constipation, dry mouth, nose bleeding, abdominal pain, and lumbosacral pain, which were all relieved without drug withdrawal.

CONCLUSIONYimusake Tablet is a safe and effective medicine for the treatment of PE.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Ejaculation ; drug effects ; physiology ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Penile Erection ; Phytotherapy ; Premature Ejaculation ; drug therapy ; Surveys and Questionnaires ; Tablets ; Time Factors

Several Orobanche medicinal plants sometimes served as alternative sources of Cistanches Herba, attributing to the benefits such as tonifying kidney, strengthening tendons and bones. Among them, O. coerulescens, O. cernua and O. pycnostachya have been widely utilized in northern China for treatments of pains in the loins and knees, impotence, and spermatorrhea. However, their chemical profiles haven't been elucidated. In the present study, UHPLC-IT-TOF-MS was implemented to conduct in-depth chemome profiling of O. coerulescens, O. cernua and O. pycnostachya, aiming to achieve a comprehensive chemical characterization and to provide pronounced information for the quality control and clinical applications. An ACE Ultra-Core 2.5 Super C_(18)(3.0 mm×150 mm, 2.5 μm) column was deployed for chromatographic separations, and high-resolution MS~n spectra were recorded by IT-TOF-MS. Forty-eight components, in total, were observed, and thirty-eight ones were structurally annotated according to proposing mass fragmentation patterns, matching with relevant databases. Particularly, nine ones were confirmed by reference compounds. Overall, the chemical compositions of O. coerulescens and O. cernua are quite similar, and differences occur between O. pycnostachya and the prior two ones; primary chemical family is phenylethanoid glycosides, and several lignan glycosides as well as iridoid glycosides are also observed; the primary components include acteoside, isoacteoside, crenatoside and 2'-acetylacteoside, etc.
China ; Cistanche ; Glycosides ; Male ; Orobanche ; Plants, Medicinal

The current study aims to rapidly and comprehensively profile the chemical composition of Cistanche salsa using direct infusion coupled with MS/MS~(ALL)(DI-MS/MS~(ALL)). The C. salsa extract was directly imported into electrospray ionization(ESI) source of quadrupole time-of-flight(Q-TOF) mass spectrometer with an infusion pump at a flow rate of 10 μL·min~(-1). Acquisition program was applied under negative ionization polarity to collect one MS~1 spectrum(m/z 50-1 200), followed by 1 150 MS~2 spectra with precursor isolation window(m/z 1) amongst mass range m/z 50-1 200. After each MS~2 spectrum was matched to its precursor ion, putative identification was conducted through matching mass spectral data with literature and database. A total of 31 components were identified from C. salsa, including 9 phenylethanoid glycosides, 2 iridoids, 4 saccharides, 9 organic acids, and 7 other compounds, similar to those from C. tubulosa and C. deserticola. In conclusion, DI-MS/MS~(ALL), a facile and reliable analytical tool, can be employed for qualitative analysis of chemical constituents in C. salsa. The research offers a promising strategy to achieve rapid chemome profiling of herbal medicine and provides an alternative source of Cistanches Herba.
Chromatography, High Pressure Liquid ; Cistanche ; Drugs, Chinese Herbal ; Glycosides ; Plants, Medicinal ; Tandem Mass Spectrometry

Objective: To explore the clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter. Methods: The retrospective observational study was conducted. From December 2018 to December 2021, 23 patients with sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter who met the inclusion criteria were admitted to Ganzhou People's Hospital, including 16 males and 7 females, aged 45 to 86 years. The size of pressure ulcers in ischial tuberosity ranged from 1.5 cm×1.0 cm to 8.0 cm×5.0 cm, and the size of pressure ulcers in greater trochanter ranged from 4.0 cm×3.0 cm to 20.0 cm×10.0 cm before debridement. After treatment of underlying diseases, debridement and vacuum sealing drainage for 5 to 14 days were performed. All the wounds were repaired by island posterior femoral composite tissue flaps, with area of 4.5 cm×3.0 cm-24.0 cm×12.0 cm, pedicle width of 3-5 cm, pedicle length of 5-8 cm, and rotation radius of 30-40 cm. Most of the donor site wounds were sutured directly, and only 4 donor site wounds were repaired by intermediate thickness skin graft from the contralateral thigh. The survival of composite tissue flaps, wound healing of the donor and recipient sites and the complications were observed. The recurrence of pressure ulcers, and the appearance and texture of flaps were observed during follow-up. Results: A total of 32 wounds in 23 patients were repaired by island posterior femoral composite tissue flaps (including 3 fascio subcutaneous flaps, 24 fascial flaps+fascio subcutaneous flaps, 2 fascial flaps+fascial dermal flaps, 2 fascial flaps+fascio subcutaneous flaps+femoral biceps flaps, and one fascial flap+fascio subcutaneous flap+gracilis muscle flap). Among them, 31 composite tissue flaps survived well, and a small portion of necrosis occurred in one fascial flap+fascio subcutaneous flap post surgery. The survival rate of composite tissue flap post surgery was 96.9% (31/32). Twenty-nine wounds in the recipient sites were healed, and 2 wounds were torn at the flap pedicle due to improper postural changes, and healed one week after bedside debridement. One wound was partially necrotic due to the flap bruising, and healed 10 days after re-debridement. Thirty-one wounds in the donor sites (including 4 skin graft areas) were healed, and one wound in the donor site was torn due to improper handling at discharge, and healed 15 days after re-debridement and suture. The complication rate was 12.5% (4/32), mainly the incision dehiscence of the flap pedicle and the donor sites (3 wounds), followed by venous congestion at the distal end of flap (one wound). During the follow-up of 3 to 24 months, the pressure ulcers did not recur and the flaps had good appearance and soft texture. Conclusions: The island posterior femoral composite tissue flaps has good blood circulation, large rotation radius, and sufficient tissue volume. It has a high survival rate, good wound healing, low skin grafting rate in the donor site, few postoperative complications, and good long-term effect in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter.
Male ; Female ; Humans ; Plastic Surgery Procedures ; Pressure Ulcer/etiology* ; Soft Tissue Injuries/surgery* ; Treatment Outcome ; Skin Transplantation ; Femur/surgery* ; Necrosis/surgery* ; Perforator Flap

Patient safety education is conducive to medical students' cognition on patient safety and to improvement of medical quality and safety. Developing patient safety education for medical students is more and more widely recognized by World Health Organization and countries all over the world. However, in China, patient safety courses aiming at medical students are relatively few, and there are few reports about the effect of patient safety courses. This paper explored the influence of patient safety curriculum on medical students' attitude to and knowledge of patient safety. The patient safety curriculum was carried out for 2011-grade undergraduates of Tongji Medical College, Huazhong University of Science and Technology. The students participated in the class according to free choice. After the curriculum, the information of gender, major, attended course, attitude toward patient safety, and knowledge of laws and regulations of the 2011-grade undergraduates were collected. After rejecting invalid questionnaires, the number of undergraduates that participated in the survey was 112 (61 students did not take part in the curriculum; 51 took part in). Chi-square test was applied to analyze patient safety education's influence on medical students' attitude to patient safety and their knowledge mastery situation. The influence of patient safety education on the attitude of medical students to patient safety was not significant, but that on their knowledge of patient safety was remarkable. No matter male or female, as compared with medical students who had not accepted patient safety education, they both had a better acquisition of knowledge after having this education (for male students: 95% CI, 4.556-106.238, P<0.001; for female students: 95% CI, 3.183-33.238, P<0.001). Students majoring in Western Medicine had a relatively better mastery of knowledge of patient safety after receiving patient safety education (95% CI, 6.267-76.271, P<0.001). Short-term patient safety education cannot change medical students' stereotyped cognition on matters related to patient safety, but it can effectively enhance their knowledge of laws and regulations of patient safety.
Adult ; China ; epidemiology ; Curriculum ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Patient Safety ; Students, Medical ; Surveys and Questionnaires

OBJECTIVE: To study the risk factors and infection characteristics of nosocomial infection in children with acute lymphoblastic leukemia (ALL) and analyze the relationship between different nutritional status and nosocomial infection, early treatment response. METHOD: The clinical data of 133 children with ALL treated with CCCG-ALL-2015 from June 2016 to June 2019 (chemotherapy stage, risk level, MRD), infection during hospitalization (course of infection, laboratory indicators, sites of infection, outcome) and nutritional status (sex, age, height/ length, weight) were enrolled. The Chi 2 test and Logistic regression analysis were used for statistical analysis. RESULTS: The rate of nosocomial infection was 19.9% in 133 children with ALL, in which 3 were infection-related death. Sex, immunophenotype and risk showed no significantly affect on the occurrence of nosocomial infection (P＞0.05), but neutrophil count, hemoglobin level, platelet count, chemotherapy stage, length of stay in hospital and nutritional status showed affect on the occurrence of nosocomial infection (P＜0.05). Logistic multivariate regression analysis showed that chemotherapy stage, length of hospital stay, neutrophils and nutritional status were the independent risk factors, in which the respiratory tract infection was the most common. Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 44.1%, 52.9% and 2.9% respectively. The negative rate of MRD in day 19 and day 46 between different nutritional status groups showed statistically significant (P＜0.05). CONCLUSION Neutrophil count, chemotherapy stage, length of stay in hospital and nutritional status are independent risk factors for nosocomial infection. Among of them, nutritional status negatively correlated with nosocomial infection, and the poorer nutritional status, the higher risk of nosocomial infection. Malnutrition, overweight and obesity can affect the early treatment response of ALL children. The level of nutrition at first diagnosis can be used as a bad factor to evaluate the early treatment response of ALL children.
Child ; Cross Infection ; Gram-Negative Bacteria ; Humans ; Nutritional Status ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies