Objective:To investigate the feasibility of stapled closure of the internal fistula orifice in anal fistula (SCIA) combined with catheter drainage in the extra-sphincteric space in the treatment of high complex anal fistula.Methods:Methods Surgical procedure: Under combined spinal-epidural anesthesia, a submucosal purse-string suture was placed above the dentate line, and the stapler was inserted to close the internal opening. The fistulous tract was dissected from the external opening toward the cranial side and excised along its path to the level of the levator ani muscle, followed by placement of catheter drainage in the extra-sphincteric space.Results:A retrospective analysis was conducted on the clinical data of a 40-year-old male patient with a high-position complex anal fistula, who underwent SCIA combined with catheter drainage in the extra-sphincteric space at the Department of Colorectal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2024. The surgery was successful with minimal intraoperative bleeding, a complete anastomosis, and thorough fistula tract dissection. There was no sphincter injury occurred, and the catheter drainage was unobstructed. The patient was discharged on postoperative day 8. Postoperative follow-up visits were conducted at 2 months and 6 months after surgery. The patient had no symptoms such as pain, purulent discharge, or pruritus. MRI scans of the anal canal (both plain and contrast-enhanced) at 2 months and 6 months showed no recurrence of the fistula. The Wexner fecal incontinence score was 0, indicating normal bowel control, and the Garg score was less than 8, suggesting fistula healing and low probability of recurrence.Conclusion:SCIA combined with catheter drainage in the extra-sphincteric space is a safe and feasible procedure for the treatment of high complex anal fistula.

Objective:To investigate the feasibility of stapled closure of the internal fistula orifice in anal fistula (SCIA) combined with catheter drainage in the extra-sphincteric space in the treatment of high complex anal fistula.Methods:Methods Surgical procedure: Under combined spinal-epidural anesthesia, a submucosal purse-string suture was placed above the dentate line, and the stapler was inserted to close the internal opening. The fistulous tract was dissected from the external opening toward the cranial side and excised along its path to the level of the levator ani muscle, followed by placement of catheter drainage in the extra-sphincteric space.Results:A retrospective analysis was conducted on the clinical data of a 40-year-old male patient with a high-position complex anal fistula, who underwent SCIA combined with catheter drainage in the extra-sphincteric space at the Department of Colorectal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2024. The surgery was successful with minimal intraoperative bleeding, a complete anastomosis, and thorough fistula tract dissection. There was no sphincter injury occurred, and the catheter drainage was unobstructed. The patient was discharged on postoperative day 8. Postoperative follow-up visits were conducted at 2 months and 6 months after surgery. The patient had no symptoms such as pain, purulent discharge, or pruritus. MRI scans of the anal canal (both plain and contrast-enhanced) at 2 months and 6 months showed no recurrence of the fistula. The Wexner fecal incontinence score was 0, indicating normal bowel control, and the Garg score was less than 8, suggesting fistula healing and low probability of recurrence.Conclusion:SCIA combined with catheter drainage in the extra-sphincteric space is a safe and feasible procedure for the treatment of high complex anal fistula.

BACKGROUND:The high rate of postoperative hypoproteinemia in patients undergoing hip revision is associated with severe trauma,which affects the rapid recovery of patients. OBJECTIVE:To investigate the risk factors of perioperative hypoproteinemia in patients with hip revision,and to provide guidance for early screening of high-risk patients with postoperative hypoproteinemia. METHODS:According to the inclusion and exclusion criteria,161 patients who underwent hip revision were divided into hypoproteinemia group(76 cases)and normal group(85 cases).The rate of hypoproteinemia was 47.2%.Data such as age,gender,body mass index,osteoporosis,operation time,preoperative erythrocytes,preoperative hemoglobin,preoperative leukocytes,preoperative platelets,preoperative fibrinogen,preoperative C-reaction protein,preoperative sedimentation rate,preoperative blood calcium,preoperative albumin,postoperative drainage tube placement,American Society of Anesthesiologists score,and postoperative hypoproteinemia were collected.SPSS software was used to analyze the independent risk factors of hypoproteinemia after hip revision using multivariate binary logistic regression analysis.R software was used to construct the nomogram prediction model.Receiver operating characteristic curve and calibration curve and decision curve were drawn to evaluate the model. RESULTS AND CONCLUSION:(1)Univariate analysis results showed that body mass index,preoperative erythrocytes,preoperative hemoglobin,preoperative platelets,preoperative fibrinogen,preoperative C-reaction protein,and operation time were significantly different between the two groups(P<0.05).(2)Multivariate binary Logistic regression analysis results showed that body mass index(OR=0.859,P=0.021),operation time(OR=1.010,P=0.002),preoperative erythrocytes(OR=0.424,P=0.036),and preoperative C-reaction protein(OR=1.043,P=0.032)levels were independent risk factors for postoperative hypoproteinemia in patients with hip revision.(3)Based on four independent risk factors:body mass index,operation time,preoperative erythrocytes and preoperative C-reaction protein,the nomogram can effectively predict the risk of hypoproteinemia after hip revision.This nomogram prediction model has good differentiation and accuracy,and may lead to better clinical net benefits for patients.

Objective:To compare the differences in lung function between sanitation workers and the general population undergoing routine physical examinations, and to analyze the risk factors for restricted airflow and severity of the condition in sanitation workers.Methods:This study is a large cross-sectional study called "Shanxin Respiratory Health Screening for Ten Thousand People". A total of 1 036 sanitation workers (sanitation group) and 6 701 individuals from the general population undergoing routine physical examinations (control group) were selected as the original study subjects from June 2021 to April 2022 (before matching). Both groups underwent pre-bronchodilator lung function tests, and the differences in lung function characteristics between the two groups were compared. The sanitation group also completed a questionnaire survey. Multivariate and ordinal multinomial logistic regression analysis were used to analyze the risk factors for airflow limitation and its severity.Results:A total of 1 027 individuals from the sanitation group and 999 individuals from the control group were included in the study. There were no significant differences in age, gender, height, weight, and body mass index (BMI) between the two groups (all P>0.05). The rate of airflow restriction was significantly higher in the sanitation group compared to the control group (22.88% vs 8.81%, P<0.001). In the sanitation group, there was no statistically significant difference in a self-assessment test for chronic obstructive pulmonary disease (CAT) scores between individuals with airflow restriction (235 cases) and those without airflow restriction (792 cases) [(1.50±2.50) vs (1.15±2.03) points, P=0.084]. There were no statistically significant differences in forced vital capacity (FVC) as a percentage of predicted value (FVC%pred) between the two groups. However, the sanitation group had significantly lower %pred for forced expiratory volume in one second (FEV 1%pred), FVC/FEV 1 ratio (FEV 1/FVC%pred), forced expiratory flow at 50% of FVC (FEF 50%%pred), forced expiratory flow at 75% of FVC (FEF 75%%pred), and maximal mid-expiratory flow (MMEF%pred) compared to the control group (all P<0.05). The rates of abnormal FEF 50%%pred, FEF 75%%pred, and MMEF%pred were significantly higher in the sanitation group compared to the control group (17.62% vs 10.31%, 17.04% vs 10.01%, 27.26% vs 18.41%, all P<0.001). Small airway parameters and the rate of airflow restriction were significantly higher in past and current smokers of the sanitation group compared to never smokers (all P<0.05). Multifactorial analysis showed that high BMI ( OR=0.929, 95% CI: 0.885-0.974) was a protective factor for airflow restriction, while high smoking index was a risk factor ( OR=1.020, 95% CI: 1.011-1.030). Ordered multinomial logistic regression analysis showed that high BMI ( OR=0.925, 95% CI: 0.882-0.971) was a protective factor for the severity of airflow restriction, while high smoking index ( OR=1.020, 95% CI: 1.011-1.029) was a risk factor for the severity of airflow restriction. Conclusions:The incidences of airflow limitation and small airway abnormalities in sanitation workers are higher than that in general physical examination population. High smoking index and low BMI are independent risk factors for airflow limitation and its severity.

Objective:To provide normal reference thresholds for clinical dynamic monitoring of the risk of microthrombus during pregnancy, we aimed to establish reference intervals of D-dimer in healthy pregnant women during different periods of gestation in Xi′an.Method:From December 2020 to March 2022, a total of 1502 healthy pregnant women and healthy non-pregnant women (healthy non-pregnant control group) who received routine prenatal examination in Northwest Women and Children′s Hospital were recruited in the study by questionnaire, including 1236 healthy pregnant women and 266 healthy non-pregnant control group. Plasma D-dimer concentration was detected by STA-R Evolution automatic blood coagulation analyzer and the concentration levels of D-dimer in different pregnancies and age groups were calculated using Graph Prism 9.0 software. In addition, 20 samples were collected in each pregnancy to verify the established reference interval.Results:There was no significant difference in plasma D-dimer levels between<30 years old and ≥30 years old at different gestational weeks. Plasma D-dimer level in healthy pregnant women group was significantly higher than that in healthy non-pregnant women group of the same age (P<0.05). With the increase of gestational week, plasma D-dimer level in pregnant women increased significantly, and plasma D-dimer level at different gestational weeks ≤13 weeks, 13+ 1-20 weeks, 20+ 1-27 weeks, 27+ 1-35 weeks, ≥35 +1 week were 0.33 (0.26, 0.47) μg/ml, 0.41 (0.30, 0.51) μg/ml, 0.71 (0.48, 0.94) μg/ml, 0.91 (0.70, 1.27) μg/ml, 1.30 (0.96, 1.72) μg/mlrespectively. Unilateral reference interval acuities were≤0.89 μg/ml, ≤1.53 μg/ml, ≤2.44 μg/ml, ≤2.74 μg/ml, ≤3.82 μg/ml respectively. The reference range established in this study was verified by 20 independent samples from each of the 5 gestational age groups, and the results were acceptable. Conclusion:This study preliminarily established the reference interval of plasma D-dimer in healthy pregnant women at different gestational weeks in Xi ′an area, which is helpful for the auxiliary diagnosis of thrombotic diseases during pregnancy.

Development of thoracolumbar vertebra (TLV) and rib primordium (RP) is a common evolutionary feature across vertebrates, although whole-organism analysis of the expression dynamics of TLV- and RP-related genes has been lacking. Here, we investigated the single-cell transcriptome landscape of thoracic vertebra (TV), lumbar vertebra (LV), and RP cells from a pig embryo at 27 days post-fertilization (dpf) and identified six cell types with distinct gene expression signatures. In-depth dissection of the gene expression dynamics and RNA velocity revealed a coupled process of osteogenesis and angiogenesis during TLV and RP development. Further analysis of cell type-specific and strand-specific expression uncovered the extremely high level of HOXA10 3'-UTR sequence specific to osteoblasts of LV cells, which may function as anti-HOXA10-antisense by counteracting the HOXA10-antisense effect to determine TLV transition. Thus, this work provides a valuable resource for understanding embryonic osteogenesis and angiogenesis underlying vertebrate TLV and RP development at the cell type-specific resolution, which serves as a comprehensive view on the transcriptional profile of animal embryo development.

Objective:To retrospectively analyze clinical characteristics, flora distribution characteristics, and antimicrobial sensitivity of type 2 diabetic patients with back abscess.Methods:The clinical data of patients with type 2 diabetes mellitus and back abscess were collected from Endocrinology Department of Henan Provincial People′s Hospital from October 2017 to April 2020. The results of bacterial culture and drug sensitivity test were analyzed, antibiotics were given to treat infection, incision and debridement of abscess were performed according to the situation of abscess, drainage of abscess cavity or continuous negative pressure suction was given when necessary, and the clinical outcome was recorded.Results:A total of 12 type 2 diabetic patients with back abscess were included. The average size of their abscess was(150.3±101.2)cm 2, with over 100 cm 2 in 8 cases(66.7%). Among the 12 patients, 11 patients underwent bacterial culture and drug sensitivity analysis. The positive rate of culture was 100%, and all of them were Staphylococcus aureus, with 10 cases of methicillin-susceptible Staphylococcus aureus(MSSA)and 1 case of methicillin-resistant Staphylococcus aureus(MRSA). MSSA strains were 100% sensitive to oxacillin, vancomycin, linezolid, levofloxacin, moxifloxacin, tetracycline, tegecycline, rifampicin, amoxicillin/clavulanic acid, amikacin, and teicoplanin. Both MSSA and MRSA strains were sensitive to vancomycin, linezolid, rifampin, amikacin, and teicoplanin. The wound of all patients was healed, with 100% cure rate and(35.8±34.0)days of average healing time. Conclusion:The back abscess in type 2 diabetic patients is characteristic of rapid progress, huge abscess, and difficult to treat, which should be treated early, incised and debrided timely. Staphylococcus aureus is its single pathogen and it is helpful to select the antibiotics empirically.

Objective:To investigate the role and mechanism of retinal Sigma-1 receptor antagonist N, N-diethyl-2-[4-methoxy-3-(2-phenylethoxy)phenyl]ethanaminehydrochloride (NE-100) in the formation of form deprivation myopia (FDM) in guinea pigs.Methods:Eighty-five 21-day-old guinea pigs were selected, and 36 of them were randomly divided into normal control group, occluded 14-day group and occluded 11-day group, with 12 in each group.The right eyes of guinea pigs in the occluded 14-day group were covered with translucent eye shield for consecutive 14 days, and guinea pigs in the occluded 11-day group were treated in the same way for consecutive 11 days plus 3 days without cover, and guinea pigs in the normal control group were not covered.The other 49 guinea pigs were randomly divided into FDM group ( n=10), FDM+ NE-100 6 μg group ( n=12), FDM+ NE-100 60 μg group ( n=10), FDM+ NE-100 600 μg group ( n=9), and FDM+ saline group ( n=8). The right eyes in each group received 100 μl peribulbar injection of NE-100 6 μg, 60 μg and 600 μg or saline once a day according to grouping.Ocular refraction and axial dimensions were measured using eccentric infrared photorefractor and A-scan ultrasonography, respectively.Corneal curvature was measured with keratometer.Immunohistochemical staining and Western blot were used to detect the expression levels of Sigma-1 receptor protein, and retinal dopamine content was evaluated by high-performance liquid chromatography with electrochemical detection.This study was approved by an Ethics Committee of the Department of Laboratory Animal Science of Central South University (No.2020sydw0084). The use and care of experimental animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals in China. Results:There were statistical significant differences in diopter and axial length among the normal control group, occluded 14-day group and occluded 11-day group ( F=147.81, 160.10; both at P<0.01). Compared with the normal control group, the relative myopia was the deepest and the axial length was the longest in the occluded 14-day group, then the occluded 11-day group, showing significant differences between them (all at P<0.05). In the normal control group, Sigma-1 protein was mainly expressed in retinal ganglion cells (RGCs), photoreceptor inner segment and the inner nuclear layer.In the occluded 14-day group, Sigma-1 protein staining was enhanced in RGCs and photoreceptor inner segment.Sigma-1 staining positive cells in the inner nuclear layer were increased significantly and were also seen in the inner and outer plexiform layers, especially in Müller cells, in which the expression levels of Sigma-1 receptor protein were significantly increased.Compared with the occluded 14-day group, the Sigma-1 receptor protein expression levels in the retina of the occluded 11-day group was significantly decreased ( P<0.01). The diopters of guinea pigs in the FDM+ NE-100 6 μg, 60 μg and 600 μg groups were lower than those in the FDM group, and the diopters of FDM+ NE-100 60 μg and 600 μg guinea pigs were lower than those in the FDM+ NE-100 6 μg group, and the differences were statistically significant (all at P<0.05). The dopamine content in the retina of the FDM+ NE-100 60 μg group was (0.74±0.09) ng/mg, which was significantly higher than (0.57±0.10) ng/mg in the FDM group, with a significant difference between them ( t=15.18, P<0.01). Conclusions:Sigma-1 receptor antagonist inhibits FDM formation, which may be associated with the elevation of dopamine content in retina.

OBJECTIVE：To prepare Imperatorin ultradeformable liposomes gel （IMP-UDLs-Gel），and to evaluate its quality. METHODS：Based on single factor test ，using 12 h accumulative penetration amount （Q12h）as evaluation index ，the proportion of carbomer 940，glycerol and propyl glycol in formulation of IMP-UDLs-Gel were investigated by orthogonal test. The optimal formulation was screened. The quality of IMP-UDLs-Gel prepared with the optimal formulation was evaluated. RESULTS ：The optimal formulation of IMP-UDLs-Gel included carbomer 940 proportion of 1％，glycerol proportion of 15％ and propyl glycol proportion of 10％. Q12 h of IMP-UDLs-Gel was （11.543±0.241）μg/cm2；the appearance was milky white and translucent ；the particle size was （93.13±1.68）nm，PDI was 0.268±0.012，Zeta potential was （－24.96±1.99）mV；pH was 7.32±0.03； viscosity was （45.37±1.27）g·s；steady flow was （0.727±0.002）μg·h/cm2，lag time was （4.358±0.175）h，apparent permeability coefficient was 1.392×10－3 cm/h，and it has good physical and optical stability. CONCLUSIONS ：The preparation method is stable and feasible ，and the prepared IMP-UDLs-Gel has good adhesion ，stability and transdermal property.

Objective:To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection in patients admitted to the hematological ward.Methods:Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1, 2017 to December 31, 2019 and underwent chemotherapy or immunosuppressive therapy comprised the intervention group. They were screened for intestinal CRE at least thrice. From December 1, 2016 to February 28, 2017, patients who underwent chemotherapy or immunosuppressive therapy without active intestinal CRE screening in the Department of Hematology formed the control group. Both the patient groups were monitored for CRE infection in real time. The χ2 test was used to compare the changes in the CRE infection rate and mortality in high-risk patients before and after the active screening. Results:During the intervention period, the CRE colonization rate of patients was 16.46% (66/401) ; in terms of disease distribution, the colonization rate of acute leukemia was the highest 23.03% (26/113) . Of the 66 colonized patients, 27 (40.9%) patients were identified as positive for CRE at the first screening, 15 (22.7%) were identified at the time of the second screening, and the remaining 24 (36.4%) were identified at the third or subsequent screening; Carbapenem-resistant Klebsiella pneumoniae (CRPK) strains were dominant among the pathogens, accounting for 54.55% (36/66) . During the active screening period, the CRE infection rate (2.49%) and mortality rate (50.00%) of high-risk patients were significantly lower than those of the controls (11.30% and 69.23%, respectively) . The pathogens of 10 CRE infection patients during the intervention period were exactly the same as the previous active screening pathogens, and the coincidence rate was 100%.Conclusion:The CRE colonization rate was the highest in patients with acute leukemia who were admitted in the hematology wards. CRPK is the main pathogen of CRE colonization, infection, and death. Increasing the frequency of screening can significantly raise the positive rate of screening, Active screening can effectively reduce the incidence and subsequent mortality of CRE in high-risk patients admitted in the hematological wards. High coincidence rate between CRE screening positive pathogens and subsequent CRE infection pathogens. Intestinal CRE screening can serve as an indicator of CRE bloodstream infection in patients with hematological diseases as well as provide information for antibiotics therapy.