踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例

目的`3b;߭3;应用踇u32;皮ݎ3;再造拇307;3ca;ࠕ3;动脉穿支皮ݎ3;n38;离移植修复ࣛ3;部供33a;的手术方法3ca;N34;床效果�3002;方法2016 年 6 月—2018 年 5 月，应用踇u32;皮ݎ3;联合ࠕ3;动脉穿支皮ݎ3;n38;离移植再造拇307;并修复ࣛ3;部供33a; 15 例�3002;u37; 10 例，֗3; 5 例；年龄 21～48 岁，ק3;均 34.6 岁�3002;致伤39f;因：重物38b;x38;伤 7 例，g3a;器绞伤 5 例，u35;锯切割伤 3 例�3002;Ⅰ度3a;35f; 9 例，Ⅱ度3a;35f; 6 例�3002;入院ࠟ3;皮ݎ3;手术时间 4～7 d，ק3;均 5.2 d�3002;߭3;果术后踇u32;皮ݎ3;3ca;ࠕ3;动脉穿支皮ݎ3;全部成m3b;，切3e3;均Ⅰ期愈合�3002;؊3;者均3b7;随访，随访时间 8～24 个月，ק3;均 16.4 个月�3002;末次随访时，再造拇307;307;u32;生长ק3;整，有光泽，307;腹饱满；ࣛ3;部皮ݎ3;外形良好，颜色3ca;质W30;3a5;近3d7;33a;�3002;h39;36e;中34e;33b;学会手外科学会拇手307;再造功能评定标准，3b7;优 9 例�3001;良 6 例；h39;36e; Maryland ࣛ3;功能评分标准，3b7;优 10 例�3001;良 5 例�3002;؊3;者行走步态ڶ3;^38;，无跛行3ca;疼痛不适�3002;߭3;论踇u32;皮ݎ3;修复拇307;Ⅰ�3001;Ⅱ度3a;35f;，再造拇307;3ef;3b7;得良好外观3ca;功能；ࠕ3;动脉穿支皮ݎ3;具有血供3ef;靠�3001;血管恒定�3001;١3;切3d6;等优点，3ef;有效修复ࣛ3;部供33a;�3002;     

Peripheral whole blood FOXP3 TSDR methylation: a potential marker in severity assessment of autoimmune diseases and chronic infections

Immune dysregulation is a cardinal feature of autoimmune diseases and chronic microbial infections. In particular, regulatory T cells are downregulated in autoimmune diseases while upregulated in chronic microbial infections. FOXP3 is the master regulator of Treg development. Treg-specific demethylated region (TSDR) is a highly conserved locus on the FOXP3 gene that is fully demethylated in natural Tregs but methylated in effector T cells. In our study, we used high resolution melt-polymerase chain reaction (HRM-PCR) to determine the FOXP3 TSDR methylation status in autoimmune diseases and chronic microbial infections. We found that FOXP3 TSDR to have the highest mean melting temperature (highly methylated) in active SLE patients compared to all the other groups (p?<?0.001). The psoriasis group also had a significantly high mean melting temperature (78.62?±?0.20) when compared with the inactive SLE group (78.49?±?0.29, p?<?0.05) and control group (78.44?±?0.25, p?<?0.01). There was no significant difference in melting temperature between inactive SLE and healthy controls. Disease activity in SLE was directly associated with methylation of the FOXP3 TSDR. On the other hand, patients with chronic microbial infections had significantly lower FOXP3 TSDR mean melting temperature (demethylated) when compared with healthy controls (78.28?±?0.21 vs 78.44?±?0.25, p?<?0.05). Our results suggest that the use of HRM-PCR to detect FOXP3 TSDR methylation status is a reliable and easy method to predict natural regulatory T cell levels in peripheral blood in different disease conditions. Determining FOXP3 TSDR methylation status can be a useful tool in diagnosis, and monitoring the severity of autoimmune diseases and chronic microbial infections.     

附加钢板技术治疗股骨干髓内钉术后骨不连的现状和研究进展

目的对附加钢板技术治疗股骨干ভ3;内钉术后骨不连的386;3f2;�3001;3b0;状和进展进行综述�3002;方法广泛查阅国内外ԗ3;于附加钢板技术治疗股骨干ভ3;内钉术后骨不连的N34;床研究文32e;，并进行综合分析�3002;߭3;果自 1997 年附加钢板技术已成功用于治疗股骨干ভ3;内钉术后骨不连，h39;36e;39f;ভ3;内钉是否Y31;效，3ef;分N3a;保留39f;ভ3;内钉和更362;39f;ভ3;内钉两类�3002;该技术不仅适用于简355;骨不连，还3ef;用于合并严重畸形的复杂性骨不连�3002;相比更362;ভ3;内钉�3001;更362;外侧钢板和3cc;钢板技术，附加钢板技术手术创伤更小，骨折愈合时间更短，骨折愈合387;更高，؊3;者能更早重返y3e;会和工作�3002;q36;而，该技术也存在一些问题有待࢞3;ԛ3;，305;括3cc;皮质螺钉固定困难�3001;3a;乏适合股骨干࢞3;剖型附加钢板以3ca;3a;乏术后功能和生m3b;质量的评O30;研究�3002;߭3;论相比其他翻修固定方式，附加钢板技术能够3b7;得更高的骨折愈合387;和更好的N34;床预后�3002;q36;而，术后؊3;者能否在功能和生m3b;质量方面进一步3b7;益还有待证实�3002;此外，还需要更高质量的N34;床对照研究深入证明其是否确实优于其他翻修固定方式�3002;     

经重睑切口的上睑旋转皮瓣矫正轻中度内眦赘皮疗效观察

目的3a2;讨重睑术中采用经重睑切3e3;的上睑旋转皮ݎ3;矫ڶ3;轻�3001;中度内眦赘皮的疗效�3002;方法回顾分析 2016 年 7 月—2017 年 10 月，重睑术中采用经重睑切3e3;的上睑旋转皮ݎ3;矫ڶ3;轻�3001;中度睑板型内眦赘皮合并355;睑的 34 例؊3;者（试验组）N34;床资料；以同期 38 例3a5;3d7;传统“Z”成形内眦开大术联合重睑术؊3;者N3a;对照（对照组）�3002;两组؊3;者年龄3ca;内侧赘皮分度比ࣸ3;，差异无统计学意义（P�3e;0.05）�3002;于术前3ca;术后 6 d�3001;6 个月测量w3c;裂长度，计算w3c;裂长度e39;善程度；3c2;照内眦赘皮矫ڶ3;标准评价手术疗效�3002; ߭3;果两组؊3;者切3e3;均Ⅰ期愈合，并3b7;随访 6 个月�3002;两组内眦赘皮明f3e;矫ڶ3;�3002;试验组内眦处无切3e3;；对照组遗留瘢痕，其中 6 例增生明f3e;�3002;术后 6 d 试验组3ca;对照组w3c;裂长度e39;善程度分别N3a; 3.63%±0.07%�3001;3.70%±0.05%；术后 6 个月分别N3a; 4.64%±0.09%�3001;4.46%±0.10%；两组比ࣸ3;差异均无统计学意义（t=0.005，P=0.996；t=0.287，P=0.871）�3002;术后 6 个月疗效评价，试验组优 20 例�3001;良 12 例�3001;差 2 例，优良387; 94.12%；对照组优 16 例�3001;良 16 例�3001;差 6 例，优良387; 84.21%；差异无统计学意义（�3c7;²=0.796，P=0.372）�3002; ߭3;论经重睑切3e3;的上睑旋转皮ݎ3;矫ڶ3;轻�3001;中度内眦赘皮手术操作简便�3001;效果满意，内眦处无瘢痕形成�3002;     

Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies

BackgroundPrioritising patients in mass casualty incidents (MCI) can be extremely difficult. Therefore, triage systems are important in every emergency medical service. This study reviews the accuracy of primary triage systems for MCI in trauma register studies.MethodsWe registered a protocol at PROSPERO ID: CRD42018115438. We searched MEDLINE, EMBASE, Central, Web of Science, Scopus, Clinical Trials, Google Scholar, and reference lists for eligible studies. We included studies that both examined a primary triage system for MCI in trauma registers and provided sensitivity and specificity for critically injured vs non-critically injured as results. We excluded studies that used paediatric, chemical, biological, radiological or nuclear MCIs populations or triage systems. Finally, we calculated intra-study relative sensitivity, specificity and diagnostic odds ratio for each triage system.ResultsTriage Sieve (TS) significantly underperformed in relative diagnostic odds ratio (DOR) when compared to START and CareFlight (CF) (START vs TS: 19.85 vs 13.23 (p<0.0001)│CF vs TS: 23.72 vs 12.83 (p<0.0001)). There was no significant difference in DOR between TS and Military Sieve (MS) (p<0.710). Compared to START, MS and CF TS had significantly higher relative specificity (START vs TS: 93.6% vs 96.1% (p=0.047)│CF vs TS: 96% vs 95.3% (p=0.0006)│MS vs TS: 94% vs 88.3% (p=0.0002)) and lower relative sensitivity (START vs TS: 57.8% vs 34.8% (p<0.0001)│CF vs TS: 53.9% vs 34.7% (p<0.0001)│MS vs TS: 51.9% vs 35.2% p<0.0001)).CF had significantly better relative DOR than START (CF vs START: 23.56 vs 27.79 (p=0.043)). MS had significantly better relative sensitivity than CF and START (MS vs CF: 49.5% vs 38.7% (p<0.0001)│MS vs START: 49.4% vs 43.9% (p=0.01)). In contrast, CF had significantly better relative specificity than MS (MS vs CF: 91.3% vs 93.3% (p<0.0001)). The remaining comparisons did not yield any significant differences.ConclusionAs the included studies were at risk of bias and had heterogenic characteristics, our results should be interpreted with caution. Nonetheless, our results point towards inferior accuracy of Triage Sieve compared to START and CareFlight, and less firmly point towards superior accuracy of Military Sieve compared to START, CareFlight and Triage Sieve     

Immunohistochemical and molecular analysis of PI3K/AKT/mTOR pathway in esophageal carcinoma

Among the numerous signaling pathways involved in tumorigenesis, PI3K‐AKT‐mTOR is a key one that regulates diverse cellular functions. However, its prognostic value in esophageal carcinoma remains unclear. In our study, we examined the immunohistochemical expression of phosphorylated (p‐) AKT, mTOR, p70S6K and 4E‐BP1 along with the mutational status of PIK3CA and AKT1 genes by High Resolution Melting Analysis and Pyrosequencing in 44 esophageal carcinomas. The results were correlated with the clinicopathological characteristics of the patients in an effort to define their possible prognostic significance. Total p‐mTOR cytoplasmic expression, assessed in 10 random areas, was positively correlated with tumor stage (Kruskal–Wallis ANOVA, I/II vs III/IV, p = 0.0500). Μoreover, maximum p‐mTOR cytoplasmic immunoexpression, estimated in hot spot areas, was positively associated with tumor grade (Mann–Whitney U test, I/II vs III, p = 0.0565). Interestingly, p‐4E‐BP1 immunoreactivity was negatively correlated with tumor histological grade (Mann–Whitney U test, I/II vs III, p = 0.0427). No mutation was observed in exons 9 and 20 of PIK3CA gene and in exon 4 of AKT1 gene. In conclusion, our findings depict the presence of activated PI3K/AKT/mTOR pathway in esophageal cancer bringing forward p‐mTOR and p‐4E‐BP1 for their potential role in esophageal carcinogenesis. Additional studies are warranted to validate our findings.     

DNA vaccine encoding the moonlighting protein Onchocerca volvulus glyceraldehyde-3-phosphate dehydrogenase (Ov-GAPDH) leads to partial protection in a mouse model of human filariasis

River blindness, caused by the filarial parasite Onchocerca volvulus, is a major socio-economic and public health problem in Sub-Saharan Africa. In January 2015, The Onchocerciasis Vaccine for Africa (TOVA) Initiative has been launched with the aim of providing new tools to complement mass drug administration (MDA) of ivermectin, thereby promoting elimination of onchocerciasis in Africa. In this context we here present Onchocerca volvulus glyceraldehyde-3-phosphate dehydrogenase (Ov-GAPDH) as a possible DNA vaccine candidate. We report that in a laboratory model for filariasis, immunization with Ov-GAPDH led to a significant reduction of adult worm load and microfilaraemia in BALB/c mice after challenge infection with the filarial parasite Litomosoides sigmodontis. Mice were either vaccinated with Ov-GAPDH.DNA plasmid (Ov-pGAPDH.DNA) alone or in combination with recombinantly expressed Ov-GAPDH protein (Ov-rGAPDH). During the following challenge infection of immunized and control mice with L. sigmodontis, those formulations which included the DNA plasmid, led to a significant reduction of adult worm loads (up to 57% median reduction) and microfilaraemia (up to 94% reduction) in immunized animals. In a further experiment, immunization with a mixture of four overlapping, synthetic Ov-GAPDH peptides (Ov-GAPDHpept), with alum as adjuvant, did not significantly reduce worm loads. Our results indicate that DNA vaccination with Ov-GAPDH has protective potential against filarial challenge infection in the mouse model. This suggests a transfer of the approach into the cattle Onchocerca ochengi model, where it is possible to investigate the effects of this vaccination in the context of a natural host–parasite relationship.