Phages also known as bacteria viruses, are recognized as the most abundant and diverse microbes. This diversity is adapting to the selective pressures such as the prevalence of the phage resistance mechanisms of bacteria. Phages invade and lyse bacterial through six steps (adsorption, injection, replication, transcription translation, assemble, release). Bacteria evolve to many anti-phage mechanisms to avoid phage infection and lysis. This paper focus on a variety of anti-phage mechanisms of bacteria.
Bacteria ; genetics ; virology ; Bacterial Physiological Phenomena ; Bacteriophages ; genetics ; physiology ; DNA Replication ; Evolution, Molecular ; Virus Attachment

Objectives To develop Z-scores reference ranges for kidney in normal fetuses from the measurements of gestational age (GA),biparietal diameter (BPD) or femur length (FL) using two-dimension ultrasound.Methods A retrospective cross-sectional study of 403 singleton normal fetuses was performed.The gestation age range was from 18 to 40 weeks.Fetal biologic parameters included GA and BPD and FL based on menstrual age.Left kidney length and left kidney width of normal fetus were measured.Normal Z-score ranges were developed for leftkidney length or left kidney width using GA,BPD and FL as independent variables.Results Linear regression model was the best description of the data in each case and correlation between left kidney length or left kidney width and independent variables were excellent (r=0.8761,0.8818,0.8797,0.8604,0.8723,0.8643).All P values were less than 0.01.The equations were as follows,Y=0.094 22 + 0.1088X,Y=0.132 57 + 0.4349X,Y=0.6664 + 0.491 05X,Y=0.060 58X-0.051 98,Y=0.262 19X-0.197 55,Y=0.294 02X + 0.136 19.Heteroscedasticity of standard deviation (s) with increasing independent variables also could be modeled with a simple linear (r=0.925,0.934,0.915,0.908,0.914,0.922),All P values were less than 0.01.The equations were as follows,Y=0.025 + 0.005 58X,Y=0.097 09 + 0.010 45X,Y=0.046 17 + 0.025 65X,Y=0.001 13 + 0.002 24X,Y=0.003 67 + 0.011 55X,Y=0.005 07 + 0.015 89X.Then we got Z-scores based on the equation,Z-score=(actual measurement data of left kidney length or left kidney width-predictive data of left kidney length or left kidney width) predictive s.Conclusions Normal reference ranges and Z-scores for fetal left kidney length and left kidney width had been provided.These normative data may be useful tools for assessment of fetal kidney length and kidney width,especially had potential applications in malformations of fetal kidney.

Objective To observe the near-term impact of the second natural delivery on the structure of a female pelvic floor by ultrasonography. Methods Selected fifty second-natural-delivery women and fifty first-natural-delivery women from Tongde Hospital of Zhejiang Province between October, 2016 and October, 2017 undertook pelvic ultrasonnography (42 days postpartum). Pelvic ultrasonography was used to determine all mothers' bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle, and the area of pelvic diaphragm hiatus when performing the Valsalva maneuver. Besides, pelvic ultrasonography was used to determine the extent of mothers' internal-urethral-of-orifice funneling, perineal hyperactivity, uterine prolapse and rectal bulge. The paired t test was applied between groups to compare the bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers with those of the first-natural- delivery mothers. The χ2test was also applied to examine the degree of mothers' uterine prolapse, rectal bulge and internal-urethral-of-orifice funneling, as well as their perineal hyperactivity rate. Results The bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers were all wider than those of the first-natural-delivery mothers [(29.37±5.32) mm vs (22.63±6.35) mm, (148.8±14.97)° vs (141.2±15.20)°, (73.69±16.03)° vs (69.8±15.25)°, (44.41±19.27)° vs (40.0±17.52)°, (21.47±5.19) cm2vs (19.15±4.10) cm2], and differences were statistically significant (t=5.761, P ＜0.001; t=2.519, P=0.001; t=2.476, P=0.001;t=3.123, P=0.001; t=2.481, P＜0.001). The degree of the second-natural-delivery mothers'uterine prolapse and internal-urethral-of-orifice funneling as well as their perineal hyperactivity rate were all higher than those of the first-natural-delivery mothers [46.0% (23/50) vs 20.0% (10/50), 12.0% (6/50) vs 6.0% (3/50), 20.0% (10/50) vs 6.0% (3/50)], and differences were statistically significant ( χ2=7.644, P=0.006; χ2=3.342, P=0.043; χ2=4.332, P=0.037). The differences in the incidence rate of rectal bulge between the two groups were of no statistical significance [4.0% (2/50) vs 2.0% (1/50), χ2=1.197, P=1.000]. Conclusions The pelvic ultrasonogram showed that the near-term impacts of the second natural-delivery on women's pelvic floor were more obvious than those of the first natural delivery. What's more, pelvic floor ultrasound has been proved to be a reliable basis for the diagnosis and screening of dysfunctional diseases of pelvic floor.

Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019, 76 patients with inferior patellar fracture were treated with non excitation tension band technique. There were 42 males and 34 females; The age was 35.48 ± 18.12 years (17-66 years), with an average of 35 years. There were 45 cases on the left and 31 cases on the right. Causes of injury: fall injury in 46 cases, bicycle injury in 16 cases and traffic accident injury in 14 cases. The time from injury to operation was 0.25-5 d, with an average of 3.2 d. There were 18 cases of open fractures, 64 cases of articular surface fractures and 52 cases of comminuted fractures. Open fracture patients were debridement first, and all cases were fixed with non excitation tension band technique. The intraoperative fracture reduction, postoperative fracture healing and internal fixation were observed. The knee function was evaluated according to the degree of claudication, the use of supports, the feeling of joint strangulation, joint instability, pain, swelling, stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24 ± 6.18 months (range 12-24 months). There was no wire fracture during and after operation. All incisions healed in the first stage after operation, and there was no deep venous thrombosis of lower limbs. The X-ray film showed that there was no further fracture and fracture displacement after operation, and there was no Kirschner wire slip before the internal fixation was taken out. Only one case had steel wire relaxation due to buckle (which did not affect fracture healing). All fractures healed well, with an average of 7.5 weeks, and the fracture line basically disappeared. 12 months after operation, according to Lysholm knee score standard, the knee function of patients was evaluated. The score of 76 cases was 95.40±4.60 points (range 82-100 points): excellent in 54 cases, good in 21 cases and fair in 1 case. The excellent and good rate was 98.7%. According to the visual analogue scale (VAS) pain score standard, the patients were scored for postoperative pain. The score of 76 cases was 0.09±2.05 points (range 0-3 points): 4 cases had mild pain, with an average score of 0.09.Conclusion:The results of the treatment of patellar inferior pole fracture with tension free band technique are satisfactory, the pain caused by tissue irritation by the internal fixation was lower, clinical application can be popularized.

Objective:To explore the selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection.Methods:From January 2011 to February 2017, 31 patients with vulvar tumor who were admitted to Hunan Cancer Hospital underwent repair of wound after tumor resection with various flaps/myocutaneous flaps. The patients were composed of 5 males and 26 females, aged 39-76 years, with 27 vulvar cancer and 4 Paget′s disease in primary diseases. The size of defects after vulvar tumor radical resection ranged from 8.0 cm×4.5 cm to 27.5 cm×24.0 cm. According to the theory of perforasome, the defects were repaired by the external pudendal artery perforator flap, deep inferior epigastric artery perforator flap, rectus abdominis myocutaneous flap, anterolateral thigh flap, internal pudendal artery perforator flap, gracilis myocutaneous flap, and profunda artery perforator flap based on the specific size and location of perineum and groin where the defect was located. According to the blood supply zone of flap, totally 17 local translocation flaps, 18 axial flaps/myocutaneous flaps, and 7 V-Y advancement flaps were resected, with an area of 7.0 cm×4.0 cm to 21.0 cm×13.0 cm. All the flaps/myocutaneous flaps were transferred in pedicled fashion, and the donor sites were closed without tension. The number of flaps/myocutaneous flaps, wound closure, flaps/myocutaneous flaps survival, and follow-up were observed and recorded.Results:Altogether 42 flaps/myocutaneous flaps were harvested in 31 patients. Two flaps/myocutaneous flaps were used in 11 cases for large circular defect repair. All the defects achieved tension-free primary closure. The blood supply of 32 flaps/myocutaneous flaps was good, while insufficient blood supply was noted in the other 10 flaps/myocutaneous flaps. Seventeen flaps/myocutaneous flaps survived smoothly. Wound dehiscence occurred in 5 flaps/myocutaneous flaps 8 to 14 days postoperatively, which was healed with dressing change. Temporary congestion was noted in 7 flaps/myocutaneous flaps 2 to 5 days postoperatively, which recovered without special treatment. Three flaps/myocutaneous flaps had infection 7 to 15 days postoperatively, two of which recovered after dressing change, while the other one had partial necrosis and received debridement and direct closure. Two flaps/myocutaneous flaps were totally necrotic 8 to 15 days postoperatively, which were repaired with pedicled rectus abdominis myocutaneous flap after debridement. Seven flaps/myocutaneous flaps had partial necrosis 7 to 20 days postoperatively and were healed after dressing change. Twenty-four patients were followed up for 9-38 months. The color of flaps/myocutaneous flaps was similar to that of the surrounding skin, the shape of vulva was natural, the movement of hip joint was not limited, the function of micturition and defecation was not affected, and tumor recurrence was noted in 3 patients.Conclusions:For the complicated large defect after perineum tumor resection, the flexible application of different forms of flaps/myocutaneous flaps to repair according to different areas regains the appearance and function. However, there are many complications, so it is necessary to further strengthen the postoperative care.

Objective: To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction. Methods: From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded. Results: (1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications. Conclusions Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.

Natural killer (NK) cells are an important part of the body's innate immune system. As the first line of defense against pathogens, they need to be transformed into a mature state under the control of various cell signaling molecules and transcription factors to play cytotoxic and immune regulatory roles. Under the interaction of activated receptors and inhibitory receptors, NK cells are activated to perform a direct cell killing effect by secreting perforin and granzyme, or indirectly eliminate pathogenic microorganisms in the body by secreting various cytokines, such as type I and type II interferons. These functions of NK cells play a very important role in antiviral and anti-autoimmune diseases, especially in anti-tumor.
Humans ; Killer Cells, Natural ; Interferon-gamma ; Apoptosis ; Autoimmune Diseases ; Cytokines