Objective To understand the distribution and antimicrobial resistance of pathogens causing wound in-fection in army officers and soldiers following military training injury,and provide reference for antimicrobial use in clinical anti-infection treatment.Methods Wound secretion from injured army patients who were admitted to a mili-tary hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing.Results 647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens ,isolation rate was 62.88%,the top 6 isolated bacteria were Staphylococcus aureus (S .aureus ,29.99%,n =194),Escherichia coli (E.coli,19.32%,n=125),Pseudomonas aeruginosa (19.17%,n=124),Enterococcus spp .(13.60%,n=88), Klebsiella pneumoniae (K .pneumoniae ,7.73%,n =50),and Acinetobacter baumannii (A.baumannii,5.87%, n=38).S .aureus and Enterococcus spp .had high susceptibility to vancomycin,linezolid ,and daptomycin (resist-ance rates ≤3.41 %),44.33% of S .aureus were methicillin-resistant,2.27% of Enterococcus spp .were vancomy-cin-resistant .E.coli and K .pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1 .60% and 0 respectively),except A.baumannii,resistance rates of gram-negative bacteria to carbapenems were all low (resistance rates ≤4.00%).Conclusion Military clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results,reduce the disability rate due to infection in trauma patients,and provide clinical support for the treatment of the wounded.

Objective To discuss the technical method,safety and clinical efficacy of CT-guided 125I radioactive seed implantation for the treatment of mediastinal lymph node metastases.Methods CT-guided 125I radioactive seed implantation was carried out in 11 patients with mediastinal lymph node metastases.Before 125I seed implantation,the interstitial brachytherapy treatment planning system (TPS) was employed to formulate a treatment plan.The particles with radioactivity of (1.11-2.96) × 107Bq (0.3-0.8 mCi) were used for the implantation.Postoperative complications were recorded.The local lesion control rate and the effective rate of pain relief were evaluated at one,3,6 and 12 months after 125I seed implantation.Results After 125I seed implantation,pneumothorax occurred in 3 patients,tracheal fistula in one patient,and pulmonary infection in one patient.The local lesion control rates at one,3,6 and 12 months were 81.8％,90.9％,72.7％ and 72.7％ respectively;the effective rate of pain relief at one week,one,3,6 and 12 months were 100％,90.9％,90.9％,81.8％ and 72.7％ respectively.Conclusion For the treatment of mediastinal lymph node metastases,CT-guided radioactive 125I seed implantation is less-invasive with less complications,and it carries reliable local lesion control rate.Therefore,this technique is a safe therapeutic means.

Objective:To investigate the clinical effectiveness of peroneal artery perforator flap with anterior tibial artery perforator in repair of the soft tissue defect of dorsum of forefoot and midfoot.Methods:From February, 2015 to July, 2019, peroneal artery perforator flaps with anterior tibial artery perforator were used to repair dorsal foot soft tissue defect in 42 patients. There were 25 males and 17 females, with an averge age of 62(44-73) years. The size of soft tissue defect ranged from 7 cm×4 cm to 18 cm×5 cm. The recipient sites on forefoot and midfoot were repaired by peroneal artery perforator flaps with anterior tibial artery from the anterolateral aspect of shank. The donor sites were resurfaced with full-thickness skin graft. All patients were followed-up at the outpatient clinic or through WeChat for 3-12 months. The appearance of the flaps and limb recovery were recorded.Results:All flaps survived successfully. The donor sites and recipient sites were well healed. At the last follow-up, the texture and aesthetic of flaps were good, and the appearance and function of the foot were satisfactory.Conclusion:The peroneal artery perforator flaps with anterior tibial artery double blood supply and can be designed to repair large and distanced soft tissue defect of forefoot and midfoot.

Objective To summarize the clinical and imaging characteristics of Rosai-Dorfman disease (RDD) in order to improve the diagnosis of the disease.Methods The clinical and imaging features of 10 patients with RDD proved by pathology were retrospectively analyzed and the related literatures were reviewed.Results Ten patients including 7 males and 3 females,aged 8 to 54 years old,with average of 32 years old.White blood cells (BCA) and erythrocyte sedimentation rate (ESR) in 8 cases were normal.Eight cases manifested as painless enlarged lymph node or mass,of which 4 cases were accompanied with multisystem involvement.Three lesions involved lymph nodes,5 lesions were located in extranodal sites,while 2 lesions involved both lymph node and extranodal sites.RDD occurred in lymph nodes (n=3) manifested as multiple enlarged lymph nodes on CT imaging,showing mild or moderate the enhancement,or a heterogeneous ring-enhancement.Of 5 extranodal RDD lesions,3 cases underwent MR exmination.2 lesions manifested as subcutaneous soft tissue mass on left shoulder and anterior abdominal wall,1 lesion manifested as intracranial mass accompany with localised cranial bone destruction.Lesions in all 3 cases had poor margins and showed scatted areas of high signal on diffusion weighted images.Lesions exhibited remarkable heterogeneous enhancement on Gd-DTPA enhanced MR imaging,dural/fascia tail sign and dilated blood vessels could be found around the lesions.Intrahepatic RDD lesion showed fast washing out phenomenon on CT enhanced imaging.In 2 cases involved both lymph node and extranodal sites,1 case manifested as swelling pharyngeal lymph chain and nasopharynx,enlargement of lymph nodes in bilateral submandibular and cervical region abdominal cavity on CT imaging,the enhancement is mild and moderate,accompany with osteolytic lesions in right proximal humerus on X-ray.For the other case,CT images manifested as bilateral neck lymphadenopathy,accompanied with soft tissue mass in nasal cavity,the lesion showed mild/moderate enhancement.Conclusions RDD mostly appears in young and middle-aged men,and is rarely preoperatively diagnosed.RDD mainly manifests as painless enlarged lymph node or mass.RDD has a broad spectrum of radiographic appearance,varied according to different location of lesion.Scatted higher signal areas on diffusion weighted images in the masses and significantly heterogeneity enhancement with dilated blood vessels around the lesion could be helpful in diagnosing of extranodal RDD.

Objective To evaluate the prognostic value of peak ejection rate (PER) and peak filling rate (PFR) in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infraction (AMI).Methods A total of 123 patients (103 males,20 females,age:(60.6± 11.2) years) with LVSD after AMI who underwent 99Tc-methoxyisobutylisonitnle (MIBI) gated SPECT myocardial perfusion imaging (GSMPI) from January 2014 to December 2015 were retrospectively analyzed.Summed rest score (SRS) and total perfusion deficit (TPD) were acquired by using quantitative perfusion SPECT (QPS) soft-ware.Left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),PER,and PFR were calculated by using quantitative gated SPECT (QGS) software.The clinical parameters of patients were recorded and the cardiac events were taken as the endpoint of follow-up (median time:27 (range:9-50) months).Pearson correlation was used to analyze the correlation between PER and PFR.Receiver operating characteristic (ROC) curve was used to evaluate optimal cut-off values of PER and PFR for predicting cardiac events.Kaplan-Meier survival analysis and Cox proportional hazards model were also used for data analysis.Results There was a great correlation between PER and PFR (r =-0.931,P＜0.001).Optimal cut-off values of PER and PFR for predicting cardiac events were-1.10 EDV/s and 1.09 EDV/s respectively.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients (n=48) with-PER≤ 1.10 EDV/s than that in patients (n=75) with-PER＞ 1.10 EDV/s (16.7％ vs 66.7％;x2=60.096,P＜0.001),and the same rate in patients (n=50) with PFR ≤ 1.09 EDV/s was lower than that in patients (n=73) with PFR＞1.09 EDV/s (16.0％ vs 68.5％;x2=74.771,P＜0.001).Cox multivariate analysis showed that PER (hazard ratio (HR)=0.40,95％ CI:0.20-0.83) and PFR (HR=0.22,95％ CI:0.12-0.47) were independent predictors for cardiac events.Conclusion There is a great correlation between PER and PFR in patients with LVSD after AMI and they are independent predictors for cardiac events.

Objective:To investigate the clinical effect of free anterolateral thigh flap(ALTF) combined with medial plantar flap(MPF) transfer in repairing forefoot and mid-foot degloving injury.Methods:From May, 2016 to November, 2019, 6 patients with forefoot and mid-foot degloving injuries underwent reconstructions using free ALTF combined with MPF. The study included 4 males and 2 females patients with an average of 43 (range, 35-55) years. The size of soft tissue defects was 15 cm×12 cm-19 cm×14 cm. The dimension of the MPF was 8 cm×5 cm-10 cm× 6 cm, and that of ALTF was 16 cm×7 cm-20 cm×8 cm. The ALTF was used to cover the dorsal and lateral foot, the flap artery was anastomosed to the dorsalis pedis artery. The MPF was used to repair the weight-bearing area of the forefoot, the flap artery was anastomosed to the medial plantar artery in recipient site. All patients entered follow-up by outpatient clinic or Wechat for 9-18(mean, 14) months, and the appearance of flap and limb function were recorded.Results:The MPF and ALTF survived uneventfully in all 6 patients, and the wound in donor and recipient areas healed in one stage. At the last follow-up, the flaps had satisfactory contour, the texture of the flaps was soft, the protective sensation was recovered, and the appearance and function of the foot recovered satisfactorily. The Maryland score of reconstructed foot function was considered excellent (90-100) in 4 cases and good (75-89) in 2 cases. The average Maryland score was 91.2.Conclusion:ALTF combined with MPF generated good effect and satisfactory function in repairing forefoot and mid-foot degloving injury.

Objective To investigate the value of local myocardial blood flow and myocardial function parameters in monitoring the dynamic changes of radiation induced heart disease (RIHD) using 13NNH3 PET gated myocardial perfusion imaging(GMPI).Methods Six healthy male Beagle dogs underwent 13N-NH3 PET GMPI 1 week before irradiation and 3,6 and 12 months after irradiation in the anterior wall of the left ventricle with a single dose of 20 Gy.Global myocardial function parameters including left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),and regional myocardial function parameters including wall motion (WM),wall thickening (WT),end-diastolic perfusion (EDP),end-systolic perfusion (ESP) before and after irradiation were compared by repeated measures analysis of variance and paired t test.Results There were no significant changes between EDV,ESV and LVEF at baseline and those at 3 months after irradiation.EDV at 6 months after irradiation still had no change,compared with baseline value and EDV at 3 months after irradiation,but ESV was increased and LVEF was decreased.Twelve months after irradiation,ESV was further expanded,LVEF was further reduced,and EDV began to increase (F values:20.974-177.846,all P＜0.05).Compared with the baseline,WM,WT,EDP and ESP were increased in 10％(2/20),20％(4/20),10％(2/20) and 15％(3/20) of myocardial segments at 3 months after irradiation (t values:14.446-672.315,all P＜0.05);those parameters were decreased in 15％(3/20),20％(4/20),15％(3/20) and 25％(5/20) of myocardial segments at 6 months after irradiation (t values:18.171-723.156,all P＜0.05),and were decreased in 35％(7/20),45％(9/20),40％(8/20) and 60％ (12/20) of myocardial segments at 12 months after irradiation (t values:14.783-711.259,all P＜0.05).Conclusions 13N-NH3 PET GMPI could be used to detect RIHD early and monitor the dynamic development of RIHD.Compared with the global left ventricular function parameters,regional myocardial function parameters (WM,WT,EDP and ESP) are more sensitive,which may be served as the early monitoring indicators for RIHD.

Objective To explore changes of blood anterior pituitary hormone and its related factors in patients with severe traumatic brain injury (TBI).Methods 113 patients diagnosed as severe TBI and met criterions were collected from Jun.2010 to Aug.2015 in the First Affiliated Hospital of Wenzhou Medical University.Clinical data such as age,gender,site of injury,epidural hematoma,subdural hematoma,basicranial fracture,injury time,Glasgow coma scale (GCS),middle line migration,diffuse axonal injury,brain hernia,traumatic subarachnoid hemorrhage were collected and recorded.Univariatex2 test and multivariate logistic regression analysis were used to explore risk factors for changes of blood anterior pituitary hormone.Results Abnormal secretion of the anterior pituitary occurred in 48 patients.10 cases had one kind of abnormal hormone secretion,while 38 cases had 2 and more than 2 kinds of abnormal hormone secretion.GH level decreased in 20 cases,TSH level decreased in 18 cases,FSH level decreased in 12 cases,PRL level increased in 10 cases,ACTH level decreased in 9 cases,and LH level decreased in 8 cases.Univariate x2 test revealed that basicranial fracture (P=0.006),middle line migration (P=0.007),GCS score (P=0.004),diffuse axonal injury (P=0.001),cerebral hernia (P=0.001),traumatic subarachnoid hemorrhage (P=0.001) were factors related to abnormal pituitary hormone levels.Multivariate logistic regression analysis revealed that basicranial fracture (P=0.019),middle line migration (P=0.015),GCS score (P=0.024),diffuse axonal injury (P=0.008),cerebral hernia (P=0.001),traumatic subarachnoid (P=0.010) were factors related to abnormal pituitary hormone levels.Conclusions The rates of abnormal pituitary hormone level were higher in patients with severe TBI.The basicranial fracture,middle line migration,GCS score,diffuse axonal injury,cerebral hernia,traumatic subarachnoid hemorrhage are factors related to abnormal pituitary hormone levels.

Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS)in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS).Methods From April 2015 to August 2018,at The First Affiliated Hospital of University of Science and Technology of China,21 patients with gynura segetum caused HSOS were selected.All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks.After operation patients were followed up with liver and portal vein Doppler ultrasonography examination,liver and kidney function tests,and survival observation.T test,logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis.Results Among the 21 patients with gynura segetum-related HSOS,18 patients were in the subacute phase and three patients in the chronic phase.All of them were moderate or severe patients and all successfully underwent TIPS.The postoperative portal vein pressure was (16.71 ± 4.68) cmH2O (1 cmH2O =0.098 kPa),which was lower than that before operation ((41.52 ±6.27) cmH2O),and the difference was statistically significant (t =16.936,P ＜ 0.01).The postoperation portal vein blood flow velocity was (41.52 ±7.70) cm/s,which was higher than before operation ((11.19 ± 3.29) cm/s),and the difference was statistically significant (t =-15.191,P ＜0.01).At one month after operation,15 of 21 patients were clinically cured;among the remaining six patients,four patients were improved and two patients were ineffective (including one patient died).At four months after operation,two patients died,and the remaining 19 patients were clinically cured.At one month after operation,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and serum creatinine were (23.7 ± 16.8) U/L,(33.9 ±7.4) U/L,(52.7 ± 38.2) μmol/L and (62.7 ± 12.6) μmol/L,respectively,which were lower than those before operation ((60.5 ± 42.4) U/L,(78.4 ± 42.4) U/L,(74.9 ± 38.2) μmol/L and (82.4 ± 19.6) μmol/L,respectively),and the differences were statistically significant (t =3.193,3.493,2.378 and 4.519;all P ＜ 0.05).The level of albumin was (39.0 ±3.1) g/L,which was higher than that before operation ((30.9 ± 3.8) g/L),and the difference was statistically significant (t =-10.283,P ＜ 0.01).Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P ＜0.05).The one-year cumulative survival rate of patients was 90.5％.Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P ＜ 0.05).Conclusion TIPS is a safe,reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy,which can improve the prognosis and survival rate of the patients.

Objective:To establish the C57BL/6 mouse models of radiation-induced cardiopulmonary dysfunction.Methods:Twenty-four male C57BL/6 mice were randomly divided into the control and irradiation groups. Mice in the irradiation group were irradiated with 20 Gy electron beam and bred for 6 months after irradiation. Cardiac function was assessed using ultrasonography. The partial pressure of oxygen was detected by blood gas analysis. Cell apoptosis was observed by Tunel assay. Myocardial and pulmonary fibrosis was assessed by Masson staining.Results:The LVEF in the irradiation group was (68.60±10.92)%, significantly less compared with (81.75±8.79)% in the control group ( P< 0.01). The apoptotic index of heart in the irraiation group was (23.90±6.60)%, considerably higher than (3.25±3.38)% in the control group ( P< 0.01). The CVF of heart in the irradiation group was (15.42±5.72)%, significantly higher than (1.45±0.64)% in the control group ( P< 0.01). The PaO 2 level in the irradiation group was (86.10±7.60) mmHg, significantly lower compared with (107.16±9.01) mmHg in the control group ( P< 0.01). The apoptotic index of lung in the irradiation group was (27.90±8.94)%, significantly higher than (2.50±3.55)% in the control group ( P<0.01). The CVF of lung in the irradiation group was (17.76±5.77)%, remarkably higher than (2.50±3.55)% in the control group ( P< 0.01). Conclusion:Radiation can induce cardiopulmonary apotosis and fibrosis remodeling, which leads to cardiopulmonary dysfunction, suggesting the successful establishment of C57BL/6 mouse model of radiation-induced cardiopulmonary dysfunction.