Islet β cell dedifferentiation is one of the important reasons leading to insulin secretion defect or insulin resistance in patients with type 2 diabetes mellitus(T2DM).HIF-1α/PFKFB3 signaling pathway is a newly discovered biological pathway related to T2DM,which is involved in the induction of islet β cells dedifferentiation by anaerobic glycolysis under high glucose environment.This article reviews the research progress of the role of HIF-1α/PFKFB3 signaling pathway in glycolysis induced islet β cell dedifferentiation.

Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.

Objective:To analyze the distribution and drug resistance of wound pathogenic microorganisms in outpatients of wound healing center so as to provide a basis for the standardized construction of wound healing centers.Methods:A retrospective case series study was used to analyzed the data of 365 outpatients treated at Ruijin Hospital, Shanghai Jiaotong University School of Medicine from December 2017 to October 2019. There were 220 males and 145 females, aged (58.8±18.9)years (range, 18-98 years). The patients included 92 first-visit patients and 273 re-visit patients. The culture results (positive rate of pathogenic microorganisms, bacterial species, bacterial distribution) and drug sensitivity results of the wound secretions were compared and analyzed.Results:(1) Among 365 samples of wound secretions, 198 patients were positive for pathogenic microorganisms with a positive rate of 54.3%. A total of 107 strains (51.0%) of Gram-positive bacteria were detected, mainly Staphylococcus aureus (70 strains, 33.3%); 95 strains (45.2%) of Gram-negative bacteria were detected, mainly Escherichia coli (20 strains, 9.5%), followed by Pseudomonas aeruginosa (17 strains, 8.1%); 8 strains (3.8%) of fungi were detected. (2) A total of 26 (28.3%) first-visit patients were positive for pathogenic microorganisms, and 172 (63.0%) re-visit patients were positive for pathogenic microorganisms. The rate of positive microorganism detection had significant differences between first-visit and re-visit patients ( P<0.05). (3) A total of 29 strains were detected in first-visit patients, including 16 strains (55.2%) of Gram-positive bacteria, 11 strains (37.9%) of Gram-negative bacteria and 2 strains (6.9%) of fungi. A total of 181 strains were detected in re-visit patients, including 91 strains (50.3%) of Gram-positive bacteria, 84 strains (46.4%) of Gram-negative bacteria and 6 strains (3.3%) of fungi. The microbial distribution was significantly different between first-visit and re-visit patients ( P<0.05). (4) Compared with first-visit patients, the resistance of Staphylococcus aureus isolated from the re-visit patients to spenicillin, oxacillin, ciprofloxacin, tetracycline, clindamycin, moxifloxacin, erythromycin, and levofloxacin were increased variably. No vancomycin-resistant Staphylococcus aureus was detected, indicating that the staphylococcus aureus presented in the wound was highly sensitive to vancomycin. Conclusions:Staphylococcus aureus is the most common microorganism in wound secretions in outpatients of wound healing center. The rate of positive pathogenic microorganisms in wound secretions of re-visit patients is significantly higher than that of first-visit patients, and the distribution of pathogenic microorganisms of first-visited and revisited patients differs significantly. The Staphylococcus aureus detected in re-visit patients has a higher resistance to common antibiotics compared with first-visit patients. It is suggested that timely detection of pathogenic microorganisms in outpatients and effective control and supervision of outpatient infections are important contents that cannot be ignored in the construction of wound healing center.

According to a document issued by the General Office of National Health Commission, "one person, one diagnosis, and one room" is required in the process of outpatient consultation. However, the patient will need to go to another room for dressing change after the doctor checks the wound if sticking to the conventional layout of current wound repair specialist outpatient clinic in hospitals and following the regulation of "separation of diagnosis and treatment". To allow a patient walking back and forth with the exposed wounds to different clinics or going to another clinic for dressing change with the original dressing reapplied to the wound is against the regulation of nosocomial infection control and the principle of sterility. To ensure that the layout of the outpatient clinic in the wound repair outpatient department not only conforms to the principle of "one person, one diagnosis, and one room", but also meets the characteristics of the diagnosis and treatment process of chronic wounds, this paper proposes the layout of "large space and small partition" in the wound repair clinic.

Objective:To explore the application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes.Methods:A retrospective observational study was conducted. From January 1 to December 23, 2019, a total of 46 patients with chronic sinus tract wounds, who met the inclusion criteria were admitted to the Wound Healing Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 23 males and 23 females, aged 18-81 (48±21) years. On admission, computer tomography (CT) imaging and three-dimensional reconstruction were performed to examine the shapes of wound sinus tract and classify the wounds, with the lengths of wound sinus tract by CT imaging examination (hereinafter referred to as reference lengths) recorded. The lengths of wound sinus tract were examined and measured by rigid endoscopy and flexible endoscopy. The wounds with and without obviously curved sinus tract were classified into curve group and linear group respectively, and the deviation rates between the lengths of wound sinus tract measured by flexible endoscopy or rigid endoscopy and the reference lengths (hereinafter referred to as deviation rates of lengths) in each group were calculated. The difference between the deviation rates of lengths examined by flexible endoscopy and rigid endoscopy and the differences between the above two and the deviation rate of reference lengths (0) in each group were compared. Data were statistically analyzed with paired sample t test and Wilcoxon signed rank sum test. Results:CT imaging and three-dimensional reconstruction showed that there were 4 types of wound sinus tract, including tubular (36/46), lamellar (4/46), club-mallet (4/46), and irregular (2/46) shape. Tubular wounds were further divided into type I (23/36), type L (4/36), and type Y (9/36). Wounds with type I tubular, lamellar, and club-mallet sinus tract were classified into linear group (31/46), while those with type Y tubular, type L tubular, and irregular sinus tract were classified into curve group (15/46). In linear group, the deviation rates of lengths examined and measured by rigid endoscopy and flexible endoscopy were 0. In curve group, the deviation rate of lengths examined and measured by flexible endoscopy was 0 (0, 0.58%), which was significantly lower than 41.18% (31.68%, 48.41%) examined and measured by rigid endoscopy, Z=-3.408, P<0.01; the deviation rate of lengths examined and measured by rigid endoscopy (40±19)% was significantly higher than the deviation rate of reference lengths ( t=8.343, P<0.01), while the deviation rate of the lengths examined and measured by flexible endoscopy was similar to the deviation rate of reference lengths ( Z=-1.342, P>0.05). Conclusions:Compared with rigid endoscopy, flexible endoscopy can observe the internal characteristics of chronic sinus tract wounds in a wider range in the clinical examination of this kind of wound, especially for the exploration of curved chronic sinus tract wounds. The promotion of this method will be conducive to the diagnosis and treatment of chronic sinus tract wounds.

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Objective: To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity. Methods: Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher′s exact probability test. Results: (1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ²=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ²=21.6, P<0.01]. Conclusions Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.

The " exploration of treatment technology of chronic wound with sinus tract supported by endoscope and related auxiliary methods" study had been conducted by Wound Healing Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The feasibility and effectiveness of this technique have been confirmed, and good clinic results have been achieved. In order to further promote the new technology and its related research, the theoretical knowledge and technical experience accumulated in the early stage are summarized as diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract, including four parts: the applicable subjects, the diagnosis and treatment procedures and classification criteria, the healing criteria, and the risk assessment and prevention measures. The purpose of this standard is to facilitate the application of standardized endoscopy technique, to make the most of its technological advantages, prevent risks, and provide a reference for the official version of the diagnosis and treatment standard.

Objective To evaluate the clinical implication of circulating endothelial microparticles in severe burned patients in burn shock resuscitation period and in patients with severe infection.Methods A retrospective case control study was conducted on 90 burned patients from January 2009 to December 2015.The patients were divided into burn shock group (n =57) and infection group (n =33).The infection group was further divided into sepsis group (n =18) and non sepsis group (n=15).There were 17 healthy controls.The numbers of CD31 +,CD51 +,CD144 +,CD54 +,and CD62E + EMPs in plasma were measured by flow cytometry immediately thereafter.The numbers and ratios of EMPs in plasma of the 16 patients from burn shock group were compared before and after fluid resuscitation.The numbers and ratios of EMPs in plasma were compared among groups.Sequential Organ Failure Assessment (SOFA) scores were used to assess the burn severity in patients at enrollment.The numbers and ratios of EMPs in plasma were compared between sepsis and non sepsis group.The correlations of SOFA with the numbers of EMPs and with the burn size were analyzed.Results Compared with control group,the numbers of CD31 +,CD51 +,CD144 +,CD54 +,and CD62E + EMPs were increased significantly in both burn shock group and infection group (P ＜0.05 or ＜0.01);the ratios of CD31 + EMPs,CD51 + EMPs,and CD54 + EMPs in plasma were significantly higher in burn shock group (P＜O.05 or ＜0.01);the ratios of CD31 + EMPs and CD54 + EMPs were significantly higher in infection group (P ＜ 0.05 or ＜ 0.01).The number of CD62E + EMPs,the ratios of CD144 + EMPs and CD62E + EMPs were higher in burn shock group than those in infection group (P ＜0.05 or ＜0.01).The ratio of CD31 + EMPs in plasma was significantly higher before resuscitation than that after resuscitation in burn shock period patients (8.8 ± 1.7 vs.5.2 ±0.9) (P ＜0.05).The ratios of CD31 + EMPs and CD54 + EMPs were significantly higher in sepsis group than those in non-sepsis group (8.0± 1.3 vs.4.5 ± 1.0;18.3 ± 2.2 vs.8.9 ± 1.4) (P ＜ 0.05 or ＜ 0.O1).The number of antigen-positive EMPs correlated significantly with SOFA score (P ＜0.05 or ＜0.01).The ratio of CD54 + EMPs correlated significantly with SOFA score (P ＜0.01).The number and the ratio of CD54 + EMPs as well as the ratio of CD144 + EMPs was correlated with bum size (P ＜ 0.05).SOFA score was positively correlated with the burn size (P ＜ 0.01).Conclusions Expressions of CD31,CD54,CD144,CD62E antigens EMPs might play a role in burn pathological damage and serve as an indicator of endothelium function change after bums.Expression of CD54 of EMPs plays a role in assessing the function and severity of burned organs.

Objective: To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic. Methods: Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope. Results: The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05). Conclusions Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.