Complete androgen insensitivity syndrome（CAIS）is one of the most common disorders of sex development，and is an X-linked recessive disorder，mainly caused by mutations in the androgen receptor gene.The clinical manifestations are 46，XY chromosome karyotype，and female external genitalia，and the patients often presented with infantile inguinal mass and primary amenorrhea in puberty.They have endocrine features of persistent androgen resistance.Children with CAIS are mostly raised as females，and the clinical management of CAIS centers on the timing of gonadectomy，which is still controversial.Clinical guidelines recommend delaying gonadectomy until after puberty to ensure normal pubertal growth and development.Postoperative estrogen replacement therapy and psychotherapy are also important aspects of comprehensive multidisciplinary treatment.In this article，we review four aspects of CAIS：pathogenesis，clinical features，diagnosis，and treatment，in order to further improve clinicians' understanding of the disease.

Objective:To investigate the clinical effects and related mechanism of antibiotic bone cement in treating diabetic foot ulcer (DFU).Methods:A prospective randomized controlled study was conducted. From August 2020 to August 2022, 24 patients with DFU who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. According to the block randomization, the patients were divided into 2 groups, with 12 patients in each group. In antibiotic bone cement group, there were 7 male and 5 female patients, aged (64±8) years, with the ulcer area of (41±21) cm 2. In silver sulfadiazine group, there were 8 male and 4 female patients, aged (62±8) years, with the ulcer area of (38±19) cm 2. Under the condition of ensuring the patency of at least one main inferior genicular artery in each patient, the continuous vacuum sealing drainage was performed for 3-5 days after thorough debridement. Thereafter, the wounds in antibiotic bone cement group were treated with gentamicin-laden bone cement, and the wounds in silver sulfadiazine group were treated with silver sulfadiazine cream for dressing change. After 3 weeks of dressing change, the wound was covered with split-thickness skin graft from the lateral thigh on the affected side. Before debridement and after 3 weeks of dressing change, the blood flow intensities of wound tissue and normal skin tissue in foot were measured using laser Doppler flowmeter, and then, the percentage of relative blood flow intensity of wound and the change rate of blood flow intensity were calculated. After 3 weeks of dressing change, the wound margin tissue was taken, the number of CD31-positive neovascular and the vascular morphology were observed and detected by immunohistochemical staining, the morphology of blood vessels surrounded by CD31 and α-smooth muscle actin (α-SMA) double-positive cells was observed by immunofluorescence staining, the cell proliferation activity was evaluated by immunofluorescence staining (denoted as the ratio of Ki67 positive cells), and the protein expression of vascular endothelial growth factor receptor 2 (VEGFR2) was detected by Western blotting. The skin graft survival was observed 3-5 days after skin grafting, and the wound healing time was recorded. Data were statistically analyzed with independent sample t test and Fisher's exact probability test. Results:The percentages of relative blood flow intensity of wounds of patients before debridement were similar between the two groups ( P>0.05). After 3 weeks of dressing change, the percentage of relative blood flow intensity of wounds and the change rate of blood flow intensity of patients in antibiotic bone cement group were (44.7±2.0)% and (129±12)%, respectively, which were significantly higher than (28.3±1.2)% and (41±8)% in silver sulfadiazine group (with t values of 24.15 and 20.97, respectively, P<0.05). After 3 weeks of dressing change, compared with those in silver sulfadiazine group, the number of CD31-positive neovascular in the wound margin tissue of patients in antibiotic bone cement group was significantly increased ( t=33.81, P<0.05) with larger diameter and more regular arrangement, the vascular wall continuity surrounded by CD31 and α-SMA double-positive cells was better, and the ratio of Ki67 positive cells and protein expression of VEGFR2 were significantly increased (with t values of 40.97 and 47.38, respectively, P<0.05). On post skin grafting day 3-5, all the patients in antibiotic bone cement group and 8 patients in silver sulfadiazine group had good skin graft survival, while 4 patients in silver sulfadiazine group showed spotted/patchy skin graft necrosis, which were cured after corresponding treatment. The wound healing time of patients in antibiotic bone cement group was (47.1±2.9) d, which was significantly shorter than (58.8±2.3) d in silver sulfadiazine group ( t=10.86, P<0.05). Conclusions:Compared with silver sulfadiazine, clinical application of antibiotic bone cement for treating DFU has the characteristics of accelerating wound healing and better reconstruction of local blood flow, which may be closely related to the fact that antibiotic bone cement promoted the local angiogenesis effectively in the wound through enhancing the expression of VEGFR2.

Objective:To analyze the epidemiological characteristics of hospitalized children with burns who developed nosocomial infection, and screen their independent risk factors, based on which, a risk prediction model was established and evaluated.Methods:A retrospective cohort study was conducted. From May 2010 to April 2023, 417 children with burns who met the inclusion criteria were admitted to the First Affiliated Hospital of the Air Force Medical University, including 248 males and 169 females, aged ≤14 years. Statistics on the composition and source distribution of pathogenic bacteria in children were detected. According to the occurrence of nosocomial infection, the children were divided into infected group (216 cases) and uninfected group (201 cases), and the children gender, age, total area of burns, presence of full-thickness burns, cause of the injury, and season of the injury of the children in the 2 groups were collected, as well as presence of an abnormal serum albumin level, delayed resuscitation, combination of inhalation injury at admission, and early shock, tracheotomy, admission to the intensive care unit, and deep venous catheterization after post-hospitalization, and more or less times (>2 times being more and ≤2 times being less) of surgeries, indwelling catheter days, and length of hospitalization stay on post-hospitalization. The burned children were divided into modeling group (291 cases) and validation group (126 cases) according to the ratio of 7∶3, and the data of the 2 groups were recorded as before. Data were statistically analyzed with Mann-Whitney U test, chi-square test, and Fisher's exact probability test. The least absolute value selection and shrinkage operator (LASSO) regression analysis was used to reduce the risk factors of nosocomial infection in the children in modeling group. Multivariate logistic regression analysis was used to further screen the above screened risk factors, and the nomogram prediction model was drawn based on the further screened independent risk factors. The Bootstrap method was used for internal validation of the aforementioned predictive models, and the receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves of the predictive models were plotted in modeling group and validation group in order to assess its discriminative power, calibration, and clinical utility, respectively. Results:A total of 245 strains of pathogenic bacteria were detected, with Staphylococcus aureus (101 strains, accounting for 41%), Pseudomonas aeruginosa (54 strains, accounting for 22%), and Acinetobacter baumannii (33 strains, accounting for 13%) dominating, and the wound secretions were the most frequent source of pathogenic bacteria (211 strains, accounting for 86%), followed by blood (10 strains, accounting for 4%), and sputum (5 strains, accounting for 2%). There were statistically significant differences between infected group and non-infected group in the total burn area, indwelling catheter days, length of hospitalization stay, presence of full-thickness burns, combined with inhalation injury, and deep vein catheterization, and more or less times of surgeries (with Z values of -2.32, -3.29, and -3.85, respectively, with χ2 values of 26.36, 7.03, 10.13, and 10.53, respectively, P<0.05); there was statistically significant difference in cause of the injury between the two groups ( P<0.05). All clinical characteristics of children with burns in the modeling and validation groups were similar ( P>0.05). The six risk factors obtained from the LASSO regression analysis were full-thickness burns, deep vein catheterization, abnormal serum albumin level, multiple surgeries, indwelling catheter days, and length of hospitalization stay; the multivariate logistic regression analysis showed that full-thickness burns, abnormal serum albumin level, deep vein catheterization, and multiple surgeries were the independent risk factors for the occurrence of nosocomial infection in burned children (with odds ratios of 2.27, 2.66, 4.08, and 2.92, respectively, with 95% confidence intervals of 1.22-4.21, 1.03-6.87, 1.07-15.49, and 1.15-7.42, respectively, P<0.05). The ROC curves of the prediction models showed that, the areas under the ROC curves of the modeling and validation groups were 0.81 (with 95% confidence interval of 0.78-0.84) and 0.81 (with 95% confidence interval of 0.76-0.85), respectively; the calibration curves showed that, the calibration curves of the prediction models of modeling and validation groups were around the ideal curves; the clinical decision curves showed that, the threshold probability values of the prediction models in modeling and validation groups were in the ranges of 5% to 70% and 1% to 46%, respectively. Conclusions:The main pathogen of infection in children with burns is Staphylococcus aureus from wound secretions. A nomogram risk prediction model constructed based on independent risk factors such as full-thickness burns, abnormal serum albumin level, deep venous catheterization, and multiple surgeries has good accuracy and can be easily used to predict the occurrence of nosocomial infections in hospitalized children with burns.

Objective? To explore the application methods and effects of early postoperative activities on patients undergoing neurosurgery. Methods? Totally 101 postoperative patients from the Department of Neurosurgery of a Class Ⅲ Grade A hospital in Beijing between June and August 2018 were selected as a control group, while 110 postoperative patients between September and November 2018 were selected as an observation group by convenient sampling. Patients in the control group received routine postoperative care, while patients in the observation group did early post-operative activities. The effects of early off-bed activities such as the time of first early off-bed activity, the frequency of daily off-bed activities and the total time of off-bed activities every day as well as postoperative outcome indicators such as the interval from first off-bed activity to discharge, ability of daily living (ADL) at discharge and hospitalization expenses were compared between the two groups postoperatively. Results? For the effects of early off-bed activities, the time of first off-bed activity and the total time of off-bed activities every day in the observation group were better than those in the control group, and there were statistically significant differences between the two groups (Z/t=-3.300,2.418;P＜0.05). After care for early postoperative activities, the median of patients' time of early off-bed activities were reduced from 27.0 h to 24.0 h, and total time of off-bed activities every day were increased from (1.06±0.72) h to (1.27±0.70) h. In terms of patients' postoperative outcomes, the interval from first off-bed activity to discharge, ADL at discharge and hospitalization expenses, there were statistically significant differences between the two groups (Z/t=-3.356,4.428,-3.316;P＜0.05). The median of patients' interval from first off-bed activity to discharge were decreased from 55.0 h to 39.3 h. Conclusions? Early postoperative activities can improve the motor ability of neurosurgical patients, shorten their length of hospital stay, and reduce their hospitalization expenses,thus enabling the patients' quicker recovery.

Objective To explore the repair effect of the superficial iliac island flap for the hypertrophic scar of mons pubis after burned.Methods From July 2013 to July 2016,the author had treated 26 patients with mons pubis hypertrophic scar after burned.There were 19 males and 7 females among them.The age was from 1 year and 5 months to 10 years old.The scar area was of 6 cm ×5 cm-15 cm ×8 cm.Some of the patients had external genital malformations caused by scar contracture.Surgery removed the scar and completely released the basic shape of the vulva.It had to expand the superficial iliac island flap of 1 cm according to the size of the wound,and sufficient length of vascular pedicle according to the distance from the wound to the flap.The flap was cut in the superficial of the deep fascia,and reserved about 2cm wide fat along the superficial iliac artery.The superficial vein was located in the fat.The wound was covered by the flap,which was rotated directly or through a subcutaneous tunnel.Results Twenty six patients were treated with a single operation and no vascular crisis occurred.All the flaps survived.One patient delayed incision healing due to the high incision tension,and the remaining patients were in primary healing.The postoperative follow-up found that all the flaps had thin thickness,similar color to the surrounding skin,soft texture and feeling.Conclusions There are obvious signs of scarring in the mons pubis area after deep burns,and scar contracture can cause vulvar deformity.The superficial iliac island flap,which has a thin thickness,soft texture,similar color,and can be sutured directly for the donor site,is a good choice to repair the mons pubis hypertrophic scar.

SUMOylation is recently found to function as a targeting signal for the degradation of substrates through the ubiquitin-proteasome system. RNF4 is the most studied human SUMO-targeted ubiquitin E3 ligase. However, the relationship between SUMO proteases, SENPs, and RNF4 remains obscure. There are limited examples of the SENP regulation of SUMO2/3-targeted proteolysis mediated by RNF4. The present study investigated the role of SENP3 in the global protein turnover related to SUMO2/3-targeted ubiquitination and focused in particular on the SENP3 regulation of the stability of Sp1. Our data demonstrated that SENP3 impaired the global ubiquitination profile and promoted the accumulation of many proteins. Sp1, a cancer-associated transcription factor, was among these proteins. SENP3 increased the level of Sp1 protein via antagonizing the SUMO2/3-targeted ubiquitination and the consequent proteasome-dependent degradation that was mediated by RNF4. De-conjugation of SUMO2/3 by SENP3 attenuated the interaction of Sp1 with RNF4. In gastric cancer cell lines and specimens derived from patients and nude mice, the level of Sp1 was generally increased in parallel to the level of SENP3. These results provided a new explanation for the enrichment of the Sp1 protein in various cancers, and revealed a regulation of SUMO2/3 conjugated proteins whose levels may be tightly controlled by SENP3 and RNF4.
Animals ; Cysteine Endopeptidases ; genetics ; metabolism ; Gene Expression Regulation, Neoplastic ; Humans ; Immunoenzyme Techniques ; Immunoprecipitation ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Prognosis ; Protein Processing, Post-Translational ; Proteolysis ; RNA, Messenger ; genetics ; Real-Time Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction ; Small Ubiquitin-Related Modifier Proteins ; antagonists & inhibitors ; genetics ; metabolism ; Sp1 Transcription Factor ; genetics ; metabolism ; Stomach Neoplasms ; genetics ; metabolism ; pathology ; Sumoylation ; Tumor Cells, Cultured ; Ubiquitination ; Ubiquitins ; antagonists & inhibitors ; genetics ; metabolism ; Xenograft Model Antitumor Assays