Objective To analyze the trend of global cellulitis disease burden from 1990 to 2019, and to provide a theoretical basis for the prevention and control of cellulitis disease. Methods The Global Burden of Disease 2021 (GBD2021) data were collected, and data on the incidence, mortality, and disability-adjusted life year (DALY) of cellulitis were analyzed for each country worldwide. The estimated annual percentage change (EAPC) and age-standardized rate (ASR) were used to estimate the trend change of cellulitis from 1990 to 2021. Results The global burden of cellulitis increased significantly in 2021, with 55.96 million cases, 28.9 million deaths and 876.1 million DALYs, respectively. Incidence and mortality rates were generally higher in males than in females. The incidence and DALYs were higher in high SDI regions, with the highest burden observed in South Asia. In contrast, East Asia exhibited the lowest burden and demonstrated a declining trend. There were significant differences between countries, with India having the highest prevalence, the United States having the highest incidence, and Bahrain having the fastest growing rate.In 2021, China had the lowest age-standardised incidence of cellulitis in the world and the fastest declining age-standardised incidence and age-standardised DALYs. Conclusion The global disease burden of cellulitis is increasing from 1990-2021, and cellulitis remains an an important global public health problem. Targeted preventive meausres should be taken in areas with different economical levels. Men, middle-aged and elderly people, and newborns are the key groups in need of attention and health education.

Transformer models have emerged as pivotal tools within the realm of drug discovery, distinguished by their unique architectural features and exceptional performance in managing intricate data landscapes. Leveraging the innate capabilities of transformer architectures to comprehend intricate hierarchical dependencies inherent in sequential data, these models showcase remarkable efficacy across various tasks, including new drug design and drug target identification. The adaptability of pre-trained transformer-based models renders them indispensable assets for driving data-centric advancements in drug discovery, chemistry, and biology, furnishing a robust framework that expedites innovation and discovery within these domains. Beyond their technical prowess, the success of transformer-based models in drug discovery, chemistry, and biology extends to their interdisciplinary potential, seamlessly combining biological, physical, chemical, and pharmacological insights to bridge gaps across diverse disciplines. This integrative approach not only enhances the depth and breadth of research endeavors but also fosters synergistic collaborations and exchange of ideas among disparate fields. In our review, we elucidate the myriad applications of transformers in drug discovery, as well as chemistry and biology, spanning from protein design and protein engineering, to molecular dynamics (MD), drug target identification, transformer-enabled drug virtual screening (VS), drug lead optimization, drug addiction, small data set challenges, chemical and biological image analysis, chemical language understanding, and single cell data. Finally, we conclude the survey by deliberating on promising trends in transformer models within the context of drug discovery and other sciences.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective To observe the clinical efficacy of Chang'an Juntai Granules(mainly composed of Pseudostellariae Radix,Atractylodis Macrocephalae Rhizoma,Poria,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Paeoniae Radix Alba,Saposhnikoviae Radix,Citri Reticulatae Pericarpium,Coptidis Rhizoma,and Aucklandiae Radix)in the treatment of diarrhea-predominant irritable bowel syndrome(IBS-D)with liver depression and spleen deficiency syndrome,and to evaluate its safety.Methods A single-center,randomized,double-blind,placebo-controlled clinical trial was designed.A total of 130 patients with IBS-D of liver depression and spleen deficiency were included.The patients were randomly divided into a treatment group and a control group by random number table method,with 65 cases in each group.The treatment group was treated with Chang'an Juntai Granules,and the control group was treated with Chang'an Juntai Placebo Granules.The course of treatment covered 12 weeks.The changes in the scores of IBS Symptom Severity Scale(IBS-SSS),Bristol Stool Form Scale(BSFS),IBS Quality of Life Questionnaire(IBS-QOL)and Hospital Anxiety and Depression Scale(HADS)in the two groups were observed before and after treatment.After treatment,the clinical efficacy and medication safety in the two groups were evaluated.Results(1)During the trial,six cases in the treatment group and eight cases in the control group fell off.Eventually,a total of 116 patients completed the clinical trial,including 59 cases in the treatment group and 57 cases in the control group.(2)After 12 weeks of treatment,the total effective rate of the treatment group was 88.14％(52/59),and that of the control group was 45.61％(26/57).The intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the treatment group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.01).(3)After treatment,the IBS-SSS scores of the two groups and the BSFS and IBS-QOL scores of the treatment group were significantly lower than those before treatment(P＜0.01),while the scores of Hospital Anxiety and Depression Scale-Anxiety subscale(HADA)and Hospital Anxiety and Depression Scale-Depression subscale(HADD)in the two groups and the BSFS and IBS-QOL scores in the control group showed no obvious changes(P＞0.05).Compared with the control group,the decrease of IBS-SSS,BSFS and IBS-QOL scores in the treatment group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(4)During the trial,no serious adverse reactions or adverse events occurred in the two groups,no drug-related abnormalities of liver and kidney function,blood,and heart function were found,either.Conclusion Chang'an Juntai Granules are effective on improving the clinical symptoms and fecal characteristics of IBS-D patients with liver depression and spleen deficiency syndrome,and on enhancing the quality of life of patients.The granules excert definite curative effect and high safety,and has certain value of clinical application.

Background::Homoharringtonine (HHT) is an effective anti-inflammatory, anti-viral, and anti-tumor protein synthesis inhibitor that has been applied clinically. Here, we explored the therapeutic effects of HHT in a mouse heart transplant model.Methods::Healthy C57BL/6 mice were used to observe the toxicity of HHT in the liver, kidney, and hematology. A mouse heart transplantation model was constructed, and the potential mechanism of HHT prolonging allograft survival was evaluated using Kaplan–Meier analysis, immunostaining, and bulk RNA sequencing analysis. The HHT-T cell crosstalk was modeled ex vivo to further verify the molecular mechanism of HHT-induced regulatory T cells (Tregs) differentiation. Results::HHT inhibited the activation and proliferation of T cells and promoted their apoptosis ex vivo. Treatment of 0.5 mg/kg HHT for 10 days significantly prolonged the mean graft survival time of the allografts from 7 days to 48 days ( P <0.001) without non-immune toxicity. The allografts had long-term survival after continuous HHT treatment for 28 days. HHT significantly reduced lymphocyte infiltration in the graft, and interferon-γ-secreting CD4 + and CD8 + T cells in the spleen ( P <0.01). HHT significantly increased the number of peripheral Tregs (about 20%, P <0.001) and serum interleukin (IL)-10 levels. HHT downregulated the expression of T cell receptor (TCR) signaling pathway-related genes ( CD4, H2-Eb1, TRAT1, and CD74) and upregulated the expression of IL-10 and transforming growth factor (TGF) -β pathway-related genes and Treg signature genes ( CTLA4, Foxp3, CD74, and ICOS). HHT increased CD4 + Foxp3 + cells and Foxp3 expression ex vivo, and it enhanced the inhibitory function of inducible Tregs. Conclusions::HHT promotes Treg cell differentiation and enhances Treg suppressive function by attenuating the TCR signaling pathway and upregulating the expression of Treg signature genes and IL-10 levels, thereby promoting mouse heart allograft acceptance. These findings may have therapeutic implications for organ transplant recipients, particularly those with viral infections and malignancies, which require a more suitable anti-rejection medication.

OBJECTIVE: To explore the mechanism of electroacupuncture (EA) in promoting recovery of the facial function with the involvement of autophagy, glial cell line-derived neurotrophic factor (GDNF), and phosphatidylinositol-3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway. METHODS: Seventy-two male Sprague-Dawley rats were randomly allocated into the control, sham-operated, facial nerve injury (FNI), EA, EA+3-methyladenine (3-MA), and EA+GDNF antagonist groups using a random number table, with 12 rats in each group. An FNI rat model was established with facial nerve crushing method. EA intervention was conducted at Dicang (ST 4), Jiache (ST 6), Yifeng (SJ 17), and Hegu (LI 4) acupoints for 2 weeks. The Simone's 10-Point Scale was utilized to monitor the recovery of facial function. The histopathological evaluation of facial nerves was performed using hematoxylin-eosin (HE) staining. The levels of Beclin-1, light chain 3 (LC3), and P62 were detected by immunohistochemistry (IHC), immunofluorescence, and reverse transcription-polymerase chain reaction, respectively. Additionally, IHC was also used to detect the levels of GDNF, Rai, PI3K, and mTOR. RESULTS: The facial functional scores were significantly increased in the EA group than the FNI group (P<0.05 or P<0.01). HE staining showed nerve axons and myelin sheaths, which were destroyed immediately after the injury, were recovered with EA treatment. The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats (P<0.01); however, EA treatment reversed these abnormal changes (P<0.01). Meanwhile, EA stimulation significantly increased the levels of GDNF, Rai, PI3K, and mTOR (P<0.01). After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist, the repair effect of EA on facial function was attenuated (P<0.05 or P<0.01). CONCLUSIONS EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI. EA may exert this neuroreparative effect through mediating the release of GDNF, activating the PI3K/mTOR signaling pathway, and further regulating the autophagy of facial nerves.
Rats ; Male ; Animals ; Rats, Sprague-Dawley ; Electroacupuncture ; Phosphatidylinositol 3-Kinase/metabolism* ; Facial Nerve Injuries/therapy* ; Phosphatidylinositol 3-Kinases/metabolism* ; Beclin-1 ; Glial Cell Line-Derived Neurotrophic Factor ; Signal Transduction ; TOR Serine-Threonine Kinases/metabolism* ; Autophagy ; Mammals/metabolism*

The Ehlers-Danlos syndrome(EDS)is a rare inherent connective tissue disorder.The prev-alence of EDS in the population is estimated at one out of ten thousand to one out of a hundred thousand.The vascular EDS(vEDS)are rare among the subtypes but are the worst in prognosis.The article reports a case of vEDS admitted to the hospital.The patient was a young man complaining of a sudden onset of aphasia in right hemiparalysis and severe left abdominal pain for unknown reasons.The diagnosis was made after the genetic testing.The patient suffered from vEDS.Then,the multi-disciplinary team(MDT)made a treatment plan tailored to this young patient.The complexity in classification and delusive presentations of the EDS make the correct diagnosis very challenging.This article hopes to report this case and to share the experiences to the bet-ter understanding of this disease.

Objective:To investigate the morphological difference and clinical significance of bilateral lumbar multifidus muscles in patients with unilateral lumbosacral radiculopathy due to lumbar disc herniation and lumbar spondylolisthesis.Methods:A retrospective analysis was conducted on patients with low back pain, lumbar disc herniation and lumbar spondylolisthesis. Patients with lumbar disc herniation or lumbar spondylolisthesis underwent single segment lesion either at L 4, 5 or L 5S 1, while those accompanied with unilateral lumbosacral radiculopathy underwent percutaneous endoscopic lumbar discectomy or conventional open surgery at Qingdao Municipal Hospital between January 2017 and January 2023. Patients with lumbar spondylolisthesis were subdivided into degenerative lumbar spondylolisthesis and isthmic spondylolisthesis. 53 patients with low back pain met the inclusion criteria. 170 patients with lumbar disc herniation met the inclusion criteria, with 101 at L 4, 5 and 69 at L 5S 1 level. 129 patients with lumbar spondylolisthesis met the inclusion criteria, including 91 of degenerative lumbar spondylolisthesis at L 4, 5 level and 9 at L 5S 1 level, and 11 of isthmic spondylolisthesis at L 4, 5 level and 18 at L 5S 1 level. Cross-sectional images at the mid-disc of L 3, 4, L 4, 5 and L 5S 1 segments in MRI were acquired. Relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), fat infiltration rate (FIR), relative fat distance (rFD) and differential value FIR (D-FIR) in bilateral lumbar multifidus muscle were measured respectively by using Image J software, and were then used to evaluate the atrophy and fat infiltration of bilateral lumbar multifidus muscles. Results:No significant difference was found between the both sides of multifidus muscle in low back pain patients. L 4, 5 lumbar disc herniation group had smaller rFCSA (0.34±0.10 and 0.35±0.10) and larger FIR [29.92(22.21, 36.46) and 26.48(17.54, 34.55)] and rFD [0.39(0.29, 0.54) and 0.32(0.21, 0.43)] on the affected side compared to the unaffected side in L 4, 5 segment, and had larger FIR (34.83±11.34 and 31.44±10.94) and rFD [0.59(0.43, 0.77) and 0.51(0.37, 0.69)] on the affected side in L 5S 1 segment. L 5S 1 lumbar disc herniation group had smaller rFCSA (0.41±0.11 and 0.42±0.12) and larger FIR [26.84(22.92, 35.29) and 24.02(20.03, 32.87)] and rFD (0.51±0.28 and 0.42±0.26) on the affected side in L 5S 1 segment. L 4, 5 degenerative lumbar spondylolisthesis group had larger FIR (36.49±9.76 and 34.72±9.86) on the affected side in L 4, 5 segment, and had larger FIR [35.03(28.64, 41.85) and 33.34(26.37, 39.76)] on the affected side in L 5S 1 segment. L 5S 1 degenerative lumbar spondylolisthesis group had larger FIR [42.53(37.94, 46.81) and 40.79(30.84, 43.53)] and rFD (1.12±0.79 and 0.94±0.79) on the affected side in L 5S 1 segment. L 4, 5 isthmic spondylolisthesis group had smaller rFCSA [0.24(0.20, 0.30) and 0.29(0.23, 0.34)]and larger FIR [34.19 31.30, 42.39) and 29.43(28.82, 36.89)] and rFD (0.39±0.15 and 0.29±0.15) on the affected side in L 4, 5 segment, and had larger FIR (43.18±12.71 and 34.12±11.63) on the affected side in L 5S 1 segment. L 5S 1 isthmic spondylolisthesis group had larger FIR (40.24±9.34 and 36.37±10.70) on the affected side in L 5S 1 segment. No significant difference was found of the multifidus muscle between the affected and unaffected sides in the proximal adjacent segment of the responsible segment in lumbar disc herniation or lumbar spondylolisthesis group patients. L 4, 5 isthmic spondylolisthesis group had larger D-FIR (6.75±8.46 and 1.78±5.77) in L 4, 5 segment, and had larger D-FIR (9.06±11.59 and 1.54±7.08) in L 5S 1 segment compared to L 4, 5 degenerative lumbar spondylolisthesis group. Grade Ⅱ L 4, 5 lumbar spondylolisthesis group had larger D-FIR (10.73±13.61 and 1.92±7.43) in L 5S 1 segment compared to grade Ⅰ L 4, 5 lumbar spondylolisthesis group. Conclusion:L 4, 5 or L 5S 1 lumbar disc herniation and lumbar spondylolisthesis patients with unilateral lumbosacral radiculopathy had asymmetric atrophy and fat infiltration of multifidus muscle. The atrophy and fat infiltration on the affected side showed greater. The asymmetry appeared in the responsible segment and its distal adjacent lumbar segment. Lumbar spondylolisthesis patients with a lager degree of slip or with isthmic type could be accompanied by more severe asymmetry of multifidus muscle.

Objective To investigate the predictive value of labor progress angle (AOP), fetal head descent distance (HPD) and their change rates in the outcome of vaginal trial of cesarean scar uterus. Methods A total of 170 pregnant women who underwent vaginal trial production of scar uterus after cesarean section were selected as study subjects, and were divided into successful group and failed group based on the trial production outcomes. Advanced oxidation processes (AOP) and head-perineum distance (HPD) were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm, respectively. The AOP change rate and HPD change rate after 1 hour of progress were calculated. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of AOP, HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section. Delong test was used to compare the differences in area under curves (AUCs). Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again, 139 cases (success group) were succeed in transvaginal delivery, while 31 cases failed trial delivery, and transferred to cesarean section (failure group). The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm, and the HPD was significantly shorter than that of the failure group (P < 0.05). The AOP change rate and the change rate of HPD of the successful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour (P < 0.05). The AUC of AOP and HPD in predicting the outcome of vaginal trial delivery of scar uterus after cesarean section were 0.846 and 0.812 respectively, and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately (P>0.05). The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesarean section was 0.899 and 0.852 respectively, and the combined prediction of AOP change rate and HPD change rate had a higher AUC value than the AUC predicted separately. Its AUC value was higher than that of AOP combined with HPD (P < 0.05). Conclusion The AOP, HPD and their change rates when the uterine orifice expands to 4 cm in the active phase of the first stage of labor have predictive value for the outcome of vaginal trial production of scarred uterus after cesarean section.

Objective:To investigate the application effect of virtual simulation combined with flipped classroom in experimental teaching of the nursing care of falls in the elderly.Methods:The 497 nursing undergraduates in the class of 2019 in Chongqing Medical University were selected as subjects and were then divided into control group (two classes with 251 students) and intervention group (two classes with 246 students). The students in the control group received traditional experimental teaching, and those in the intervention group received blended experimental teaching with virtual simulation combined with flipped classroom. At the end of the course, the use of virtual simulation platform was analyzed for the students in the intervention group, and a questionnaire survey and theoretical examination were used to compare the effect of experimental teaching between the two groups. SPSS 27.0 was used for the t-test and the chi-square test. Results:The frequency of use of the virtual simulation platform was (2.65±1.38) times per person in the intervention group, with an online learning time of 54.12-147.32 minutes. The questionnaire survey showed that compared with the control group, the intervention group had significantly higher scores of the achievement of teaching objectives and teaching satisfaction ( P<0.05). Compared with the control group after teaching, the intervention group had significantly higher scores of teaching promotion in terms of stimulating learning interest, cultivating self-learning ability, developing clinical thinking ability, improving innovation, and enhancing health education ability ( P<0.05). The intervention group had a significantly higher theoretical examination score than the control group [(79.38±5.09) vs. (77.88±4.97), P<0.05]. Conclusions:In the blended experimental teaching of the nursing care of falls in the elderly, virtual simulation combined with flipped classroom can help students master related knowledge and skills and cultivate their self-learning ability, clinical thinking ability, innovation ability, and health education ability.