Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection.

BACKGROUND AND AIMS: The unique anatomical and physiological function of the perineum region makes it difficult to be repaired after tumor resection. We aim to evaluate the efficacy of PSC divisional reconstruction strategy in the reconstruction of perineal skin defect. MATERIALS AND METHODS: This study includes patients undergoing perineal skin defect reconstruction with PSC strategy-P (penis), S (scrotum), C (circum-penoscrotal skin) divisional reconstruction strategy. RESULTS: From August 2013 to August 2018, 47 patients were enrolled in the surgical procedure. The defect area after resection measured 2 cm × 2.5 cm, minimum, and 12 cm × 18 cm, maximum. Among them, the cases involved one, two, and three zones are 12, 10, and 25, respectively. The skin defects were divisionally repaired. All flaps were well survived without complications or scar contracture. No tumor recurrence happened. CONCLUSION: The application of PSC divisional reconstruction strategy is a promising way to repair wounds in circum-penoscrotal skin area. Moreover, this strategy is easy to process and shows no significant complications during follow-up period.

[Epidemiological and etiological surveillance on infectious diarrhea in Pudong New Area, Shanghai, 2013-2017].

Objective: To understand the epidemiological characteristics of infectious diarrhea pathogens in Pudong New Areas of Shanghai from 2013 to 2017 to provide evidence for control and prevention of the disease. Methods: From Jan 2013 to Dec 2017, active surveillance program on diarrhea was conducted in 14 sentinel hospitals (three tertiary-level and nine secondary-level, and two primary-level hospitals) in Pudong New Areas of Shanghai, based on location, catchment areas and number of patients. All recruited outpatients were interviewed in hospitals, using a standard questionnaire. Stool specimens were collected and tested for five viral and eight bacterial pathogens. Results: A total of 9 301 cases with infectious diarrhea were included, and the overall positive rate was 55.7% (5 179). Positive rates of single virus, single bacteria and mixed infections were 26.7% (2 481), 17.0% (1 579) and 12.0% (1 119), respectively. For single infection, the most commonly detected viruses appeared as norovirus (15.4%, 1 428/9 301) and rotavirus (7.2%, 667/9 301). The most commonly detected bacteria were diarrheagenic Escherichia coli (6.7%, 619/9 301) and non-typhoid Salmonella (3.3%, 305/9 301). The most common mixed infections were caused by virus-bacteria (4.9%, 459/9 301). Norovirus (17.0%, 838/4 938) showed the highest positive rates, followed by Escherichia coli (7.2%, 354/4 938), both seen in the age group of 20-59 years old group. Rotavirus (9.4%, 178/1 896) and non-typhoid Salmonella (4.9%, 93/1 896) were the most common pathogens found in the age group of 0-4 years old. The prevalence of norovirus peaked both in spring and autumn. The other peaks were seen as: Rotavirus in winter, diarrheagenic Escherichia coli in summer and non-typhoid Salmonella in summer. Conclusions: Our data showed that the positive rates of infectious diarrhea pathogens were high in Pudong New Areas of Shanghai from 2013 to 2017. The dominant pathogens would include norovirus, rotavirus and diarrheagenic Escherichia coli but with differenct distributions in age groups. Obvious seasonal patterns were also observed.

[Analysis of the maternal glucolipid metabolism in twin pregnancies complicated by gestational diabetes mellitus].

Objective: To explore the characteristics of maternal glucose and lipid metabolism in twin pregnancies complicated by gestational diabetes mellitus (GDM). Methods: The clinical features of twin and singleton pregnancies complicated by GDM, which delivered in Peking University First Hospital from January 1st, 2012 to December 31st, 2017 were retrospectively analyzed. A total of 286 twin pregnancies with GDM (GDM-T group) were collected, and 572 singleton pregnancies complicated by GDM (GDM-S group) which were matched by delivery time in a ratio of 1∶2 among all singleton pregnancies with GDM. The characteristics of maternal glucolipid metabolism in the second trimesters of pregnancy was compared between two groups. Results: (1) Compared with GDM-S group, the maternal delivery age were lower [(32±4), (33±4) years] and prepregnancy body mass index (BMI) were higher [(24±4), (23±4) kg/m(2)] in GDM-T group, the differences were statistically significant (all P<0.05). The incidence of chronic hypertension was found no significant difference (P=0.581). (2) The 3 points of glucose values in 75 g oral glucose tolerance test (OGTT) and OGTT-area under curve (AUC) had no significant difference between GDM-T and GDM-S group.When compared with GDM-S group, the maternal glycosylated hemoglobin levels [(5.41±0.35)%, (5.32±0.28)%], the insulin resistance index (4.07±0.77, 2.63±1.50) and the proportion of insulin use (7.7%, 4.4%) were all significantly higher in GDM-T group (all P<0.05). The values of triglyceride [(3.4±1.4), (2.6±1.2) mmol/L], total cholesterol [(6.3±1.1), (6.0±1.0) mmol/L], low density lipoprotein cholesterol [(3.3±0.9), (3.1±0.8) mmol/L] were significantly higher and values of high density lipoprotein cholesterol [(1.7±0.4), (2.0±0.5) mmol/L] were significantly lower in GDM-T group than GDM-S group (all P<0.05). (3) There was no significant difference in the incidence of gestational hypertension between the two groups (P>0.05). When compared with GDM-S group, the incidences of preeclampsia and small for gestational age were both significantly higher (13.3% vs 2.4%; 28.7% vs 1.7%) and the incidence of large for gestational age was significantly lower in GDM-T group (4.5% vs 15.2%; all P<0.05). Conclusions: The insulin resistance is aggravated in twin pregnancies and the characteristics of lipid metabolism are different between singleton and twin pregnant women complicated by GDM, and there are more complications in twin GDM pregnancies.

A cross-sectional study of acute diarrhea in Pudong, Shanghai, China: prevalence, risk factors, and healthcare-seeking practices.

Diarrhea is a common cause of morbidity and mortality and the incidence of diarrhea in the world has changed little over the past four decades. To assess the prevalence of and healthcare practices for diarrhea, a cross-sectional study was conducted in Pudong, Shanghai, China. In October 2014, a total of 5324 community residents were interviewed. Respondents were asked if they had experienced diarrhea (defined as ⩾3 passages of watery, loose, bloody, or mucoid stools within a 24-h period) in the previous month prior to the interview. The monthly prevalence of diarrhea was 4·1% (95% CI: 3·3-4·8), corresponding to an incidence rate of 0·54 episodes per person-year. The proportion of individuals with diarrhea who sought healthcare was 21·2% (95% CI: 13·4-29·0). Diarrhea continues to impose a considerable burden on the community and healthcare system in Pudong. Young age and travel were identified as predictors of increased diarrhea occurrence.

Pedicled lower lid-sharing flap for full-thickness reconstruction of the upper eyelid.

PURPOSE: To explore the clinical effect of the pedicled lower lid-sharing flap for full-thickness reconstruction of the upper eyelid . METHODS: From 2009 to 2013, 13 upper eyelids with meibomian gland carcinoma (13 patients, age range 52-78 years) were excised, and immediately reconstructed with a pedicled lower lid-sharing flap used for full-thickness upper eyelid defects (up to two-thirds of the eyelid width). Traditionally, the flap is divided after 3 to 4 weeks, and the recipient site closed directly. RESULTS: During a 1-18-month follow-up period, no recurrence, lagophthalmos, hypertrophic scar, or bulky appearance was noted in any of the patients. Aesthetic results for the upper eyelid were obtained for all patients. CONCLUSIONS: We conclude that the pedicled lower lid-sharing flap is a safe and reliable method for reconstruction of full-thickness upper eyelid defects. This procedure not only enables eyelid closure for eye protection, but also directly improves the aesthetic appearance of the face. After second-stage surgery, a stable eyelid margin and lashes with good blood supply and an acceptable cosmetic appearance with regard to symmetry of eyelid height, contour, tarsal show, and skin fold were achieved.

Cloning and phylogenetic analysis of hemagglutinin gene of H9N2 subtype avian influenza virus from different isolates in China during 2002 to 2009.

Forty-seven strains of H9 subtype avian influenza viruses identified by specific reverse transcription-PCR method were isolated from the chicken and duck flocks in different areas of China during the 2002 to 2009 epizootic period. Hemagglutinin (HA) genes of these strains were sequenced and analyzed with the representative strains published in GenBank. The results indicated that the HA genes of these strains and the vaccine strains displayed nucleotide homologies ranging from 91.7 to 96.6% and amino acid homologies ranging from 92.3 to 95.7%, respectively. Analysis of the mature peptide sequences of these HA genes showed that the presence of leucine at position 216 (corresponding to residue 226 in H3 numbering) indicated a preference to the binding of alpha (2-6) sialic acid receptors, which was the same as human isolates. Extra potential glycosylation sites appeared in the HA genes of most tested isolations compared with the vaccine strains. The HA cleavage sites of most of the strains were the 335PSRSSR downward arrow GLF341, but all of the strains met the characteristics of low-pathogenic avian influenza. The results of phylogenetic analysis indicated that all 47 strains and the current vaccine strains belong to the same phylogenetic lineage h9.4.2, but they had some genetic deviation in the last decade. Compared with the vaccine strains, 7 mutations were found in the antigen epitope region of the HA genes of the field strains. These results suggested that the commercial vaccine might not induce satisfactory prevention against infection of H9N2 avian influenza virus.

Immunopathological effects of ochratoxin A and T-2 toxin combination on broilers.

The purpose of this study was to investigate the immunopathological effects of combinations of ochratoxin A (OTA) and T-2 toxin on broilers. Four hundred eighty 1-d-old broilers were randomly assigned to 4 groups, each group consisting of 4 duplicates each with 30 broilers. The 4 groups were fed the following diets for 4 wk: group 1=basal diet (control, mycotoxin-free); group 2=basal diet+2,000 mg/kg of Mycofix Plus; group 3=basal diet+0.25 mg/kg of OTA and 0.5 mg/kg of T-2; and group 4=basal diet+0.25 mg/kg of OTA and 0.5 mg/kg of T-2+2,000 mg/kg of Mycofix Plus. The feeding of OTA-T-2 toxin diets reduced (P<0.05) the level of anti-Newcastle disease virus antibody titers by 10.4%. When broilers were administered lipopolysaccharide, the results of real-time PCR showed that broilers fed OTA-T-2 toxin reduced the cytokine mRNA expression levels of interleukin-2 and interferon-gamma to some extent but not significantly (P>0.05). The concentrations of interleukin-2 and interferon-gamma in serum were significantly decreased (P<0.05) by OTA-T-2 toxin combination. Histopathological studies demonstrated that OTA-T-2 toxin combination caused abnormalities in the thymus, bursa of Fabricius, spleen, and liver. Ochratoxin A-T-2 toxicity could be counteracted by Mycofix Plus partially but not significantly (P>0.05). The concentrations of OTA and T-2 toxin used in this study are under the maximum tolerated levels recommended by Canadian Food Inspection Agency. Our study clearly put the standard and detoxification method for these toxins into question. We suggest that it may be time to reduce the maximum allowable limits of OTA and T-2 mycotoxins in feeds to improve animal health and the safety of the food chain.

Molecular detection of Muscovy duck parvovirus by loop-mediated isothermal amplification assay.

Muscovy duck parvovirus (MDPV) usually causes high morbidity and mortality in 1- to 3-wk-old Muscovy ducklings due to serious infections, which is an imminent threat to the commercial duck industry in China. The objectives of this study were to develop and evaluate a simple, rapid, and inexpensive loop-mediated isothermal amplification (LAMP) method for specific detection of MDPV and to compare it with the PCR method in rapidity, sensitivity, and accuracy. The novel LAMP assay used a set of 4 specific primers to recognize 6 distinct genomic sequences of capsid protein (VP3) from MDPV, which could be completed within 50 min at 63 degrees C in a simple water bath. The diagnostic results demonstrated that the LAMP assay detected all 7 preserved MDPV isolates, had no cross-reactivity with other duck pathogens (i.e., goose parvovirus, duck plague virus, H9N2 avian influenza virus, duck hepatitis type virus I, and Muscovy duck reovirus). The LAMP assay was at least 10-fold more sensitive than the routine PCR assay and obtained more sensitivity in 61 clinical samples. Therefore, the newly developed LAMP assay provides a specific and sensitive means for detecting MDPV and can be simply applied both in field conditions and in laboratory operations in a cost-effective manner with primary care facilities.

Preparation and immune activity analysis of H5N1 subtype avian influenza virus recombinant protein-based vaccine.

Avian influenza is a severe disease among farmed poultry and free-living birds and a constant threat to the commercial chicken industry around the world. Hemagglutinin (HA) is the major immunogen on the envelope of influenza A virus and is the predominant inducer of neutralizing antibody. To obtain the bioactive antigen proteins in large quantities, a new protein expression vector pBCX was constructed, which is based on the pET32a vector. The HA gene of the H5N1 subtype of avian influenza virus (AIV) was inserted into the pBCX vector and expressed efficiently in Escherichia coli BL21 (DE3). Fused expression of the exogenous gene and msyB produced a 97-kDa msyB-HA fusion protein. Sodium dodecyl sulfate-PAGE combined with scanning analysis demonstrated that the msyB-HA fusion protein accounted for 29.5% of the total bacterial protein, 90.5% being soluble. The msyB-HA fusion protein was purified with nondenaturing 50% Ni-NTA column chromatography, and the result showed that 24 mg of purified msyB-HA fusion protein could be obtained from 1 L of induced expression bacterial culture medium. The comparative results in the present study showed that pBCX was superior to pET32a as a protein expression vector. Western blotting showed the recombinant msyB-HA (rHA) to have better antigenic activity, which may be the result from the better posttranslation protein modification and folding in the pBCX expression system. With the rHA fusion protein as antigen, we successfully prepared and screened specific monoclonal antibodys against the H5N1 subtype AIV, which indicated that the rHA had antigen epitopes and biofunctions. The immune test confirmed that the rHA protein vaccine could also induce high neutralizing antibodies, and the AIV challenge test proved that the rHA protein-based vaccine could prevent the corresponding infection. This study demonstrates that the recombinant HA protein produced by the pBCX expression system could be used as a recombinant protein-based vaccine and has potential for further development for diagnosis.

The axial frontonasal flap for reconstruction of large nasal-tip defects based on modified nasal subunits in East Asians.

The nasal tip is a prominent landmark on the face, and skin carcinomas of this area are very common. Moderate and large deep skin defects of the nasal tip normally represent a difficult reconstructive challenge. Nasal-tip reconstruction techniques have evolved to allow not only filling of the gap, but cosmetic and functional retention. Numerous flap options are available to reconstruct the defect of the tip of the nose. In this paper, we report the technique of the axial frontonasal flap and its use in reconstruction of large nasal-tip defects in East Asians. The axial frontonasal flap described is a good alternative for reconstruction of nasal-tip defects > 15 mm in diameter, with excellent aesthetic results. This technique is reliable, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defects of the nasal tip.

Effects of combinations of ochratoxin A and T-2 toxin on immune function of yellow-feathered broiler chickens.

The study was to investigate the effects of combinations of ochratoxin A (OTA) and T-2 toxin on immune function of yellow-feathered broiler chickens. Three-hundred sixty 21-d-old broiler chickens were randomly assigned to 3 groups, each group consisting of 4 duplicates each with 30 chickens. The 3 groups were fed the following diets for 3 wk: C, basal diet (control, mycotoxin-free); L, basal diet + 0.25 mg/kg of OTA, 0.5 mg/kg of T-2 toxin; and H, basal diet + 0.5 mg/kg of OTA, 1 mg/kg of T-2 toxin. Body weight and feed consumption of chickens in the H group decreased significantly (P < 0.05) during the study, but their efficiency of feed utilization was not affected. The feeding of OTA-T-2 toxin diets decreased not only the relative weight of spleen, thymus, and bursa of Fabricius, but also serum concentrations of total protein, albumin, and globulin. Meanwhile, the feeding of OTA-T-2 toxin diets elevated the activities of serum gamma-glutamyltransferase, asparate aminotransferase, and alanine aminotransferase. The results of methyl thiazolyl tetrazolium reduction assay indicated that the mitogenic responses of peripheral blood lymphocytes were diminished significantly (P < 0.05 for L group; P < 0.01 for H group). Flow cytometry was employed to determine 3 indexes in peripheral blood lymphocyte of broilers, including CD4(+)/CD3(+), CD8(+)/CD3(+), and CD4(+)/CD8(+). Both toxin treatments significantly decreased (P < 0.01) CD4(+)/CD3(+) and CD4(+)/CD8(+) ratios. In summary, the combination of OTA and T-2 toxin impaired chick immune function even at combined concentrations as low as 0.25 mg/kg of OTA and 0.5 mg/kg of T-2 toxin.

In situ localization of infectious bursal disease virus-binding cells by a biotin-streptavidin system.

A biotin-streptavidin system was established to directly visualize infectious bursal disease virus (IBDV)-binding cells in cell culture or in fresh tissues. The cells or tissue sections were first incubated with a biotinylated, purified IBDV strain GZ911 and then with a streptavidin-beta-galactosidase conjugate. In the presence of the enzyme substrate X-gal, IBDV-binding cells were labeled in blue color. By applying this method to frozen tissue sections, virus-binding sites were localized in situ in the bursa, spleen, and kidney tissue sections, whereas no positive cells were detected in the thymus tissue sections. Chicken embryo fibroblasts, Vero cells, MOP-8 cells, 293-EBNA cells, PANC-1 cells, and HuTu 80 cells were found to bind to the virus. However, the binding of the virus to MDA-MB-231 cells and SVG p12 cells was undetectable. This method can be employed for the expressional cloning of IBDV receptor and can be applied to studies on other avian viruses.

Different origin of hypertriglyceridemia induced by a high-fat and a high-sucrose diet in ventromedial hypothalamic-lesioned obese and normal rats.

OBJECTIVE: To clarify the mechanism by which plasma triacylglycerol is affected by a high fat or a sucrose diet. DESIGN: Two sets of six groups each having six rats were prepared-(1) ventromedial hypothalamic (VMH)-lesioned rats fed a standard diet; (2) sham VMH-lesioned rats fed a standard diet; (3) VMH-lesioned rats fed a high-fat diet; (4) sham VMH-lesioned rats fed a high-fat diet; (5) VMH-lesioned rats fed a high-sucrose diet; and (6) sham VMH-lesioned rats fed a high-sucrose diet. After VMH lesions and sham operations, the rats were provided standard, high-fat and high sucrose diets for 2 weeks. Two weeks later, blood samples were collected after overnight fast to determine plasma triacylglycerol (TAG), hepatic triacylglycerol secretion rate (TGSR), fractional catabolic rate (FCR) of triacylglycerol and postheparin plasma lipoprotein lipase (LPL), plasma glucose, insulin and leptin. RESULTS: Values of TAG, TGSR, FCR and LPL in VMH-lesioned obese rats were all greater than those in sham-operated rats, regardless of the diet fed. In sham-operated rats, high-fat diet fed rats showed higher TAG with similar TGSR, higher LPL and lower FCR than those of standard diet fed rats. High-sucrose diet fed rats showed significantly higher TAG with higher TGSR, higher LPL and lower FCR than those of standard diet fed rats. Moreover, high-sucrose diet fed rats showed higher TAG with higher TGSR, lower LPL and higher FCR than those of high-fat diet fed rats. In VMH-lesioned rats, high-fat diet fed rats showed higher TAG with similar TGSR, higher LPL and lower FCR than those of standard diet fed rats. High-sucrose diet fed rats showed markedly higher TAG with notably higher TGSR, higher LPL and lower FCR than those of standard diet fed rats. High-sucrose diet fed rats showed still higher TAG with markedly higher TGSR, similar LPL and higher FCR than those of high-fat diet fed rats. CONCLUSIONS: The mechanism by which TAG metabolism is affected by a high-fat or a high-sucrose diet differed; a high-fat diet increased plasma TAG level by lowering removal of TAG without increase in hepatic TAG secretion in sham-operated (normal) rats. A high-sucrose diet, in contrast, induced much higher plasma TAG levels by both increased hepatic TAG secretion and decreased removal of TAG. The effects of a high-fat or a high-sucrose diet were similar but exaggerated in VMH lesioned animals.

[Assessment of application of computerized local anesthetic delivery system in periodontal ligament injection].

OBJECTIVE: To assess the pain intensity and anesthetic effect in peridontal ligament injection using the computerized local anesthetic delivery system made by Milestone company in USA. METHODS: 40 cases were selected,and comparing the periodontal ligament injection through using the computerized local anesthetic delivery with traditional manul local anesthesia. RESULTS: By using the computerized local anesthetic delivery system the pain in peridontal ligament injection was significantly less than traditional methods. There was no difference in anesthetic effect when teeth were extracted. CONCLUSION: The peridontal ligament injection usually as an adjunctive anesthesia method could attain good anesthetic effect and would have a wide application by using the computerized local anesthetic delivery system.