Objective: To investigate the predictive value of the joint prediction model based on the modified systemic inflammatory response syndrome (SIRS) score (hereinafter referred to as the joint prediction model) for the mortality risk of patients with large area burns within 24 hours after admission. Methods: The clinical data of 158 patients [111 males, 47 females, aged 40 (28, 50) years] admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University from January 2005 to January 2018, conforming to the study criteria, were analyzed retrospectively by the method of case-control study. The age, gender, total burn area, full-thickness burn area, injury cause, with or without inhalation injury, severity of inhalation injury, and tracheotomy condition of patients were recorded, and the modified SIRS score and the modified Baux score of patients were calculated. According to the final outcome, all patients were divided into survival group (n=123) and death group (n=35). The clinical data of patients between two groups, except for modified Baux score, were compared by chi-square test or Mann-Whitney U test to screen the death-related factors of patients. The indexes with statistically significant difference between the two groups were included in the multivariate logistic regression analysis to screen the independent risk factors related to the death of patients, and the prediction model was constructed by combining the modified SIRS score. The receiver′s operating characteristic curves of the modified SIRS score, the modified Baux score, and the joint prediction model of 158 patients were drawn to analyze their ability to predict death of patients. The area under curve (AUC) of the receiver′s operating characteristic and the sensitivity and specificity of optimal threshold were calculated, and the quality of AUC of the three prediction indexes was compared with Jonckheere-Terpstra test. Results: (1) There were statistically significant differences between the two groups in the modified SIRS score, age, total burn area, full-thickness burn area, severity of inhalation injury, with or without inhalation injury, and tracheotomy condition of patients (Z=-4.356, -3.568, -5.291, -6.052, -4.720, χ²=12.967, 19.692, P<0.01). (2) The modified SIRS score, age, full-thickness burn area were the independent risk factors for the death of patients with large area burn (odds ratio=2.699, 1.069, 1.029, 95% confidence interval=1.447-5.033, 1.029-1.109, 1.005-1.054, P<0.05). (3) The AUC of modified SIRS score, the joint prediction model, and the modified Baux score for predicting death of 158 patients within 24 hours after admission were 0.730, 0.879, and 0.895 respectively (95% confidence interval=0.653-0.797, 0.818-0.926, 0.836-0.938, P<0.01). The sensitivities of the three optimal threshold values to death prediction were 54.3%, 91.4%, and 82.9% respectively, while the specificities were 81.3%, 76.4%, and 84.6% respectively. The AUC quality of the joint prediction model was similar to that of the modified Baux score (95% confidence interval=-0.057-0.088, P>0.05), and both of them were significantly better than that of the modified SIRS score (95% confidence interval=0.072-0.259, 0.023-0.276, P<0.05 or P<0.01). Conclusions Both the joint prediction model and the modified Baux score are considered to be good to predict the death rate of patients with large area burns at early stage after admission. However, the joint prediction model has better clinical practice value due to its advantage of simple scoring and easier access to data acquisition.

OBJECTIVE: To analyze the incidence and risk factors of benign liver space-occupying mass in patients with chronic hepatitis B (CHB) and the ultrasound features that differentiate these masses from small hepatocellular carcinoma. METHODS: We retrospectively analyzed the color Doppler and clinical data of 17 721 patients with CHB treated in the Hepatology Unit of Nanfang Hospital between January, 2016 and December, 2017. The data were compared with those of 21629 healthy control subjects undergoing routine physical examination in the Center of Heath Management of Nanfang Hospital during the same period. RESULTS: Compared with the control subjects, the patients with CHB had significantly higher incidences of hepatic cysts (11.8% 8.7%, < 0.05), hepatic hemangioma (8.2% 1.6%, < 0.05) and hepatic cirrhosis nodules (20.6% 2.4%, < 0.05). The incidences of hepatic cysts and cirrhosis nodules increased with age and was significantly higher in male than in female patients ( < 0.001). The highest incidence of hepatic hemangioma was found in CHB patients aged 30-49 years without a gender difference (>0.05). Sonographically, the benign liver masses commonly showed homogeneous echo within the lesion with clear boundaries and regular shape. Hepatic hemangioma was distinctively hyperechoic in 83.32% (1579/1895) of the patients, while small hepatocellular carcinoma presented with weaker peripheral and internal blood flow signals with a lower flow velocity in the arteries and a higher flow velocity in the portal vein. Liver cirrhosis nodules mostly showed a mixture of strong and weak echoes (79.60%; 7637/9595) without blood flow signal within or around the nodule; an increased volume of the nodule accompanied by heterogeneous echoes within the nodule indicated an increased probability of malignant lesion. Hepatic cysts often displayed no echo within the lesion, but the echo could be enhanced posteriorly. CONCLUSIONS The patients with CHB are at a significantly higher risk of developing hepatic cysts, hepatic hemangiomas and hepatic cirrhosis nodules than the control population, and an older age and the male gender are associated with a higher incidence of hepatic cysts or cirrhosis. The differences in the sonographic and hemodynamic features can help to differentiate hepatic benign mass from malignant lesions, and kinetic changes in sonography can be used to monitor potential malignant transformation of the cirrhotic lesions.

Objective To evaluate the application value of real-time three-dimensional echocardiography (RT-3D TEE) in nonvalvular atrial fibrillation patients after transcatheter left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug (ACP).Methods The two-dimensional transesophageal echocardiography (2D TEE) and RT-3D TEE were performed in selected patients to measure the diameter of left atrial appendage ostium and landing zone,to observe left atrial appendage morphology and lobular distribution.These were also performed to guide the whole process of transcatheter LAAC with ACP,which included the atrial septal puncture,sheathing canal cruise,occluder device implantation,and verifying the stability of occluder device and releasing the device.It involved observing ACP occluder morphology,location,stability,surrounding residual shunt,whether influencing the mitral valve and left superior pulmonary vein flow,and pericardial effusion.Results A total of 15 patients (100％) successfully underwent LAAC with the ACP.The maximum diameter of left atrial appendage ostium by 2D-TEE measurement during operation was (20.5 ± 2.9)mm,located at 135°.The diameter of left atrial appendage landing zone was (17.1 ± 2.8) mm,located at 45°;(18.0 ± 4.0) mm,located at 90°;(22.1 ± 4.7)mm,located at 135°,respectively.The left atrial appendage morphology:2 had one leaf and 13 had two leaves or more,including 2 cases of bifoliate short neck shape.In 15 patients,6 cases of cauliflower type,2 cases of wind sock type,3 cases of chicken wing type,2 cases of cactus type and 2 cases of complex type.The proximal left atrial appendage morphology:3 cases of boot type,2 cases of wide mouth type,6 cases of narrow mouth type,2 cases of straight tube type,and 2 cases of bifoliate short neck type.There was no obvious residual shunt in all the patients at immediately post-operation.Conclusions In the transcatheter LAAC with the ACP,RT-3D TEE has important application value in the preoperative selection of patients,the choice of appropriate occluder,guidance of full-process monitoring during operation,the postoperative effect evaluation and so on.

By formulating the standard operating procedures for clinical skills, and standardizing the operation steps, the Affiliated Hospital of Inner Mongolia Medical University further refines and quantifies the scoring criteria, and this is also applied in the teaching practice of medical students' clinical skills. The two operations of clean wound dressing and diagnostic peritoneal puncture are taken as an example for description. The assessment results shows that the level of medical students' clinical skills has improved significantly. Questionnaire survey also shows that teachers' training efficiency and students' learning effi-ciency have been improved , indicating that clinical skills standard operation procedures have achieved good teaching results in clinical skills teaching practice.

Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

Objective To investigate the effect and mechanisms of factor fibroblast growth factor inducible 14(Fn14)in the high glucose induced-cardiomyocyte hypertrophy. Method To observe the expression of collagenⅠ, connective tissue growth factor ( CTGF ) , transforming growth factor-β1 ( TGF-β1 ) , and Fn14 in high glucose induced-cardiomyocyte hypertrophy. Fn14 expressions was down-regulated by siRNA interference technique, and then the expressions of collagen Ⅰ, CTGF, and TGF-β1 were observed, and the mechanism was also explored. Results The expression of collagen I, CTGF and TGF-β1 was significantly up-regulated after high glucose induced-cardiomyocyte hypertrophy for 72 h. At the same time, the expression of Fn14 was increased after 72 h-treatment, and reached the peak at concentration of 30 mmol/L high glucose. High glucose could not up-regulated the expression of collagenⅠ, CTGF, and TGF-β1 after siFn14 interference, while the same result was observed in the expression of p-JNK. Conclusion The expressions of collagenⅠ, CTGF, TGF-β1, and Fn14 in cardiomyocyte of neonatal rats were induced by high glucose. While Fn14 expression was inhibited, the expressions of collagenⅠ, CTGF, and TGF-β1 were down-regulated, which seems to be involved with p-JNK signaling pathway.

Ammonia is commonly used in industry and agriculture. It is also one of the most frequently accidentally spilled chemicals. Exposure to ammonia can cause severe cutaneous burn or freezing injury, ocular injury, and inhalation injury, among them inhalation injury is the most lethal one. Although the diagnosis and treatment of ammonia burns have been improved, the long-term prognosis is not satisfactory. In this article, we reviewed the literature concerning ammonia burns, in order to summarize the clinical features and treatment of such injury.
Ammonia ; adverse effects ; Burns, Chemical ; etiology ; physiopathology ; therapy ; Burns, Inhalation ; Humans ; Inhalation Exposure ; adverse effects ; Prognosis

BACKGROUND:Our previous studies have shown that a soft substrate has a significant effect on morphology and cytoskeleton of rat bone marrow mesenchymal stem cel.
OBJECTIVE:To explore the effect of polyacrylamide gels as soft substrates with different elastic moduli on the chondrogenic differentiation of human synovial-derived mesenchymal stem cels.
METHODS:The synovium was harvested from patients with osteoarthritis under sterile conditions, and primary human synovial-derived mesenchymal stem cels were separated using limiting dilution assay. The flow cytometry and multi-directional differentiation experiments were used to identify the cel surface markers and function of the human synovial-derived mesenchymal stem cels, respectively. The polyacrylamide gels with the elastic modulus of 0.4, 6, 30 kPa, which were made using various amounts of acrylamide and bis-acrylamide, were used to culture human synovial-derived mesenchymal stem cels under induction with transforming growth factor-β1 for 7 and 14 days. RT-PCR was used to test the expression of chondrogenic genes, type II colagen gene and cartilage acidic protein 1. The 6-wel cel culture plates served as controls.
RESULTS AND CONCLUSION: The human synovial-derived mesenchymal stem cels showed different cel morphology in the different elastic modulus of polyacrylamide gels. The expression of type II colagen gene and cartilage acidic protein 1 were affected by the different elastic modulus of polyacrylamide gels and culture time, and there was an interaction between these two factors. At 7 days of induction, the expression of cartilage acidic protein 1 gene on 6 kPa polyacrylamide gels was the highest (F=44.350,P=0.000); meanwhile, the expression of type II colagen gene on 0.4 kPa polyacrylamide gels was the highest (F=6.384,P=0.005). These findings indicate that polyacrylamide gels with lower elastic modulus are superior to routine culture plates to promote the chondrogenic differentiation of human synovial-derived mesenchymal stem cels.

Objective To identify interleukin 17 (IL-17) and B cell activating factor (BAFF) that could influence B cell biology by detecting the expression of BAFF in the serum and labial salivary glands from primary Sj(o)gren's syndrome (pSS) patients and to test the apoptosis rates of B cells cultured with Th17 cells which were transfected with IL-17-siRNA,BAFF-siRNA.Methods A total of 40 patients with pSS who were referred to the Department of Rheumatology and Immunology at Anhui Provincial Hospital from June 2011 to June 2012 were enrolled into this study.The expression of BAFF on salivary gland and serum from pSS patients and healthy controls were detected by ELISA and immunohistochemical examination (22 patients with pSS).Flow cytometry was used to detect B cell's apoptosis,BAFF and IL-17 interfered with amplified Th17 cells,and co-cultured with B cells.Immunoblot was used to detect supernatant antibody in 5 patients with pSS.Independent samples t test was used for statistical analysis.Results In all pSS specimens,infiltrating inflammatory cells expressed BAFF,so did some ductual cells,but acinar cells did not express these markers.There was no expression of BAFF in the controls.BAFF-positive cell numbers in the labial salivary glands of pSS patients with focal infiltrating lymphocytes were more than that with non-focal infiltrating lymphocytes (888±372 vs 164±161,t=5.94,P＜0.05),and the percentage of BAFF-positive lymphocytes over the total infiltrating lymphocytes in the salivary glands of pSS patients with focal infiltrating lymphocytes [(0.18 ±0.08) ％] was higher than those with non-focal infiltrating lymphocytes [(0.09 ±0.07) ％] (t =3.03,P＜0.05).The level of soluble BAFF in patients with pSS [(6.0±2.8) ng/ml] was significantly higher than the controls [(3.8±1.7) ng/ml,t=3.26,P＜0.05].BAFF or IL-17 transfected group,B cell apoptosis rate [(24± 5)％,(23±5)％] were significantly higher than the non-transfected group [(7±4)％],t=4.6,4.4; P＜0.05].And there was no significant difference when compared with cultured B cells (P＞0.05).Compared with the controls,no antibody could be detected in the supernatants.Conclusion BAFF may be involved in the process of local inflammatory damage of the pSS,it may have a synergistic effect with IL-17 on abnormal B cell function.

OBJECTIVETo investigate the expression of SOX2 in cervical intraepithelial neoplasia (CIN) and cervical cancer and explore its association with the clinical features.

METHODSSOX2 expressions were examined using immunohistochemical method in 10 normal cervical tissue specimens, 36 cervical intraepithelial neoplasia specimens (including 10 cases of grade I, 12 of grade II, and 14 grade III) and 40 cervical cancer specimens (including 21 cases of stage I and 19 of stage II). The correlation between the immunohistochemical results and the clinical features of the patients was analyzed.

RESULTSSOX2 expression was negative in normal cervical tissues, and was positive in 41.6% of CIN specimens (10.0% in CIN I, 41.7% in CIN II, and 64.3% in CIN III) in 82.5% of cervical cancer specimens (78.2% in stage I and 88.2% in stage II). The patients with cervical cancer had a significantly higher positivity rate of SOX2 than normal control group (P<0.05). The positivity rate of SOX2 increased with the evolution of cervical disease. SOX2 protein expression was significantly correlated with the histological grade and lymph node metastasis (P<0.05), but not with the age or clinical stage of the patients (P<0.05).

CONCLUSIONSOX2 expression may serve as a useful indicator for evaluating metastasis and malignancy of cervical cancer.

Adult ; Aged ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; Female ; Humans ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; SOXB1 Transcription Factors ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology