Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective To compare the complications,etiology,and clinical manifestations between pediatric patients with heart valve disease undergoing surgical treatment.Methods A retrospective analysis was conducted on the clinical data of 169 pediatric patients aged 0-14 years diagnosed with heart valve abnormalities at Wuhan Union Hospital from January 2019 to October 2022.Patients were divided into two groups based on whether they received surgical intervention for valve abnormali-ties:the surgical treatment group and the medical treatment group.Results There were significant differences in age,type and grade of heart failure,club-finger,pneumonia and cough,cardiac morphology,arrhythmia,ventricular septal width and left ven-tricular ejection fraction(all P＜0.05).Univariate and multivariate binary logistic regression analyses revealed that left ventricu-lar ejection fraction(OR=1.206,95％CI:1.072-1.357,P＜0.05)was an independent risk factor for the surgical treatment group.Conclusion The clinical manifestations of heart valve abnormalities in children are often atypical.Clinicians should ac-tively evaluate the etiology based on clinical symptoms and echocardiographic findings,and develop individualized treatment strategies,either surgical or medical,to prevent the progression of severe heart disease.

Objective To explore the possible mechanism underlying the role of forkhead box A1 circular RNA(circ-FAT1)regulating pericyte pyroptosis in diabetic retinopathy(DR).Methods The experiment was divided into two parts.Firstly,thirty male C57BL/6J mice(totaling 60 eyes)were randomly divided into normal,DR and circFAT1 overex-pression groups,with 10 mice in each group.Fasting plasma glucose(FPG)was detected by a glucometer.The serum lev-els of total cholesterol(TC)and triacylglycerol(TG)were measured by enzyme-linked immunosorbent assay(ELISA)kits.Hematoxylin and eosin(HE)staining was used to examine the pathological structure of mouse retina.Reverse tran-scription-quantitative polymerase chain reaction(RT-qPCR)was used to detect the mRNA expression of circFAT1 in retinal tissues.The relative protein expression levels of NOD-like receptor protein 3(NLRP3),Caspase-1 and porin D(GSDMD)in the retina of mice were detected by Western blot.Secondly,retinal perivascular cells were extracted from 5 C57BL/6J mice(totaling 10 eyes)and divided into control,high glucose and circFAT1 overexpression+high glucose groups.The protein expression levels of NLRP3,Caspase-1 and GSDMD in pericytes were detected by Western blot.ELISA kits were used to measure the content of interleukin-18(IL-18)and interleukin-1β(IL-1β)in pericytes.Results(1)Compared with those in the normal group,the levels of FPG,serum TC and TG were increased while the relative expression level of circFAT1 mRNAs in the retinal tissue was decreased in the DR group(all P＜0.05).Compared with the DR group,the circ-FAT1 overexpression group showed decreased levels of FPG,serum TC and TG(all P＜0.05),and increased relative ex-pression levels of circFAT1 mRNAs in the retinal tissue(P＜0.05).The relative expression levels of NLRP3,Caspase-1 and GSDMD proteins in the retinal tissue of the DR Group were higher than those in the normal group(all P＜0.05).The rela-tive expression levels of NLRP3,Caspase-1 and GSDMD proteins in the retinal tissue of the circFAT1 overexpression group were lower than those in the DR group(all P＜0.05).(2)Compared with those in the control group,the relative expres-sion levels of NLRP3,Caspase-1,and GSDMD proteins and the content of IL-18 and IL-1 β in the pericyte of the high glucose group were increased(all P＜0.05).The relative expression of NLRP3,Caspase-1 and GSDMD proteins and the content of IL-18 and IL-1 β in the pericyte of the circFAT1 overexpression+high glucose group were lower than those in the high glu-cose group(all P＜0.05).Conclusion Overexpression of circFAT1 can improve DR by inhibiting pericyte pyroptosis.

Objective Innovatively establish an information management model for the entire lifecycle of equipment ap-plicable to disease prevention and control centers.Methods An in-depth analysis of the current situation of equipment manage-ment and existing problems,relying on the laboratory information management system,combined with the theory of high-quality full-life-cycle management,incorporating advanced information technology management,and adoption of targeted measures to pro-mote the solution of problems one by one.Results Implement and improve the whole life cycle information management node,set up an equipment management committee,innovate the use of new equipment identification plates,develop a mobile platform client,and realize management data visualization.Conclusion The Informatisation management mode of the whole life cycle of equipment with the Center for Disease Control and Prevention characteristics.It realizes the whole life cycle,dynamic and Informatisation man-agement of equipment from demand,acceptance,use,maintenance,measurement,deactivation and scrapping.It strengthens the process management and quality control of equipment and serves to improve disease prevention and control capabilities.

Objective To explore the delirium incidence and risk factors among patients undergoing abdominal surgery in the post-anesthesia care unit(PACU),and establish a column chart prediction model.Methods A total of 1851 patients who underwent abdomi-nal surgery,with a surgery duration exceeding 4hours and were routinely transferred to the PACU after surgery in the First Affiliated Hos-pital of Wenzhou Medical University from January 2022 to December 2023 were selected.The patients were divided into a delirium group and a non-delirium group based on a nursing delirium screening scale score≥2.The relative factors of before and during the surgery were analyzed retrospectively.The LASSO regression was used to screen the variables,and the independent influencing factors were deter-mined using univariate and multivariate Logistic regression before creating a forest plot.The predictive efficacy of the column chart predic-tion model was evaluated by area under the curve(AUC)of receiver operating characteristic(ROC)and the Hosmer-Lemeshow test.Results A total of 113(6.1％)patients experienced delirium in the PACU.The result of the multivariate Logistic regression analysis in-dicated that gender,age,flurbiprofen,hypotension,hypothermia,hypercapnia,and surgery duration were independent influencing factors for delirium in the PACU,while a long surgery duration and using flurbiprofen were protective factors.The nomogram model was construc-ted based on the result and the AUC value of this model was 0.738.The Hosmer-Lemeshow goodness-of-fit test for the model demon-strated a good fit(P=0.686).Conclusion Medical staff should enhance intraoperative management,ensure sufficient analgesia,main-tain hemodynamic stability,reduce the incidence of intraoperative adverse events,pay attention to elderly male patients,and decrease the occurrence of delirium in the PACU.

Nocardia is a Gram-positive pathogen responsible for causing dairy mastitis,which leads to purulent granulomatous lesions in mammary tissue and can significantly impact the dairy indus-try,resulting in substantial economic losses.To develop a rapid and accurate diagnostic method for detecting Nocardia of bovine origin,a conserved sequence of the 16S rRNA gene from Nocardia was selected from the NCBI database.Based on this sequence,a pair of primers and a TaqMan fluo-rescent quantitative probe were designed.The validation of the TaqMan fluorescence quantitative PCR(qPCR)method found in this study showed that the Ctvalue had a good linear relationship with recombinant plasmid concentrations ranging from 1×1010 to 1×102 copies/μL,with a regres-sion equation of y=-3.536x+43.78,a correlation coefficient(R2)of 0.997 5,a slope of-3.536,and an amplification efficiency(E)of 91％(where 90％＜E＜110％).The specificity was strong,with no cross-reactions with other pathogens.The standard curve had a high sensitivity with a low-er detection limit of 1 × 102 copies/μL,it was 100-fold higher than conventional PCR.The repeatability of the standard curve was also good.Both intra-and inter-group coefficients of varia-tion were below 2％.Using this method,234 milk samples and 80 environmental samples were tested using this method,respectively,with a positive detection rate of 27.07％,whereas conven-tional PCR had a positive detection rate of 19.43％,indicating that this method was more sensitive compared to conventional PCR.The fluorescent quantitative PCR detection method established in this study provides an effective means for the clinical detection of Nocardia in dairy cows.

A case report of adult skeletal class Ⅲ patient with high angle open bite is presented in this article.The patient underwent extraction of bilateral mandibular first molars and straightening the third molars,open bite was resolved,normal over bite,over jet and good occlusion were established.

ObjectiveTo investigate the potential mechanisms of Zingiberis Rhizoma in treating inflammatory bowel disease （IBD） by integrating network pharmacology with in vitro and in vivo experiments. MethodsTraditional Chinese Medicine Systems Pharmacology Database And Analysis Platform （TCMSP）， Traditional Chinese Medicine Integrated Database （TCMID） Database were used to obtain the active component targets of Zingiberis Rhizoma. GeneCards was used to obtain the IBD targets. DAVID was used to perform Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analyses on core targets. Cytoscape 3.10.2 was used to establish the "active component-disease target-signaling pathway" interaction network. Mice were randomly assigned to control， model， and Zingiberis Rhizoma （400 mg·kg^-1） groups. An IBD model was induced via dextran sulfate sodium （DSS）. The colonic tissue was collected post-treatment to assess histology， expression of Ly6C⁺ monocytes/macrophages， and mRNA levels of Toll-like receptor 4 （TLR4）， and inflammatory cytokines. The effect of Zingiberis Rhizoma aqueous extract on RAW264.7 cell viability was evaluated. Furthermore， the effects of the extract at 100， 10， and 1 mg·L^-1 on LPS-induced differentiation of RAW264.7 cells into Ly6C^hi monocytes/macrophages， mRNA levels of TLR4 and inflammatory cytokines， and protein levels of factors in the TLR4/mitogen-activated protein kinase （MAPK） signaling pathway. ResultsA total of 241 targets were identified for Zingiberis Rhizoma and 6 787 for IBD， with 122 shared targets among Zingiberis Rhizoma， ulcerative colitis （UC）， and Crohn's disease （CD）. The enrichment analyses yielded 297 GO terms and 88 KEGG pathways. Associations were noted between Zingiberis Rhizoma's active component targets and IBD targets. In vivo experiments： Compared with the control group， the model group showed decreased body weight and disease activity index （DAI）（P<0.01）， shortened colon length， damaged mucosal epithelium with inflammatory cell infiltration， raised pathological scores （P<0.05）， increased Ly6C^hi and Ly6C^lo monocytes/macrophages （P<0.05）， and up-regulated mRNA levels of TLR4， TNF-α， IL-1β， and IL-6 （P<0.05） and protein levels of TLR4， phosphorylated extracellular signal-regulated protein kinase 1/2 （p-ERK1/2）， and phosphorylated p38 MAPK （p-p38 MAPK） （P<0.05）. Zingiberis Rhizoma intervention reversed these changes and reduced Ly6C^hi monocytes/macrophages （P<0.01）. In vitro experiments： compared with the control， LPS increased the proportion and number of Ly6C^hi monocytes/macrophages and mRNA levels of TLR4， TNF-α， IL-1β， and IL-6 （P<0.01） and enhanced the expression of TLR4， p-ERK1/2， and p-p38 MAPK （P<0.05）. Zingiberis Rhizoma reduced Ly6C^hi monocytes/macrophages （P<0.05）， down-regulated the mRNA levels of inflammatory cytokines （P<0.05）， and suppressed the TLR4/MAPK pathway （P<0.05）. ConclusionZingiberis Rhizoma alleviates IBD by suppressing the TLR4/ERK/p38 MAPK signaling pathway and reducing inflammatory cytokine levels in Ly6C^hi monocytes/macrophages.

ObjectiveTo clarify the repair effect of Mume Fructus on the intestinal mucosal epithelial barrier in the mouse model of inflammatory bowel disease （IBD） and explore the repair mechanism. MethodsThirty-six male C57BL/6 mice were randomly assigned into six groups： normal， model， low-， medium-， and high-dose （200， 400， and 800 mg·kg^-1） Mume Fructus， and sulfasalazine （300 mg·kg^-1）. Except the normal group， the rest groups had free access to 2% dextran sulfate sodium （DSS） solution for seven days to establish the IBD model， followed by a seven-day drug intervention. The body weight change and disease activity index （DAI） were recorded. After the last administration， spleen and colon tissue samples were collected to analyze the differences in colon length and spleen index. Hematoxylin-eosin staining was used to observe the morphology of the colon tissue. The level of diamine oxidase （DAO） in the serum was measured by the DAO assay kit. Immunohistochemistry was employed to determine the expression of tight junction proteins such as Claudin-1， Occludin， and zonula occludens-1 （ZO-1） in the colon tissue. Real-time PCR was performed to measure the mRNA levels of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in the colon tissue. Finally， Western blot was employed to determine the protein levels of mitogen-activated protein kinase kinase （MEK）， extracellular signal-regulated kinase （ERK）， phosphorylated （p）-MEK， and phosphorylated ERK in the colon tissue. ResultsCompared with the normal group， the model group exhibited decreases in body weight and colon length （P<0.01）， increases in DAI， spleen index， and serum DAO level （P<0.01）， damaged colonic epithelium and goblet cells， and obvious infiltration of inflammatory cells. In addition， the model group exhibited higher positive expression of Claudin-1， Occludin， and ZO-1 （P<0.01）， higher mRNA levels of TNF-α and IL-1β （P<0.01）， and higher protein levels of p-MEK and p-ERK （P<0.05， P<0.01） than the normal group. However， sulfasalazine and three doses of Mume Fructus markedly decreased the body weight and DAI （P<0.05）， recovered the colon length and spleen index， alleviated colon tissue damage， lowered the level of DAO in the serum （P<0.01）， and down-regulated the mRNA levels of TNF-α and IL-1β （P<0.01） and the protein levels of p-MEK and p-ERK （P<0.05）. Sulfasalazine and low- and medium-dose Mume Fructus increased the positive expression of Occludin， Claudin-1， and ZO-1 （P<0.05， P<0.01）. Furthermore， high-dose Mume Fructus elevated the protein expression of Occludin （P<0.05）. ConclusionMume Fructus can restore the expression of intestinal epithelial tight junction proteins by inhibiting the phosphorylation of proteins in the MEK/ERK signaling pathway and down-regulating the levels of TNF-α and IL-1β， thus repairing the intestinal mucosal barrier in the mouse model of IBD.

ObjectiveTo investigate the modulating effect of modified Wumeiwan （MWMW） on the ulcerative colitis （UC）-associated intestinal helper T cell 17 （Th17）/regulatory T cell （Treg） balance and intestinal flora by using a human flora-associated model of UC patients with dampness-heat obstruction syndrome， thus providing a new idea for the UC-related research and therapeutic strategies. MethodsThe 24 male C57BL/6J mice were randomized into normal control， model， and MWMW groups （n=8）. Model and MWMW groups were first treated with an antibiotic cocktail （vancomycin， 0.1 g·kg^-1； neomycin sulfate， 0.2 g·kg^-1； ampicillin， 0.2 g·kg^-1； metronidazole， 0.2 g·kg^-1） for 21 days. At the end of antibiotic treatment， the gavage of fecal microbiota suspension from UC patients with dampness-heat obstruction syndrome was started at a dose of 0.2 mL·d^-1 for 19 consecutive days， by which a human flora-associated model of UC was obtained. The MWMW group was administrated daily with MWMW liquid （12.5 g·kg^-1）， while the normal control and model groups were administrated by gavage with an equal amount of sterile water for 7 consecutive days. The symptoms of dampness-heat obstruction were observed. The colon length and spleen index were measured and calculated， and the proportions of Th17 and Treg cells were detected by flow assay. The intestinal flora was analyzed by 16S rRNA high-throughput sequencing. ResultsCompared with the normal control group， the model group showed shortened colon （P<0.05） and increased spleen index （P<0.01）. Compared with the model group， the MWMW group showed prolonged colon （P<0.01） and decreased spleen index （P<0.05）. After the intervention of MWMW， the Th17 proportion and Th17/Treg ratio in the colon decreased （P<0.01）， and the proportion of Treg cells increased （P<0.05）. The number of species and alpha and beta diversity of intestinal flora in mice were regulated by MWMW （P<0.05）. In terms of intestinal flora composition， MWMW increased the relative abundance of several phyla （Firmicutes， Proteobacteria， Fusobacteriota， Actinobacteriota， and Gemmatimonadota）， the genus Bacteroides， and two species （Bacteroides thetaiotaomicron and B. fragilis） in model mice. Moreover， Spearman's correlation analysis showed that the relative abundance of B. thetaiotaomicron and B. fragilis were negatively correlated with the Th17 level （P<0.05）. In addition， the above changes in intestinal flora caused the changes in microbial genes involved in 14 pathways， such as glycolysis， amino acid degradation， inorganic nutrient metabolism， biosynthesis of pyrimidine deoxyribonucleotides， antibiotic resistance， and degradation of polysaccharides. ConclusionsThe human flora-associated model successfully simulated the changes （marked by a decrease in the abundance of Bacteroides） of intestinal flora in UC patients with dampness-heat obstruction syndrome. MWMW can enrich the abundance of beneficial bacteria such as B. thetaiotaomicron and B. fragilis and promote the synergistic intestinal immune modulation with the metabolic functions centered on glycolysis， amino acid metabolism， and nucleotide synthesis through bacterial polysaccharide utilization sites to reduce the Th17/Treg ratio， thereby exerting a protective effect on UC.