BACKGROUND: Diabetic foot is a complex condition with high incidence, recurrence, mortality, and disability rates. Current treatments for diabetic foot ulcers are often insufficient. This study was conducted to identify potential therapeutic targets for diabetic foot. METHODS: Datasets related to diabetic foot and diabetic skin were retrieved from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using R software. Enrichment analysis was conducted to screen for critical gene functions and pathways. A protein interaction network was constructed to identify node genes corresponding to key proteins. The DEGs and node genes were overlapped to pinpoint target genes. Plasma and chronic ulcer samples from diabetic and non-diabetic individuals were collected. Western blotting, immunohistochemistry, and enzyme-linked immunosorbent assays were performed to verify the S100 calcium binding protein A9 (S100A9), inflammatory cytokine, and related pathway protein levels. Hematoxylin and eosin staining was used to measure epidermal layer thickness. RESULTS: In total, 283 common DEGs and 42 node genes in diabetic foot ulcers were identified. Forty-three genes were differentially expressed in the skin of diabetic and non-diabetic individuals. The overlapping of the most significant DEGs and node genes led to the identification of S100A9 as a target gene. The S100A9 level was significantly higher in diabetic than in non-diabetic plasma (178.40 ± 44.65 ng/mL vs. 40.84 ± 18.86 ng/mL) and in chronic ulcers, and the wound healing time correlated positively with the plasma S100A9 level. The levels of inflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-1, and IL-6) and related pathway proteins (phospho-extracellular signal regulated kinase [ERK], phospho-p38, phospho-p65, and p-protein kinase B [Akt]) were also elevated. The epidermal layer was notably thinner in chronic diabetic ulcers than in non-diabetic skin (24.17 ± 25.60 μm vs. 412.00 ± 181.60 μm). CONCLUSIONS S100A9 was significantly upregulated in diabetic foot and was associated with prolonged wound healing. S100A9 may impair diabetic wound healing by disrupting local inflammatory responses and skin re-epithelialization.
Calgranulin B/therapeutic use* ; Diabetic Foot/metabolism* ; Humans ; Datasets as Topic ; Computational Biology ; Mice, Inbred C57BL ; Animals ; Mice ; Protein Interaction Maps ; Immunohistochemistry

Objective    To investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer. Methods    Clinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared. Results    Compared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05). Conclusion    In the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.

Traditional Chinese medicine （TCM） is a great treasure house， exhibiting unique advantages in the treatment of some difficult and critical diseases. The incidence rate of membranous nephropathy has increased year by year in recent years， and has become the first cause of primary glomerular diseases. However， its pathogenesis is not clear. Modern medicine often uses immunosuppressive therapy， but it often faces the problems of high side effects and high recurrence rate. The China Association of Chinese Medicine （CACM） invited clinical experts of TCM and western medicine to fully discuss membranous nephropathy， which was later confirmed to be one of the clinical diseases responding specifically to TCM. Apart from summarizing the pathogenesis and clinical diagnosis and treatment of membranous nephropathy in both TCM and western medicine， this paper also detailed TCM cognition， syndrome differentiation， and therapeutic schemes of membranous nephropathy， aiming to improve the clinical remission rate of membranous nephropathy and provide reference for its clinical treatment.

Objective To investigate the efficacy of AI-SONICTM Thyroid system, a version 2.0 artificial intelligence (AI) automatic detection system, in the preoperative ultrasound diagnosis of thyroid nodules, and to evaluate the application value of AI automatic detection system version 2.0 in the differential diagnosis of benign and malignant thyroid nodules by comparing with the subjective diagnosis conclusions of sonographers with different seniorities. Methods A total of 247 patients (325 thyroid nodules) admitted to the Department of General Surgery in our hospital from Aug. 2019 to Jan. 2020 were selected for this study. All patients underwent routine ultrasound examinations by a senior sonographer with 13 years of experience in thyroid ultrasound diagnosis and a junior sonographer with 4 years of work experience. At the same time, the patients were also examined by another sonographer with 20 years of work experience using AI automatic detection system version 2.0, without knowing the diagnosis conclusions of the above two sonographers. Kappa test was used to evaluate the consistency of the results of routine ultrasound examination of sonographers with different seniorities and AI automatic detection system version 2.0 and the postoperative pathological results. Results The postoperative pathology confirmed 229 malignant nodules and 96 benign nodules. The sensitivity, specificity and accuracy in the diagnosis of benign and malignant thyroid nodules were 85.15% (195/229), 66.67% (64/96) and 79.69% (259/325), 93.45% (214/229), 79.17% (76/96) and 89.23% (290/325), and 92.58% (212/229), 71.88% (69/96) and 86.46% (281/325) for junior sonographer, senior sonographer and AI automatic detection system version 2.0, respectively. The Kappa consistency test results showed that the diagnosis result of senior sonographer was highly consistent with the pathological diagnosis result (Kappa value 0.78, P＜0.01), while the diagnosis results of junior sonographer and AI automatic detection system version 2.0 were generally consistent with the pathological diagnosis result (Kappa values 0.55 and 0.74, both P＜0.01). Conclusion The sensitivity, accuracy and specificity of the AI automatic detection system version 2.0 AI-SONICTM Thyroid in diagnosing benign and malignant thyroid nodules are similar to those of routine ultrasound examination by senior sonographers, and the system might be a reliable auxiliary means for preoperative evaluation of benign and malignant thyroid nodules.

OBJECTIVE: To explore the mechanism of METHODS: Healthy male DBA/1 mice were used for CIA modeling. Twenty-five CIA mice with successful modeling and similar arthritis index (AI) scores were randomized equally into model group (CIA), methotrexate (MTX) group, and low-, medium-, and high-dose XWGD groups (0.975, 1.95, and 3.9 g/mL, respectively), with another 5 normal mice as the normal control group. The mice in normal control and CIA groups were given saline once a day, those in MTX group were given 0.1 mg/mL MTX once a week, and those in XWGD groups were treated daily via garage of XWGD containing crude drugs of different doses for 28 consecutive days. The AI score and HE staining were used to evaluate the changes in the joints of the CIA mice. The effect of XWGD on Th1, Th17, MDSC, G-MDSC and M-MDSC cells were evaluated with flow cytometry. RESULTS: Treatment with MTX and different doses of XWGD significantly decreased the AI score of the mice and relieved joint inflammation as compared with the model group ( CONCLUSIONS XWGD can improve joint inflammation in CIA mice by increasing the percentages of G-MDSC cells and decreasing the percentages of M-MDSC, Th1 and Th17 cells, and a high dose of XWGD can produce an equivalent therapeutic effect to methotrexate but with better safety.
Animals ; Arthritis, Experimental/drug therapy* ; Arthritis, Rheumatoid/drug therapy* ; Male ; Methotrexate ; Mice ; Mice, Inbred DBA ; Th17 Cells

Objective: To explore the application value of artificial intelligence (AI) automatic detection system in preoperative ultrasonic diagnosis of thyroid nodules. Methods: Totally 98 patients with 137 thyroid nodules admitted to the General Surgery Department of Changzheng Hospital of Naval Medical University (Second Military Medical University) from April 2019 to July 2019 were enrolled in this study. Pathological data and ultrasonic diagnosis results were retrospectively analyzed. All patients underwent conventional ultrasonography and AI automatic detection before surgery. The diagnoses for benign and malignant thyroid nodules were compared between conventional ultrasonography and AI automatic detection system, which were based on the postoperative pathology. The sensitivity, specificity and accuracy of the two examination methods were calculated, and Kappa coefficient was performed to measure the consistency between the two methods and postoperative pathological diagnosis. Results: The sensitivity, specificity and accuracy of conventional ultrasonography in diagnosis of benign and malignant thyroid nodules were respectively 93.75% (90/96), 80.49% (33/41) and 89.78% (123/137), and those of AI automatic detection were 89.58% (86/96), 68.29% (28/41) and 83.21% (114/137). There was substantial coefficience between conventional ultrasonography and pathological diagnosis results (Kappa=0.75, P<0.001), and that was fair coefficience between AI automatic detection system and pathological diagnosis results (Kappa=0.59, P<0.001). Conclusion: The sensitivity and accuracy of AI automatic detection system are slightly lower than but close to those of conventional ultrasonography in differentiating benign from malignant thyroid nodules. AI automatic detection system can be used as an effective supplement to assist conventional ultrasonography for preoperative assessment of thyroid nodules.

Disorders of Excessive Somnolence ; Humans ; Parkinson Disease ; complications ; REM Sleep Behavior Disorder ; therapy ; Restless Legs Syndrome ; therapy ; Sleep Apnea, Obstructive ; therapy ; Sleep Wake Disorders ; therapy

Consensus ; Humans ; Insomnia, Fatal Familial ; diagnosis ; Mutation ; Pedigree

This article introduced professor WANG Shu-chen's experience in picture treating bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation with tougue picture as the key link. Patients with BOS showed deficiency of essence of tongue crack, which should be treated by warming kidney yang, replenishing essence and marrow; fester tongue for qi disorder, inflammation caused by fire, which should be treated by regulating qi, and clearing heat; exfoliative fur accumulation, which should be treated with blood stasis and toxin, removing blood stasis and toxin; thick and greasy fur, which should be treated by warming spleen and activating spleen.

OBJECTIVETraditional Chinese medicine (TCM) is regarded as an important treatment for gastric cancer patients, especially for those in advanced stage. To evaluate the effects of TCM treatment on gastric cancer patients, the authors performed a retrospective study to report the result of the integrated treatment of TCM with chemotherapy for stage IV non-surgical gastric cancer.

METHODSIn this study, 182 patients with stage IV and non-surgical gastric cancer were retrospectively analyzed to evaluate the effects of TCM integrated with chemotherapy. Among the 182 cases, 88 cases received integrated therapy consisting of TCM and chemotherapy, while 94 cases received chemotherapy alone. The overall survival and Karnofsky performance status (KPS) score were measured as the main outcome.

RESULTSThe median overall survival of the integrated therapy group and chemotherapy group were 16.9 and 10.5 months, respectively. The 1-, 3- and 5-year survival rates of integrated therapy group vs. chemotherapy group were 70% vs. 32%, 18% vs. 4%, and 11% vs. 0%, respectively. There was a significant difference between the two groups (χ= 42.244, P > 0.001). After six-month treatment, KPS scores of the integrated therapy group and the chemotherapy group were 75.00 ± 14.78 and 60.64 ± 21.39, respectively (P > 0.001). The Cox regression analysis showed that TCM treatment is a protective factor for patients' overall survival.

CONCLUSIONThis study demonstrated that TCM integrated with chemotherapy may prolong overall survival and improve survival rate and life quality of patients with stage IV non-surgical gastric cancer.