Taking into consideration the characteristics and current development status of air medical rescue,an analysis is conducted from the perspective of hospitals to examine the focal points and challenges in establishing the capability of hospital air medical rescue.A capability framework comprising five modules,namely planning system,service model,professional teams,hardware platform,and operational procedures,is proposed.The key tasks for each module are sorted out.Furthermore,the ex-ploration and practical experience of The First Affiliated Hospital of Sun Yat-sen University are shared,with the aim of providing a reference for the construction of hospital air medical rescue capabilities in the modern era.

Objective:To investigate the clinical effect of Ilizarov technique of tibial bone transverse transport combined with flap transfer in the treatment of severe diabetic foot.Methods:From April 2016 to March 2020, 7 patients with severe diabetic foot were treated by Ilizarov technique of tibial bone transverse transport combined with flap transfer in the Department of Hand and Foot Surgery of Foshan Nanhai Public Health Hospital. Diabetes Wagner classification: 2 cases were in Grade 3, in which, 1 case was ulcer in right heel and deep plantar with abscess and infection, and 1 case was ulcer in left great toe and phalanx infection; Other 5 cases were in Grade 4, of them, 2 cases were gangrene in proximal and distal of left great toe, 1 case were gangrene and infection in proximal, middle and distal segment of right 2nd toe, 1 case were gangrene and infection in proximal, middle and distal segment of left 4th toe, and 1 case were gangrene in distal segment of left 4th toe. Wound area was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Sural neurouascular flaps were used in 1 case, dorsal plantar artery flaps in 4 cases and medial plantar artery flaps in 2 cases. Size of flap was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Follow-up was conducted regularly by outpatient clinic, telephone and WeChat interviews. Content of the follow-up included foot wound healing, skin temperature of dorsal foot, lower limb paralysis, puncture exudation of external fixation stent, and blood supply of calf skin. Foot function was assessed according to the American Orthopedic Foot and Ankle Association (AOFAS) score.Results:All 7 patients entered the follow-up for 6-28 months, with an average of 8.2 months. All the foot ulcers healed. The pain of affected limbs eased off in 5 patients, and 2 patients had significant pain relief in affected limbs. Foot paralysis significantly alleviated in 7 patients, with calf skin temperature increased (1.81±0.56) ℃, and no recurrence of foot ulcers. According to AOFAS score, 3 cases were excellent, 3 cases were good and 1 case was fair.Conclusion:Ilizarov technique of tibial bone transverse transposition combined with flap transfer in the treatment of severe diabetic foot has a good clinical effect and it could be an option in the treatment of diabetic foot.

Objective: To explore effects of dendritic epidermal T cells (DETCs) and Vγ4 T lymphocytes on proliferation and differentiation of mice epidermal cells and the effects in wound healing of mice. Methods: (1) Six C57BL/6 male mice aged 8 weeks were collected and divided into control group and wound group according to random number table (the same grouping method below), with 3 mice in each group. A 4 cm long straight excision with full-thickness skin defect was cut on back of each mouse in wound group, while mice in control group received no treatment. On post injury day (PID) 3, mice in 2 groups were sacrificed, and skin within 5 mm from the wound margin on back of mice in wound group and normal skin on corresponding part of mice in control group were collected to make single cell suspensions. The percentage of Vγ4 T lymphocyte expressing interleukin-17A (IL-17A) and percentage of DETCs expressing insulin-like growth factor Ⅰ (IGF-Ⅰ) were detected by flow cytometer. (2) Ten C57BL/6 male mice aged 8 weeks were collected and divided into control group and Vγ4 T lymphocyte depletion group with 5 mice in each group. Mice in Vγ4 T lymphocyte depletion group were injected with 200 g Vγ4 T lymphocyte monoclonal neutralizing antibody of Armenian hamster anti-mouse intraperitoneally, and mice in control group were injected with the same amount of Armenian hamster Ig intraperitoneally. One hole with full-thickness skin defect was made on each side of spine of back of each mice. The wound healing was observed on PID 1-8, and percentage of remaining wound area was calculated. (3) Six C57BL/6 male mice aged 8 weeks were grouped and treated in the same way as in experiment (2), with 3 mice in each group. On PID 3, expressions of IL-17A and IGF-Ⅰ in epidermis on margin of wound were detected with Western blotting. (4) Thirty C57BL/6 male mice aged 3 days were sacrificed, and epidermal cells were extracted. The keratin 14 positive cell rate was examined by flow cytometer (the same detecting method below). (5) Another batch of mouse epidermal cells were collected and divided into control group, IGF-Ⅰ group, and IL-17A group, with 3 wells in each group (the same well number below). Cells in IGF-Ⅰ group and IL-17A group were added with 1 mL recombinant mouse IGF-Ⅰ and IL-17A with final mass concentration of 100 ng/mL respectively, while cells in control group were added with the same amount of sterile phosphate buffered saline (PBS). On post culture day (PCD) 5, keratin 14 negative cell rate was examined. Another batch of mouse epidermal cells were collected, grouped, and treated in the same way as aforementioned experiment, and keratin 10 positive cell rate was examined on PCD 10. (6) Another batch of mouse epidermal cells were collected and added with 4 mmol/L 5(6)-carboxyfluorescein diacetate N-succinimidyl ester (CFSE) solution, and divided into control 0 d group, control 7 d group, IGF-Ⅰ group, and IL-17A group. Cells in IGF-Ⅰ group and IL-17A group were treated in the same way as the corresponding groups in experiment (5), and cells in control 0 d group and control 7 d group were treated in the same way as the control group in experiment (5). The CFSE fluorescence peaks were examined on PCD 0 of control 0 d group and PCD 7 of the other 3 groups. (7) Another batch of mouse epidermal cells were collected and divided into control group and IGF-Ⅰ group. Cells in IGF-Ⅰ group were added with 1 mL recombinant mouse IGF-Ⅰ with final mass concentration of 100 ng/mL, and cells in control group were added with the same amount of sterile PBS. On PCD 5, cells were underwent keratin 14 staining and CFSE staining as aforementioned, and keratin 14 negative cell rate of CFSE positive cells was examined. Another batch of mouse epidermal cells were collected and divided into control group and IL-17A group. Cells in IL-17A group were added with 1 mL recombinant mouse IL-17A with final mass concentration of 100 ng/mL, and cells in control group were added with the same amount of sterile PBS. On PCD 5, keratin 14 negative cell rate of CFSE positive cells was examined. Data were processed with one-way analysis of variance and t test. Results: (1) On PID 3, percentage of DETC expressing IGF-Ⅰ in normal epidermis of control group was (9.9±0.8)%, significantly lower than (19.0±0.6)% of epidermis around margin of wound group (t=8.70, P<0.01); percentage of Vγ4 T lymphocyte expressing IL-17A in normal epidermis of control group was (0.123±0.024)%, significantly lower than (8.967±0.406)% of epidermis around margin of wound group (t=21.77, P<0.01). (2) On PID 1-4, there was obvious inflammatory reaction around wounds of mice in control group, and on PID 5-8, the wound area was still large. On PID 1-4, there was slight inflammatory reaction around wounds of mice in Vγ4 T lymphocyte depletion group, and on PID 5-8, the wound area was significantly reduced. On PID 3-7, percentages of residual wound area in Vγ4 T lymphocyte depletion group were significantly lower than those in control group (t=5.92, 5.74, 7.17, 5.38, 5.57, P<0.01), while percentages of residual wound area in two groups on PID 1, 2, 6 were similar (t=1.46, 3.17, 3.10, P>0.05). (3) On PID 3, compared with those in control group, expression of IL-17A and IGF-Ⅰ in epidermis around wound margin of mice in Vγ4 T lymphocyte depletion group was markedly decreased and increased respectively (t=8.47, 19.24, P<0.01). (4) The keratin 14 positive cell rate of mouse epidermal cells was 94.7%. (5) On PCD 5, the keratin 14 negative cell rate of mice in control group was markedly higher than that of IGF-Ⅰ group, while significantly lower than that of IL-17A group (t=7.25, 5.64, P<0.01). On PCD 10, the keratin 10 positive cell rate of mice in control group was significantly higher than that of IGF-Ⅰ group, while significantly lower than that of IL-17A group (t=3.99, 10.82, P<0.05 or P<0.01). (6) Compared with that of control 0 d group, CFSE fluorescence peaks of mouse epidermal cells in control 7 d group, IGF-Ⅰ group, and IL-17A group on PCD 7 shifted to the left. Compared with that of control 7 d group, CFSE fluorescence peaks of mouse epidermal cells in IGF-Ⅰ group and IL-17A group on PCD 7 shifted to the left. (7) On PCD 5, keratin 14 negative cell rate of CFSE positive cells of mice in control group was significantly higher than that in IGF-Ⅰ group (t=9.91, P<0.01), and keratin 14 negative cell rate of CFSE positive cells of mice in control group was markedly lower than that in IL-17A group (t=6.49, P<0.01). Conclusions In the process of wound healing, IGF-Ⅰ secreted by DETC can promote the proliferation of mouse keratin 14 positive epidermal cells and inhibit their terminal differentiation, while IL-17A secreted by Vγ4 T lymphocyte can promote the proliferation and terminal differentiation of mouse keratin 14 positive epidermal cells, thus both IGF-Ⅰ and IL-17A can affect wound healing.

Objective: To investigate the value of next-generation sequencing (NGS) technology in the prognosis monitoring and treatment guidance for molecular minimal residual disease (MRD) in acute myeloid leukemia (AML) patients with complete remission (CR). Methods: The clinical data of 68 AML (non-acute promyelocytic leukemia) patients who received gene mutation spectrum by using NGS technology at initial diagnosis and in CR phase in Tangdu Hospital of Air Force Military Medical University from January 2016 to July 2018 were retrospectively analyzed. The recurrence and survival of both molecular MRD positive group and negative group were analyzed and compared, and the value of NGS technology and multiparameter flow cytometry (MFC) were also analyzed in MRD monitoring. Results: There were 39 males (57.4%) and 29 females (42.6%) in 68 patients, and the median age was 52 years old (8-82 years old). Molecular MRD positive group included 38 patients, while negative group included 30 patients. Residual mutation gene type in CR phase was most frequently detected in epigenetic regulator gene mutations, such as ASXL1, TET2, DNMT3A and IDH1/IDH2. Statistical analysis showed that the 2-year cumulative recurrence rate (CIR) in the molecular MRD positive group was higher than that in the molecular MRD negative group (86.8% vs. 51.3%; χ² = 9.249, P = 0.002); the 2-year relapse-free survival (RFS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (13.2% vs. 48.7%; χ² = 9.249, P = 0.002); the 2-year overall survival (OS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (58.0% vs. 100%; χ² = 4.122, P = 0.042). Up to follow-up date, 3 patients with molecular MRD positive and 1 patient with molecular MRD negative who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) were still in disease-free survival. The results of monitoring MRD showed high consistency (76.7%, 33/43) in NGS and MFC. Compared with the other groups, the patients with both positive NGS and MFC had a higher relapse rate, and the difference was statistically significantly (P < 0.05). Conclusions Molecular MRD of AML patients is detected by using NGS technology, which could be used to predict the relapse and survival, suggesting that molecular MRD may guide post-remission treatment regimens and the determination of allo-HSCT indications.

Objective To explore the effect of micro-lectures withadvanced simulation man in improving the practical skills teaching of nursing students, so as to promote the students' post competency. Methods Totally the 186 nursing internswere divided into control group and observation group by random number method with 93 people in each group. The control group used the traditional teaching modein the teaching of practical skills.The observation group used the micro-lectures with high simulation teaching.Comparing the two groups of nursing students comprehensive assessment test simulation results in the theory, skills, scenarios, and nursing students the evaluation of the curriculum. Results The scores of the two groups were all above the qualification line, but the scores of the observation group were significantly higher than those of the control group (P<0.05). The theoretical examinations and the situation simulation comprehensive testswas(77.89 ± 7.79), (75.60 ± 7.92)points in control group, and (93.87 ± 3.90),(92.87 ± 4.08)points in observation group, there was significant difference between two groups (t=17.67, 18.70,all P=0.000). The curriculum evaluation results of improving learning initiative, active curriculum atmosphere, clear operation demonstration, exercise clinical thinking, improve the clinical interest were 81.72％(76/93), 72.04％(67/93), 93.55％(87/93), 60.22％(56/93), 67.74％(63/93)in control group, and 96.77％(90/93), 95.70％(89/93), 100.00％(93/93), 92.47％(86/93), 98.92％(92/93)in observation group, there was significant difference between two groups(χ2=20.39, P=0.016).Conclusions The effect is significant of micro-lectures combined with high simulation of human using in clinical skills teaching. Thismold can conducive to the cultivation of clinical thinking of nursing students, and improve clinical comprehensive ability, and promote the promotion of nursing students post competency.

Objective To investigate the expression of long-chain non-coding RNA gastric cancer high expression transcription factor 1 (GHET1) in hepatocellular carcinoma (HCC) and the correlation with prognosis,cell proliferation,migration and invasion.Methods 20 HCC patients who underwent surgery from Fuzhou General Hospital of Chinese People's Liberation Army from March to May 2016 were included.The HCC tissue and adjacent normal tissue of 182 patients from June 2012 to December 2013 were retrospectively collected.According to the median value of GHET1 expression,it was divided into GHET1 high expression group and low expression group,91 cases each.Huh7 and HepG2 cells were divided into:blank control group (Con) with serum-free medium,siRNA-GHET1 group transfected with siRNA-GHET1,and negative control group (siRNA-NC) transfected with negative control sequence.The expression of GHET1 was detected by real-time fluorescence quantitative polymerase chain reaction,and the effect of GHET1 on HCC cells was analyzed by CCK-8,Transwell assay and Western blot.Results Compared with adjacent normal tissue,the relative expression of GHET1 mRNA in HCC tissues was significantly increased.Compared with LO2 cells,the mRNA expression of GHET1 in Huh7 and HepG2 cells was higher (P＜0.05).The GHET1 high expression group had tumor＞5 cm,vascular invasion,AFP＞400 μg/L,Edmonson grade Ⅰ,and the tumor-free ratio was lower in the expression group (P＜0.05).Survival analysis showed that HCC patients with high GHET1 expression had a poorer prognosis than patients with low expression.Multivariate Cox regression analysis showed that high expressed GHET1,vascular invasion (HR=2.067,95％ CI:1.350 to 3.162),and without tumor capsule are independent predictors of recurrence in HCC patients.After transfection with Huh7 and HepG2 cells,the proliferation of siRNA-GHET1 group was significantly decreased comparing with Con and siRNA-NC groups.Compared with siRNA-NC group,the migration and invasion ability of siRNA-GHET1 group decreased,and E-cadherin expression increased.The expression of fibronectin and vimentin decreased,and the difference was statistically significant (P＜0.05).Conclusions The expression of GHET1 in HCC tissue is higher comparing with normal tissue,which increases the proliferation,migration and invasion of hepatoma cells.It is an independent predictor of prognosis in HCC patients and a potential target for clinical treatment.

Objective To explore a one-time repairing method for defects in palmar skin soft tissue, proper palmar nerves and arteries, and flexor tendon.Methods From March 2011 to June 2016, the defects in palamar skin, nerves, blood vessels or flexor tendons of 21 fingers in 20 cases were repaired by using the resected superficial veins and tendons and nerves of skin soft tissue on axes of indicis proprius tendon (extensor digiti quinti) or forearm-palmaris longus tendon or foot back short tendons of the first or second toes were cut according to the defects in palmar skin soft tissue, nerves, blood vessels and flexor tendon, Results All the vein flaps of the 20 cases were survived.The patients were followed up for 6 to 24 months.Both the shape and function of the fingers recovered well.The flaps were of good quality, with no obvious pigmentation, and good at sensations (The sensation between two points were 9 mm on average).Conclusion It was a simpler and more convenient way to repair defects in palmar skin soft tissue, nerves, blood vessels and flexor tendons using free venous flap with tendons and nerves for transplantation.It also ensures the blood-supply without sacrificing the main vessels, and thus it is an ideal method for repairing simultaneous defects in skin soft tissue, nerves and flexor tendon.

To study the anticoagulant effect of Xiang-Qi-Tang (XQT),the mice model of endotoxemia was established to detect the expression of coagulation factors and their regulatory proteins in serum and aorta.The results showed that XQT could decrease the expression of TF and increase the expression of tPA in the aorta of mice with endotoxemia,and also decrease the expression of sEPCR in the serum.We further found that XQT caused the decrease of sEPCR through the regulation of PKC δ and ADAM17 to contribute the anticoagulation in mice.This study may provide a new strategy for treating endotoxin-induced disease and provide evidences for further researching the pharmacological action of XQT.

Objective To explore the effects of H 2 S on neuronal injuries induced by oxygen glucose deprivation /reoxygenation ( OGD/R) in cortical neurons .Methods For OGD, the primary cultured cortical neurons were incubated with glucose-free EBSS media for 4h in N2/CO2/O2 (93%/5%/2%) atmosphere.Thereafter, the media were replaced by Neurobasal/B27 culture media and the neurons were incubated for 12 h in a 5%CO2 incubator at 37℃.NaHS was used as a H2S donor and cell survival rate was determined by cell counting kit 8(CCk-8).[Ca2+]i was determined using fura-2/AM and fluorescence microscopic imaging systems .The release rate of lactate dehydrogenase ( LDH) was determined by lactate dehydrogenase assay kit , and cell damage was analyzed by staining of propidium iodide ( PI ) .Results After pretreated with 200, 300 and 600μmol/L sodium hydrosulfide ( NaHS) for 30min before OGD/R, the cell survival rate of neurons significantly increased (n=4).[Ca2+]I(n=5), LDH release rate (n=4) and cell damage percentage (n=6) in the neuron pretreated with 300 μM NaHS were significantly lower than those in ODG/R cells.Treatment with 10μmol/L calcium chelator BAPTA also reduced the LDH release rate and cell damage percentage induced by ODG /R in neurons . Conclusion The results indicate that H 2 S may inhibit the OGD/R induced damage in cortical neurons via reducing calcium overload of neurons .

Inflammation and immune response are the key parts in pathophysiological processes of cerebral ischemia.CD4+ T cells play an important role in it.This article reviews the roles and mechanisms of each subtype of CD4+ T cells in cerebral ischemia in order to provide the basis for the treatment of cerebral ischemia with CD4 + T cells as targets.