Objective To investigate the impact of different application methods of tissue compensators(bolus)on the skin dose delivered to the chest wall following radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025.The Pinnacle3 9.10 radiotherapy planning system(TPS)was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient,with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions.In Plan 1,a Bolus was applied and optimized during the first 15 fractions,and subsequently removed for the remaining 10 fractions without re-optimization.The sub-field configuration and dose weighting from the initial optimization were retained,and only dose recalculations were performed.The final treatment plan combined both the Bolus-included and Bolus-excluded phases.In contrast,Plan 2 involved the application and optimization of Bolus during the first 15 fractions,followed by its removal and re-optimization of the plan for the last 10 fractions.The two optimized plans were then combined for the overall treatment delivery.Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software.Results There was a statistically significant difference(P＜0.05)in skin Dmean,V52.5,and V55;heart Dmean,V5,V30,and V40;affected lung Dmean,V5,and V20;PRVcord Dmean and Dmax;healthy breast Dmean,V5,and V10;affected humeral head Dmean and V30;as well as PTV Dmean,V50,V55,D2％,D98％,CI,and MU.Moreover,the dose distribution on the target layer and the DVH curves showed marked differences.However,no statistically significant difference was observed in PTV HI(P=0.125).Conclusion The combination of the two optimized plans,consisting of 15 fractions with bolus and 10 fractions without bolus,more accurately reflects the dose distri-bution within the planned target area and organs at risk,thereby providing enhanced protection for the patient's chest wall skin.

Objective:To investigate the distribution of pathogens and changes in serum levels of pyruvate kinase isozyme type M2 (PKM2) and Galectin-3 in patients with severe trauma complicated by ventilator-associated pneumonia (VAP).Methods:A total of 139 patients with severe trauma and underwent mechanical ventilation in Zhangjiakou First Hospital from February 2022 to February 2024 were selected as the study subjects. They were divided into the VAP group (57 cases) and non- VAP group (82 cases) based on whether they developed VAP. The distribution of pathogenic bacteria in the VAP group was analyzed. Enzyme-linked immunosorbent assay (ELISA) method was applied to determine the expression levels of serum PKM2 and Galectin-3. Multivariate Logistic regression was applied to analyze the influencing factors of VAP in patients with severe trauma. Receiver operator characteristic (ROC) curve was applied to analyze the diagnostic value of serum PKM2 and Galectin-3 levels for severe trauma complicated by VAP.Results:Seventy-one strains of pathogenic bacteria were isolated from 57 patients in the VAP group, mainly including Gram positive bacteria (36.62%), Gram negative bacteria (59.15%), and fungi (4.23%). Among them, Gram positive bacteria were mainly Staphylococcus epidermidis and Staphylococcus aureus, Gram negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumoniae, and fungi were mainly tropical Candida and Candida albicans. The proportion of history of diabetes, the proportion of eating through nasogastric tube, the proportion of trauma severity score ≥ 16 and the levels of serum PKM2 and Galectin-3 in the VAP group were higher than those in the non- VAP group: 54.39%(31/57) vs. 32.93%(27/82), 82.46%(47/57) vs. 52.44%(43/82), 66.67%(38/57) vs. 24.39%(20/82), (32.46 ± 7.28) μg/L vs. (24.25 ± 6.17) μg/L, (3.26 ± 0.75) ng/L vs. (2.39 ± 0.61) ng/L, there were statistical differences ( P<0.05). Serum PKM2, Galectin-3, history of diabetes, nasal feeding mode and trauma severity score were the influencing factors of severe trauma patients complicated by VAP ( P<0.05). The area under the curve (AUC) of serum PKM2, Galectin-3, and their combination in predicting severe trauma complicated by VAP was 0.90, and the combination of the two was superior to their respective individual diagnoses ( Zcombination - PKM2 = 2.00, Zcombination - Galectin-3 = 1.99, P = 0.046, 0.047), its sensitivity and specificity were 92.98% and 84.15%, respectively. Conclusions:The distribution of urinary tract pathogens in patients with severe trauma complicated by VAP is mainly Gram negative bacteria, and serum PKM2 and Galectin-3 levels are obviously increased in patients with severe trauma complicated by VAP . The combination of the two has higher diagnostic value for severe trauma complicated by VAP and certain clinical application value.

Objective To compare the clinical efficacy between liposuction combined with circumareolar small incision and three-port endoscopic surgery for the treatment of Simon Ⅱ gynecomastia (GYN). Methods Comparative case data of 120 patients with GYN were retrospectively analyzed, 61 patients in the open group underwent circumareolar small incision mastectomy after liposuction, and 59 patients in the endoscopic group underwent three-port endoscopic mastectomy after liposuction. The two groups were compared in terms of surgery-related indexes, occurrence of postoperative complications and patient satisfaction. Results The unilateral operation time of the open group was shorter than that of the endoscopic group, the unilateral gland resection weight in the open group was more than that in the endoscopic group, the hospitalization cost of the open group was less than that of the endoscopic group (all P<0.01). There was no significant difference in unilateral liposuction volume, drainage volume on the first postoperative day, and time to drain removal between the two groups (P>0.05). The incidence of complications in the open group and the endoscopic group were 8.2% and 13.6% respectively, and there was no significant difference between the two groups (P>0.05). The difference in the overall satisfaction scores between the two groups was not statistically significant (P>0.05). Conclusions Liposuction combined with circumareolar small incision or three-port endoscopic surgery both has good cosmetic effects in the treatment of Simon Ⅱ GYN. The operation with circumareolar small incision is simple, has a shorter operation time, costs less, and does not require special equipment, which is suitable for promotion and application in medical institutions.

Objective To compare the application effect of platelet rich fibrin(PRF)prepared at different centrifugal speeds in tooth extraction wounds using network meta-analysis statistical method.Methods PubMed,Co-chrane Library,Embase,Web of Science,CNKI,Wanfang,VIP and China Biology Medicine disc(CBM)databases were searched to collect the randomized controlled trials on the effect of PRF in tooth extraction from January 1,2024.Note-Express software was used to select literatures,RevMan5.3 was used to evaluate the quality of the included literatures,and Stata14.0 software was used to perform mesh meta-analysis on outcome indicators such as bone mineral density,bone height loss,visual analog scale of pain(VAS),dry groove,and bleeding after tooth extraction.Results A total of 31 randomized controlled trials were included,including 2 824 extraction sites,involving 7 rotational speeds for PRF preparation(3 000,2 800,2 700,2 300,1 500,1 400,1 300 r/min).The results of cu-mulative sequencing showed that PRF prepared by 2 700 r/min centrifugation had the best effect in improving bone mineral density.In terms of improving the buccal bone height,the PRF prepared by 2 700 r/min centrifu-gation had the best effect.In terms of pain improvement,PRF prepared by 1 500 r/min centrifugation had the best effect;PRF prepared by 2 500 r/min centrifugation had the best effect in reducing the incidence of dry trough.PRF prepared by 2 500 r/min centrifugation was the most effective in reducing bleeding.Conclusion Based on the available evidence,PRF prepared with 2 700 r/min has the best effect on improving bone density and bone height after tooth extraction.In terms of pain improvement,1 500 r/min was the most effective;2 500 r/min was the most effective in improving the incidence of dry trough and bleeding.

[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].

In recent decades, the prevalence of hyperuricemia and gout has increased dramatically due to lifestyle changes. The drugs currently recommended for hyperuricemia are associated with adverse reactions that limit their clinical use. In this study, we report that berberine (BBR) is an effective drug candidate for the treatment of hyperuricemia, with its mechanism potentially involving the modulation of gut microbiota and its metabolite, succinic acid. BBR has demonstrated good therapeutic effects in both acute and chronic animal models of hyperuricemia. In a clinical trial, oral administration of BBR for 6 months reduced blood uric acid levels in 22 participants by modulating the gut microbiota, which led to an increase in the abundance of Bacteroides and a decrease in Clostridium sensu stricto_1. Furthermore, Bacteroides fragilis was transplanted into ICR mice, and the results showed that Bacteroides fragilis exerted a therapeutic effect on uric acid similar to that of BBR. Notably, succinic acid, a metabolite of Bacteroides, significantly reduced uric acid levels. Subsequent cell and animal experiments revealed that the intestinal metabolite, succinic acid, regulated the upstream uric acid synthesis pathway in the liver by inhibiting adenosine monophosphate deaminase 2 (AMPD2), an enzyme responsible for converting adenosine monophosphate (AMP) to inosine monophosphate (IMP). This inhibition resulted in a decrease in IMP levels and an increase in phosphate levels. The reduction in IMP led to a decreased downstream production of hypoxanthine, xanthine, and uric acid. BBR also demonstrated excellent renoprotective effects, improving nephropathy associated with hyperuricemia. In summary, BBR has the potential to be an effective treatment for hyperuricemia through the gut-liver axis.

Objective:To investigate the distribution of pathogens and changes in serum levels of pyruvate kinase isozyme type M2 (PKM2) and Galectin-3 in patients with severe trauma complicated by ventilator-associated pneumonia (VAP).Methods:A total of 139 patients with severe trauma and underwent mechanical ventilation in Zhangjiakou First Hospital from February 2022 to February 2024 were selected as the study subjects. They were divided into the VAP group (57 cases) and non- VAP group (82 cases) based on whether they developed VAP. The distribution of pathogenic bacteria in the VAP group was analyzed. Enzyme-linked immunosorbent assay (ELISA) method was applied to determine the expression levels of serum PKM2 and Galectin-3. Multivariate Logistic regression was applied to analyze the influencing factors of VAP in patients with severe trauma. Receiver operator characteristic (ROC) curve was applied to analyze the diagnostic value of serum PKM2 and Galectin-3 levels for severe trauma complicated by VAP.Results:Seventy-one strains of pathogenic bacteria were isolated from 57 patients in the VAP group, mainly including Gram positive bacteria (36.62%), Gram negative bacteria (59.15%), and fungi (4.23%). Among them, Gram positive bacteria were mainly Staphylococcus epidermidis and Staphylococcus aureus, Gram negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumoniae, and fungi were mainly tropical Candida and Candida albicans. The proportion of history of diabetes, the proportion of eating through nasogastric tube, the proportion of trauma severity score ≥ 16 and the levels of serum PKM2 and Galectin-3 in the VAP group were higher than those in the non- VAP group: 54.39%(31/57) vs. 32.93%(27/82), 82.46%(47/57) vs. 52.44%(43/82), 66.67%(38/57) vs. 24.39%(20/82), (32.46 ± 7.28) μg/L vs. (24.25 ± 6.17) μg/L, (3.26 ± 0.75) ng/L vs. (2.39 ± 0.61) ng/L, there were statistical differences ( P<0.05). Serum PKM2, Galectin-3, history of diabetes, nasal feeding mode and trauma severity score were the influencing factors of severe trauma patients complicated by VAP ( P<0.05). The area under the curve (AUC) of serum PKM2, Galectin-3, and their combination in predicting severe trauma complicated by VAP was 0.90, and the combination of the two was superior to their respective individual diagnoses ( Zcombination - PKM2 = 2.00, Zcombination - Galectin-3 = 1.99, P = 0.046, 0.047), its sensitivity and specificity were 92.98% and 84.15%, respectively. Conclusions:The distribution of urinary tract pathogens in patients with severe trauma complicated by VAP is mainly Gram negative bacteria, and serum PKM2 and Galectin-3 levels are obviously increased in patients with severe trauma complicated by VAP . The combination of the two has higher diagnostic value for severe trauma complicated by VAP and certain clinical application value.

Objective To investigate the impact of different application methods of tissue compensators(bolus)on the skin dose delivered to the chest wall following radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025.The Pinnacle3 9.10 radiotherapy planning system(TPS)was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient,with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions.In Plan 1,a Bolus was applied and optimized during the first 15 fractions,and subsequently removed for the remaining 10 fractions without re-optimization.The sub-field configuration and dose weighting from the initial optimization were retained,and only dose recalculations were performed.The final treatment plan combined both the Bolus-included and Bolus-excluded phases.In contrast,Plan 2 involved the application and optimization of Bolus during the first 15 fractions,followed by its removal and re-optimization of the plan for the last 10 fractions.The two optimized plans were then combined for the overall treatment delivery.Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software.Results There was a statistically significant difference(P＜0.05)in skin Dmean,V52.5,and V55;heart Dmean,V5,V30,and V40;affected lung Dmean,V5,and V20;PRVcord Dmean and Dmax;healthy breast Dmean,V5,and V10;affected humeral head Dmean and V30;as well as PTV Dmean,V50,V55,D2％,D98％,CI,and MU.Moreover,the dose distribution on the target layer and the DVH curves showed marked differences.However,no statistically significant difference was observed in PTV HI(P=0.125).Conclusion The combination of the two optimized plans,consisting of 15 fractions with bolus and 10 fractions without bolus,more accurately reflects the dose distri-bution within the planned target area and organs at risk,thereby providing enhanced protection for the patient's chest wall skin.

Objective:To investigate the effect of combination of infrared thermography (IRT) and high frequency colour Doppler ultrasound (HFCDU) in location of superficial fascia perforating vessels and to guide the design and harvest of super-thin anterolateral thigh flap (ALTF) .Methods:A total of 15 patients who received medical treatment in the Department of Orthopaedics, Zhoushan Hospital and Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital from January 2022 to July 2023 were selected to participate the study. The patients were 11 males and 4 females, aged 26 to 64 years with an average age of 48.3 years. A total of 14 wounds of foot, 1 of hand, 1 of forearm and 1 of ankle were reconstructed with 17 free super-thin ALTFs. The sizes of soft tissue defect were 5 cm×3 cm-23 cm×7 cm. The flaps were 6 cm×4 cm to 25 cm×8 cm in size. The donor sites were directly pulled together and sutured. Before surgery, HFCDU was applied to locate the perforator vessels across deep fascia into superficial fascia of the ALTF. IRT was further employed to locate the superficial perforator vessels on the superficial fascia in operating room. The running course of a perforating branch in the superficial fascia was determined by the running courses of the perforating branch located by the two location methods. Super-thin ALTFs were harvested and the precise locations of the perforating vessels were verified in surgery. SPSS 23.0 software was used for data analysis. Rank sum test was performed on the location data of superficial fascial perforating branches found by IRT and the data in surgery. P<0.05 was considered a statistically significant difference. All patients were included in the postoperative follow-up by means of visit of outpatient clinic and via WeChat reviews, where the survival and functional recovery of the flaps were observed. Results:A total of 30 perforating vessels had been located by HFCDU and 30 by IRT, and a total of 31 perforating vessels were found in superficial fascia in surgery. The true positive rate was 93.3%, with a false positive rate at 6.7% and a false negative rate at 9.7%. The rank sum test calculated P=0.853 for the number of perforating vessels located by the IRT and those found from surgery. There was no significant difference between the 2 detecting methods. No postoperative complication occurred in all 14 flaps. Partial necrosis occurred in 1 flap but healed after dressing changes. Venous occlusion had occurred in 1 flap, it was rectified after surgical exploration. Superficial infection happened in 1 flap and it was improved after anti-infection treatment. Postoperative follow-up was conducted for 3-12 months. The flaps were in good texture with satisfactory appearance and function of limbs. All donor sites healed well without scar hyperplasia. Conclusion:IRT combined with HFCDU is a reliable method in location of perforator vessels of ALTF, and it is an ideal technique in the exploration of perforator vessels and in the harvest of a super-thin flap.

Objective:To investigate the application of 3-D ultrasonography enabled by a wide band linear matrix array volume transducer in the localisation of perforating vessels of a free anterolateral thigh perforator flap (ALTPF) before surgery, and to guide microsurgeons in precise design and harvest of a ALTPF.Methods:From May 2020 to October 2022, a retrospective study was carried out on 35 patients who had soft tissue defects and undertaken free ALTPF surgery in Department of Foot and Ankle Surgery, Wuxi No.9 People's Hospital Affiliated to Soochow University. ALTPFs were transfered for reconstruction of soft tissue defects of foot in 25 patients and of ankle in 10 patients. The age of patients were 20 to 66 years old. The defects were 11.0 cm×8.0 cm-28.0 cm×9.0 cm in size. The sizes of ALTPFs were at 12.0 cm×9.0 cm-29.0 cm×10.0 cm. Before surgery, ultrasound scans with a wide band linear matrix array volume transducer were performed to locate the perforating vessels. The 3-D ultrasound images showing the perforating vessels of ALTPFs were acquired and the number, location and classification of the perforating vessels were saved. After the appropriate perforating vessels had been determined, ALTPFs were designed for precisely intraoperative incision. The accuracy of preoperative location of perforating vessels by the linear matrix array volume ultrasound transducer was investigated in surgery. All patients received the scheduled postoperative follow-up at outpatient clinics.Results:Of the 72 perforating vessels discovered in surgery, 70 matched with those being located by ultrasound before surgery. It was found that a total of 67 perforating vessels located before surgery by ultrasonography were consistently mapped with the perforators discovered in surgery. Of the 67 consistently mapped perforating vessels, 19 were Kimura type I, 27 of Kimura type II and 21 of Kimura type III perforators. The rate of sensitivity and positive prediction were 95.7% and 93.1%, respectively, in the preoperative localisation of perforating vessels of ALTPFs with a wide band linear matrix array volume ultrasound transducer. Twenty-five ALTPFs were harvested subfascially and 10 superfascially. Average size of ALTPFs was 17.7 cm × 8.6 cm. The perforating vessels revealed during the harvest of all ALTPFs were basically consistent with the preoperative 3-D ultrasound. All flaps survived after surgery without any incident. The postoperative follow-up lasted 8 to 20 months, with 12.7 months in average.Conclusion:The 3-D ultrasonography with a wide band linear matrix array volume ultrasound transducer can accurately locate the perforating vessels of ALTPF before surgery. This technique has many advantages in the design and harvest of super-thin ALTPFs.