Objective:To investigate the perioperative management of wounds associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy, and to evaluate its clinical effects.Methods:This study was a retrospective observational study. From January 2017 to December 2022, 36 patients with wounds associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy who were conformed to the inclusion criteria were admitted to the Burn Center of PLA of the First Affiliated Hospital of Air Force Medical University, including 23 males and 13 females, aged 25 to 81 years. Preparation for surgery was made. For patients with suspected retrosternal mediastinal abscess cavity, all cancellous bone of the unhealed sternum was bitten off to fully expose the retrosternal mediastinum, remove the source of infection and granulation tissue, and to fill the sternum defect with flipped unilateral pectoralis major muscle. For patients who had no retrosternal mediastinal infection but had fresh granulation tissue in unhealed sternal wounds, the necrotic tissue and a small amount of necrotic sternum were palliatively removed, and bilateral pectoralis major muscles were advanced and abutted to cover the sternal defect. After the skin in the donor area was closed by tension-relieving suture, continuous vacuum sealing drainage was performed, and continuous even infusion and lavage were added 24 hours later. The thorax was fixed with an armor-like chest strap, the patients were guided to breathe abdominally, with both upper limbs fixed to the lateral chest wall using a surgical restraint strap. The bacterial culture results of wound exudation specimens on admission were recorded. The wound condition observed during operation, debridement method, muscle flap covering method, intraoperative bleeding volume, days of postoperative infusion and lavage, lavage solution volume and changes on each day, and postoperative complications and wound healing time were recorded. After discharge, the wound healing quality, thorax shape, and mobility functions of thorax and both upper limbs were evaluated during follow-up. The stability and closure of sternum were observed by computed tomography (CT) reexamination.Results:On admission, among 36 patients, 33 cases were positive and 3 cases were negative in bacterial culture results of wound exudation specimens. Intraoperative observation showed that 26 patients had no retrosternal mediastinal infection but had fresh granulation tissue in unhealed sternal wounds, palliative debridement was performed and bilateral pectoralis major muscles were advanced and abutted to cover the defect. In 10 patients with suspected retrosternal mediastinal abscess cavity, the local sternum was completely removed by bite and the defect was covered using flipped unilateral pectoralis major muscle. During the operation, one patient experienced an innominate vein rupture and bleeding of approximately 3 000 mL during mediastinal exploration, and the remaining patients experienced bleeding of 100-1 000 mL. Postoperative infusion and lavage were performed for 4-7 days, with a lavage solution volume of 3 500-4 500 mL/d. The lavage solution gradually changed from dark red to light red and finally clear. Except for 1 patient who had suture rupture caused by lifting the patient under the armpit during nursing on the 3 rd day after surgery, the wounds of the other patients healed smoothly after surgery, and the wound healing time of all patients was 7-21 days. Follow-up for 3 to 9 months after discharge showed that the patient who had suture rupture caused by armpit lifting died due to multiple organ failure. In 1 patient, the armor-like chest strap was removed 2 weeks after surgery, and the shoulder joint movement was not restricted, resulting in local rupture of the suture, which healed after dressing change. The wounds of the remaining patients healed well, and they resumed their daily life. The local skin of patient's pectoralis major muscle defect was slightly sunken and lower than that of the contralateral thorax in the patients undergoing treatment of pectoralis major muscle inversion, while no obvious thoracic deformity was observed in patients undergoing treatment with pectoralis major muscle propulsion and abutment. The chest and upper limb movement in all patients were slightly limited or normal. CT reexamination results of 10 patients showed that the sternum was stable, the local sternum was closed or covered completely with no lacuna or defects. Conclusions:Once the wound associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy is formed, individualized and precise debridement should be performed as soon as possible, different transfer ways of pectoralis major muscle flap should be chosen to cover the defect, and postoperative continuous infusion and lavage together with strict thorax and shoulder joint restraint and immobilization should be performed. This treatment strategy can ensure good wound healing without affecting the shape and function of the donor area.

Objective To investigate the therapeutic effect of pectoralis major muscle flap combined with negative pressure lavage in one-stage repair of refractory wounds after thoracotomy.Methods From January 2020 to January 2023,21 patients with refractory wounds after thoracotomy were retrospectively selected from the First Affiliated Hospital of Air Force Military Medical University,including 16 males and 5 females,aged 35 to 75 years old,with an average age of(62.2±11.3)years old.The wound area was 6cm×3cm to 25cm×5cm.The infected sternum was removed.According to the location and size of the residual cavity,the pectoralis major muscle of the corresponding segment on both sides of the free wound was sutured and filled.The irrigation tube was reserved below the muscle flap.After the muscle flap covered the residual cavity,the skin around the wound was sutured without tension,and the negative pressure suction of-30 to-20 kPa was given.From the first day after operation,physiological saline was used for lavage,2000ml per day.The character,color and amount of lavage fluid and the systemic symptoms of patients were observed.After the lavage fluid was clear,the tube and the negative pressure device were removed.The wound was changed once every other day,and the stitches were removed 2 weeks after operation.Results Nineteen patients achieved primary healing within 14 days after operation.Two patients had scattered wounds of about 1 cm×1 cm in size,and continued dressing change.All patients healed one month after operation.The patients were followed up for half a year to 2 years.The patient's chest shape was beautiful.There was no effect on the activity of the forebody and upper limbs,and there was no significant change in the muscle strength of the upper limbs.Conclusion For the refractory wounds after thoracotomy,after removing the infected sternum,using the pectoralis major muscle flap combined with negative pressure lavage to close the wound in one stage can reduce the risk of wound infection and death,shorten the hospital stay of patients,and the operation is simple and the trauma to patients is less.

Objective:To evaluate the effect of Barker aseptic application on the treatment of deep second-degree burns and scars after healing.Methods:According to the inclusion and exclusion criteria, deep second-degree patients admitted to the Affiliated Hospital of Jining Medical College from September 2016 to September 2019 were randomly divided into treatment and control groups using a random number table method. Barker aseptic application was used for the treatment group, and silver sulfadiazine cream was used for the control group. Patients in two groups were changed dressing every 2 to 3 days. Wound healing time, times of dressing change, pain score during the dressing change, secondary trauma score, and Vancouver Scar Scale (VSS) score at 1, 3, and 6 months after wound healing were compared between the two groups. Differences in patient satisfaction at discharge and 6 months after wound healing were also compared at follow-up. According to the result type of the data, it is expressed as Mean±SD, M( Q1, Q3) or frequency (percentage), and it is described as the t-test, Mann-Whitney U test, or chi-square test. Results:One hundred and thirty-two burn patients were enrolled in each treatment and control group. There were 115 males and 17 females in the treated group, aged (34.5±11.1) years, with the burn surface area accounting for (15.87±8.66)% of the total body surface area (TBSA). 107 males and 25 females were in the control group, aged (32.4±14.1) years, with burn surface area accounting for (16.31±7.06)% TBSA. The healing time of the treated group was significantly shorter than that of the control group [(17.65±5.87) d vs. (23.06±8.78) d, P<0.01], and the VSS scores at 1, 3, and 6 months after wound healing were also lower than that of the control group [5(3, 5) vs. 6(5, 7), 4(3, 5) vs. 6(4, 7), 4(3, 5) vs. 5(4, 6), P<0.01]. In addition, the number of dressing changes, pain scores during dressing changes, and secondary trauma scores in the treatment group were lower than in the control group (all P values<0.01). The satisfaction score and percentage of satisfaction with treatment were higher in the patients at discharge and 6 months of wound healing than in the control group (all P values<0.01). Conclusions:Barker aseptic application can significantly shorten the healing time of deep second-degree burn wounds, reduce scar hyperplasia, improve comfort during dressing changes, and improve patient satisfaction.

Objective:To evaluate the effect of Barker aseptic application on the treatment of deep second-degree burns and scars after healing.Methods:According to the inclusion and exclusion criteria, deep second-degree patients admitted to the Affiliated Hospital of Jining Medical College from September 2016 to September 2019 were randomly divided into treatment and control groups using a random number table method. Barker aseptic application was used for the treatment group, and silver sulfadiazine cream was used for the control group. Patients in two groups were changed dressing every 2 to 3 days. Wound healing time, times of dressing change, pain score during the dressing change, secondary trauma score, and Vancouver Scar Scale (VSS) score at 1, 3, and 6 months after wound healing were compared between the two groups. Differences in patient satisfaction at discharge and 6 months after wound healing were also compared at follow-up. According to the result type of the data, it is expressed as Mean±SD, M( Q1, Q3) or frequency (percentage), and it is described as the t-test, Mann-Whitney U test, or chi-square test. Results:One hundred and thirty-two burn patients were enrolled in each treatment and control group. There were 115 males and 17 females in the treated group, aged (34.5±11.1) years, with the burn surface area accounting for (15.87±8.66)% of the total body surface area (TBSA). 107 males and 25 females were in the control group, aged (32.4±14.1) years, with burn surface area accounting for (16.31±7.06)% TBSA. The healing time of the treated group was significantly shorter than that of the control group [(17.65±5.87) d vs. (23.06±8.78) d, P<0.01], and the VSS scores at 1, 3, and 6 months after wound healing were also lower than that of the control group [5(3, 5) vs. 6(5, 7), 4(3, 5) vs. 6(4, 7), 4(3, 5) vs. 5(4, 6), P<0.01]. In addition, the number of dressing changes, pain scores during dressing changes, and secondary trauma scores in the treatment group were lower than in the control group (all P values<0.01). The satisfaction score and percentage of satisfaction with treatment were higher in the patients at discharge and 6 months of wound healing than in the control group (all P values<0.01). Conclusions:Barker aseptic application can significantly shorten the healing time of deep second-degree burn wounds, reduce scar hyperplasia, improve comfort during dressing changes, and improve patient satisfaction.

A female patient aged 42 years with deep burn on right lower limb was admitted to Affiliated Hospital of Jining Medical University on January 25, 2019. The patient previously had cerebral infarction, hypertension, and hysteria, with long-term use of aspirin and risperidone. After admission, the patient underwent tangential excision twice. On the third day after the second tangential excision and skin grafting, the muscle strength of the right limb gradually decreased, and the patient was treated with emergency craniocerebral magnetic resonance imaging, which suggested acute cerebral infarction. Improvement of cerebral circulation and vasodilatation were given immediately. The limb muscle strength of the patient gradually recovered on the fifth day after the operation, and no sequela was left when the patient was discharged. After the case was discussed, we think that postoperative decreased blood volume and blood concentration resulting from tangential excision bleeding of deep burn and wound exudate as well as inadequate fluid infusion are the main causes of hemodynamic change, the patient had the basis of multiple cerebral artery stenosis, and superposition of multiple factors led to the occurrence of postoperative acute cerebral infarction. Appropriate increase in the fluid infusion volume during and after surgery and transfusion if necessary to increase blood and oxygen supply to the brain can reduce the occurrence of cerebral infarction.

AIM:To study the protective effect of anti-aging Klotho protein on human umbilical vein endothe-lial cells (HUVECs) treated with high glucose (HG).METHODS:HUVECs were cultured in vitro, and divided into PBS control group, 5.5 mmol/L glucose group, 33.3 mmol/L glucose group, 0.1 μmol/L Klotho +33.3 mmol/L glucose group, 1 μmol/L Klotho+33.3 mmol/L glucose group , and 10μmol/L Klotho+33.3 mmol/L glucose group .The viabili-ty of the HUVECs was measured by MTT assay .The content of malondialdehyde ( MDA) , and the activities of lactate de-hydrogenase (LDH), superoxide dismutase (SOD) and glutathione (GSH) in cell culture supernatants were observed . The production of reactive oxygen species ( ROS) in HUVECs was analyzed by flow cytometry .The levels of nitric oxide ( NO) , endothelin ( ET-1 ) , intercellular adhesion molecule-1 ( ICAM-1 ) in HUVEC culture medium were detected by ELISA.The protein expression of nuclear factor-kappa B (NF-κB) in the HUVECs was determined by Western blot .RE-SULTS:Compared with PBS control group , 33.3 mmol/L glucose significantly decreased the HUVEC viability , increased ROS, LDH and MDA levels , reduced the activities of SOD and GSH , decreased the NO secretion , and induced the ET-1 and ICAM-1 secretion and the protein expression of NF-κB in HUVECs.When HUVECs were treated with Klotho protein at different concentrations combined with 33.3 mmol/L glucose, the cell viability was increased significantly , the ROS, LDH and MDA levels were decreased significantly , the antioxidant SOD and GSH activities were significantly increased , the se-cretion of NO was increased , but ET-1 and ICAM-1 releases and protein expression of NF-κB were significantly reduced . CONCLUSION:Anti-aging Klotho protein promotes the viability of HUVECs treated with HG , reduces the oxidative dam-age and ROS production , and restores the normal secretory function of HUVECs , thus playing a protective role in vascular endothelial cells through reducing the protein expression of NF-κB.

Objective To investigate the therapeutic effect of quercetin on acute gouty arthritis and its influence in re-nal function in rats. Methods Seventy male Sprague-Dawley rats were randomly divided into normal control group, model group, colchicine group (0.5 mg/kg), allopurinol group (20 mg/kg), quercetin 100, 200 and 400 mg/kg groups (n=10 for each group). Rats were administered various drugs by oral gavage once a day for seven consecutive days throughout the experi-ment. On the fifth day, the animal model of acute arthritis was set up by giving monosodium urate crystal combined with hypo-xanthine. The inflammatory reaction was detected by measuring the circumference of right hind leg anklejoint with a tie line method at 0, 2, 6, 12, 24 and 48 h. The swelling ratio was calculated. The serum levels of uric acid (UA),β2-microglobulin (β2-MG), cystatin C (Cys-C), urea nitrogen (Urea) and creatinine (Cr) were detected by colorimetry and enzyme-linked im-munosorbent assay.Rats were sacrificed at the end of experiment, and the kidney was weighed and the renal index was calcu-lated. Results Treatment with quercetin, colchicine or allopurinol can significantly attenuate swelling rate in rats of acute gouty arthritis. The serum levels of UA were significantly higher in colchicine group and quercetin group than those of nor-mal control group and allopurinol group. The serum levels of UA was significantly lower in allopurinol group than that of nor-mal control group. After 48-h modeling, there was no significant difference in serum UA level between seven groups except allopurinol group. The levels ofβ2-MG and Cys-C were the lowest in normal control group than those of other groups. The se-rum levels of Urea and Cr and renal index were the highest in allopurinol group compared with those of other groups ( P<0.05). Conclusion Quercetin shows a significant effect of anti-inflammatory on acute gouty arthritis in rats. The model es-tablishment may lead to different degrees of renal damage. Quercetin has no protective effect against renal injury, and allopu-rinol aggravates kidney injury.

AIM:To explore the effects of transforming growth factor-α( TGF-α) in the monoclonal formation , proliferation, migration and adhesiveness of human endothelial progenitor cells ( EPCs).METHODS: The isolated and cultured EPCs were treated with various concentrations of TGF-α(final concentrations of 1, 5, 10μg/L, respectively).At the same time, the PBS control and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) group (10μg/L TGF-αplus 1∶1 000 EGFR-TKI) were set.The effects of TGF-αon monoclonal formation , proliferation, migration and adhesiveness of EPCs were determined by clone formation experiment , thiazolyl blue tetrazolium bromide (MTT), EdU, Transwell and adhesion assays , respectively.The expression of epithelial growth receptor (EGFR) and vascular endothelial growth factor ( VEGF) were measured by Western blotting .RESULTS:Different concentrations of TGF-αall significantly induced the monoclonal formation , proliferation, migration and adhesiveness of EPCs (P<0.01), which were inhibited by EGFR-TKI.The results of Western blotting showed that TGF-αalso induced the expression of EGFR and VEGF with a cer-tain concentration effect ( P<0.01) .CONCLUSION:By combining with EGFR induced the expression of VEGF , TGF-αsignificantly promotes the related cell function of monoclonal formation , proliferation, migration, adhesiveness in EPCs.

[ ABSTRACT] AIM:To study the effects of anti-aging Klotho protein on neonatal rat myocardial cells with hypo-xia/reoxygenation ( H/R) injury.METHODS:The cardiomyocytes of neonatal SD rats were cultured to establish hypoxia/reoxygenation model.The myocardial cells were divided into normal control group, H/R model group, different concentra-tions of Klotho protein (0.1μmol/L, 1μmol/L and 10μmol/L) pretreatment groups.The myocardial cells pulse frequen-cy was observed before and after H/R.The cell viability was measured by MTT assay.The leakages of LDH, CK and AST, the content of MDA and the activity of SOD were detected.The apoptotic rate of the myocardial cells was analyzed by flow cytometry.The mRNA expression of endoplasmic reticulum stress markers and apoptosis-related molecules GRP78, CRT, CHOP and caspase-12 was measured by real-time PCR.The protein levels of CHOP, caspase-12 and phosphorylated Akt in the myocardial cells were determined by Western blot.RESULTS: Compared with normal control group, the pulse fre-quency, cell viability rate and SOD activity of myocardial cells were significantly decreased, the cell apoptotic rate as well as the contents of LDH, CK, AST and MDA were increased in H/R model group.The mRNA expressions of GRP78, CRT, CHOP and caspase-12 as well as the protein levels of CHOP and caspase-12 were increased, whereas p-Akt level was decreased obviously.Compared with H/R model group, the pulse frequency, cell viability rate and SOD activity were in-creased significantly, the cell apoptotic rate as well as the contents of LDH, CK, AST and MDA were decreased in Klotho pretreated group.The mRNA expression of GRP78, CRT, CHOP and caspase-12 as well as the protein levels of CHOP and
caspase-12 were decreased, while p-Akt level increased significantly.CONCLUSION:Anti-aging Klotho protein improves the myocardial cell survival and inhibits the apoptosis by increasing the resistance of the cells to oxidative stress and exces-sive endoplasmic reticulum stress response, which is related with the activation of Akt phosphorylation in H/R-injured my-cardial cells.

Objective To study the quality of life(QOL) of patients with mild to moderate primary hypertension after treatment adjusted medication time by ambulatory blood pressure .Methods All 128 cases were divided into two groups randomly including chronos medication group and normal medication group .We tested ambulatory blood pressure ,QOL and influencing factors before medication and 6 months later .Results It′s observed the parameters of the ambulatory blood pressure improved significantly in all of the groups .There existed significant difference in nSBP ,nDBP ,nMAP ,SBP in dangerous night time ,and nocturnal blood pres‐sure decline rate between two groups (P<0 .05) .There existed very significant difference in DBP and MAP in dangerous night time (P<0 .01) .There were significant difference in the fields of MH (mental health) and RE (role limitation because of emotional health problem) (P<0 .05) ,and very significant difference in the fields of PF (physical functioning) ,RP (role limitation because of physical health) ,VT(vitality) (P<0 .01) .Multiple regression analysis indicate the influencing factors of the quality of life about patients with hypertension are age ,BMI index number ,medication time ,average family income ,medical insurance type ,culture de‐gree and job title .Age ,BMI index number and medication time depress QOL of patient with hypertension while average family in‐come ,better medical insurance type ,culture degree and job title improve it .Conclusion It′s possible to improved the parameters of the ambulatory blood pressure for patients with mild to moderate primary hypertension by chronos medication compared with nor‐mal medication more significantly .It′s useful to improve the QOL of patient with hypertension by improving average family income , medical insurance type and culture degree .