ObjectiveTo evaluate the effectiveness of stone needle thermocompression and massage compared to flurbiprofen gel patch in relieving chronic musculoskeletal pain in the shoulder and back， and to explore the potential mediating mechanism through muscle elasticity. MethodsA total of 120 patients with chronic musculoskeletal pain in the shoulder and back were randomly assigned to either stone needle group or flurbiprofen group， with 60 patients in each. The stone needle group received stone needle thermocompression and massage for 30 minutes， three times per week； the flurbiprofen group received flurbiprofen gel patch twice daily. Both groups were treated for 2 weeks. Pain improvement， as the primary outcome， was assessed using the Global Pain Scale （GPS） at baseline， after 2 weeks of treatment， and again 2 weeks post-treatment. To explore potential mechanisms， a mediator analysis was conducted by measuring changes in superficial and deep muscle elasticity using musculoskeletal ultrasound at baseline and after the 2-week treatment period. ResultsThe stone needle group showed significantly greater pain relief than the flurbiprofen group 2 weeks post-treatment. After adjusting for confounders related to pain duration， the between-group mean difference was -8.8 ［95% CI （-18.2， -0.7）， P＜0.05］. Part of the therapeutic effect was mediated by changes in deep muscle elasticity， with a mediation effect size of -1.5 ［95% CI （-2.0， -0.9）， P = 0.024］， accounting for 17.9% of the total effect. ConclusionStone needle thermocompression and massage can effectively relieve chronic musculoskeletal pain in the shoulder and back， partly through a mediating effect of improved deep muscle elasticity.

Objective: To investigate and analyze the actual intake of protein and energy in adult patients with severe burns during post burn days (PBDs) 3 to 14. Methods: Records of 52 adult patients with severe burns [37 males and 15 females, (37±9) years old], admitted to the Department of Plastic Surgery and Burns of Tianjin First Central Hospital from January 1st 2011 to December 31st 2017 and meeting the study inclusion criteria, were retrospectively analyzed. Nutrition intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations of patients during PBDs 3 to 14 were obtained from critical care records. During PBDs 3 to 7 and PBDs 8 to 14, the personal daily total energy intake and the ratio of it to energy target of patients were calculated and compared; the personal daily intake of carbohydrate, fat, and protein and calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake, and the ratios of non-protein calories to total nitrogen of patients were calculated and compared; the personal daily energy and protein intake of patients from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations were analyzed; the percentages of energy intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total energy intake, and the percentages of protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake of patients were calculated. Vomiting and diarrhea of patients during PBDs 3 to 7 and PBDs 8 to 14 were recorded. Levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, nitrogen balance values of patients on PBDs 7 and 14 were recorded or calculated. Data were processed with paired t test and chi-square test. Results: (1) The personal daily total energy intake of patients during PBDs 3 to 7 and PBDs 8 to 14 were (8 696±573) and (11 980±1 259) kJ respectively, and ratios of them to energy target [(13 290±1 561) kJ] were 65.4% and 90.1% respectively. The personal daily total energy intake of patients during PBDs 3 to 7 was obviously lower than that during PBDs 8 to 14 (t=18.172, P<0.01). (2) The personal daily intake of carbohydrate, fat, and protein of patients during PBDs 8 to 14 were obviously higher than those during PBDs 3 to 7 (t=15.628, 22.231, 10.403, P<0.01). The personal daily calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake of patients were 56.8%, 25.1%, and 18.3% respectively during PBDs 3 to 7 and 54.2%, 27.0%, and 18.7% respectively during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy intake of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ²=0.185, P>0.05). The ratios of non-protein calories to total nitrogen (kJ∶g) of patients during PBDs 3 to 7 and PBDs 8 to 14 were 469∶ 1 and 456∶ 1 respectively. (3) The personal daily energy intake of patients from routes of oral diet and parenteral nutrition preparations during PBDs 8 to 14 [(4 394±978), (5 723±898) kJ] were obviously higher than those during PBDs 3 to 7 [(2 137±453), (4 855±825) kJ, t=26.516, 6.583, P<0.01], while the personal daily energy intake of patients from routes of enteral nutrition preparations during PBDs 8 to 14 was close to that during PBDs 3 to 7 (t=1.922, P>0.05). The constituent ratio of personal daily energy during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ²=4.100, P>0.05). The personal daily protein intake of patients from route of oral diet during PBDs 8 to 14 was (58±22) g, obviously higher than (25±6) g during PBDs 3 to 7 (t=14.514, P<0.01). The personal daily protein intake of patients from routes of enteral nutrition preparations and parenteral nutrition preparations during PBDs 8 to 14 was close to those during PBDs 3 to 7 (t=1.924, 1.110, P>0.05). The constituent ratio of personal daily protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake during PBDs 8 to 14 was close to that during PBDs 3 to 7 (χ²=5.634, P>0.05). (4) There were 3 patients with vomiting and 4 patients with diarrhea during PBDs 3 to 7, and 1 patient experienced both of them during PBDs 8 to 14. The levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, and nitrogen balance values of patients on PBDs 7 and 14 were (29±4) and (30±4) g/L, (132±42) and (171±48) mg/L, (7.4±2.8) and (6.7±2.8) mmol/L, (1.5±0.7) and (1.4±0.7) mmol/L, (30.5±4.3) and (34.5±2.2) g, -(25.1±2.6) and -(23.7±3.9) g, respectively. Conclusions The personal daily total energy intake of patients during PBDs 3 to 7 was lower than that during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14. Energy and protein intake were mostly derived from parenteral nutrition preparations during PBDs 3 to 7, while those during PBDs 8 to 14 were mainly derived from parenteral nutrition preparations and oral diet.

At present, the contents and class hours of contact lens course cannot meet the teaching and clinical requirements. Therefore, the curriculum of contact lens on practical operation was optimized, the number of practice hours was increased, and various models for practice course were applied, including problem-based learning, community practice course, and practice enhancement course, to improve students' learning interest and initiative. A variety of evaluation models were used to help teachers understand the performances of their students and make adjustments in the process of teaching and evaluation, so as to improve students' score of practical test, help them better master the practical skills and enter clinical practice without difficulties. The feedback scores of teachers in clinical practice have also been improved compared with the former ones.

Objective To analyze the application value of evidence-based nursing(EBN) in LASEK surgery.Methods Totals of 120 cases of LASIK surgery patients from December 2013 to December 2015 were selected, and divided into observation group and control group by sortition. Patients in observation group received EBN, while patients in control group received routine nursing. Systolic blood pressure(SBP), diastolic blood pressure( DBP ) , heart rate, and SAS score before surgery, postoperative complications after 1 week, visual acuity, diopter and intraocular pressure after 4 weeks, and Haze grading are observed in two groups. Results The preoperative SBP, DBP and heart rate in observation group were lower than in the control group, SAS score in observation group was lower than the control group, differences were statistically significant ( P<0.05);complication rate 1. 67% in observation group was lower than 8. 67% in control group 1 week after surgery. The difference was statistically significant (χ2=5. 886, P<0. 05 ); 4 weeks after surgery, visual acuity in observation group was higher than that in control group, diopter was lower than in control group, and intraocular pressure was lower than in control group, The difference was statistically significant ( P<0.05);4 weeks after surgery, 1.67% patients in observation group were Haze 1 and was lower than that 11.67% in control group (P<0.05).Conclusions The application of EBN in LASEK surgery can effectively relieve patients′negative emotions, reduce the complication rate, and improve the surgical curative effect.

Objective To explore the effect of 1,25-dihydroxyvitamin D3 [1,25-(OH)2VitD3] on insulin resistance and inflammatory response in mice with severe burns under stress. Methods One hundred and thirty mice were randomly divided into healthy group (n=10), experimental groupⅠ(n=40), experimental groupⅡ(n=40) and control group (n=40). The model mice were scalded to 30%of total body surface area (TBSA) burnt (Ⅲ°) in experimental groupⅠ, the experi-mental groupⅡand control group. Mice in experimental groupⅠwere given by gavaging 1,25-(OH)2VitD3 (1μg·kg-1) with 0.6 mL peanut oil at 8 am for every other day. At the same time and by the same way, mice in experimental groupⅡreceived 1,25-(OH)2VitD3 (4μg·kg-1) with 0.6 mL peanut oil, and mice in control group received only 0.6 mL peanut oil. The serum levels of fasting blood glucose (FBG), fasting insulin (FIns), TNF-αconcentration, and the NF-κB positive rate in wound tis-sues were determined respectively on day1, day3, day7 and day14 after burn. Results (1) The values of insulin resistance index (HOMA-IR), serum TNF-αand the NF-κB positive rate in wound tissues were higher at different time points in exper-imental groupⅠ, experimental groupⅡand control group than those in healthy group. (2) The levels of HOMA-IR at the same time points were significantly lower in experimental groupⅠand experimental groupⅡthan those in control group, and the value was significantly lower in experimental groupⅡthan that of experimental groupⅠ(P<0.05). The level of HOMA-IR was the highest at day 3 and then gradually decreased at the different time points in the same group (P<0.05). (3) The se-rum levels of TNF-αand NF-κB positive rate of wound tissues at the same time points were significantly lower in experimen-tal group Ⅰand experimental group Ⅱ than those in control group, and the value was significantly lower in experimental groupⅡthan that of experimental groupⅠ(P<0.05). The serum level of TNF-αand NF-κB positive rate of wound tissues were gradually decreased at the different time points in same group (P<0.05). Conclusion 1,25-(OH)2VitD3 can reduce the insulin resistance and inflammatory response in mice with severe burns under stress.

OBJECTIVETo investigate the roles of Domain I and Domain II of hepatitis C virus (HCV) 5' untranslated region (UTR) in the translation initiation activity of HCV 5'UTR in different host cell lines.

METHODSThe eukaryotic expression plasmid pCMVNCRLuc (pCN1), in which full-length HCV 5'UTR regulates firefly luciferase expression, was modified by deleting Domain I and the downstream single-stranded sequence (43 bp in total) from the UTR (pCNl-d2), Domain I with the downstream single-stranded sequence and Domain II (118 bp in total) from the UTR (pCNl-d3), or the total UTR (pCNl-d5). The modified plasmids were transfected via liposome into different cell lines with pRL-TK plasmid co-transfected as the normalization control. At 36 h after the transfection, the total cellular RNA was harvested for semi-quantitative RT-PCR, and the relative expression activities of luciferase were assayed with a dual luciferase reporter gene assay system. The translation initiation activities of the truncated HCV 5'UTRs in different translation systems were analyzed.

RESULTSDeletion of Domain I and the downstream single-stranded sequence caused no significant changes of the translational activity of HCV 5'UTR in Hela or C6 cells, but decreased the translational activity by 46% in L-02 cells and increased the translational activity by 46% in 293T cells. Deletion of both Domain I and Domain II resulted in decreased translational activity of HCV 5'UTR by 51% in HeLa cells, but increased the translational activity by 40% in L-02 cells, 60% in C6 cells and 135% in 293T cells.

CONCLUSIONSDomain I and Domain II of HCV 5'UTR perform cell type-specific roles in HCV IRES-driven translation initiation.

5' Untranslated Regions ; Genes, Reporter ; HeLa Cells ; Hepacivirus ; genetics ; Humans ; Luciferases ; Plasmids ; Protein Biosynthesis ; genetics ; RNA, Viral ; genetics ; Transfection

OBJECTIVETo observe and evaluate the clinical effects of improved scapula flap in repairing refractory wound.

METHODSTen patients, with refractory wounds (ranging from 11 cm×7 cm to 16 cm×15 cm) on face and extremities combined with bone and tendon exposure as a result of traffic injury, burns, or diabetic feet, were hospitalized from February 2008 to February 2013. The wounds were repaired with improved scapula flap ranging from 12 cm×8 cm to 17 cm×16 cm. Six of them were grafted directly; 4 of them were grafted with bridging. The vessel of flap was freed to the subscapular vessel and its thoraco-dorsal branch, forming the T-shape vessel pedicle with circumflex scapular vessel, and the vessels on two sides of vessel pedicle were anastomosed with vessels in recipient area. The donor sites were sutured directly or covered with autologous medium-thickness skin graft.

RESULTSNine flaps survived after surgery; the wounds were healed. Few blisters and exudation were observed at the distal end of one flap, which was cured after dressing change for 2 weeks. The pedicles of the bridge-like flap were divided 4-6 weeks after surgery. All the patients were followed up for 6 to 12 months. Slight swelling was observed in 2 flaps. The appearance and texture of the other 8 flaps were good, and the function of the recipient area recovered. No obvious hypertrophic scar was observed in donor site on the back, with normal function of shoulder joint and pulsation of named vessels.

CONCLUSIONSRepairing refractory wounds with improved scapula flaps can result in good appearance, texture, and satisfactory function, which should be popularized in clinic.

Burns ; surgery ; Humans ; Scapula ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Wound Healing

Objective Study the effect of recombinant human acidic fibroblast growth factor combined suction drainage in the treatment of refractory wound. Methods Fifty-four patients with refractory wound were analyzed from January 2010 to December 2012 and were randomly divided into the treatment group (n=29, treated with rh-aFGF washing dur-ing operation) and control group (n=25, treated with 0.9% NS). Both groups were treated combined suction drainage treatment. Exposed areas of surface and deep tissue were recorded during the treatment, then the rate of deep wound healing and the rate of cavity volume improvement were calculated. Results Wound in the treatment group cured pri-marily, and the area of bone tendons exposure reduced. The rate of deep wound healing and the rate of cavity volume improvement in the treatment group were better than the control group (P<0.05). The treatment group all healed after short time dressing change. However, the control group all healed after long time dressing change or with skin flap transplantation. Conclusion By exogenous long-term supplementing aFGF and it can achieve the purpose of therapy.

Objective To investigate the roles of Domain I and Domain II of hepatitis C virus (HCV) 5' untranslated region (UTR) in the translation initiation activity of HCV 5'UTR in different host cell lines. Methods The eukaryotic expression plasmid pCMVNCRLuc (pCN1), in which full-length HCV 5'UTR regulates firefly luciferase expression, was modified by deleting Domain I and the downstream single-stranded sequence (43 bp in total) from the UTR (pCNl-d2), Domain I with the downstream single-stranded sequence and Domain II (118 bp in total) from the UTR (pCNl-d3), or the total UTR (pCNl-d5). The modified plasmids were transfected via liposome into different cell lines with pRL-TK plasmid co-transfected as the normalization control. At 36 h after the transfection, the total cellular RNA was harvested for semi-quantitative RT-PCR, and the relative expression activities of luciferase were assayed with a dual luciferase reporter gene assay system. The translation initiation activities of the truncated HCV 5'UTRs in different translation systems were analyzed. Results Deletion of Domain I and the downstream single-stranded sequence caused no significant changes of the translational activity of HCV 5'UTR in Hela or C6 cells, but decreased the translational activity by 46%in L-02 cells and increased the translational activity by 46%in 293T cells. Deletion of both Domain I and Domain II resulted in decreased translational activity of HCV 5'UTR by 51%in HeLa cells, but increased the translational activity by 40%in L-02 cells, 60%in C6 cells and 135%in 293T cells. Conclusions Domain I and Domain II of HCV 5'UTR perform cell type-specific roles in HCV IRES-driven translation initiation.

Objective To investigate the roles of Domain I and Domain II of hepatitis C virus (HCV) 5' untranslated region (UTR) in the translation initiation activity of HCV 5'UTR in different host cell lines. Methods The eukaryotic expression plasmid pCMVNCRLuc (pCN1), in which full-length HCV 5'UTR regulates firefly luciferase expression, was modified by deleting Domain I and the downstream single-stranded sequence (43 bp in total) from the UTR (pCNl-d2), Domain I with the downstream single-stranded sequence and Domain II (118 bp in total) from the UTR (pCNl-d3), or the total UTR (pCNl-d5). The modified plasmids were transfected via liposome into different cell lines with pRL-TK plasmid co-transfected as the normalization control. At 36 h after the transfection, the total cellular RNA was harvested for semi-quantitative RT-PCR, and the relative expression activities of luciferase were assayed with a dual luciferase reporter gene assay system. The translation initiation activities of the truncated HCV 5'UTRs in different translation systems were analyzed. Results Deletion of Domain I and the downstream single-stranded sequence caused no significant changes of the translational activity of HCV 5'UTR in Hela or C6 cells, but decreased the translational activity by 46%in L-02 cells and increased the translational activity by 46%in 293T cells. Deletion of both Domain I and Domain II resulted in decreased translational activity of HCV 5'UTR by 51%in HeLa cells, but increased the translational activity by 40%in L-02 cells, 60%in C6 cells and 135%in 293T cells. Conclusions Domain I and Domain II of HCV 5'UTR perform cell type-specific roles in HCV IRES-driven translation initiation.