Volume 97  ·  Issue 06  ·  2017

In the process of human society, public events such as sudden accidents and disasters, social security and natural disasters always exist. Since the 1990s, with the rapid development of China's economy and society, accidents and disasters such as fire and explosion have occurred from time to time, resulting in a large number of casualties^[1,2,3,4]。 The characteristics of disastrous group or mass burns (MBCD) also show certain changes: the number of wounded is large, often accompanied by combined injuries such as inhalation injury and impact injury and poisoning, and the overall injury is serious; The early treatment time is tight and the task is heavy. From on-site first aid, transportation to early treatment, a lot of manpower, material resources, command and coordination are required; The incidence of complications such as shock and infection is high and severe, and the condition is complicated and the treatment is difficult. The disaster scene is difficult to approach, the early rescue force is insufficient, and the rescue facilities are damaged; The social impact is huge^[1,5,6,7]。 The treatment of MBCD needs the support of national and local medical and health rescue system for public emergencies, which is both a medical problem and a social problem. This paper analyzes and summarizes the experience and lessons of MBCD treatment at home and abroad in recent years, and discusses the relevant problems in several key links of early treatment, in order to provide reference for improving the emergency treatment ability and treatment level of MBCD.

Ptosis is a common clinical disease, which not only affects the appearance of patients, but also causes adverse effects on the visual function^[1,2]。 At present, there are many examination methods and detection indexes for ptosis^[3]Many doctors are unclear about the significance and methods of some examinations and tests, and they often do not conduct relevant examinations and tests before surgery; In addition, there are many surgical methods related to ptosis. Since the first report of simple skin resection to correct ptosis, dozens of methods including levator muscle-related surgery, frontal muscle-related surgery and Müller muscle-related surgery have been reported by domestic and foreign scholars to correct ptosis^{[4,5,6,7,8,9,10,11,12,13,14,15,16,17]}。 Faced with numerous surgical options, clinicians are often caught in the dilemma of choosing, and the indications of surgery are not accurate, resulting in unsatisfactory surgical results and high complication rate^{[18,19,20,21,22]}。 In recent years, China's plastic surgery market has developed rapidly, and many new diagnosis and treatment methods have emerged constantly, but there are also many problems such as irregular diagnosis and treatment. In order to solve these problems, this consensus was finally formulated after seven rounds of discussion and revision by experts from major ophthalmoplastic surgery centers in China under the organization of the Ophthalmoplastic Professional Committee of the Aesthetic and Plastic Surgeon Branch of Chinese Medical Doctors Association.

To detect the methylation status of DLC-1 gene in the patients with myelodysplastic syndrome(MDS), the effect of abnormal methylation of DLC-1 gene on the expression of DLC-1 gene, the clinical significance of methylation of DLC-1 gene in MDS patients, and the effect of decitabine on DLC-1 gene expression.

A total of 43 MDS patients were treated in Fujian Medical University Union Hospital from 2013 to 2015. Methylation status of DLC-1 gene in MDS patients were detected by the methylation specific PCR(MSP). The expression of DLC-1 gene mRNA was determined with real-time fluorescence quantitative PCR(RTFQ-PCR). MDS patients were divided into 5 groups (very low-risk, low-risk, intermediate-risk, high-risk and very high-risk, n=0, 8, 7, 18, 10) according to WPSS classification. And the clinical significance of methylation of DLC-1 gene in patients with MDS were investigated. In order to investigate the change in gene methylation and expression of DLC-1 gene after treatment with decitabine, methylation statuses of DLC-1 gene in MDS patients before and after be treated with decitabine were detected by the bisulfite sequencing PCR(BSP). The expressions of DLC-1 gene mRNA of these patients were determined with RTFQ-PCR.

Hypermethylation of CpG island of DLC-1 gene was observed in 55.16%(22/43)MDS patients. The expressions of DLC-1 gene mRNA in methylation positive patients were significantly lower than that in methylation negative patients (0.32±0.06 vs 0.91±0.11)(P=0.008). For MDS patients, the DLC-1 methylation rate of intermediate-and high-risk patient was 21/35, which was significantly higher than that of low-risk patient(1/8, P=0.006). The methylation status of DLC-1 gene were monitored in 8 patients before and after treatment with the decitabine (decitabine 20 mg/m^2, d1-d5/d28, more than 4 courses) , the methylation rate of DLC-1 gene dropped from 57.50%±5.11% to 14.13%±2.07% after treatment(P=0.010). The expression of DLC-1 gene increased after treatment with decitabine(0.67±0.08 vs 0.28±0.06, P=0.015).

Methylation of DLC-1 gene is common in MDS patients and may be associated with poor prognosis. Decitabine may activate the expression of DLC-1 gene by demethylation, which may be one of the mechanisms for the treatment of patients with MDS.

To detect the subtle variant of survival motor neuron gene 1(SMN1) by Sanger sequencing, and to assess the value of Sanger sequencing for the diagnosis of spinal muscular atrophy(SMA) with compound heterozygous mutation of SMN1.

Fifty-two patients suspected SMA were recruited by the Capital Institute of Pediatrics from Jan.2014 to June.2016. PCR was used for amplifying exon7 of SMN1 and SMN2 in 52 patients. Natural different base peaks on the sequencing chromatogram in the SMN1 and SMN2 within the amplified segments were identified with Sanger DNA sequencing to detect the homozygous deletion or heterozygous deletion of SMN1. Then we screened the SMN1 subtle variants in heterozygous deletion patients by genomic Sanger sequencing for the other SMN exons. At last, multiplex ligation-dependent probe amplification(MLPA) was carried out to confirm the results of SMN1 heterozygous deletion, and T-A cloning confirmed the subtle variants were located in SMN1.

Forty-seven of 52 cases were homozygous deletion of SMN1, while 5 cases were heterozygous deletion which were confirmed by MLPA.Then, by genomic and T-A cloning sequencing, five SMN1 subtle mutations were separately identified in 5 cases of heterozygous deletion.

Sanger sequencing is an effective method for the clinical diagnosis of compound heterozygous mutation of SMN1, and is meaningful for improving genetic diagnosis rate of SMA.

To explore the correlation between polymorphism of the angiotensin-converting enzyme (ACE) gene and lower extremity atherosclerosis (LEA) in type 2 diabetes mellitus (T2DM) patients.

A total of 380 patients diagnosed with T2DM in Department of Endocrinology from June 2015 to March 2016 were enrolled and divided into two groups: group A had no LEA (n=120) and group B had LEA(n=260). Color doppler ultrasound was used to detect the vascular lesions of the patients. For all patients in groups A and B, the polymerase chain reaction (PCR) was applied to determined the insertion/deletion polymorphism in intron 16 of the ACE gene of the patients. Then the blood pressure, blood lipid, glycated hemoglobin, and renal function were measured. Furthermore, the measured data was compared between the two groups. Multivariate logistic regression analysis was used to analyze the independent risk factors for LEA.

There was no significant statistical difference in age, sex, smoking and disease course between the two groups. The frequencies of DD genotype and D allele in the ACE gene of group B were much higher than those in group A. More specifically, DD genotype frequency was 18.8% in group B and 9.2% in group A, D allele frequency was 36.8% in group B and 29.2% in group A (all P<0.05). Multivariate logistic regression analysis showed that DD genotype in ACE gene (OR=2.744, 95% CI: 1.326-5.682), systolic blood pressure (OR=1.725, 95% CI: 1.072-2.778), total cholesterol (OR=3.785, 95% CI: 1.796-7.978), and glycated hemoglobin (OR=2.612, 95% CI: 1.602-4.258) were risk factors for LEA in T2DM patients.

ACE gene insertion/deletion polymorphism was associated with the incidence of LEA in T2DM patients. DD genotype of the ACE gene may be a genetic risk factor for T2DM patients with concurrent atherosclerosis.

To observe the intraoperative influences on pharmacodynamics of rocuronium in children inhaling sevoflurane and desflurane for 40 min balance.

Ninety children (ASAⅠ-Ⅱ) undergoing elective surgery with general anesthesia in Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University from July 2015 to May 2016 were randomly assigned into six groups ( n=15): Sevoflurane group (group S1 and S2), Desflurane group (group D1 and D2) and Propofol group (group P1 and P2). Children in group D1, S1 and P1 were allocated to research the dose-effect relationship of rocuronium, children in group D2, S2 and P2 were allocated to research the time-effect relationship of rocuronium. TOF-Watch SX monitor was used to exert a train-of-four stimulation (TOF) at ulnar nerve in wrist, then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T₁, T₂, T₃ and T₄ respectively. After the success of the muscle relaxant calibration, 1.3 MAC sevoflurane and desflurane were inhaled and maintained for 40 min respectively in children in Sevoflurane group (group S1 and S2) and Desflurane group (group D1 and D2), Plasma target controlled infusion of 3.5-4.0 μg/ml propofol was always administered in Propofol group (group P1 and P2). 75 μg/kg rocuronium was injected each time in group S1, D1 and P1 respectively. Maximum inhibited effect of T ₁ was recorded after every injection until inhibition of T₁ more than 95% eventually. The method of cumulative dose four times was used to calculate the efficiency curve of rocuronium[median effective dose (ED₅₀), 90% effective dose (ED₉₀) and 95% effective dose (ED₉₅)]. 0.6 mg/kg rocuronium was injected respectively through vein in group S2, D2 and P2. The recovery times of muscle relaxant were recorded which including time of T₁ disappeared (onset time), T₁ from 0% to 5% (peak effect time), T₁ from 0% to 25% (clinical effect time), T₁ from 25% to 75% (recovery index), T₁ from 0% to 70% (internal effect time), T₄/T₁ (TOFr) from 0% to 70% and 90%.

ED₅₀, ED₉₀ and ED₉₅ in group D1 were 128.73, 212.45 and 245.78 μg/kg respectively. ED ₅₀, ED₉₀ and ED₉₅ in group S1 were 132.46, 218.94 and 252.30 μg/kg respectively. ED ₅₀, ED₉₀ and ED₉₅ in group P1 were 230.56, 381.02 and 439.55 μg/kg respectively. ED ₅₀, ED₉₀ and ED₉₅ in group D1 and S1 were significantly lower than those in group P1 (all P<0.05), but there was no significant difference between D1 and S1 group (P>0.05). Compared with group P2, the shorter onset time, the longer peak effect time and clinical effect time was observed in group D2 and S2, the longer recovery index, internal effect time and TOFr from 0% to 70% and 90% was observed in group S2 (allP<0.01).

1.3 MAC sevoflurane and desflurane inhaling for 40 min significantly reduces ED₅₀ and ED₉₅ of rocuronium, prolongs the onset time and action time of rocuronium in children. Sevoflurane can significantly prolong the recovery characteristics of rocuronium.

To evaluate whether brachial artery peak velocity variation(ΔVp) during a Valsalva maneuver(VM) could predict fluid responsiveness in spontaneously breathing patients.

Ninety-six patients required radial artery catheter for elective surgery of Ningbo Yinzhou People's Hospital from December 2014 to June 2016 were enrolled. The brachial artery Doppler signal was recorded to measure the ΔVp while the VM was performed.Then doing the volume expansion (VE) , the cardiac output variation (ΔCO) before and after VE were measured.Pearson correlational analyses were conducted between ΔVp and ΔCO. Also the sensitivity and specificity of ΔVp were determined in predicting fluid responsiveness by the receiver operating characteristic (ROC) curve.

Patients were classified as group responders (n=24) and group non-responders (n=72). Responder was defined as cardiac output increased≥15% after VE.The ΔVp correlated well with ΔCO ( r=0.792, P<0.01). The area under ROC curve was 0.903, with the ΔVp cut-off of 33%, the sensitivity of 87% and the specificity of 82%(P<0.01).

Brachial artery peak velocity variation during a valsalva maneuver is a feasible method for predicting fluid responsiveness in spontaneously breathing patients

To study the effect and its mechanism of recombinant human bone morphogenetic protein 7 (rhBMP-7) on urethral keloid fibroblast.

Urethral fibroblasts were extracted and cultured, and the fourth-generation fibroblasts were used for experiment. Urethral fibroblasts were treated with rhBMP-7. Proliferation rate was detected by CCK-8 method. RT-PCR was applied to test changes of mRNA in α smooth muscle actin (α-SMA) and type Ⅰ collagen protein (COL-1) of each group. Western blot was used to measure α-SMA protein expression and the effect of rhBMP-7 on signaling pathway of urethral keloid fibroblasts.

With the increase of rhBMP-7 concentrations, the proliferation rate of urethral keloid fibroblast was generally decreased. Cells kept proliferating with time at the same concentration of rhBMP-7. mRNA level of COL-1 and α-SMA in rhBMP-7-treated (>20 ng/ml) urethral keloid fibroblasts was greatly reduced with statistical significance ( P<0.05) and dose dependency. It was found rhBMP-7 inhibited the overexpression of p-smad2/3 and α-SMA mediated by transforming growth factor beta 1 (TGF-β₁) signaling pathway.

rhBMP-7 could adjust TGF-β₁ signaling pathway to inhibit gene expression of COL-1 and a-SMA in urethral keloid fibroblast, which provided evidences for further animal experiments or clinical trials.

To explore the technical advantages of artery approach in lymph node sortingofrectal cancer.

Sixty patients with rectal cancer who treated in general surgery department of Henan provincial tumor hospitalfrom July 2015 to January 2016 were enrolled. Patientswere divided into two groupsrandomly.Lymph node sorting methods of control group andobservation group were the traditional method and the artery approach method respectively. The total number of lymph nodes, the average inspection number, the patients number of lymph nodes less than 12, the number of positive lymph nodes, the metastasis rate of the patients, the number of average diameter less than 5 mm, the number of the positive lymph nodes which average diameter less than 5 mm, the sorting time of lymph nodes, the total number of every stationand other indicators were collected and compared.

There wasa significant difference between the observation group and the control groupin the total number(553 vs 395, P<0.05), the number of positive ones(96 vs 54,P<0.05), average inspection number(18.43±5.93 vs 13.27±1.96,P=0.000), the sorting time (min) (14.1±2.5 vs 17.4±3.2, P=0.000), the average diameter less than 5 mm number(4.73±1.31 vs 1.23±1.14, P=0.000), the number of positive ones average diameter less than 5 mm(0.97±1.03 vs 0.20±0.55, P=0.010), the first(8.17±4.58 vs 5.07±1.96, P=0.000) and second station(6.57±1.87 vs 4.90±1.69, P=0.001)inspection number.The inspection number less than 12, the positive rate of lymph node, the metastatic rate of the patient and the inspection number of third station have no significant differences (all P≥0.05).

Theartery approach method inrectal cancer lymph node inspectionhas many advantages such as simple operation, obtaining more lymph nodes and more accurate pathological staging.

To observe the clinical efficacy and safety of the LOP regimen (L-asparaginase, vincristine, dexamethasone) combined with intensity modulated radiation therapy(IMRT)in the treatment of early nasal NK/T cell lymphoma.

Clinical data of 65 patients with nasal NK/T cell lymphoma treated with LOP chemotherapy combined with IMRT at the Guizhou Province Tumor Hospital between March 2010 and January 2015 were retrospectively analyzed.

Among the 65 patients, 39 cases obtained complete remission (CR), 18 cases obtained partial remission(PR), 1 case obtained stable disease (SD), 7 cases had progressive disease(PD). The objective response rate (ORR) was 87.7%, the disease control rates (DCR) was 89.2%. The DCR was lower in the patients with B symptoms or over age of 60. Patients with super cavity obtained a worse progression-free survival(PFS). The 1-, 2-, 3-year PFS were 91.7%, 74.8% and 61.3%, the overall survival(OS) were 91.8%, 81.3% and 78.9%, respectively. Main adverse reactions were myelosuppression, gastrointestinal reaction, hepatic lesion, hypoproteinemia, percutaneous reaction and oral mucosa reaction. No severe pancreatitis, severe anaphylaxis and toxic related death were observed.

The LOP regimen combined with IMRT treatment for nasal NK/T cell lymphoma may have a good therapeutic effect, low toxicity, and good tolerance.

To explore the role of nuclear factor of activated T-cells cytoplasmic 1 (NFATc1) on vascular calcification in chronic renal failure rats.

Nineteen male Sprague-Dawley (SD) rats were randomly divided into three groups: sham-operated group (n=6), 5/6 Nephrectomy (Nx) group (n=6), 5/6 Nx+ calcitriol group (n=7). Vascular calcification was determined by von Kossa staining and orthocresolphthalein complexone (OCPC) method. Protein expressions of NFATc1 and runt-related transcription factor 2 (Runx2) in aortas were measured by immunohistochemistry.In vitro, vascular smooth muscle cells (VSMCs) were primarily cultured and calcification was induced by β-glycerophosphate (β-GP). These cells were then randomly divided into control group, calcification group (10 mmol/L β-GP) and cyclosporin A (CsA) intervention group (10 mmol/L β-GP+ 1 μg/ml CsA). Calcium deposition was measured by Alizarin red staining and OCPC method; alkaline phosphatase (ALP) activity was measured by enzyme-linked immunosorbent assay. RT-PCR and Western blotting were used to observe the mRNA and protein expression of VSMCs NFATc1 and Runx2 respectively.

Compared to that in sham-operated and 5/6 Nx group, the expression of NFATc1 was obviously up-regulated in 5/6 Nx+ calcitriol group (7.20±0.46 vs 1.52±0.77, 2.04±1.31, P<0.05).In vitro, VSMCs calcification was successfully induced by high phosphorus environment, and RT-PCR and Western blotting showed that the expressions of NFATc1 and Runx2 were up-regulated (P<0.05). The calcification level in CsA intervention group was lower than that in calcification group [(60.86±7.95) vs (107.20±11.07) mg/g,P<0.05], and expression of Runx2 (mRNA and protein level) and ALP activity [(48.63±3.02) vs (98.75±3.46) U/g,P<0.05] decreased as well.

NFATc1 contributes to accelerating vascular calcification in rat with chronic renal failure, the possible mechanism of which is that NFATc1 promotes VSMCs transformation to osteogenic phenotype.

To investigate the effects of Yiqi Huatan Quyu prescription on oxidative stress and pathological changes in chronic intermittent hypoxia rats liver.

A total of 24 male SD rats aged eight weeks were randomly divided into 3 groups by the random number table: normal control group (NC), chronic intermittent hypoxia group (CIH) and chronic intermittent hypoxia plus Yiqi Huatan Quyu prescription supplement group (Chinese medicine group, CM)(n=8 each). The CIH group and CIHN group were exposed to intermittent hypoxia every day for 8 consecutive weeks. In addition, the CIHN group received Yiqi Huatan Quyu prescription via gavage 30 min before the CIH. Eight weeks later, serums were collected to test alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level. Meanwhile, rat livers were extracted to evaluate malondialdehyde (MDA), total superoxide dismutase (T-SOD), glutathione (GSH) and Nuclear factor κB (NF-κB) and observe the pathological changes of liver.

The levels of serum ALT and AST in the CIH group were significantly higher than those of NC group[(112.1±31.7) vs (41.3±6.6) U/L, (295.4±39.8) vs (104.5±12.3) U/L], the contents of the MDA and NF-κB in the CIH group were notably higher than those of NC group[(7.9±1.1) vs (3.6±0.7) nmol/mgprot, (16.2±3.3) vs (5.7±2.2) ng/L], the activities of T-SOD and GSH in the CIH group were significantly lower than those of control group[(181.6±28.6) vs (304.3±42.9) U/mgprot, (5.5±1.3) vs (14.9±2.4) mg/gprot](allP<0.001). The levels of the serum ALT and AST in CM group were significantly lower than those of CIH group[(52.2±8.6) vs (112.1±31.7) U/L, (148.1±20.4) vs (295.4±39.8) U/L], the contents of liver MDA in CM group was notably lower than those of CIH group[(4.5±0.7) vs (7.9±1.1) nmol/mgprot], the activities of liver T-SOD and GSH in CM group were significantly higher than those of CIH group[(226.9±38.9) vs (181.6±28.6) U/mgprot, (10.3±1.7) vs (5.5±1.3) mg/gprot](allP<0.05). Compared with CIH group, declining tendency was observed from contents of NF-κB in CM group, but there was no statistical difference[(15.8±2.1) vs (16.2±3.3) ng/L,P>0.05]. Pathology observation showed the CIH group had abundant inflammatory cells infiltration in the liver portal area and the inflammatory cells infiltration decreased following Chinese medicine treatments.

Yiqi Huatan Quyu prescription has some protection to CIH rat liver, which might mediate by the reduction of oxidative stress and inflammatory mediator.

To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China.

Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis.

Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ²=21.239, 59.442, 7.333, all P<0.01). Most of the patients (57.8%) were admitted within 2 hours after injury. However, when it came to the pre-hospital emergency management of burn wound, 164 patients (33.7%) did not use any drug or wound dressing, whereas the wound area of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without (P<0.01). The average length of stay for pediatric burn patients was (52.3±40.2) days.

Children under 3 years old are important target population of severe burns. Scald is the most common type of burns, while the proportion of flames increases as age goes up. Most patients are likely to get clinical treatment in time, however, the pre-hospital emergency burn care is not satisfying at present.

Hemodialysis is one of the main methods for the treatment of end-stage renal disease. The National Kidney Foundation of the United States recommends that autologous arteriovenous fistula be the first choice to establish hemodialysis access. However, artificial arteriovenous fistuloplasty (AVG) may be considered for patients with unsuitable autologous vascular conditions or occlusion of autologous vascular fistula. This study retrospectively analyzed the clinical efficacy and follow-up results of AVG for maintenance hemodialysis, and explored its treatment strategy and effectiveness.

Neuroendocrine tumors originate from embryonic neuroendocrine cells and can occur in many organs and tissues throughout the body. The 2010 World Health Organization (WHO) Gastrointestinal Pancreatic Neuroendocrine Tumor Classification classified this tumor with highly heterogeneous clinical manifestations into well-differentiated neuroendocrine tumors (NET) and poorly differentiated neuroendocrine carcinomas (NEC)^[1]。 Localized neuroendocrine tumors can be surgically resected, but about half of neuroendocrine tumors are locally advanced or have distant metastases at the time of diagnosis. Radical surgical resection is difficult, and drug treatment is needed to delay tumor progression and prolong patient survival. At present, the drug therapy for advanced NEC is still platinum-based chemotherapy, and the progress in the field of drug therapy in recent years mainly focuses on advanced NET. Phase III clinical study results show that somatostatin analogs (SSA) and molecular targeted drugs (including everolimus and sunitinib) can delay the progression of patients with advanced NET.