[A prospective study on application of human umbilical cord mesenchymal stem cells combined with autologous Meek microskin transplantation in patients with extensive burns].

Objective: To investigate the effects of human umbilical cord mesenchymal stem cells (hUCMSCs) combined with autologous Meek microskin transplantation on patients with extensive burns. Methods: The prospective self-controlled study was conducted. From May 2019 to June 2022, 16 patients with extensive burns admitted to the 990th Hospital of PLA Joint Logistics Support Force met the inclusion criteria, while 3 patients were excluded according to the exclusion criteria, and 13 patients were finally selected, including 10 males and 3 females, aged 24-61 (42±13) years. A total of 20 trial areas (40 wounds, with area of 10 cm×10 cm in each wound) were selected. Two adjacent wounds in each trial area were divided into hUCMSC+gel group applied with hyaluronic acid gel containing hUCMSCs and gel only group applied with hyaluronic acid gel only according to the random number table, with 20 wounds in each group. Afterwards the wounds in two groups were transplanted with autologous Meek microskin grafts with an extension ratio of 1∶6. In 2, 3, and 4 weeks post operation, the wound healing was observed, the wound healing rate was calculated, and the wound healing time was recorded. The specimen of wound secretion was collected for microorganism culture if there was purulent secretion on the wound post operation. In 3, 6, and 12 months post operation, the scar hyperplasia in wound was assessed using the Vancouver scar scale (VSS). In 3 months post operation, the wound tissue was collected for hematoxylin-eosin (HE) staining to observe the morphological changes and for immunohistochemical staining to observe the positive expressions of Ki67 and vimentin and to count the number of positive cells. Data were statistically analyzed with paired samples t test and Bonferronni correction. Results: In 2, 3, and 4 weeks post operation, the wound healing rates in hUCMSC+gel group were (80±11)%, (84±12)%, and (92±9)%, respectively, which were significantly higher than (67±18)%, (74±21)%, and (84±16)% in gel only group (with t values of 4.01, 3.52, and 3.66, respectively, P<0.05). The wound healing time in hUCMSC+gel group was (31±11) d, which was significantly shorter than (36±13) d in gel only group (t=-3.68, P<0.05). The microbiological culture of the postoperative wound secretion specimens from the adjacent wounds in 2 groups was identical, with negative results in 4 trial areas and positive results in 16 trial areas. In 3, 6, and 12 months post operation, the VSS scores of wounds in gel only group were 7.8±1.9, 6.7±2.1, and 5.4±1.6, which were significantly higher than 6.8±1.8, 5.6±1.6, and 4.0±1.4 in hUCMSC+gel group, respectively (with t values of -4.79, -4.37, and -5.47, respectively, P<0.05). In 3 months post operation, HE staining showed an increase in epidermal layer thickness and epidermal crest in wound in hUCMSC+gel group compared with those in gel only group, and immunohistochemical staining showed a significant increase in the number of Ki67 positive cells in wound in hUCMSC+gel group compared with those in gel only group (t=4.39, P<0.05), with no statistically significant difference in the number of vimentin positive cells in wound between the 2 groups (P>0.05). Conclusions: The application of hyaluronic acid gel containing hUCMSCs to the wound is simple to perform and is therefore a preferable route. Topical application of hUCMSCs can promote healing of the autologous Meek microskin grafted area in patients with extensive burns, shorten wound healing time, and alleviate scar hyperplasia. The above effects may be related to the increased epidermal thickness and epidermal crest, and active cell proliferation.

Radiation-induced cancer after treatment for nasopharyngeal carcinoma: a study from a high prevalence area.

BACKGROUND: Radiation-induced cancer (RIC) is a late complication in patients who have been treated for nasopharyngeal carcinoma (NPC). The comparison of index anatomic location, index histological type, and survival of RIC in patients with NPC after different radiotherapy modalities (intensity-modulated radiotherapy [IMRT], 3-dimensional conformal radiotherapy [3D-CRT], and conventional 2D radiotherapy) is currently unavailable. METHODOLOGY: A total of 38,565 patients with NPC who received curative-intent radiotherapy at Sun Yat-sen University Cancer Center between January 1986 and December 2017 were reviewed. A total of 141 patients who developed RIC and fulfilled the study criteria were included. Categorical variables were compared by the chi-square test or Fisher's exact test. Kaplan-Meier curves were used to evaluate overall survival. Cox proportional hazards models were used to examine the independent significance of RIC treatment. RESULTS: Among IMRT, 3D-CRT, and conventional 2D radiotherapy, the incidence of mandible RIC was higher in patients who received 3D-CRT (0.07%) than in those who received IMRT (0%). The proportion of mandible RICs was higher in patients who received 3D-CRT (16.667%) than in those who received IMRT (0%) and conventional 2D radiotherapy (3.529%). Regarding the histological type, the incidence of squamous cell carcinoma (SCC) was higher in patients who received conventional 2D radiotherapy (0.266%) than in those who received 3D-CRT (0.175%); patients who received IMRT had a higher proportion of SCC than those who received 3D-CRT/conventional 2D radiotherapy (86.4% vs. 41.7% vs. 74.2%); the incidence of sarcoma was higher in patients who received 3D-CRT (0.175%) than in those who received IMRT (0.025%); and the proportion of sarcoma was higher in patients who received 3D-CRT (41.667%) than in those who received IMRT (6.818%) and conventional 2D radiotherapy (17.647%). Patients who received surgery for RICs had better survival than those who received no surgery (64.49 vs. 12.42 months). In the univariate and multivariate analyses, surgery was an independent prognostic factor for overall survival. CONCLUSIONS: Our results have implications for long-term follow-up of RIC, multidisciplinary management, and patient counseling of RIC after nasopharyngeal carcinoma treatment by treating clinicians.

Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients.

INTRODUCTION: Pelvic ring fractures are common following high-energy blunt trauma and can lead to substantial haemorrhage, morbidity and mortality. Pelvic circumferential compression devices (PCCDs) improve position and stability of open-book type pelvic fracture, and can improve haemodynamics in patients with hypovolaemic shock. However, PCCDs may cause adverse outcomes including worsening of lateral compression fracture patterns and routine use is associated with high costs. Controversy regarding indication of PCCDs exists with some centres recommending PCCD in the setting of hypovolaemic shock compared to placement for any suspected pelvic injury. OBJECTIVE: To assess the need for PCCD application based on pre-hospital vital signs and mechanism of injury. METHODS: A retrospective cohort study was conducted in a single adult major trauma centre examining a 2-year period. Patients were sub-grouped based on initial pre-hospital and emergency department observations as haemodynamically normal (heart rate <100 bpm, systolic blood pressure ≥100 mmHg and Glasgow Coma Scale ≥13) or abnormal. Diagnostic accuracy of pre-hospital haemodynamics as a predictor of pelvic fracture requiring intervention within 24 h was assessed. RESULTS: There were 376 patients with PCCD in-situ on hospital arrival. Pelvic fractures were diagnosed in 137 patients (36.4%). Of these, 39 (28.5%) were haemodynamically normal and 98 (71.5%) were haemodynamically abnormal. The most common mechanisms of injury were motor vehicle collision (57.7%) and motorcycle collision (13.8%). Of those with fractures, 40 patients (29.2%) required pelvic intervention within 24 h of admission; of these, 8 (20%) were haemodynamically normal and 32 (80%) were haemodynamically abnormal. As a test for pelvic fracture requiring intervention within 24 h, abnormal pre-hospital haemodynamics had a sensitivity of 0.80 (95% CI 0.64-0.91), specificity of 0.32 (95% CI 0.27-0.38) and negative predictive value (NPV) of 0.93 (95% CI 0.88-0.96). Combined with absence of a major mechanism of injury, normal haemodynamics had a sensitivity 1.00, specificity 0.51 (95% CI 0.36-0.66) and NPV of 1.00 for pelvic intervention within 24 h. CONCLUSION: Normal haemodynamic status, combined with absence of major mechanism of injury can rule out requirement for urgent pelvic intervention. Ongoing surveillance is recommended to monitor for any adverse effects of this change in practice.

Self-assembly of highly conductive self-n-doped fullerene ammonium halides and their application in the in situ solution-processable fabrication of working electrodes for alcohol electrooxidation.

Stable and highly conductive self-n-doped fullerene ammonium halides are promising optoelectronic materials. It is necessary to thoroughly understand their structure-function relationship and to develop their applications. Here, the assembly behaviors of the self-n-doped fullerene ammonium halides, as well as the functional areas in the well-developed 2D-3D lamellar structures in their ordered aggregates are systematically characterized using comprehensive methods. In the self-assembly, the solvation effect of DMSO promotes the flexibility of side-chains and drives the formation of fullerene ammonium halides into ordered bilayer structures. The conductivity-active area, which contains tightly packed halide anions sandwiched between fullerenes, provides good electron transfer property. Remarkably, residual DMSO in the side-chain area can induce aqueous Pd precursor into the highly conductive framework. After reduction, Pd nanoparticles are immobilized in the confined spaces within the conductive support. The resulting electrode can be used to electrooxidize ethanol. This study provides a facile solution strategy for the in situ fabrication of electrocatalysts on working electrodes, which can be applied in direct alcohol fuel cells.

Immunotolerant indoleamine-2,3-dioxygenase is increased in condyloma acuminata.

BACKGROUND: The tryptophan-depleting enzyme indoleamine-2,3-dioxygenase (IDO) is critical for the regulation of immunotolerance and plays an important role in immune-associated skin diseases. OBJECTIVES: To analyse the level of IDO in condyloma acuminata (CA) and its role in this condition. METHODS: IDO expression was assessed in the skin and peripheral blood of healthy controls and patients with CA. To assess the role of skin IDO in immunity, the ability of isolated epidermal cells to metabolize tryptophan and the influence on polyclonal T-cell mitogen (PHA)-stimulated T-cell proliferation were explored. RESULTS: IDO median fluorescence intensities in peripheral blood mononuclear cells from patients with CA were similar to those from healthy controls. Immunohistochemistry showed that IDO+ cells were rare in normal skin and the control skin of patients with CA, but were greatly accumulated in wart tissue. Most fluorescence signals of IDO+ cells did not overlap with those of CD1a+ Langerhans cells. Human papillomavirus (HPV) DNA probe in situ hybridization showed a large number of IDO+ cells in the HPV- site. Keratinocytes in the skin of healthy controls and the circumcised skin of patients with CA could minimally transform tryptophan into kynurenine, but IDO-competent epidermal cells from warts could transform tryptophan. In addition, these IDO-competent epidermal cells could inhibit PHA-stimulated T-cell proliferation. The addition of an IDO inhibitor, 1-methyl-d-tryptophan, restored the inhibited T-cell proliferation. CONCLUSIONS: Abnormally localized high IDO expression might be involved in the formation of a local immunotolerant microenvironment.

Serum uric acid predicts cardiovascular mortality in male peritoneal dialysis patients with diabetes.

BACKGROUND AND AIMS: Serum uric acid may predict mortality in diabetic patients and dialysis patients. However, the relationship between serum uric acid and prognosis in diabetic peritoneal dialysis (PD) patients is unclear. METHODS AND RESULTS: We conducted a cohort study of 1278 incident PD patients, (mean age 47.6 years), of which 328 (25.7%) had diabetes and 289 (22.6%) had diabetic nephropathy. During a median follow-up period of 30.7 months, 231 deaths occurred, of which 126 were ascribed to cardiovascular events. Mean serum uric acid was lower for diabetic patients than non-diabetic patients (6.8 ± 1.3 vs. 7.4 ± 1.4 mg/dL, respectively; P < 0.001). Cox regression models were adjusted for glycated hemoglobin, dialysis-related factors, traditional risk factors, and treatments. After adjustments, the highest sex-specific tertile of uric acid was associated with an increased risk of cardiovascular mortality (HR, 2.26; 95% CI, 1.14-4.48) compared to the lowest tertile in diabetic patients. Adjusted HRs per 1 mg/dL higher uric acid for all-cause and cardiovascular mortality were 1.09 (95% CI, 0.91-1.32) and 1.42 (95% CI, 1.13-1.79) for diabetic men and 1.06 (95% CI, 0.83-1.35) and 1.12 (95% CI, 0.78-1.61) for diabetic women, respectively. Elevated serum uric acid predicted a higher risk of all-cause and cardiovascular mortality in non-diabetic men but not in non-diabetic women. CONCLUSIONS: Elevated serum uric acid is an independent predictor of cardiovascular mortality in diabetic male PD patients.

Psychiatric disturbances regulate the innate immune system in CSF of conscious mice.

Environment may affect brain activity through cerebrospinal fluid (CSF) only if there are regulatory molecules or cascades in CSF that are sensitive to external stimuli. This study was designed to identify regulatory activity present in CSF, better elucidating environmental regulation of brain function. By using cannulation-based sequential CSF sampling coupled with mass spectrometry-based identification and quantification of proteins, we show that the naive mouse CSF harbors, among 22 other pathways, the innate immune system as a main pathway, which was downregulated and upregulated, respectively, by acute stressor (AS) and acute cocaine (AC) administrations. Among novel processes and molecular functions, AS also regulated schizophrenia-associated proteins. Furthermore, AC upregulated exosome-related proteins with a false discovery rate of 1.0 × 10(-)(16). These results suggest that psychiatric disturbances regulate the neuroimmune system and brain disorder-related proteins, presenting a sensitive approach to investigating extracellular mechanisms in conscious and various mouse models of psychiatric disorders.

Effect of propofol on twitch diaphragmatic pressure evoked by cervical magnetic stimulation in patients.

BACKGROUND: Several studies have demonstrated the inhibitory effect of propofol on diaphragmatic contractility in laboratory animals, but there have been few studies in humans. We have investigated the effect of a single bolus injection of propofol on twitch diaphragmatic pressure (TwPdi) evoked by cervical supramaximal magnetic stimulation, and its impact on diaphragmatic contractility. METHODS: In 16 patients scheduled for elective operation, TwPdi was evoked bilaterally at the cervical phrenic nerves with supramaximal magnetic stimulations using a 140 mm diameter magnetic coil. Changes of TwPdi were monitored dynamically before and during general anaesthesia induced by single bolus of propofol 2 mg kg (-1). During the study, all patients breathed 100% oxygen by a face mask, maintaining Sp(O(2)) > or = 99% and PE'(CO(2)) 4.6-5.2 kPa. RESULTS: TwPdi declined after administration of propofol with gradual recovery. Compared with baseline [20.6 (6.0) cm H(2)O], TwPdi decreased by 23.3% (P<0.001) to [15.8 (6.4) cm H(2)O]. When the patients regained awareness, TwPdi returned to [19.1 (6.1) cm H(2)O], close to baseline (P=0.063). The time from starting the propofol infusion to the lowest TwPdi was [240 (86) s]. Total time course of stimulation lasted [363 (89) s]. CONCLUSIONS: A single bolus propofol depressed TwPdi evoked by cervical magnetic stimulation, demonstrating inhibitory effects of propofol on diaphragmatic contractility in patients during general anaesthesia.

Mobility asymmetry in InGaAs/InAlAs heterostructures with InAs quantum wires.

Strong asymmetry of electron mobility in InGaAs/InAlAs heterostructures (lattice matched to InP) with the presence of InAs quantum wires was observed. Self-assembled InAs quantum wires, embedded in an InGaAs matrix close to the hetero-interface, has a strong effect in electron conduction in the interface channel. The low temperature mobility for electrons moving parallel to the quantum wires is much higher than that of electrons moving perpendicular to the wires. The asymmetry in mobility is attributed to the difference in scattering cross section of the quantum wires in these two directions.

The possibility of GST antigen from Chinese strain of Schistosoma japonicum for immunodiagnosis of schistosomiasis.

The GST antigen (called 26-28 kDa antigen) extracted and purified from Schistosoma japonicum adult worms was applied to the detection of specific antibodies in sera of infected mice and mice immunized with the above protein antigen by ELISA technique. The 26-28 kDa antigen was better than crude antigens (SEA, SWAP) when used to detect specific antibodies in sera from immunized mice. As with crude antigens (SEA and SWAP), the 26-28 kDa antigen could be used to detect specific antibodies in infected sera, with titers as high as 1:160-1:320. There were no false positive reactions and a positivity rate as high as that using SWAP occurred when the 26-28 kDa antigen was used in schistosomiasis patients and normal subjects by intradermal test. It is suggested that the 26-28 kDa antigen may be a suitable candidate for immunodiagnosis of schistosomiasis.

[Incidence of venous air embolism in parturients during cesarean section with regional anesthesia].

The purpose of the study is to probe the situation of venous air embolism (VAE) and the accompanying complications occurring in Chinese parturients in Taiwan during Cesarean section. Sixty ASA physical status class I-II parturients who were subjected to cesarean section under regional anesthesia were evaluated. The sensor of the Doppler device was placed on the anterior chest to detect the rumbles of air when it came to pass, and simultaneously the signs and symptoms following VAE were observed. Our results demonstrated that the usual or normal Doppler heart sound changed in 38 parturients out of 60 (63.3%), and the alteration occurred very often when the uterus was being incised (81.6%), or sutured (97.4%), and concurred strong correlation with such signs and symptoms such as chest tightness or precordial pain (78.9%), shortness of breath (60.5%), and change of heart rate or blood pressure (86.8%). The method of anesthesia (spinal or epidural block) did not have effect on the occurrence of VAE, but different surgical approaches and different positions in which the patients were posed during operation did apparently bring about VAE of variable degree. Besides, supplying of oxygen could mitigate the symptoms produced by VAE. Consequently, the application of Doppler monitor during Cesarean section can detect VAE earlier and more efficiently and thus provides information timely treatment.