Objective To observe the effect of lattice silver wound repair dressings on large-area abrased wounds . Methods A total of 60 patients with large-area skin abrasions were randomly divided into the observation group and the control group with 30 cases in each group. Both groups were treated with the same antibacterial treatment and nutritional support treatment. The control group received conventional general routine dressings and the observation group had the silver wound repair dressings every day. The two groups were compared in terms of the wound pain, wound infection rate, time for wound healing and scars of patients. Results The wound healing time in the observation group was significantly shortened (P<0.01). The scaring of the observation group was better than that in the control group (P<0.01). The pain degree and the exudation rate were both significantly lower in the observation group than those of the control group (P<0.01), and wound infection rate was lower than that of control group. Conclusions The lattice silver wound repair dressing can effectively promote the wound healing, shorten hospitalization duration, promote the patient recovery soon. It is simple and worthy of clinical popularization.

Objective:To study the characteristics of intestinal tract pathological injury of rats in hypobaric hypoxia at different high altitude.Methods:30 male SD rats were randomly divided into 5 groups:Plain group (n=6),High-altitude (HA) 5000 m for 10 day group(n=6),HA 5000 m for 21day group(n=6),HA 6500 m for 10day group(n=6),HA 6500 m for 21day group (n=6).Rats were raised normally either in plain or simulated high altitude environment,at the corresponding time point,rats were euthanized,small intestines were harvested,fixed tissues were processed routinely into paraffin and sections were stained routinely with hematoxylin and eosin.Morphologic parameters were measured by optical microscope and then the pathological injury score were evaluated.Results:The pathological injury scores ofjejunnm and ileum in the high altitude group were significantly higher than that of the plain group (P＜0.01),the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 5000 m for 21 day group than that of the HA 5000 m for 10 day group,but significant lower than that of the HA 6500 m for 21 day group,the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 6500 m for 10 day group than that of the HA 5000 m for 10 day group(P＜0.01,P＜0.05).The pathological injury scores of colon were significantly higher in the groups of the high altitude than the plain group except for the HA 5000 m for 10 day group (P＜0.01,P＜0.05).The pathological injury scores of jejunum had significant different with that of the colon in the HA 5000 m for 21 day group (P＜0.05);the pathological injury scores of both jejunum and ileum had significant different with that of the colon in the HA 6500 m for 21 day group(P＜0.05,P＜0.01).Conclusions:The injuries of the intestinal mucosa became serious with the with rising altitude and the stayed time,the intestinal injuries were more serious than that of colon at same situation,however there were no significant different between jejunum and ileum,the injuries of colon happened later than intestine,and they correlated with the stay time in the high altitude,which indicated that intestinal injury should be pay more attention in the early time of entering the hypobaric hypoxia environment of the high altitude.

Objective:To study the effects of insulin and berberine on osseointegration of titanium implant in type Ⅱ diabetic rats.Methods:10 out of 53 SD rats were randomly selected and selected into H group(healthy group)(n =10).The remaining rats were treated with high glucose diet plus low dose of streptozotocin(STZ) and 40 rats were induced into the models of type Ⅱ diabeties.The 40 dibetic rats were randomly divided into group B(berberine),group Ⅰ(insulin),group IB(insulin + berberine) and group N(without treatment).2 pure titanium implants were implanted into the bilateral femoral metaphysis of each rat.Mter 7,32,38,66 and 101 d,the body weight(BW) and fasting blood glucose(GLU) were measured.After 10 week,the rats were sacrifice,femoral metaphysis samples were subjected to Micro-CT scan,VG staining and implant pull-out test.Hard tissue slices were observed;bone volume fraction(BV/TV),Liang Houdu (Tb.Th),trabecular bone trabecular number(Tb.N),Liang Jianxi (Tb.Sp),trabecular bone trabecular bone volume (TBV),bone contact ratio(BIC) and the maximum pull-out strength (MPF) were measured.Results:There was no significant difference of BW and GLU between IB group and H group(P ＞ 0.05),but the BW and GLU of IB group was better than those of Ⅰ group and B group,Ⅰ group and B group were better than those of group N (P ＜ 0.05).BV/TV,Tb.Th,Tb.N,Tb.Sp,TBV,BIC and MPF of IB group were not statistically different from those of H group(P ＞0.05);but the indexes of IB group were higher than those of Ⅰ group and B group,those of Ⅰ group and B group were higher than those of N group (P ＜ 0.05).Conclusion:The combination of insulin and berberine can effectively reduce blood glucose and can promote osseointegration of titanium implants in type Ⅱ diabetic rats.

Objective:To investigate the relationship between different obesity metabolic phenotypes and the incidence of new carotid artery plaque.Methods:The present study is a retrospective cohort study, collecting individuals from the Health Management Center of the Second Affiliated Hospital of Dalian Medical University who had two or more cervical vascular color ultrasound examinations and met the inclusion criteria from 2014 to 2022, and collected their baseline clinical data. According to whether the subjects were obese and had metabolic syndrome, they were divided into metabolically healthy non-obese group, metabolically unhealthy non-obese group, metabolically healthy obese group, and metabolically unhealthy obese group. The first physical examination time of the subjects was taken as the starting point of follow-up, and cervical vascular color ultrasound was performed during the follow-up physical examination, with the outcome event being carotid artery plaque. Kaplan-Meier survival curve analysis was used to analyze the cumulative incidence of carotid artery plaques in the four groups and log-rank test was performed, and a multifactorial Cox proportional hazards model was used to analyze the relationship between different obesity metabolic phenotypes and the risk of carotid artery plaque incidence.Results:A total of 4 890 subjects were enrolled, aged (45.4±9.6) years, and 2 754 (56.3%) males. The follow-up time was 1.14(0.93, 2.20) years. Compared with the other 3 obesity metabolic phenotypes, the incidence of carotid plaques in the metabolically unhealthy obesity group was the highest (15.4% (286/1 861)). Kaplan-Meier survival curve analysis showed that the cumulative incidence of carotid plaques in metabolically unhealthy obese subjects was about 2.962 times that of metabolically healthy non-obese subjects (log-rank P<0.001). Multivariate Cox regression results showed that the risk of carotid plaque in metabolically unhealthy obese subjects was 1.650 times that of metabolically healthy non-obese subjects (95% CI: 1.203-2.264, P=0.002). Conclusion:Metabolically unhealthy obesity phenotype is an independent risk factor for carotid plaque.

Objective:To investigate the association between different dietary patterns and subtypes of metabolic associated fatty liver disease(MAFLD).Methods:A total of 6 022 check-ups at the health management center of the Second Hospital of Dalian Medical University from January 2022 to March 2023 were selected as study subjects. MAFLD was categorised into three subtypes: overweight/obese type, metabolic disorder type, and diabetic type. Factor analysis was used to extract dietary patterns. Logistic regression was used to assess the impact of dietary patterns on MAFLD occurrence, constructing interaction models between dietary patterns intake and age, gender, and physical exercise levels. Results:Four dietary patterns were extracted based on feature sorting after factor analysis and were named as the high-quality protein pattern, the fruit-vegetable pattern, egg-aquatic pattern, and the processed meat pattern. Regression analysis of the unadjusted model showed that overweight/obese and diabetic types of MAFLD were negatively associated with the high-quality protein mode, while model-adjusted regression analysis showed that the processed meat pattern was positively associated with the risk of MAFLD, and fruit-vegetable pattern was positively associated with overweight/obese MAFLD( P<0.05). The results of subgroup analyses suggested that female( OR=1.55, 95% CI 1.14-2.15) with a high intake of pickle pattern had a higher risk of overweight/obese MAFLD than male( OR=1.18, 95% CI 1.02-1.49). Conclusion:High-quality protein pattern was negatively correlated with MAFLD, whereas fruit-vegetable pattern and processed meat pattern were positively correlated with MAFLD. Female with high consumption of processed meat pattern are more likely to develop overweight/obesity MAFLD compared with male. It is recommended that people with MAFLD reduce their intake of processed products and high-fructose food, and consume adequate amounts of high-quality protein food to maintain a balanced diet.

Objective:To investigate the relationship between obesity and incident chronic kidney disease(CKD) in a population undergoing health check-ups.Methods:This is a retrospective cohort study. A total of 31 251 participants who had at least 2 health physical examinations in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University from January 2017 to December 2022 and met the inclusion criteria were selected. The participants were divided into normal body weight group, overweight group, and obese group according to baseline body mass index. Cox proportional hazard regression model was used to analyze the relationship between obesity and new-onset CKD, and the dose-response relationship between body mass index and CKD was analyzed with restricted cubic splines.Results:Multivariate Cox regression analysis showed that the risk of developing CKD increased by 13%( HR=1.13, 95% CI 1.01-1.25) and 55%( HR=1.55, 95% CI 1.36-1.76) in the overweight and obese group compared to the normal weight group. Subgroup analysis indicated that obese women had a higher risk of developing CKD compared to men. There was a " U-shaped" correlation between body mass index and CKD in male population, with the lowest risk of CKD occurring at body mass index of 19.6-24.2 kg/m 2. In women, the relationship between body mass index and CKD was approximately linear, with the risk of CKD gradually increasing when body mass index exceeded 22.5 kg/m 2. Conclusions:Obesity is an independent risk factor for new-onset CKD, and obese women have a higher risk of developing CKD than men. Regarding CKD prevention, men are advised to maintain a higher level of body weight within the normal range of body mass index, while women are encouraged to control their weight to a lower level within the normal body mass index range.

Objective:To explore the correlation between systemic immunity-inflammation index(SII) and hyperuricemia(HUA).Methods:Participants who had at least 3 health checkups in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University from January 2014 to December 2022 were selected to construct a dynamic cohort. The SII, reflecting the inflammatory state of the body, was constructed using neutrophil, platelet, and lymphocyte counts. A Cox proportional hazard regression model was used to explore the association between SII and HUA in the overall population and different subgroups of the population, and sensitivity analysis was performed twice. Results:A total of 20 022 subjects were included, and the mean follow-up time was 3.67 years. After adjusting for confounding factors, each unit increase in the natural logarithm of SII(lnSII) was associated with a 24% increased risk of hyperuricemia( HR=1.24, 95% CI 1.16-1.32, P<0.001). As a categorical variable, compared with the lowest quartile array( Q1), the risk of HUA in the total population increased by 12%( HR=1.12, 95% CI 1.03-1.21, P=0.006), 14%( HR=1.14, 95% CI 1.06-1.24, P=0.001), 27%( HR=1.27, 95% CI 1.17-1.37, P<0.001) in Q2, Q3 and Q4 groups within the general population, respectively. All subgroup analysis and sensitivity analysis showed that SII was positively correlated with HUA. Conclusions:Elevated levels of SII significantly increase the risk of HUA. Assessing the body′s inflammatory status using SII can aid in risk screening and preventive management for individuals at high risk of HUA.

Objective: To evaluate the effect of prophylactic nimodipine in vasospasm prevention and outcome improvement in children with subarachnoid hemorrhage (SAH). Methods: A prospective, randomized controlled clinical trial which enrolled children with SAH who were admitted to pediatric intensive care unit (PICU) of Beijing Children′s Hospital from January 2015 to October 2018 was conducted. A total of 43 patients were randomly divided into nimodipine group (24 patients) and control group (19 patients) according to random number table. Transcranial Doppler (TCD) was used to dynamically monitor blood flow velocity and spectrum monography of bilateral middle cerebral artery (MCA) for vasospasm evaluation. Pediatric cerebral performance category (PCPC) scale was used to evaluate patients′ brain function on 28^th day after discharge. Data were analyzed by t test, Mann-Whitney U test, χ² test. Results: Except heart rate ((157±26) vs. (137±34) beats/min, t=2.079, P=0.045), no significant differences existed between the two groups in basic demographic characteristics, primary diseases, and clinical manifestations (all P>0.05). The peak velocities of bilateral MCA on the 5^th day after admission were significantly lower in nimodipine group (left MCA (136±34) vs. (158±23) cm/s, t=-2.890, P=0.006; right MCA (129±34) vs. (176±27) cm/s, t=-3.717, P=0.001). Likewise, a lower peak velocity of left MCA was observed on the 7^th day after admission in nimodipine group ((127±45) vs. (152±13) cm/s, t=-2.903, P=0.007), but no significant difference existed in that of right MCA ((131±48) vs. (150±22) cm/s, t=-1.760, P=0.090). Eleven patients suffered from vasospasm, 25% (6/24) in nimodipine group and 26% (5/19) in control group (χ²=0.010, P=1.000), within whom 8 patients had complete remission after continuing nimodipine treatment, one died in hospital and the other two′s vasospasm still existed at the time of discharge. No significant differences were found between the two groups in mean length of hospitalization, proportion of mechanical ventilation, Glasgow coma scale at discharge, survival rate at discharge or survival rate on 28^th day after discharge (all P>0.05). However, nimodipine group had a higher proportion of favorable PCPC brain function (92% (22/24) vs. 63% (12/19), χ²=5.208, P=0.030). No side effects such as hypotension, rash or injection site erythema were observed. Conclusion Prophylactic nimodipine cannot reduce vasospasm incidence in children with SAH but may improve short-term brain function, without any significant safety issues.

Objective:To investigate the correlation between paraspinal muscle atrophy, morphological changes of facet joints and adjacent segment disease (ASDis) after lumbar fusion operation.Methods:A retrospective study was conducted among 195 patients who underwent posterior lumbar fusion again for ASDis at this institution from January 2014 to December 2020, including 29 patients with ASDis whose initial surgical fusion segment was L 4,5. According to Roussouly's staging, there were 5 cases of type I, 9 cases of type II, 10 cases of type III, and 5 cases of type IV. Another 29 cases were selected from patients without ASDis after lumbar fusion as a control group. The control group was paired 1∶1 with the ASDis group according to gender, fusion segment, and Roussouly typing of the lumbar spine. The cross-sectional area (CSA) and fat infiltration (FI) of paravertebral muscle, facet joint angle (F-J) and pedicle facet (P-F) angle before the first (second) operation were measured and compared between the two groups. Then logistic regression analysis was used to determine the predictors of ASDis after posterior lumbar fusion. Finally, the receiver operation characteristic (ROC) curve was described, and the area under the curve (AUC) and cut-off point were calculated. At the same time, the paraspinal muscle atrophy before the second operation in ASDis group was measured. Results:The average follow-up time of 98 patients was 59.25±6.38 months (range, 49-73 months). The average body mass index (BMI) of ASDis group was 24.76±3.64 kg/m 2, which was higher than that in control group (22.24±2.92 kg/m 2) ( t=2.481, P=0.041). The average CSA and relative cross-sectional area (rCSA) of paraspinal muscle in ASDis group were 3 214.32± 421.15 mm 2 and 1.69±0.36 respectively, which were less than 3 978.91±459.87 mm 2 and 2.26±0.29 in control group ( t=10.22, P=0.012; t=9.47, P=0.038). The FI degree of paraspinal muscle in ASDis group (21.95%±5.89%) was significantly higher than that in control group (14.64%±7.11%) ( t=7.32, P=0.002). The F-J angle in ASDis group was 35.06°±3.45°, which was less than 38.39°±4.67° in control group ( t=4.76, P=0.027). The P-F angle in ASDis group was 117.39°±8.13°, which was greater than 111.32°±4.78° in control group ( t=5.25, P=0.031). Multivariate logistic regression analysis showed that higher BMI ( OR=1.34, P=0.038), smaller rCSA of paraspinal muscle ( OR=0.02, P=0.017) and higher FI of paraspinal muscle ( OR=1.58, P=0.032) were the risk factors of postoperative ASDis. The ROC curve showed that the AUC of BMI was 0.680 and the cut-off point was 22.58 kg/m 2; The AUC of the FI of paraspinal muscle was 0.716 and the cut-off point was 15.69%; The AUC of rCSA of paraspinal muscle was 0.227 and the cut-off point was 1.92. For ASDis patients, the paraspinal muscle before the second operation had a higher degree of FI (25.47%±6.59% vs. 21.95%±5.89%, t=3.99, P=0.042) and a smaller rCSA (1.52±0.28 vs. 1.69±0.36, t=3.85, P=0.038) than that before the first operation. The difference between the FI degree of paraspinal muscle before the second operation and the first operation was negatively correlated with the occurrence time of ASDis ( r=-0.53, P=0.039) , and the difference of rCSA was positively correlated with the occurrence time of ASDis ( r=0.64, P=0.043) . Conclusion:When BMI >22.58 kg/m 2, FI of paraspinal muscle >15.69%, and rCSA of paraspinal muscle <1.92, it suggests that ASDis is more likely to occur after operation. And the more obvious paraspinal muscle atrophy after the first operation, the earlier ASDis may occur. Morphological changes of facet joints cannot be used as an index to predict the occurrence of ASDis.

Objective:To establish an integrated model with KANO model and quality function deployment theory to determine the priority of measures in improving the quality of physical examination service.Methods:It was a cross-sectional study. A total of 196 physical examinees from the Health Management Center of the second affiliated Hospital of Dalian Medical University were selected by simple random sampling. Reliability test was used to analyze the reliability and validity of the questionnaire. KANO model was used to determine the importance of physical examination needs in health examination population. The quality function deployment model was used to create the house of quality and determine the priority of the importance of various service measures.Results:In the high important attribute requirements of physical examination, the final importance of emergency ability, outpatient time, professional and advanced equipment are 0.054, 0.052, 0.047 and 0.046 respectively. The measures that needed to be given priority to improve the quality of physical examination services were to improve the quality of medical services (absolute importance=107.5), strengthen skill assessment (absolute importance=70.1), define guidance, consultation and clinic identification (absolute importance=56.2), introduce advanced equipment and facilities (absolute importance=53.7), timely and accurate physical examination report (absolute importance=51.9) and interpretation of physical examination report (absolute importance=50.9).Conclusions:The physical examination center should give priority to the measures such as improving the medical level, strengthening the skill examination, introducing advanced equipment and facilities, defining the guidance of examination, consultation and consultation room identification, and strengthening service management.