BACKGROUND:There are less reports about the external use of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) hydrogel to repair thick skin graft donor sites. By now, relevant self-control studies have not been retrieved. OBJECTIVE:To observe the effect of rhGM-CSF on the repair of thick skin graft donor sites. METHODS:Sixty patients with burns and scar hyperplasia undergoing autologous thick skin grafting were enroled, 47 males and 13 females, aged 18-65 years. The thigh was selected as donor sites. According to the depth of donor sites, the patients were divided into 0.4 mm and 0.55 mm groups, with 30 cases in each group. Wounds on the symmetric areas with equal area and same depth were selected or wounds with same depth were selected and divided equaly. The wounds were randomly assigned into treatment group and control group. The treatment group was treated with rhGM-CSF hydrogel externaly; the control group was only given vaseline dressing. At postoperative 3, 7, 10, 14 days, the fresh dressing was changed. Then, the wound appearance, healing time, healing rate and adverse effects were observed in the two groups. RESULTS AND CONCLUSION:At 14 days after operation, the wound surface was smoother and the pigmentation was relatively less in the treatment group compared with the control group; the degree of wound pain
was less in the treatment group than the control group during dressing change (P < 0.05). At 10 and 14 days after operation, the healing rate and healing time were better in the treatment group than the control group (P < 0.05). No general malaise or hypersensitivity cases were reported, and local issue hyperplasia was also not found. Al the above indicate that the external use of the rhGM-CSF hydrogel can evidently shorten the healing time and improve the healing condition when it is applied in the thick skin graft donor sites.

Objective: To investigate the correlation between CXC chemokine receptor 6 (CXCR6) and prognosis of renal clear cell carcinoma. Methods: A total of 100 patients with renal clear cell carcinoma who underwent surgery in the First People's Hospital of Ziyang from January 2013 to October 2014 were selected. Immunohistochemistry was used to detect the expression of CXCR6 in 100 cases of renal clear cell carcinoma and adjacent normal tissues. The patients were followed up to observe the positive rate of CXCR6 expression and the factors affecting overall survival (OS) and progression-free survival (PFS) of renal clear cell carcinoma and adjacent normal tissues. Results: The positive rate of CXCR6 expression in renal clear cell carcinoma tissues was higher than that in adjacent tissues, and the difference was statistically significant [46.0% (46/100) vs. 20.0% (20/100), χ² = 15.287, P < 0.01]. The positive expression rate of CXCR6 in patients with clinical stage Ⅲ-Ⅳ, lymph node metastasis and pathological grade Ⅲ-Ⅳ was higher than that in patients with clinical stage Ⅰ- Ⅱ, pathological grade Ⅰ- Ⅱ and without lymph node metastasis, and the difference was statistically significant (all P < 0.05). A total of 92 patients were followed up and 40 died. The follow-up time reached to (35-60) months and the median follow-up time was 48.9 months. Kaplan-Meier and log-rank test showed that patients with positive CXCR6 expression had lower 3-year OS and PFS rate compared with patients with negative CXCR6 expression, and the difference was statistically significant (3-year OS rate: 52.1% vs. 78.6%, χ² = 10.027, P = 0.001; 3-year PFS rate: 48.3% vs. 67.8%, χ² = 4.344, P = 0.037). Cox regression multivariate analysis showed pathological grade (OS: OR = 2.154, 95% CI 1.547-9.517, P = 0.023; PFS: OR = 1.235, 95% CI 1.109-5.917, P = 0.042), lymph node metastasis (OS: OR = 1.412, 95% CI 1.109-5.917, P = 0.041; PFS: OR = 1.841, 95% CI 1.354-8.994, P = 0.010), CXCR6 expression (OS: OR = 1.864, 95% CI 1.358-6.813, P = 0.031; PFS: OR = 1.457, 95% CI 1.127-6.884,P = 0.025) were independent risk factors of OS and PFS for renal clear cell carcinoma patients treated by the surgery. Conclusions The positive expression of CXCR6 is an independent risk factor for OS and PFS of renal clear cell carcinoma. The prognosis of patients with positive CXCR6 expression is poor.

Objective To analyze the epidemiological characteristics of pathogenic bacteria for respiratory tract infection in children with asthma to facilitate the prevention, diagnosis, and treatment. Methods Among 206 hospitalized children with asthma and respiratory tract infection from January 2019 to December 2021 were selected for analysis in this study, including 131 cases with upper respiratory tract infection and 75 cases with lower respiratory tract infection. The potential correlation between the distribution of pathogenic bacteria and drug resistance was analyzed and compared between the two groups. Results A total of 167 strains of pathogenic bacteria were detected in 131 children with upper respiratory tract infection, and 262 strains were detected in 75 children with lower respiratory tract infection. The distribution characteristics of pathogenic bacteria in children with asthma and acute upper respiratory tract infection were consistent with the total distribution characteristics. Among children with asthma and acute lower respiratory tract infection, the infection of Gram-positive bacteria was higher than that of Gram-negative bacteria in female children younger than 5 years old, and the proportion of staphylococcus epidermidis was the highest (P<0.05), The distribution characteristics of pathogenic bacteria in children of other ages and sexes were consistent with the total distribution characteristics. The resistance rate of Gram-positive bacteria to penicillin, erythromycin and clarithromycin was high, while the resistance rate of Gram-negative bacteria to ampicillin, cefazolin and cefuroxime was high. The distribution characteristics of pathogenic bacteria in children with upper respiratory tract infection and lower respiratory tract infection were consistent. Conclusion In children with pediatric asthma and respiratory tract infection, the main pathogens are Gram-negative bacteria, and the drug resistance rate is high. However, the infection of Gram-positive bacteria (mainly Staphylococcus epidermidis) in young female children under 5 years old is higher than that of Gram-negative bacteria in other children, which deserves special attention.

Objective To explore the correlation between clinical distribution characteristics of streptococcal pharyngitis in children and seasonal variations in Ziyang area, so as to provide basis for disease prevention and control. Methods A multistage and stratified random sampling technique was used to investigate 583 children with streptococcal pharyngitis attending Ziyang first people's Hospital from January 2022 to January 2023. The clinical data were recorded. The pharyngeal specimens were cultured for streptococci test. The number of streptococcal pharyngitis cases per season was counted. The metereological conditions (average barometric pressure, temperature, rainfall, and wind speed) were recorded. Pearson method was used to discuss the correlation between metereological factors and streptococcal pharyngitis onset. Results A total of the 583 children, 329 were male and 254 were female. The main age of onset was 7-12 years old, with a total of 227 cases (38.94%), followed by 199 cases (34.13%) aged 3-6 years old, 126 cases (21.61%) aged 1-2 years old, and 31 cases (5.32%) under 1 year old. A total of 614 strains of pathogenic bacteria were detected, of which 479 strains of Streptococcus hemolyticus were dominant, accounting for 78.01%, followed by 175 strains of Streptococcus pyogenes, accounting for 28.50%. Seasonally, 192 cases of streptococcal pharyngitis occurred in spring, 51 in summer, 72 in autumn and 268 in winter. In Ziyang, spring and winter were characterized by high mean wind speeds and barometric pressure, while summer and autumn were characterized by high mean temperatures and heavy rainfall. Pearson correlation analysis revealed that the prevalence rate streptococcal pharyngitis was positively correlated with average wind speed and barometric pressure (P<0.05), and negatively correlated with mean temperature and rainfall (P<0.05). Conclusion In Ziyang, streptococcal pharyngitis occurs mostly in children over 5 years old, and the main pathogen is Streptococcus hemolyticus. The onset of the disease is mostly in spring and winter, which is closely related to the seasonal variations of the region.

Objective : To investigate the role and mechanism of bone formation caused by the ratio of advanced platelet-rich fibrin (A-PRF) and β-tricalcium phosphate (β-TCP) in rabbit femur defect model, which provides a new idea for clinical treatment of bone defect. Methods : Twenty-four New Zealand white rabbits were divided into model group, 1∶1 complex group (A-PRF∶β-TCP=1∶1), 2∶1 complex group (A-PRF∶β- TCP=2∶1) and 4∶1 complex group (A-PRF∶β- TCP=4∶1）, with 6 rabbits in each group. Femoral defect models were constructed in each group. In the composite group, the bone defect was filled with composite material, while in the model group, no material was filled. After 8 weeks, the animals were euthanized and specimens were collected. Bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.SP) and trabecular number (Tb.N) in femoral defect tissue were measured by micro-CT and photographed. Hematoxylin - eosin staining was used to detect the pathological changes of new bone tissue. The morphological changes of the new bone tissue were observed by scanning electron microscopy. Determination of phospho-mitogen activated protein kinase p38 (p-p38MAPK), CCAAT/enhancer binding protein homologous protein (CHOP) and phospho-cysteine aspartic protease-3 (p-Caspase3) in newborn femur by ELISA. The mRNA expressions of osteoprotegerin (OPG), bone morphogenetic protein-2 (BMP-2), receptor activator of nuclear factor kappa-B ligand (RANKL) and p38MAPK were detected by real-time quantitative PCR. The expression of OPG, BMP-2, RANKL, p-p38MAPK and p-Caspase3 protein in the new bone tissue was observed by immunohistochemistry. Results : In the model group, bone formation in the femoral defect area was slow and osteogenic quality was poor. Compared with the model group, the bone formation and neocapillaries of femoral defect area in the complex group was good, BMD, BV.TV, Tb.Th, Tb.N were increased, and Tb.Sp were decreased, the expressions of p-p38MAPK, CHOP and p-Caspase3 were decreased, and the mRNA and protein expressions of OPG and BMP-2 were increased. The mRNA expression of RANKL and p38MAPK was decreased. Apoptosis in new bone tissue of each group showed the lowest apoptosis rate in samples of the 2∶1 complex group (P<0.05); A-PRF: β-TCP=2∶1 ratio has the best osteogenic effect. Conclusion The complex composed of A-PRF and β-TCP can promote the expression of OPG, inhibit the expression of RANKL and phosphorylation of p38MAPK, reduce the apoptosis of new bone tissue cells, and promote osteogenic differentiation.

Objective:To establish and verify a simple clinical prediction model for obstructive sleep apnea syndrome(OSAS)in children.Methods:The clinical data of 95 children aged 2-12 years underwent polysomnography(PSG)were screened.The subjects with OAHI≤1 were included into non-OSAS group(n=22)and those with OAHI＞1 into OSAS group(n=73).Gender,age,body mass index(BMI),night pulse minimum oxygen saturation(SpO2),tonsil grading and adenoid grading of the 2 groups were compared and analyzed.Binary Logistic regression analysis was used to statistically analyze the data and establish a clinical prediction model for OSAS in children.Results:There was significant difference in age,BMI,SpO2,tonsil grading and adenoid grading between the 2 groups(P＜0.05),there was no significant gender difference(P＞0.05).The model equation was as follows:X=2.366-0.769(age-continuous variable)+0.248(BMI-continuous variable)-3.413(SPO2-continuous variable)+2.104(tonsil grade Ⅲ-Ⅳ"yes").The result of internally validated Hosmer-Lemeshow test was P=0.612(P＞0.05),AUC was 0.821(0.713-0.929,P＜0.01),sensi-tivity was 83.3％,specificity was 76.4％.The accuracy of external validation was 73.8％,the AUC was 0.805(0.664-0.943,P＜0.01),the sensitivity was 84.6％and the specificity was 75％.Conclusion:The predictive model may have good predictive efficacy for 2-12 years old children with OSAS,and may assist clinicians in diagnosing children with OSAS.

Objectives:To analyze the correction of postoperative coronal imbalance in adult degenerative scoliosis patients undergoing spinal fusion surgery,and to explore the impact of leveling of the most tilted vertebra(L4 or L5)in the lumbosacral curve on the correction of coronal imbalance.Methods:A retrospective analysis was conducted on 61 patients(17 male and 44 female;aged 51 to 78 years,mean 63.57±8.41 years;body mass index 15.79-35.55kg/m2,mean 25.83±3.69kg/m2)who underwent degenerative scoliosis correction surgery between January 2019 and March 2023 in Tianjin Union Medical Center.The patients were catego-rized based on the Obeid classification and the length of fusion segments into concave long segment group(17 cases),concave short segment group(15 cases),convex long segment group(15 cases),and convex short seg-ment group(14 cases).Coronal radiographic parameters[Cobb angle,coronal balance distance(CBD),coronal tilt angle]and sagittal radiographic parameters(sagittal vertical axis,thoracic kyphosis,lumbar lordosis,pelvic inci-dence,pelvic tilt,sacral slope)were measured on full spine anteroposterior and lateral X-rays preoperatively and on 3d postoperatively.The postoperative coronal and sagittal imbalance corrections were compared be-tween groups.Pearson correlation analysis was performed to investigate the relationship between the correction ratio of the maximal coronal tilt angle in the lumbosacral curve(L4 or L5)and postoperative CBD.The opera-tive time,blood loss,and visual analogue scale(VAS)pre-and postoperatively were compared between the four groups.Results:The postoperative coronal Cobb angle,CBD,and maximal coronal tilt angle at L4 or L5 of the concave long segment group,convex long segment group,and convex short segment group were statisti-cally different from those before operation(P＜0.05).In the concave short segment group,the postoperative coronal Cobb angle and maximal coronal tilt angle at L4 or L5 were significantly different from those before operation(P＜0.05),while no significant difference was found between pre-and postoperative CBD(P=0.085).Pearson correlation analysis revealed a significant negative correlation(r=-0.570,P＜0.01)between postoperative CBD and coronal tilt correction ratio in the convex group,with the linear regression equation being postoper-ative CBD=32.81-28.38 x coronal tilt correction ratio.When the correction ratio of the maximal coronal tilt angle at L4 or L5 exceeding 45％in convex coronal malalignment patients,it's predicted that the CBD could be corrected to within 20mm.No significant correlation was found between postoperative CBD and the coronal tilt correction ratio in the concave group(r=0.098,P=0.59).Patients in both the convex and concave short segment groups had shorter operative time and less blood loss than long segment groups.Postoperative VAS scores improved significantly in all groups(P＜0.05).Conclusions:In adult degenerative scoliosis patients with convex coronal malalignment,both short and long segment fusions are capable of correcting coronal imbalance.Concave coronal malalignment patients require long segment fusion for the correction of coronal imbalance.To achieve optimal coronal balance in convex coronal malalignment patients,a correction ratio of the maximal coronal tilt angle at L4 or L5 shall exceed 45％.

Objective:To study the rate of capsule contracture after operation of the textured surfaces breast implants and the smooth surfaces breast implants, to provide evidence for plastic surgeons to select the type of breast implants during breast augmentation.Methods:This study started from January 2018 to May 2019. Chinese and English databases including Wanfang Science and Technology Periodical Full-text Database, VIP Chinese Science and Technology Periodical Full-text Database (VIP) and CNKI, PubMed, Cochrane Library, Web of Science, Science Drirect Online were searched by computer. Some relevant studies were collected for this meta-analysis.Results:We identified 9 studies including a total of 13165 subjects for the meta-analysis. The OR value of the study was 0.43 (95% CI: 0.35, 0.51), and the incidence rate of capsule contracture in the experimental group was lower than that in the control group. In cumulative meta-analysis and sensitivity test, the conclusion was stable. And there was no publication bias found by Egger regression test. Conclusions:The textured surfaces breast implants are better than the smooth surfaces breast implants in terms of incidence rate of capsule contracture after augmentation mammoplasty.

To investigate the genomic features and perform cluster analysis of Carbapenem-resistant Klebsiella pneumoniae (CRKP) to provide an experimental basis for guiding the prevention and treatment of CRKP infections.A retrospective case-cohort study was conducted on 19 non-redundant CRKP strains isolated from the Tenth Affiliated Hospital of Southern Medical University between January and June 2023. Whole genome sequencing (WGS) and multilocus sequence typing (MLST) were performed to compare genomic features and analyze the resistance genes and homology of the strains.The results showed that the 19 CRKP strains were isolated from 8 different clinical departments, mainly from respiratory specimens. The whole genome sequencing revealed that the genomic lengths of CRKP ranged from 4.90 to 5.85 Mbp, with contigs N50 values>20 kb for each genome. The median overall GC content was 57.0% (50.4%-57.1%). Comparative genomic analysis identified three regions with high genomic variability. WGS detected 32 resistance genes across 11 categories. All 19 strains carried carbapenem resistance genes ( blaKPC-2 and blaOXA-48), blaTEM-1B extended-spectrum β-lactamase resistance genes, qnrS1 quinolone resistance gene, and fosA fosfomycin resistance gene, with each strain carrying only one carbapenemase gene. The detection rate of blaKPC-2 was 94.7% (18/19). MLST identified three sequence types: ST11, ST437 and ST147, with ST11 being predominant (89.5%, 17/19). Clustering analysis based on acquired resistance genes revealed three clonal transmission patterns among strains 72 and 90, and strains 88, 84, 66 and 79.In conclusion, CRKP strains carry multiple resistance genes, and clustering analysis indicating that nosocomial clonal transmission is closely related to acquired resistance genes. The ST11- blaKPC-2 type strain is the predominant clone. Strengthened surveillance and effective control strategies are necessary to reduce nosocomial transmission of CRKP.

To investigate the genomic features and perform cluster analysis of Carbapenem-resistant Klebsiella pneumoniae (CRKP) to provide an experimental basis for guiding the prevention and treatment of CRKP infections.A retrospective case-cohort study was conducted on 19 non-redundant CRKP strains isolated from the Tenth Affiliated Hospital of Southern Medical University between January and June 2023. Whole genome sequencing (WGS) and multilocus sequence typing (MLST) were performed to compare genomic features and analyze the resistance genes and homology of the strains.The results showed that the 19 CRKP strains were isolated from 8 different clinical departments, mainly from respiratory specimens. The whole genome sequencing revealed that the genomic lengths of CRKP ranged from 4.90 to 5.85 Mbp, with contigs N50 values>20 kb for each genome. The median overall GC content was 57.0% (50.4%-57.1%). Comparative genomic analysis identified three regions with high genomic variability. WGS detected 32 resistance genes across 11 categories. All 19 strains carried carbapenem resistance genes ( blaKPC-2 and blaOXA-48), blaTEM-1B extended-spectrum β-lactamase resistance genes, qnrS1 quinolone resistance gene, and fosA fosfomycin resistance gene, with each strain carrying only one carbapenemase gene. The detection rate of blaKPC-2 was 94.7% (18/19). MLST identified three sequence types: ST11, ST437 and ST147, with ST11 being predominant (89.5%, 17/19). Clustering analysis based on acquired resistance genes revealed three clonal transmission patterns among strains 72 and 90, and strains 88, 84, 66 and 79.In conclusion, CRKP strains carry multiple resistance genes, and clustering analysis indicating that nosocomial clonal transmission is closely related to acquired resistance genes. The ST11- blaKPC-2 type strain is the predominant clone. Strengthened surveillance and effective control strategies are necessary to reduce nosocomial transmission of CRKP.