ObjectiveTo investigate the clinical efficacy of oral/ gastric tube/ jejunal tube administration or retention enema of Qingjie Huagong Formula （清解化攻方， QHF） mirabilite abdominal bag external application combined with conventional western medicine in patients with acute pancreatitis （AP）. MethodsA prospective， randomized， double-blind， placebo-controlled trial was conducted. A total of 128 AP patients were enrolled and randomly assigned to a control group and a treatment group， with 64 cases in each group. The control group received placebo and conventional western medicine， while the treatment group additionally received oral/ gastric tube/ jejunal tube administration or retention enema of QHF， and mirabilite abdominal bag external application. Both groups received treatment from admission to discharge as one complete course， with the maximum treatment duration not exceeding 14 days.The primary outcome was the severity grading of AP. Secondary outcomes were clinical efficacy， laboratory indicators including white blood cell count （WBC）， C-reactive protein （CRP）， procalcitonin （PCT）， blood urea nitrogen （BUN）， lactate （Lac）， and D-dimer， gastrointestinal function recovery indicators including time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition， total fluid volume administered within 24 h after admission， intra-abdominal pressure， length of hospital stay， hospitalization costs， and incidence of complications. ResultsDuring the treatment period， 3 cases dropped out in the control group and 9 cases in the treatment group， leaving 116 cases for final analysis （55 in the treatment group and 61 in the control group）. After treatment， the markedly effective rate and overall effective rate in the treatment group were 69.09% （38/55） and 92.73% （51/55）， respectively， which was higher than 49.18% （30/61） and 80.33% （49/61） in the control group. The severity of the disease in the treatment group was significantly lower than that in the control group （P＜0.05）. Compared to the control group， the treatment group showed significantly reduced levels of WBC， CRP， PCT， BUN， Lac， and D-dimer； the time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition were significantly shortened； the fluid volume administered within 24 h after admission and intra-abdominal pressure were significantly reduced， as well as the length of hospital stay and hospitalization costs （P＜0.05 or P＜0.01）. The incidences of acute kidney injury， systemic inflammatory response syndrome， and infected pancreatic necrosis in the treatment group were significantly lower than those in the control group （P＜0.05）. ConclusionQHF combined with conventional western medicine can significantly improve the inflammatory status of AP patients， promote gastrointestinal function recovery， reduce intra-abdominal pressure and fluid resuscitation requirements， lower the risk of certain complications， and shorten the length of hospital stay.

ObjectiveTo investigate the clinical efficacy of oral/ gastric tube/ jejunal tube administration or retention enema of Qingjie Huagong Formula （清解化攻方， QHF） mirabilite abdominal bag external application combined with conventional western medicine in patients with acute pancreatitis （AP）. MethodsA prospective， randomized， double-blind， placebo-controlled trial was conducted. A total of 128 AP patients were enrolled and randomly assigned to a control group and a treatment group， with 64 cases in each group. The control group received placebo and conventional western medicine， while the treatment group additionally received oral/ gastric tube/ jejunal tube administration or retention enema of QHF， and mirabilite abdominal bag external application. Both groups received treatment from admission to discharge as one complete course， with the maximum treatment duration not exceeding 14 days.The primary outcome was the severity grading of AP. Secondary outcomes were clinical efficacy， laboratory indicators including white blood cell count （WBC）， C-reactive protein （CRP）， procalcitonin （PCT）， blood urea nitrogen （BUN）， lactate （Lac）， and D-dimer， gastrointestinal function recovery indicators including time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition， total fluid volume administered within 24 h after admission， intra-abdominal pressure， length of hospital stay， hospitalization costs， and incidence of complications. ResultsDuring the treatment period， 3 cases dropped out in the control group and 9 cases in the treatment group， leaving 116 cases for final analysis （55 in the treatment group and 61 in the control group）. After treatment， the markedly effective rate and overall effective rate in the treatment group were 69.09% （38/55） and 92.73% （51/55）， respectively， which was higher than 49.18% （30/61） and 80.33% （49/61） in the control group. The severity of the disease in the treatment group was significantly lower than that in the control group （P＜0.05）. Compared to the control group， the treatment group showed significantly reduced levels of WBC， CRP， PCT， BUN， Lac， and D-dimer； the time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition were significantly shortened； the fluid volume administered within 24 h after admission and intra-abdominal pressure were significantly reduced， as well as the length of hospital stay and hospitalization costs （P＜0.05 or P＜0.01）. The incidences of acute kidney injury， systemic inflammatory response syndrome， and infected pancreatic necrosis in the treatment group were significantly lower than those in the control group （P＜0.05）. ConclusionQHF combined with conventional western medicine can significantly improve the inflammatory status of AP patients， promote gastrointestinal function recovery， reduce intra-abdominal pressure and fluid resuscitation requirements， lower the risk of certain complications， and shorten the length of hospital stay.

OBJECTIVE: To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand. METHODS: A retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023. All patients were male, aged 22-65 years, with an average of 45.9 years. The duration of gout history ranged from 2 to 18 years, with an average of 8.8 years. The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months, with an average of 17.6 months. The gouty tophus eroded the flexor pollicis longus tendon in 4 cases, with Verdan flexor tendon zones being Ⅰ-Ⅱ in 1 case and Ⅳ-Ⅴ in 3 cases. The flexor digitorum profundus tendons were affected in 2 cases for the index finger, 1 for the middle finger, and 1 for the ring finger, all located in zone Ⅳ-Ⅴ. The long axis of the gouty tophus ranged from 2.3 to 4.5 cm, with an average of 3.4 cm. All 8 patients presented with limited finger flexion and extension. Among them, 4 cases were accompanied by median nerve compression symptoms, and 1 case had associated bone and joint destruction in the hand. The total active motion (TAM) of the affected finger was (81.3±30.2)° before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, and the functional evaluation was poor. The harvested palmaris longus tendon intraoperatively was 7-9 cm in length. RESULTS: Surgical incisions in all 8 patients healed by first intention, with no infections, graft non-union, or significant adhesion complications. All patients were followed up 8-25 months, with an average of 14.8 months. Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms. Patients did not experience wrist pain or other discomfort, and function was not compromised. At last follow-up, according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, the TAM of 8 patients was (197.5±55.8)°, which significantly improved when compared with that before operation ( t=11.638, P<0.001); the hand function of 1 patient with gouty tophus in zone Ⅰ-Ⅱ flexor pollicis longus tendon was good, and the other 7 patients were excellent. CONCLUSION Free palmaris longus tendon graft reconstruction demonstrates good effectiveness in treating gouty tophus erosion lesions in flexor tendon of wrist and hand.
Humans ; Middle Aged ; Male ; Adult ; Tendons/surgery* ; Retrospective Studies ; Aged ; Gout/complications* ; Wrist/surgery* ; Plastic Surgery Procedures/methods* ; Hand/surgery* ; Treatment Outcome ; Young Adult

Objective:To investigate pediatric colonoscopy procedures and the associated changes in the disease spectrum.Methods:The clinical data of 1 087 children who underwent pediatric colonoscopy at the Second Affiliated Hospital of Nanjing Medical University and Yili Prefecture Friendship Hospital Affiliated to Nanjing Medical University from January 2012 to December 2022 were retrospectively collected. Patients were divided into 0-3 ( n=165), 4-6 ( n=307), 7-10 ( n=275) and 11-14 ( n=340) years groups according to their age, and also divided into two time periods according to the examination time point, 2012-2017 ( n=302) and 2018-2022 ( n=785) groups. Indicators that were observed and analyzed included the primary reasons for colonoscopy, types and proportions of abnormalities, distribution of cases and symptoms by period and age group, and disease diagnosis and treatment before and after colonoscopy. Results:A total of 1 238 colonoscopies were completed in 1 087 children. Blood in the stool was the most common cause (337/1 087, 31.00%). The most abnormalities were found in intestinal polyps (190/1 087, 17.48%) and inflammatory bowel disease (IBD) (181/1 087, 16.65%), as well as in 95 cases (95/1 087, 8.74%) who were confirmed autism and requested colonoscopy placement for fecal microbiota transplantation (FMT). There were differences in case distribution and symptoms among different age groups: polyps were most common in the 0-3 years group (75/165, 45.45%), and IBD was most common in the 11-14 years group (97/340, 28.53%). Compared with 2012-2017, during 2018-2022, the proportion of colonoscopies for polyps in children decreased [from 49.67% (150/302) to 5.10% (40/785), P<0.001], while the proportion for IBD increased [from 12.25% (37/302) to 18.34% (144/785), P=0.016], and autism requiring colonoscopic duct placement for FMT increased [from 2.32% (7/302) to 11.21% (88/785), P<0.001]. Conclusion:Pediatric colonoscopy plays an important role in the diagnosis and treatment of pediatric diseases. With the increasing clinical application demands, diversified procedures such as pre-FMT colonoscopic duct placement are becoming important directions for the future development of pediatric colonoscopy.

Objective:To investigate the clinical effect of turbocharged large free anterolateral thigh flaps (ALTF) by anastomosis with a superior perforator of the flap in reconstruction of large soft tissue defects of limbs.Methods:From June 2017 to June 2021, 6 patients with large soft tissue defects of limbs with exposed joints and tendons were treated in the Department of Hand and Foot Surgery of the Affiliated Hospital of Qingdao University with turbocharged large free ALTFs. The pressurised blood supply of ALTF was achieved by anastomosing a superior perforating branch carried in the flap. Such large and turbocharged ALTFs were used to repair large soft tissue defects with exposed joints and tendons in limbs. Of the 6 patients, there were 4 males and 2 females, and aged 32-60(46.0±8.1) years old. Cause of injury: 5 by traffic accident and 1 by machine crush. Four patients had soft tissue defects in lower limbs: 2 with open tibia and fibula fractures, 1 had patellar defect and fibula fracture, and 1 associated with fibula fracture. The other 2 patients had soft tissue defect in upper limbs with bone and tendon exposed but without fracture. The sizes of wound were 25.0 cm×12.0 cm-35.0 cm×19.0 cm. In the primary surgery, Vacuum sealing drainage (VSD) was applied. In the second stage, free ALTFs were used to cover the wound. The area of flap incision was increased by anastomosing the superior perforators and as the consequence, the size of flaps was achieved to 26.0 cm×13.0 cm-36.0 cm×15.0 cm. Donor site of 6 cases were reduced by direct suture, and the remaining wound was covered by free skin graft. Postoperative follow-ups were conducted at outpatient clinic reviews at 1, 2, 3 and 6 months after surgery, and followed by telephone or WeChat interviews. The results of the operation were evaluated according to the appearance, texture and sensory recovery of the flap.Results:All 6 flaps survived and the patients completed the postoperative follow-up that lasted for 6-24 (16.7±5.0) months. No necrosis of flap occurred after surgery. The appearance and texture of the flaps were satisfactory without wear and tear. Sensation recover was evaluated by the standered of British Medical Research Council (BMRC), 4 patients recovered to S 3 and 2 patients to S 2. The Mayo score of the elbow joint was good in 2 patient with upper extremity injuries. Of the other 4 patients with lower limb injuries, the knee function evalued by Hospital for Special Surgery(HSS) score were excellent in 3 patients and good in 1 patient, and the American Orthopedic Foot and Ankle Societ(AOFAS) ankle-hind foot function score was excellent in 2 patients and good in 2 patients. There was no infection or function loss at all donor sites. Conclusion:The perforator of an ALTF is relatively constant, and the flap can partially restore sensation. The superior perforator is reliable and the incision area of the flap can be enlarged by anastomosing the superior perforator vessels. It is a better way to reconstruct a large soft tissue defects in limbs.

Objective:To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects.Methods:The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery.Results:The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence.Conclusions:Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

Background: Arctic-like (AL) lineages of rabies viruses (RABVs) remains endemic in some Arctic and Asia countries. However, their evolutionary dynamics are largely unappreciated. Objectives: We attempted to estimate the evolutionary history, geographic origin and spread of the Arctic-related RABVs. Methods: Full length or partial sequences of the N and G genes were used to infer the evolutionary aspects of AL RABVs by Bayesian evolutionary analysis. Results: The most recent common ancestor (tMRCA) of the current Arctic and AL RABVs emerged in the 1830s and evolved independently after diversification. Population demographic analysis indicated that the viruses experienced gradual growth followed by a sudden decrease in its population size from the mid-1980s to approximately 2000.Genetic flow patterns among the regions reveal a high geographic correlation in AL RABVs transmission. Discrete phylogeography suggests that the geographic origin of the AL RABVs was in east Russia in approximately the 1830s. The ancestral AL RABV then diversified and immigrated to the countries in Northeast Asia, while the viruses in South Asia were dispersed to the neighboring regions from India. The N and G genes of RABVs in both clades sustained high levels of purifying selection, and the positive selection sites were mainly found on the C-terminus of the G gene. Conclusions The current AL RABVs circulating in South and North Asia evolved and dispersed independently.

Background: High concentrations of particulate matter less than 2.5 μm in diameter (PM2.5) in poultry houses is an important cause of respiratory disease in animals and humans. Pseudomonas aeruginosa is an opportunistic pathogen that can induce severe respiratory disease in animals under stress or with abnormal immune functions. When excessively high concentrations of PM2.5 in poultry houses damage the respiratory system and impair host immunity, secondary infections with P. aeruginosa can occur and produce a more intense inflammatory response, resulting in more severe lung injury. Objectives: In this study, we focused on the synergistic induction of inflammatory injury in the respiratory system and the related molecular mechanisms induced by PM2.5 and P. aeruginosa in poultry houses. Methods: High-throughput 16S rDNA sequence analysis was used for characterizing the bacterial diversity and relative abundance of the PM2.5 samples, and the effects of PM2.5 and P. aeruginosa stimulation on inflammation were detected by in vitro and in vivo. Results: Sequencing results indicated that the PM2.5 in poultry houses contained a high abundance of potentially pathogenic genera, such as Pseudomonas (2.94%). The lung tissues of mice had more significant pathological damage when co-stimulated by PM2.5 and P. aeruginosa, and it can increase the expression levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α through nuclear factor (NF)-κB pathway in vivo and in vitro. Conclusions The results confirmed that poultry house PM2.5 in combination with P. aeruginosa could aggravate the inflammatory response and cause more severe respiratory system injuries through a process closely related to the activation of the NF-κB pathway.

Objective:To explore the clinical efficacy of different modes of continuous negative pressure wound therapy (NPWT) on venous ulcer wounds of lower limbs, and to analyze the influencing factors.Methods:From January 2018 to December 2019, 53 patients with venous ulcer of lower limbs who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospective randomized controlled study. According to the random number table, the patients were divided into single negative pressure therapy (SNPT) group (19 patients, 11 males and 8 females), cyclic alternating negative pressure therapy (CANPT) group (17 patients, 12 males and 5 females), and routine dressing change (RDC) group (17 patients, 10 males and 7 females), aged (47±11), (49±10), and (47±10) years respectively. After admission, patients in SNPT group were given continuous NPWT with the single negative pressure setting at -13.3 kPa, patients in CANPT group were also given continuous NPWT but with the cyclic alternating negative pressure setting from -16.0 to -10.7 kPa, while patients in RDC group were given dressing change with vaseline gauze soaked with iodophor. The wound healing rate was calculated on treatment day 7 and 14. Transcutaneous oxygen pressure (TcPO 2) around the wound was detected by TcPO 2 meter before treatment and on treatment day 7 and 14. The wound exudate/drainage fluid was collected on treatment day 1, 4, 7, 10, and 14, with the pH value measured using a pH meter, and the volume of exudate/drainage fluid recorded. Before treatment and on treatment day 7 and 14, venous blood was collected to detect the serum levels of interleukin 1β (IL-1β), IL-6, tumor necrosis factor α(TNF-α), transforming growth factor-β 1 (TGF-β 1), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Before treatment and on treatment day 7 and 14, wound exudates were collected for bacterial culture, and Visual Analogue Scale and Hamilton Anxiety Scale were used to evaluate the degree of wound pain and anxiety of patients respectively. The length of hospital stay and the total treatment cost were counted. Analysis of variance for repeated measurement, one-way analysis of variance, least significant difference test, Kruskal Wallis H test, Mann Whitney U test, chi-square test, Fisher′s exact probability method test, and Bonferroni correction were used to analyze the data. According to the wound healing rate on treatment day 14, the efficiency of patients were divided into two grades of significant healing with wound healing rate≥70% and non significant healing with wound healing rate<70%. According to the two categories of wound healing rate as dependent variables, the levels of TcPO 2, IL-1β, IL-6, TNF-α, TGF-β 1, VEGF, bFGF levels and bacterial detection, wound pain and anxiety before treatment, wound exudate/drainage fluid volume and pH value on treatment day 1 were taken as covariates, and binary classification multifactor logistic regression analysis was used to analyze the risk factors of significant wound healing. Results:(1) On treatment day 7, the wound healing rate of patients in SNPT group was (33±10) %, which was significantly higher than (24±9) % of RDC group ( P<0.05). On treatment day 14, the wound healing rates of patients in SNPT group and CANPT group were (71±15)% and (66±18)%, respectively, which were significantly higher than (45±19)% of RDC group ( P<0.01). (2) Compared with those of RDC group, the TcPO 2 value around the wound of patients was significantly increased in SNPT group on treatment day 14 and in CANPT group on treatment day 7 and 14 ( P<0.05 or P<0.01), the pH value of wound drainage fluid of patients was significantly decreased in SNPT group on treatment day 10 and 14 and in CANPT group on treatment day 7 and 14 ( P<0.05), the volume of wound drainage fluid of patients was significantly reduced in SNPT group on treatment day 10 and 14 and in CANPT group on treatment day 7, 10, and 14 ( Z=-4.060, -4.954, -2.413, -4.085, -4.756, P<0.05 or P<0.01), the serum levels of IL-1β, IL-6, and TNF-α of patients were significantly decreased in SNPT group and CANPT group on treatment day 7 and 14 ( P<0.01), the serum level of TGF-β 1 of patients was significantly increased in CANPT group on treatment day 14 ( P<0.05), the serum levels of VEGF and bFGF were significantly increased in SNPT group and CANPT group on treatment day 14 ( P<0.01), the bacteria detection proportion of wound exudate, wound pain, and anxiety scores of patients were significantly decreased in SNPT group and CANPT group on treatment day 7 and 14 ( P<0.01). Compared between the negative pressure therapy two groups, except the wound pain score of patients in CANPT group was significantly lower than that in SNPT group ( P<0.01) on treatment day 7, the other indicators mentioned above were similar. (3) The length of hospital stay of patients in SNPT group was similar to that in CANPT group ( P>0.05), which were significantly shorter than the time in RDC group ( P<0.01). The total treatment cost of patients among the three groups was similar ( F=1.766, P>0.05). (4) Before treatment, the serum levels of TNF-α and bFGF, TcPO 2 around the wound, and the degree of wound pain were risk factors for significant wound healing (odds ratio=1.109, 0.950, 1.140, 2.169, 95% confidence interval=1.012-1.217, 0.912-0.988, 1.008-1.290, 1.288-3.651, P<0.05 or P<0.01). Conclusions:Clinical application of continuous NPWT under single negative pressure mode and cyclic alternating negative pressure mode has a positive effect on improving the wound base and healing rate of venous ulcer of lower limbs. But cyclic alternating negative pressure mode is significantly more effective than single negative pressure mode in improving TcPO 2 around the wound, reducing wound pH value, reducing exudate volume and relieving pain. The serum levels of TNF-α and bFGF, TcPO 2 around the wound and the degree of wound pain were the risk factors that affect the wound healing significantly.