Objective: To explore the subunit strategy for perineal defect reconstruction and flap selection. Methods: This is a respective study of 21 patients, with perineal defect, during January 2008 to December 2018. All patients were admitted to the fifth section of Burn and Plastic Surgery in the Fourth Medical Center of the People′s Liberation Army General Hospital. There were 10 males and 11 females, aged from 4 to 68 years old, with the mean age of 26.4 years. The causes of injury included burn (n=11), trauma (n=2), Paget′s disease (n=2), Brown′s disease (n=2), perineal squamous cell carcinoma (n=3)and hemangioma (n=1). The perineum is divided into 4 subunits, according to the anatomical structure: a front area monsveneris or pubic symphysis, 2 middle areas (labia or scrotum) and a posterior area (anal). The defects ranged 23 cm×11 cm-5 cm×3 cm after perineal lesions were removed. Appropriate flaps were selected based on tissue defect. Results: Nine patients were repaired with superficial inferior epigastric artery flap, 3 patients were repaired with superficial circumflex iliac artery flap, and 2 patients were repaired with combined superficial inferior epigastric artery flap and superficial circumflex iliac artery island flap. Internal pudendal arterial perforator flap was performed in 5 patients, and anterolateral thigh perforator flap in 2 patients. The size of flap was 25 cm×12 cm-6 cm×3 cm. All flaps survived, and incisions were primary healing. Patients were followed up for 6 months to 9 years, with an average of 13 months. The patients were satisfied with the appearances and functions of the recipient and doner sites. Scars were concealed well. Conclusions Appropriate flap can be chosen to repair perineal defects, based on the subunit principle in perineum, in order to restore function and appearance, and achieve satisfactory clinical outcomes.

Objective: To explore the clinical application of ultra-pulsed CO₂ laser skin abrasion combined with micro-skin graft in the treatment of skin depigmentation. Methods: From January 2010 to June 2014, depigmented skin specimens were used for ultra-pulsed CO₂ laser skin abrasion treatment, at 0, 10, 20, 30, 40, 50, 60 mJ. HE stain was performed to observe the abrasion depth under the 100 times microscope view. The most appropriate parameter was set to completely remove the epidermis, and leave dermis undamaged. From January 2011 to December 2017, 16 patients with skin depigmentation, 12 males and 4 females, aged 12-47 years, were treated with super-pulsed carbon dioxide laser and autologous microdermis transplantation. At 1, 3, 6 and 12 months after the operation, patients′ photos were record. The color improvement was analyzed using Image-Pro Plus 6.0 software. Results: The laser energy for complete epidermis removal is different at different sites. It is 50 mJ for back skin, 40 mJ for face and hand skin and 30 mJ for neck skin. After one year of follow-up, there was no hypertrophy scar caused by over-abrasion in all 16 patients. Combined with the micro-skingrafting, 15 patients with skin depigmentation were completely resolved, with more than 90%color improvement rate. The improvement rate was 75% in a patient with un-uniform appearance, due to part failure of micro-skin graft. The neck movement and uncertain fixation were the reasons. Conclusions The appropriate energy parameters can control the abrasion depth to avoid the hypertrophic scar. Combined with micro-skin graft, the depigmentation area can be improved with uniform color and reliable effect.

Objective: To analyze the genotypes, amino acid vatiations and molecular epidemiological characteristics of respiratory syncytial virus (RSV) infection in pediatric patients in Gansu province for the future research. Methods: A total of 4 556 respiratory tract specimens were colleted from pediatric patients under 10 years of age in five cities in Gansu from 2012 to 2017. These specimens were tested for RSV and its subtypes.The coding region of the RSV G gene was amplified using reverse transcription-polymerase chain reaction (RT-PCR) and sequenced for RSV positive specimens. Sequences were edited using DNA Star software. Sequence alignment and phylogenetic trees were built by MEGA 6.0 software. Results: Out of 4 556 specimens, 1 135 (24.91%) were positive for RSV, totally 216 G protein sequences were obtained. RSV A isolates were clustered into three genotypes: NA1、NA3 and ON1. The nucleotides and amino-acid homology was 84.9%-100% and 77.3%-100%, respectively. The nucleotides and amino-acid homology between this study and prototype long strain was 81.2%-83.3% and 74.1%-88.0%. RSV B isolates were clustered into only BA9 one genotypes. The nucleotides and amino-acid homology was 97.7%-100% and 95.8%-100%, respectively. The nucleotides and amino-acid homology between this study and prototype CH18537 strain was 84.9%-85.7% and 77.9%-80.1%. Conclusions The genetic characteristics and the amino-acid changes were analyzed systematically using data of RSV G gene collected from 2012 to 2017 in Gansu province in this study. These data were used for analyses of the etiology, control and prevention of RSV infection.

OBJECTIVE To study the impacts of different noise patterns on speech perception in normal hearing subjects and patients with sensorineural hearing loss. METHODS Mandarin Hearing in Noise Test for Children was played by MATLAB software in this study. The speech intelligibility of 25 normal hearing subjects and 20 patients with sensorineural hearing loss in quiet, speech-shaped noise and two-talker babbles were tested. The differences between normal hearing subjects and patients with sensorineural hearing loss in quiet and noise conditions were analyzed. RESULTS With the decrease of signal-to-noise ratios, the speech intelligibility of normal hearing subjects in speech-shaped noise pattern was declining more severely compared with the two-talker babbles pattern but there were no significant differences between them (P＞0.05). There were significant statistical differences in speech intelligibility under quiet, speech-shaped noise and two-talker babbles at 5 dB SNR (^＜0.05) for patients with sensorineural hearing loss. And the speech recognition rate in speech-shaped noise decreased more remarkable than that in the two-talker babbles. CONCLUSION Compared two noise patterns, the accuracy of speech recognition for normal hearing subjects in two-talker babbles was higher, while the speech intelligibility was better for patients with sensorineural hearing loss in speech-shaped noise.

Objective To analyze the characteristics of clinical manifestation, brain magnetic resonance imaging ( MRI ) and 18 F-fluoro-deoxy-glucose positron emission tomography ( FDG-PET ) , inflammatory cerebrospinal fluid ( CSF ) , electroencephalography ( EEG ) , and associated tumour in autoimmune epilepsy ( AE) patients with different autoantibodies. Methods Forty-two patients diagnosed as AE with different autoantibodies in Beijing Tiantan Hospital, Capital Medical University between May 2014 and May 2017 were recruited. The clinical manifestation, brain MRI and PET, CSF findings, EEG and biochemical examination of these patients were analyzed. Results Specific autoimmune antibodies were detected in 42 patients, including anti-amphiphysin in one patient, anti-contactin-associated protein 2 in two, anti-γ-aminobutyric acid-B receptor in six, anti-leucine-rich glioma inactivated 1(LGI1) in 24, anti-N-methyl-D-aspartate receptor ( NMDAR ) in nine. The case series of 42 patients had an average age of (49. 9 ± 14. 5) years with a male to female ratio of 5:1. Except anti-NMDAR associated AE, most patients (21/33) presented with the symptoms of limbic encephalitis including temporal lobe seizures, memory decline, personality and neuropsychiatric changes, mesial temporal lobe abnormality in MRI or FDG-PET, and CSF inflammation. The seizure semiologic characteristics included frequent seizure, short seizure duration and common secondarily generalized tonic-clonic seizures during sleeping. Faciobrachial dystonic seizures and hyponatremia were the special clinical manifestation of AE with anti-LGI1. AE patients with all kinds of antibodies presented as initial resistance to anti-epilepsy drugs ( AEDs) and favorable outcome of immunosuppressive treatment in combination with AEDs. Conclusions AE patients with each type of antibody have the special clinical manifestation. Except anti-NMDAR associated AE, the seizure semiologic characteristics often present as frequent and short seizures. All AE patients present as drug refractory epilepsy initially. Seizures in AE patients can be well controlled by immunotherapy combined with AEDs.

Objective To identify the epidemiological changes in invasive fungal infection (IFI) in a neonatal intensive care unit (NICU) to provide information for prevention and treatment of IFI.Methods A total of 102 cases who were diagnosed with IFI among 42 187 neonates hospitalized in the NICU of Affiliated BaYi Children's Hospital,Chinese People's Liberation Army General Hospital from January 1,2009 to December 31,2014 were enrolled in this study.Since January 1,2012,the divisions of our NICU were more specific and intravenous fluconazole was administered as a routine preventive measure for high-risk infants.Clinical information of the IFI cases including general features,incidence,distribution of pathogens and drug (Amphotericin B,Fluconazole,Flucytosin,Itraconazole and Voriconazole) sensitivity were analyzed between former period (January 1,2009 to December 31,2011) and latter period (January 1,2012 to December 31,2014) by Chi-square test.Results The total incidence of IFI was 2.42‰ (102/42 187),and among the 102 IFI cases,73.5％ (75/102) were preterm infants and 75.5％ (77/102) were low birth weight infants.The incidence ofIFI in the latter period was lower than that in the former period [1.8‰ (48/26 046) vs 3.3‰ (54/16 141),x2=9.329,P＜0.01].The incidences of IFI in neonates with gestation age ＜28,≥ 28-＜32 and ≥ 32-＜37 weeks in latter period were decreased as compared with those in former period [10.6 ‰ (3/284) vs 76.9 ‰ (9/117),x2=12.569;6.1‰ (13/2 134) vs 21.9‰ (28/1 277),x2=16.868;1.4‰ (12/8 706) vs 1.9‰ (10/5 256),x2=7.165] (all P＜0.01).Altogether 103 pathogen strains were identified from 102 IFI cases as one Candida parapsilosis strain and one Laurent cryptococcus strain were both isolated from one patient.The most prevalent three pathogens were Candida albicans [51.5％ (53/103)],Candidaparapsilosis [24.3％ (25/103)] and Candida glabrata [8.7％ (9/103)].The isolated rates of Candida albicans and Candida glabrata strains in the latter period were higher than those in the former period [63.3％ (31/49) vs 40.7％ (22/54),x2=5.218;18.4％ (9/49) vs 0.0％ (0/54),x2=10.868],while the isolated rate of Candida parapsilosis strain was lower in the latter period than that in the former period [12.2％(6/49) vs 35.2％(19/54),x2=7.355] (all P＜0.05).All pathogen strains were sensitive strains except one Candida krusei strain which was isolated in the former period and was resistant to Fluconazole.Conclusions Premature infants born at lower gestational ages or with low birth weights are still at high-risk of IFI,but the incidence of IFI has declined in recent years.Routine administration of fluconazole in high-risk infants in NICU could prevente IFI without increasing drug resistance.Candida albicans is the predominant pathogen ofIFI.

Objective To establish a accurate and rapid method of loop-mediated isothermal amplification(LAMP) for detecting Legionella Pneumophila(LP) .Methods The strains of LP ,Staphylococcus aureus ,Pseudomonas aeruginosa ,Escherichia coli ,Enterobacter sakazakii ,Listeria monocytogenes ,Salmonella typhimurium ,shigella flexneri and Vibrio parahaemolyticus were selected . According to six special domains of toxicity-related mip gene on LP ,the LAMP primers(mip-1 ,mip-2 ,mip-3) were designed by using the Primer Explorer Version 4 .0 .The genomic DNA was extracted for conducting LAMP .Then its specificity ,lowest detectable limit and stability were evaluated .Results The screened primer mip-3 appeared the peak after amplification for about 10 min in the LAMP reaction system for detecting LP ,moreover the peak value was higher ;while the strains of non-LP had no amplification reaction ;the LAMP detection limit could reach 100 fg/μL .The primer mip-3 appeared the peak almost at the same time in 20 times of duplicated detection ,and its stability was good .Conclusion The established LAMP detection method has the advantages of strong specificity and high stability ,can rapidly and accurately detect LP and has large prospect of promotion and application .

Objective To analyze the infection features,risk factors,and the relationship with the efficacy in patients with acute leukemia during initial induction chemotherapy.Methods The clinical data of 200 patients with newly diagnosed acute leukemia from January 2015 to February 2016 in the Second Hospital of Shanxi Medical University were retrospectively analyzed.Results The infection rate of patients with acute leukemia under induction chemotherapy was 84.0％ (168/200).Among 168 patients with infection,159 cases (94.6％) had known infection sites,the top three infection sites were the lungs,gastrointestinal tract and the oral cavity.Total 213 strains of pathogens were identified,Gram-negative bacilli accounted for 39.0％ (n =83),Gram-positive cocci for 34.3％ (n =73),fungi for 23.5％ (n =50) and the virus for 3.3％ (n =7).Multivariate regression analysis showed that agranulocytosis was the independent risk factor for acute leukemia patients during induction chemotherapy (OR =14.370,95％ CI:2.576-116.518,P ＜ 0.01).The rate of complete remission (CR) and CR with incomplete hematologic recovery (CRi) in infection group was 74.4％ (125/168),and the rate of CR + CRi in non-infected group was 87.5％ (28/32),and there was no significant difference between the two groups.(χ2 =2.564,P =0.109).Conclusion During the induction therapy for acute leukemia patients,the rate of infection and the rate of fungal infection are high;lung is the most common site,Gram-negative bacteria is more common;agranulocytosis increases the chance of infection;and the infection may not affect the disease remission rate.

Objective To determine the trend of emergency department (ED)mortality of a tertiary general hospital from 2004 to 2014 in order to find the factors that may impact on ED mortality.Methods Mortality in ED was estimated according to the ratio of ED visiting patients to ED deaths.And the data of all ED deaths in 2004,2009 and 2014 were collected.Variance analysis and chi-square test were used for data analysis.Results During the past decade,ED visiting patients was increased significantly by 38.0% in 2014,compared with those in 2004,and the mortality was also increased accordingly from 0.7% in 2004, to 0.9% in 2009,to 1.2% in 2014 (P <0.01).Finally,a total of 1,091 deaths occurred in these three years were included for further evaluation.There were no significant changes in average age and gender distribution,and the average age was 61.9 and the male /female ratio was 1.36∶1 during past decade.The number of adults under 40 years old (18 -39)increased from 7.5% in 2004,to 10.6% in 2009,to 14.4% in 2014 (P <0.05).Both the facilities were upgraded and the number of staffs in ED increased markedly.The cardiovascular illness,cerebrovascular diseases,and sudden death were the leading causes of ED death during past decade.The incidences of trauma and tumor remained unchanged.Average time consumed from onset of illness to arrival to ED didn’t vary significantly during past decade.The study showed no changes in use of ambulance,but remarkable increases in number of non-compliant patients or their family from 18.3% in 2004,to 25.6% in 2009,to 38.3% in 2014 (P <0.01).The percentage of patients in the night time was higher,but there were no significant changes in number of emergency patients in the night time and during holidays in the past decade,but the mean ED stay time increased obviously from 22.4 h in 2004 to 53.3 h in 2014 (P <0.05 ).Conclusions During the past decade,although ED facilities and number of staffs have been improved apparently,ED mortality rate still keeps on escalating. The increase in ED mortality rate may be related to the severely ill patients presenting to ED,the obvious decrease in compliance of patients and the prolonged ED stay time.

Objective To preliminarily explore the effects and brain protective mechanism of intermittent hypoxia preconditioning ( IHP) on rats with seizures induced by lithium-pilocarpine ( Li-pilo) .Methods A total of 96 8-week old male Sprague Dawley rats ( clean grade ) were randomly divided into control group , seizure group and four IHP-seizure groups.The animal model of epilepsy was established by intraperitoneal injection of Li-pilo in the seizure group and four IHP-seizure groups (Li-pilo was injected at 1, 3, 7, or 14 days after a 5-day regimen of IHP).Subsequent seizure behavior , the latency period and percentage of generalized seizures were quantitatively evaluated for 240 min and the cognitive function was tested by Morris water maze task , and followed by the detection of hippocampus neuron apoptosis and related protein (BCL-2, Bax, and cleaved-caspase-3) by TUNEL labeling and Western blot, respectively.Results The induced seizure peaked on an average between 50-150 min after Li-pilo administration , scored using a modified Racine scale.The average scores of modified Racine scale in the IHP-3d seizure group was significantly lower than that in the other groups.The latency period and percentage of generalized seizures in the IHP-3d seizure group rats were significantly different from the parameters in the seizure group rats (P<0.05).IHP-3d seizure rats showed lower escape latency, neuronal apoptosis counts and higher percentage of time in the probe quadrant compare with the seizure group and the other three IHP-seizure groups ( P <0.05 ) .Compared with the control group , the parameters of water maze and apoptosis detection in the IHP-3d seizure group showed no significant changes (P>0.05).Conclusions The results indicate that IHP treatment may help to decrease the susceptibility to epilepsy by reducing abnormal apoptosis , and has a brain protective effect on the seizure rats .