AIM: To observe the level of vascular endothelial growth factor (VEGF) secreted by monocytes cultured with electrical burn serum, and to explore the effect of VEGF on monocyte-endothelial cell adhesion.METH-ODS:The electrical burn serum of the rat was prepared.The normal serum from the rats without treating electric current was also collected for control.The contents of VEGF and its soluble receptor sFlt-1 in electrical burn group were determined by double-antibody sandwich ELISA.THP-1 cells were randomly divided into normal serum group and electrical burn serum group.The contents of VEGF and sFlt-1 in the culture supernatants were measured by double-antibody sandwich ELISA. THP-1 cells were also randomly divided into another 4 groups:normal serum group, electrical burn serum group, normal serum +inhibitor group and electrical burn serum +inhibitor group.THP-1 cells, which were incubated with the serum for 3 h and 6 h, were labeled with calcein-AM and then were added into the well with monolayer of endothelial cell line EA.hy926 to detect monocyte-endothelial cell adhesion.RESULTS:The levels of serum VEGF of the rats with electrical burns were significantly increased, the levels of serum sFlt-1 were significantly decreased as compared with the controls. The levels of VEGF secreted by THP-1 cells cultured with electrical burn serum were significantly increased, the levels of sFlt-1 were decreased correspondingly.Electrical burn serum enhanced monocyte-endothelial cell adhesion, sFlt-1 inhibi-ted the adhesion between monocytes and endothelial cells.CONCLUSION:The monocytes exposed to the electrical burn serum secrete VEGF, which enhance the adhesion between monocytes and endothelial cells.Blockage of VEGF activity may effectively inhibit monocyte-endothelial cell adhesion.

Objective To investigate the hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination reengineering the surgical methods and clinical effects of thumb.Methods From May,2010 to February,2015,thcrc had fifteen cases of the thumb defect on Ⅱ-Ⅳ degree of the patients in our hospital,and we took anastomosis vascular pedicle of the hallux nail flap and thumb reconstruction with a second phalange with the tibia lateral diamond shaped flap,joint,and tendon composite tissue combination to reconstruct the thumb.The provided district of the second metatarsal was amputated to repair the ligaments between metatarsal bones.And we took the second toe bone nail flap covering the hallux toe area wound in anterograde shift.Results 15 cases of thumb reconstruction survived.The patients were followed-up for 6 to 30 months,the shape of the reconstructed thumb was closed to the contralateral thumb.The thumb to the finger and the palm function was good,two-point discrimination of the finger pulp were 0.6-1.0 cm.According to the upper limb function of the Chinese Medical Association Hand Surgery Society,the upper limb partial function of the evaluation trial standard:excellent in 11 cases,good in 4 cases.The district was recovered well,normal walking and running function were not restricted.Long term follow-up showed no blisters formation and skin ulceration.No nail deformity,good growth.Conclusion The hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination to reconstruct the thumb of the defect on Ⅱ-Ⅳ degree can restore good function and feeling,but also to have beautiful appearance.It is an effective method for reconstruction of thumb defect on Ⅱ-Ⅳ degree.

Objective To evaluate the cardiac function of the patients with liver cirrhosis before orthotopic liver transplantation(OLT)using Swan-Ganz catheter.Methods Sixty ASAⅡ-Ⅳ patients aged 45-64 yr with liver cirrhosis scheduled for OLT without veno-venous bypass were allocated into 2 groups according to preoperative liver function:compensated group(group C,n=28)and decompensated group(group H,n=32).Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propofol 1 mg/kg and vecuronium 0.1 mg/ks and maintained with 0.5%-3.0% isoflurane,fentanyl 0.05-0.10 mg and vecuronium 4 mg/h.The patients were mechanically ventilated after tracheal intubation,and P_(ET)CO_2 was maintained at 30-45 mm Hg.Radial artery was cannulated and Swan-Ganz catheter was placed via right internal jugular vein for monitoring of mean arterial pressure(MAP),cardiac output(co),cardiac index(CI),right ventricular ejection fraction(RVEF),mean pulmonary arterial pressure(MPAP),pulmonary arterial wedge pressure(PAWP),right atrial pressure(RAP),right ventricular end-diastolic volume(RVEDV),fight ventricular end-systolic volume(RVESV)and stroke volume index(SVI).Right and left ventricular stroke work index(RVSWI,LVSWI)and systolic and pulmonary vascular resistance(SVR,PVR)were calculated.Results CO,CI,SVI,MPAP,PAWP,RVEDV,RVESV,RVSWI and LVSWI were significantly elevated in group H as compared with group C indicating hyper-hemodynamic state.The SVR and PVR were significantly decreased in group H.There was no significant difference in HR,MAP,RAP and RVEF between the two groups.Conclusion The patients with decompensated liver function before OLT are in a hyper-hemodynamic state.More attention should be paid to perioperative myocardial protection.

Objective To evaluate the synergistic effect of Baoxinkang on chronic heart failure ( CHF) rats by observing the effect of the combination of Baoxinkang and conventional medicine intervention on cardiac function and adenylate metabolism. Methods Sixty Sprague-Dawley rats were randomly divided into 6 groups, namely sham-operation group, model group, Baoxinkang group ( Baoxinkang 1 020 mg/kg) , conventional medicine intervention group (metoprolol 10 mg/kg, captopril 5 mg/kg, and digoxin 0.022 5 mg/kg), combination group 1 ( conventional medicine intervention + Baoxinkang 1 020 mg/kg) , and combination group 2 ( conventional medicine intervention + trimetazidine 10 mg/kg) . Abdominal aora was constricted to establish CHF rat model. The rats except for the sham-operation group and model group were given the corresponding medicine according to the experimental design for 6 weeks. Echocardiography ( ECHO) was performed to evaluate the cardiac function of rats. High performance liquid chromatography was utilized to investigate the contents of myocardiac adenylate of adenosine triphosphate ( ATP) , adenosine diphosphate ( ADP) , adenosine monophosphate (AMP) . Total adenylate nucleotide pool (TAN) was equal to ATP+ADP+AMP, energy charge (EC) was equal to ( ATP+0.5 ×ADP) /TAN. Results The results of ECHO showed that the heart size was reduced, left ejection fraction and cardiac output were increased in the combination group 1 compared with the model group and conventional medicine intervention group. The levels of ATP, TAN, and EC were significantly increased, whereas the levels of ADP and AMP were decreased in the combination group 1 (P<0.05 or P<0.01). However, there were no significant differences of heart size, left ejection fraction, cardiac output, ATP, ADP, AMP, TAN or EC between combination group 1 and combination group 2 ( P>0.05) . Conclusion Baoxinkang may have some synergistic effect on the improvement of CHF rat cardiac energy metabolism disorder treated by conventional medicine.

Objective:To assess the enhancement characteristics of responsibility plaque of patients with intracranial artery stenosis(ICAS)and explore the correlation between that and stroke by using three dimensional high-resolution magnetic resonance imaging(3D-HR-MRI).Methods:A total of 72 ICAS patients who admitted to Beijing Huairou Hospital from April 2019 to April 2022 were retrospectively selected as the study objects,with a total of 96 atherosclerotic stenosis plaques.The plaques were divided into mild to moderate stenosis group(33 cases)and severe stenosis group(63 cases)according to the results of whole brain digital subtraction angiography.They were also were divided into sub-acute/acute plaque group(within 1 month)(47 cases)and non-acute plaque group(including chronic and non-responsible plaques)(49 cases)according to the time of occurring plaque.The imaging characteristics of the 3D-HR-MRI results were assessed by two radiologists.The degrees of plaque enhancement referred to the degrees of pituitary enhancement,and the degrees of plaque enhancement were divided into significant enhancement group(52 cases)and non-significant enhancement group that included moderate enhancement group and non-enhancement group(44 cases).The relationships between ICAS,degree of plaque enhancement and stroke were analyzed.Results:A total of 96 atherosclerotic stenosis plaques were confirmed in 72 patients.The statistical analysis of Kruskal-Wallis H test of multiple samples showed that there was a significant correlation between the time of occurring plaque and the degree of plaque enhancement(H=3.294,P＜0.05).Univariate Logistic regression analysis indicated that the difference between the acute plaque group and the non-acute plaque group was respectively significant correlations with ICAS degree[P＜0.05,OR(95%CI)=1.0(0.3-2.6)]and degree of plaque enhancement[P＜0.05,OR(95%CI)=1.0(0.4-2.0)].The multivariate Logistic regression analysis demonstrated that both severe arterial stenosis[P＜0.05,OR(95%CI)=1.0(0.3-1.9)]and significant enhancement of plaque[P＜0.05,OR(95%CI)=1.0(0.4-2.1)]were independent risk factors of stroke.Conclusion:Severe ICAS and significant plaque enhancement are the independent risk factors of stroke,which can provide effective basis for clinical prevention,diagnosis and treatment of stroke.

Objective:To investigate the characteristics and distribution of plaque of patients with mild middle cerebral artery(MCA)stenosis by using three dimensional(3D)high-resolution magnetic resonance imaging(3D HR-MRI),and the correlation between that and the occurrence of ischemic stroke.Methods:The clinical data of 64 patients with mild MCA stenosis who admitted to Beijing Huairou hospital from March 2020 to March 2022 were retrospectively analyzed.They were divided into symptomatic group(n=30)and asymptomatic group(n=34)according to whether occurred transient ischemic cerebral attack or ischemic cerebral stroke.The degree and distribution of plaque enhancement between the two groups were assessed and analyzed,and the correlation of plaque features in HR-MRI and ischemic stroke was analyzed.Results:There were a total of 71 plaques in 64 patients,including 30 responsible plaques and 41 non-responsible plaques.The enhancement degree of responsible plaques was significantly stronger than that of non-responsible plaques,and the difference was statistically significant(Z=5.645,P<0.05).Compared with non-responsible plaques,the responsible plaques more concentrated at the dorsal and upper walls of MCA,and the probability of occurring positive remodeling of responsible plaques was greater than that of non-responsible plaques,with statistical significance(x2=7.658,P<0.05).Conclusion:In patients with mild MCA stenosis,the degree enhancement and distribution location of plaque,and positively remodeling index of vessel are closely related to the occurrence of ischemic cerebral stroke.

Objective: To explore the differential expression of microRNAs in the serum among patients with electrical burn or thermal burn and healthy persons and to explore the significance. Methods: In this study we included three patients with electrical burn and three patients with thermal burn, conforming to the inclusion criteria and hospitalized in our burn ward from June to August 2015, and three healthy adult volunteers. Their serum samples were separated from whole blood and divided into electrical burn group, thermal burn group, and normal control group. Total RNA was extracted from their serum samples using Trizol method. The differentially expressed microRNAs (with differential ratio larger than or equal to 2.000, less than or equal to 0.500) among the three groups were screened by microRNA chip technique. Then cluster and Venn diagram analysis of the differentially expressed microRNAs were performed. Enrichment analysis of Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway was performed on the distinctly changed microRNAs (with differential ratio larger than or equal to 5.000, less than or equal to 0.500). Results: There were 220 differentially expressed microRNAs among serum of the three groups. MicroRNA expression profiles in serum of electrical burn and thermal burn groups were different from that in serum of normal control group. Compared with those in serum of normal control group, the expressions of 59 microRNAs changed more than 2.000 times in serum of electrical burn group, with 50 up-regulated microRNAs and 9 down-regulated microRNAs; the expressions of 40 microRNAs changed more than 2.000 times in serum of thermal burn group, with 21 up-regulated microRNAs and 19 down-regulated microRNAs. Compared with those in serum of thermal burn group, the expressions of 167 microRNAs changed more than 2.000 times in serum of electrical burn group. There were 17 exclusively expressed microRNAs in serum of thermal burn group and 26 exclusively expressed microRNAs in serum of electrical burn group, compared with those in serum of normal control group. Enrichment analysis of KEGG signaling pathway showed that compared with those in serum of normal control group, microRNAs which changed distinctly in serum of electrical burn group took part in the insulin secretion signaling pathway, arrhythmogenic right ventricular cardiomyopathy signaling pathway, hypertrophic cardiomyopathy signaling pathway, glutamatergic synapse signaling pathway, calcium signaling pathway, cyclic adenosine monophosphate signaling pathway, glycerophospholipid metabolism, pyrimidine metabolism, serotonergic synapse signaling pathway, etc, while microRNAs which changed distinctly in serum of thermal burn group took part in the tumor transcription misregulation signaling pathway, proteoglycans in tumor signaling pathway, microRNAs in tumor signaling pathway, long-term potentiation signaling pathway, citrate cycle signaling pathway, tumor necrosis factor signaling pathway, focal adhesion signaling pathway, endocytosis signaling pathway, insulin secretion signaling pathway, p53 signaling pathway, and estrogen signaling pathway, etc. Conclusions MicroRNA expression profiles in serum of electrical and thermal burn are different from that in serum of healthy adult. The signaling pathways enriched with target genes which are regulated by the differentially expressed microRNAs are related to the pathological changes and clinical manifestations after electrical or thermal burn.

Objective: To explore differential expression of microRNAs in serum of patients with severe burn and analysis of the signaling pathway at early stage. Methods: In this study, we included three healthy adult volunteers and three patients with severe burn, conforming to the inclusion criteria and hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital in July 2015. Venous whole blood of 6 mL of each burn patient and healthy volunteer was collected at 24 to 48 h post injury of burn patients. The whole blood was divided into burn group and healthy control group. Whole blood of 2 mL of each one was used to determine white blood cell count and neutrophile granulocyte content. Serum was separated from the other whole blood of 4 mL of each one. Half of serum was used to determine content of blood glucose, total protein, and albumin; another half of serum was used to extract total RNA with Trizol method. The differentially expressed microRNA, with differential expression ratio larger than or equal to 1.500 between 2 groups, were screened by microRNA chip technique. Then cluster analysis and functional enrichment analysis of Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway were performed on the differentially expressed microRNAs. Data were processed with t test. Results: (1) Content of white blood cell count, neutrophile granulocyte of whole blood, and blood glucose of serum of patients in burn group was obviously higher than that in healthy control group (with t values from 4.27 to 7.83, P<0.05 or P<0.01). Content of total protein and albumin of serum of patients in burn group was significantly lower than that in healthy control group (with t values respectively -12.80 and -12.36, P values below 0.01). (2)Compared with those in serum of healthy control group, differential expression ratios of 48 microRNAs in serum of burn group were larger than 1.500, with 22 up-regulated microRNAs and 26 down-regulated microRNAs. MicroRNA expression profile in serum of burn group was different from that of healthy control group. (3)Functional enrichment analysis of KEGG signaling pathway showed that compared with those in serum of healthy control group, microRNAs of differential expression in serum of burn group took part in tumor transcription misregulation signaling pathway, tumor proteoglycan signaling pathway, long-term potentiation signaling pathway, tumor associated microRNAs signaling pathway, citrate cycle signaling pathway, tumor necrosis factor signaling pathway, focal adhesion signaling pathway, endocytosis signaling pathway, insulin secretion signaling pathway, and estrogen signaling pathway. Conclusions MicroRNA expression profile in serum of patients with severe burn is different from that in serum of healthy adults. MicroRNAs of differential expression may take part in important pathophysiological process of energy metabolism, inflammatory response, and regulation of blood glucose at early stage of severe burn.

Objective:To investigate the early changes in serum osteoprotegerin/receptor activator of nuclear factor-κB ligand (RANKL) and related indexes of calcium and phosphorus in severe burn patients.Methods:Thirty severe burn patients who met the inclusion criteria and were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital within 8 hours post injury from June 2017 to December 2018 were recruited into severe burn group (24 males and 6 females, aged (38±13) years). Ten healthy volunteers with normal physical examination results in the Physical Examination Center of the same hospital in the same period of time were recruited into healthy control group (7 males and 3 females, aged (37±8) years). A prospective controlled study was conducted. The fasting venous blood of 5 mL was taken from each patient in severe burn group on post injury day (PID) 1, 7, 14, 21, and 28, respectively, and the fasting venous blood of 5 mL was taken from each volunteer in healthy control group. The serum osteoprotegerin, RANKL, 25 hydroxyvitamin D, and parathyroid hormone (PTH) levels were determined by enzyme-linked immunosorbent assay, and the RANKL/osteoprotegerin ratio was calculated. Serum albumin, serum calcium, and serum phosphorus levels were determined by bromocresol green method, methylthymol blue method, and phosphomolybdic acid method, respectively. Data were statistically analyzed with Fisher′s exact probability test, analysis of variance for repeated measurement, Mann-Whitney U test, independent sample t test, and Bonferroni correction. Results:(1) The serum osteoprotegerin levels of patients in severe burn group on PID 1, 7, 14, 21, and 28 were 155.11 (102.91, 187.02), 170.07 (84.60, 196.86), 174.95 (59.09, 208.35), 190.01 (47.08, 214.52), and 188.85 (58.73, 223.13) pg/mL, respectively, which were significantly higher than 33.34 (28.59, 45.68) pg/mL of volunteers in healthy control group, Z=-3.436, -4.311, -3.248, -2.811, -4.217, P<0.01. The serum levels of RANKL of patients in severe burn group on PID 1, 7, 14, 21, and 28 were (1 869±791), (1 746±857), (1 781±713), (2 015±825), and (2 272±583) pg/mL, respectively, significantly higher than (49±16) pg/mL of volunteers in healthy control group, t=12.600, 10.844, 13.294, 13.041, 20.880, P<0.01. The ratios of RANKL/osteoprotegerin of patients in severe burn group on PID 1, 7, 14, 21, and 28 were 12.23 (8.10, 24.73), 11.40 (8.25, 16.96), 11.15 (6.91, 38.32), 12.98 (9.22, 49.68), and 13.91 (10.29, 40.68), respectively, which were significantly higher than 1.17 (0.91, 1.74) of volunteers in healthy control group, Z=-4.560, -4.529, -4.529, -4.560, -4.623, P<0.01. (2) The serum level of 25 hydroxyvitamin D of patients in severe burn group on PID 1 was significantly lower than that of volunteers in healthy control group ( Z=-2.749, P<0.01). Compared with those of volunteers in healthy control group, the serum levels of albumin of patients in severe burn group on PID 1, 7, 14, 21, and 28 were significantly lower ( t=-4.374, -7.689, -8.257, -7.651, -6.259, P<0.01), the serum levels of PTH were significantly elevated ( Z=-4.685, -4.685, -4.685, -4.654, -4.685, P<0.01), and the serum levels of phosphorus were not changed significantly. The serum levels of calcium of patients in severe burn group on PID 1, 7, 14, and 21 were significantly lower than the level of volunteers in healthy control group ( Z=-2.375, -3.455, -2.442, -2.016, P<0.05 or P<0.01). Conclusions:The serum osteoprotegerin, RANKL, RANKL/osteoprotegerin ratio, and PTH are increased, and the serum 25 hydroxyvitamin D, albumin, and calcium are decreased in the early stage of severe burn patients, which may be the mechanism leading to bone loss in patients.

Objective:To observe the changes in the related indicators of bone formation and bone resorption in severely burned rats.Methods:The experimental research method was adopted. Thirty female Sprague-Dawley rats aged 6 to 8 weeks were divided into sham injury group, 12% total body surface area (TBSA) full-thickness burn group, and 24%TBSA full-thickness burn group according to the random number table, with 10 rats in each group. The rats were treated on the back correspondingly, after which, the burned rats were rehydrated by intraperitoneal injection according to the Parkland formula, and the wound was coated with 20 g/L iodophor until wound healing. On post injury day (PID) 28, the tibia tissue of rats in each group was collected. The new bone tissue and the number of osteoclasts were observed after staining with Masson and tartrate-resistant acid phosphatase, respectively. The abdominal aortic blood of rats in each group was harvested for serum preparation. The bone metabolism indexes of serum calcium ion and phosphorus ion concentration were determined by the methyl thymol blue colorimetric method and phosphomolybdic acid method, respectively. The serum levels of bone formation marker of aminoterminal propeptide of type 1 procollagen (P1NP) and bone resorption marker of beta-carboxy-terminated peptide of type Ⅰ collagen (β-CTX) were determined by enzyme-linked immunosorbent assay. The first lumbar spine tissue of rats in each group was collected, and the mRNA expression levels of osteoprotegerin, receptor activator of nuclear factor-κB ligand (RANKL), tumor necrosis factor receptor-associated factor 6 (TRAF-6), nuclear factor of activated T cell 1 (NFATC1), c-Fos, and c-Src were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were statistically analyzed with one-way analysis of variance, Bonferroni method, Welch test, Games-Howell test, Kruskal-Wallis test, Mann-Whitney U test, and Bonferroni correction. Results:On PID 28, compared with that in sham injury group, the formation of new bone tissue in the tibia tissue of rats in the two burn groups was decreased, and the larger the burn area, the more obvious the decrease. The numbers of osteoclasts in the tibia tissue of rats in the two burn groups were similar, both significantly more than the number in sham injury group. On PID 28, the serum calcium ion concentration and serum level of β-CTX of rats in the three groups were similar ( P>0.05). The serum phosphorus ion concentration of rats in 24%TBSA full-thickness burn group was significantly higher than that in 12%TBSA full-thickness burn group ( P<0.05), and the serum phosphorus ion concentrations in the two burn groups were significantly higher than the concentration in sham injury group ( P<0.01). The serum level of P1NP of rats in 24%TBSA full-thickness burn group was significantly lower than that in sham injury group ( P<0.01). On PID 28, the mRNA expression levels of osteoprotegerin in the first lumbar spine tissue of rats in sham injury group, 12%TBSA full-thickness burn group, and 24%TBSA full-thickness burn group were 1.01±0.20, 1.71±0.83, and 2.24±0.51, respectively, and that in 24%TBSA full-thickness burn group was significantly higher than that in sham injury group ( P<0.01). The mRNA expression level of RANKL in the first lumbar spine tissue of rats in 24%TBSA full-thickness burn group was 1.31±0.17, which was significantly higher than 1.00±0.14 in sham injury group and 0.97±0.10 in 12%TBSA full-thickness burn group ( P<0.01). The mRNA expression levels of TRAF-6, NFATC1 ( Z=3.141, 3.782), and c-Src in the first lumbar tissue of rats in 12%TBSA full-thickness burn group and 24%TBSA full-thickness burn group and the mRNA expression level of c-Fos in the first lumbar tissue of rats in 12%TBSA full-thickness burn group were significantly higher than those in sham injury group ( P<0.05 or P<0.01). The mRNA expression levels of c-Fos and c-Src in the first lumbar spine tissue of rats in 12%TBSA full-thickness burn group were significantly higher than those in 24%TBSA full-thickness burn group ( P<0.01). Conclusions:Severe burns can cause a decrease in the generation of new bone tissue, an increase in the number of osteoclasts and the serum phosphorus ion concentration, and a decrease in the serum level of P1NP in rats. The level of osteoprotegerin, RANKL, TRAF-6, NFATC1, c-Fos, and c-Src in bone tissue showed an increasing trend while the level of NFATC1, c-Fos, and c-Src showed a decreasing trend with the increase of burn area.