Objective To prepare a dissolvable microneedle(DMN)with a tip-layer loaded with hyaluronic acid(HA)modified sinomenine hydrochloride liposomes(HA-SMH-Lip),as well as characterize,evaluate its in vitro transdermal permeability,cellular uptake ability,and anti-inflammatory ability.Methods HA-SMH-Lip-DMNs were prepared by a two-step casting method,and the drug loading capacity was determined using HPLC.The morphology,skin permeation properties and in vitro transdermal ability were investigated by scanning electron microscopy,puncture assay and Franz diffusion cell method.Fluorescent microneedles were prepared by replacing HA-SMH-Lip with fluorescein isothiocyanate liposomes(HA-FITC-Lip/FITC-Lip).The uptake behavior of inflammation cells on HA-FITC-Lip-DMNs/FITC-Lip-DMNs was investigated using a flow cytometer and a fluorescence microscope.To evaluate the anti-inflammatory activity of HA-SMH-Lip-DMNs,the levels of inflammatory factors including nitric oxide(NO),tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β),and IL-10 in cell supernatants were measured using an ELISA kit.Results The prepared HA-SMH-Lip-DMNs have uniform shape and size,integral and visually pleasing array,and an average drug loading of(114.01±1.04)μg.Additionally,they have good puncture ability.The results of in vitro transdermal experiments showed that the accumulated amounts of HA-SMH-Lip-DMNs were(101.47±2.91)μg·cm-2 at 36 hours.Its transdermal ability was better than that of the SMH solution group and SMH liposome group.In vitro cellular uptake results indicated that HA-FITC-Lip-DMNs were more effectively taken up by RAW 264.7 cells(P＜0.01).Compared to the model group,HA-SMH-Lip-DMNs group significantly reduced TNF-α,IL-1β,and NO levels while increase IL-10 levels(P＜0.01).Conclusion The prepared HA-SMH-Lip-DMNs have a complete and beautiful morphology with excellent cellular uptake capability,remarkable in vitro transdermal performance,and potent anti-inflammatory properties.HA-SMH-Lip-DMNs are expected to become a new type of transdermal drug delivery system.

Objective:To simulate the neuroendoscopy assisted contralateral cervical 7 (C 7) nerve transfer via prespinal route and measure its relevant anatomical landmarks to explore the clinical feasibility and efficacy of this surgical approach for central upper limb spastic paralysis. Methods:(1) Six fresh cadaver specimens of the head and neck were obtained. Linear incisions of approximately 5 cm were made above the midpoint of the bilateral clavicles to simulate neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. With the superior margin of midpoint of the clavicle as central point, distance to the distal bifurcation of the C 7 nerve, distances to the superior or inferior trunks of the proximal brachial plexus nerves, and distances to the exit of the intervertebral foramina of the C 6, C 7, and C 8 nerves were measured. (2) One patient with upper limb spastic paralysis after intracerebral hemorrhage accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route; the clinical data and efficacy of the patient were retrospectively analyzed. Results:(1) The C 7 nerve, the upper trunk of brachial plexus formed by the C 5 and C 6 nerves and the lower trunk of brachial plexus formed by the C 8 and T 1 nerves could be exposed after neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. The distance between the superior margin of midpoint of the clavicle and the distal bifurcation of the C 7 nerve is (2.20±0.11) cm, and its distance to the superior trunk of the proximal brachial plexus is (2.62±0.10) cm, and its distance to the inforior trunk of the proximal brachial plexus nerve is (2.72±0.11) cm. The distance between the superior margin of midpoint of the clavicle and the proximal C 7 nerve (at the exit of the intervertebral foramen) is (7.22±0.15) cm, its distance to the proximal C 6 nerve (at the exit of the intervertebral foramen) is (7.84±0.12) cm, and its distance to the proximal C 8 nerve (at the exit of the intervertebral foramen) is (6.96±0.12) cm. (2) The patient with central upper limb spastic paralysis accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route successfully, with surgical time lasting for 2 h and bleeding amount of 20 mL. After surgery, the incision healed well, and the patient experienced pain and numbness in the healthy side of the upper limb with subsided symptoms one month after surgery. The spasticity symptoms of the affected upper limb obviously improved after surgery with decreased muscle tone. Follow-up after discharge was performed for 14 months, and the muscle strength of the affected upper limb recovered to level 1 +. Conclusion:Neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route can expose the proximal and distal C 7 nerves, with minimal invasion; this clinical study has preliminarily confirmed the safety and effectiveness of this transfer via prespinal route in central upper limb spastic paralysis.

Objective:To investigate the impact of the implementation of GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker" on the results of occupational health examination for radiation workers.Methods:In April 2022, the subjects of the study were the radiation workers who underwent occupational health examination in Occupational Disease Prevention and Treatment Institute of Hefei. The radiation workers whose registration period was from May 1, 2021 to April 30, 2022 were the new standard group, and the occupational health surveillance standard was GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker". The radiationl workers registered from May 1, 2020 to April 30, 2021 were the old standard group, whose occupational health surveillance standards were GBZ 98- 2017 "Health Requirements for Radiation Workers" and GBZ 235-2011 "Specifications for Occupational Health Surveillance for Radiation Workers". To analyze whether there were differences between the two groups in the detection rate of missing items in the examination, re-examination, and the detection rate of occupational contraindications. The radiation workers whose occupational health examination results showed re-examination and/or occupational contraindications were judged to be in the unqualified group. Univariate and multivariate logistic regression analysis was used to find the factors affecting the determination of unqualified group.Results:The missing item detection rate of radiation workers in the new standard group was 3.04% (63/2074) , significantly higher than that in the old standard group (0.68%, 14/2054) ( P<0.05) . The re-examination and occupational contraindications detection rates in the new standard group were 5.93% (123/2074) and 0.58% (12/2074) , respectively, which were significantly lower than those in the old standard group (13.83%, 284/2054) and 2.34% (48/2054) ( P<0.05) . The missing item detection rate of males in the new standard group was 2.78% (40/1440) , which was significantly higher than that in the old standard group (0.72%, 11/1536) ( P<0.05) . The re-examination and occupational contraindications detection rates of males in the new standard group were 3.61% (52/1440) and 0.21% (3/1440) , respectively, which were significantly lower than those in the old standard group (12.17%, 187/1536) and 2.08% (32/1536) ( P<0.05) . The missing item detection rate of females in the new standard group was 3.63% (23/634) , which was significantly higher than that in the old standard group (0.58%, 3/518) ( P<0.05) . The re-examination detection rate of females in the new standard group was 11.20% (71/634) , which was significantly lower than that of females in the old standard group (18.73%, 97/518) ( P<0.05) . Univariate logistic regression analysis showed that gender, radiation classification, determination basis, occupational health examination category, and registration category were all influencing factors for the unqualified occupational health examination results of radiation workers ( P<0.05) . Multivariate logistic regression analysis showed that the risk of being judged as unqualified based on the old standard was 2.466 times that of the new standard (95% CI: 1.975-3.080, P<0.05) , and the risk of being judged as unqualified for females was 1.869 times that of males (95% CI: 1.498-2.333, P<0.05) , the risk of being judged as unqualified for radiation workers during and after employment was 0.802 times that of pre-employment individuals (95% CI: 0.650-0.989, P<0.05) , and the risk of being judged as unqualified for re-examined individuals was 4.056 times that of initial examinees (95% CI: 3.161-5.203, P<0.05) . Conclusion:The results of occupational health examination of radiation workers are related to the determination basis, gender, occupational health examination category, and registration category. The implementation of GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker" may reduce the detection rate of unqualified personnel.

OBJECTIVE To evaluate the ameliorative effect of Juanbi Tongluo Oral Liquid on sciatic neuronal apoptosis in Type 2 diabetic model mice.METHODS The Type 2 diabetes mouse model was established by feeding with high-fat and high-sugar diet combined with intraperitoneal injection of streptozotocin(STZ).The mice were treated with metformin(200 mg·kg-1·d-1),low dose(3.9 g·kg-1·d-1)and high dose(7.8 g·kg-1·d-1)Juanbi Tongluo Oral Liquid for 35 days.The latency of response to thermal stimu-lation was detected by hot plate,and the values of blood glucose insulin and glycosylated hemoglobin were determined.Biochemical kits were used to detect the expression of serum total cholesterol(T-CHO),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)and oxidation product malondialdehyde(MDA).The expression of tumor cytokine α(TNF-α),interleukin(IL)-1β,IL-6 and IL-10 in serum of mice were detected by ELISA method;the injury of sciatic nerve of model mice was detected by HE staining;the apoptosis of sciatic nerve was detected by TUNEL method;and the expression of neurofilament protein NF-L,apoptosis(cleaved Caspase-3,Caspase-3)and oxidative stress(Nrf2,HO-1)signal pathway proteins in sciatic nerve of model mice were detected by Western blot method.RESULTS High-dose Juanbi Tongluo Oral Liquid shortened the latent period of heat pain response in model mice(P<0.01);downregulated fasting blood glucose and glycated hemoglobin(P<0.01),and upregulated fasting plasma insulin in model mice(P<0.01);downregulated serum T-CHO,TG,and LDL-C levels(P<0.01),upregulated HDL-C levels(P<0.01);downregulated serum pro-inflammatory factors TNF-α,IL-1β and IL-6 levels(P<0.05),upregulated the anti-inflammatory cyto-kine IL-10 level(P<0.01);inhibited sciatic nerve structural damage and apoptosis(P<0.05);downregulated the ratio of cleaved Caspase-3 to Caspase-3 in the apoptosis pathway(P<0.01);upregulated the expression of neurofilament proteins NF-L and NF-H in sciatic nerve tissue(P<0.05,P<0.01);and upregulated the expression of antioxidant stress proteins Nrf2 and HO-1(P<0.01).CONCLUSION Juanbi Tongluo Oral Liquid can improve sciatic neuronal apoptosis of Type 2 diabetic mice,which may be related to its effect on improving oxidative stress and inflammatory stress.

Objective To compare the effects of visual rigid laryngoscope and visual laryngoscope in nasotracheal intubation(NTI)for patients with cervical spine immobilization simulated difficult airway.Methods Ninety patients scheduled for selective surgery under general anesthesia requiring NTI,52 males and 38 females,aged 18-64 years,BMI 18.5-25.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were scheduled for selective surgery under general anesthesia requiring NTI.Before anesthesia induction,the spinal surgeon selected an appropriate cervical collar and adjusted it to fix patient's neck to establishing difficult airway sim-ulation model.All patients were randomly assigned into two groups:visual rigid laryngoscope(group R)and common visual laryngoscope(group C),45 patients in each group.NTI was performed using either visual rigid laryngoscope or visual laryngoscope in groups R and C,respectively.The nasal passage time,glottic exposure time,intubation time,number of successful first intubation attempts,and intubation attempts were recorded.Glottic exposure was assessed using the Cormack-Lehane(C-L)grading system,and the intuba-tion condition was quantitatively evaluated using the modified nasal intubation difficulty scale(NIDS).The blood pressure and heart rate were measured at baseline(T1),immediately after intubation(T2),and at 1 minute(T3)and 3 minutes(T4)after intubation.The occurrence of intubation-related complications(nasal bleeding,sore throat,hoarseness)was recorded.Results Compared with group C,the nasal passage time and proportion of successful intubations without difficulty were significantly increased in group R,and the glottic exposure time and intubation time were significantly decreased in group R(P<0.05).Compared with group C,the HR and MAP at T2 and T3 were significantly decreased in group R(P<0.05).Com-pared with group C,group R had significantly lower incidence rates of nasal bleeding,sore throat,and hoarseness(P<0.05).There were no statistically significant differences in the first intubation success rate,number of intubation attempts,or C-L grade between the two groups.Conclusion Patients with cer-vical spine immobilization simulated difficult airway,both visual rigid laryngoscope and visual laryngoscope can be performed safely and effectively in NTI.Compared with visual laryngoscope,visual rigid laryngoscope can provide faster glottic exposure,shorter intubation time,lower intubation difficulty,less hemodynamic impact,and lower incidence of complications.

Objective:To investigate the clinical effect of super-thin free anterolateral thigh (ALT) flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods:The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed. During the operation, the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound. The donor site wound was sutured directly or repaired with full-thickness skin graft. The flap survival and complications were observed after the operation, and the operation effect was evaluated from the following five aspects. (1) The Maryland foot function score was used to evaluate the recovery of foot function. The full score was 100 points, of which 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, and < 50 points were poor. (2) The Vancouver scar scale (VSS) was used to evaluate the scar condition of the foot. The total score was 0-15 points. The higher the score, the more serious the scar. (3) The cold intolerance symptom severity (CISS) scale was used to evaluate the cold tolerance of the affected foot. The total score was 4-100 points. The higher the score, the more serious the symptoms. (4) Measuring static two-point discrimination to evaluate foot sensation, the smaller the measured value, the better the sensory recovery. (5) The satisfaction of patients with foot appearance was investigated, which was divided into five grades: very satisfied, satisfied, general, dissatisfied and very dissatisfied. Descriptive analysis of the data was performed using SPSS 26.0 software.Results:A total of 13 patients with foot soft tissue defects were enrolled, including 8 males and 5 females. The mean age was 54.7 years (range, 39-70 years). There were 10 cases of left foot and 3 cases of right foot. The wound area after thorough debridement ranged from 5.5 cm ×5.0 cm to 22.0 cm ×18.0 cm. The operation time was (145.1 ± 30.6) min. The area of the flap was 6.0 cm×5.5 cm to 23.5 cm×19.0 cm, and the thickness was (5.2 ± 1.1) mm (range, 3.0- 6.5 mm). The wound at the donor site was sutured directly in 9 cases, and coverd with the abdominal full-thickness skin graft in 4 cases. After the operation, 1 patient had partial epidermal necrosis at the distal end of the flap, 1 patient had venous crisis.The flaps survived after symptomatic treatment. The remaining 11 flaps survived smoothly. The patients were followed up for 12 to 20 months, with an average of 16 months. The foot flaps were soft and free of damage, and no secondary fat reduction or plastic surgery was required. There were no complications such as wound dehiscence, skin graft necrosis, muscle hernia, and quadriceps weakness in 13 cases of donor site except for hypoesthesia caused by scar hyperplasia in 4 cases with skin graft. At the last follow-up, the Maryland foot function score was (87.4±7.3) points, of which 7 cases were excellent, 4 cases were good, and 2 cases were fair. The excellent and good rate was 11/13. The foot scar was not obvious, the VSS score was (3.2±1.2) points. The foot was more tolerant to cold and the sensory recovery was better, the CISS score was (37.5±7.1) points and the static two-point discrimination was (13.9±1.0) mm. One month after the operation, the results of patients’ satisfaction with foot appearance were as follows: 11 cases were very satisfied and 2 cases were satisfied.Conclusion:The super-thin free ALT flap is obtained at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defect of the foot, which can optimize the operation time. The appearance and function of the foot recover well after the operation, avoiding the secondary shaping operation, reducing the damage to the donor site, and the patients are satisfied.

Objective:To investigate the impact of the implementation of GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker" on the results of occupational health examination for radiation workers.Methods:In April 2022, the subjects of the study were the radiation workers who underwent occupational health examination in Occupational Disease Prevention and Treatment Institute of Hefei. The radiation workers whose registration period was from May 1, 2021 to April 30, 2022 were the new standard group, and the occupational health surveillance standard was GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker". The radiationl workers registered from May 1, 2020 to April 30, 2021 were the old standard group, whose occupational health surveillance standards were GBZ 98- 2017 "Health Requirements for Radiation Workers" and GBZ 235-2011 "Specifications for Occupational Health Surveillance for Radiation Workers". To analyze whether there were differences between the two groups in the detection rate of missing items in the examination, re-examination, and the detection rate of occupational contraindications. The radiation workers whose occupational health examination results showed re-examination and/or occupational contraindications were judged to be in the unqualified group. Univariate and multivariate logistic regression analysis was used to find the factors affecting the determination of unqualified group.Results:The missing item detection rate of radiation workers in the new standard group was 3.04% (63/2074) , significantly higher than that in the old standard group (0.68%, 14/2054) ( P<0.05) . The re-examination and occupational contraindications detection rates in the new standard group were 5.93% (123/2074) and 0.58% (12/2074) , respectively, which were significantly lower than those in the old standard group (13.83%, 284/2054) and 2.34% (48/2054) ( P<0.05) . The missing item detection rate of males in the new standard group was 2.78% (40/1440) , which was significantly higher than that in the old standard group (0.72%, 11/1536) ( P<0.05) . The re-examination and occupational contraindications detection rates of males in the new standard group were 3.61% (52/1440) and 0.21% (3/1440) , respectively, which were significantly lower than those in the old standard group (12.17%, 187/1536) and 2.08% (32/1536) ( P<0.05) . The missing item detection rate of females in the new standard group was 3.63% (23/634) , which was significantly higher than that in the old standard group (0.58%, 3/518) ( P<0.05) . The re-examination detection rate of females in the new standard group was 11.20% (71/634) , which was significantly lower than that of females in the old standard group (18.73%, 97/518) ( P<0.05) . Univariate logistic regression analysis showed that gender, radiation classification, determination basis, occupational health examination category, and registration category were all influencing factors for the unqualified occupational health examination results of radiation workers ( P<0.05) . Multivariate logistic regression analysis showed that the risk of being judged as unqualified based on the old standard was 2.466 times that of the new standard (95% CI: 1.975-3.080, P<0.05) , and the risk of being judged as unqualified for females was 1.869 times that of males (95% CI: 1.498-2.333, P<0.05) , the risk of being judged as unqualified for radiation workers during and after employment was 0.802 times that of pre-employment individuals (95% CI: 0.650-0.989, P<0.05) , and the risk of being judged as unqualified for re-examined individuals was 4.056 times that of initial examinees (95% CI: 3.161-5.203, P<0.05) . Conclusion:The results of occupational health examination of radiation workers are related to the determination basis, gender, occupational health examination category, and registration category. The implementation of GBZ 98-2020 "Health Requirements and Surveillance Specifications for Radiation Worker" may reduce the detection rate of unqualified personnel.

Air embolism is a rare but dreaded complication of medical or surgical procedures with sig-nificant mortality.An abnormal air-to-blood pressure gradient and communication between the vein and atmosphere can lead to the venous air embolism.Here,we presented a rare case of venous air embolism just after the removal of the central venous catheters.A 59-year-old female was admitted to Peking Uni-versity International Hospital suffering from neuromyelitis optica spectrum disorder.After 5 rounds of im-munosorbent therapy,her hemodialysis catheter was removed.Five hours later,she suddenly experienced shortness of breath,dizziness,weakness of the lower extremities,transient loss of consciousness and sei-zures.Ultrasound showed a small amount of gas in the right internal jugular vein and brain CT showed scattered air accumulation in part of venous blood ducts and bilateral cavernous sinuses,which was diag-nosed as air embolism.High-flow oxygen inhalation,compression of the right neck extubation site,head down and feet up left decubitus position,intravenous fluid therapy were used.The patient gradually im-proved and returned to normal activities after one week.To sum up,air embolism is a rare,but serious and life-threatening complication after central catheters removal.Clinicians need to be alerted and take appropriate preventive measures.

Ameloblastoma is a benign tumor characterized by locally invasive phenotypes,leading to facial bone destruction and a high recurrence rate.However,the mechanisms governing tumor initiation and recurrence are poorly understood.Here,we uncovered cellular landscapes and mechanisms that underlie tumor recurrence in ameloblastoma at single-cell resolution.Our results revealed that ameloblastoma exhibits five tumor subpopulations varying with respect to immune response(IR),bone remodeling(BR),tooth development(TD),epithelial development(ED),and cell cycle(CC)signatures.Of note,we found that CC ameloblastoma cells were endowed with stemness and contributed to tumor recurrence,which was dominated by the EZH2-mediated program.Targeting EZH2 effectively eliminated CC ameloblastoma cells and inhibited tumor growth in ameloblastoma patient-derived organoids.These data described the tumor subpopulation and clarified the identity,function,and regulatory mechanism of CC ameloblastoma cells,providing a potential therapeutic target for ameloblastoma.

Objective Microcystin-leucine-arginine(MC-LR)exposure induces lipid metabolism disorders in the liver.Secreted frizzled-related protein 5(SFRP5)is a natural antagonist of winglesstype MMTV integration site family,member 5A(Wnt5a)and an anti-inflammatory adipocytokine.In this study,we aimed to investigate whether MC-LR can induce lipid metabolism disorders in hepatocytes and whether SFRP5,which has anti-inflammatory effects,can alleviate the effects of hepatic lipid metabolism by inhibiting the Wnt5a/Jun N-terminal kinase(JNK)pathway. Methods We exposed mice to MC-LR in vivo to induce liver lipid metabolism disorders.Subsequently,mouse hepatocytes that overexpressed SFRP5 or did not express SFRP5 were exposed to MC-LR,and the effects of SFRP5 overexpression on inflammation and Wnt5a/JNK activation by MC-LR were observed. Results MC-LR exposure induced liver lipid metabolism disorders in mice and significantly decreased SFRP5 mRNA and protein levels in a concentration-dependent manner.SFRP5 overexpression in AML12 cells suppressed MC-LR-induced inflammation.Overexpression of SFRP5 also inhibited Wnt5a and phosphorylation of JNK. Conclusion MC-LR can induce lipid metabolism disorders in mice,and SFRP5 can attenuate lipid metabolism disorders in the mouse liver by inhibiting Wnt5a/JNK signaling.