Objective To constitute a database of chronic wounds for characterizing the patients with chronic wounds.Methods Based on the guideline of chronic wounds defined by international wound healing society,86 outpatients with chronic wounds were selected between January and October in 2013 to set up a wound database using the wound information management system.The parameters including etiology,age distribution,mean time of fracture healing and wound healing time posterior to different treatments were analyzed.Results (1) Statistical difference existed for cause distribution (P ＜0.05).Top three causes were trauma (29％),varicosity (26％) and pressure sore (19％).(2) Age distribution varied significantly among the patients with various causes of chronic wounds (P ＜ 0.05).(3) Statistical difference was observed in healing time of various types of chronic wounds (P ＜ 0.05).Diabetic wound and varicose ulcer took the longest healing time,with average 116.36 days and 88.48 days respectively.(4) Patients treated with novel dressings had shorter healing time than those managed with traditional dressings (P ＜ 0.05).Conclusions Trauma,varicosity and pressure ulcer are relatively common among the outpatients.Etiology of chronic wounds is strongly related to age and novel dressings contributed to a shortened cause of the disorder.

Objective To investigate the effect of pemetrexed on the immune function,quality of life and survival time of patients with malignant pleural effusion.Methods Eighty cases patients with non-small cell lung cancer from July 2013 to October 2015 in the People′s Hospital of Hunan Province were complicated with pleural effusion,and randomly divided into observation group and control group,40 cases in each group.The control group were used chemotherapy with GP(gemcitabine plus cisplatin) and the central venous catheter was placed in the thoracic cavity.The observation group was treated with retrograde injection of pemetrexed catheter on the basis of the control group.The changes of immunoglobulin and inflammatory cytokines were compared between the two groups,and the quality of life and the 1 year survival rate of the two groups were statistically analyzed.Results The IgM,IgG and IgA of the observation group after the intervention were higher than those in control group((1.65±0.03) mg/L vs.(1.31±0.02) mg/L,(9.55±0.12) mg/L vs.(8.82±0.10) mg/L,(3.99±0.20) mg/L vs.(1.81±0.13) mg/L,t=59.640,29.557,57.800,P<0.05),the TNFα-,IL-1,hs-CRP levels of the observation group after the intervention were lower than the control group((12.0±0.2) μg/L vs.(18.1±0.5) μg/L,(0.60±0.1) mg/L vs.(0.92±0.2) mg/L,(10.3±1.0) mg/L vs.(31.3±2.0) mg/L,t=71.641,9.051,59.397,P<0.05),and quality of life score after the intervention than before((81.5±2.3) points vs.(81.6±2.3) points,(35.3±1.1) points vs.(56.6±1.7) points,t=114.608,55.823,P<0.05).Quality of life of the observation group was better than the control group(t=66.530,P<0.01),1 year survival rate was higher than the control group(25.0%(10/40) vs.50.0%(20/40),U=5.903,P<0.05).Conclusion Local chemotherapy with pemetrexed could significantly improve the immune function of patients with malignant pleural effusion,reduce the inflammatory response,improve the quality of life and prolong the survival time of patients with malignant pleural effusion.

Objective To observe the occurrence of cardiovascular adverse events in patients undergoing mechanical ventilation with dexmedetomidine sedation,and to evaluate its safety in intensive care unit (ICU).Methods A prospective randomized controlled trial was conducted.Adult critical patients undergoing mechanical ventilation over 48 hours admitted to ICU of Zigong First People's Hospital in Sichuan Province were enrolled.The patients were divided into dexmedetomidine group (Dex group) and midazolam group (Mid group) according to the randomise number generated by computer.The patients in both groups were given slow intravenous infusion of 0.05 mg/kg midazolam and 1-2 μg/kg fentanyl to induce anesthesia before tracheal intubation,followed by 0.06 mg· kg-1· h-1 midazolam and 20-50 μg· kg-1 · h-1 fentanyl or 0.1-0.2 μg· kg-1 · h-1 sufentanil for continuous intravenous pumping to maintain analgesia and sedation;on the next day,the patients in Dex group was given dexmedetomidine (with the initial dose of 0.4 μg· kg-1 · h-1,and maintenance dose of 0.1-0.7 μg· kg-1 · h-1),and midazolam was stopped half an hour later;the original sedation and analgesia plan remained unchanged in Mid group.The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of-2 to 1 or a Ramsay sedation score of 3 to 4;patients were given midazolam if obvious agitation occurred,in combination with propofol for sedation if necessary;wakeup test was performed every day.Observation endpoints included patients discharged from ICU,death or mechanical ventilation over 28 days.Occurrence of cardiovascular adverse events during sedation such as hypertension,hypotension,bradycardia,tachycardia and arrhythmia,dose of sedatives and analgesics,duration of mechanical ventilation,length of ICU stay and 28-day mortality were observed in two groups.Results A total of 383 patients were enrolled,with 190 patients in Dex group and 193 in Mid group.There was no statistically significant difference in general data such as gender,age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and predicted mortality between two groups.Doses of midazolam,propofol and fentanyl in Dex group were reduced as compared with those of Mid group,while the dose of sufentanil was similar in two groups.The Ramsay score and RASS score of Dex group were significantly reduced as compared with those of Mid group (3.34± 0.63 vs.3.95 ± 0.86,-1.33 ±0.87 vs.-1.98 ± 1.27,both P ＜ 0.01).Bradycardia was prominent in Dex group,which was observed in more than half of patients at the beginning of the treatment (1-2 hours),but the patients requiring isoprenaline treatment for heart rate lower than 50 bpm were less than that of Mid group (3.7％ vs.5.2％,x 2 =0.506,P =0.477).The incidences of hypotension (45.3％ vs.68.4％),tachycardia (16.3％ vs.33.7％) and arrhythmia (14.7％ vs.31.1％) in Dex group were significantly lower than those of Mid group (all P ＜ 0.01),and no other cardiovascular adverse events such as cardiac arrest,sinus arrest,hyperglycemia or hypoglycemia were observed in two groups.There was no statistically significant difference in duration of mechanical ventilation between Dex group and Mid group [days:5 (2,28) vs.4 (2,56),Z =-1.917,P =0.055],but compared with Mid group,the length of ICU stay in Dex group was significantly prolonged [days:9 (2,67) vs.6 (2,57),Z =-4.302,P =0.000],and the 28-day mortality in Dex group was significantly reduced (22.6％ vs.44.6％,x2 =20.610,P =0.000).Conclusion Long time dexmedetomidine sedation is safe in critical patients undergoing mechanical ventilation,which can significantly reduce cardiovascular adverse events except bradycardia,and lower the 28-day mortality.

Objective Tumor cells are able to support their malignant proliferation by changing metabolic models .Prostate cells rely much on lipid metabolism in which ATP-citrate lyase ( ACLY) plays a very important role .The aim of this research was to study the effects of downregulated ACLY on the cell proliferation , cycle distribution and apoptosis of androgen-independent prostate cancer cells DUl45. Methods DU145 cells were divided into two groups:the cells in experiment group were transfected with the small interfering RNA-mediated knockdown of ACLY , while the cells in control group were transfected with meaningless small interfering RNA.Cell counting Kit test ( CCK-8 ) was applied to detect the effects of the downregulation of ATP citrate lyase on the proliferation of DU145.Flow cytometry instrument was used to analyze the variation of cell cycle distribution and apoptosis rate between groups .Western blot was used to detect the change of intracellular Caspase-3 protein content. Results Western blot showed favorable effects of ACLY interference .Compared with control group , ACLY protein content significantly decreased in experiment group ( P<0.05) ;the acetyl coenzyme A content and the percentage of early apoptosis cells and late apoptosis cells increased significantly [(0.42±1.99) vs (0.79±2.38), (37.10±3.28) vs (6.20±2.88), P<0.05].As to the selec-tive ACLY knockdown in DU145 cells, the proliferation ability in experiment group weakened in comparison with control group , which became more and more apparent as time went on .At 48h and 72h time points, the cell absorbance between two groups at the same time point was of significant difference (P<0.05).As to the interfering ACLY expression in DU145 cells, the percentage of G1 cells in-creased without any statistical significance (P>0.05), while the percentage of G2 cells decreased and the percentage of S cells in-creased with most cell cycle blocking at G 0/G1 stage, which were of significant difference .Meanwhile the expression of apoptosis pro-tein Caspase-3 upregulated significantly . Conclusion ACLY is of vital significance to maintain the malignant proliferation of prostate cancer cells and its downregulation results in the inhibition of cell proliferation and the promotion of cell apoptosis .

Objective To evaluate the application of the binary Logistic regression model to analyze ultrasonographie indexes of the solid breast tumors. Methods The indexes of two dimensional gray scale ultrasonography,two dimensional color Doppler flow imaging,three dimensional gray scale ultrasonography, three dimensional color Doppler flow imaging and ultrasonic elastography were evaluated in 151 breast lesions confirmed by surgical pathology. A Logistic regression model for predicting breast rnalignaney on the basis of ultrasonographic indexes was obtained. A receiver operating characteristic (ROC) curve was used to assess the performance of the Logistic regression model. Results Six ultrasonic indexes were finally entering the Logistic regression model. They were elasticity score, shape,internal echo, RI, enhancement of posterior acoustic alteration and the converging pattern in the coronal plane. The area under the ROC curve was 0. 996. The percentage correct of prediction was 97.35 %. Conclusions The multivariate analysis model of binary Logistic regression can describe and analyze the process of differential diagnosis of malignant and benign solid breast tumors by ultrasonography and can select out the valuable indexes of differential diagnosis.

Objective: To investigate the expression of LL37 in oral lichen planus (OLP) lesions. Methods: 25 OLP and 7 health controls were included in this study. IHC and RT-PCR methods were used to detect the LL37 expression on protein level and mRNA level. T-test was used for data analysis. Results: Positive staining of LL37 was found in all the samples in cytoplasm of epithelium cells using IHC method, and mostly in prickle and basal layers. But the reaction intensity in health control was weak, compared to the strong signal in OLP group(P<0.05). The expressions of LL37 mRNA in OLP were significantly higher than those in health controls(P<0.05). Conclusion: The expression of LL37 on normal oral mucosa suggests that it may play a role in maintaining the health of oral mucosa as a part of innate immunity. The up-regulation of LL37 under inflammation status might participate in the immunopathological development of OLP.

Objective To study the clinical outcomes and safety of immunoadsorption therapy for refractory autoimmune disease in children.Methods Three boys who suffered of severe autoimmune disease-one boy suffered of severe dermatomyositis and pulmonary infection; one suffered of severe anaphylactoid purpura with alimentary tract hemorrhage and entero ablation for intestinal perforation ; other one suffered of systemic juvenile idiopathic arthritis and severe prosopo-cellular tissue infection,macrophage active syndrome,were treated with blood immunoadsorption by resin immunoadsorbent of HA280.Then evaluated the clinical outcome of 3 cases,including symptom improvement,change of serum immune globulin,complement,enzyme of liver and heart,autoantibody.Results After the treatment of immunoadsorption,the symptom of 3 cases improved obviously; the sensitivity of the corticosteroids increased; autoantibody of antinuclear antibody (ANA) and anti-cyclic citrullinated peptide antibody (CCP) changed to negative; C-reactive protein (CRP) dropped (P ＜ 0.05) ; descending scale of IgM,IgA,C3,C4 increased (P ＜ 0.05) ; the normal scale of immunoglobulin didn't changed (P ＞ 0.05) ; besides aspartate aminotransferase (AST) dropped in the case of dermatomyositis,the other enzyme of liver and heart didn't changed.Conclusions The body could be restored quickly by the treatment of immunoadsorption together with the drug; CRP in the blood could be removed by immunoadsorbent of resin; 1 or 2 times blood immunoadsorption could not change the level of enzyme,but it need to do more on severe cases,especially those with poor organ function; for the safe of the treatment of immunoadsorption for the young age,low weigh and severe cases,the operative procedure should be critical care.

BACKGROUND:The experimental animal models can be used to in-depth investigate the effect of ultrasound and contrast-enhanced ultrasound in the diagnosis and treatment of ischemic biliary lesions. But there is no report on the phase timing standard of rabbit model contrast-enhanced ultrasound that used in various hepatobiliary diseases. OBJECTIVE:To investigate the ultrasonic appearance of normal rabbit biliary ducts with conventional ultrasonography and contrast-enhanced ultrasonography, and the criterion of contrast-enhanced ultrasonography phase timing of rabbit liver. METHODS:The conventional ultrasonography of hepatobiliary system was performed on 10 healthy New Zealand rabbits, and contrast-enhanced ultrasonography was performed on duct wal s that displayed in conventional ultrasonography, then the features were analyzed. RESULTS AND CONCLUSION:(1) The bile duct of normal New Zealand rabbits showed a portal to biliary caliber ratio of 3.59±0.54. (2) The detection rates of common and middle lobe bile ducts were significantly higher than that of lateral lobe bile ducts on both conventional ultrasonography and contrast-enhanced ultrasonography. (3) The phases of contrast-enhanced ultrasonography of normal rabbit liver were divided into arterial phase (10-20 seconds), portal phase (21-30 seconds) and late phase (31-180 seconds). The normal duct wal presented hyper-enhancing at arterial phase and persistent iso-enhancing at portal and late phases. The establishment of these parameters of normal New Zealand rabbits not only lays a foundation for the application of contrast-enhanced ultrasonography on biliary ischemia but also expands to other hepatobiliary models.

The development of TCM acupuncture represents a internationalized and modern trend. A recent study with the title of "Acupuncture for chronic knee pain: a randomized clinical trial" published in Journal of the American Medical Association on October 1st, 2014, which raised doubts on acupuncture efficacy as well as traditional manipulation and acupoint theory, makes some negative impact and challenges on the development of acupuncture. From the view of future development of acupuncture, the potential influence of this research on acupuncture development is proposed, and by combining acupuncture theory, some discussions and doubts on the research design and outcome explanations are made. Additionally, enlightenments of this research on further clinical research are summarized.
Acupuncture Therapy ; Chronic Pain ; therapy ; Female ; Humans ; Low-Level Light Therapy ; Male

Objective To evaluate the accuracy of thyromental height (TMH) in predicting difficult airway.Methods Three hundred and thirty patients of both sexes requiring endotracheal intubation,aged ＞18 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were selected.The modified Mallampati test (MMT) score,thyromental distance (THD),sternomental distance (SMD) and TMH were measured following admission to the operating room.Direct laryngoscope was placed after induction of anesthesia to expose the glottis,and the Cormack-Lehane grade was recorded.Difficult airway was defined as Cormack-Lehane grade Ⅲ or Ⅳ.The receiver-operating characteristics curve was used to evaluate the accuracy of MMT,THD,SMD and TMH in predicting difficult airway.Results The diagnostic threshold of TMH in predicting difficult airway was 39.04 mm,the sensitivity 88.24％,the specificity 90.42％,the area under the curve (95％ confidence interval) 0.897 (0.859-0.928),and the odds ratio 70.750.Compared with MMT,THD and SMD,the area under the curve of TMH in predicting difficult airway was significantly increased (P＜0.05).Conclusion TMH can accurately predict difficult airway,and the diagnostic threshold is 39.04 mm in patients.