Objective: To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma. Methods: From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient′s clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded. Results: Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case. Conclusions In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient′s tolerance, thereby improving patient survival rate.

Objective To explore the therapeutic effect of different doses of botulinum toxin A injections on bromhidrosis.Methods A total of 200 cases were divided into mild-to-moderate group (N=100) and severe group (N=100) based on the grade of bromhidrosis,and each group was further divided into two groups:low dose group (50 cases) were treated by botulinum toxin A injections (100 U) and high dose group (50 cases) were treated with 200 U for bilateral axillary.The total effective rate and recurrence rate in both groups were compared.Results In the mild to moderate group,after treatment for 3 months,the total effective rate of both groups had no statistical difference (P＞ 0.05),and the same with recurrence rate in 6 months follow-up (P＞0.05).In the severe group,after treatment for 3 months,the total effective rate of the high dose group (82％) was significantly higher than that of the low dose group (64％),with statistical significance (x2 =4.110,P＜0.05).After 6 months follow-up,recurrence rate in the high dose group (22％) was significantly lower than that of the low dose group (46％),with statistical significance (x2 =6.417,P ＜ 0.05).Conclusions A suitable dose of botulinum toxin A can be selected based on the severity of bromhidrosis,which is a individualized therapy for cost savings and might have potential benefits for patients with osmidrosis.

Objective: To explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test. Results: The size of residual wound of patients in Meek skin graft group on 28 days post injury was (59±13)% total body surface area (TBSA), which was obviously smaller than that in microskin graft group [(70±14)%TBSA, t=4.379, P<0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum (4 patients), vola (10 patients), and toe or finger web (8 patients). Conclusions Meek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

Objective To explore the role of decorin (DCN) on the pathogenesis of schizophrenia by analyzing the correlation between serum DCN levels and cognitive impairment in the first-episode drug-native (FEDN) patients with schizophrenia.Methods 30 FEDN patients with schizophrenia and 30 age and gender matched healthy volunteers (control group) were enrolled.The psychopathological symptoms were assessed by the PANSS and the cognitive function was assessed by the MATRICS Consensus Cognitive Battery (MCCB).The serum DCN levels were measured by using enzyme linked immunosorbent assay (ELISA).The difference of DCN levels between the two groups were compared and the correlations of serum DCN levels to age,sex,the score of the MCCB and PANSS were analyzed.Results The serum DCN levels were lower in patients with schizophrenia than those in control group ((1.56±0.96) ng/ml vs (3.35± 1.71) ng/ml,P＜ 0.01).The serum DCN levels were positively correlated with the positive symptom score (r=0.41,P=0.03).The serum DCN levels were significantly negatively correlated with MCCB verbal fluency (r =-0.40,P =0.04),verbal memory (r=-0.42,P=0.02),visual memory (r=-0.39,P=0.04),continuous operation (r=-0.41,P=0.03),encoding symbols (r=-0.49,P=0.01),T line (r=-0.42,P=0.02) and total score (r=-0.55,P＜0.01),and after controlling the age and gender,the relationships were still exist.Conclusion It suggests that serum DCN levels are associated with cognitive function in first-episode patients with schizophrenia,and that DCN may be involved in the pathogenesis of schizophrenia.

Objective:To investigate the roles of S100B protein and anti-brain antibody (ABAb) in the pathophysiology of Alzheimer's disease (AD) by analyzing the changes of the serum levels of S100B and ABAb and the relationships of the measures with cognition deficits in patients with AD.Methods:In this study,32 patients with AD(AD group) and 40 age-matched volunteers without cognitive impairment(control group) were enrolled.The diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ).The mental and social functional conditions were assessed with the Mini-Mental State Examination (MMSE) and Activity of Daily Living Scale(ADL),the cognitive function of patients was evaluated with the Alzheimer's Disease Assessment Scale-cognitive subscale(ADAS-Cog).The serum S100B proteinand ABAb levels were examined by enzyme-linked immuno sorbent assay(ELISA).Results:The serum S100B protein[(0.66 ± 0.17) μg/L vs.(0.30 ± 0.04)μg/L] and ABAb [(1.93 ± 0.95) U/L vs.(1.31 ± 0.25) U/L] levels were higher in AD patients than in the controls (Ps ＜ 0.01).In AD patients,the serum S 100B protein markedly negatively correlated with the scores of the MMSE(r =-0.66),while positively correlated with ADL and ADAS-Cog(r =0.57,r =0.53)(Ps ＜ 0.005).ABAb levels negatively correlated with the scores of the MMSE(r =-0.57),while positively correlated with ADL and ADAS-Cog(r =0.52,r =0.34)(Ps ＜0.05).The serum S100B protein levels were positively related to ABAb levels in AD group(r =0.51.P ＜0.005),but not in control group(r =0.076,P =0.654).Conclusions:It suggests that the serum levels of S100B protein and ABAb are related with cognitive function in patients with Alzheimer's disease,and S100B protein and ABAb might play key roles in mechanism of Alzheimer's disease.

Objective:To investigate the possible pathological mechanisms of tardive dyskinesia (TD) by analyzing brain cortex morphological changes and it's correlation to abnormal involuntary movement in schizophrenic patients with TD.Methods:Thirty-two schizophrenia patients with TD (TD group),31 schizophrenia patients without TD (non-TD group) and 21 healthy volunteers (control group) were recruited.Combined TD and non TD group into schizophrenia group.The psychopathological symptoms and abnormal involuntary movement were assessed with the Positive and Negative Syndrome Scale (PANSS) and Abnormal Involuntary Movement Scale (AIMS).The brain magnetic resonance imaging (MRI) data and Freesurfer software were used to measure the gray matter volume,cortical thickness,cortical surface area and volume of sub-conical regions among the three groups.Results:Schizophrenia group had significantly smaller gray matter volume in right nucleus accumbens,bilateral hippocampus,left superior frontal gyrus,left precentral sulcus superior part,and cortical surface area in left precentral sulcus superior part than the controls.The TD group had significantly smaller gray matter volume in right nucleus accumbens,larger gyrus gray matter volume and conical surface area in left precentral sulcus superior part than non-TD group (Ps ＜ 0.05).To test the difference between TD and non-TD group further,the chlorpromazine equivalent dose and PANSS negative scores Was controlled,the TD group still had significantly larger gray matter volume and surface area in left precentral sulcus superior part than the non-TD group [(2.03 ±0.07) × 103mm3 vs.(1.68-± 0.07) × 103 mm3,(1.01 ± 0.03) × 103 mm2 vs.(0.84 ± 0.03) × 103 mm2;Ps ＜ 0.05].Correlation analyses showed in schizophrenia group the cortical thickness in right inferior frontal gyrus correlated negatively with PANSS positive and general scores,positively with total scores;cortical volume in left occipital temporal sulcus correlated negatively with PANSS general and total scores,right inferior frontal gyrus correlated positively with PANSS positive scores,right intraparietal sulcus correlated positively with PANSS positive scores.In TD group,the cortical volume in left precentral sulcus superior part correlated positively with AIMS scores (r =0.46,P ＜0.01).Conclusions:The schizophrenia patients with TD had significantly increased gray matter volume and cortical surface area in left precentral sulcus superior part,which suggested there were motion compensation in the left precentral sulcus superior part in the pathogenesis of TD.

Objective:To investigate the association between catechol-O-methyl transferase (COMT)Vall58Met polymorphism and prepulse inhibition of the auditory startle reflex (PPI) in patients with schizophrenia.Methods:Totally 178 patients with schizophrenia and 190 healthy volunteers were recruited.The auditory startle reflex was detected by using SR-HLAB monitoring system.The indexed of the auditory startle reflex included the amplitude,habituation％ and PPI30,PPI60,PPI120 (the lead interval was set 30 ms,60 ms,120 ms).COMT Vall58Met polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP).The differences of PPI among COMT genotypes were compared.Results:Compared to the healthy volunteers,patients with schizophrenia had a significant lower the amplitude of auditory startle reflex[(563± 460) mV vs (695 ± 447) mY,P ＜ 0.05] and habituation％ [(32 ± 46) vs (48 ± 33),P ＜ 0.01] as well as the ％PPI120[(27 ± 5) vs (35 ± 3),P ＜ 0.05].The significant differences in COMT allelic and genotypic distribions were observed between patients with schizophrenia and healthy volunteers (x2 =8.16,11.74,Ps ＜ 0.05).The significant main effect of COMT genotype on habituation％ was observed (P ＜0.05) but no interaction genotype by diagnosis on the amplitude of auditory startle reflex,habituation％ and ％ PPI120 was observed (Ps ＞ 0.05).Conclusions:There may be a correlation between COMT genotype and adaptability,but not between COMT genotype and PPI deficit present in patients with schizophrenia

Objective To explore the aesthetic results of medial upper Iip repair for skin and soft tissue defects using local flap.Methods According to the location and the size of upper lip defect,the modified rhomboid flap of 60 ° above the defect was designed to repair the wound in philtrum;the O-L flap along philtral column to vermilion border was designed to cover the wound close to the peak and lateral to philtral column.Results Twenty-one postoperative patients that underwent pigmented nevus removal (12 female,9 male;ages 16-33 years) had defects in philtrum for 10 cases and close to the peak and philtral column for 11 cases.The diameter of the defect ranged from 0.5 cm to 1.0 cm.All flaps survived primarily without any complications and follow-up was for 1 to 18 months with excellent outcomes in all cases.All patients were satisfied with contour and functions.No pigmented nevus recurrence occurred.Conclusions The flap designed according to the aesthetic principle could be used to repair medial upper lip defect of medium-sized,which not only obtains functional reconstruction,but also satisfies aesthetic results,with aesthetic subunits saved and scar concealed.

Objective To investigate the efficacy of treatment and prevention of VitE on vacuous chewing move-ments (VCMs) of haloperidol-induced tardive dyskinesia (TD) rats and serum levels of brain-derived neurotrophic fac-tor ( BDNF) and total antioxidant capacity ( TAC) , and to explore the possible mechanisms.Methods Thirty-two male Sprague-Dawley (SD) rats were randomly divided into TD, P-Vit E, T-Vit E and control group (n=8), receiving to-week treatment with Haloperidol (Hal)+NS, Hal+Vit E (medicated at the baseline), Hal+VitE (medicated at the fifth week) or normal saline (NS), respectively.VCM was evaluated at each week.ELISA and spectrophotometer were used to detect the serum levels of BDNF and TAC, respectively.Results The VCM score of both TD group and T-Vit E group increased at the 2nd weekend, reached the peak at the 5th weekend.VCM score of T-Vit E group declined gradually at the 6th weekend and was significantly lower than that in the TD group [(6.5 ±3.3) vs.(27.9 ±5.8), P<0.001] but was not significantly different from the control group (3.5 ±1.9) (P>0.05) at the 10th weekend.There was no significant difference in VCM score between P-Vit E group and control group for ten weeks(P>0.05).At the 10th weekend, serum BDNF [(6.9 ±1.0) pg/mL] and TAC [(11.9 ±3.2) U/mL] levels of TD group were significantly lower than those of the controls [BDNF (8.6 ±2.5) pg/mL, TAC (18.2 ±5.5) U/mL] and T-Vit E group [BDNF (8.7 ±2.0) pg/mL, (18.6 ±5.9) U/mL] (P<0.01).However, there was no significant difference in the BDNF and TAC levels between TD and P-Vit E groups (P>0.05).Conclusions Vit E may relieve and prevent VCM in TD model rats though alleviation of free radical damage.

Colorectal Neoplasms ; genetics ; Colorectal Neoplasms, Hereditary Nonpolyposis ; metabolism ; DNA Mismatch Repair ; Humans ; Microsatellite Instability