To observe the relationship among amyloid beta-peptide (Abeta)-induced neurotoxicity, serum-inducible kinase (SNK)-spine-associated Rap guanosine triphosphatase activating protein (SPAR) pathway and N-methyl-D-aspartate receptor (NMDAR), and to explore the mechanism of the protective effect of spleen-yin nourishing recipe (Zibu Piyin Recipe, ZBPYR) in hippocampal neurons against Abeta-induced neurotoxicity.

Objective To explore the function and mechanism of estrogen receptor α (ERα) in bladder cancer cell proliferation and aggressivity.Methods The ERα expression bladder cancer cell line T24ERα model was established.The cell growth was detected by MTT assay,apoptosis by flow cytometry,cell invasion by matrigel transwell.Western blot was used to check signals by ERα regulation in bladder cancer cells related to the proliferation and metastatic ability.Results Compared to the control group,the cell inhibition rates of experimental group in 96 h and 144 h were 18.85％ and 37.21％,respectively.The difference was significant compared with the control group (P ＜ 0.05).The apoptosis rates of the experimental group and control group were (18.93 ±1.41)％ and (9.91 ±1.08)％ (P＜0.05).The experimental group through matrix adhesive cell proportion was (10.00 ± 2.00)％,significantly lower than that of the control group (26.00 ± 3.61) ％ (P ＜ 0.05).Western blot showed integrin-β1,p-FAK,p-Src and Scr expression were reduced compared to control group (P ＜ 0.05).Conclusion ERα could inhibit bladder cancer cell growth and metastasis through down-regulating integrin-β1-FAK/Src signal pathway,while promote the apoptosis of bladder cancer cells.

Objective:To explore the clinical effect of bi-layered artificial dermis combined with autologous skin graft in the repair of wounds with exposed bone and/or tendon.Methods:The medical records of 25 patients (aged 3 to 79 years, including 21 males and 4 females) with bone and/or tendon exposed wounds caused by various reasons, admitted to Nanfang Hospital of Southern Medical University from May 2014 to December 2018 were analyzed retrospectively. Of the 25 patients, 7 patients had exposed bone only, 13 patients had exposed tendon only, and 5 patients had exposure of both bone and tendon. The total wound area was 78.0 (53.4, 103.2) cm 2. The widths of bone exposure and tendon exposure were 3.2 (3.0, 3.6) cm and 2.0 (1.7, 2.4) cm, respectively. All wounds were implanted with bi-layered artificial dermis in the first stage after thorough wound debridement. After 2 to 3 weeks of vascularization of artificial dermis, autologous thin-to-medium-thickness skins or split-thickness skins were grafted to repair the wounds in the second stage. The vascularization of artificial dermis and its time, whether or not producing hematoma, the skin graft survival rate on day 7 post autologous skin grafting, whether or not repeating skin grafting, and the time of complete wound healing were observed and recorded. The patients were further followed up and observed for 3 or more months after discharge. Results:The vascularization of artificial dermis was achieved in 24 patients after the first transplantation with vascularization time being 11-21 (16±4) days. No hematoma was observed in the transplanted artificial dermis. Failed vascularization of grafted artificial dermis was observed in one patient who was later treated with negative pressure drainage and skin grafting alone, and was discharged with wound healing. The skin graft survival rate on day 7 post autologous skin grafting was 92.2%-100.0% ( (99.3±1.3)%), with the remaining wound areas recovered later by themselves or healed by dressing changes without repeated skin grafting. The complete wound healing time was 7-19 (11.9±2.8) days after autologous skin grafting. The patients were followed up for 3 to 60 months after discharge. Except for the pigmentation in skin graft area, the skin grafts survived well, being soft in texture and with no repeated ulceration, obvious hypertrophic scar, or contracture deformity.Conclusions:Artificial dermis combined with autologous skin grafting can effectively repair wounds with bone and/or tendon exposure, providing a repair strategy for this type of wounds.

Objective:To explore the application value of virtual reality technology in thoracoscopic anatomical segmentectomy.Methods:Eighty-four patients with early stage non-small cell lung cancer admitted to the First Hospital of Jiaxing from December 2017 to December 2018 were enrolled in the study.They were divided into observation group and control group according to the random digital table method, with 42 cases in each group.The observation group used virtual reality technology to construct a three-dimensional digital model, and performed preoperative evaluation and simulated surgical drills and intraoperative navigation on the three-dimensional digital model, based on the preoperative evaluation and simulated surgical drill results, combined with the specific actual situation during the operation, developed and implemented individualized thoracoscopic anatomical segmentectomy.Thoracoscopy anatomical segmentectomy was routinely performed in the control group.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization, cost and incidence of postoperative complications were compared between the two groups.Results:The operation of both two groups was successfully completed, and no intraoperative thoracic surgery was performed during the operation.There was no perioperative death.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization cost and the incidence of postoperative complications in the observation group were (100.98±26.51)min, (67.98±32.96)mL, (7.79±1.32), (11.98±4.69), (4.60±1.43)d, (2.86±0.81)d, (437.14±193.86)mL, (3.76±0.31)million, 9.52%(4/42), respectively, which in the control group were (114.88±24.26)min, (104.52±52.37)mL, (6.45±0.3), (8.31±1.94), (6.50±2.55)d, (4.00±2.25)d, (667.26±415.01)mL, (4.20±0.65)million, 26.19%(11/42), respectively, the differences between the two groups were statistically significant ( t=-2.208, -3.328, 5.916, 4.678, -4.221, -3.993, -3.265, -3.968, χ 2=3.977, all P<0.05). No local recurrence or distant metastasis was found during the follow-up period. Conclusion:Virtual reality technology can provide preoperative evaluation and simulated surgical exercises and intraoperative navigation for thoracoscopic anatomical segmentectomy, which can reduce the difficulty of surgery and improve the accuracy and safety of the operation.

Objective: To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods: From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley′s stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results: Bacterial culture result of wound tissue before lesion resection was positive in all patients, mainly Staphylococcus, Streptococcus, Proteus mirabilis, and anaerobic bacteria, etc., while that of wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was negative. The content of TNF-α in wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was (10.1±2.9) pg/L, significantly lower than (73.6±5.6) pg/L before lesion resection (t=33.47, P<0.01). The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed. The patients were hospitalized for 17-31 days. During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment. Conclusions Sequential treatment with extensive resection, VSD combined with irrigation of oxygen-loaded fluid, and tissue transplantation can thoroughly remove HS lesions in the buttocks and improve the condition of wound bed for skin acceptance after debridement, which is conducive to the cure of HS in the buttocks which has undergone multiple operations but still recurs after operation.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.