Objective:To investigate the therapeutic effect of anterolateral thigh Flow-through flap transfer surgery combined with Masquelet technique in reconstruction of Gustilo IIIC open fractures of distal tibia.Methods:Between July 2017 and May 2021, 7 patients who had Gustilo IIIC injuries in the lower limb were treated in the Department of Orthopaedics Surgery, Wuxi 9th People's Hospital by emergency surgery with transfer of anterolateral thigh Flow-through flap combined with Masquelet technique. The patients were 5 males and 2 females, aged 36 to 63 (50.0±10.4) years old. Size of soft tissue defects was 11 cm × 4 cm to 23 cm × 7 cm, the length of bone defects was 3.5-7.5 (5.34±1.52) cm and the bridging length for vascular defects was 7-12 (9.21 ± 2.34) cm. The size of the flaps was 12 cm × 5 cm - 24 cm × 8 cm. All patients received postoperative follow-up at the outpatient clinic and complications of wound, fracture healing and the recovery of limb function were observed.Results:All flaps survived uneventfully and successful limb salvage were achieved in all 7 patients, together with all bone grafts healed without infection. The follow-up lasted for 12-38 (26.69±10.73) months. At the last follow-up, the appearance and functional recovery of the lower limbs were satisfactorily. The function of ankle was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) : 3 patients in excellent, 3 in good and 1 in fair.Conclusion:Emergency anterolateral thigh Flow-through flap transfer surgery with Masquelet technique is a safe, effective and feasible surgical procedure for Gustilo IIIC open fractures of distal tibia. It allows to close the wound and rebuild the blood supply in distal limb in the primary or emergency surgery, and allows to perform bone grafting and internal fixation in stage-II surgery. The patients benefit from high rate of success in limb salvage and good function recovery of the affected limb.

Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.

Objective: To explore the degree of social support in patients after Coronary Artery Bypass Grafting(CABG) and its influence on Acute Stress Disorder (ASD), in order to provide theory evidence for nursing intervention. Methods: From June 2017 to Mar 2018, 359 patients after CABG in Tangshan Workers Hospital were recruited for the study. Their general information were collected, SASRQ, SSRS and PSS-Fa were used for professional evaluation. Results: The degree of social support in patients after CABG was at medium level, the total score of social support was (41.69±0.28), higher than the normal domestic value[(34.56±3.73)score, n=128]; character (F=29.652), employment (t=6.526)and the type of health insurance (F=20.547)impacted on the degree of social support (P<0.05). Total score of social support had negative correlation with SASRQ total score (r=-0.528, P<0.05); character (β=0.262), family support (β=-0.281) and social support (β=-0.267) were picked in the regression equation (P<0.05), the results showed that introversion was a risk factor for ASD in patients after CABG, high degree of family support and social support were protective factors for ASD in patients after CABG. Conclusions Social support of patients after CABG needs to be improved, so as to reduce the incidence of acute stress disorder.

Objective To evaluate the effect of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)on the detection of carbapenemase producing enterobacteriaceae. Methods A total of 21 carbapenem non-susceptible enterobacteriaceaeclinical strains were collectedfrom the Second Affiliated Hospital of Soochow University during January to May, 2018, including 11 strains of Klebsiella pneumonia, 3 strains of Klebsiella oxytoca, 3 strains of Enterobacter cloacae, and 4 strains of Escherichia coli. All the isolates were incubated with 0.5g/L meropenem solution for 2 hours. The supernatant was centrifuged and collected for MALDI-TOF MS detection. The characteristic peaks were captured to determin whether the strain was producing carbapenemase or not. And then, the results were compared with PCR results by Kappastatistical analysis. Results The PCR results showed that all the strains were positive for carbapenmase genes, among them 15 isolates were encoding KPC genes, 6 isolates encoding GES genes, 2 isolates encoding NDM genes, 1 isolate encoding VIM genes, 4 isolates encoding GIM and 1 isolate encoding SIM. And the strains could carry one or more carbapem-resistant determinants. MALDI-TOF MS showed that meropenem were hydrolyzed by 21 isolates and a characteristic drug hydrolysis peak appeared at 199 m/z, as a result of carbapenemase produced by enterobacteriaceae. The assay of MALDI-TOF MS was highly consistentwith PCR results. Conclusions The investigation showed that MALDI-TOF MS can directly detect the carbapenemase by capture the characteristic drug hydrolysis peak.

Objective: To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH). Methods: In this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration. Results: There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579, P<0.001),RVSP (r=-0.442, P=0.002) ,RVGLS (r=-0.521, P<0.001) , LASr (r=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4±2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively. Conclusions RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent.

Essential of rheumatoid arthritis (RA) is destruction of invasive pannus formation in cartilage, bone and surrounding tissues Chronic inflammation of synovial membrane. Vascular endothelial growth Factor (VEGF) increases vascular permeability and induces angiogenesis. It plays a very important role in the process of joint erosion and destruction of RA. It not only promotes the formation of RA synovial pannus formation, but also acts as a direct proinflammatory factor in the pathogenesis of RA.

Objective To analyze hemolysin and virulence -related genes in incomplete hemolytic Staphylococcus aureus.Methods Fifty strains of incomplete hemolytic Staphylococcus aureus were isolated from patients admitted in the Second Affiliated Hospital of Soochow University during 2013 and 2014, and the isolates with complete hemolytic phenotype were also collected at the same period as the control strains . All the strains were inoculated and subcultured on four kinds of sheep blood agar plates supplied by different manufacturers to compare their hemolytic phenotype .The relative mRNA expressions of hemolysin genes (hla, hlb, hlc, hld) in standard strain, complete and incomplete hemolytic phenotype strains were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and valued by 2 -△△Ct method.t test was used to compare mRNA expressions of hemolysin genes .Western blot was performed to analyze the expression of α-hemolysin.Antibiotic susceptibility test of incomplete hemolytic strains was performed using broth microdilution method.Resistant gene mecA and virulence genes pvl, tst were detected by PCR.Results The steady and hereditary incomplete hemolysis was observed in 50 strains of incomplete hemolytic Staphylococcus aureus on the sheep blood agar plates from different suppliers .Taking mRNA expression of hla, hlb, hlc, hld in standard strain as 1, the relative mRNA expressions of hemolysin genes in incomplete hemolytic strains were 0.02, 7.51, 0.06 and 0.12 respectively, there were statistical differences between standard strain and incomplete hemolytic strains (t =8.46, -56.40, 8.12 and 7.61, all P <0.05).And the expression of α-hemolysin was decreased in incomplete hemolytic strains .All the strains were identified as methicillin resistant Staphylococcus aureus (MRSA).Three strains exhibited different minimum inhibitory concentrations of teicoplanin and linezolid after subcultured , but the differences had no impact on the final results of antibiotic susceptibility test .mecA, pvl and tst genes were positive in incomplete hemolytic strains . Conclusion Staphylococcus aureus with incomplete hemolytic phenotype is methicillin resistant with higher expression of β-hemolysin and lower expressions of α-hemolysin, γ-hemolysin and δ-hemolysin.It carries plv and tst virulence genes and is of high virulence .

Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application.Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect of hands in 18 patients,in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases,anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases,anterosuperior malleolus flap-dorsal pedal trilobate flap in 2 cases;Anterosuperior malleolus retrograde island (bone) flap was used in recovering pedal soft tissue in 22 patients,the flap pedicled from stem of anterior tibial artery in 16 cases,dorsal pedal flap-anterosuperior malleolus flap in 2 cases,the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases,the bone flap combined with the distal of tibia in 2 cases.Results In the 18 cases of hands,17 cases survived,and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair.Twenty cases of anterosuperior malleolus retrograde island (bone) flap survived,and the other 2 cases needed secondary skin-grafting to repair the necrosis edge of flaps because of venous limited.After a follow-up from 3 to 6 months,30 cases showed the satisfied postoperative outlook,with the good healing of the donor sites.Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap,20 cases locate in the medial of anterior tibial muscle,16 cases locate between the anterior tibial muscle and extensor hallucis longus,4 cases locate between extensor hallucis longus and extensor digitorum longus.Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of operations、preventing cutaneous branches,but also improving the success rate of surgery.

Lignocellulosic biomass represents an abundant, low-cost and renewable source of potentially fermentable sugars. It is acandidate besides petroleum as feedstock for fuel and chemical production. Recent researches on utilizing lignocellulosicsas feedstock boost development of numerous-promising processes for a variety of fuels and chemicals, such as biodiesel, biohydrogen and ethanol. However, high cost in depolymerization is a primary obstacle preventing the use of lignocellulosic biomass as feedstock. Consolidated bioprocessing (CBP), refers to the bioprocess without any exogenous cellulolyotic enzymes added, converting the lignocellulosic material into biochemicals directly, which could potentially avoid the cost of the dedicated enzyme generation step by incorporating enzyme-generating, biomass-degrading and bioproduct-producing capabilities into a single organism through genetic engineering. There are two CBP strategies, native strategy and recombinant strategy. We mainly introduce the recombinant strategy, including its principle, the two responding styles, the contributions of synthetic biology and metabolic engineering and the future challenges.
Bacteria ; genetics ; metabolism ; Biofuels ; Biotechnology ; methods ; Ethanol ; metabolism ; Fungi ; genetics ; metabolism ; Hydrolases ; biosynthesis ; genetics ; Industrial Microbiology ; methods ; Lignin ; metabolism ; Metabolic Engineering ; methods ; Recombinant Proteins ; biosynthesis ; genetics

Objective To assess the therapeutic efficacy of colonic tumor with targeted microbubbles encapsulated VEGFR2 monoantibody (mAb) combined with ultrasonic abrupted destroy.Methods Seventeen Balb/C nude mice with subcutaneous colonic carcinoma xenografts were divided into three groups:group A (5 mice) underwent contrast-enhanced ultrasonography (CEUS) examination and sham ultrasonic abrupted destroy;group B (6 mice) underwent lipid-microbubbles administration combined with ultrasonic irradiation;group C (6 mice) underwent VEGFR2 monoantibody-loaded microbubbles injection combined with ultrasonic irradiation.Red fluorescent protein(RFP) was labeled to all the nude mice model.Both CEUS and flurography were performed before and one week after abrupted destroy.The size,fluroscent area and fluroscent intensity(FI) and vessel density (VD) of each tumor were measured and compared.Results The parameters of length,fluroseent area,FI and VD of each tumor before abrupted destroy were no significant difference among three groups ( P ＞0.05).Parameters of post-sham ultrasonic abrupted destroy in group A were higher than those before sham ultrasonic abrupted destroy ( P ＜0.05).FI and VD in group B were significantly lower than those after abrupted destroy( P ＜0.05).There were no difference of length,fluroscent area of tumor in group B between pre- and post- ultrasonic abrupted destroy (P ＞0.05).Length,fluroscent area,FI and VD of each tumor in groups C were decreased significantly compared with post ultrasonic abrupted destroy ( P ＜0.01 ).There were significant difference of length,fluroscent area,FI and VD of each tumor among groups after ultrasonic abrupted destroy( P ＜0.05).Conclusions VEGFR2 mAb-loaded lipid microbubble combined with ultrasonic abrupted destroy can improve the therapeutic efficacy of colonic tumor.