Objective:To investigate the complex Calculus Bovis-target-keratitis network and to explore the molecular mechanism of Calculus Bovis treating keratitis through network pharmacology. Methods:Genes related to keratitis were searched in the online DisGeNET database and the protein-protein interaction (PPI) network of keratitis-associated proteins was constructed.The components isolated and identified in Calculus Bovis were collected through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP, https: //tcmsp-e.com/tcmsp.php), Chemistry Database by Shanghai Institute of Organic Chemistry of CAS (http: //www.organchem.csdb.cn), and published literature.The canonical SMILES information of the collected components was exported, which were submitted to the SwissTargetPrediction platform to predict potential targets of the components.The active component-predicted target network of Calculus Bovis was constructed and merged with the PPI network of keratitis-associated proteins to build the active component-potential target network of Calculus Bovis and systemically investigate the potential targets and signal pathways of Calculus Bovis in treatment of keratitis.The component-target-pathway network was established to analyze the mechanism of Calculus Bovis treating keratitis. Results:Thirty-nine components isolated and identified in Calculus Bovis were searched and 65 target genes related to keratitis were screened.Of the 28 potential targets involved in Calculus Bovis treating keratitis, there were 7 direct targets, including tumor necrosis factor, caspase 1, Toll-like receptor 9, C-X-C motif chemokine ligand 8, interleukin-6, mitogen-activated protein kinase 8, neurotrophic receptor tyrosine kinase 1.The 28 potential targets were annotated to 12 entries for biological process, 18 for cellular components and 13 for molecular function.In the Kyoto encyclopedia of genes and genomes pathway enrichment analysis, 10 signal pathways were identified as enriched categories, which were mainly related to human cytomegalovirus infection, amoebiasis, antifolate resistance, PI3K-Akt signaling pathway, rheumatoid arthritis, apoptosis, cytokine-cytokine receptor interaction, malaria, non-alcoholic fatty liver disease, interleukin-17 signaling pathway. Conclusions:Calculus Bovis may play an adjuvant therapeutic effect on keratitis through anti-inflammatory, antibacterial, antiviral, immune regulation, inflammatory regulation and other functions.

Objective:To prepare water-soluble graphene-based itraconazole antifungal eye drops and evaluate its antifungal activity against Fusarium solani. Methods:By oxidative modification of graphene and modification of polymer materials, water-soluble graphene oxide-modified polyethylene glycol (GO-PEG) composites were prepared.The composites were characterized by scanning electron microscopy, zeta potential, and Raman spectroscopy.The antifungal drug itraconazole was loaded onto the GO-PEG vector by solvent evaporation method, and itraconazole eye drops were obtained.The drug loading of itraconazole eye drops was measured using a UV and visible spectrophotometer.The antifungal effect in vitro was assessed by the microdilution method and light microscopy. Results:Scanning electron microscopy showed that GO-PEG had a two-dimensional nanosheet structure and many wrinkles.The zeta potential of GO-PEG was -42.40 mV.Raman spectroscopy showed that the ID/ IG of GO-PEG was 1.003.Using the water-soluble GO-PEG vector, a maximum itraconazole concentration of 10 mg/ml was achieved with a 10 000-fold increase in apparent solubility (10 mg/ml vs 0.001 mg/ml). The antifungal results showed that the minimum inhibitory concentration of itraconazole eye drops against Fusarium solani was approximately 1.88 μg/ml, but the GO-PEG vector has no significant antifungal activity against Fusarium solani. Conclusions:GO-PEG achieves effective loading and solubilization of itraconazole, demonstrating an in vitro inhibitory effect on Fusarium solani.

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective: To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe. Methods: A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level. Results: All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones. Conclusions Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment.

The embedded subject service model in ubiquitous knowledge environments has gradually become an important means to deepen library service and promote its reform.The embedded subject services, established service system, its assessment and its support mechanisms were described, the embedded subject service model of medical library for affiliated hospitals in ubiquitous knowledge environments was elaborated in order to pave the way for improving the future service in college and university library.

Objective: To assess the therapeutic effect of management for lymphatic malformation(LM)in infants. Methods: This retrospective study recruited clinical data of 996 patients with LM from June 2004 to July 2015 in our center. All patients were diagnosed as LM after ultrasound, CT or MR scan. All patients were divided into Group 1 (427 patients, treated by endoscopic LM partial resection combined with cautery and postoperative intratumoral negative pressure and absolute ethyl alcohol), Group 2(239 patients, treated by combined pinyangmycin and dexamethasone injection), Group 3 (330 patients, treated by surgical resection only). The clinical effects were observed in three groups, and therapeutic effect differences in gender, age, maximum diameter, location, range, histological typing, lymph property and treatments were analysed in cervicofacial LM. Results: Group 1: 333 patients were cured (78.0%), Group 2: 165 patients were cured(69.0%), Group 3: 238 patients were cured (72.1% ). The difference in cure rate between Group 1 and Group 2 or between Group 1 and Group 3 was significant(P<0.05). The number of patients with ≥2 treatments in Group 3 was significantly less than that in other two groups. The cure rate of LM in cervicofacial area was significantly lower than that in other parts of body (P<0.05). In cervicofacial LM patients, the therapeutic effect differences in maximum diameter, range, histological typing, lymph property were statistically significant (P<0.05). At the multivariable logistic regression analysis, LM range as well as histological typing were independent factors influencing the therapeutic effect (P<0.05). Conclusions Both treatment of endoscopic LM partial resection combined with cautery and postoperative intratumoral negative pressure and absolute ethyl alcohol, and surgical resection have good therapeutic effect on LM in infants. LM range as well as histological typing are important factors independently influencing the therapeutic effect of cervicofacial LM in infants.

A blended readers training model which combines online training (micro-lecture, online class, etc) with traditional training ( face to face teaching plus computer training) was proposed according to the theories in re-lation with blended learning, and scientific strategies for interaction of readers were established, which include the 5 dimensions ( demand, object, content, resource and evaluation) in order to integrate online learning resources and traditional offline training, optimize the allocation of training resources, and improve the training efficiency.