Volume 100 ·  Issue 21 ·  2020

Every year, 200 million people occur in China, such as car accidents, falling from buildings, fights, occupational injuries and other kinds of trauma^[1]。 In developed countries such as the United States, wounds are one of the common reasons people seek emergency medical help. Emergency departments in the United States treat approximately 11.8 million traumatic wounds each year^[2]； More than 7.3 million of them were open wounds^[3]With an estimated cost of more than $3 billion^[4]If these wounds have complications such as infection, the cost will be greater^[2]。 Emergency open wound management has become a major public health problem faced by the world. Emergency debridement and suture is a necessary technique for surgeons. Attaching importance to debridement can reduce wound infection and reduce or even eliminate antibiotics. Emphasis on suture technique can reduce scar formation and reduce trauma sequelae^[5]。 However, in practice, doctors often operate according to their own experience, which lacks evidence-based medicine. In order to avoid the situation that debridement is feasible for everyone but the debridement procedures are not standardized and thus delays the condition, China Trauma Treatment Alliance, National Trauma Medicine Center and Trauma Treatment Center of Peking University People's Hospital organized some domestic experts and scholars to formulate this consensus, and summarized the steps of debridement, in order to improve the standardization of clinical debridement and suture of emergency open wounds, reduce the wound infection rate and improve the primary wound healing rate.

The novel coronavirus pneumonia (COVID-19) epidemic has brought great challenges and pressures to our society^[1]。 In this epidemic, traditional Chinese medicine and the combination of traditional Chinese and western medicine have played an important role in clinical treatment. According to statistics, more than 90% of patients have been treated with traditional Chinese medicine in Wuhan, including Hubei Province^[2]Traditional Chinese medicine is also active in the front line of fighting the epidemic in many provinces and cities. The effective participation rate of traditional Chinese medicine in Guangdong, Zhejiang, Sichuan and other provinces has reached more than 80%^[3]。 In order to further guide the first-line clinical use of Chinese medicine, the collaboration group systematically retrieved the direct clinical evidence of Chinese medicine in the prevention and treatment of COVID-19 with reference to the basic methods formulated by the WHO Quick Recommendation Guide, combed and summarized first-hand clinical information, high-level expert opinions, and clinical diagnosis and treatment plans promulgated by national and local governments, synthesized them based on evidence-based thinking, and put forward key suggestions for the treatment of COVID-19 with Chinese medicine.

To investigate the spectral CT-based radiomics in predicting preoperatively the lymph node metastasis (LNM) of advanced gastric cancer.

From January 2014 to October 2018, the spectral CT imaging and clinical data of 196 gastric adenocarcinoma patients confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled (training set and test set were randomly divided according to the ratio of 1∶1). These 196 patients include143 males and 53 females, aged from 28 to 81 years, with an average age of (59±11) years, and were divided into nodular metastasis group and non-metastasis group according to clinicopathological data. The spectral parameters were measured and calculated, and the CT-reported lymph node (LN) status from CT images were obtained. 273 radiomics features were extracted from the dual-phases CT images in different energy level (40, 65 and 100 keV) to build the radiomics signature respectively. Univariate analysis was used to compare the differences of spectral parameters and radiomics features between two groups, and then the significant indicators were put into multivariable logistic regression analysis to construct combined prediction model and radiomics nomogram. In addition, the performance of prediction model in training and test set were measured using the receiver operating characteristics (ROC) curves and were compared using DeLong test.

Both in training set and in test set, the iodine concentration (IC) of tumor in venous phase (VP) in nodular metastasis group were higher than that in non-metastasis group [training set: 22.98 (100 mg/L)>20.31 (100 mg/L),P=0.086; test set: 25.14 (100 mg/L)>21.07 (100 mg/L),P=0.009]. The CT-reported LN status showed significant differences between the two group (P<0.001, P=0.001). The radiomics signatures 40 keV-arterial phase, 65 keV-venous phase, IC-VP of tumor and CT-reported LN status were independent indicators for prediction of preoperative LNM of advanced gastric cancer in combined prediction model (P<0.05). The radiomics nomogram predicated LNM with an area under curve (AUC) and 95% confidence interval (CI) of 0.822 (0.739-0.906) in training set and 0.819(0.732-0.906) in test set, and there were no significant differences in AUC between two sets (P>0.05).

The spectral CT-based radiomics can be used to quantitatively predict the LNM of advanced gastric cancer preoperatively.

To investigate the impact of metabolic syndrome (MS) and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention(PCI).

Patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided to two groups: with MS and without MS. The primary endpoint of 2-year follow-up was major adverse cardiovascular events (MACE), including death, myocardial infarction, and repeat revascularization.

Of the 10 422 PCI patients, there were 5 656 (54.27%) without MS and 4 766 (45.73%) with MS. Patients in the MS group were younger, tended to be male and had more comorbidities. There were no significant differences between the two groups in the proportion of drug-coated stents and the success rate of interventional therapy. The 2-year follow-up showed that the incidence of MACE in the MS group was significantly higher than that in the MS-free group (12.0% vs 10.0%, P<0.001), which was mainly due to the significantly higher revascularization rate in the MS group than in the non-MS group (9.5% vs 7.9%, P=0.003). Cox's regression analysis showed that MS was an independent risk factor for MACE. In MS component analysis, abnormal glucose metabolism was an independent risk factor for MACE events.

Among the patients undergoing PCI, the incidence of MACE in patients with MS is significantly higher than that in patients without MS, and MS was an independent risk factor for MACE. In addition, hyperglycemia is an independent predictor for MACE.

To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults.

The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve.

A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all P>0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all P<0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all P<0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%.

aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.

To screen the different microRNAs in the serum exosomes of patients with malignant glioma, to explore the effect of non-coding microRNA-376b-3p (miR-376b-3p) on the proliferation, invasion and tumor vasculogenic mimicry of glioma cells, and to verify its targeting effect on HOXD10.

HiSeq/MiSeq high-throughput sequencing was used to screen the different microRNA expression profiles, target genes and action pathways in the serum exosomes of patients with malignant glioma. Samples were used to evaluate the expression of candidate microRNAs in serum exosomes of high-grade gliomas. The effects of miR-376b-3p on the proliferation, invasion and angiogenesis of glioma cells were detected by MTT assay, Transwell migration assay and Matrigel vasculogenic mimicry assay. The mRNA and protein expression of HOXD10 were detected to evaluate the regulatory effect of miR-376b-3p on it.

There were 144 different expression microRNAs in the serum exosomes between malignant glioma and the normal control. Focal adhesion and tumor protein polysaccharides were involved in the regulation of glioma enriched by KEGG(Kyoto Encyclopedia of Genes and Genomes). MiR-376b-3p was down regulated in malignant glioma, and AUC of malignant glioma was 0.85 (P<0.01). MTT test showed that the proliferation ability of miR-376b-3p inhibitor group was higher than that of the control group, and that of miR-376b-3p mimic group was lower than that of the control group. Transwell migration test showed that the number of transmembrane cells in miR-376b-3p inhibitor group was higher than that in NC inhibitor group, and the number of transmembrane cells in miR-376b-3p mimic group was lower than that in NC mimic group. The number of tubes of vasculogenic mimicry in miR-376b-3p mimic group was lower than that in NC mimic group. MiR-376b-3p inhibitor decreased the expression level of HOXD10 mRNA and protein, and miR-376b-3p mimic increased the expression level of HOXD10 mRNA and protein.

MiR-376b-3p is down-regulated in the serum exosomes of malignant glioma patients. The up-regulated miR-376b-3p can reduce the proliferation and invasion of glioma cells, inhibit the formation of vasculogenic mimicry, and increase the expression of HOXD10, which is expected to inhibit the formation of two forms of angiogenesis at the same time. MiR-376b-3p may be a new therapeutic target of anti-angiogenesis for malignant glioma.

To explore the application value of mass spectrometry (MS) combined with next generation sequencing (NGS) in diagnosing neonatal inherited metabolic diseases (IMD).

The clinical information, metabolites in blood and urine, and gene sequencing results of 19 neonates with IMD coming from the Department of Neonatology of Jiangxi Provincial Children′s Hospital from March 2017 to September 2019 were analyzed retrospectively. The metabolites in blood were detected by liquid chromatography tandem mass spectrometry and urine were detected by gas chromatography-mass spectrometry respectively.Meanwhile, the whole bloods were dectected by neonatal genetic disease panel based on NGS.

Twelve neonates had the same results between MS and NGS among the 19, 2 had different results from MS to NGS, and 4 had no disease indication by MS but were diagnosed by NGS whose clinical phenotype were partially consistent with NGS results. One of them who did not carry out MS was considered as the diagnosis of IMD because of the detection of gene, and was followed up on this basis.

MS could diagnose IMD relatively quickly to guide clinical treatment, and while NGS could verify the results of MS detection. Combination of MS and NGS would understand the cause of disease on genetic level, so as to guide further treatment and genetic consultation.

To explore clinical outcome of isolated arthroscopic biceps tenodesis by double row for pulley lesions.

Forty-nine patients with pulley lesions were treated from July 2017 to June 2018 in the Department of Sport Medicine, the Affiliated Zhongshan Hospital of Dalian University by isolated arthroscopic biceps tenodesis by double row. Patients were divided into 2 groups according to the intraoperative damage of the pulley system. In group A, there were 16 patients with isolated superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex lesions, including 9 males and 7 females, aged (55±6) years. In group B, there were 33 patients (15 males and 18 females, aged (57±8) years) with SGHL/CHL complex and adjacent supraspinatus tendon and/or subscapularis tendon articular-side partly tears. Patients in two groups were treated with different isolated arthroscopic biceps tenodesis by double row. Constant-Murley shoulder score and pain visual analogue scale (VAS) score were assessed before operation and 3, 6, 12 months after the operation. Postoperative complications were also recorded in two groups. The t test was used to compare the quantitative data within and between two groups.

All 49 patients were followed up for 12 to 24 months with an average of (17±6) months. The first-stage healing was achieved in all incisions in the two groups. No surgical complications related to revision, infection, Popeye syndrome and cramping pain were observed in either group. There was 1 case treated by secondary arthroscopy for retrauma in group B. The Constant-Murley shoulder score in group A before the operation was 46±10, and it was increased to 89±9 at the 12 months post operation(t=-22.637, P<0.05); and it was 39±10 and 87±8 before and 12 months after the operation respectively in group B (t=-44.849, P<0.05). The VAS scores in the two groups were both decreased significantly at the 12 months post operation when compared with those before the operation (0.68±0.70 vs 5.25±0.27 and 0.72±0.83 vs 5.69±0.84, respectively) (t=29.007, 37.079, both P<0.05).

Isolated arthroscopic biceps tenodesis by double row can relieve pain, recover functions of shoulder joint effectively, and achieve a satisfactory outcome in the treatment of pulley lesions.

To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis.

The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson′s correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. The SWE diagnostic performances of Liver (L-SWE), Spleen (S-SWE) were also evaluated.

Of all 58 patients, 47 were found HVPG ≥10 mmHg, diagnosed as clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH), which patients are at increased risk of developing complications. Thirty-four patients were found HVPG≥12 mmHg, diagnosed as SPH, which patients were at increased risk of variceal bleeding. Moderate positive correlation was found between L-SWE and HVPG (r=0.42, P<0.01), and S-SWE were significantly correlated with HVPG (r=0.68, P<0.01), while serological models and HVPG were slightly correlated (r=0.36 and 0.28, all P<0.01). The area under the receiver operating characteristic curves of L-SWE, S-SWE and the combination for CSPH were 0.78, 0.88 and 0.89. When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa, patients were at increased risk of developing complications. The area under the receiver operating characteristic curves for SPH were 0.68, 0.81 and 0.77 and the S-SWE had the highest specificity, so when S-SWE was>41.5 kPa, patients were at increased risk of variceal bleeding.

L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.

To investigate the timely return visit rates after first visits of adolescent clients to the psychiatric outpatient clinic in a general hospital and analyze the relevant factors.

All adolescent clients firstly visited psychiatric outpatient clinic of the Third Affiliated Hospital of Sun Yat-sen University from May to October 2018 were surveyed. The timely return visit was defined as the return visit within one month after the first visit and the timely return visit rate (RVR) was calculated. Chi-square test and binary Logistic regression were used to compare the RVR subgroup differences and relevant factors. Reasons for non-attendance at the return visit were acquired by the telephone follow-up.

A total of 1 121 cases were enrolled, with an age of (16.0±1.6) years, 85.8% of them were students, and the overall RVR was 62.7% (703/1 121). The highest RVR was found in those who hoped for drug treatment (69.8%) and the lowest in those who did not accept drug treatment (55.8%) (χ²=9.028, P=0.029). The highest RVR was found in hospitalized patients (97.6%), followed by outpatient pharmacotherapy group (61.2%) and keeping observation and self-adjustment group (45.3%) (χ²=82.269, P<0.001). The RVR of patients prescribed mood stabilizers was significantly higher than that of non-users (χ²=9.498, P=0.002). Logistic regression analysis showed the main factors that affect the timely return visit included treatment regimens and prescribing of mood stabilizers. Results of telephone follow-up of clients with non-attendance showed that the main reasons were symptoms alleviation (68.4%) and various visiting barriers (14.3%).

Clients with active attitude towards pharmacotherapy, hospitalization and using mood stabilizers in outpatient have higher RVR rates. Insufficient understanding of systemic therapy remains the main reason why the clients fail to attend the return visit in time.

To observe the effect of different modes of mechanical ventilation on patient-ventilator synchrony and diaphragm function in rabbits with acute respiratory distress syndrome(ARDS).

Eighteen New Zealand rabbit models of ARDS were induced by intratracheal infusion hydrochloric acid until the oxygenation index (PaO₂/FiO₂) was less than 200 mmHg, and then divided into three groups with random number: assisted-controlled mechanical ventilation (A/C) group, pressure support ventilation (PSV) group and neurally adjusted ventilatory assist (NAVA) group. All of them were ventilated for four hours with the targeted tidal volume (V_T) (6 ml/kg) and the positive end-expiratory pressure (PEEP) titrated with the maximum oxygenation method. Gas exchange, pulmonary mechanics and patient-ventilator synchrony were determined during 4 h of ventilation and the concentrations of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) in diaphragm were measured after 4 h of ventilation. The q test was used for the multiple comparison of the sample mean.

There were no significant differences in PaO₂/FiO₂ between three groups during ventilation 1-4 h (F=1.029, P>0.05). The V_T in NAVA group was obviously lower than that in PSV group and the respiratory rate (RR) and the electrical activity of diaphragm(EAdi) were higher than those in A/C group(all P<0.05).The trigger delay and off cycle delay the in NAVA group were markedly lower than those in A/C and PSV group during ventilation 1-4 h(F=14.312, 9.342, both P<0.05). Asynchrony index in NAVA group (3.1%±1.0%) was obviously lower than those in A/C group (22.3%±5.2%) and PSV group(8.4%±2.3%) (F=7.192, P<0.05). In NAVA group, peak EAdi (EAdi_peak) and peak airway pressure (Ppeak) were markedly correlated (r=0.97±0.16, P<0.05), while Ppeak delivery in A/C and PSV group was not correlated to EAdi_peak (r=0.38±0.13,0.46±0.15, both P>0.05).Compared with A/C group, the concentration of MDA in the diaphragm in NAVA group was obviously lower(P<0.05). SOD and GSH level inthe diaphragm in NAVA group were both obviously higher than those in A/C group (both P<0.05).

It is helpful to avoid eccentric contraction of diaphragm, lessen oxidative stress and alleviate ventilator-related diaphragm dysfunction by keeping spontaneous breathing as far as possible and subject-ventilator synchrony when ventilation in ARDS with NAVA.

To study the effects of miR-16-5p on proliferation, migration and invasion of osteosarcoma cells and its mechanism.

Quantitative polymerase chain reaction (qPCR) and Western blotting were used to detect the mRNA and protein expression of miR-16-5p and TSPAN15 in human normal osteoblasts hFOB 1.19 and osteosarcoma cells MG63, Saos2 and HOS. The miR-16-5p or si-TSPAN15 was transfected into MG63 cells to observe its role in cell proliferation, migration and invasion. Cell proliferation was measured with MTT assay, cell migration and invasion were examined by Transwell, and the protein expression of CyclinD1, matrix metalloproteinase 2 (MMP-2), MMP-9, tetraspanin 15 (TSPAN15), phospha-tidylinositol3-kinase(p-PI3K) and phospha-protein kinase B(p-AKT) were determined by using Western blotting. The starbase website prediction combined with dual luciferase gene reporter assay was performed to analyze the targeting relationship between miR-16-5p and TSPAN15. miR-16-5p and pcDNA-TSPAN1 were co-transfected to assess the effect of high expression of TSPAN15 on overexpression of miR-16-5p-induced proliferation, migration and invasion of MG63 cells. Data comparison between the two groups was performed by using t test.

Compared with hFOB 1.19 cells (1.00±0.12), the expression of miR-16-5p was significantly decreased in MG63, Saos2 and HOS cells (0.32±0.05, 0.40±0.04, 0.45±0.06, respectively)(F=156.204, P<0.05), and TSPAN15 mRNA and protein levels were greatly increased (F=71.718, 110.350, both P<0.05). Overexpression of miR-16-5p obviously reduced the expression of CyclinD1, MMP-2, MMP-9 protein, cell viability, cell migration and invasion (F=150.136,117.228, 154.971, 89.479, 98.373, 130.880, all P<0.05) in MG63 cells. Knockdown of TSPAN15 greatly reduced CyclinD1, MMP-2, MMP-9 protein levels, cell survival rate, cell migration, and invasion number (F=93.206, 107.030, 109.326, 115.625, 146.113, 139.300, all P<0.05). Overexpression of miR-16-5p markedly decreased the expression of p-PI3K and p-AKT protein in MG63 cells (F=156.755, 181.419, both P<0.05). miR-16-5p targeted to regulate the expression of TSPAN15. High expression of TSPAN15 partially reversed the inhibitory effect of miR-16-5p on TSPAN15, CyclinD1, MMP-2, MMP-9, p-PI3K, p-AKT protein expression, cell viability, cell migration number and invasion number in MG63 cells.

miR-16-5p inhibits the proliferation, migration and invasion of osteosarcoma cells by targeting the TSPAN15 gene and regulating the PI3K/AKT signaling pathway.