Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective To study the three-dimensional changes of soft and hard tissue in male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period before and after maxillary protraction.Methods Twenty male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period treated by maxillary anterior traction in the Department of Orthodontics of Affiliated Stomatological Hospital of Nanjing Medical University were selected(average age(10.6±1.23)years old).Cone beam CT was taken before and after treatment.Dolphin 3D 11.95 software was used for three-dimensional measurement and analysis.SPSS 25.0 software package was used for statistical analysis.The self-controlled paired t test was used to compare the changes in soft and hard tis-sues of male patients with unilateral cleft lip and palate before and after treatment.The changes in the anterior displacement of the ANS point,the anterior displacement of point A,and the posterior displacement of point B were tested using the one-sample t test.Results The sagittal skeletal changes were significantly increased in ∠ SNA(P＜0.01),∠ANB(P＜0.01),Y axis(P＜0.05),the forward displacement of ANS point(P＜0.01)and A point(P＜0.01)and the backward displacement of B point(P＜0.01),but ∠SNB(P＜0.05)was decreased significantly.The vertical skeletal changes showed that ∠MP-FH(P＜0.01),∠MP-SN(P＜0.05)and the dis-tance of ANS-Me(P＜0.05)were increased significantly,but ∠SN-PP(P＜0.01)was decreased significantly.The dental changes inclu-ding ∠U1-NA(P＜0.01),the distance of U1-NA(P＜0.01),∠U1-SN(P＜0.01),overjet and the Wits were increased significantly,but ∠ L1-NB(P＜0.01),the distance of L1-NB(P＜0.01)and ∠L1-MP(P＜0.01)were decreased significantly.The changes of soft tis-sue including ∠ S-Ns-Sn(P＜0.01),∠ Sn-Ns-Bs(P＜0.01),the distance of UL-EP(P＜0.01)and LL-UL(P＜0.01)were increased sig-nificantly.Conclusion After the treatment of maxillary protraction,the forward growth of maxilla will be possibly promoted on patients with cleft lip and palate in the peak of growth timing,as well as the intermaxillary relationship and soft tissue profile,but the side effects should be paid attention to.

AIM:This study aims to investigate of perodic expression,distribution and interaction between es-trogen receptor α(ERα)and ClC-3 chloride channel,and their relevance to the cell cycle specificity of tamoxifen(TAM)in anti-breast cancer treatment.METHODS:We utilized a web database to analyze the correlation between ERα and ClC-3 expression.Three-dimentional molecular simulation software and co-immunoprecipitation were employed to detect and analyze the interactions between these two proteins.To assess cell cycle dynamics,we performed thymidine(TdR)double-blocking release assay and used nocodazole to block the cell cycle,with subsequent analysis via flow cytometry.Cell viability was measured by MTT assay.Western blot was conducted to evaluate the protein expression levels of ERα and ClC-3,while immunofluorescence staining was utilized to assess their subcellular distribution.RESULTS:(1)Anal-ysis from the web database revealed a significant correlation between ERα and ClC-3 expression,and co-immunoprecipita-tion confirmed their interaction.(2)We successfully obtained human breast cancer T47D cells at different cycle stages us-ing the TdR double-blocking release method and nocodazole treatment.(3)Treatment with TAM primarily inhibited T47D cell viability during G2/M phase.(4)Both ERα and ClC-3 exhibited cyclic variations in protein expression,with their sub-cellular distributions showing periodicity and co-localization.(5)Protein interactions between ERα and ClC-3 were ob-served across all cell cycle phases;(6)After TAM treatment,ERα expression peaked in G2/M phase,while ClC-3 expres-sion remained unaffected.CONCLUSION:Our findings demonstrate cyclic differences in the expression and distribution of ERα and ClC-3 in human breast cancer T47D cells,along with confirmed interactions between these two proteins.The cyclic properties of ERα may play a role in mediating the cell cycle specificity of TAM's anti-breast cancer effect.

Objective To study the three-dimensional changes of soft and hard tissue in male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period before and after maxillary protraction.Methods Twenty male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period treated by maxillary anterior traction in the Department of Orthodontics of Affiliated Stomatological Hospital of Nanjing Medical University were selected(average age(10.6±1.23)years old).Cone beam CT was taken before and after treatment.Dolphin 3D 11.95 software was used for three-dimensional measurement and analysis.SPSS 25.0 software package was used for statistical analysis.The self-controlled paired t test was used to compare the changes in soft and hard tis-sues of male patients with unilateral cleft lip and palate before and after treatment.The changes in the anterior displacement of the ANS point,the anterior displacement of point A,and the posterior displacement of point B were tested using the one-sample t test.Results The sagittal skeletal changes were significantly increased in ∠ SNA(P＜0.01),∠ANB(P＜0.01),Y axis(P＜0.05),the forward displacement of ANS point(P＜0.01)and A point(P＜0.01)and the backward displacement of B point(P＜0.01),but ∠SNB(P＜0.05)was decreased significantly.The vertical skeletal changes showed that ∠MP-FH(P＜0.01),∠MP-SN(P＜0.05)and the dis-tance of ANS-Me(P＜0.05)were increased significantly,but ∠SN-PP(P＜0.01)was decreased significantly.The dental changes inclu-ding ∠U1-NA(P＜0.01),the distance of U1-NA(P＜0.01),∠U1-SN(P＜0.01),overjet and the Wits were increased significantly,but ∠ L1-NB(P＜0.01),the distance of L1-NB(P＜0.01)and ∠L1-MP(P＜0.01)were decreased significantly.The changes of soft tis-sue including ∠ S-Ns-Sn(P＜0.01),∠ Sn-Ns-Bs(P＜0.01),the distance of UL-EP(P＜0.01)and LL-UL(P＜0.01)were increased sig-nificantly.Conclusion After the treatment of maxillary protraction,the forward growth of maxilla will be possibly promoted on patients with cleft lip and palate in the peak of growth timing,as well as the intermaxillary relationship and soft tissue profile,but the side effects should be paid attention to.

AIM:This study aims to investigate of perodic expression,distribution and interaction between es-trogen receptor α(ERα)and ClC-3 chloride channel,and their relevance to the cell cycle specificity of tamoxifen(TAM)in anti-breast cancer treatment.METHODS:We utilized a web database to analyze the correlation between ERα and ClC-3 expression.Three-dimentional molecular simulation software and co-immunoprecipitation were employed to detect and analyze the interactions between these two proteins.To assess cell cycle dynamics,we performed thymidine(TdR)double-blocking release assay and used nocodazole to block the cell cycle,with subsequent analysis via flow cytometry.Cell viability was measured by MTT assay.Western blot was conducted to evaluate the protein expression levels of ERα and ClC-3,while immunofluorescence staining was utilized to assess their subcellular distribution.RESULTS:(1)Anal-ysis from the web database revealed a significant correlation between ERα and ClC-3 expression,and co-immunoprecipita-tion confirmed their interaction.(2)We successfully obtained human breast cancer T47D cells at different cycle stages us-ing the TdR double-blocking release method and nocodazole treatment.(3)Treatment with TAM primarily inhibited T47D cell viability during G2/M phase.(4)Both ERα and ClC-3 exhibited cyclic variations in protein expression,with their sub-cellular distributions showing periodicity and co-localization.(5)Protein interactions between ERα and ClC-3 were ob-served across all cell cycle phases;(6)After TAM treatment,ERα expression peaked in G2/M phase,while ClC-3 expres-sion remained unaffected.CONCLUSION:Our findings demonstrate cyclic differences in the expression and distribution of ERα and ClC-3 in human breast cancer T47D cells,along with confirmed interactions between these two proteins.The cyclic properties of ERα may play a role in mediating the cell cycle specificity of TAM's anti-breast cancer effect.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

AIM:To investigate the role of ClC-3 chloride channel in the promotion of radio sensitization of na-sopharyngeal carcinoma CNE-2Z cells by dihydroartemisinin(DHA).METHODS:MTT was used to detect the inhibito-ry effect of DHA on the viability of CNE-2Z cells and normal nasopharyngeal epithelial NP69-SV40T cells,the radio sensi-tization effect of DHA on CNE-2Z cells was detected by cloning assay,the expression of ClC-3 protein was detected by Western blot,the expression of ClC-3 protein was down-regulated by siRNA technology,and the chlorine current of cells was recorded by whole cell patch-clamp technology.RESULTS:(1)Compared with NP69-SV40T cells,DHA selective-ly inhibited the proliferation of CNE-2Z cells,with IC10 values of(13.020±4.831)μmol/L and(5.244±1.050)μmol/L,respectively(P＜0.01).(2)The results of clonal formation experiments showed that DHA had a radio sensitizing effect on CNE-2Z cells,with a radio sensitization ratio of 1.9.(3)DHA could activate the chlorine channel of CNE-2Z cells and produce an outward chlorine current,but had no effect on the chlorine channel of NP69-SV40T cells.(4)DHA promoted the expression of ClC-3 chloric channel protein in CNE-2Z cells(P＜0.01).(5)Chlorine channel blocker NPPB could in-hibit the radio sensitizing effect of DHA on CNE-2Z cells by 1.84 times,and also inhibited the chlorine current activated by DHA.(6)the down-regulation of CNE-2Z ClC-3 protein could inhibit the radio sensitization effect of DHA on CNE-2Z cells by 4.19 times,and the activation of chlorine current by DHA on CNE-2Z cells was no longer produced.CONCLU-SION:DHA has a radio sensitizing effect on nasopharyngeal carcinoma CNE-2Z cells,which is likely to be related to the activation of ClC-3 chloride channel.

Strengthening the management of key positions in medical and health institutions, implementing rotation management of personnels in key positions, is of great significance for regulating the operation of power and preventing corruption risks. A tertiary grade A hospital in Qingdao has implemented a rotation system for personnels in key positions among functional department from an internal control perspective since 2022. On the basis of conducting job risk assessment, the hospital has developed a key position rotation system, determining the scope, rotation cycle, and rotation method for key position personnels, and formulated key position rotation plan. The Party Committee Office and the Human Resources Department were responsible for organizing and implementing it, and evaluating the implementation effect. From 2022 to 2023, 61 key positions were rotated between departments and within departments, accounting for 37.7% of the total number of key positions. Compared with 2021, the number of petitions and reports received by the Discipline Inspection and Supervision Office for key positions in 2022 has decreased by 12.5%, which can provide reference for other medical and health institutions to carry out anti-corruption risk management.