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Introduction: Angong Niuhuang Wan (AGNHW), developed during the Qing dynasty (18th century) for the treatment of consciousness disturbances caused by severe infections, has been used to treat brain edema caused by ischemia‒reperfusion. However, it remains unclear whether AGNHW can ameliorate vascular-origin brain edema caused by lipopolysaccharides (LPS). This study explored the ameliorative effects of AGNHW on LPS-induced cerebrovascular edema in mice, as well as the potential underlying mechanisms. Methods: A cerebrovascular edema model was established in male C57BL/6N mice by two intraperitoneal injections of LPS (15 mg/kg), at 0 and 24 h. AGNHW was administered by gavage at doses of 0.2275 g/kg, 0.455 g/kg, and 0.91 g/kg, 2 h after LPS administration. In control mice, normal saline (NS) or AGNHW (0.455 g/kg) was administered by gavage 2 h after intraperitoneal injection of NS. The survival rate, cerebral water content, cerebral venous FITC-dextran leakage, Evans blue extravasation, and expression of vascular endothelial cadherin (VE-cadherin), zonula occludens-1 (ZO-1), claudin-5, phosphorylated caveolin-1 (CAV-1), and cytomembrane and cytoplasmic aquaporin 1 (AQP1) and aquaporin 4 (AQP4) were evaluated. The cerebral tissue phosphoproteome, blood levels of AGNHW metabolites, and the relationships between these blood metabolites and differentially phosphorylated proteins were analyzed. Results: AGNHW inhibited the LPS-induced decrease in survival rate, increase in cerebral water content, decrease in VE-Cadherin expression and increase in phosphorylated CAV-1 (P-CAV-1). AGNHW treatment increased the expression of AQP4 on astrocyte membrane after LPS injection. AGNHW also inhibited the LPS-induced increases in the phosphorylation of 21 proteins, including protein kinase C-α (PKC-α) and mitogen-activated protein kinase 1 (MAPK1), in the cerebral tissue. Eleven AGNHW metabolites were detected in the blood. These metabolites might exert therapeutic effects by regulating PKC-α and MAPK1. Conclusion: AGNHW can ameliorate cerebrovascular edema caused by LPS. This effect is associated with the inhibition of VE-Cadherin reduction and CAV-1 phosphorylation, as well as the upregulation of AQP4 expression on the astrocyte membrane, following LPS injection.

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Estuaries, as connectors between land and ocean, have complex interactions of river and tidal flows that affect the transport of buoyant materials like floating plastics, oil spills, organic matter, and larvae. This study investigates surface-trapped buoyant particle transport in estuaries by using idealized and realistic numerical simulations along with a theoretical model. While river discharge and estuarine exchange flow are usually expected to export buoyant particles to the ocean over subtidal timescales, this study reveals a ubiquitous physical transport mechanism that causes retention of buoyant particles in estuaries. Tidally varying surface convergence fronts affect the aggregation of buoyant particles, and the coupling between particle aggregation and oscillatory tidal currents leads to landward transport at subtidal timescales. Landward transport and retention of buoyant particles is greater in small estuaries, while large estuaries tend to export buoyant particles to the ocean. A dimensionless width parameter incorporating the tidal radian frequency and lateral velocity distinguishes small and large estuaries at a transitional value of around 1. Additionally, higher river flow tends to shift estuaries toward seaward transport and export of buoyant particles. These findings provide insights into understanding the distribution of buoyant materials in estuaries and predicting their fate in the land-sea exchange processes.

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Immune-related adverse events (irAEs) are complications of the use of immune checkpoint inhibitors (ICIs). ICI-associated gastritis is one of the main irAEs. The gastric microbiota is often related to the occurrence and development of many gastric diseases. Gastric microbiota adjustment may be used to treat gastric disorders in the future. Faecal microbiota transplantation can alter the gut microbiota of patients and has been used for treating ICI-associated colitis. Therefore, we propose gastric microbiota transplantation as a supplementary treatment for patients with ICI-associated gastritis who do not respond well to conventional therapy.

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Triploids are rare in nature because of difficulties in meiotic and gametogenic processes, especially in vertebrates. The Carassius complex of cyprinid teleosts contains sexual tetraploid crucian carp/goldfish (C. auratus) and unisexual hexaploid gibel carp/Prussian carp (C. gibelio) lineages, providing a valuable model for studying the evolution and maintenance mechanism of unisexual polyploids in vertebrates. Here we sequence the genomes of the two species and assemble their haplotypes, which contain two subgenomes (A and B), to the chromosome level. Sequencing coverage analysis reveals that C. gibelio is an amphitriploid (AAABBB) with two triploid sets of chromosomes; each set is derived from a different ancestor. Resequencing data from different strains of C. gibelio show that unisexual reproduction has been maintained for over 0.82 million years. Comparative genomics show intensive expansion and alterations of meiotic cell cycle-related genes and an oocyte-specific histone variant. Cytological assays indicate that C. gibelio produces unreduced oocytes by an alternative ameiotic pathway; however, sporadic homologous recombination and a high rate of gene conversion also exist in C. gibelio. These genomic changes might have facilitated purging deleterious mutations and maintaining genome stability in this unisexual amphitriploid fish. Overall, the current results provide novel insights into the evolutionary mechanisms of the reproductive success in unisexual polyploid vertebrates.

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OBJECTIVE: To investigate the natural history of persistent pulmonary pure ground-glass nodules (pGGNs) with deep learning-assisted nodule segmentation. METHODS: Between January 2007 and October 2018, 110 pGGNs from 110 patients with 573 follow-up CT scans were included in this retrospective study. pGGN automatic segmentation was performed on initial and all follow-up CT scans using the Dr. Wise system based on convolution neural networks. Subsequently, pGGN diameter, density, volume, mass, volume doubling time (VDT), and mass doubling time (MDT) were calculated automatically. Enrolled pGGNs were categorized into growth, 52 (47.3%), and non-growth, 58 (52.7%), groups according to volume growth. Kaplan-Meier analyses with the log-rank test and Cox proportional hazards regression analysis were conducted to analyze the cumulative percentages of pGGN growth and identify risk factors for growth. RESULTS: The mean follow-up period of the enrolled pGGNs was 48.7 ± 23.8 months. The median VDT of the 52 pGGNs having grown was 1448 (range, 339-8640) days, and their median MDT was 1332 (range, 290-38,912) days. The 12-month, 24.7-month, and 60.8-month cumulative percentages of pGGN growth were 10%, 25.5%, and 51.1%, respectively, and they significantly differed among the initial diameter, volume, and mass subgroups (all p < 0.001). The growth pattern of pGGNs may conform to the exponential model. Lobulated sign (p = 0.044), initial mean diameter (p < 0.001), volume (p = 0.003), and mass (p = 0.023) predicted pGGN growth. CONCLUSIONS: Persistent pGGNs showed an indolent course. Deep learning can assist in accurately elucidating the natural history of pGGNs. pGGNs with lobulated sign and larger initial diameter, volume, and mass are more likely to grow. KEY POINTS: • The pure ground-glass nodule (pGGN) segmentation accuracy of the Dr. Wise system based on convolution neural networks (CNNs) was 96.5% (573/594). • The median volume doubling time (VDT) of 52 pure ground-glass nodules (pGGNs) having grown was 1448 days (range, 339-8640 days), and their median mass doubling time (MDT) was 1332 days (range, 290-38,912 days). The mean time to growth in volume was 854 ± 675 days (range, 116-2856 days). • The 12-month, 24.7-month, and 60.8-month cumulative percentages of pGGN growth were 10%, 25.5%, and 51.1%, respectively, and they significantly differed among the initial diameter, volume, and mass subgroups (all p values < 0.001). The growth pattern of pure ground-glass nodules may conform to exponential model.

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To address the question of whether the behavior of humans to view different phenological peony flowers has various effects on their physical and mental parameters, we investigated psycho-physiological responses of 74 participants (61.3 ± 10.78 years old) to environments of pre- and post-viewing tree peonies at four stages, including the exhibition leaf stage (ELS), initial bloom stage (IBS), full bloom stage (FBS), and terminal bloom stage (TBS). Physiological factors were examined using systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), fingertip pulse (FP), blood oxygen saturation (SpO2), and psychological evaluation, which was carried out using the Profile of Mood States (POMS) and State⁻Trait Anxiety Inventory (STAI). The results indicated that the SBP, DBP, HR, and FP levels of participants were significantly reduced after viewing tree peonies, whereas no remarkable alterations in SpO2 were found. The POMS scores of anger⁻hostility (A⁻H), fatigue⁻inertia (F⁻I), tension⁻anxiety (T⁻A), confusion⁻bewilderment (C⁻B), and depression⁻dejection (D⁻D) were significantly lower, but of vigor⁻activity (V⁻A) was higher post-viewing than pre-viewing. Furthermore, participants exhibited markedly decreased anxiety levels according to the STAI. Notably, the changes in measurement indices were more pronounced at the FBS. Our studies demonstrated that a short peony-viewing program, especially at the FBS with completely opened and large tree peony flowers, would be a promising therapeutic method for improving physiological functions as well as an effective psychological relaxation strategy for middle-aged and elderly individuals.

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Objective: To observe the effect of Shenqi compound recipe on glucose and lipid metabolism in patients with Qi and Yin deficiency and blood stasis syndrome newly diagnosed type 2 diabetes mellitus (T2DM), and its intervention effect on intestinal microecology and serum proinflammatory factors. Method: The 106 eligible patients were divided into the observation group (54 cases) and the control group (52 cases) by random number table method. Another 40 healthy volunteers in physical examination center of the hospital during the same period were enrolled as health control group. On the basis of Guidelines for the Prevention and Treatment of Type 2 Diabetes in China(2013 edition), control group was provided lifestyle interventions, such as reasonable diet, weight control, moderate exercise, salt restriction, tobacco control, alcohol restriction and psychological balance. In addition to the therapy of the control group, the observation group was given Shengi compound for oral administration, 2 times/days. Both groups were treated for 8 weeks. The fasting blood glucose (FBG), postprandial 2 h blood glucose (PBG), glycosylated hemoglobin (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) before and after treatment were evaluated. The structure and quantity of intestinal flora before and after treatment were detected. The traditional Chinese medicine(TCM)symptom was scored. The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) were measured before and after treatment. Result: FBG, PBG, HbA1c and HOMA-IR levels in observation group were lower than those in control group (PPPPβ, IL-6, IL-8 and TNF-α levels in observation group were lower than those in control group (PZ=2.134, PConclusion: Shenqi compound can regulate blood glucose and blood lipid in patients with newly diagnosed T2DM (Qi and Yin deficiency and blood stasis syndrome), improve IR, intestinal microecology imbalance, and reduce non-specific inflammatory response, with a good clinical efficacy on intestinal microecology of patients with Qi and Yin deficiency and blood stasis syndrome newly diagnosed type 2 diabetes mellitus.

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MAIN CONCLUSION: We provide evidence that Aspergillus oryzae not only acts as an endophyte in Raphanus sativus, but also works as a plant growth promoter and provides some protection against its herbivore, Plutella xylostella affecting its feeding rate, mortality and fitness parameters, thereby contributing to the pest population suppression. Seed inoculation of radish seeds with the fungus Aspergillus oryzae allowed its establishment as an endophyte promoting plant growth and negatively affecting fitness parameters of its major herbivore, diamondback moth, Plutella xylostella. Endophytic fungi may contribute to the growth of their host plants and enhance resistance to herbivores and diseases. We evaluated the effect of A. oryzae (Ahlburg) E. Cohn as an endophyte in radish (Raphanus sativus L.) on growth and development of the plants themselves and their major herbivore, the diamondback moth P. xylostella (L). A. oryzae colonization rates in leaves were significantly higher than in roots and stems, with a rate of 80% in leaves, 40% in stems and 20% in roots 1 week after seed inoculation. Colonization gradually decreased in the various plant tissues, and disappeared completely in roots, stems and leaves within 2, 5 and 7 weeks, respectively. A. oryzae did not affect seed germination; however, it promoted radish growth with endophytic plants attaining average heights of 116 mm compared to 99.6 mm in the controls at the third week post-inoculation. The P. xylostella fitness parameters, consumption, larval and pupal weights, and feeding on the endophytic plants were significantly lower than the controls, while larval mortality was significantly higher. Larvae fed on endophytic plants consumed 0.46 mg less leaf matter in the first week post seed inoculation and weighed 0.83 mg less as mature 4th instars than controls. We have demonstrated that A. oryzae can establish as an endophyte in R. sativus through seed inoculation providing some plant growth promotion and protection against its herbivore by increasing its mortality and negatively affecting its fitness parameters, suggesting that adopting seed treatments with A. oryzae may be beneficial in the commercial cultivation of radish.

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The observed variability of trace-element concentration in basaltic lavas and melt inclusions carries information about heterogeneity in the mantle. The difficulty is to disentangle the contributions of source heterogeneity (i.e., spatial variability of mantle composition before melting) and process heterogeneity (i.e., spatial and temporal variability in melt transport). Here we investigate the end-member hypothesis that variability arises due to source heterogeneity alone. We model the attenuation of trace-element variability introduced into the bottom of a one-dimensional, steady-state melting column. Our results show that the melting column can be considered to be a filter that attenuates variability according to the wavelength of heterogeneity, the partition coefficient of the trace element, melt productivity, and the efficiency of melt segregation. We further show that while the model can be fit to the observations, this requires assumptions inconsistent with constraints on the timescales of magma assembly. Hence, we falsify the end-member hypothesis and, instead, conclude that observed variability requires heterogeneity of melt transport. This might take the form of channels or waves and would almost certainly interact with source heterogeneity.

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Objective To investigate the effects of fasting serum triglycerides (TG) levels at different baseline on the risk of new-onset acute pancreatitis (AP) in in-service and retired employees of Kailuan Group.Methods A total of 125 178 in-service and retired employees of Kailuan Group who received health check-ups from 2006 to 2009 and had no AP history but had complete TG data were prospectively enrolled.According to quantile level,the baseline serum fasting TG level of study subjects were divided into ＜1.01 mmol/L group (n=42 128),1.01 to 1.64 mmol/L group (n=41 711) and ＞ 1.64 mmol/L group (n=41 339).The incidence of new-onset AP of these three groups was analyzed.The survival curve was plotted by Kaplan-Meier method.The cumulative incidence rate was calculated and tested by log-rank method.And multivariate Cox proportional hazards regression model was performed to calculate hazard ratios (HR) of baseline fasting serum TG level for AP.Results After followed up for (7.36±1.23) years,a total of 193 cases of AP occurred.The incidences of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.43 events/10 000 person-years,2.37 events/10 000 person-years and 2.49 events/10 000 person-years,respectively.The cumulative incidence rates of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞1.64 mmol/L group were 0.10％ (44/42 128),0.18％ (73/41 711) and 0.18％ (76/41 339),respectively,and the difference was statistically significant (x2 =9.998,P=0.007).The results of multivariate Cox proportional hazards regression model analysis indicated that the risk of AP increased in 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group compared with that of ＜1.01 mmol/L group,HR and 95％ confidence interval (CI) were 1.56 (1.07 to 2.29) and 1.57 (1.06 to 2.32),respectively.After excluded onset AP within one year,with a control group of ＜1.01 mmol/L group,the results of multivariate Cox proportional hazards regression model analysis indicated that the HR and 95％CI for AP of 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.70 (1.11 to 2.58) and 1.69 (1.10 to 2.60),respectively.Conclusion Baseline fasting serum TG levels over 1.01 mmol/L may increase the risk of AP.

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Objective To launch systematic research on long-term asymptomatic hyperuricemia (HUA) from hemorheological viewpoint, so as to provide references for clinical treatment of asymptomatic HUA. Methods Twenty rats were randomly and evenly divided into normal control group and model group. The rats were intraperitoneally injected with 250 mg/(kg•d) oxonate for 8 weeks to induce the model of asymptomatic HUA. The blood samples were obtained to measure the serum uric acid, hemorheological parameters, oxidative and anti-oxidative indices. Results The aggregation index, haemolysis rate, serum xanthine oxidase (XOD), plasma fibrinogen and blood viscosity significantly increased, while the orientation index, electrophoresis rate, serum superoxide dismutase (SOD), activated partial thromboplastin time (APTT) and prothrombin time (PT) significantly induced. Conclusions The asymptomatic HUA can lead to more serious oxidative stress, deteriorate the hemorheological parameters of red blood cells in rats, and induce higher blood viscosity and coagulation status. The research findings indicate that asymptomatic HUA should be correctly understood and timely intervened in clinical diagnosis.

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Objective To investigate whether continuous mild high temperature (increased temperature without causing significant damage to host cells) can inhibit the biofilm formation of Aspergillus niger (A.niger) and its vitality.Methods A.niger biofilms were formed on a coverslip in 24-well tissue culture plate and were checked at the time points 4,8,10,16,24,48 and 72 hours.Confocal laser scanning microscopy (CLSM) was used to image and quantify A.niger biofilm formation under three different continuous mild high temperatures at 37℃,39℃,and 41℃.Furthermore,2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay was used to quantify the dynamic growth of A.niger biofilm under the above conditions.Results Compared with the culture condition 37℃,CLSM analysis at 39℃ or 41℃ showed that higher temperature induced later germination at 4 hours (t=8.603,P=0.047;t=14.550,P=0.008),poorer hyphal elongation at 8 hours(t=35.118,P=0.039;t=63.450,P=0.006),poorer polar growth,and reduced biofilm thickness from 10 to 24 hours.The XTT assay showed that higher temperature (39℃ or 41℃) lead to lower vitality at 10 hours,higher vitality at 16 hours,but finally lower vitality from 24 to 72 hours (t=24.262,P=0.038;t=7.556,P=0.031).Conclusion Continuous mild high temperature may have a negative regulatory effect on biofilm formation of A.niger and its vitality.

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Objective To launch systematic research on long-term asymptomatic hyperuricemia (HUA) from hemorheological viewpoint,so as to provide references for clinical treatment of asymptomatic HUA.Methods Twenty rats were randomly and evenly divided into normal control group and model group.The rats were intraperitoneally injected with 250 mg/(kg · d) oxonate for 8 weeks to induce the model of asymptomatic HUA.The blood samples were obtained to measure the serum uric acid,hemorheological parameters,oxidative and anti-oxidative indices.Results The aggregation index,haemolysis rate,serum xanthine oxidase (XOD),plasma fibrinogen and blood viscosity significantly increased,while the orientation index,electrophoresis rate,serum superoxide dismutase (SOD),activated partial thromboplastin time (APTT) and prothrombin time (PT) significantly induced.Conclusions The asymptomatic HUA can lead to more serious oxidative stress,deteriorate the hemorheological parameters of red blood cells in rats,and induce higher blood viscosity and coagulation status.The research findings indicate that asymptomatic HUA should be correctly understood and timely intervened in clinical diagnosis.

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Objective To launch systematic research on long-term asymptomatic hyperuricemia (HUA) from hemorheological viewpoint,so as to provide references for clinical treatment of asymptomatic HUA.Methods Twenty rats were randomly and evenly divided into normal control group and model group.The rats were intraperitoneally injected with 250 mg/(kg · d) oxonate for 8 weeks to induce the model of asymptomatic HUA.The blood samples were obtained to measure the serum uric acid,hemorheological parameters,oxidative and anti-oxidative indices.Results The aggregation index,haemolysis rate,serum xanthine oxidase (XOD),plasma fibrinogen and blood viscosity significantly increased,while the orientation index,electrophoresis rate,serum superoxide dismutase (SOD),activated partial thromboplastin time (APTT) and prothrombin time (PT) significantly induced.Conclusions The asymptomatic HUA can lead to more serious oxidative stress,deteriorate the hemorheological parameters of red blood cells in rats,and induce higher blood viscosity and coagulation status.The research findings indicate that asymptomatic HUA should be correctly understood and timely intervened in clinical diagnosis.

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Background:Gastric cancer is a common gastrointestinal malignancy. The detection rate of early gastric cancer is still low in China,and some gastric cancer patients visit the hospital due to acute disease,such as gastric perforation. Aims:To investigate the influence of acute disease on long-term prognosis in gastric cancer patients. Methods:A total of 318 patients with gastric cancer from Jan. 2009 to Jan. 2015 at Shaoxing People’s Hospital were enrolled,and were divided into acute disease group and non-acute disease group. Clinicopathological characteristics were analyzed. Patients were followed up,and survival rate was compared between the two groups. Results:Fifty-three(16. 7% )patients had acute disease,and the remaining 265(83. 3% )patients were without acute disease. Compared with non-acute disease group, percentage of TNM Ⅳ stage was significantly increased(P < 0. 05),and percentage of radical surgery was significantly decreased in acute disease group(P < 0. 05). Kaplan-Meier assay showed that survival rate in acute disease group was significantly decreased when compared with non-acute disease group( P < 0. 05). After adjusting the TNM stage and surgical treatment,no significant difference in survival rate was found between the two groups. Conclusions:Gastric cancer patients with acute disease have lower survival rate. Acute disease may be not an independent prognostic factor, higher TNM stage and lower proportion of radical surgery are the main reasons for poor prognosis in gastric cancer patients with acute disease.

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Objective To report the early mortality and associated risk factors after damage control operation (DCO) in patients with severe abdominal trauma.Methods A total of 146 patients hospitalized from January to March in 2015 were retrospectively analyzed.Early death was defined as death occurring within 72 h of first surgery and before the definitive surgery.Based on the death definition, the subjects were divided into death group and survival group.The two groups were compared for gender, age, injury time, injury classification, vital signs, need for cardiopulmonary resuscitation, Glasgow coma score (GCS), injury severity score (ISS), hemoglobin, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), blood pH, base excess, operative time, and postoperative acute physiology and chronic health evaluation score Ⅱ (APACHE Ⅱ).Logistic regression analysis was applied to examine the predicators of early postoperative mortality.Results There were 118 patients (80.8％) in survival group and 28 patients (19.2％) in death group.Survival and death groups differed significantly with regard to the percent of elderly (6.8％ vs.21.4％), percent of patients with multiple injury (62.7％ vs.85.7％), body temperature [(36.1 ± 0.4) vs.(35.2 ± 0.8) ℃], percent of patients with greater ISS (31.4％ vs.64.3％), PT [(12.1±1.5) vs.(13.9±1.2)s], bloodpH (7.25±0.04vs.7.08±0.11), base excess [(-8.9±2.8) vs.(-10.6±3.3)mmol/L], postoperative APACHE Ⅱ[(12.8 ± 1.8) vs.(17.5 ± 2.0) points] (P ＜ 0.05).Logistic regression analysis identified the age (OR=1.512, 95％ CI 1.112-4.157,P＜0.05), ISS (OR =1.313,95％ CI 1.134-5.442, P ＜ 0.05), APACHE Ⅱ (OR =1.361,95 ％ CI 1.182-5.222, P ＜ 0.05) as the independent risk factors for early mortality.Conclusion The patients underwent DCO for severe abdominal trauma has a high early mortality, which is closely associated with the age, injury severity and postoperative medical status.

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<p><b>OBJECTIVE</b>To investigate the effect of body mass index (BMI) on new-onset non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>Subjects with T2DM were recruited from the population of individuals attending the Affiliated General Hospital of North China University for routine health examination between 2006 and 2007 and offered participation in this community-based prospective cohort study. Enrollees were categorized into groups according to weight assessed by baseline BMI (underweight, normal, overweight, and obese groups). Cumulative incidence of NAFLD was compared between each group and the effect of baseline BMI on new-onset NAFLD was assessed by Cox regression analysis.</p><p><b>RESULTS</b>The cumulative incidence of NAFLD increased in conjunction with increases in weight (low weight: 69%, normal weight: 73%, overweight: 90%, obese: 97%; P<0.01). Subjects in the overweight and obese groups showed an increased risk of NAFLD (relative risk (RR)=2.00, 95% CI: 1.76-2.29 and =2.87, 95% CI: 2.42-3.40; P<0.01), compared to those in the normal weight group. Moreover, after adjustment for baseline factors (e.g.age, sex) risk of NAFLD remained higher for the overweight and obese subjects (RR=1.73, 95% CI: 1.49-2.00 and =2.12, 95% CI: 1.73-2.60; P<0.01).</p><p><b>CONCLUSION</b>Risk of NAFLD in T2DM patients increases in parallel to increase in weight assessed by BMI. BMI appeared to be an independent risk factor for NAFLD.</p>

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OBJECTIVE: To explore the methods for repairing deep wound on the head due to high-voltage electrical burn (HEB). METHODS: Twenty-six patients with deep wounds on the head due to HEB were hospitalized from June 2002 to May 2012. They were all injured by high-voltage (voltage ranged from 380 V to 300 kV) electric current, involving head and several other parts over the body. The total burn area ranged from 1% to 75% TBSA, and the depth ranged from deep partial-thickness to full-thickness (including muscle or even bone). Scalp defect area ranged from 3 cm×2 cm to 20 cm×18 cm, and the maximum size of skull exposure was 12 cm×9 cm and the maximum size of skull defect was 7 cm×6 cm. The wounds of 26 patients were repaired with 7 local advance flaps, 4 bilateral rotation flaps, 18 local rotation flaps combined with thin split-thickness skin grafts in donor site, and 3 free anterolateral thigh flaps with vascular anastomosis. In four of the 26 patients, expander was used in the early stage after burn and 5 after wound healing (with thin split-thickness grafts). RESULTS: All flaps and skin grafts survived, except for one flap which was complicated by wound infection, and it was healed after dressing and secondary suturing. The implanted expander expanded smoothly. Patients were followed up for 15 days to three years after surgery. Satisfactory results were obtained, and wounds of 15 patients were repaired completely. CONCLUSIONS: Deep wound on the head due to HEB should be repaired with suitable flap combined with skin graft in donor site, and implantation of expander according to the injury area and condition of patient.

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<p><b>OBJECTIVE</b>To explore the methods for repairing deep wound on the head due to high-voltage electrical burn (HEB).</p><p><b>METHODS</b>Twenty-six patients with deep wounds on the head due to HEB were hospitalized from June 2002 to May 2012. They were all injured by high-voltage (voltage ranged from 380 V to 300 kV) electric current, involving head and several other parts over the body. The total burn area ranged from 1% to 75% TBSA, and the depth ranged from deep partial-thickness to full-thickness (including muscle or even bone). Scalp defect area ranged from 3 cm×2 cm to 20 cm×18 cm, and the maximum size of skull exposure was 12 cm×9 cm and the maximum size of skull defect was 7 cm×6 cm. The wounds of 26 patients were repaired with 7 local advance flaps, 4 bilateral rotation flaps, 18 local rotation flaps combined with thin split-thickness skin grafts in donor site, and 3 free anterolateral thigh flaps with vascular anastomosis. In four of the 26 patients, expander was used in the early stage after burn and 5 after wound healing (with thin split-thickness grafts).</p><p><b>RESULTS</b>All flaps and skin grafts survived, except for one flap which was complicated by wound infection, and it was healed after dressing and secondary suturing. The implanted expander expanded smoothly. Patients were followed up for 15 days to three years after surgery. Satisfactory results were obtained, and wounds of 15 patients were repaired completely.</p><p><b>CONCLUSIONS</b>Deep wound on the head due to HEB should be repaired with suitable flap combined with skin graft in donor site, and implantation of expander according to the injury area and condition of patient.</p>

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OBJECTIVE: To summarize the experience in the treatment of severe pressure sore. METHODS: From Aug. 2007 to Jun. 2011, 21 cases of severe pressure sore with 43 III-IV degree lesions were treated with combination treatment, including vacuum sealing drainage technique, local fascia flaps, upper or lower gluteus maximus island myocutaneous flaps, lower gluteus maximus myocutaneous flap, neurocutaneous femoris posterior flaps, tensor fascia lata island myocutaneous flaps, free latissimus dorsi myocutaneous flaps, and skin graft, combined with stryker frame and nursing tracking guidance. 13 of 21 cases had multiple pressure sore. Among them, 5 III degree pressure sores were covered by skin grafting and 3 non-caudal III degree pressure sores (< 2 cm in width) were directly closed after debridement. 8 of 21 cases had single IV degree pressure sore. RESULTS: All the 43 wounds healed completely. 5 wounds in 3 cases had effusion under flap which healed after re-drainage. The wounds were not healed in 3 cases with flap transposition which were also healed after re-debridement. All the flaps survived completely. 16 cases were followed up for 2-26 months. Recurrence happened in 4 cases after discharge because of not following the required nursing care. CONCLUSIONS: Comprehensive application of vacuum sealing drainage technique, multiple myocutaneous flaps and skin grafting, combined with stryker frame and nursing tracking guidance after discharge can be used for the treatment of severe pressure sore with satisfactory results.

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