Foot ulcer prevention plays a crucial role in reducing the amputation rate among diabetic patients. With regard to the prevention of diabetic foot ulcers, the 2023 guidelines of the International Working Group of Diabetic Foot(IWGDF) were different from the 2019 counterpart. The most notable change is the addition of high-level evidence to support recommendations, primarily derived from randomized controlled studies. The 2023 guidelines also advocate for local skin temperature measurement, participation in ankle exercise training, and psychological intervention for foot ulcer prevention. This article conducts a comparative analysis of the two guidelines across six key dimensions: identification of high-risk feet, regular examination of high-risk feet, health education, ensuring appropriate daily footwear, addressing ulcer risk factors, and comprehensive foot care. Drawing from clinical insights, the application and prospective implications of the 2023 guidelines in China are also examined.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Objective:To investigate the mechanism of maggot debridement therapy (MDT) in promoting wound angiogenesis in patients with diabetic foot ulcer (DFU).Methods:(1) From June 2018 to June 2019, the patients admitted to Nanjing Junxie Hospital who met the inclusion criteria were recruited, including 12 DFU patients given MDT for three days [6 males and 6 females, aged (56±12) years] and 12 acute trauma patients without diabetes mellitus [6 males and 6 females, aged (53±10) years], who were enrolled into DFU group and non-diabetic trauma group respectively. Before and after application of MDT, the wound characteristics of patients in DFU group were observed and the wound tissue samples were taken. The wound tissue in non-diabetic trauma group was taken at patient′s first visit before debridement. The expression of angiogenesis marker CD31 in the wound tissue of patients in DFU group was detected by immunohistochemistry before and after application of MDT. Western blotting and real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR) were used respectively to detect the protein and mRNA expressions of fatty acid synthase (FAS) in wound tissue of patients in DFU group before and after application of MDT and in non-diabetic trauma group before debridement. (2) Human umbilical vein endothelial cells (HUVECs) were cultured in endothelial cell culture medium containing 10% fetal bovine serum. The 3rd to 6th passages of cells in logarithmic growth phase were used in the following experiments. Excretions/secretions (ES) were extracted from 3-day-old sterile Lucilia sericata larvae for subsequent experiments. Three batches of cells were divided into phosphate buffer solution (PBS) control group, high glucose alone group, high glucose+ 5 μg/mL maggot ES group, and high glucose+ 10 μg/mL maggot ES group, which were treated with PBS, glucose in final molarity concentration of 20 mmol/L, glucose in final molarity concentration of 20 mmol/L+ maggot ES in final mass concentration of 5 μg/mL, and glucose in final molarity concentration of 20 mmol/L+ maggot ES in final mass concentration of 10 μg/mL respectively. The total volume of reagents in each group was the same. After 48 hours of culture, Western blotting, real-time fluorescent quantitative RT-PCR and immunofluorescence method were used to detect the protein and mRNA expressions of FAS in each batch of cells and the expression and localization of FAS protein in cells respectively. The number of samples for mRNA expression was 3. (3) Two batches of cells were divided into small interference RNA (siRNA) alone group, siRNA control+ maggot ES group and siRNA-FAS+ maggot ES group, which were transfected with 100 μmol/L (final molarity concentration) insignificant control siRNA, insignificant control siRNA, and siRNA-FAS for 4-6 h respectively, and then they were routinely cultured for 24 h with PBS added, maggot ES in final mass concentration of 10 μg/mL, and maggot ES in final mass concentration of 10 μg/mL respectively. The total volume of reagents in each group was the same. One batch of cells was used for scratch test, the scratch width was observed at 24 hour after scratching to detect the cell migration ability; one batch of cells was subjected to tube forming experiment, and the formation of cell tubules was observed after 24 hours of culture. The number of samples was 3 in scratch test and tube forming experiments. Data were statistically analyzed with t test, one-way analysis of variance, least significant difference test, analysis of variance for repeated measurement, and Bonferroni method. Results:(1) Compared with those before application of MDT, fresh granulation tissue significantly increased and necrotic tissue decreased obviously in wound, and the expression of CD31 significantly increased in wound tissue of patients in DFU group after application of MDT. The expression of FAS protein in wound tissue of patients in DFU group before application of MDT was significantly lower than that in non-diabetic trauma group before debridement, and the expression of FAS protein in wound tissue of patients in DFU group after application of MDT was significantly higher than that before application of MDT. The expression of FAS mRNA in wound tissue of patients in DFU group before application of MDT was 1.00±0.17, which was significantly less than 3.87±1.02 in non-diabetic trauma group before debridement ( t=9.808, P<0.01). The expression of FAS mRNA in wound tissue of patients in DFU group after application of MDT was 1.85±0.31, which was significantly higher than that before application of MDT ( t=-10.853, P<0.01). (2) After 48 hours of culture, Western blotting detection showed that the expression of FAS protein in cells in high glucose alone group was significantly less than that in PBS control group, and the expressions of FAS protein in cells in high glucose+ 5 μg/mL maggot ES group and high glucose+ 10 μg/mL maggot ES group were significantly higher than the expression in high glucose alone group. Real-time fluorescent quantitative RT-PCR determination showed that the expression of FAS mRNA in cells in high glucose alone group was 0.392±0.073, which was significantly lower than 1.000±0.085 in PBS control group ( P<0.01); there was statistically significant difference between the expression of FAS mRNA in cells in high glucose+ 5 μg/mL maggot ES group (0.561±0.047) and that in high glucose+ 10 μg/mL maggot ES group (0.687±0.013) ( P<0.05), both of which were significantly higher than the expression in high glucose alone group ( P<0.01). The results of immunofluorescence detection showed that FAS protein was mainly located in the cytoplasm of cells in each group, and its expression was similar to that detected by Western blotting. (3) At 24 hour after scratch, the uncured widths of cell scratch in siRNA control+ maggot ES group and siRNA-FAS+ maggot ES group were significantly narrower than the uncured width in siRNA alone control group ( P<0.01), and the uncured width of cell scratch in siRNA-FAS+ maggot ES group was significantly wider than that in siRNA control+ maggot ES group ( P<0.01). After 24 hours of culture, the numbers of tubules in siRNA+ maggot ES group and siRNA-FAS+ maggot ES group were significantly more than the number in siRNA alone control group ( P<0.05 or P<0.01), and the number of tubules in siRNA-FAS+ maggot ES group was obviously less than that in siRNA control+ maggot ES group ( P<0.05). Conclusions:MDT up-regulates the expression of FAS through maggot ES, which promotes the activity of vascular endothelial cells, thus promoting the wound angiogenesis in patients with DFU.

Objective To study the effects of microemulsion/ethosomes on transdermal absorption properties and efficacy of Huoxue Zhitong Cataplasm. Methods The improved Franz diffusion cells were used for the in-vitro permeation experiment with rat skins as the barriers, which was used to evaluate the transdermal absorption properties. In the erxeriment, the contents of paeonol, eugenol and methyl salicylate were used as markers, and detected by ultra performance liquid chromatography to evaluate the transdermal absorption effects. The anti-inflammatory and analgesia activity were evaluated through the writhing plate experiments. Results The cumulative release rate of paeonol in Huoxue Zhitong Cataplasm, Microemulsion Huoxue Zhitong Cataplasm and Ethosomes Huoxue Zhitong Cataplasm were, in order, 65.30%, 61.30%and 60.20%in 24 h;eugenol were, in order, 51.08%, 54.71% and 55.66% in 24 h; methyl salicylate were, in order, 49.20%, 65.17% and 72.15% in 24 h. Furthermore, Microemulsion Huoxue Zhitong Cataplasm high-dose group and Ethosomes Huoxue Zhitong Cataplasm medium-dose group had good effects on reducing the inflammatory exudate of peritoneal capillary and capillary permeability (P<0.05) in animal models. Conclusion Huoxue Zhitong Cataplasm based on microemulsion/ethosomesnano-technology has good transdermal absorption properties and efficacy.

Objective To evaluate the role of caspase-1 in the spinal cord in a rat model of incisional pain.Methods Eighteen adult male Sprague-Dawley rats,weighing 250-280 g,in which intrathecal catheters were successfully implanted,were divided into 3 groups (n =6 each) using a random number table:incision pain group (group Ⅰ),incision pain plus dimethyl sulfoxide group (group ID) and incision pain plus caspase-1 inhibitor (Ac-YVAD-CMK) group (group IA).At 10 min before establishment of the model,0.9％ normal saline 20 μl was intrathecally injected in group Ⅰ,dimethyl sulfoxide 20 μl was intrathecally injected and then the catheter was washed with 0.9％ normal saline 10 μl in group ID,and Ac-YVAD-CMK 1 nmol/μl (dissolved in 20 μl dimethyl sulfoxide) and then the catheter was washed with 0.9％ normal saline 10 μl in group IA.The mechanical paw withdrawal threshold (MWT) of the ipsilateral hind paw was measured at 2 h before intrathecal catheterization (T0),3 days after intrathecal catheterization (T1) and 2,6,24 and 48 h after establishment of model (T2-5).The rats were sacrificed after the last measurement of pain threshold at T5,and lumbar enlargement segments of the spinal cord were removed for detection of caspase-1 (p20) expression and interleukin-1beta (IL-1β) content by Western blot and enzyne-linked immunosorbent assay,respectively.Results Compared with the baseline at T0,the MWT was significantly decreased at T2-5 in Ⅰ and ID groups (P＜0.05),and no significant change was found in MWT at T1-5 in group IA (P＞0.05).Compared with Ⅰ and ID groups,the MWT at T2-5 was significantly increased at T2-5,and the caspase-1 (p20) protein expression and IL-1β content were decreased in group IA (P＜0.05).There was no significant difference in MWT,expression of caspase-1 (p20) protein or IL-1β content between group Ⅰ and group ID (P＞0.05).Conclusion The activation of caspase-1 in the spinal cord can promote the release of IL-1β and thus is involved in the incision pain in rats.

Objective To explore the influence of rational cognitive behavioral therapy on the mental status and quality of life in patients with hysterectomy.Methods A total of 100 pa-tients with hysterectomy were randomly divided into observation group and control group,50 cases in each group.The control group was treated with routine nursing,while the observation group was treated with rational cognitive behavior therapy on the basis of the control group.Cognitive conditions,mental status,quality of life and satisfactory degree toward nursing were compared be-tween two groups.Results Level of operation hope and health knowledge in the observation group were significantly higher than those in the control group,the scores of anxiety and depres-sion after nursing were lower than the control group(P <0.05).Life quality scores in physical function,psychological function and social function in the observation group were significantly higher than those in the control group,and satisfactory degree toward nursing was significantly higher than the control group (P <0.05).Conclusion Rational cognitive behavioral therapy can help patients with hysterectomy to establish a good cognitive condition,improve the adverse mental status and improve the quality of life.

Objective To explore the influence of rational cognitive behavioral therapy on the mental status and quality of life in patients with hysterectomy.Methods A total of 100 pa-tients with hysterectomy were randomly divided into observation group and control group,50 cases in each group.The control group was treated with routine nursing,while the observation group was treated with rational cognitive behavior therapy on the basis of the control group.Cognitive conditions,mental status,quality of life and satisfactory degree toward nursing were compared be-tween two groups.Results Level of operation hope and health knowledge in the observation group were significantly higher than those in the control group,the scores of anxiety and depres-sion after nursing were lower than the control group(P <0.05).Life quality scores in physical function,psychological function and social function in the observation group were significantly higher than those in the control group,and satisfactory degree toward nursing was significantly higher than the control group (P <0.05).Conclusion Rational cognitive behavioral therapy can help patients with hysterectomy to establish a good cognitive condition,improve the adverse mental status and improve the quality of life.

Objective To compare the osteogenesis effect of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) and investigate the methods of repairing bone defect with PRF.Methods Four defects measuring 7 mm in diameter were made in the parietal bone of 16 New Zealand white rabbits.The defects named A,B,C,and D and were filled with PRF,PRF-mixed Bio-Oss (BO),PRP-mixed BO,and PRP separately.Every four rabbits were sacrificed at postoperative 2,4,8,and 12 weeks and defects were examined grossly,radiographically,and histologically.Besides,bone mineral density and bone trabecular area were determined and expressed as gray-scale values.Results Newly regenerated bone appeared at all defect areas at postoperative 2 weeks.Thereafter,more bone formations were observed over time and area B demonstrated the best bone healing followed by area C,A,and D in succession.Bone trabecular area in areas A,B,C,and D was 10.95 ± 0.58,15.45 ± 0.79,10.22 ± 0.43,and 6.58 ± 0.64 at postoperative 2 weeks with significant differences in pair comparison (F =22.869,P ＜0.01),followed by some increase at postoperative 4 and 8 weeks.Whereas,bone trabecular area in areas A,B,C,and D increased largely at postoperative 12 weeks (35.09 ± 0.58,59.44 ± 0.60,50.75 ± 1.56,and 30.94 ± 1.19) and showed significant difference when compared in a pair (F =1 002.904,P ＜ O.01).Conclusion PRF is superior to PRP in promoting bone formation,but a much better effect of PRF/BO composite is observed in bone repair.

The basic medicine teaching must meet the clinical application,while the clinical practice should be timely feedback to basic medical teaching,which is the embodiment of the idea in the translational medicine.The experimental teaching is an important part of modern pathology teaching.We actively improve the experiment course and deepen the basic concept of translational medicine in the medical education development by adopting such approaches as using the problem-based learning method(PBL) to promote the link between basic courses and clinical pathology,integrating and optimizing the teaching content to promote the knowledge mastery and conducting molecular pathology research to promote the implementation of translational medicine.