Colorectal cancer is a common malignancy in the digestive tract,open and laparoscopic surgery are the main treatment methods.Anastomotic fistula,anastomotic bleeding,ileus,voiding and sexual dysfunction are the common postoperative complications.Chylous fistula,incision infection,pulmonary infection and incision metastasis occasionally occurred.Compared with open surgery,laparoscopic surgery does not increase the postoperative complications,and it can be safely applied in the radical resection of colorectal cancer.

Acute aortic dissection is the most lethal one among the diseases involving the aorta.This article reviewed the operative indications,methods,curative effects and clinical prospect of Endovascular Graft Exclusion (EVGE) for aortic dissection .The indications for EVGE are DeBakeyⅢB type aortic dissections with the intimal tear. EVGE is a minus invasive method with a firmly curative effects, and its clinical prospect will be very bright.

According to the infection characteristics of batches of patients with extensive burns in dust explosion, the article focused on the concept and mode of whole-range fine management.Based on the characteristics and rules of infection prevention in bat-ches of patients with extensive burns, the measurement and examination of infection management were refined, the infection monitoring indexes were designed scientifically, the infection prevention scheme and monitoring table were formulated.By early and whole-range intervention of infection prevention, quantitative evaluation, fine management and precise control at different times, all levels of infec-tion management teams could fully serve their purposes in order to realize effective infection prevention.

OBJECTIVE:To establish an RP-HPLC method for simultaneous determination of the contents of costunolide and dehydrocostuslactone in Xuedan weichang pill. METHODS:The determination was performed on Shim-pack VP-ODS column(150 mm?4.6 mm,5 ?m) with methanol-water(60∶40) as mobile phase and the detection wavelength was set at 225 nm.RESULTS:The linear ranges of costunolide and dehydrocostuslactone were 13.6～272.0 ?g?mL-1 and 11.25～225.0 ?g?mL-1,respectively,and their average recoveries were 99.47% and 99.62%,respectively with RSD of 1.75%(n=6) and 1.14%(n=6),respectively. CONCLUSION:The method established is simple,feasible,accurate and reliable,and it is applicable for the quality control of Xuedan weichang pill.

Objective:To investigate the clinicopathological features of Erdheim-Chester disease (ECD) initially diagnosed at extraskeletal locations.Methods:Clinical and pathological data of four cases of ECD diagnosed initially in extraskeletal locations were collected at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2013 to June 2023. BRAF V600E gene was detected by reverse transcription polymerase chain reaction (RT-PCR). Pertinent literatures were reviewed.Results:Four ECD patients included two males and two females ranging in ages from 2 years 11 months to 69 years. The lesions located in the lung (two cases), central nervous system (one case), and the testicle (one case) were collected in the study. One patient had occasional fever at night, one had nausea and vomiting, and two were asymptomatic. Radiologically, the two pulmonary ECD showed diffuse ground-glass nodules in both lungs, and the lesions in central nervous system and testicle both showed solid masses. Microscopically, there were infiltration of foamy histiocyte-like cells and multinucleated giant cells in a fibrotic background, accompanied by varying amounts of lymphocytes and plasma cells. The infiltration of tumor cells in pulmonary ECD was mainly seen in the subpleural area, interlobular septa, and perivascular and peribronchiolar areas. The fibrosis was more pronounced in the pleura and interlobular septa, and less pronounced in the alveolar septa. Immunohistochemical staining showed that all tumor cells expressed CD68, CD163 and F a; one case showed S-100 expression; three cases were positive for BRAF V600E; all were negative for CD1α and Langerin. RT-PCR in all four cases showed BRAF V600E gene mutation. Conclusions:Extraskeletal ECD is often rare and occult, and could be easily misdiagnosed, requiring biopsy confirmation. The radiologic findings of pulmonary ECD is significantly different from other types of ECD, and the histopathological features of pronounced infiltration in the subpleura area, interlobular septa, perivascular and peribronchiolar areas can be helpful in the differential diagnosis from other pulmonary diseases. Detection of BRAF V600E gene mutation by RT-PCR and its expression by immunohistochemical staining are also helpful in the diagnosis.

Objective:To explore the aging care willingness and requirements for long-term care services among elderlies with different activity of living(ADL).Methods:7 070 elderlies aged 60 years and above were subject to a questionnaire survey using stratified multistage random cluster sampling in three municipalities of Shandong province from August through September, 2017. Data information was obtained by a customized questionnaire and ADL scale. Rank sum test and multivariate logistic regression were used for statistical analysis.Results:According to the ADL scoring, the participants were divided into 3 groups: normal, decreased function, and dysfunction, with 5 467(77.3%), 1 283(18.2%), and 320(4.5%)people respectively. Elderlies with different ADL had different aging care willingness, and the difference was statistically significant( Z=8.704, P<0.05). The factors influencing long-term care services need varied with the degree of ADL. The willingness was a common factor for long-term care services needs of the three elderly groups. The age and living arrangements were factors among the normal ADL group. The living arrangements and chronic diseases were those among the decreased function group, and the education and self-rated economic status were those among the dysfunction group. Conclusions:The demand for long-term care service were diversified with the degree of ADL. Targeted interventions should be taken to meet the needs of elderlies of different ADL.

Objective:To investigate the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood platelet count (BPC) in judging the prognosis of adult patients with extensive burns.Methods:From January 2012 to December 2018, 99 adult patients with extensive burns who met the inclusion criteria were admitted to Union Hospital of Fujian Medical University, including 76 males and 23 females, aged 18 to 75 (43±13) years. According to the prognosis, the patients were divided into survival group of 79 cases and death group of 20 cases. Their clinical data were retrospectively analyzed by the method of case-control study. The gender, age, total burn area, inhalation injury, use of mechanical ventilation and white blood cell count, neutrophil count, lymphocyte count, and BPC on post injury day (PID) 1, 3, and 7 were collected, and the NLR, PLR, difference value of BPC on PID 3 and PID 1 (ΔBPC3), difference value of NLR on PID 3 and PID 1 (ΔNLR3), difference value of PLR on PID 3 and PID 1 (ΔPLR3), difference value of BPC on PID 7 and PID 1 (ΔBPC7), difference value of NLR on PID 7 and PID 1 (ΔNLR7), difference value of PLR on PID 7 and PID 1 (ΔPLR7) of patients in the two groups were calculated. Data were statistically analyzed with Mann-Whitney U test, independent sample t test, chi-square test to screen the death-related factors of patients. Binary classification single factor and multifactor logistic regression analysis were used to analyze the death-related factors of patients. The receiver′s operating characteristic (ROC) curve of the independent risk factor of death of patients predicting the prognosis of adult patients with extensive burns was drawn, and the area under the curve, the optimal threshold and its sensitivity and specificity were calculated. Results:(1) There were statistically significant differences in total burn area and use of mechanical ventilation of patients between the two groups ( Z=-2.615, χ2=7.282, P<0.01). (2) On PID 1, there was statistically significant difference in NLR of patients between the two groups ( Z=-2.414, P<0.05). On PID 3, there were statistically significant differences in BPC and ΔNLR3 of patients between the two groups ( Z=-2.048, -2.780, P<0.05 or P<0.01). On PID 7, there were statistically significant differences in lymphocyte count, BPC, NLR, and ΔNLR7 of patients between the two groups ( Z=-2.248, -2.231, -2.641, -3.669, P<0.05 or P<0.01). (3) Binary classification single factor logistic regression analysis showed that the total burn area, mechanical ventilation, BPC and NLR on PID 7, and ΔNLR7 were related to death of patients (odds ratio=1.038, 0.193, 0.990, 1.086, 1.105, 95% confidence interval=1.010-1.067, 0.062-0.598, 0.982-0.998, 1.012-1.165, 1.037-1.178, P<0.05 or P<0.01). Binary classification multifactor logistic regression analysis showed that ΔNLR7 was the independent risk factor of death of adult patients with extensive burns (odds ratio=1.090, 95% confidence interval=1.008-1.178, P<0.05). (4) The optimal threshold of ROC curve of ΔNLR7 for predicting the prognostic death of 97 adult patients with extensive burns was -0.073 4. The sensitivity under the optimal threshold was 65.0%, and the specificity was 78.5%. The area under the ROC curve was 0.776 (95% confidence interval=0.650-0.882, P<0.01). Conclusions:Dynamic monitoring of NLR and BPC is of great significance to assist in judging the prognosis of adult patients with extensive burns. ΔNLR7 is an independent predictor of death in adult patients with extensive burns, while PLR can not predict the death of adult patients with extensive burns.

Objective:To investigate the effect and mechanism of exosomes derived from human amniotic epithelial cells (hAEC-Exos) on the proliferation and migration of HaCaT in high glucose environment.Methods:The experimental research method was adopted. The amniotic membrane tissue was collected from 10 healthy pregnant women at full term delivery in the Department of Obstetrics and Gynecology of Fujian Medical University Union Hospital from January to June 2019, and the primary human amniotic epithelial cells (hAECs) were isolated. The growth status and morphological changes of the primary hAECs on the 2nd, 4th, and 7th day of culture were observed, and the expressions of the cells surface markers of CD73, CD90, CD29, CD34, and human leukocyte antigen DR (HLA-DR). The 2nd to 4th passages of hAECs were used in the following experiments. The hAEC-Exos were separated by ultracentrifugation method. The HaCaT and hAEC-Exos were co-cultured for 3 h, and the uptake of hAEC-Exos by HaCaT was observed by inverted fluorescence microscopy. The HaCaT were divided into phosphate buffer solution (PBS) group and hAEC-Exos group or dimethyl sulfoxide (DMSO)+PBS group, DMSO+hAEC-Exos group, and LY294002+hAEC-Exos group, which were dealt correspondingly, with 3 wells in each group. Cell counting kit 8 (CCK-8) method was used to detect cell proliferation activity after 0 (immediately), 12, 24, 36, 48, and 60 h of culture. The scratch test was conducted to detect the scratch healing at 0, 24, 48, and 72 h after the scratch, and the scratch healing rate was calculated, respectively. The Transwell experiment was conducted to detect the number of transmembrane cells after 48 h of culture. The Western blotting was used to detect the protein expressions of mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), protein kinase B (Akt), and phosphorylated Akt (p-Akt) related to phosphatidylinositol 3-kinase-Akt-mTOR (PI3K-Akt-mTOR) pathway after 24 h of culture. Data were statistically analyzed with analysis of variance for repeated measurement, one-way analysis of variance, and independent sample t test. Results:Most of the primary hAECs were oval and uniform in size on the 2nd day of culture. The hAECs were arranged in a typical cobblestone-like monolayer on the 4th and 7th day of culture. The primary hAECs highly expressed CD73, CD90, and CD29 of mesenchymal stem cell related surface markers, and were with no or low expressions of CD34 and HLA-DR of hematopoietic stem cell related surface markers. After 3 h of culture, hAEC-Exos were successfully endocytosed by HaCaT into the cytoplasm and gathered around the nucleus. After 12, 24, 36, 48, and 60 h of culture, the proliferation activity of HaCaT in hAEC-Exos group was significantly higher than that in PBS group ( t=3.691, 10.861, 12.121, 10.531, 14.931, P<0.01). At 24, 48, and 72 h after scratch, the scratch healing rates of HaCaT in PBS group were significantly lower than those in hAEC-Exos group (t=3.342, 6.427, 5.485, P<0.05 or P<0.01). After 48 h of culture, the number of transmembrane HaCaT in hAEC-Exos group was significantly more than that in PBS group ( t=5.385, P<0.01). After 24 h of culture, the protein expressions of p-mTOR and p-Akt in HaCaT of hAEC-Exos group were significantly higher than those in PBS group ( t=4.240, 5.586, P<0.01), while the protein expressions of mTOR and Akt in HaCaT of the two groups were similar ( P>0.05). After 24 h of culture, the protein expressions of p-mTOR and p-Akt in HaCaT of DMSO+hAEC-Exos group were significantly higher than those in DMSO+PBS group ( t=6.155, 8.338, P<0.01) and LY294002+hAEC-Exos group ( t=5.030, 3.960, P<0.01), while the protein expressions of mTOR and Akt in HaCaT of the three groups were similar ( P>0.05). The proliferation activity of HaCaT in DMSO+hAEC-Exos group at 12, 24, 36, 48, and 60 h of culture was 0.78±0.05, 1.23±0.07, 1.60±0.09, 1.86±0.09, and 2.03±0.08, which was significantly higher than 0.46±0.04, 0.69±0.07, 0.98±0.08, 1.16±0.08, and 1.26±0.11 in DMSO+PBS group ( t=4.376, 7.398, 8.488, 9.766, 10.730, P<0.01). The proliferation activity of HaCaT in DMSO+hAEC-Exos group at 24, 36, 48, and 60 h was significantly higher than 0.96±0.09, 1.20±0.08, 1.39±0.08, and 1.55±0.10 in LY294002+hAEC-Exos group ( t=3.639, 5.447, 6.605, 6.693, P<0.05 or P<0.01). The scratch healing rates of HaCaT in DMSO+hAEC-Exos group at 24, 48, and 72 h after scratch were significantly higher than those in DMSO+PBS group ( t=4.003, 6.349, 7.714, P<0.01) and LY294002+hAEC-Exos group ( t=3.805, 4.676, 4.067, P<0.05 or P<0.01). After 48 h of culture, the number of transmembrane HaCaT in DMSO+hAEC-Exos group was significantly more than that in DMSO+PBS group and LY294002+hAEC-Exos group, respectively ( t=7.464, 1.232, P<0.01). Conclusions:PI3K-Akt-mTOR pathway can promote the proliferation and migration of HaCaT in high glucose environment by mediating hAEC-Exos.

Objective:To explore the clinical effects of antegrade anterolateral thigh pedicled flaps in repairing wounds in the perineum or inguinal regions.Methods:The study was a retrospective observational study. From January 2022 to May 2024, 7 patients with wounds in the perineum or inguinal regions who met the inclusion criteria were admitted to Fujian Medical University Union Hospital, including 5 males and 2 females, aged 54 to 72 years. The wound area after debridement was 8 cm×6 cm to 16 cm×11 cm. During the operation, antegrade anterolateral thigh pedicled flaps with area of 9 cm×7 cm to 18 cm×13 cm were harvested to repair the wounds. The wounds in the flap donor sites were sutured directly or repaired with split-thickness skin grafts from the thigh. The survival of flaps and the healing of wounds and the survival of skin grafts in flap donor sites were observed after operation. During follow-up, the texture, color, and blood supply of flaps were observed, the muscle strength of the lower extremities on the affected side was evaluated according to Lovett muscle strength grading standard, the muscle tension of the lower extremities on the affected side was evaluated by modified Ashworth scale, and the recovery of lower extremity movement, wound recurrence, and scar formation in the flap donor sites were observed.Results:The flaps all survived successfully after operation. All the wounds in the flap donor sites healed and the skin grafts all survived. During 2 to 29 months of follow-up, the flaps were soft in texture, similar in color to the surrounding normal skin tissue with good blood supply. The muscle strength of the lower extremities on the affected side was evaluated as grade 4 in 2 patients and grade 5 in 5 patients. The muscle tension was grade 0 in all patients with no abnormality in movement. No wound recurred and no obvious scar deformity in the flap donor site was observed.Conclusions:The antegrade anterolateral thigh pedicled flap transplant is one of the effective methods to repair wounds in the perineum and inguinal regions. The procedure is easy to operate, with good postoperative appearances of the donor and recipient sites and good function of affected limbs, which is worthy of clinical promotion.