OBJECTIVE: To review the latest research advancements in surgical techniques for the treatment of limb lymphedema. METHODS: The relevant literature at home and abroad in recent years was extensively reviewed, and the research on the treatment of limb lymphedema by surgical techniques were summarized and analyzed. RESULTS: Lymphovenous anastomosis has demonstrated good effectiveness for early to mid-stage limb lymphedema, however its long-term effectiveness and applicability for late-stage limb lymphedema still require further validation. Autologous lymphatic/venous grafting has shown clinical feasibility in the treatment of secondary limb lymphedema. Research on tissue-engineered lymphatic scaffolds remains insufficient, primarily due to the complexity of lymphatic anatomical structures and the technical challenges involved. Nevertheless, its potential application is promising. Vascularized lymph node flap transplantation has shown significant effectiveness in treating limb lymphedema, particularly yielding good outcomes in upper limb cases. However, it can not guarantee a complete cure for the condition. Charles' operation is the most effective treatment option for patients with late-stage limb lymphedema, but its extensive incision and severe postoperative complications limit its application. Liposuction has the advantages such as minimal invasiveness, high safety, and repeatability. It is suitable for patients with late-stage limb lymphedema who have failed conservative treatment or developed adiposity. However, its effectiveness is limited in patients with significant limb fibrosis. CONCLUSION Current treatments for limb lymphedema require further improvement, and there is considerable debate regarding treatment strategies for different stages of the condition. Future high-quality, multi-system combined treatment approaches are anticipated to guide clinical practice.
Humans ; Lymphedema/surgery* ; Surgical Flaps/blood supply* ; Lymphatic Vessels/surgery* ; Anastomosis, Surgical/methods* ; Lymph Nodes/transplantation* ; Lipectomy/methods* ; Extremities/surgery* ; Treatment Outcome ; Tissue Engineering ; Tissue Scaffolds ; Veins/transplantation*

Global public health faces substantial challenges from malignant tumors and infectious diseases. Vaccination provides an approach for treating and preventing these diseases. Oral vaccinations are particularly advantageous in disease treatment and prevention due to their non-invasive nature, high patient compliance, convenience, cost-effectiveness, and capacity to stimulate comprehensive and adaptive immune responses. However, the overwhelming majority of oral vaccines remain in experimental development, struggling with clinical and commercial translation due to their suboptimal efficacy. Thus, enhancing scientists' understanding of the interaction between vaccines and gastrointestinal immune system, creating antigen delivery systems suitable for the gut mucosal environment, developing more potent antigenic epitopes, and using personalized combination therapies are critical for advancing the next generation of oral vaccines. This article explores the fundamental principles and applications of current oral anti-tumor and anti-infective vaccines and discusses considerations necessary for designing future oral vaccines.

Background Unhealthy lifestyle behaviors may be associated with an increased risk of cardiometabolic risk factor aggregation (CMRF≥ 2), and few studies have focused on the correlation between the two in occupational populations. Objective To investigate the current status of CMRF≥2 and the compliance of healthy lifestyle in male occupational personnel, explore the effect of lifestyle on cardiometabolic risk, and provide reference for formulating healthy behavior promotion strategies and reducing cardiometabolic risk in occupational populations. Methods The study subjects were selected from male workers who completed occupational health examinations at an occupational disease prevention and control hospital in Shanxi Province from May to December 2023, and 15125 study subjects aged 18−60 years were finally included according to pre-determined inclusion and exclusion criteria. All subjects received a series of assessments including questionnaires (basic information, lifestyle habits, and occupational factors), physical examination, laboratory tests, and six cardiometabolic risk factors (central obesity, hypertension, type 2 diabetes, hypertriglyceridemia, low-density lipoprotein cholesterolemia, and hyperuricemia). A healthy lifestyle score was calculated based on six behavioral factors (smoking, drinking, physical activity, diet, sleep, sedentary behavior) and 1 point for one positive healthy behavior. The enrolled workers were then divided into three groups according to their total scores: 0−1 points (poor group), 2−3 points (moderate group), and 4−6 points (good group). Logistic regression models were used to analyze the statistical associations between lifestyle and CMRF≥2. Results The median age of the 15125 male study participants was 40 years, and the positive rate of CMRF≥2 was 53.5%. Adherence to moderate alcohol consumption was the most compliant healthy behavior (79.4%), followed by current non-smoking (41.7%), while adherence to adequate sedentary behavior (23.6%) and healthy eating (21.1%) were relatively low, and only 17.4% were able to adhere to four or more healthy lifestyle behaviors. After adjusting for confounders, when compared with the poor group high lifestyle score was found to be a protective factor for CMRF≥2 (moderate group: OR=0.70, 95%CI: 0.63, 0.77; good group: OR=0.66, 95%CI: 0.58, 0.75). In stratified analyses across different job types (coal miners, auxiliary workers, ground workers, and others), occupational stress (with or without), shift patterns (day shift, night shift, or rotating shift), dust exposure (with or without), and noise exposure (with or without), individuals with higher lifestyle scores exhibited a consistently lower risk of CMRF≥2. There was an interaction between shift pattern and lifestyle on CMRF≥2 (P_interaction<0.05). Conclusion This occupational group has a high positive rate of CMRF≥2 and a high prevalence of poor lifestyles with low adherence to some healthy behaviors. High healthy lifestyle scores are associated with a lower risk of aggregation of cardiometabolic risk factors, which may be reduced through lifestyle interventions.

Objective:To prepare histatin 1 (Hst 1) and D-histatin 1 (D-Hst 1) coatings on pure titanium surfaces and to evaluate their impact on the initial adhesion and spreading of mouse bone marrow mesenchymal stem cells (mBMSC).Methods:The test pieces were divided into four groups: pure titanium, piranha solution-treated, 3-aminopropyltriethoxysilane-treated, Hst 1 modified groups or D-Hst 1 modified groups, with five pieces in each group. The surface hydrophilicity of the test pieces was detected by contact angle measurement. The surface microtopography was observed using atomic force microscopy (AFM), and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy (XPS). The modification of Hst 1 on the titanium surface and the early adhesion and spreading of the third-generation normal mBMSC on Hst 1/D-Hst 1 modified group were observed using confocal laser scanning microscopy (CLSM).Results:The Hst 1 modified group had better surface hydrophilicity (contact angle 51.63°±3.80°) compared to the pure titanium group (contact angle 60.36°±4.38°). AFM observations revealed shallow mechanical scratches on the surfaces of all test pieces. CLSM and XPS elemental analysis confirmed the successful modification of Hst 1 on the titanium surface. Compared with the pure titanium group, both Hst 1 and D-Hst 1 could promoted the early adhesion of mBMSC. The Hst 1 modified group promoted the spreading of mBMSC after early adhesion, while the D-Hst 1 modified group showed no statistically significant difference in promoting mBMSC spreading compared to the pure titanium group ( P>0.05). Conclusions:The modification of Hst 1/D-Hst 1 on pure titanium surfaces using Schiff base reaction is effective. It is conducive to the early adhesion and spreading of mBMSC.

Objective To analyze in depth the job satisfaction and influencing factors of medical staff in tertiary public hospitals in Gansu Province,especially to explore the important factors affecting the survival and development of hospitals as core talents,in order to provide reference for promoting the stable development of medical staff in medical institutions in Gansu Prov-ince.Methods From July to October 2024,a random sampling method was used to select relevant personnel from tertiary public hospitals in Gansu Province for a questionnaire survey.Descriptive analysis were conducted on the collected data.Multivariate lo-gistic regression analysis was used to identify the main influencing factors of job satisfaction among medical staff.The difference is statistically significant with P＜0.05,and the test level is α=0.05.Results 1 890 questionnaires were distributed and 1 885 valid questionnaires were collected,with an effective rate of 99.74％.The overall job satisfaction score of medical staff in tertiary hospitals in Gansu Province is 3.06±0.86,which is at a moderate level.Hospitals can consider improving management models,establishing scientific,reasonable,and humane management systems,enhancing doctors'sense of belonging,and improving sat-isfaction;The satisfaction brought by salary to medical staff is higher than promotion opportunities and career development,indi-cating that a reasonable salary incentive system in hospitals,with excellent performance and compensation,can increase doctors'subjective well-being and improve satisfaction.Optimising the allocation of health human resources and appropriately in creasing personnel allocation based can help improve doctors'job satisfaction.Conclusion The overall job satisfaction of medical staff in tertiary hospitals in Gansu Province is generally satisfactory,and there are statistically significant differences in job satisfaction a-mong medical staff with different work experience,education level and monthly income(P＜0.05).When formulating policies and measures,the government pays attention to factors that affect the job satisfaction of medical personnel,optimizes the alloca-tion of health human resources,continuously improves incentive mechanisms,and improves hospital management models,enhan-cing the job satisfaction of medical staff and laying the foundation for promoting the developmrnt of provincial health talent team.

Objective:To prepare histatin 1 (Hst 1) and D-histatin 1 (D-Hst 1) coatings on pure titanium surfaces and to evaluate their impact on the initial adhesion and spreading of mouse bone marrow mesenchymal stem cells (mBMSC).Methods:The test pieces were divided into four groups: pure titanium, piranha solution-treated, 3-aminopropyltriethoxysilane-treated, Hst 1 modified groups or D-Hst 1 modified groups, with five pieces in each group. The surface hydrophilicity of the test pieces was detected by contact angle measurement. The surface microtopography was observed using atomic force microscopy (AFM), and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy (XPS). The modification of Hst 1 on the titanium surface and the early adhesion and spreading of the third-generation normal mBMSC on Hst 1/D-Hst 1 modified group were observed using confocal laser scanning microscopy (CLSM).Results:The Hst 1 modified group had better surface hydrophilicity (contact angle 51.63°±3.80°) compared to the pure titanium group (contact angle 60.36°±4.38°). AFM observations revealed shallow mechanical scratches on the surfaces of all test pieces. CLSM and XPS elemental analysis confirmed the successful modification of Hst 1 on the titanium surface. Compared with the pure titanium group, both Hst 1 and D-Hst 1 could promoted the early adhesion of mBMSC. The Hst 1 modified group promoted the spreading of mBMSC after early adhesion, while the D-Hst 1 modified group showed no statistically significant difference in promoting mBMSC spreading compared to the pure titanium group ( P>0.05). Conclusions:The modification of Hst 1/D-Hst 1 on pure titanium surfaces using Schiff base reaction is effective. It is conducive to the early adhesion and spreading of mBMSC.

Objective To analyze in depth the job satisfaction and influencing factors of medical staff in tertiary public hospitals in Gansu Province,especially to explore the important factors affecting the survival and development of hospitals as core talents,in order to provide reference for promoting the stable development of medical staff in medical institutions in Gansu Prov-ince.Methods From July to October 2024,a random sampling method was used to select relevant personnel from tertiary public hospitals in Gansu Province for a questionnaire survey.Descriptive analysis were conducted on the collected data.Multivariate lo-gistic regression analysis was used to identify the main influencing factors of job satisfaction among medical staff.The difference is statistically significant with P＜0.05,and the test level is α=0.05.Results 1 890 questionnaires were distributed and 1 885 valid questionnaires were collected,with an effective rate of 99.74％.The overall job satisfaction score of medical staff in tertiary hospitals in Gansu Province is 3.06±0.86,which is at a moderate level.Hospitals can consider improving management models,establishing scientific,reasonable,and humane management systems,enhancing doctors'sense of belonging,and improving sat-isfaction;The satisfaction brought by salary to medical staff is higher than promotion opportunities and career development,indi-cating that a reasonable salary incentive system in hospitals,with excellent performance and compensation,can increase doctors'subjective well-being and improve satisfaction.Optimising the allocation of health human resources and appropriately in creasing personnel allocation based can help improve doctors'job satisfaction.Conclusion The overall job satisfaction of medical staff in tertiary hospitals in Gansu Province is generally satisfactory,and there are statistically significant differences in job satisfaction a-mong medical staff with different work experience,education level and monthly income(P＜0.05).When formulating policies and measures,the government pays attention to factors that affect the job satisfaction of medical personnel,optimizes the alloca-tion of health human resources,continuously improves incentive mechanisms,and improves hospital management models,enhan-cing the job satisfaction of medical staff and laying the foundation for promoting the developmrnt of provincial health talent team.

Objective·To study the alterations in vestibular hair cell morphology and function of ATPase plasma membrane Ca2+transporting 2 oblivion(Atp2b2 Oblivion)heterozygous mice at different ages.Methods·Atp2b2 Oblivion heterozygous male mice aged 2 months and 8 months were selected with ten in each kind and C57BL/6J wild-type mice with the same gender,age and number were selected as the control group.Expression patterns of ATP2B2 in vestibular hair cells and numbers of hair cells in the striola zone and the extra striola zone in the two groups of mice at different ages were observed and calculated respectively through immunofluorescence assay.Hair bundle structures were detected by scanning electron microscopy(SEM),and mitochondria and ribbon synapse structures were observed by transmission electron microscopy(TEM).Vestibular evoked potential(VsEP),vestibular evoked myogenic potential(VEMP),rotarod rod test,and balance beam test were adopted for the evaluation of vestibular functions.Results·ATP2B2 was mainly expressed in the hair bundle of vestibular hair cells in the two groups of mice.Hair cell numbers in the striola zone and the extra-striola zone did not exhibit any differences between Atp2b2 Oblivion heterozygous mutant mice and wild-type mice of 2-month-old and 8-month-old.No visible structural abnormality in the hair bundle could be seen through SEM.TEM results implied no morphological abnormality in mitochondria or ribbon synapses in the 2-month-old heterozygous mutant mice,while vacuolar degeneration was discovered in the mitochondria under the cuticular plate in the 8-month-old heterozygous mutant mice with the normal ribbon synapses and the normal mitochondria near the innervation site.VsEP and VEMP thresholds of 2-month-old and 8-month-old Atp2b2 Oblivion heterozygous mutant mice were significantly elevated compared with the wild-type mice.Analysis of VsEP waveform manifested prolonged P1 latency and declined P1N1 amplitude in heterozygous mutant mice(P＜0.05).Results of rotarod rod test and balance beam test acquired from 2-month-old Atp2b2 Oblivion heterozygous mutant mice were not significantly different from the wild-type mice,while the ability of the mutant mice to accomplish the tests descended significantly at 8 months of age compared with the wild-type mice(P＜0.05).Conclusion·Atp2b2 Oblivion heterozygous mutant mice showed defective vestibular electrophysiological function at 2 months old,and abnormalities in vestibule-related behaviors can be detected at 8 months old.The vestibular function ofAtp2b2 Oblivion heterozygous mutant mice deteriorate progressively.

Objective:To investigate the application value of laparoscopic natural orifice specimen extraction surgery (NOSES) based on purse-string suture for sigmoid colon and upper rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 14 patients undergoing laparoscopic NOSES based on purse-string suture for sigmoid colon and upper rectal cancer in The First Affiliated Hospital of Sun Yat-sen University from October 2022 to June 2023 were collected. There were 8 males and 6 females, aged (56±10)years. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers. Results:(1) Surgical conditions. All patients underwent laparoscopic NOSES based on purse-string suture for sigmoid colon and upper rectal cancer successfully, without conversion to open surgery. The operation time of 14 patients was (162±32)minutes, and the volume of intraoperative blood loss was (22±12)mL. (2) Postoperative conditions. Time to postoperative first out-of-bed activity, time to postoperative first flatus, time to postoperative first drinking, time to postoperative initial liquid food intake, duration of postoperative hospital stay of 14 patients were (1.6±0.7)days, (2.1±0.6)days, (2.4±0.6)days, (3.8±1.0)days, (6.0±0.9)days, respectively. None of patient had perioperative complications such as postoperative anastomotic leakage and bleeding. (3) Follow-up. All 14 patients were followed up for (9.7±1.9)months. There was no postoperative recurrence, metastasis or death in 14 pati-ents.Conclusion:The laparoscopic NOSES based on purse-string suture can be used for sigmoid colon and upper rectal cancer, which is safe and feasible.

Objective:To study the differentially expressed genes (DEG) during the differentiation of human induced pluripotent stem cells (hiPSC) and human embryonic stem cells (hESC) into pericytes and endothelial cells, and to identify key molecules and signaling pathways that may regulate this differentiation process.Methods:hiPSC and hESC were selected and expanded using mTeSR medium. A "two-step method" was used to induce the differentiation of hiPSC and hESC into pericytes and endothelial cells. Pericytes were identified using immunofluorescence staining, while endothelial cells were isolated and identified using flow cytometry. Total RNA samples were extracted on days 0, 4, 7, and 10 of differentiation and consistently significant DEGs were screened. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signal pathway enrichment analysis were performed on the screened DEGs.Results:Both hiPSCs and hESCs successfully differentiated into pericytes and endothelial cells under induction conditions. Transcriptome sequencing results showed that with the extension of differentiation time, the DEGs in hiPSCs and hESCs were significantly upregulated or downregulated, following a generally consistent trend. During the differentiation process, marker genes for pericytes and endothelial cells were significantly upregulated. A total of 491 persistent DEGs were detected in both hiPSC and hESC, with 164 unique to hiPSCs and 335 to hESCs, while 8 DEGs were co-expressed in both cell lines. Among these, SLC30A3, LCK, TNFRSF8, PRDM14, and GLB1L3 showed sustained downregulation, whereas CLEC18C, CLEC18B, and F2RL2 exhibited sustained upregulation. GO enrichment analysis revealed that DEGs with sustained upregulation were primarily enriched in terms related to neurogenesis, differentiation, and developmental proteins, while DEGs with sustained downregulation were enriched in terms related to membrane structure and phospholipid metabolic processes. KEGG pathway analysis showed that upregulated genes were primarily enriched in cancer-related pathways, pluripotency regulatory pathways, the Wnt signaling pathway, and the Hippo signaling pathway, whereas downregulated genes were predominantly enriched in metabolism-related pathways. Conclusions:During the differentiation of hiPSC and hESC into pericytes and endothelial cells, 8 DEGs exhibit sustained specific expression changes. These changes may promote pericyte and endothelial cell differentiation by activating the Wnt and Hippo pathways, inhibiting metabolic pathways, releasing the maintenance of stem cell pluripotency, affecting the cell cycle, and inhibiting cell proliferation.