The American Burn Association updated and released the " Clinical practice guidelines on burn shock resuscitation" in December 2023. This guideline is an extension and refinement of the " Practice guidelines on burn shock resuscitation" released in 2008. It mainly provides evidence-based recommendations for acute fluid resuscitation in adults with burn shock. In order to enable clinicians to better apply the 2023 guideline, this article focuses on the interpretation of the guideline.

ObjectiveTo observe the clinical effect of Jieyu Qingxin formula granules combined with remote interactive cognitive behavioral therapy for insomnia （CBT-I） on chronic insomnia of liver depression and fire-turning type. MethodThis study was a prospective randomized controlled trial. 120 patients with chronic insomnia of liver depression and fire-turning type in Lu'an traditional Chinese medicine Hospital from January 2022 to June 2023 were selected as objects. They were randomly divided into two groups，with 60 cases in each group. The control group received remote interactive CBT-I. The observation group was treated with Jieyu Qingxin formula granules on the basis of the control group. Intervention treatment lasted for four weeks，and observation lasted for six weeks. Comparison of data of each group：clinical efficacy，changes in traditional Chinese medicine （TCM） syndrome score before and after treatment，changes in insomnia severity index （ISI） score，self-rating depression scale （SDS） and self-rating anxiety scale （SAS） score changes，total sleep time，wake time，sleep latency，sleep efficiency， Actigraphy sleep parameter value changes，serum neuron specific enolase （NSE） ，adenosine，dopamine （DA）， 5-hydroxytryptamine （5-HT） level changes，and adverse reactions. ResultThe total effective rate in the observation group （92.45%，49/53） was higher than that in the control group（76.92%，40/52）， and the difference was statistically significant（χ²=4.711 1，P<0.05）. After treatment，TCM syndrome score，ISI score，SAS score， and SDS score were decreased in all groups. The total sleep time was extended，and wake time and sleep latency were shortened. The sleep efficiency was increased，but the NSE and DA levels were decreased. Adenosine and 5-HT levels were increased in all groups（P<0.05）. After treatment，compared with the control group，the observation group had lower TCM syndrome score，ISI score，SAS score， and SDS score，longer total sleep time，higher sleep efficiency，shorter wake time and sleep latency，lower NSE and DA levels， and higher adenosine and 5-HT level （P<0.05）. There was one case of nausea in the observation group and no adverse reaction in the control group during treatment. There was no significant difference between the two groups. ConclusionBy reducing NSE and DA and increasing the levels of 5-HT and adenosine，the anxiety （SAS score） and depression （SDS score） of patients can be improved， so as to improve their sleep and effectively treat chronic insomnia of liver depression and fire-turning type.

Objective To investigate the role of caspase-1-medicated canonical pyroptosis pathway in chlorogenic acid(CGA)treatment of acute kidney injury(AKI)in mice.Method Twenty-four C57Bl/6J mice were randomized into sham-operated group,cecal ligation and puncture(CLP)group,CLP+dexamethasone group(CLP+DXM group),and CLP+CGA group(n=6)and subjected to either sham operation(laparotomy only)or CLP.After modeling the mice received intravenous infusion of 10 mg/kg normal saline(in sham and CLP groups),1 μg/kg dexamethasone or 15 mg/kg of chlorogenic acid for 6 h delivered using an intravenous pump.Eight hours after the infusion,renal morphology and histology,renal cell apoptosis,and the renal function parameters such as urea nitrogen(BUN),creatinine(Scr),and kidney injury molecule 1(KIM-1)were compared among the 4 groups;the 7-day survival rates of the mice were recorded,and the expressions of NLRP3 inflammasomes and key proteins of the caspase-1 pathway in the renal tissue were detected.Results CGA treatment significantly improved the 7-day survival rate,reduced renal pathologies of the septic mice(P<0.05),and lowered the levels of BUN,Scr,KIM-1,NLRP3 inflammasome and expressions of key proteins of the caspase-1 pathway.Conclusion CGA alleviates AKI in mice with CLP-induced sepsis by inhibiting NLRP3 inflammasomes and the caspase-1 signaling pathway.

Objective To investigate the effect of parent-child alienation on depression in surface ship officers and soldiers based on the theory of"diathesis-stress",and the mediating role of resilience between parent-child alienation and depression in them.Methods A cross-sectional study was conducted on 599 officers and soldiers from a surface ship unit.The participants were surveyed with inventory of alienation toward parents,connor-davidson resilience scale and patient health questionnaire-9 to obtain and analyze their demographic-military characteristics of their depression scores.The participants with depression scores ≥5 were recruited as the subjects,and Spearman correlation analysis was used to explore the correlation among parent-child alienation,resilience and depression.On the basis of hierarchical regression analysis,AMOS software was used to establish a structural equation modelling of intermediary effects.Results The depression score was 1(0,4)in the participants,and the depression scores of those with service length ≥11 years were comparatively higher than those with shorter length.Our results indicated that parent-child alienation was positive correlated with depression(r=0.451,P＜0.001),while resilience was negatively correlated with depression and parent-child alienation(r=-0.412,-0.407,P＜0.001).Regression analysis revealed that parent-child alienation had a direct positive predictive value for depression(β=0.574,P＜0.001),and resilience showed a negative predictive value for depression(β=-0.211,P＜0.01).Model analysis displayed that resilience had a significant mediating role in the effect of parent-child alienation on depression among these surface ship officers and soldiers,with an effect value of 0.088,and accounting for 15.86％of the total effect.Conclusion Parent-child alienation has a significant influence on depression among surface ship officers and soldiers,with resilience playing a partial mediating role.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

Objective To investigate the role of caspase-1-medicated canonical pyroptosis pathway in chlorogenic acid(CGA)treatment of acute kidney injury(AKI)in mice.Method Twenty-four C57Bl/6J mice were randomized into sham-operated group,cecal ligation and puncture(CLP)group,CLP+dexamethasone group(CLP+DXM group),and CLP+CGA group(n=6)and subjected to either sham operation(laparotomy only)or CLP.After modeling the mice received intravenous infusion of 10 mg/kg normal saline(in sham and CLP groups),1 μg/kg dexamethasone or 15 mg/kg of chlorogenic acid for 6 h delivered using an intravenous pump.Eight hours after the infusion,renal morphology and histology,renal cell apoptosis,and the renal function parameters such as urea nitrogen(BUN),creatinine(Scr),and kidney injury molecule 1(KIM-1)were compared among the 4 groups;the 7-day survival rates of the mice were recorded,and the expressions of NLRP3 inflammasomes and key proteins of the caspase-1 pathway in the renal tissue were detected.Results CGA treatment significantly improved the 7-day survival rate,reduced renal pathologies of the septic mice(P<0.05),and lowered the levels of BUN,Scr,KIM-1,NLRP3 inflammasome and expressions of key proteins of the caspase-1 pathway.Conclusion CGA alleviates AKI in mice with CLP-induced sepsis by inhibiting NLRP3 inflammasomes and the caspase-1 signaling pathway.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

Objective:To investigate the effects of Ureaplasma urealyticum GrpE ( Uu-GrpE) on the maturation of dendritic cells and the polarization of T cells. Methods:Uu-GrpE was expressed and purified, and then identified by Western blot. The cytotoxicity of Uu-GrpE to mouse bone marrow-derived dendritic cells (BMDCs) was analyzed by LDH kit. After stimulating BMDCs with Uu-GrpE, the expression of costimulatory molecules, CD80, CD86 and major histocompatibility complex Ⅱ (MHCⅡ), on the surface of BMDCs was detected by flow cytometry, and ELISA was used to detect the cytokines such as IL-12p70, TNF-α, IL-1β and IL-6. CD4 + Na?ve T cells were isolated from mouse spleen tissues by magnetic beads. A co-culture system of BMDCs and Na?ve T cells was constructed to analyze the effects of GrpE-stimulated mature BMDCs (GrpE-BMDCs) on T cell proliferation and polarization towards Th1/Th2. Mice were immunized with GrpE-BMDCs through the tail vein, and the induced humoral and cellular immune responses were detected by ELISA and flow cytometry. Results:Uu-GrpE was successfully express and high purity BMDCs were isolated. Uu-GrpE could stimulate BMDCs to secrete cytokines such as IL-12p70, TNF-α, IL-1β and IL-6 without having cytotoxicity. Uu-GrpE significantly increased the expression of CD80 [mean flourscence indensity (MFI): (324.00±22.11) vs (91.03±10.95), P<0.01], CD86 [MFI: (1 176.00±51.39) vs (217.00±14.93), P<0.01] and MHCⅡ [MFI: (708.70±56.32) vs (185.70±16.77), P<0.01] on BMDCs. Compared to the GrpE-BMDCs only group and GrpE (boiled)-BMDCs+ T cell group, the GrpE-BMDCs+ T cell group showed significantly increased T cell proliferation [stimulation index: (7.25±0.21) vs(6.55±0.23) and (6.09±0.35), both P<0.05], and dramatically promoted T cell secretion of IL-2 and IFN-γ [IL-2: (145.60±14.67) pg/ml vs(55.92±3.12) pg/ml and (26.05±2.40) pg/ml, P<0.05 and P<0.01; IFN-γ: (267.20±37.80) pg/ml vs(146.70±20.65) pg/ml and(27.84±6.69) pg/ml, both P<0.05]. However, no significant change was observed in the expression of Th2-type cytokines. Moreover, the adoptive transfer of GrpE-BMDCs induced a Th1-type immune response. Conclusions:Uu-GrpE could stimulate the maturation and polarization of BMDCs. Moreover, it could induce Th1 immune response as a candidate protein vaccine for Ureaplasma urealyticum.

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.