Objective:To explore the clinical effect of a modified surgical procedure for replantation of severed digit-tips in Tamai zones I-II.Methods:From November 2019 to October 2022, the Department of Hand and Foot Microsurgery of the First Affiliated Hospital of Bengbu Medical College employed a modified procedure (to abandon the anatomically labelling of blood vessels and nerves after naked-eye debridement and fracture fixation, then perform the microscopic dissections and anastomoses of blood vessels and nerves, and the anastomosis of dorsal veins though an auxiliary small incision by the lateral nail fold of the severed digit-tip) to replant severed digit-tips in Tamai zones I-II of 26 patients (29 digits). The patients were 20 males (23 digits) and 6 females (6 digits), aged 3-66 years old, with mean age at 28 years old. Nineteen digit-tips were severed in Tamai zone I and 10 in Tamai zone II. The severed digit-tips were 7 of thumbs, 9 of index fingers, 5 of middle fingers, 5 of ring fingers and 3 of little fingers. Causes of injury were 12 of cut, 8 of crush and 6 of avulsion. Postoperative management included infection prevention, antispasmodic for 3 days and keeping in bed for 5 days. The time of surgery was recorded on all patients. Postoperative follow-ups were conducted at outpatient clinics for 6 to 12 months to observe the survival of digit-tips and the appearance, recovery of sensation and motor functions, strength of digits and patient satisfaction.Results:(1)The surgical time was about 1.0 hour for replantation of a severed digit-tip in Tamai zone I, while it took about 1.5 hours for those in Tamai zone II. (2)Survival rate and appearance: all 29 replanted digit-tips survived, except 2 in Tamai zone I which encountered venous occlusion and survived after small incision for bloodletting. Twenty-two digit-tips gained pulp fat pads with full digit pulps. Four avulsed digit-tips had mild atrophy of pulp. The 15 digit-tips severed in Tamai zone I were about 2 mm shorter than the healthy sides, but without deformity. One digit-tip had poor nail appearance due to preoperative fungal infection of nail bed. (3)Sensory recovery: with the British Medical Research Council (BMRC), 23 digit-tips recovered to S 3+, and 2 digit-tips of avulsion and 1 digit-tip of crush recovered to S 3. TPD of the replanted digit-tips were: 4-7 mm in those of cut injury; 6-8 mm in those of crush and 9-11 mm in those of avulsion. (4)Motion and digit strength: results of functional assessment according to the total active mobility standard promoted by China's Society for Surgery of the Hand were: 21 cases of excellent and 5 of good, without pain in digit pulp when pinching and griping. The mobility of the digits with replanted digit-tips of both Tamai zones I and II were close to that of the healthy sides. The motions of the digits with replanted digit-tips in Tamai zone I were close to the healthy sides and the 5 of those in Tamai zone II had 0° in extension and 2°-3° in flexion, due to the severed plane at distal interphalangeal joint. (5)Patient satisfaction: 25 patients were satisfied, however 1 patient was dissatisfied to the poor function of the distal interphalangeal joint due to the severed thumb-tip in Tamai zone II. Conclusion:Modified replantation procedure for severed digit-tip in Tamai zones I-II has significant achievement in cutting down the surgical time through a modified procedure of debridement and fracture fixation (tendon suture) by naked-eyes operation first, followed by dissections and anastomoses of the blood vessels and nerves under the surgical microscope. The auxiliary small incision by the lateral nail fold of digit-tip in Tamai zone I facilitates an exposure of a constant, healthy lateral nail fold vein. It enables the anastomosis with a high-quality vein, hence improves the success rate of replantation. The appearance and function of the replanted digit-tip are found better in the severed digit-tips of cut injury than those with injuries of avulsion and crush.

Objective:To investigate the clinical effects of free superficial circumflex iliac artery (SCIA) superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities.Methods:The study was a retrospective observational study. From January 2020 to June 2022, 19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College, including 15 males and 4 females, aged 28-75 years. The debridement, fracture reduction and fixation, tendon, vessel, and nerve repair, and vacuum sealing drainage were performed in the first stage surgery. After debridement in the second stage surgery, the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm. The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm. The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm. All the wounds in donor site were sutured. The operation time and amount of bleeding of patients during the surgery were recorded, the survival of flap and skin graft were observed after surgery. During follow-up, the flap and skin graft, scar in the donor site and its effect on donor site function were observed. At the last follow-up, the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score.Results:The operation time of patients was 2.0-3.5 h. The amount of bleeding of patients during the surgery was 100-320 mL. One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery, and the flap survived after exploration. The flaps of the other patients survived smoothly. The skin grafts of patients all survived smoothly. Two patients had bloated flaps due to obesity in the later stage, and the expected results were achieved after flap thinning surgery 6 months after operation. During the follow-up of 6 to 24 months, the flaps had good elasticity and soft texture, and the skin grafts had no wear or ulceration; linear scars were left in all the donor sites but their functions were not affected. The patients were all satisfied with the efficacy.Conclusions:Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities, which was safe, reliable, and less traumatic and short in operation time, and resulted in good postoperative appearance and function in the donor sites and recipient sites.

Objective: To understand the current status of the team structure of health personnel in primary and secondary schools, and to provide suggestions and references for strengthening and optimizing school health workforce. Methods: A nationwide stratified random cluster sampling method was adopted to select provinces for investigation in stratification from 2015-2016, a total of 16 provinces, autonomous regions, and municipalities directly under the Central Government, 26 survey sites, 10 027 primary and secondary schools, 9 536 questionnaires of health personnel were collected. Results: Among the 9 536 school health staffs, there were various types of positions, and different types of schools had different position types construction. Elementary schools had the most part time health care teachers, accounting for 77.6%, while full time school doctors only accounting 10.0%; high schools had the most full time school doctors, accounting for 65.7%, and part time health care teachers only accounting for 15.1 %. There were various employment channels, with the most transfer jobs in schools, accounting for 70.7%. The series of professional titles were diverse, with the teaching profession accounting for 67.4%. Most of school health teachers had junior and intermediate professional titles, accounting for 42.6%, respectively. Proportion of medium, medium low, and low level of salary accounted for 39.3%, 27.9% and 21.1% respectively. Conclusion The educational background and age distribution of school health personnel is reasonable, but the proportions of medical background and full time school doctors are relatively low. School health personnel have various job types, professional titles, salary level, and limited space of career development. Top level design from the policy level, and clearly defined improve the structure of school health personnel to meet the needs of high quality development of school health work in the new era.

BACKGROUND: Adult stem cells are pluripotent stem cells that exist in differentiated tissues. Urine-derived stem cells are newly discovered adult stem cells. They have attracted increasing attentions in the tissue engineering, due to its advantages of convenient sampling, highly proliferative ability and multidirectional differentiation potential. OBJECTIVE: To investigate the separation and extraction method of urine-derived stem cells and to investigate the feasibility of differentiation into urothelial cells and smooth muscle cells in vitro. METHODS: Urine specimens were collected from healthy adults, and urine-derived stem cells were obtained by isolation and culture in vitro. Cell counting kit-8 assay was used to detect cell proliferation and plot cell growth curve. Cell phenotype was detected by flow cytometry. The differentiation into urothelial and smooth muscle cells was induced by special medium respectively in vitro. The cell differentiation was detected by quantitative PCR, immunohistochemical staining, immunofluorescence cell staining and western blot assay. RESULTS AND CONCLUSION: Urine-derived stem cells were successfully isolated from the urine specimens of healthy adults. Urine-derived stem cells possessed high proliferation rate and the cell growth curve exhibited an S-shape. Urine-derived stem cells exhibited high expression of CD29 (98.11%) and CD90 (95.74%), both of which are mesenchymal stem cell surface markers. After 14 days of induction in vitro, urine-derived stem cells were able to express urothelial cell specific genes Cytokeratin 7, Cytokeratin 20, Uroplakin II and smooth muscle cell specific genes α-SMA and SM22. These results suggest that urine-derived stem cells can differentiate into urothelial cells and smooth muscle cells after induction in vitro and can be used as ideal seed cells for urinary tract tissue engineering.

Objective: To analyze the current situation and needs of primary and secondary school health clinic services, and to provide a reference for strengthening school health service in China. Methods: Investigation provinces were selected according to China s three major economic zones, 1 or 2 survey centers were selected from each province, 16 provinces and 26 survey centers were selected. In each survey centers, six schools from primary and secondary schools, junior high schools and high schools in urban and rural areas were randomly selected as research sites. Each research site randomly selected 10 students in each grade(grade three, four, five from primary schools) to fill in the questionnaire anonymously. A total of 4 661 valid questionnaires were collected. Results: Among the services provided by the school clinics to students, "trauma treatment" "consulting health problems" "physical examination" accounted for 49.4%, 40.5% and 39.0% respectively. Within the past one year, 45.1% students went to the school clinic for consultation or consultation 1-3 times, 6.4% for 4-5 times, and 3.7% for 6 times or more. When students were sick in school, 65.8%(primary school), 64.0%(junior high school), and 54.4%(high school) of them selected to go to the school clinic. When suddenly suffered trauma in school, 78.2%(primary school), 73.2%(junior high school) and 69.6%(high school) of the students went to the school clinic. Conclusion Primary and middle school students have a great demand for school health services, and it is necessary to continue to strengthen the construction of primary and secondary school health clinics.

Ubiquitination, an essential post-transcriptional modification (PTM), plays a vital role in nearly every biological process, including development and growth. Despite its functions in plant reproductive development, its targets in rice panicles remain unclear. In this study, we used proteome-wide profiling of lysine ubiquitination in rice (O. sativa ssp. indica) young panicles. We created the largest ubiquitinome dataset in rice to date, identifying 1638 lysine ubiquitination sites on 916 unique proteins. We detected three conserved ubiquitination motifs, noting that acidic glutamic acid (E) and aspartic acid (D) were most frequently present around ubiquitinated lysine. Enrichment analysis of Gene Ontology (GO) annotations and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of these ubiquitinated proteins revealed that ubiquitination plays an important role in fundamental cellular processes in rice young panicles. Interestingly, enrichment analysis of protein domains indicated that ubiquitination was enriched on a variety of receptor-like kinases and cytoplasmic tyrosine and serine-threonine kinases. Furthermore, we analyzed the crosstalk between ubiquitination, acetylation, and succinylation, and constructed a potential protein interaction network within our rice ubiquitinome. Moreover, we identified ubiquitinated proteins related to pollen and grain development, indicating that ubiquitination may play a critical role in the physiological functions in young panicles. Taken together, we reported the most comprehensive lysine ubiquitinome in rice so far, and used it to reveal the functional role of lysine ubiquitination in rice young panicles.
Acetylation ; Lysine/metabolism* ; Oryza/metabolism* ; Plant Proteins/metabolism* ; Protein Interaction Maps ; Protein Processing, Post-Translational ; Proteome/metabolism* ; Ubiquitin/metabolism* ; Ubiquitination

Objective To compare the effects of ticagrelor and clopidogrel on platelet aggregation rate, myocardial perfusion and prognosis in patients with acute myocardial infarction. Methods One hundred and sixty-nine patients with acute ST segment elevation myocardial infarction (STEMI) and emergency percutaneous coronary intervention (PCI) were recruited and randomly divided into ticagrelor group (85 cases) and clopidogrel group (84 cases). The TIMI blood flow before and after PCI was recorded, and the ST segment fall rate of 1 h ECG after PCI was calculated. The platelet aggregation rate was measured. After 12 months' follow-up, the incidence of major adverse cardiac events (MACE) was recorded. The Logistic regression analysis was used to discover the factors of MACE. Results One hundred and sixty-nine patients with acute STEMI were recruited including 85 cases treated with ticagrelor and 84 cases in clopidogrel group. The ECG ST segment fall rate after PCI in ticagrelor group was significantly higher than that in clopidogrel group: (61.3 ± 30.7)％ vs. (47.8 ± 26.6)％, P<0.05. The platelet aggregation rate 2 h, 24 h and 7 d after PCI in ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). MACE occurred in 19 cases (22.4％) in ticagrelor group and in 21 cases (25.0％) in clopidogrel group, and there was no significant difference (P > 0.05). Multiple Logistic regression analysis revealed that age and ECG ST segment fall rate were independent risk factors for MACE (P<0.05). Conclusions Compared with clopidogrel, ticagrelor can effectively reduce platelet aggregation rate and accelerate ST segment fall in STEMI patients, but their long-term prognosis is similar.

Objective To understand the current situation of scientific exercise literacy of middle school students,including basic knowledge,attitude,skills and exercise habits.Methods One middle school was selected from each of Shulan county in Jilin province,Wuxi city in Jiangsu province and Chengdu city in Sichuan province,including two junior high schools and one senior high school.Two classes were randomly selected in each grade from each of the three schools.All students in the selected classes took part in the study.1 360 questionnaires were distributed and all were collected,1 355 of them were qualified questionnaires.The questionnaire contains knowledge (12 items),attitudes (10 items),skills (1 items) and habits (3 items).The one who correctly answered 80％ or more of the questions was considered as having the competent literacy.Results Among middle school students,27.4％ had the scientific exercise literacy,47.5％ had the knowledge literacy and 49.0％ had the attitudes literacy for scientific exercise.68.8％ reported regular exercise,but only 12.5％ had exercise habits.Conclusion The level of scientific exercise literacy among middle school students is low,suggesting that multiple measures should be taken to improve scientific exercising knowledge and concept among middle school students,helping them to develop a scientific exercising habit and improve their literacy of scientific exercising.

Objective To explore the effect of endoscopic sinus surgery combined with postoperative nasal irrigation on the symptoms improvement and prognosis for patients with allergic fungal sinusitis.Methods The clinical data of 145 patients with allergic fungal sinusitis who had received treatment in our hospital from January 2010 and January 2014 were reviewed.According to different treatment methods,they were divided into two groups,65 cases in the control group was treated with conventional surgical treatment,80 cases in the obeservation group was treated with endoscopic sinus surgery combined with postoperative treatment.The therapeutic conditions of two groups were compared. Results The symptom scores of patients with polyps,edema,rhinorrhea in two groups were decreased compared with those before treatment, and the obeservation group decreased more significantly (P <0.05,P <0.01).After the operation,patients with nasal mucociliary transport rate of two groups were higher compared with postoperative 6 months and 9 months,and the obeservation group improved more significantly (P <0.05).In addition,two groups of postoperative SNOT-20 scores (physiological problems,limitations and affective outcomes)treatment were lower than those before,and the obeservation group decreased significantly than that of the control group (P <0.05,P <0.01).Con-clusion Endoscopic sinus surgery combined with postoperative nasal irrigation can effectively alleviate the symptoms and improve the prog-nosis in the treatment of allergic fungal sinusitis.

Objective To study the effect of behavioral therapy combined with Paroxetine in the treatment of overactive bladder accompanied by depression and anxiety.Methods Over the past two years,a total of 69 cases of patients with overactive bladder accompanied by depression and anxiety were diagnosed by outpatient,they were divided into experimental group (n=33)and control group(n=36).The experimental group were given behavior therapy and Paroxetine in the treatment of anxiety,depression,while the control group were given behavior therapy.Then the overactive bladder symptom score(OABSS),urgency score,SDS,SAS score before and after treatment of the two groups of patients were statistically analyzed.Results (1)The OABSS score ((3.30± 1.01) vs (7.51 ± 0.69)),urgency score((2.60±0.51) vs (3.93±0.69)),SDS score((43.1±6.2) vs (66.4±4.7)) and SAS score ((41.9±0.6) vs (61.4±3.9)) decreased after treatment of the experimental group.There were statistically significant compared with before treatment(t=17.8773,8.9045,17.2039,16.0273,all P＜0.01).(2) The OABSS score,urgency score decreased after treatment of the control group.There were statistically significant compared with before treatment (t=6.1926,6.3483;both P＜0.01).SDS,SAS score before and after treatment of the control group were not statistically significant (t=1.3105,0.5852,bothP＞0.05) (3) The OABSS score,urgency score,of the experimental group were more depressed than the control group,which were statistically significant (t =3.3830,3.6391,both P＜0.01).Conclusion For overactive bladder patients with anxiety and depression,behavioral therapy combined with Paroxetine is better than behavioral therapy alone.