The impairment of speech perception in noise following pure tone hearing recovery in patients with sudden sensorineural hearing loss

To explore whether patients with unilateral idiopathic sudden sensorineural hearing loss (uISSNHL) have normal speech in noise (SIN) perception under different masking conditions after complete recovery of pure tone audiometry. Eight completely recovered uISSNHL patients were enrolled in ISSNHL group, while 8 normal-hearing adults matched with age, gender, and education experience were selected as the control group. Each group was tested SIN under four masking conditions, including noise and speech maskings with and without spatial separation cues. For both ISSNHL and control groups a two-way ANOVA showed a statistically significant effect of masking type (p = 0.007 vs p = 0.012). A significant effect of perceived spatial separation (p < 0.001 vs p < 0.001). A significant interaction between masking type and perceived spatial separation was found (p < 0.001 vs p < 0.001). A paired sample T-test showed that the SIN perception of the control group was statistically significant lower than that of ISSNHL patients only under speech masking without spatial separation cues (p = 0.011). There were still abnormalities in the auditory center shortly after complete recovery in the ISSNHL group (within 2 weeks). However, the auditory periphery and higher-level ability to use spatial cues was normal.

Association Between the Number of Intratympanic Steroid Injections and Hearing Recovery in Sudden Sensorineural Hearing Loss

The frequency of intratympanic (IT) steroid injection varies from once daily to once weekly or less among studies and does not reach a uniform standard. This study investigated the potential association between the number of IT steroid injections and hearing recovery to determine the optimal number in sudden sensorineural hearing loss (SSNHL) patients. A retrospective study involving 233 SSNHL patients receiving IT steroids plus batroxobin within 7 days of onset was performed. Patients were followed up for 3 months. More than 15 dB of HL improvement in the pretreatment pure tone average (PTA) was defined as effective. The effective group had a higher IT injection numbers than the ineffective group (≥ 6 times: 84.6 vs. 61.1, p < 0.001). Regardless of the unadjusted model or adjusted model, patients who received more frequent IT steroid injections seemed more likely to recover hearing (unadjusted model, OR, 95% CI: 1.25, 1.06-1.48; p = 0.007; adjusted model, OR, 95% CI: 1.21, 1.01-1.45; p = 0.044). Six IT injections had the highest rate of hearing recovery (79.1%). In conclusion, IT injection number was an independent factor that was positively associated with hearing recovery, and the optimal number of IT steroid injections was 6. Batroxobin plus higher number of IT steroid injections showed more effective for treating SSNHL.

Genome-wide analysis of mitochondrial DNA copy number reveals loci implicated in nucleotide metabolism, platelet activation, and megakaryocyte proliferation

Mitochondrial DNA copy number (mtDNA-CN) measured from blood specimens is a minimally invasive marker of mitochondrial function that exhibits both inter-individual and intercellular variation. To identify genes involved in regulating mitochondrial function, we performed a genome-wide association study (GWAS) in 465,809 White individuals from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank (UKB). We identified 133 SNPs with statistically significant, independent effects associated with mtDNA-CN across 100 loci. A combination of fine-mapping, variant annotation, and co-localization analyses was used to prioritize genes within each of the 133 independent sites. Putative causal genes were enriched for known mitochondrial DNA depletion syndromes (p = 3.09 × 10-15) and the gene ontology (GO) terms for mtDNA metabolism (p = 1.43 × 10-8) and mtDNA replication (p = 1.2 × 10-7). A clustering approach leveraged pleiotropy between mtDNA-CN associated SNPs and 41 mtDNA-CN associated phenotypes to identify functional domains, revealing three distinct groups, including platelet activation, megakaryocyte proliferation, and mtDNA metabolism. Finally, using mitochondrial SNPs, we establish causal relationships between mitochondrial function and a variety of blood cell-related traits, kidney function, liver function and overall (p = 0.044) and non-cancer mortality (p = 6.56 × 10-4).

Repurposing Ivermectin to augment chemotherapy's efficacy in osteosarcoma

BACKGROUND

Osteosarcoma is the most frequent malignant bone malignancy and the current treatments are ineffective. Ivermectin, an anti-protozoal drug, has been shown to have anti-cancer activity. This work investigated the potential of repurposing ivermectin to augment chemotherapy's efficacy in osteosarcoma.

METHODS

Proliferation, migration and apoptosis assays were performed in ivermectin-treated osteosarcoma cells. Combination studies were performed. Osteosarcoma xenograft mouse model was established to investigate the in vivo efficacy of ivermectin. Intracellular reactive oxygen species (ROS) and mitochondrial superoxide, membrane potential, ATP, 8-OHdG level, protein carbonylation and lipid peroxidation were determined after ivermectin treatment.

RESULTS

Ivermectin was effective and acted synergistically with doxorubicin in osteosarcoma cells regardless of cellular origin and genetic profiling. This was achieved through suppressing inhibiting growth and migration, and inducing caspase-dependent apoptosis. Ivermectin also significantly inhibited osteosarcoma growth in vivo and its combination with doxorubicin resulted in much greater efficacy than doxorubicin alone. Importantly, the effective dose of ivermectin was clinically feasible and did not cause significant toxicity in mice. Mechanistical analysis showed that ivermectin induced oxidative stress and damage, and mitochondrial dysfunction.

CONCLUSIONS

Our findings indicate that ivermectin has utility in treating patients with osteosarcoma, especially those resistant to chemotherapy.

[Screening of drugs that selectively inhibit uveal melanoma cells with SF3B1 mutations]

OBJECTIVE

To screen compounds that can selectively inhibit uveal melanoma cells with splicing factor 3B subunit 1 (SF3B1) mutations in comparison with isogenic SF3B1 wild-type counterparts in a cell model of SF3B1 mutant allele knockout.

METHODS

Principal component analysis was used to analyze transcriptome alternative splicing in TCGA cohorts of uveal melanoma with wild-type SF3B1 and SF3B1 mutations, and abnormal alternative splicing events derived from SF3B1 mutations were identified. The SF3B1 mutant allele in Mel202 cells was knocked out using CRISPR-Cas9 technology, and Sanger sequencing was used to verify the edited sequence. MTT and colony formation assays were used to assess the proliferation of Mel202 and Mut-KO cells. RT-PCR agarose electrophoresis combined with Sanger sequencing was used to determine alternative splicing events in Mel202 and Mut-KO cells. MTT assay was performed to screen the compounds that showed selective inhibitory effect against Mel202 cells with SF3B1 mutation.

RESULTS

Specific knockout of SF3B1 mutant allele in Mel202 cells obviously promoted the cell proliferation and caused changes in alternative splicing of ZDHHC16 and DYNLL1 transcripts. The screening data showed that 13 compounds had selective inhibitory activity against Mel202 cells with SF3B1 mutation (Fold change≥2), and among them, tetrandrine and lapatinib showed good dose-effect curves.

CONCLUSION

This study provides a cell screening model for identification of potential individualized treatment drugs for patients with uveal melanoma with SF3B1 mutation.

Extramedullary plasmacytoma of the nasal inferior turbinate: a case report

An extramedullary plasmacytoma (EMP) is a rare neoplasm characterized by monoclonal proliferation of plasma cells without features of multiple myeloma. Most EMPs occur in the head and neck region, especially in the aerodigestive tract. We herein report a case of an EMP arising from the nasal inferior turbinate. The mass was surgically removed, and a short cycle of radiotherapy was performed after the surgery. There was no recurrence of the tumor after 1 year of follow-up. These result may be useful for physicians who encounter similar situations in clinical practice.

The Correlation Between Hearing Loss, Especially High-Frequency Hearing Loss and Cognitive Decline Among the Elderly

Objective: The relation between cognition and hearing loss has been increasingly paid high attention, however, few studies have focused on the role of high-frequency hearing loss in cognitive decline. This study is oriented to role of hearing loss especially high-frequency hearing loss in cognitive impairment among elderly people (age ≥ 60 years).

Methods: The Montreal Cognitive Assessment Scale (MoCA) and pure tone audiometry were used to investigate the hearing loss and cognitive function of 201 elderly people older than 60 years. Factors possibly related to cognitive impairment including age, years of education, occupation, living conditions, history of otologic diseases, and high blood pressure were registered. This study consisted of two parts. First, univariate analysis and multiple linear regressions were performed to analyze the possible influencing factors of cognitive function among the 201 elderly people. Second, average hearing thresholds of low frequencies (250, 500 Hz), intermediate frequencies (1 k, 2 kHz), and high frequencies (4 k, 8 kHz) were calculated to screen out 40 cases with high-frequency hearing loss alone and 18 cases with normal hearing. Univariate analysis was used to compare the general condition, cognitive function, and each cognitive domain between the two groups, analyzing the relation between high-frequency hearing loss and cognitive function.

Result: We found that age, years of education, pure tone average (PTA), occupation, living condition, history of otologic diseases, years of self-reported hearing loss, and hypertension history were related to cognitive function. Furthermore, age, education experience, duration of self-reported hearing loss, and hypertension were independent factors (p < 0.05). PTA was negatively related with attention, orientation, and general cognition (p < 0.05). There were only 18 cases (9.0%) with normal hearing, and 40 cases (19.9%) with abnormal high-frequency hearing alone. The overall cognitive function showed no significant difference between them (p > 0.05); in contrast, the speech and abstract ability were significantly decreased in cases with high-frequency hearing loss (p < 0.05).

Conclusion: The increase of PTA among the elderly may affect the overall cognition by reducing attention and orientation. High-frequency hearing loss alone can affect the language and abstract ability to a certain extent, which is worthy of more attention.

Association between meteorological factors and audiogram configurations in patients with sudden sensorineural hearing loss: a cross-sectional study

OBJECTIVE

We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations.

DESIGN

Retrospective review of medical records from 1 October 2007 to 31 December 2018.

SETTING

A tertiary hospital.

PARTICIPANTS

510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions.

RESULTS

Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations.

CONCLUSIONS

Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.

[Application of diffusion-weighted magnetic resonance imaging in evaluating the efficacy of radiotherapy and chemotherapy for esophageal cancer]

This study was a prospective single arm trial conducted in Zhejiang Jinhua Guangfu hospital from February 2018 to June 2020. A total of 39 patients (32 males and 7 females) with esophageal cancer, aged from 44 to 82 (69±9) years were enrolled. Diffusion weighted magnetic resonance imaging(MR-DWI) was implemented to evaluate the changes of apparent diffusion coefficient(ADC) value before and after chemoradiotherapy. The results showed that the ADC value after chemoradiotherapy was higher than that before treatment[(2.03±0.42)×10⁻³ mm ²/s vs (1.60±0.28)×10⁻³ mm²/s], and there was a positive correlation between the increase of ADC value and the prognosis of patients.

Impact of rate control medications on one-year outcomes with atrial fibrillation and heart failure

Purpose

Atrial fibrillation (AF) and heart failure (HF) often coexist. The impact of rate-control regimens in AF and HF patients has not been well understood.

Methods

In this multicenter, prospective registry with one-year follow-up, 1359 persistent or permanent AF patients got enrolled. A 1:1 HF to non-HF propensity score matching was applied to adjust for confounding variables. The primary endpoint was all-cause mortality while the secondary endpoint was defined as cardiovascular death and stroke. Multivariate Cox analysis was performed to evaluate the association between different rate-control treatment and incidence of adverse events.

Results

Before matching, HF patients were much younger and more likely to be female. They had a much higher prevalence of previous myocardial infarction, chronic obstructive pulmonary disease and valvular heart disease. Among 1359 participants, we identified 1016 matched patients. The number of drugs did not affect the risk of all-cause mortality in both cohorts. For non-HF patients, using calcium channel blockers (CCBs) plus digoxin had a significant higher risk of all-cause death (HR=5.703, 95% CI 1.334–24.604, p=0.019) and cardiovascular death (HR=9.558, 95% CI 2.127–42.935, p=0.003) compared with patients not receiving rate-control treatment. The use of beta-blockers, CCBs, digoxin alone, other dual or triple combinations was not related to risk of adverse events in both groups.

Conclusions

The combined use of CCBs and digoxin was related to increase all-cause and cardiovascular mortality in AF patients without HF but not for those with HF. However, the ideal rate-control regimen for AF and HF patients has not been established and well-designed clinical trials are needed.

Funding Acknowledgement

Type of funding sources: None. Results of multivariate Cox analysisKaplan-Meier curves by drug numbers

Predictive performance of different bleeding risk scores in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention

Background

Standard scoring system for bleeding risk assessment has not been developed in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). The study aims to evaluate the predictive value of the HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score in patients with AF and ACS/PCI who received both anticoagulant and antiplatelet therapy.

Methods

A total of 930 patients with AF and ACS/PCI receiving both anticoagulant and antiplatelet therapy were consecutively recruited and followed up for 1 year. The primary endpoint was defined according to the bleeding academic research consortium (BARC) criteria as major (BARC 3a, 3b, 3c, and 5) and any bleeding (BARC 2, 3a, 3b, 3c, and 5). The secondary endpoints included major or minor bleeding according to TIMI criteria. Univariate and multivariate logistic regression were performed to evaluate the association between bleeding risk scores and outcomes. Receiver operating characteristic (ROC) curves were constructed and c-statistics were calculated to evaluate the predictive performance of different bleeding risk scores.

Results

BARC class ≥2 bleedings occurred in 36 patients (3.9%), while BARC class ≥3 bleedings were seen in 134 patients (14.4%). The HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score were significantly associated with incidences of BARC class ≥2 and ≥3 bleedings during 1-year follow-up (all p&lt;0.05). The ROC analysis showed that the predictive performance of the five bleeding risk scores for BARC class ≥3 bleedings were low-to-moderate [c-statistic: HASBLED 0.584 (0.552–0.616), ATRIA 0.624 (0.592–0.655), ORBIT 0.623 (0.591–0.654), PARIS 0.633 (0.601–0.664), PRECISEDAPT 0.616 (0.584–0.647)]. Multivariable logistic regression indicated that previous bleeding history and hemoglobin were independent predictors of BARC class ≥3 bleedings. Compared to the HAS-BLED score, the model constructed by previous bleeding history and hemoglobin displays a significant improvement in bleeding risk prediction (0.704 vs. 0.584, p=0.013).

Conclusions

In patients with AF and ACS/PCI receiving both anticoagulant and antiplatelet therapy, the HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score displayed low-to-moderate performance for predicting BARC class ≥3 bleedings during 1-year follow-up. More accurate scoring systems for bleeding risk evaluation should be developed for these patients in the future.

Funding Acknowledgement

Type of funding sources: None. Receiver operating characteristic curve

[Analysis of bacterial infection and drug sensitivity in patients with chronic suppurative otitis media]

Objective:To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media. Methods:Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People's Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed. Results:A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureus（MSSA） strains, 7 methicillin-resistant staphylococcus aureus（MRSA） strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strains（4/10） of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor. Conclusion:The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whether patients with chronic suppurative otitis media could have dry ears. Therefore, patients with chronic suppurative otitis media should be treated with specific antibiotics or surgical interventions as soon as possible in combination with drug sensitivity results to avoid prolonging disease course or causing serious infectious complications.

Association between plasma big endothelin-1 level and the severity of coronary artery disease in patients with non-ST segment-elevated myocardial infarction

Background

This study aimed to evaluate the association between plasma big endothelin-1 (ET-1) level and the severity of coronary artery disease assessed by the SYNTAX score (SS) in patient with non-ST segment-elevated myocardial infarction (NSTEMI).

Methods

A total of 766 patients with NSTEMI undergoing coronary angiography were recruited. Patients were divided into divided into three groups: low SS (SS ≤22), intermediate SS (23–32) and high SS group (SS &gt;32). Spearman correlation, smooth curve fitting, logistic regression and Receiver operating characteristic (ROC) curve analysis were performed to evaluated the association between plasma big ET-1 level and the SS.

Results

There was a significant correlation between the big ET-1 and the SS (r=0.378, p&lt;0.001). Smoothing curve indicated a positive correlation between plasma big ET-1 level and the SS, after adjustment for potential confounders. The ROC curve analysis showed that the area under the curve was 0.695 (0.661–0.727) and the optimal cutoff of plasma big ET-1 level were 0.35pmol/l, with a sensitivity of 68.9% and a specificity of 62.9%. Logistic regression showed that elevated big ET-1 was an independent predictor of intermediate-high SS in patients with NSTEMI, no matter entered as a continuous variable [OR (95% CI): 1.110 (1.053–1.170), p&lt;0.001] or as a categorical variable [OR (95% CI): 2.873 (2.016–4.094), p&lt;0.001]. The association between big ET-1 and intermediate-high SS was consistent across subgroups without significant interactions.

Conclusion

In patients presenting with NSTEMI, plasma big ET-1 level was significantly correlated with the SS. Elevated plasma big ET-1 level was an independent predictor for intermediate-high SS.

Funding Acknowledgement

Type of funding sources: None. ROC of big ET-1 for high SYNTAX score

Incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Objective

The Global Registry of Acute Coronary Events (GRACE) score is recommended for risk stratification for patients with ST-segment elevation myocardial infarction (STEMI) by clinical guidelines. Data about comorbidities were not incorporated in the GRACE score. This study aimed to evaluate the incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with STEMI.

Methods

7476 patients with STEMI were recruited and divided into five groups according to the CHA2DS2-VASc score (1, 2, 3, 4 and ≥5 points) at admission. The primary outcome was defined as in-hospital mortality, while the secondary outcomes were recurrent MI, stroke and major adverse cardiovascular events (MACE) during hospitalization. Univariate and multivariate logistic regression were performed to evaluate the association between the CHA2DS2-VASc score and outcomes. Incremental predictive performance of adding the CHA2DS2-VASc score to the GRACE score were evaluated through analysis of the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results

With the increase of CHA2DS2-VASc score, patients with STEMI tended to have more comorbidities, receive less evidence-based treatments and carry worse in-hospital outcomes. Multivariate logistic regressions demonstrated that the CHA2DS2-VASc score was an independent predictor for in-hospital mortality [OR (95% CI): 1.320 (1.238–1.407), p&lt;0.001], recurrent myocardial infarction [OR (95% CI): 1.233 (1.086–1.401), p=0.001], stroke [OR (95% CI): 1.433 (1.207–1.702), p&lt;0.001] and MACE [OR (95% CI): 1.146 (1.088–1.207), p&lt;0.001]. The c statistic value of combining the GRACE score with the CHA2DS2-VASc score was significantly higher than that of the GRACE score alone in predicting in-hospital mortality (0.784, 95% CI: 0.774–0.793 vs. 0.769, 95% CI: 0.760–0.779, z=4.180, p&lt;0.001). The addition of the CHA2DS2-VASc score to the GRACE score resulted in significantly improved predictive performance for in-hospital mortality, with a NRI of 0.356 (95% CI: 0.280–0.432, p&lt;0.001) and a IDI of 0.013 (95% CI: 0.009–0.018, p&lt;0.001).

Conclusion

The CHA2DS2-VASc score was an independent predictor of in-hospital outcomes in patients with STEMI. Compared to the GRACE score alone, the addition of the CHA2DS2-VASc score to the GRACE score improved the predictive performance for in-hospital mortality in patients STEMI.

Funding Acknowledgement

Type of funding sources: None. Receiver operating characteristic curve

Role of laryngopharyngeal reflux (LPR) in complications after tonsillectomy in adult patients

BACKGROUND

Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice, but the complications, especially the postoperative bleeding, are seriously troubling surgeons. Some authors had identified that gastroesophageal reflux and LPR are both risk factors for complications in tonsillectomy of children patients.

AIMS/OBJECTIVES

Therefore, we designed this prospective study to assess the role of LPR in the development of complications following tonsillectomy in adult patients. We want to provide a basis for future clinical practice.

MATERIAL AND METHODS

We recruited a totally of 150 adult patients (18-60 years old) who had an indication of tonsillectomy because of recurrent tonsillitis and divided them into two groups, the laryngopharyngeal reflux (LPR) group and the control group identified by the results of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The complications that were observed and evaluated were pain, hemorrhage, fever, infection, and pulmonary problems.

RESULT

All the patients complained of pain after surgery. The duration of the pain in the LPR group was much longer than that of the control group. In the LPR group, patients had a similar pain level on the first day after surgery. However, on the 7th day and 14th day after surgery, the pain level was obviously higher than that of the control group. We found that the body temperature mildly rose on the 1st day after surgery and gradually fell to normal level in both groups. No cases had bleeding within 24 h after surgery. There were nine cases of bleeding in the LPR group, while only one case of bleeding occurred in the control group. There were no cases of infection or pulmonary complications in either group.

CONCLUSIONS AND SIGNIFICANCE

LPR is closely related to the complications followed by tonsillectomy and we also suggest that high dosages of proton pump inhibitors (PPI), alkaline water, and alginates should be prescribed to the patients with LPR during the perioperative period.

[A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients]

Objective: To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism. Methods: The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results: On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively (t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group (t=2.671, P<0.05). Conclusions: Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.