Objective: To investigate the molecular mechanism of Syk in phagocytosis induced by CD36 antibodies. Methods: In vitro, two CD36 monoclonal antibodies, GZ1 (IgG2a) and GZ4 (IgG1), at different concentrations were co-incubated with platelets from CD36-positive blood donors, and the affinity of the antibodies for platelets was assessed using flow cytometry. CD36 positive platelets from donors were labeled with Red-SE. The GZ1 and GZ4 antibodies were added together with dye-labeled platelets to peripheral blood from blood donors for phagocytosis experiments. The expression of the Spleen Tyrosine Kinase (Syk), P-Syk, P38 MAPK and P-P38 were detected using Western blot(WB). In the in vitro phagocytosis inhibition assay, Fcγ receptor (FcγR) antibodies or Syk inhibitor (R406) were pre-incubated with monocytes prior to performing the phagocytosis experiment. In vivo experiments were performed using female C57BL/6J mice. R406 was administered via intraperitoneal injection, followed by tail vein infusion of GZ1 or GZ4 antibodies. Additionally, a treatment group was set up in which the antibodies were infused first, followed by administration of R406. Changes in platelet counts were analyzed using a blood routine analyzer, and antibody binding to platelets was detected by flow cytometry. Results: GZ1 had higher affinity for CD36positive platelets than GZ4. The phagocytosis rate induced by GZ1 was significantly higher than that of GZ4 [(42.12±2.25)% vs (16.25±6.45)%, P<0.001]. Moreover, GZ1-mediated platelet phagocytosis mainly depends on FcγRⅠ of monocytes, while GZ4-mediated platelet phagocytosis mainly relies on FcγRⅡ of monocytes. WB results showed that the GZ1 group significantly upregulated the expression of Syk and phosphorylated Syk (P-Syk), and induced phosphorylation of the downstream P38 MAPK signaling pathway. Pretreatment of monocytes with R406 inhibited the phagocytosis of antibodyopsonized platelets by monocytes. After injecting GZ1 or GZ4 antibodies into C57BL/6 female mice through the tail vein, GZ1 mAbs had a stronger binding rate to the platelets compared with GZ4 mAbs, leading to a significant decrease in platelet count. After pre-injecting R406 into mice, the platelet count reduction in both the GZ1 and GZ4 groups was alleviated, and the binding rate of antibodies to platelets was also significantly reduced. However, administration of R406 after antibody injection failed to prevent the decrease in platelet counts in mice. Conclusion: This study indicates that Syk plays an important role in the phagocytosis of anti-CD36 opsonized platelets by monocytes/macrophages and is closely associated with the activation of the P38 MAPK signaling pathway.

Objective:To explore the effectiveness of body weight support in gait training after surgery for an ankle fracture.Methods:Thirty-eight ankle fracture patients who received surgery were divided at random into an observation group and a control group, each of 19. In addition to 3 sessions of routine gait rehabilitation training a week for 6 weeks, only those in the observation group received body weight support training with body weight support boots. Gait data were collected using the GaitWatch three-dimensional gait action capture and training system before the training and after 2, 4 and 6 weeks of the training.Results:At each assessment the gait frequency, gait cycle, stride length, stride rate, bilateral step length, step length deviation, bilateral support phase and bilateral swing phase of both groups had improved significantly. After 6 weeks the average stride frequency, gait cycle, stride length on both sides and speed of the observation group had improved significantly more than among the control group. Step length deviation was not significantly different, however. At each evaluation the proportions of affected and healthy side support had decreased significantly in both groups, but affected and healthy side swing had increased and the proportion of bilateral support had decreased significantly.Conclusion:Body weight support training with body weight support boots can significantly improve gait after ankle fracture surgery. Its effect is superior to that of conventional gait training.

Objective To observe the effects of Yiqi Jiedu Compound on TCM syndrome score and immune regulation of Th17/Treg cells in peripheral blood of patients with myasthenia gravis.Methods 63 patients with myasthenia gravis were randomly divided into the control group(n=31)and the treatment group(n=32).The control group was given the basic treatment of pyridostigmine bromide and glucocorticoid and so on,and the treatment group was given Yiqi Jiedu Compound based on the control group.The two groups were treated for 12 weeks.Clinical efficacy was observed,TCM syndrome scores were statistically analyzed,and the expression levels were detected,which Th17/Treg cells,Foxp3/RORγ t gene and IL-6 and IL-17 cytokines in peripheral blood of patients in both groups before and after treatment.Results After 12 weeks of treatment,compared with the control group,the TCM syndrome score of patients in the treatment group was significantly decreased(P<0.05),and the expression of Foxp3 and Treg genes in peripheral blood was promoted(P<0.05),and the expression of Th17 and Treg cells and IL-6 and IL-17 cytokines in peripheral blood was decreased(P<0.05).Conclusion Yiqi Jiedu Compound may regulate the immune balance of Th17/Treg cells by affecting the differentiation of Th17 and Treg cells in peripheral blood and the expression levels of transcription factors RORγ t and Foxp3 genes and related cytokines,thus achieving the effect of myasthenia gravis treatment.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa( Z=-2.197, -3.180, -2.271, -2.803 and 2.756, P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively). Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.

Objective:To investigate the efficacy and side effects of amnion stent implanted in lacrimal duct for the lacrimal duct obstruction diseases (LDOD).Methods:A randomized controlled clinical trial was adopted.Seventy-two eyes of 72 patients with LDOD treated in Jiangxi Provincial People's Hospital from June 2014 to January 2015 was randomized into the experiment group and the control group with amnion stent or silicone tube retrogradely implanted according to grouping in accordance with block randomization with 36 eyes in each group.All patients were performed irrigation of lacrimal passage at 3 and 6 months postoperatively to compare the patency rate of lacrimal duct and side effects between the two groups.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Jiangxi Provincial People's Hospital (No.2014-002).Results:The patency rate of lacrimal duct was 91.7%(33/36) and 80.6%(29/36) at 3 months postoperatively in the experimental and control group, respectively.Although the difference was obvious, there was no statistical significance ( P=0.307). The patency rate of lacrimal duct was 88.9%(32/36) and 75.0%(27/36) at 6 months postoperatively in the experimental and control groups, respectively.Similarly, the difference was obvious, however there was no statistical significance ( P=0.220). At 3 months and 6 months postoperatively, the incidence of epiphora in the experimental group was lower than that in the control group, it was significantly different ( Z=2.729, P=0.006), and there was no significant difference at 6 months postoperatively ( Z=1.921, P=0.055). At 6 months follow-up period, the attack rate of side effects, such as dacryon congestion and exudation, was 2.8%(1/36) and 13.9%(5/36) in the experiment and control groups, respectively, however, the difference was no statistical significance ( P=0.199). Conclusions:The implantation of amnion stent in lacrimal duct for LDOD is effective, and the patency rate of lacrimal duct is not lower than that of the implantation of silicone tube in the lacrimal duct.

Objective To assess the prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score for septic shock of adults with soft tissue infections.The clinical characteristics of these patients were analyzed to provide reference for their multidisciplinary treatment.Methods A retrospective study was conducted.The patients with soft tissue infections admitted to the General Surgery Department of Beijing Hospital and the Burn and Plastic Surgery Department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled and patients combined with other infections were excluded.Patients were divided into the septic shock group and the non-septic group according to whether septic shock occurred during hospitalization.The baseline data,non-operative management and prognosis were compared between the two groups with Fisher's exact test.The sensitivity,specificity,positive predictive value,negative predictive value and the area under the receiver operating characteristic curve (AUC) of the qSOFA for diagnosis of sepsis and septic shock were calculated.Patients were also divided into four groups according to the etiology of soft tissue infection.The pathogens,surgical treatment and morbidity of septic shock among the four groups were also compared.Results A total of 192 patients were enrolled,including 28 (14.6％) patients with septic shock.Compared with the non-septic shock group,there were more proportion of patients with qSOFA ≥ 2 (60.7％ vs 18.3％,P=0.001) within 24 h of diagnosis of infection,and higher morbidity of sepsis (82.1％ vs 32.9％,P＜0.01)within 48 h of diagnosis of infection in the septic shock group.At the cut-off value of qSOFA ≥ 2,the sensitivity,specificity,positive predictive value,negative predictive value and the AUC were 60.7％,81.7％,36.2％,92.4％ and 0.767 (95％CI:0.665-0.869,P＜0.01) respectively for diagnosis of septic shock.The morbidity of septic shock (36.4％) and 28-day mortality (13.6％) in patients with necrotizing fasciitis were higher than those in patients with other causes (both P＜0.05).The most common pathogens were methicillin-sensitive Staphylococcus (6.8％),methicillin-resistant Staphylococcus (6.2％),Enterobacter (5.7％) and Enterococcus (5.2％).Conclusions qSOFA ≥ 2 can be used as a rapid septic shock screening tool for adults with soft tissue infection.Early diagnosis of sepsis,thorough debridement and effective antibiotic treatment are essential for these patients.

Objective:To explore the types of symptoms in patients receiving chemotherapy for gynecological malignant tumors and their correlation with health behavior compliance.Methods:In this cross-sectional study, totally 422 inpatients receiving chemotherapy for gynecological malignant tumors at a Class Ⅲ Grade A specialized maternal and children's hospital in Chengdu between January and June 2019 were selected by convenient sampling, and investigated with the Chinese version of the M. D. Anderson Symptom Inventory (MDASI) , the Revised Gynecological Malignant Tumor Symptom Module, and the Health Behavior Compliance Questionnaire. A total of 422 questionnaires were distributed, and 398 valid questionnaires were collected, accounting for an effective recovery rate of 94.31%.Results:The 398 patients receiving chemotherapy for gynecological malignant tumors had multiple symptoms. The top 3 symptoms were nausea (96.23%, 383/398) , distress (93.22%, 371/398) , and vomiting (92.46%, 368/398) , and the median symptom severity score was 1.00-7.00. The top 3 incidences of daily life disturbances were interpersonal relationship (76.63%, 305/398) , walking (76.38%, 304/398) , and work (72.61%, 289/398) , and the median score of daily life disturbances was 3.50-5.00. Exploratory factor analysis revealed 4 symptom clusters, namely, emotional symptom cluster, fatigue symptom cluster, sickness symptom cluster, and gastrointestinal symptom cluster. The results of Pearson correlation analysis showed that the total score of health behavior compliance was positively correlated with the scores of emotional, fatigue, sickness and gastrointestinal symptom clusters ( P<0.05) . Multiple linear regression analysis demonstrated that the sickness and gastrointestinal symptom clusters were the influencing factors of health behavior compliance ( P<0.001) . Conclusions:Patients receiving chemotherapy for gynecological malignant tumors are troubled by multiple symptoms. Nursing staff should establish an efficient symptom management model to improve the patient's symptom experience and health behavior compliance.

Objective To analyze driver genes status and its clinical characteristics of advanced lung adenocarcinoma, then evaluate the status of first-line treatment in a single centric real-world. Methods EGFR, ALK, ROS-1 gene in 204 advanced lung adenocarcinoma tissue were tested by ARMS-PCR method. And the relationship between driver genes status and clinical characteristics was analyzed as the first line treatment in real clinical practice. Results The positive rate of driver genes status in 204 advanced lung adenocarcinoma was 53.9％ (110/204) , including EGFR mutation 46.1％ (94/204) , ALK positive 6.4％ (13/204) and ROS1 positive 1.5％ (3/204). The driving genes status was significantly correlated with gender, smoking history, tumor staging and serosal invasion (P < 0.05). There were significantly differences among the proportion of first-line standard treatment in different subgroup (P = 0.000) , the first-line standard treatment rate of EGFR mutation, ALK/ROS1 positive and drive gene negative were 77.7％, 37.5％, and 46.8％ respectively. And the ratio of using 1 st generation EGFR-TKIs in all patients is 70.6％ (60/85). Conclusion More than half of advanced lung adenocarcinoma have driver genes changes, and EGFR-TKI first-line treatment has higher acceptability in real-word.