Objective To evaluate the clinical effects of platelet-rich plasma in treatment of DeepⅡburn wounds. Methods Sixty eight cases of inpatients with Deep Ⅱburns were selected, whose age were from 1 to 65 years and their burn areas were between 5%~62%of total body surface area (TBSA). Deep gradeⅡburn of each sample was divided into two parts. Part A was the treatment group and part B was the control group.The burn wounds in the treatment group were treated with platelet-rich plasma and the counterpart in the control group were treated with SD-Ag. Healing time ,recovering rate and the frequency of dressing changes,frequency of changing the most innerlayer gauze and the rate of wound infection were also analyzed. Finally the laboratory abnormalities and adverse effect were monitored regularly. Results The healing time of the treatment group (16.5±3.1 ) d was shorter than that of the control group (19.5±3.8 ) d. The recovering rate of the treatment group was higher than that of the control group on the 14th and 17th day after treatment. There were statistically sig?nificant differences between these two groups (P<0.05). After two weeks’treatment, the internal and external dressing per?meability into wet gauze layers were 20.6 ± 1.7, which were significantly decreased than that in the control group 23.3 ± 5.9. The frequency of dressing changes was(7.2±1.1)times in treatment group versus(9.2±1.4)times in control group and the frequency of changing the inner most layer gauze was( 2.3±0.6)times in the treatment group versus(5.3±1.3)times in con?trol group. There were 5 inflammation reaction cases in the treatment group, but 13 cases in the control group. However, there was no statistic significance between the two group in the outcomes of bacterial culture, the laboratory abnormalities and the adverse effect. Conclusion Platelet-rich plasma can remarkably shorten the healing time,improve healing rate,re?duce frequency of dressing change and promote wound healing for deepⅡburn wound. PRP is a potential safety reagent in treating deepⅡburn wound.

s: Objective To investigate the efficacy and safety of ultrasound-guided upper-pole access percutaneous nephrolithotomy (PCNL) for the treatment of renal staghorn calculi. Methods From October 2008 to July 2012,193 cases of renal staghorn calculi treated with ultrasound-guided upper-pole access PCNL were reviewed. Among the 193 cases,74 cases were complete staghorn calculi while the other 119 cases were partial staghorn calculi, and the calculi diameter was 2. 5 to 9. 0 cm. All the 193 cases were treated through upper-pole ac-cess successfully,70 accesses were accomplished below the 12th rib,while the other 123 accesses were accomplished between the 11th adn 12th rib. Disintegration of the stone was accomplished using Holmium laser. Results The mean operative time was 70 min (45~150 min), single tract was used in 186 cases, and double tracts were used in the other 7 cases. The stone clearance rate for one session was 72. 0%(139/193),and the total stone clearance rate was 88. 1%(170/193). Transfusion was required in 6 patients, while 2 patients with signifi-cant bleeding were treated with selective renal arterial embolization. Hydrothorax occured in 4 patients, and closed thoracic drainage was re-quired in 2 of them. 20 patients had fever, and they recovered after effective antibiotic treatment. No patients had injury to the lung or other viscera. Conclusion Upper-pole access offers optimal visibility and convenience for rigid ureteroscope to achieve a high rate of stone-free status and operating time reduce. Ultrasound guided upper-pole access PCNL should be attempted in selected cases of renal staghorn stone.

BACKGROUND: To discuss the feasibility of allogeneic freeze-drying radiation sterilization bone sheet applying in the prevention of post-laminectomy adhesion as an ideal biological material for filling and repairing bone defect. OBJECTIVE: To observe the preventive effect of allogeneic freeze-drying radiation sterilization bone sheet on the postlaminectomy adhesion and restenosis.DESIGN: Follow-up survey on cases.SETTINGS: Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology; Shanxi Medical Tissues of China Institute for Radiation Protection PARTICIPANTS: From March 2003 to June 2005, 58 patients with segmental lumbar spinal stenosis (LSS) were selected from Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology, including 34 males and 24 females, aged 30-78 years, including 25 cases of simple LSS and 33 combined LSS; and including 36 cases in L4-5 and 33 cases in L5, S1 segments. All the patients were similar in age, gender and healthy conditions.METHODS: The segmental whole laminectomies were performed in 58 patients with prolapse of lumbar intervertebral or LSS, and allogeneic freeze-drying radiation sterilization bone sheet in "H" shape was used to cover the vertebral laminae. According to the follow-up standard of lumbar spine operation recommended by the Orthopaedics Branch of Chinese Medical Association, all patients were followed up to evaluate their clinical symptoms, absorption of implanted bone as well as CT and MRI presentations.MAIN OUTCOME MEASURES: Improvements of clinical symptoms;Absorption of bone sheet in lumbar spinal canal.RESULTS: Totally 58 LSS patients were involved in the result analysis.In postoperative 0.5-year follow-up period, 17 of 21 patients showed excellent curative effects while other 4 patients showed fine effects. In postoperative 1-year follow-up period for 23 patients, CT and MRI results demonstrated that the spinal canal had been extended obviously. There was no tilt or displacement of the femoral sheet or compression of the spinal cord. As for 14 patients who were followed up for 1.5 years, CT results displayed that there was no rejective reaction observed in this study. The edgeof the allograft was inosculated with connective lamina of vertebra, and the shape of lumber spinal was good.CONCLUSION: Allogeneic freeze-drying radiation sterilization bone sheet is an ideal dressing material for epidural laminoplasty. The imaging results of patients in postoperative 1.5-year follow-up indicate that it can effectively reduce the post-laminectomy adhesion formation and prevent recurrence of post-laminectomy spinal restenosis, so as to apply on the segmental vertebral plate dressing.

Objective To discuss the clinical characteristics of yon Hippel-Lindau (VHL)syndrome and the significance of genetic test for this disease.Methods Patients with VHL disease from 3 different families were reviewed from August 1985 to October 2017.The study was including clinical family survey and VHL-gene test on phylogenetic level.Totally 21 family members from 3 families were investigated,consisting of 14 males and 7 females with average age of 48.6 (5-70)years when analyzed.There were 8 patients with VHL disease comprising 5 males and 3 females with average onset age of 31.5 (9-67) years.Results The proband of pedigree one (VHL-Ⅱ C) was diagnosed as pheochromocytoma (PHEO) of right adrenal gland at 18 years old and underwent adrenalectomy,and her son was diagnosed with PHEO of bilateral adrenal glands with diagnostic age of 9 years old and received bilateral adrenalectomy sequentially.Her niece was diagnosed as PHEO of bilateral adrenal glands at 28 years old and received bilateral adrenal-sparing surgery simultaneously.Genetic analysis revealed a heterozygous mutation located at the third exon of the VHL gene (c.482G ＞ A).The proband of pedigree two (VHL-Ⅱ B) was diagnosed as right PHEO,bilateral multiple renal clear cell carcinoma (RCC),multiple pancreatic cysts and bilateral epididymal cystadenoma,and he received right adrenalectomy,right partial nephrectomy at 25 years old and delayed eystadenoma excision.His younger brother was also diagnosed as bilateral,pancreatic multiple cysts and bilateral epididymal nodules at 27 years old,and underwent right radical nephrectomy.Genetic analysis revealed a heterozygous mutation located at the first exon of the VHL gene (c.233A ＞ G).The proband of pedigree three (VHL-Ⅱ B) was diagnosed with central nerve system hemangioblastomas (CNS-HB) at 35 years old and received external beam radiotherapy.His elder sister was diagnosed as CNS-HB at 43 years old and received surgery.His father was diagnosed as right PHEO,bilateral RCC,bilateral multiple renal and pancreatic cysts and pancreatic neuroendocrine tumors at 67 years old.He received right adrenalectomy and partial nephrectomy.Genetic analysis showed a heterozygous mutation located at the third exon of the VHL gene(c.500G ＞ A).In addition,two cases (F2-Ⅲ 1 and F3-ⅣV1) were found to be asymptomatic VHL gene carriers by genetic screening.8 patients were followed up for an average of 9.8 (2-32) years.The symptoms were stable and no local recurrence or distant metastasis was found after operation.In this study,no CNS-HB was found in patients within family 1 and family 2,and RCC in 3 patients within family 2 and family 3 were low grade.Conclusions The clinical manifestations of VHL disease are diverse.RCC and CNS-HB are not present in all patients with the disease.PHEO is the only manifestation in patients with VHL-ⅡC.It is necessary to inform the members of VHL syndrome family for genetic test.Genetic test combined with clinical screening can facilitate differential diagnosis for VHL syndrome and other hereditary urological diseases.

Aim To evaluate the short-term biocompatibility of a newkind of prosthetic nucleus-Evergel, which is made from the modifiedpolyvinyl alcohol hydrogel. Methods According to China national standardGB/T16886 documents, the toxicity of Evergel prosthetic nucleus materialwas investigated by the cytotoxicity test, sensitization test, haemolysis test,Ames test, mice marrow micronucleus test and chromosome aberration test ofmammalian cell in vitro. Results This material had no cytoxicity, no sen-sitivity, no obvious haemolysis, and no mutagencity in Ames test, micemarrow micronucleus test and chromosome aberration test of mammalian cellin vitro. Conclusion The Evergel prosthetic nucleus has a good biocom-patibility and can be used clinically.

Objective:To clarify the anti-inflammatory effects and anti-endoplasmic reticulum stress effects of resolvin D2 (RvD2) in viral myocarditis mice and to explore its possible mechanism.Methods:Fifty male BALB/c mice were collected and assigned corresponding numbers. Then 40 male BALB/c mice were selected randomly with 10 mice in each group. They were set as normal control group, RvD2 control group, viral myocarditis group and RvD2 treatment group. Afterwards, mice in the RvD2 control group received continuous intraperitoneal injection of RvD2 for 7 days, while mice in the viral myocarditis group received intraperitoneal injection of Coxsackievirus B3 virus (CVB3) in the purpose of constructing an animal model of viral myocarditis. Then, mice in the RvD2 treatment group were given continuous intraperitoneal injection of RvD2 for 7 days. After these 7 days, the mice of each group were sacrificed and their cardiac tissue and serum samples were taken. The expression levels of serum inflammatory factors including IL-1β and TNF-α were detected by ELISA in each group of mice, and HE staining were used to detect the inflammatory cell infiltration in myocardial tissue of each group. Meanwhile, the expression levels of inflammation-related proteins IL-1β, TNF-α as well as endoplasmic reticulum stress-related proteins like GRP78 and Chop in the myocardial tissue in each group of mice were detected by Western blot experiment. The remaining 10 BALB/c mice were treated with intraperitoneal injection of RvD2 as well as GPR18 protein inhibitors after constructing the animal model of viral myocarditis mentioned above. In the end, the expression levels of GPR18 protein, inflammation-related proteins including IL-1β and TNF-α as well as endoplasmic reticulum stress-related proteins like GRP78 and Chop in the myocardial tissue of each group were detected by Western blot experiments.Results:Compared with the normal control group, the expression levels of inflammatory factors IL-1β and TNF-α in the serum of mice with viral myocarditis were significantly increased, and the degree of infiltration of inflammatory cells in myocardial tissue was also significantly increased. Besides, the expression levels of the inflammation-related proteins IL-1β, TNF-α as well as endoplasmic reticulum stress-related proteins including GRP78 and Chop increased largely. While compared with the viral myocarditis group, the expression levels of serum inflammatory factors IL-1β and TNF-α in the mice of the RvD2 treatment group were significantly reduced and the degree of infiltration of inflammatory cells in the cardiac tissue was significantly reduced. Also, the expression levels of inflammation-related proteins IL-1β and TNF-α as well as endoplasmic reticulum stress-related proteins GRP78 and Chop were significantly reduced. After intraperitoneal injection of RvD2 and GPR18 inhibitor, in the mice treated with viral myocarditis, the expression levels of IL-1β, TNF-α and endoplasmic reticulum stress-related proteins like GRP78 and Chop in myocardial tissue of these mice significantly increased when it came to compare with the RvD2 treatment group, while the expression levels of GPR18 protein were significantly reduced.Conclusions:RvD2 can inhibit the inflammatory response and endoplasmic reticulum stress injury in mice with viral myocarditis by binding to the membrane protein receptor GPR18, thus exerting a protective effect on heart.

Objective To establish a high-precision and high-specificity quantitative nuclear magnetic resonance phosphorus spectrometry method(31P-qNMR)for detecting the phosphorus content in calcium hydrogen phosphate chewable tablets.Methods Hexamethyl phosphoramide was used as an internal standard,phosphorus spectrum data of calcium hydrogen phosphate chewable tablets solution was collected.The linear relationship of calcium hydrogen phosphate within the concentration range of 1.0 to 9.0 mg/ml was studied,and sample recovery rate and repeatability experiments were conducted.Results Calcium hydrogen phosphate and the internal standard demonstrated a good linear relationship within the concentration range of 1.0 to 9.0 mg/ml,with a regression equation A=0.004 3+0.183 6C.The recovery rates for low,medium,and high concentrations were 98.0%,98.1%,and 98.4%,respectively,with relative standard deviations(RSD)of 0.31%,0.68%,and 0.62%,respectively(n=9).The average content of calcium hydrogen phosphate in the chewable tablets was determined to be 98.1%.Conclusion This study successfully established a high-precision and highly specific method for quantifying the content of calcium hydrogen phosphate in chewable tablets,which did not require a self-reference substance,was simple in sample preparation,and had a fast detection speed.The method could provide a new technical support for the quality control of phosphorus-containing drugs.

Objective To study the phosphorylation of AKT2 protein and autophagy activation in cardiac tissues of mice infected with coxsackievirus B3 (CVB3) for further analyzing the regulatory mecha-nism of PI3K/AKT2/mTOR signaling pathway on autophagy activation in viral myocarditis. Methods Thir-ty BALB/c mice were randomly divided into three groups (n=10): control group, myocarditis group and AKT activator-treated group. Those in the latter two groups were intraperitoneally injected with CVB3 to es-tablish the mouse model of acute viral myocarditis. Daily intraperitoneal injection of 0.04 mg/g of Akt acti-vator (SC79) was given to each mouse in the AKT activator-treated group 24 hours after CVB3 infection for 7 consecutive days,while the mice in the other two groups were given the same dose of normal saline. HE staining was used to observe the infiltration of inflammatory cells and tissue necrosis. Expression of CVB3 and inflammatory cytokines such as IL-1β and IL-6 in cardiac tissues at mRNA level was detected by q-PCR. Brain natriuretic peptide(BNP) and cardiac troponin I(cTnI) were measured by ELISA to evaluate myocardial injury. Changes in the expression of autophagy-related protein LC3 and Beclin1 at protein level as well as PI3K/AKT2/mTOR pathway were analyzed by Western blot assay. Results Compared with the con-trol group,massive inflammatory cell infiltration was observed in cardiac specimens of mice with myocarditis, but no obvious tissue necrosis was detected. Moreover,expression of CVB3 and inflammatory factors in car-diac tissues at mRNA level,levels of BNP and cTnI in blood,LC3Ⅱto LC3Ⅰratio as well as Beclin1 pro-tein level in cardiac tissues were significantly increased after CVB3 infection(P<0.05),whereas the activi-ty of PI3K/AKT2/mTOR signaling pathway was decreased. AKT activator not only down-regulated the LC3Ⅱ to LC3Ⅰratio and the expression of Beclin1 protein, but also enhanced the activation of PI3K/AKT2/mTOR signaling pathway in cardiac tissues of mice with myocarditis (P<0.05). Conclusion Enhanced autophagy and suppressed PI3K/AKT2/mTOR signaling pathway are observed in cardiac tissues of mice with myocarditis,indicating that the activation of autophagy may be regulated by PI3K/AKT2/mTOR signaling pathway.

The medical metaverse is a combination of medicine and other cutting-edge technologies such as computer and information ones. In the medical metaverse, medical knowledge in the real world will be transformed into a digital form, so that activities concerning diagnosis, treatment, education and clinical practice can be carried out in a virtual environment. Based on the latest research advances at home and abroad, this review expounds on the medical metaverse from the aspects of supporting technologies, applications in clinic and medical education, current deficiencies and future development.

Since the first medical reform, China has carried out three reforms and improvements to the medical system. However, there are still some shortcomings, the problems at different levels are mainly reflected in the doctor-patient relationship. Doctor-patient conflict has become one of the hot topics of social focus. Under the development of the country and the joint efforts of all parties, doctor-patient conflict has been alleviated to a certain extent, and the doctor-patient relationship has been developing in a better direction. With the proposal of the concept of "doctor-patient community with a shared future", the joint construction of a community between doctors and patients has become a further goal. Mencius’ theory of original goodness of human nature echoes the construction of the contemporary doctor-patient community with a shared future. It criticizes the empirical theory of human nature and emphasizes the constructive and initiative of goodness in nature, that is, to achieve goodness in nature through preservation and expansion. In the doctor-patient relationship, goodness in nature is the construction of doctor-patient community with a shared future, which requires both doctors and patients to work together with firm confidence and gradually complete the construction of the community by continuous practice.