Objective:To explore the effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury.Methods:This study was a retrospective observational study. From January 2022 to March 2024, the First Affiliated Hospital of Air Force Medical University admitted twenty-nine patients who met the inclusion criteria and used the self-made static progressive braces for stepwise treatment of hand flexion dysfunction caused by scar contracture, including 23 males and 6 females, aged 16 to 55 years. The depth of burn on the back of the hand was deep partial-thickness to full-thickness. The self-made static progressive brace referred to the self-made static progressive joint distractor and the self-made static progressive hand flexion distractor. The stepwise treatment was adopted. In the first stage, in-hospital treatment for 2 to 4 weeks was selected. The treatment contents included conventional rehabilitation training and training on the application of the self-made joint distractors. When the active flexion range of motion of the metacarpophalangeal joint was ≥60°, the second stage of treatment was carried out, that is, two weeks of home remote rehabilitation treatment. The treatment contents included individualized exercise training such as training with self-made static progressive joint distractors and training with self-made static progressive hand flexion distractors. Adverse events such as blister, brace compression, and tissue strain during the stepwise treatment were recorded. After the end of the stepwise treatment, the active flexion of the affected hand was observed. During follow-up, the total active range of motion of the affected hand was measured, and the extensibility of the scar and skin and soft tissue on the back of the affected hand and the patient's satisfaction with the therapeutic effect were evaluated. At the last follow-up, the function of the affected hand was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.Results:During the stepwise treatment, a small amount of blisters developed on the skin at the wrist joint in 2 patients, which was cured after symptomatic treatment; the other patients had no adverse events such as brace compression and tissue strain. After the end of the stepwise treatment, the active flexion function of the hand was better, and the fist could be basically clenched. After 1-3 months of follow-up, the total active range of motion of the affected hand was 200-245°; the scar on the back of the hand was soft and light-colored, and the skin and soft tissue was malleable. Twenty-two patients were very satisfied with the curative effect, 6 patients were satisfied, and 1 patient was dissatisfied. At the last follow-up, there were 20 cases with excellent hand function and 9 cases with good hand function.Conclusions:The stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury with self-made static progressive braces has a good effect and few complications. Moreover, the two self-made static progressive distractors are convenient in material acquisition, simple to make, cost-effective, and highly practical, which is worthy of clinical promotion.

Objective:To explore the effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury.Methods:This study was a retrospective observational study. From January 2022 to March 2024, the First Affiliated Hospital of Air Force Medical University admitted twenty-nine patients who met the inclusion criteria and used the self-made static progressive braces for stepwise treatment of hand flexion dysfunction caused by scar contracture, including 23 males and 6 females, aged 16 to 55 years. The depth of burn on the back of the hand was deep partial-thickness to full-thickness. The self-made static progressive brace referred to the self-made static progressive joint distractor and the self-made static progressive hand flexion distractor. The stepwise treatment was adopted. In the first stage, in-hospital treatment for 2 to 4 weeks was selected. The treatment contents included conventional rehabilitation training and training on the application of the self-made joint distractors. When the active flexion range of motion of the metacarpophalangeal joint was ≥60°, the second stage of treatment was carried out, that is, two weeks of home remote rehabilitation treatment. The treatment contents included individualized exercise training such as training with self-made static progressive joint distractors and training with self-made static progressive hand flexion distractors. Adverse events such as blister, brace compression, and tissue strain during the stepwise treatment were recorded. After the end of the stepwise treatment, the active flexion of the affected hand was observed. During follow-up, the total active range of motion of the affected hand was measured, and the extensibility of the scar and skin and soft tissue on the back of the affected hand and the patient's satisfaction with the therapeutic effect were evaluated. At the last follow-up, the function of the affected hand was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.Results:During the stepwise treatment, a small amount of blisters developed on the skin at the wrist joint in 2 patients, which was cured after symptomatic treatment; the other patients had no adverse events such as brace compression and tissue strain. After the end of the stepwise treatment, the active flexion function of the hand was better, and the fist could be basically clenched. After 1-3 months of follow-up, the total active range of motion of the affected hand was 200-245°; the scar on the back of the hand was soft and light-colored, and the skin and soft tissue was malleable. Twenty-two patients were very satisfied with the curative effect, 6 patients were satisfied, and 1 patient was dissatisfied. At the last follow-up, there were 20 cases with excellent hand function and 9 cases with good hand function.Conclusions:The stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury with self-made static progressive braces has a good effect and few complications. Moreover, the two self-made static progressive distractors are convenient in material acquisition, simple to make, cost-effective, and highly practical, which is worthy of clinical promotion.

Objective:To investigate the clinical effects of autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing middle urethral defect with penile defect.Methods:The retrospective observational study was conducted. Eight male patients (aged 14 to 58 years) with middle urethral defect and penile defect caused by various injuries who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University from January 2015 to January 2022. The length of urethral defect was 3 to 5 cm, and the wound area of penile defect after debridement was 5.0 cm×2.5 cm to 7.0 cm×5.5 cm. All the patients underwent autologous split-thickness skin grafting for prefabricating defect urethra in stage Ⅰ, and urethral anastomosis was performed and unilateral scrotal flap was transferred to reconstruct urethra and penis in stage Ⅱ. The area of scrotal flap was 6.0 cm×3.0 cm to 8.0 cm×6.0 cm. The wound in the donor area of skin graft was covered by oil gauze, and the wound of flap donor area was sutured directly. On the 7 th day after the operation of stage Ⅱ, the survival of the flap was observed. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was measured by the urinary flow rate detector (urinary flow rate >15 mL/s was regarded as unobstructed urination), the urinary fistula and erectile function were observed, and the self-made therapeutic satisfaction questionnaire was used to investigate the therapeutic satisfaction degree of patients. During follow-up, the appearance of the flap recipient area was observed, the Vancouver scar scale (VSS) was used to evaluate the scar situation in the donor areas of skin graft and flap, the urinary flow rate was detected as before, the urethral stricture, urinary fistula, and erectile function were observed, and the therapeutic satisfaction degree of patients was investigated. Results:On the 7 th day after the operation of stage Ⅱ, the flaps survived completely in 8 patients. In 3 weeks after the operation of stage Ⅱ, the urinary flow rate was 25.3 (18.0, 38.5) mL/s, with unobstructed urination, without urinary fistula and with erectile function, and the score of therapeutic satisfaction degree was 14.3 (14.0, 15.0). During follow-up of 1 to 7 years, the flap recipient area of 8 patients was full in appearance and not swollen, with similar color to the surrounding tissue; the VSS scores of the donor areas of skin graft and flap were 11.5 (10.0, 13.0) and 10.5 (9.3, 12.0), respectively, the urinary flow rate was 24.6 (17.7, 34.1) mL/s, with no urethral stricture, urinary fistula, and erectile dysfunction, and the score of therapeutic satisfaction degree was 13.5 (13.3, 14.8). Conclusions:Autologous split-thickness skin grafting for prefabricating urethra combined with scrotal flap in repairing the urethral and penile defects not only reconstructs the structure of urethra and the shape of penis, but also restores the sensation and erectile function of penis, with few postoperative complications, no obvious scar hyperplasia, and high satisfaction degree of patients, which is worthy of clinical promotion.

OBJECTIVE：To investigate inhibitory effects of Qing fei baoyu an capsule on airway inflammation in rats with chronic obstructive pulmonary disease （COPD），and its effects on NLRP 3 signaling pathway. METHODS ：Totally 60 SD male rats were randomly divided into blank control group ，model group ，dexamethasone group （positive control ，0.2 mg/kg），Qingfei baoyuan capsule high-dose ，medium-dose and low-dose groups （1 232.0，616.0，308.0 mg/kg），with 10 rats in each group. Except for blank control group ，other groups were fumigated for 28 days and given intratracheal dripping of lipopolysaccharide twice to induce COPD model. Since the 29th day after modeling ，blank control group and model group were given constant volume of normal saline intragastrically ，and administration groups were given related medicine intragastrically. The administration volume was 10 mL/kg，once a day ，for consecutive 28 days. After last administration ，the lung function was detected. The pathological changes of lung tissue were observed by HE staining. The content of interleukin- 1β（IL-1β）in bronchoalveolar lavage fluid （BALF）were detected by ELISA ，and the number of leukocytes was counted ；the expression of NLRP 3 and Cleaved caspase- 1 in lung tissue of rats were detected by Western blotting assay. RESULTS：Three，two，one，one and two rats died in model group， dexamethasone group ， Qingfei baoyuan capsule high-dose，medium-dose and low-dose groups ，respectively. Compared with blank control group ，FEV0.3/FVC of rats in # model group was significantly decreased （P＜0.01）. A large number of inflammatory cells infiltration we re found in the lung tissue ，and lung tissue lesion was obvious. The content of IL- 1β and white blood cell count in BALF，relative expression of NLRP3 and Cleaved caspase- 1 protein in lung tissue were increased significantly （P＜0.05 or P＜0.01）. Compared with model group，FEV0.3/FVC of administration groups were increased significantly （P＜0.05 or P＜0.01）；lung tissue lesion of them were improved to different extents. The content of IL- 1β and white cell count in BALF，relative expression of NLRP 3 protein（except for Qingfei baoyuan capsule low-dose group ）and Cleaved caspase- 1 protein（except for Qingfei baoyuan capsule medium-dose and low-dose groups ）in lung tissue were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Qingfei baoyuan capsule can relieve lung tissue lesion and improve lung function in COPD model rats ，the effects of which may be associated with inhibiting inflammation reaction by inhibiting NLRP 3 signaling pathway.

Objective:To investigate the clinical application effect of latissimus dorsi muscle flap in reconstruction of muscle strength around shoulder after electric burns.Methods:From March 2014 to September 2020, 13 patients with electric burns and severe injury around shoulder were admitted to the First Affiliated Hospital of Air Force Medical University, including 11 males and 2 females, aged 19-55 years. A retrospective observational study was conducted. The left upper limbs were injured in 8 cases, and the right upper limbs were injured in 5 cases, all with eschar wounds of Ⅲ-Ⅳ degree. Among which, there were biceps defects in 6 cases, deltoid defects in 3 cases, triceps defects in 2 cases, and composite defects of multiple muscles around shoulder in 2 cases. The surgery was carried out in two stages. In stage Ⅰ, debridement and exploration of electric burn wounds around shoulders were conducted to preserve local tissue and save the limb as much as possible on the premise of guaranteeing the stability of the body condition. After the last debridement, the wound area was from 10 cm×6 cm to 40 cm×15 cm, the muscle defect area was from 8 cm×4 cm to 19 cm×12 cm, and the humerus was exposed in 7 patients. In stage Ⅱ, according to the residual limb defect degree, muscle reconstruction around shoulder was conducted with the latissimus dorsi muscle flap, and area of the latissimus dorsi muscle flap was 15 cm×6 cm to 20 cm×18 cm. The residual wounds were repaired with autologous split-thickness skin grafts of head, and the donor sites of muscle flaps were sutured directly. The survivals of the muscle flaps and wounds closure post operation, and the appearances of the donor sites and recipient sites during follow-up were observed. At the last follow-up, the shoulder joint function was evaluated using the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the satisfaction degrees of patients for appearance and function recoveries of shoulder were investigated by self-made questionnaire with reference to the concise test scoring system of shoulder joint.Results:All of the 13 muscle flaps around shoulder survived after surgery. Two patients had residual wounds in the skin grafting area, the wound in one of the patients was healed after dressing change, and the wound in the other 1 patient was healed with the second autologous split-thickness skin grafting on head after dressing change. During follow-up of 6 to 18 months for all the patients, the muscle flaps of patients were full in appearance and not bloated, and atrophic scar in the repaired area was soft in texture and closed with normal skin around. Linear suture scars were left in the donor sites of muscle flaps, which did not affect the overall appearance. At the last follow-up, the active abduction range of the shoulder joint was 60-90°, upward lift on 120-180°, muscle strength recovered to level Ⅳ and above in 8 cases and to level Ⅲ in 5 cases, and the shoulder joint function was evaluated as excellent in 8 cases and good in 5 cases; 10 patients were very satisfied and 3 patients were satisfied with the appearance and function recovery of the shoulders.Conclusions:The application of latissimus dorsi muscle flap provides a better choice for the muscle strength reconstruction around shoulder after electric burns, with good appearance of the operative areas and ideal prognosis of upper limb function.

Objective:To observe the clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap.Methods:The retrospective observational study was conducted. From April 2018 to October 2020, ninety-five patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 55 males and 40 females, aged 5-78 years, with a defect wound area of 82 (9, 216) cm 2. All patients underwent abdominal flap repair for soft tissue defects of hand and forearm. According to the different fixation methods adopted in the operation area, the patients were divided into negative pressure group ( n=48) and plaster group ( n=47). Wounds of the injury sites of patients in the 2 groups were repaired by flap transplantation after debridement. The negative pressure suction device was placed after dry gauze dressing to form a "bridge" to fix the affected upper limb and chest and abdomen in negative pressure group. Patients in plaster group were treated with conventional dry gauze matting and plaster fixation. On post surgery day (PSD) 1, 3, 5, 7, and 14, flap blood circulation and pain intensity of patients in the 2 groups were calculated by self-made blood flow scoring scale and Changhai Pain Ruler, respectively. On PSD 5, the common complications in operative area and surrounding skin were observed and their incidences were calculated. On PSD 7, satisfaction degree of patients was scored. During follow-up of one month after pedicle division, the appearance and functional recovery of the affected limb were observed. Data were statistically analyzed with analysis of variance for repeated measurement, independent samples t est, Cochran & Cox approximate t test, chi-square test, and Wilcoxon rank-sum test. Results:On PSD 1, 3, 5, 7, and 14, the flap blood circulation scores of patients in negative pressure group did not change significantly, while that of patients in plaster group showed a time-dependent decrease, and the flap blood circulation scores of patients in negative pressure group were significantly higher than those in plaster group ( t=2.259, 2.552, 2.784, 2.821, 3.003, P<0.05 or P<0.01). There were no significant changes in the pain intensity scores of patients in negative pressure group, while those of patients in plaster group increased in a time-dependent manner, and the pain intensity scores of patients in negative pressure group were significantly lower than those in plaster group ( t=-4.818, -4.944, -5.011, -5.976, -6.721, P<0.05). On PSD 5, the incidences of common complications in operative area and surrounding skin of patients in negative pressure group were significantly lower than those in plaster group ( χ2=6.773, 5.269, P<0.05 or P<0.01). On PSD 7, the satisfaction score of patients in negative pressure group was 14.7±1.1, which was significantly higher than 7.4±1.8 in plaster group ( t=23.934, P<0.01). During follow-up of one month after pedicle division, the appearance and function of the affected limb of patients in the 2 groups recovered well. Conclusions:After repairing the upper limb soft tissue defect wound with pedicled abdominal flap, the bridge-type continuous negative-pressure suction fixation can effectively immobilize the affected limbs, chest and abdomen, reduce the incidence of common complications in the operative area and surrounding skin, relieve the pain of immobilization of patients, improve the blood circulation of flap and patient's satisfaction. Thus, it is an effective, portable, comfortable, and easy-to-operate method.

Objective:To compare the clinical effects of continuous negative-pressure wound therapy (NPWT) and conventional pressure dressing at at hard-to-fix sites after split-thickness skin grafting.Methods:From September 2017 to August 2019, 129 patients who met the inclusion criteria and had spilt-thickness skin grafting at hard-to-fix sites were admitted to the First Affiliated Hospital of Air Force Medical University and included in this retrospective cohort study. The patients were divided into NPWT group (67 patients, 41 males and 26 females, aged (32±6) years) and conventional pressure dressing group (62 patients, 37 males and 25 females, aged (30±5) years) according to whether the hard-to-fix sites were applied with NPWT after spilt-thickness skin grafting. After debridement and spilt-thickness skin grafting at hard-to-fix sites in patients of 2 groups, the wounds of patients in conventional pressure dressing group were applied with conventional pressure bandaging after being filled with dry gauze; for the wounds of patients in NPWT group, the semi-permeable membrane was pasted and sealed for continuous negative pressure suction after filled with dry gauze and placed the drainage foam or drainage tube, with the negative pressure ranging from -16.6 to -9.9 kPa. The bandage was opened during the first dressing change on the 5th day after surgery in NPWT group and on the 7th day after surgery in conventional pressure dressing group. The skin graft surviving area and proportion, the area and proportion of hematoma, the incidence of common complications of skin graft were observed and calculated. The times of postoperative dressing change and the length of hospital stay were counted. Data were statistically analyzed with two independent sample t test, Cochran & Cox approximate t test, chi-square test, and Fisher′s exact probability test. Results:(1) At the first dressing change, the skin graft surviving area of patients in NPWT group was (420±94) cm 2, which was significantly larger than (322±97) cm 2 in conventional pressure dressing group ( t′=12.33, P<0.01); the skin graft surviving area proportion of patients in NPWT group was (97.0±2.3)%, which was significantly higher than (74.4±4.8)% in conventional pressure dressing group ( t′=50.11, P<0.01). (2) At the first dressing change, the skin hematoma area of patients in conventional pressure dressing group was (31.7±10.1) cm 2, which was significantly larger than (3.2±0.7) cm 2 in NPWT group ( t′=23.04, P<0.01); the skin hematoma area proportion of patients in conventional pressure dressing group was (7.3±2.3)%, which was significantly higher than (0.7±0.3)% in NPWT group ( t′=76.21, P<0.01). (3) At the first dressing change, there was 1 case of skin movement and no case of skin graft edge tear in NPWT group with an incidence of 1.5% (1/67). In the conventional pressure dressing group, there were 4 cases of skin movement and 2 cases of skin graft edge tear with an incidence of 9.7% (6/62), P<0.05. The incidence of complication of skin graft of patients in NPWT group was significantly lower than that in conventional pressure dressing group ( P<0.05). (4) The times of postoperative dressing change of patients in NPWT group was significantly less than that in conventional pressure dressing group ( t=7.93, P<0.01). The postoperative length of hospital stay in NPWT group was significantly less than that in conventional pressure dressing group ( t=11.71, P<0.01). Conclusions:Continuous NPWT can effectively promote wound healing, improve the survival rate of skin graft, reduce the incidence of complications after skin grafting, and shorten the length of hospital stay in split-thickness skin grafting at hard-to-fix sites.

Objective:To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea.Methods:Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient’s.Results:A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion:Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.

Objective: To analyze the genotype diversity and phylogenetic characterization of norovirus(NoV) in patients with diarrhea from Anhui province. Methods: NoV positive fecal specimens from sentinel hospitals were collected from January, 2016 to December, 2017. The samples were detected by Real-time fluorescent quantitative PCR. Positive samples were of randomly selected and amplified by RT-PCR and the products were sequenced. Phylogenetic tree was constructed by the Neighbor-Joining method based on partial VP1 gene regions of NoV to perform phylogenetic analysis. Results: A total of 263 NoV positive samples were genotyped, of which 239 belonged to genogroup II, 24 belonged to genogroup I. Fifty-five positive samples were successfully sequenced. There were 6 NoV GII genotypes, which included GII.2, 3, 4/Sydney_2012, 13, 17 and 21, while NV GII.17 and GII.4 were the dominant genotypes from 2016 to 2017. The predominant genotype was GII.4/Sydney 2012 (47.27%, 26/55), followed by GII.17 (23.64%, 13/55) and GII.2 (14.55%, 8/55). Phylogenetic tree showed that 26 strains belonged to genotype GII.4/Sydney 2012, NoV. The nucleotide homology among the 26 VP1 genes was 97.8% to 100%. Analysis of the partial VP1 genes of 26 strains showed that it shared the highest homology of 98.9% with the strain of GII.4Sydney2012 (GenBank ID: KU720515). However, the prevailing genotype in the Anhui province has shifted on two separate occasions, the GII.17 strain was dominant in 2016, and the GII.4/Sydney 2012 strain was dominant in 2017. Conclusions NoV GII was the major pathogen causing sporadic diarrhea in Anhui province during from 2016 to 2017, the genotypes are widely distributed, and shifted into the two predominant strains.

Objective To understand genomic characteristics of 2 strains of influenza A (H9N2) virus isolated from human infection cases in Anhui province in 2015.Methods Two human infection with H9N2 virus were confirmed by national influenza surveillance laboratory network in Anhui through viral isolation in April and September,2015,respectively.The full genomic sequences of the two viral isolates were analyzed in this study by using molecular bioinformatics software Mega 6.0.Results Human infection with H9N2 virus was first reported in Anhui province.The analysis of genomic sequence showed that the HA and NA genes of the two H9N2 isolates belonged to A/Chicken/ Shanghai/F/98(H9N2)-like lineage,and shared high identity with H9N2 virus circulating in poultry in 2013.The PB2 and MP genes belonged to the A/quail/Hong Kong/G 1/97-like lineage,and shared high homology with H7N9,H10N8 or H6N2 viruses.The amino acid sequence alignment results showed that several mutations for human infection tropism presented in the two virus strains,including Q226L,H183N and E190T in HA;S31N in M2;63-65 deletion in NA.In addition,the H9N2 influenza virus strains possessed the PSRSSR\GL motif in HA.Meanwhile several human-like signatures,including PA-100A,PA-356R and PA-409N were also found in the two virus strains.Conclusion The H9N2 viruses isolated from human infection cases in Anhui province belonged to a reassortant virus originated from different lineage H9N2 avian influenza virus.The virus has possessed several human susceptibility locus.