Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

Objective:To study distribution of CD24 in immune microenvironment and its relationship between pathological status of axillary lymph nodes during neoadjuvant therapy(NAT)for breast cancer.Methods:A total of 200 breast cancer patients admitted to the First People's Hospital of Chenzhou City from February 2021 to February 2024 were selected as research objects.According to CD24 expression,patients were divided into high expression group(n=126)and low expression group(n=74),and divided into pCR group(n=91)and non-pCR group(n=109)according to clinical treatment effect.Hierarchical regression model was used to analyze influence of different clinicopathological features on CD24 expression,generalized linear mixed model was constructed to judge relationship between CD24 and pCR,and dose-response relationship between CD24 and pCR was analyzed by restricted cubic spline method,GMDR model was used to analyze interaction of CD24 and immune microenvironment factors on pCR.Results:CD24 expression was correlated with TNM stage,vascular invasion,number of lymph nodes and tumor markers levels.CD24 mRNA level in patients after NAT showed a gradually decreasing trend.Compared with before treatment,CD24 mRNA expression at 1 month,3 months and 6 months after treatment had statistical significance(P<0.05),immune microenvironment factors levels in patients were signifi-cantly changed,and CD3+T,CD4+T,CD8+T,FOXP3,IL-10,IgG and IgM levels were increased,while CD10+T,IL-6 and IL-17 levels were decreased.TNM stage,vascular invasion,number of lymph nodes,CA125 and CEA levels were significant positive related with CD24 level(P<0.05).Tumor aspect ratio,TNM stage,vascular invasion,number of lymph nodes,HER-2,Ki-67,CD24 expres-sions and CD24 mRNA level were correlated with post-NAT axillary lymph node pCR in breast cancer patients.CD24 mRNA expres-sion was a risk factor for post-NAT axillary lymph node pCR,and probability of pCR in patients decreased significantly with increase of CD24 mRNA expression.CD24 interacted with CD3+T,CD4+T,CD8+T,CD10+T,FOXP3,IL-6,IL-10,IL-17,IgG and IgM on pCR.Conclusion:CD24 level in patients after NAT showes a gradually decreasing trend.CD24 mRNA expression is a risk factor for axillary lymph node pCR after NAT.With increase of CD24 mRNA expression,probability of pCR in patients decreases significantly.

Objective:To study distribution of CD24 in immune microenvironment and its relationship between pathological status of axillary lymph nodes during neoadjuvant therapy(NAT)for breast cancer.Methods:A total of 200 breast cancer patients admitted to the First People's Hospital of Chenzhou City from February 2021 to February 2024 were selected as research objects.According to CD24 expression,patients were divided into high expression group(n=126)and low expression group(n=74),and divided into pCR group(n=91)and non-pCR group(n=109)according to clinical treatment effect.Hierarchical regression model was used to analyze influence of different clinicopathological features on CD24 expression,generalized linear mixed model was constructed to judge relationship between CD24 and pCR,and dose-response relationship between CD24 and pCR was analyzed by restricted cubic spline method,GMDR model was used to analyze interaction of CD24 and immune microenvironment factors on pCR.Results:CD24 expression was correlated with TNM stage,vascular invasion,number of lymph nodes and tumor markers levels.CD24 mRNA level in patients after NAT showed a gradually decreasing trend.Compared with before treatment,CD24 mRNA expression at 1 month,3 months and 6 months after treatment had statistical significance(P<0.05),immune microenvironment factors levels in patients were signifi-cantly changed,and CD3+T,CD4+T,CD8+T,FOXP3,IL-10,IgG and IgM levels were increased,while CD10+T,IL-6 and IL-17 levels were decreased.TNM stage,vascular invasion,number of lymph nodes,CA125 and CEA levels were significant positive related with CD24 level(P<0.05).Tumor aspect ratio,TNM stage,vascular invasion,number of lymph nodes,HER-2,Ki-67,CD24 expres-sions and CD24 mRNA level were correlated with post-NAT axillary lymph node pCR in breast cancer patients.CD24 mRNA expres-sion was a risk factor for post-NAT axillary lymph node pCR,and probability of pCR in patients decreased significantly with increase of CD24 mRNA expression.CD24 interacted with CD3+T,CD4+T,CD8+T,CD10+T,FOXP3,IL-6,IL-10,IL-17,IgG and IgM on pCR.Conclusion:CD24 level in patients after NAT showes a gradually decreasing trend.CD24 mRNA expression is a risk factor for axillary lymph node pCR after NAT.With increase of CD24 mRNA expression,probability of pCR in patients decreases significantly.

Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

Objective:To analyze the risk factors and clinical characteristics of liver injury in patients with sepsis and to provide a reference for early recognition, early diagnosis, early intervention, and improve the survival rate of patients.Methods:The clinical data of sepsis patients admitted to the department of general intensive care unit (ICU) of the Second Affiliated Hospital of Zhejiang University School of Medicine from July 2014 to October 2020 were retrospectively analyzed. According to the occurrence of acute liver injury, patients with sepsis were divided into the liver injury group and the non-liver injury group, and the differences of demographic data, history, history of primary diseases, laboratory indicators on the first time of admission, treatments, the severity of the disease and other indicators were compared and analyzed. Logistic regression was used to analyze the risk factors for sepsis-related liver injury.Results:A total of 527 patients with sepsis were enrolled, and 129 patients with acute liver injury, accounting for 24.48%. Compared with the non-liver injury group, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), pro-brain natriuretic peptide (pro-BNP), serum MB isoenzyme of creatine kinase (CK-MB), total bile acid (TBA), serum creatinine (SCr), blood urea nitrogen (BUN), lactic acid (Lac), lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin (PCT) in liver injury group were significantly increased [APACHEⅡ score: 23.00±10.40 vs. 16.10±8.10, SOFA score: 9.17±4.29 vs. 5.90±3.12, pro-BNP (ng/L): 5 500.0 (1 166.0, 16 865.0) vs. 1 377.2 (448.8, 6 136.5), CK-MB (U/L): 23.0 (13.0, 55.0) vs. 18.0 (13.0, 31.0), TBA (μmol/L): 5.0 (2.4, 12.9) vs. 2.6 (1.4, 4.9), SCr (μmol/L): 146.0 (75.0, 222.0) vs. 71.0 (52.0, 125.8), BUN (mmol/L): 13.4 (8.8, 20.2) vs. 7.9 (4.9, 11.6), Lac (mmol/L): 2.0 (1.4, 4.4) vs. 1.4 (1.0, 2.2), LDH (μmol·s -1·L -1): 6.43 (3.76, 11.99) vs. 4.55 (3.38, 6.63), CRP (mg/L): 113.0 (61.8, 201.0) vs. 95.0 (37.3, 170.1), PCT (μg/L): 3.8 (1.0, 23.3) vs. 0.8 (0.2, 6.4)], prothrombin time (PT), international standard ratio (INR) and activated partial thrombin time (APTT) were significantly longer [PT (s): 19.4±7.6 vs. 16.0±4.0, INR: 1.7±1.0 vs. 1.3±0.5, APTT (s): 54.0±25.8 vs. 44.1±15.1], plasma fibrinogen (FIB), platelet count (PLT), albumin (ALB), and cholesterol (CHOL) were decreased [FIB (g/L): 4.2±2.3 vs. 4.9±1.8, PLT (×10 9/L): 116.3±74.3 vs. 182.7±108.6, ALB (g/L): 25.4±5.5 vs. 27.6±5.5, CHOL (mmol/L): 2.5±1.2 vs. 3.2±1.3], the probability of shock was significantly increased (91.47% vs. 59.19%), and the duration of shock was prolonged [days: 5.0 (2.0, 9.0) vs. 1.0 (0.0, 3.0)], positive rate of microbial culture (81.40% vs. 71.11%), probability of occurrence of drug-resistant bacteria (67.44% vs. 47.99%) were significantly higher, mechanical ventilation time [days: 6.0 (2.0, 12.7) vs. 2.4 (0.0, 6.9)], continuous renal replacement therapy (CRRT) time [days: 1.2 (0.0, 5.0) vs. 0.0 (0.0, 0.0)], the length of intensive care unit (ICU) stay [days: 9.0 (5.0, 18.0) vs. 7.0 (3.0, 13.0)] were significantly longer, 28-day mortality was significantly higher (80.62% vs. 28.89%), and the differences were statistically significant (all P < 0.05). Further Logistic regression analysis showed that PLT decline, PT prolongation, CRRT duration, shock duration and 28-day mortality were correlated with sepsis-related liver injury [odds ratios ( OR) and 95% confidence interval (95% CI) were 0.992 (0.987-0.998), 3.103 (1.507-6.387), 1.198 (1.074-1.336), 1.196 (1.049-1.362), and 0.213 (0.072-0.633), respectively, all P < 0.05]. Conclusions:Prolonged PT and decreased PLT are independent risk factors for sepsis complicated with liver injury. The long duration of CRRT, long duration of shock, and high mortality are independent clinical characteristics of patients with sepsis-related liver injury.

Objective: To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia. Methods: Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method. Results: Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05). Conclusions Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients.

BACKGROUND/AIMS: The Rome III criteria separated chronic constipation into functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C), but some researchers questioned the partitioning and treated both as distinct parts of a continuum. The study aims to explore the similarity and diversity of brain white matter between FC and IBS-C. METHODS: The voxel-wise analysis of the diffusion parameters was used to quantify the white matter changes of female brains in 18 FC patients and 20 IBS-C patients compared with a comparison group with 19 healthy controls by tract-based spatial statistics. The correlations between diffusive parameters and clinical symptoms were evaluated using a Pearson’s correlation. RESULTS: In comparison to healthy controls, FC patients showed a decrease of fractional anisotropy (FA) and an increase of radial diffusivity (RD) in multiple major fibers encompassing the corpus callosum (CC, P = 0.001 at peak), external capsule (P = 0.002 at peak), corona radiata (CR, P = 0.001 at peak), and superior longitudinal fasciculus (SLF, P = 0.002 at peak). In contrast, IBS-C patients showed FA and RD aberrations in the CC (P = 0.048 at peak). Moreover, the direct comparison between FC and IBS-C showed only RD differences in the CR and SLF. In addition, FA and RD in the CC were significantly associated with abdominal pain for all patients, whereas FA in CR (P = 0.016) and SLF (P = 0.040) were significantly associated with the length of time per attempt and incomplete evacuation separately for FC patients. CONCLUSION: These results may improve our understanding of the pathophysiological mechanisms underlying different types of constipation.
Abdominal Pain ; Anisotropy ; Brain ; Constipation ; Corpus Callosum ; Diffusion ; Diffusion Tensor Imaging ; External Capsule ; Female ; Humans ; Irritable Bowel Syndrome ; White Matter

Objective To use the enzyme linked immunosorbent (ELISA)to detect the hepatitis B virus (HBV)markers,and to perform the HBsAg quantitation and the HBV load detection for understanding the HBV carrying and viral replication situation when single HBcAb positive or both HBcAb and HBeAb positive.Methods The HBV markers HBsAg,HBsAb,HBeAg,HBeAb and HBcAb were detected with ELISA.1 098 cases of HBcAb positive,966 cases of both HBeAb and HBcAb positive and 832 cases of all HBV markers negative as control were selected and quantitatively re-detected HBsAg by using the chemiluminescence meth-od.The HBV load was detected by using the PCR method.Results Among 1 098 cases of single HBcAb positive,436 cases (39.7%)of HBsAg quantitation and 230 cases (20.9%)of PCR-DNA were detected out respectively;among 966 cases of both HBeAb and HBcAb positive,387 cases(40.1 %)of HBsAg quantitation and 212 cases(21.9%)of PCR-DNA were detected out re-spectively;among 832 cases of all HBV markers negative,6 case (0.7%)of HBsAg quantitation and 4 case (0.5%)of PCR-DNA were detected out respectively,there were statistically significantly differences among them (P < 0.05 ).Conclusion Adopting ELISA for detecting HBV markers,when single HBeAb positive or both HBcAb and HBeAb positive,HBsAg and the viral replica-tion are still be detected out,which needs to conduct further detection in order to avoid the medical risk due to the missed detection.

Objective To study the role of deleted in liver cancer-1 (DLC-1) gene main domains on the regulation of human colon cancer HT29 cell proliferation.Methods Subcloning recombinant plasmid vectors with Rho GTPase activating protein (RhoGAP),sterile alpha motif (SAM) or steroidogenic acute regulatory-related lipid-transfer (START) domains of DLC-1 gene knockout were constructed and transfected into human colon cancer cell HT29.Wild HT29 cell group (control group),pcDNA3.1-HT29 cell group (vector group) and pcDNA3.1-HT29-DLC-1 cell group (whole DLC-1 gene transfected group) were set as control.The change of cell proliferation was detected by methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay and colony formation test.The cell apoptosis was analyzed by flow cytometry.The activity of RhoA protein was detected by pull-down assay.The differences between the groups were analyzed by the analysis of variance.Results At 48 hours after the successful transfection,compared with control group and vector group,cells proliferation and the activity of RhoA protein were significantly suppressed in whole DLC-1 gene transfected group (F=146.36,698.08,both P＜0.05) and early cell apoptosis increased (F=294.08,P＜0.05).Compared with control group and vector group,there was no significant difference in cell proliferation ability,cell apoptosis and the activity of RhoA protein activity in RhoGAP knockout transfected cells (F=0.99,0.049,5.769,all P＞0.05).Compared with whole DLC-1 gene transfected group,the suppression of cell proliferation was more significant in SAM knockout transfected cells (F=31.00,P＜0.05),the activity of RhoA protein down regulated (F=92.57,P＜0.05) and apoptosis increased (F=130.44,P＜0.05).Compared with whole DLC-1 gene transfected group,the ability of cell proliferation increased (F=15.47,P＜0.05),apoptosis cell decreased (F＝110.23,P＜0.05) and the activity of RhoA protein up regulated (F=199.39,P＜0.05) in START knockout transfected cells.Conclusions The role of DLC-1 gene in the suppression of cell proliferation in HT29 cells was RhoGAP-dependent.SAM domain may be the self suppression domain for endogenous RhoGAP activity.START domain may take effect through enhancing RhoGAP domain.