Objective To study the effects of early enteral feeding on the preservation of intestinal mucosal barrier in severely burned patients. Methods Twenty-two patients with severe burn were randomly divided into early enteral feeding group (EF) and delayed enteral feeding group (DF). The levels of serum endotoxin and TNF-? were dynamically detected in the patients of both groups, and two unmetabolized sugars (lactose and mannitol) were orally administered in these patients on 1d, 3d and 5d of postburn. The concentrations of lactose and mannitol in urinary and the L/M ratio were observed. Intestinal permeability was assessed by the L/M ratio. Results The levels of serum endotoxin and TNF-? in severely burned patients were significantly higher than in normal (P

Objective To establish VX2 hepatic carcinoma model in rabbits by implanting the tumor fragment into the liver through percutaneous puncture under ultrasound guidance and to observe its growing and metastatic characteristics, to determine the optimal time for interventional experiment study with the model. Methods Inoculation of VX2 carcinoma fragment was performed in 28 New Zealand white rabbits. PET/CT and ultrasonography (US) examinations were carried out in the second, third and forth week after the inoculation, and each time two tumor-bearing rabbits were sacrificed for pathologic study. Results The successful rate of model establishment was 89.28% (25/28). On PET or CT scans, single lesion in the liver was demonstrated in 25 rabbits. Two, three and four weeks after the inoculation, the maximum diameter of the tumor was (4.82±0.80) mm, (16.05±2.89) mm and (30.08±5.38) mm respectively, while the metastasis rates was 0% (0/25), 13.04% (3/23), 76.19% (16/21) respectively. No significant necrosis was found in the second week after inoculation, only tiny coagulation necrosis was revealed in the third week, and massive necrosis was seen in the forth week. Conclusion Percutaneous inoculation of the tumor fragment into the liver under ultrasonographic guidance is a simple method to establish VX2 hepatic carcinoma in rabbits with a high successful rate. The third week after inoculation is the suitable time for making interventional experiment study.

Objective To understand the diagnostic values of procalcitonin (PCT),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC) and neutmphilic granulocyte ratio (NE％) in distinguishing concurrent bacterial infection from idiopathic inflammatory myopathy (ⅡM).Methods Clinical data and laboratory examinations of 118 ⅡM patients were collected.The ⅡM patients were assigned to the bacterial infection group (n=66) or the non-infection group (n=52).The levels of PCT,CRP,ESR,WBC and NE％ were compared by the Mann-Whitney U tests between the two groups and receiver operating characteristic curves were generated in order to evaluate the diagnostic value.Results The levels of PCT (0.06 ng/ml,0.03 ng/ml,U=2.637,P＜0.01);CRP (15.80 mg/L,4.40 mg/L,U=5.944,P＜0.01);ESR (43.50 mm/1 h,27.00 mm/1 h,U=2.266,P＜0.05);WBC (9.85×109/L,7.70×109/L,U=2.675,P＜0.01) and NE％ (80.70％,75.75％,U=2.344,P＜0.01) were significantly higher in the ⅡM patient group with concurrent infection than in the noninfection ⅡM patient group.CRP showed the highest diagnostic value with sensitivity,specificity,positive predictive value and negative predictive value of 72.7％,82.7％,84.2％ and 70.5％,respectively.Conclusion The inflammatory biomarkers PCT,CRP,ESR,WBC and NE％ offer diagnostic accuracy in detecting bacterial infection in ⅡM patients.Particularly,CRP is the most sensitive and specific biomarker indetecting bacterial infection in ⅡM patients.

Objective To summarize the experience of the management of 329 patients with major burn accompanied by severe systemic infection during the past 42 years, so as to help improve the treatment standard. Methods One thousand and one hundred twenty seven cases with major burns( TBSA ＞ 50% ) were admitted to our hospital during the past 42 years. The incidence of postburn systemic infection and change in the mortality were analyzed in terms of 3 periods, i. e. 1958 to 1980,1981 to 1990 and 1991 to 2000. Results Postburn systemic infection developed in 329 out of 1127 cases with the morbidity of 29.4%. The incidences of the infection were 48.5% ,29.3% and 13. 1% in the 3 periods, consectively, with significant differences between them( P ＜0.01 ～ 0. 05 ). During the 3 periods of past 42 years, the overall cure rate and cure rates in patients with different TBSA increased gradually,especially in those with TBSA Larger than 70%. Conclusion The management of pastburn systemic infection was satisfactorily achieved by early comprehensive clinical measures such as immediate fluid resuscitation, early feeding, appropriate application of antibiotics and early escharectomy en masse,etc. which were established on the basis of experimental results.

Objective To explore the change of apoptosis factor Caspase-3 and Bcl-2 in the injured segment of rat with spinal cord injury after inhibiting lentivirus expression of inflammation factor TNF-α. To study the relationship between Caspase-3, Bcl-2, Bax and TNF-α in spinal cord injury. Mthods Spinal cord contusion model was prepared by Allen method. The relation between tumor necrosis factor alpha and Bcl-2, was predicted by the method of GeneMANIA bioinformatics. The RNA which was packaged by lentivirus constructed the RNA interference model of tumour necrosis factor alpha. After interference of tumor necrosis factor alpha, we used the method of QRT-PCR to assays the mRNA expression of Caspase-3 and Bcl-2 in spinal cord and detect of the localization of Caspase-3 and Bcl-2 by immunohistochemistry. Statistical analysis with SPSS17.0. Results SD rats had paraplegia and urinate retentaion because of spinal cord injury. The result of QRT-PCR showed that in the seventh day after SCC, the expression of Caspase-3 reduced significantly (P < 0.05) and Bcl-2 did not change significantly (P > 0.05). Immunohistochemistry experiment results showed that Caspase-3 Bcl-2 and Bax immunoreactive cells were observed in the neurons and glial cells of both white matter and gray matter in the spinal cord. The results were the same with QRT-PCR.. Conclusion TNF-α in rats after SCC can effectively regulate the ratio of Bcl-2 and Bax , and then regulate the expression of Caspase-3 , which may affect the function of apoptosis and function recovery after spinal cord injury.

OBJECTIVETo investigate the total in situ apoptotic cell number and the apoptotic situation in erythroid cell and megakaryocytes in patients with myelodysplastic syndromes (MDS).

METHODSApoptosis cell number and the apoptotic situation of erythroid cell and megakaryocytes were analysed on cold embedded bone marrow sections from 25 MDS patients by DNA in situ end labelling (ISEL)/alkaline phosphatase anti-alkaline phosphatase (APAAP) double stained techniques. Fourteen cases of iron deficiency anemia (IDA) were taken as control.

RESULTSMean apoptotic cell numbers in MDS and control group were (39.44 +/- 29.34)/mm(2) and (13.43 +/- 8.39)/mm(2) respectively (P < 0.01). RA/RAS subtypes had a higher apoptosis ratio (47.56 +/- 32.86/mm(2)) than that in RAEB/RAEB-t subtypes (21.87 +/- 13.65/mm(2)) (P < 0.05). Double staining showed similar apoptosis percentage in erythroid cell and megakaryocytes in MDS patients comparing with that of controls (P > 0.05). Some apoptotic cells showing erythroid or megakaryocytic morphologic characteristics expressed no cluster differentiation antigen.

CONCLUSIONOverapoptosis existed in MDS, RA/RAS group had a higher apoptosis ratio than RAEB/RAEB-t group. No obvious increased apoptosis in erythroid cell and megakaryocytes was observed in MDS perhaps due to the loss of surface antigens in later stages of apoptotic cells.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alkaline Phosphatase ; immunology ; Apoptosis ; Bone Marrow Cells ; cytology ; metabolism ; Child ; DNA ; genetics ; Female ; Humans ; Immunoenzyme Techniques ; In Situ Nick-End Labeling ; Male ; Middle Aged ; Myelodysplastic Syndromes ; genetics ; pathology

Objective To evaluate the efficacy and safety of recombinant adenovirus-p53(rAdp53) injection combined with radiotherapy and hyperthermia in the treatment of unresectable advanced soft tissue sarcoma.Methods In this retrospective study, we evaluated 76 patients with unresectable advanced primary or recurrent soft tissue sarcoma treated in our hospital from November 2005 to November 2012.These patients received radiotherapy and hyperthermia with rAdp53(p53 group, n=41) or without rAdp53(control group, n=35).rAdp53((1-2)×1012viral particles each time, once a week, 8 times on average) was injected into the tumor or infused into the pelvic cavity.Radiotherapy (2 Gy each time, 5 times a week) was performed for the planning target volume at 56.3±5.3 Gy in the p53 group and 58.1±4.2 Gy in the control group, with no significant difference between the two groups (P>0.05).Superficial or deep thermotherapy was employed 8 times on average (twice a week).Clinical features, response rate, time to progression (TTP), overall survival (OS), and adverse events were compared between the two groups (P>0.05).The Kaplan-Meier method was used to calculate OS;the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparison of categorical data.Results At 2 months after treatment, the p53 group had significantly increased response rate (partial response+ complete response+ stable disease)(85% vs.54%, P=0.003) and local control rate (49% vs.23%, P=0.020) as well as prolonged TTP (12 months vs.5 months, P=0.010) and OS (48 months vs.31 months, P=0.049), as compared with the control group.No adverse events caused by radiotherapy and hyperthermia except transient fever were seen in the two groups.Conclusions Concurrent radiotherapy and hyperthermia combined with rAdp53 injection is effective and safe for patients with advanced soft tissue sarcoma.

Objective:To investigate the clinical efficacy and feasibility of anterolateral thigh perforator flap with fascia lata in repairing hand and foot wounds complicated with extensor tendon defect.Methods:The clinical data of patients with hand and foot wounds complicated with extensor tendon defect who were repaired with anterolateral thigh perforator flap with fascia lata in Long Gang District Orthopedic Hospital of Shenzhen from May 2014 to December 2019 were analyzed retrospectively. During the operation, fascia lata was used to repair the defect of extensor tendon.The proximal and distal endof fascia lata were anastomosis with defect extensor tendon by figure 8 sutures.The soft tissue defects of hand and foot were repaired with anterolateral thigh (ALT)perforator flap. The donor site was closed primarily or covered by free skin graft. After operation, the sensory recovery of the flap was evaluated according to the evaluation standard of sensory function after peripheral nerve injury formulated by British Medical Research Association. According to the total active range of movement (TAM) of fingers recommended by the evaluation standard of hand tendon repair of Hand Surgery Society of Chinese Medical Association, the hand motor function was evaluated systematically. Foot motor function was evaluated according to the ankle-hind foot scoring system developed and recommended by the American Association of Foot and Ankle Surgeons.Results:A total of 23 patients were enrolled, including 19 males and 4 females, aged from 9 to 61 years old, with an average age of 26 years old. Causes of injury: there were 11 cases of crushinjury associated with machine, 4 cases of road traffic injury, 6 cases of injury by falling heavy object, 2 cases of saw injury. The area of wound defect ranged from 2 cm × 6 cm to 7 cm × 25 cm, and the length of tendon defect ranged from 1.0 cm to 10.0 cm. All cases were complicated with partial or complete defect of extensor tendon. There were 19 cases with fracture and nerve injury. All the injuries were successfully repaired. All the flaps survived well. The rande of flap harvest was 3 cm × 5 cm to 9 cm × 23 cm, and the fascia lata was 1.0 cm × 1. 5 cm to 4.5 cm × 11. 0 cm. There were no complications such as arteriovenous crisis, infection, fat liquefaction, etc. Andall the wounds were closed primarily. Follow-up period ranged from 3 to 36 months (average 14 months) showed that all flaps had aestheticappearance, good color, and texture. Sensory recovery: excellent in 19 cases and good in 4 cases. TAM system evaluation method and ankle-hind foot scoring system were used to evaluate the function of hand and foot: 21 cases were excellent and 2 cases were good.Conclusions:The application of anterolateral thigh perforator flap with fascia lata to repair the hand and foot wound with extensor tendon defect can restore the motor and sensory function of the injured limb while covering the wound surface.This method has less damage to the donor site and less postoperative complications, and can significantly improve the quality of life of patients. It is an effective method to repair the wounds of hand and footcombined with extensor tendon defect.

Objective:To investigate the clinical efficacy and feasibility of anterolateral thigh perforator flap with fascia lata in repairing hand and foot wounds complicated with extensor tendon defect.Methods:The clinical data of patients with hand and foot wounds complicated with extensor tendon defect who were repaired with anterolateral thigh perforator flap with fascia lata in Long Gang District Orthopedic Hospital of Shenzhen from May 2014 to December 2019 were analyzed retrospectively. During the operation, fascia lata was used to repair the defect of extensor tendon.The proximal and distal endof fascia lata were anastomosis with defect extensor tendon by figure 8 sutures.The soft tissue defects of hand and foot were repaired with anterolateral thigh (ALT)perforator flap. The donor site was closed primarily or covered by free skin graft. After operation, the sensory recovery of the flap was evaluated according to the evaluation standard of sensory function after peripheral nerve injury formulated by British Medical Research Association. According to the total active range of movement (TAM) of fingers recommended by the evaluation standard of hand tendon repair of Hand Surgery Society of Chinese Medical Association, the hand motor function was evaluated systematically. Foot motor function was evaluated according to the ankle-hind foot scoring system developed and recommended by the American Association of Foot and Ankle Surgeons.Results:A total of 23 patients were enrolled, including 19 males and 4 females, aged from 9 to 61 years old, with an average age of 26 years old. Causes of injury: there were 11 cases of crushinjury associated with machine, 4 cases of road traffic injury, 6 cases of injury by falling heavy object, 2 cases of saw injury. The area of wound defect ranged from 2 cm × 6 cm to 7 cm × 25 cm, and the length of tendon defect ranged from 1.0 cm to 10.0 cm. All cases were complicated with partial or complete defect of extensor tendon. There were 19 cases with fracture and nerve injury. All the injuries were successfully repaired. All the flaps survived well. The rande of flap harvest was 3 cm × 5 cm to 9 cm × 23 cm, and the fascia lata was 1.0 cm × 1. 5 cm to 4.5 cm × 11. 0 cm. There were no complications such as arteriovenous crisis, infection, fat liquefaction, etc. Andall the wounds were closed primarily. Follow-up period ranged from 3 to 36 months (average 14 months) showed that all flaps had aestheticappearance, good color, and texture. Sensory recovery: excellent in 19 cases and good in 4 cases. TAM system evaluation method and ankle-hind foot scoring system were used to evaluate the function of hand and foot: 21 cases were excellent and 2 cases were good.Conclusions:The application of anterolateral thigh perforator flap with fascia lata to repair the hand and foot wound with extensor tendon defect can restore the motor and sensory function of the injured limb while covering the wound surface.This method has less damage to the donor site and less postoperative complications, and can significantly improve the quality of life of patients. It is an effective method to repair the wounds of hand and footcombined with extensor tendon defect.

Objective:To explore the brain activation intensity changes of depressed patients in the phase of expected value (EV), positive prediction error (+ PE) and negative prediction error (-PE) under uncertain (risky, ambiguous) decision-making.Methods:From July 2018 to February 2021, a total of 48 depressed patients in the Affiliated Hospital of Qingdao University were collected (depression group), and 69 sex-, age-, and educational level-matched healthy people were recruited as the control group. All participants completed risky and ambiguous decision-making tasks under the E-Prime system.SA-9800 brain functional audio-visual stimulation system and GE3.0 T functional magnetic resonance imaging (fMRI) scanners were used to conduct synchronous scanning and data acquisition. Using Xjview software to analyze the activation intensity of related brain areas to compare the activity intensity of the two groups.SPSS 16.0 software was used for chi square test, independent sample t-test. Results:Under risky decision-making, compared with the control group, the brain areas with reduced activation during EV phase in depression group were bilateral prefrontal cortex (PFC)(MNI coordinate: left x=-45, y=21, z=-6; right x=0, y=69, z=-3), left para hippocampal gyrus(PHG)(MNI coordinate: x=-9, y=0, z=-22), bilateral occipital lobe(OL)(MNI coordinate: left x=-51, y=-81, z=-3; right x=48, y=-84, z=-9)( P<0.05). The brain areas with reduced activation during + PE phase were bilateral PFC, left hippocampus (HIP), bilateral temporal lobe (TL), left middle occipital gyrus( P<0.05). The brain areas with reduced activation were bilateral PFC, right putamen, bilateral TL( P<0.05) during -PE phase. Under ambiguous decision-making, compared with the control group, the brain areas with reduced activation during EV phase in depression group were bilateral PFC, right OL( P<0.05); the brain areas with reduced activation during + PE phase were bilateral PFC, right putamen and hippocampus, bilateral TL, bilateral OL( P<0.05); and the brain areas with reduced activation were bilateral PFC, bilateral TL( P<0.05) during -PE phase. Conclusion:The study shows that the activities of reward brain areas such as PFC, limbic system and OL system are reduced during EV and PE phase under uncertain decision-making in depressed patients.