The optimal therapeutic regimen for patients with asymptomatic carotid artery stenosis (ACS) has been controversial.Early research suggests that carotid endarterectomy (CEA) is effective for the treatment of patients with severe ACAS.In recent years,as a minimally invasive treatment,carotid artery stenting (CAS) is as effective as CEA.It has a trend of replacing CEA.In recent 10 years,medicine standardized treatment has made great progress.Recent studies have shown that the risk of stroke is lower using the optimal medical treatment in patients with ACAS compared with CEA and CAS.The key of choosing optimal therapeutic regimen is to identify the high risk patients with stroke.

In recent years, a large number of studies have shown that non-coding RNAs play an important role in wound healing process. Among them, studies on the mechanism of circular RNA (circRNA) have shown that circRNA is closely related to the proliferation of cells related to wound healing, such as endothelial progenitor cells and keratinocytes, and circRNA is also involved in the chronic wound healing process. Based on the introduction of the related concept of circRNA, this paper focuses on the possible regulatory mechanism of circRNA in different stages of diabetic wound healing and summarizes the potential role of circRNA in the process of diabetic peripheral vascular atherosclerosis, aiming to explore the in-depth molecular mechanism and clinical significance of circRNA in diabetic wound healing process, and provide reference for further research.

Objective:To explore the research hotspots and evolutionary trends in the field of wound repair mechanism research.Methods:This study was a bibliometric analysis study. English literature related to wound repair mechanism published in the core collection of Web of Science database from the establishment of the database to December 26 th, 2023 that met the inclusion criteria were retrieved. The annual number of publications and their citations were counted, and the change trend was analyzed. Based on the aforementioned annual publication volume, the relevant literature in the core collection of Web of Science database in this field from the first 5 years when the publication growth in this field was rapidly turning, to December 31 st, 2023 was searched again, and the total number of publications was recorded and annual growth rate of published literature was calculated; and based on the trend line of annual publication volume, the publication volume in this field in 2024 was predicted. The CiteSpace 6.2.R4 software was used for visualized analysis of the literature from the second retrieval, including the source journals, the cited literature, and the keywords, to discuss the current research status and the evolution of hotspots of wound repair mechanism. Results:The first search retrieved a total of 3 992 literature related to the research on wound repair mechanisms, among which the annual number of publications and their citations increased rapidly from 2015 to 2023. The time limit for the second retrieval was set to be from January 1 st, 2011 to December 31 st, 2023, during which a total of 3 206 literature was published, with an average annual growth rate of 13.30%. According to the publication trend line at this stage, it was predicted that the number of publications in this field will reach 500 in 2024. The literature from the second retrieval was published in 717 journals. The research directions of the top 10 journals with the most published literature (accounting for 18.75% (601/3 206) of the total number of publications) mainly focused on trauma, molecules, pharmacology of Chinese medicine, and stem cells, with the United Kingdom and the United States, etc. as the main publishing countries. There were 7 journals with impact factors >5 and 6 journals belonging to the Q1 or Q2 areas of the Chinese Academy of Sciences. There were 906 nodes and 9 large clusters for the keywords of cited literature of literature from the second retrieval (Q=0.64, S=0.82). The main clusters of cited literature of literature from the second retrieval were #2 matrix metalloproteinases and #3 transforming growth factor β 1 from 2006 to 2015, #1 macrophage polarization, #4 mesenchymal stem cells, #6 antibacterial, and #7 plant extraction from 2016 to 2023. During 2021-2023, the main clusters of cited literature of literature from the second retrieval being #1 macrophage polarization, #4 mesenchymal stem cells, #6 antibacterial, and #7 plant extraction had the most closely related co-occurrence. The analysis of the top 5 cited literature of literature from the second retrieval with high citation value, high centrality value, and high Sigma value showed that the main research directions were the influence of macrophages and inflammation regulation on wound repair, the influence of fibroblasts on wound repair, and the influence of growth factors and cytokines on wound repair. The keywords of literature from the second retrieval formed 636 nodes and 7 clusters, that being #0 antibacterial, #1 mesenchymal stem cells, #2 cell migration, #3 wound repair, #4 exosomes, #5 negative pressure wound treatment, and #6 diabetic foot ulcer (Q=0.59, S=0.80). For the literature from the second retrieval, the main clusters from 2016 to 2023 were #0 antibacterial, #1 mesenchymal stem cells, and #4 exosomes, and the main clusters before 2015 were #2 cell migration and #3 wound repair. A total of 110 burst keywords (hereinafter referred to as burst words) were formed for the keywords of literature from the second retrieval, and the top 10 burst words in terms of intensity were mouse, gene expression, skin injury, epithelial cells, signaling pathways, biomaterials, exosomes, molecular docking, hydrogels, and macrophage polarization, with different start and end time periods. Among them, the high-intensity burst words from 2021 to 2023 were hydrogel (belonging to cluster #0 antibacterial), exosome (belonging to cluster #1 mesenchymal stem cells), molecular docking (belonging to cluster #0 antibacterial), and macrophage polarization (belonging to cluster #0 antibacterial). Conclusions:In the future, the development of wound repair mechanism research will still be at a steady phase. The research hotspots in this field have shifted from growth factors and wound repair physiology to antibacterial and stem cells. Future research directions in this field may include using molecular docking technology and network pharmacology to screen drugs that promote wound repair and study their underlying mechanisms, the regulation of macrophage polarization by exosomes, and the mechanism by which hydrogels promote wound healing through antibacterial effects.

In recent years, non-coding RNAs (ncRNAs) carried by exosomes have been shown to play an important regulatory role in multiple stages of wound healing. Exosomes can transport ncRNAs to different target cells or tissue and regulate the expression of target genes and downstream molecules. The proposed competing endogenous RNA (ceRNA) hypothesis suggests that RNAs can build a more sophisticated and complex gene regulatory network by competing for common response elements. Therefore, this review focuses on the long ncRNAs and circular RNAs carried by exosomes, discusses their regulatory roles as ceRNAs in the stages of inflammation, cell proliferation, and tissue remodeling in wound repair, respectively, and summarizes the feasibility of ncRNAs carried by exosomes as cell-free therapy, in order to provide a theoretical basis for clinical treatment of wounds.

Objective:To establish a set of artificial intelligence (AI) verification rules for blood routine analysis.Methods:Blood routine analysis data of 18 474 hospitalized patients from the First Hospital of Jilin University during August 1st to 31st, 2019, were collected as training group for establishment of the AI verification rules,and the corresponding patient age, microscopic examination results, and clinical diagnosis information were collected. 92 laboratory parameters, including blood analysis report parameters, research parameters and alarm information, were used as candidate conditions for AI audit rules; manual verification combining microscopy was considered as standard, marked whether it was passed or blocked. Using decision tree algorithm, AI audit rules are initially established through high-intensity, multi-round and five-fold cross-validation and AI verification rules were optimized by setting important mandatory cases. The performance of AI verification rules was evaluated by comparing the false negative rate, precision rate, recall rate, F1 score, and pass rate with that of the current autoverification rules using Chi-square test. Another cohort of blood routine analysis data of 12 475 hospitalized patients in the First Hospital of Jilin University during November 1sr to 31st, 2023, were collected as validation group for validation of AI verification rules, which underwent simulated verification via the preliminary AI rules, thus performance of AI rules were analyzed by the above indicators. Results:AI verification rules consist of 15 rules and 17 parameters and do distinguish numeric and morphological abnormalities. Compared with auto-verification rules, the true positive rate, the false positive rate, the true negative rate, the false negative rate, the pass rate, the accuracy, the precision rate, the recall rate and F1 score of AI rules in training group were 22.7%, 1.6%, 74.5%, 1.3%, 75.7%, 97.2%, 93.5%, 94.7%, 94.1, respectively.All of them were better than auto-verification rules, and the difference was statistically significant ( P<0.001), and with no important case missed. In validation group, the true positive rate, the false positive rate, the true negative rate, the false negative rate, the pass rate, the accuracy, the precision rate, the recall rate and F1 score were 19.2%, 8.2%, 70.1%, 2.5%, 72.6%, 89.2%, 70.0%, 88.3%, 78.1, respectively, Compared with the auto-verification rules, The false negative rate was lower, the false positive rate and the recall rate were slightly higher, and the difference was statistically significant ( P<0.001). Conclusion:A set of the AI verification rules are established and verified by using decision tree algorithm of machine learning, which can identify, intercept and prompt abnormal results stably, and is moresimple, highly efficient and more accurate in the report of blood analysis test results compared with auto-vefication.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.