Analysis of the hypovirulent Klebsiella pneumoniae with the NDM-5 gene on IncN plasmids.

IMPORTANCE: It is crucial to strengthen the ongoing clinical surveillance of non-highly virulent, multi-resistant Klebsiella pneumoniae.

Usage of intermingled skin allografts and autografts in a senior patient with major burn injury.

Mortality rate in older adults following extensive burn injury is extremely high, and management of these patients is challenging. One of the main problems is that autologous split-thickness skin grafts are scarce and the wounds cannot be covered quickly and effectively. Intermingled skin grafting is a low-tech and economic method, which not only maximizes the use of precious autologous skin but also prevents the wounds from infection and consumption. Herein we present a case of extensive burn injury in a 68-year-old female successfully treated with intermingled skin grafting. The patient was accidentally burned by gas flame, resulting in a major burn injury covering 80% of her total body surface area. Early burn wound excision was performed and the wound was temporarily covered with irradiated porcine skin in the first week after injury. Autologous stamp-like skin grafts were applied to the wound bed 4 weeks after injury. In this operation, the results were not satisfactory. The take rate of the skin grafts is only about 50%. We covered the wounds with intermingled skin allografts and autografts 8 weeks after injury: autografts (0.5 cm × 0.5 cm) + fresh close relative's allografts (1 cm × 1 cm) + cryopreserved allografts (2 cm × 2 cm).

Effect of electroacupuncture on arginine vasopressin-induced endolymphatic hydrops.

OBJECTIVE: To investigate the influence of electroacupuncture (EA) on experimentally induced endolymphatic hydrops (EH) in guinea pigs, and elucidate the association between the dehydrating effect of EA and changes in stria vascularis ultrastructure and expression of vasopressin type 2 receptor (V2R), cyclic adenosine monophosphate (cAMP), and aquaporin 2 (AQP2) in the endolymphatic sac (ES). METHODS: The EH model was established by intraperitoneal injection of arginine vasopressin (AVP). As a treatment, EA was delivered to Baihui (GV 20) and Tinggong (SI 19) acupoints, once daily for 10 consecutive days. For histomorphological studies, degree of cochlear hydrops was evaluated by hematoxylin-eosin staining, and the ratio of scala media (SM) area to SM + scala vestibuli area was calculated. In mechanical studies, ultrastructural changes in stria vascularis tissue were examined by transmission electron microscopy. In addition, cAMP levels and mRNA expression levels of V2R and AQP2 in the ES were compared among groups. RESULTS: EA treatment significantly reduced cochlear hydrops compared with hydropic guinea pigs (P = 0.015). Furthermore, EA attenuated ultrastructural changes in the stria vascularis tissue following EH, significantly upregulated the expression of V2R (P = 0.016), and attenuated AVP-induced upregulation of both cAMP (P = 0.038) and AQP2 expression (P = 0.017) in the ES. CONCLUSION: Collectively, the results of the present study suggest that the dehydrating effect of EA is associated with improvement of stria vascularis ultrastructure and V2R-cAMP-AQP2 signaling pathway regulation in the ES.

Arginine Vasopressin-Aquaporin-2 Pathway-Mediated Dehydration Effects of Electroacupuncture in Guinea Pig Model of AVP-Induced Eendolymphatic Hydrops.

OBJECTIVE: To investigate the effects of electroacupuncture (EA) on endolymphatic hydrops (EH) and the regulation of arginine vasopressin (AVP)-aquaporin-2 (AQP2) pathway in guinea pigs. METHODS: EH was induced in male guinea pigs by an intraperitoneal injection of AVP. For the treatment, EA was delivered to Baihui (GV 20) and Tinggong (SI 19) acupoints, once per day for 10 consecutive days. In histomorphological studies, cochlear hydrops degree was evaluated by hematoxylin-eosin (HE) staining, and then the ratio of scala media (SM) area to SM + scala vestibuli (SV) area (R value) was calculated. In mechanical studies, a comparison of plasma AVP (p-AVP) concentrations, cyclic adenosine monophosphate (cAMP) levels, vasopressin type 2 receptor (V2R) and AQP2 mRNA expressions in the cochlea were compared among groups. RESULTS: EA significantly reduced cochlear hydrops in guinea pigs (P=0.001). EA significantly attenuated the AVPinduced up-regulation of p-AVP concentrations (P=0.006), cochlear cAMP levels (P=0.003) and AQP2 mRNA expression (P=0.016), and up-regulated the expression of V2R mRNA (P=0.004) in the cochlea. CONCLUSIONS: The dehydrating effect of EA might be associated with its inhibition of AVP-AQP2 pathway activation.

[Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization: a randomized controlled trial].

OBJECTIVE: To verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization. METHODS: A total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with Han's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group. RESULTS: VAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all P<0.05). After treatment, VAS score, UCLA score and ROM in the combined therapy group were remarkably improved as compared with those in the EA group and the rehabilitation group (all P<0.05). Regarding the improvements of VAS and UCLA scores, the results in the EA group were better than those in the rehabilitation group (both P<0.05). Regarding ROM improvement, the results in the rehabilitation group were superior to those in the EA group (all P<0.05). There was no adverse reaction in the two groups. CONCLUSION: The combined therapy of EA and Mulligan's mobilization relieves shoulder joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.

The Efficacy of Acupuncture for the Treatment of Cervical Vertigo: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aims to evaluate the efficacy and safety of acupuncture for the treatment of cervical vertigo (CV). METHODS: Randomized controlled trials (RCTs) regarding effectiveness of acupuncture for treating CV were searched in 7 comprehensive databases prior to April 2016. The data analysis was performed by using RevMan version 5.3. RESULTS: A total of 10 studies with 914 participants were included. Results showed that acupuncture was more effective than conventional medicine therapy (CMT) in effectiveness, improvement rate of vertigo and headache, and increased average blood flow velocity of vertebral-basilar artery. In the subgroup analysis, the results did not change in different acupuncture methods and drug categories substantially. Sensitivity analysis demonstrated that the results of this meta-analysis were stable. Meanwhile, the long-term safety of acupuncture for CV still remains uncertain. GRADE analysis indicated that the quality of evidence for all outcomes was from very low to low which limited the value of the meta-analysis. CONCLUSION: Based on the systematic review, acupuncture appeared to be a promising therapeutic approach for CV based on low or very low quality of evidence. However, large-scale and high-quality trials are required to provide stronger evidence for the conclusion.

[Protective effects of valproic acid on gut barrier function after major burn injury and its mechanism].

OBJECTIVE: To investigate the potential protective effects of valproic acid (VPA) on gut barrier function after major burn injury in rats and its mechanism. METHODS: Forty male Sprague-Dawley (SD) rats were divided into sham + normal saline (NS), sham + VPA, scald + NS, and scald + VPA groups, with 10 rats in each group. Rat with 55% total body surface area (TBSA) third-degree severe-burns model was reproduced by immersing into 80 °C water, and the rats in sham groups were given sham-burns by immersing into 37 °C water. The rats after severe-burns were immediately treated with 0.25 mL of 300 mg/kg VPA or NS by subcutaneous injection. Rats were sacrificed at 2 hours and 6 hours after injury, and abdominal aortic blood and ileal tissue were harvested. The levels of vascular endothelial growth factor (VEGF) were determined by enzyme-linked immunosorbent assay (ELISA). The intestinal permeability was evaluated by fluorescein isothiocyanate-dextran (FITC-dextran) determination. The histomorphological changes in gut barrier were evaluated by Chiu grading system. Levels of acetylated lysine at the ninth position of histone 3 protein (Ac-H3K9), hypoxia-inducible factor 1α (HIF-1α), zona occludens 1 (ZO-1) and myosin light chain kinase (MLCK) were determined by immunofluorescence staining and Western Blot. RESULTS: Compared with sham + NS group, rats in scald + NS group showed intestinal mucosal damage 2 hours after burn injury, as well as increased mucosal permeability, protein expression levels of HIF-1α, VEGF, MLCK, and lowered levels of AC-H3K9 and ZO-1. These changes were much more prominent at 6 hours after injury. VPA treatment significantly attenuated the burn-induced intestinal damage. Compared with scald + NS group, the protective effects in scald + VPA group was not evident at 2 hours after injury; however, intestinal damage was much less severe at 6 hours after injury (Chiu score: 2.03±0.27 vs. 3.12±0.15), intestinal permeability was significantly decreased [FITC-dextran (µg/L): 709±76 vs. 1 138±75], histone acetylation was enhanced [Ac-H3K9 (gray value): 1.55±0.12 vs. 0.48±0.12], ZO-1 degradation was significantly inhibited (gray value: 0.69±0.12 vs. 0.43±0.16), the protein expression levels of VEGF and MLCK were significantly down-regulated [VEGF (ng/mg): 51.7±3.7 vs. 71.2±4.3, MLCK (gray value): 1.98±0.20 vs. 2.80±0.24], while the HIF-1α protein expression levels were significantly reduced at both 2 hours and 6 hours after injury (gray value: 2.50±0.39 vs. 3.88±0.42 at 2 hours, 1.83±0.42 vs. 4.42±0.41 at 6 hours, all P < 0.05). CONCLUSIONS: Severe burn injury can induce histone deacetylation, ZO-1 degradation and intestinal barrier dysfunction. VPA can improve the levels of histone acetylation and ZO-1, and protect intestinal epithelial barrier function. These may probably be mediated through inhibiting HIF-1α and its downstream gene VEGF and MLCK.

Fluoroscopy versus ultrasonography guided mini-percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease.

The objective of the study was to compare the therapeutic outcomes between the ultrasonography-guided (USG) and the fluoroscopy-guided (FG) mini-percutaneous nephrolithotomy (MPCNL) for the treatment of large or complex upper urinary tract stones (S.T.O.N.E. scores 5-11) in patients with autosomal dominant polycystic kidney disease (ADPKD). 45 ADPKD patients who were suffering from large or complex upper urinary tract stones (S.T.O.N.E. scores 5-11, mean score 7.6) in 45 renal units were accrued into this retrospective study. They were treated by either USG (20 patients) or FG (25 patients) MPCNL in our center. The treatment results as well as the complications according to the modified Clavien system were assessed and compared. The FG MPCNL group had a higher success rate in accessing the targeted calyces than the USG MPCNL group (96 vs. 70 %, p = 0.048). There was no significant difference observed between the two groups with respect to the operative time, the mean hemoglobin drop, and the stone free rate. The overall operative complications and the perioperative blood transfusion rates were significantly higher in the USG than the FG MPCNL groups, 71.4 vs. 29.2 %, p = 0.011, and 35.7 vs. 4.2 %, p = 0.018, respectively. There was no significant difference between these two groups in terms of major complications (Clavien score 3a-4a) (p = 0.542). In our center, the FG MPCNL was a superior modality to the USG MPCNL in the treatment of large or complex kidney stones in the ADPKD patients. It resulted in higher successful calyceal punctures and less operative complications.

[Analgesic Effect and Mechanism of Electroacupuncture on Rats with Chronic Inflammatory Pain].

OBJECTIVE: To observe analgesic effect of electroacupuncture ( EA) on rats with chronic inflammatory pain and its regulatory mechanism on ispilateral dorsal root ganglion (DRG) and spinal dorsal horn (SDH) Mas-related G protein-coupled C receptor (MrgprC). METHODS: Totally 40 healthy male SD rats were divided into 4 groups according to random number table, i.e., the normal (N) group, the model (M) group, the acupuncture (Acu) group, the EA group, 10 rats in each group. The model of chronic inflammatory pain was established by subcutaneous injecting 0. 1 mL complete Freund's adjuvant (CFA) into right hind paw. Paw withdrawal thresholds (PWTs) were measured before modeling, at day 1, 3, 5, 7, and after CFA injection, respectively. Expression levels of MrgprC in ispilateral DRG and SDH were detected by Western blot. The content of bovine adrenal medulla 22 (BAM22) in SDH was detected by immunohistochemical assay. RESULTS: Compared with N group at each time point, PWTs significantly decreased in M group (P <0. 01). Compared with M group, PWTs significantly increased at day 5 of EA and after EA in EA group (P < 0.05, P < 0.01). Compared with Acu group at each time point, post-EA PWTs significantly increased in the EA group (P < 0.05). Compared with N group, expression of MrgprC in ispilateral DRG and ratio of BAM22 positive cells in ispilateral SDH increased in M group (P < 0.01). Compared with M group, expression of MrgprC in ispilateral DRG and ratio of BAM22 positive cells in ispilateral SDH increased in the EA group (P < 0.05). CONCLUSION: EA had favorable analgesic effect on chronic inflammatory pain induced by CFA, and its mechanism might be possibly associated with up-regulating MrgprC expression in ispilateral DRG and BAM22 content in ispilateral SDH.

Acupuncture Points Stimulation for Meniere's Disease/Syndrome: A Promising Therapeutic Approach.

Objective. This study aims to explore evidence for acupuncture points stimulation (APS) in treatment of Meniere's disease (MD). Method. A literature search was conducted in seven databases including EMBASE, Medline, Cochrane Library, Web of Science, CBM, CNKI, and WangFang database and the data analysis was performed by using the RevMan version 5.3. Results. 12 RCTs with 993 participants were acquired after the search. The quality of most eligible studies was very low which limited the value of the meta-analysis. Compared with western medicine comprehensive treatment (WMCT), the APS alone or in combination with WMCT had a significant positive effect in controlling vertigo; however, the result was negative in hearing improvement and DHI. No adverse events were reported in the studies. Conclusion. The APS might be a promising therapeutic approach for MD. However, the currently available evidence is insufficient to make a definitive conclusion for the poor quality of included studies. More high-quality researches with larger sample size are urgently needed to assess the effectiveness and safety.

["Dredging governor vessel" for cervical vertigo with deficiency of qi and blood:a randomized controlled trial].

OBJECTIVE: To compare the effect differences of acupuncture of dredging the governor vessel (GV) and conception vessel (CV) for cervical vertigo with deficiency of qi and blood so as to provide Objective evaluation and guide for clinical treatment. METHODS: A total of 60 patients were randomly divided assigned into an observation group and a control group, 30 cases in each one. The acupoints of the observation group were mainly in the GV, namely Shenting (GV 24), Baihui (GV 20), Fengfu (GV 16), Dazhui (GV 14), Shenzhu (GV 12), Jiaji (EX-B 2) of C6 and C7, Zusanli (ST 36) and Sanyinjiao (SP 6). The acupoints of the control group were mainly in the CV, including Danzhong (CV 17), Zhongwan (CV 12), Xiawan (CV 10), Guanyan (CV 4), Qihai (CV 6), Jiaji (EX-B 2) of C6 and C7, Zusanli (ST 36) and Sanyinjiao (SP 6). Acupuncture was given once every other day and 10 treatments were taken as one course. After 2-course treatment, the changes before and after treatment of the scores of symptoms of cervical vertigo and functional evaluation scale, the scores of symptoms of deficiency of qi and blood, the mean blood flow rate of vertebral-basilar artery were observed. Also, the effects were evaluated. RESULTS: (1) The cured and effective rate and total effective rate of the observation group were 76.7% (23/30) and 93.3% (28/30), which were better than 46.7% (14/30) and 70.0% (21/30) of the control group (both P<0.05). (2) As for the scores of symptoms of cervical vertigo and functional evaluation scale and the mean blood flow rate, the results were obviously improved after treatment in the two groups (all P<0.05), with superiority in the observation group (all P<0.01). (3) After treatment,the scores of the symptoms of deficiency of qi and blood were decreased obviously in the two groups (all P<0.05). As to fatigue,facial expression,tongue and pulse condition,there was no statistical significance between the two groups after treatment (all P>0.05),but treatment for palpitation and shortness of breath achieved better effect in the control group(P<0.01). CONCLUSIONS: The effect of dredging the GV for cervical vertigo with deficiency of qi and blood is superior to that of acupuncture mainly in the CV,which can improve the symptoms of cervical vertigo and the mean blood flow rate of vertebral-besilar better. But acupuncture at acupoints both in the GV and CV may be better for the patients with syndrome of deficiency of qi and blood seriously.

[Analysis of liver damage and reactivation of hepatitis B virus in hepatitis B surface antigen positive patients after extremely severe burn injury].

OBJECTIVE: To analyze the development of liver damage and reactivation of hepatitis B virus (HBV) during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn. METHODS: Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen (HBeAg) and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test. RESULTS: (1) The incidence of liver damage in the process of treatment of these patients was 85.2% (46/54). Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female (11/16, χ² = 4.867, P<0.05). Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission (20/28), patients who were HBV DNA negative on admission (12/20), and patients who did not develop sepsis in the process of treatment (10/18), with χ² values respectively 11.801, 18.384, and 20.574, P values below 0.01. (2) The incidence of HBV reactivation in these patients was 29.6% (16/54). Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them (χ² = 0.656, P>0.05). The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, and patients who developed sepsis in the process of treatment were respectively 13/26, 16/34, and 15/36, and they were significantly higher than those in patients who were HBeAg negative on admission (3/28), patients who were HBV DNA negative on admission (0/20), and patients who did not develop sepsis in the process of treatment (1/18), with χ² values respectively 9.979, 18.615, and 5.873, P<0.05 or P<0.01. CONCLUSIONS: Patients who are HBsAg positive, HBeAg positive, HBV DNA positive on admission, and develop sepsis in the process of treatment of extremely severe burn injury are more likely to develop liver damage and HBV reactivation. It is necessary to dynamically monitor the changes in HBV DNA and liver function, in order to identity the reactivation of virus.

[Effects of electroacupuncture on cochlea morphology and expression of aquaporins in guinea pigs with endolymphatic hydrops].

OBJECTIVE: To observe the effects of electroacupuncture (EA) on cochlea morphology and expression of aquaporin 1 (AQP1) in guinea pigs with endolymphatic hydrops, so as to explore the possible mechanism of EA on endolymphatic hydrops. METHODS: Forty guinea pigs were randomly divided into a blank group, a model group, a medication group and an EA group, 10 guinea pigs in each one. Model of endolymphatic hydrops was established by using intraperitoneal injection of aldosterone. Guinea pigs in the blank group and model group were treated with identical immobilization as EA group but no treatment was given; guinea pigs in the medication group were treated with intragastric administration of hydrochlorothiazide at a dose of 5 mg/kg, once a day for consecutive 10 days; guinea pigs in the EA group were treated with' EA at "Baihui" (GV 20) and "Tinggong"(SI 19), once a day for consecutive 10 days. The serum ionic concentration in each group was tested by turbidimetric method; hematoxylin-eosin staining was used to measure the severity of cochlea hydrops; immunohistochemical method was used to observe the expression of AQP1 in the cochlea. RESULTS: (1) There was no endolymphatic hydrops in the blank group, moderate-severe endolymphatic hydrops in the model group and slight endolymphatic hydrops in the EA group and medication group. (2) The concentration of K+ and Ca2+ in the EA group was higher than that in the model group and medication group (all P<0. 01); the concentration of Na+ was lower than that in the model group (P< 0. 01) but higher than that in the medication group (P<0. 01); the concentration of Cl- was higher than that in the medication group (P<0. 01), but not significantly different from the model group (P>0. 05). (3) The ratio of expression area of AQP1 in the model group was lower than that in the blank group (P<0. 01); the ratio of expression area of AQP1 in the EA group was higher than that in the model group (P<0. 01), and lower than that in the medication group without significant difference (P>0. 05). CONCLUSION: EA could relieve the endolymphatic hydrops in guinea pigs; the mechanism is likely to be related with up-regulating the expression of AQP1 in cochlea and ion concentration might be an important factor involved.

Guidelines for burn rehabilitation in China.

Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

[Classification and management of sternal wound complications after cardiac surgery].

OBJECTIVE: To define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment. METHODS: Between July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years (mean, 49.5 years). The disease duration was 13-365 days (mean, 26.6 days) with a wound length of 1-25 cm (mean, 13.4 cm). The wounds were divided into type I (n = 70), type II (n = 64), type III (n = 42), type IV (n = 78), and type V (n = 6) according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type I and type II were repaired with local flap transplantation; wounds of type III were repaired with local flap transplantation combined with butterfly sternal fixation (n = 28), with bilateral pectoralis muscle flap combined with butterfly sternal fixation (n = 11), and with bilateral pectoralis muscle flap (n = 3); wounds of type IV were repaired with bilateral pectoralis muscle flap (n = 65), rectus abdominis muscle flap (n = 5), and pedicled omental flap (n = 8); and wounds of type V were repaired with pedicled omental flap. RESULTS: All the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type IV and 2 cases of type V. The hospitalization time were 4-86 days (mean, 18.3 days). Primary wound healing was obtained in 248 cases (96.5%); poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case. CONCLUSION: The surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.

[Effect of bone marrow mesenchymal stem cells on lipopolysacharide-induced secretion of inflammatory cytokines in rat macrophages in vitro].

OBJECTIVE: To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) on secretion of inflammatory cytokines in macrophages stimulated by lipopolysacharide (LPS). METHODS: Rat BMSCs and macrophages were isolated, cultured, and identified. The BMSCs and macrophages, cultured alone or in co-culture, were treated with LPS or PBS or without treatment and tested for interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) concentrations in the supernatants at 1, 3, 5, 7, 12, and 24 h after the treatment using enzyme-linked immunosorbent assay. RESULTS: Exposure to LPS caused significantly increased IL-10 and TNF-α concentrations in the supernatant of cultured macrophages but not in BMSC culture. Macrophages co-cultured with BMSCs showed significantly lowered IL-10 and TNF-α secretions in response to LPS exposure as compared with the macrophages cultured alone. CONCLUSION: BMSCs can reduce LPS-induced secretion of inflammatory cytokines by the macrophages to ameliorate inflammatory reactions.

[Study on rules of acupoints selection for vertigo in ancient acupuncture].

The characteristics of selection and matching acupoint and application rules of meridians in ancient acupuncture literature for vertigo were explored. The data were collected from literature regarding acupuncture for vertigo from the pre-Qin period to Qing dynasty and then database was established. Frequency statistics method and comparison of support degree were applied to analyze and explore application rules of acupoints and meridians, while association rules in data mining was used to extract combinations of acupoints. As a result, for treatment of vertigo, according to frequency of use and support degree, generally the most selected acupoints, in turn, were Fengchi (GB 20), Shangxing (GV 23), Yanggu (SI 5), Jiexi (ST 41), Zulinqi (GB 41) and Shenting (GV 24), etc.; the most methods for matching acupoint were combination of adjacent acupoints, combination of same-meridian acupoints, combination of the superior-inferior acupoints, combination of yang-meridian and yang-meridian acupoints and combination of child-mother meridians acupoints; the most selected meridians were bladder meridian of foot-taiyang, gallbladder meridian of foot-shaoyang and governor vessel. Compared between the ancient and modern literature, it was found out that the ancient and modern clinic has same points in selection of acupoint-meridian and matching acupoints methods. However, the use of Yanggu (SI 5), Jiexi (ST 41) and Feiyang (BL 58) as well as combination of child-mother meridians acupoints were less seen in modern clinic, which could provide new reference.

Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013.

Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.

[Clinical application of low-molecular-weight heparin (Fraxiparine) in rescuing venous crisis of island skin flap].

OBJECTIVE: To evaluate the clinical efficacy of low molecular weight heparin (Fraxiparine) in rescuing venous crisis of island skin flap. METHODS: Of the 73 patients with venous crisis of island skin flap, 47 received subcutaneous injection of low-molecular-weight heparin (group I) and 26 were treated with phlebotomy, local compression and topical application of unfractionated heparin solution gauze (group II). RESULTS: The flap survival ratio was (88.46∓8.64)% in group I and (38.37∓6.53)% in group II (P<0.001). At 0, 2, and 4 h after injection of low-molecular-weight heparin, the activated partial thromboplastin time (APTT) was obviously delayed (24.28∓6.71, 41.35∓7.64 and 32.34∓6.35, respectively, P<0.01), FXa:C level was significantly decreased (152.4∓30.7, 65.8∓24.4 and 83.4∓18.4, respectively, P<0.01), while FIIa:C level underwent no obvious alterations (155.70∓31.61, 143.20∓24.75, and 143.4∓23.35, respectively, P=NS). CONCLUSION: Fraxiparine has good antithrombotic efficacy in rescuing venous crisis of island skin flap without adverse effect on systemic coagulation.