Objective Explored the clinical efficacy and mechanism of improved CO2 fractional laser on treatment for refractory wounds.Methods A total of 122 patients with refractory wounds who were admitted to the hospital from May 2022 to May 2024 were selected and randomly divided into a conventional group(conventional dressing change treatment+photodynamic therapy+conventional CO2 fractional laser treatment)and an improved group(conventional dressing change treatment+photodynamic therapy+improved CO2 fractional laser treatment)by lottery,with 61 cases in each group.The serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)levels,the number of wound bacteria before treatment and after 1,2,and 3 weeks of treatment were compared between the two groups.The wound healing rates after 1,2,and 3 weeks of treatment were compared between the two groups.The clinical efficacy of the two groups was compared.The levels of wound exudate basic fibroblast growth factor(bFGF)and angiopoietin-1(Ang-1)before treatment and after 1,2,and 3 weeks of treat-ment were compared.The adverse reactions of the two groups were compared.Results Repeated measures analy-sis of variance showed that there were an interaction effect between groups and over time in the serum CRP and ESR levels,the number of wound bacteria in both groups(P<0.05).There were no significant differences in the serum CRP and ESR levels and the number of wound bacteria between the two groups before treatment(P>0.05).The serum CRP and ESR levels and the number of wound bacteria in the improved group were lower than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the wound healing rates of both groups(P<0.05).The wound healing rates in the improved group were higher than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).The total clinical effective rate of the improved group was higher than that of the conventional group(P<0.05).Repeated measures analysis of variance showed that there was an inter-action effect between groups and over time in the levels of bFGF and Ang-1 in wound exudates of both groups(P<0.05).There was no significant difference in the levels of bFGF and Ang-1 in wound exudates between the two groups before treatment(P>0.05).The levels of bFGF and Ang-1 in wound exudates in the improved group were higher than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).There were no signifi-cant differences in the incidence of pain,pruritus and rash between the two groups(P>0.05).Conclusions In the treatment of refractory wounds,the combination of improved CO2 fractional laser and photodynamic therapy could promote the secretion of wound exudate growth factors,inhibit wound bacterial growth and inflammatory response,accelerate wound healing,and improve clinical efficacy,with high safety.The mechanism of action is related to the promotion of wound exudate growth factor secretion.

Objective:To investigate the distribution characteristics of CTLA-4 on the surface of CD4+T cells in patients with breast cancer at different stages,and to evaluate its predictive value for the efficacy of radical mastectomy.Methods:A retrospective study was conducted on 200 breast cancer patients admitted between January 2020 and December 2022.Patients were divided into four groups based on clinical staging:stage Ⅰ(64 cases),stage Ⅱ(57 cases),stage Ⅲ(43 cases),and stage Ⅳ(36 cases).The clinical pathological characteristics of the four groups were compared,and the expression level of CTLA-4 on the surface of CD4+T cells in peripheral venous blood(CTLA-4+CD4+)was detected.Patients were divided into a poor prognosis group(52 cases)and a good prognosis group(148 cases)based on their prognosis,and the clinical pathological characteristics of the two groups were compared.A stratified regression model was used to analyze the relationship between CTLA-4+CD4+expression levels and different clinical characteristics.Logistic regression analysis was employed to evaluate the independent correlation between CTLA-4+CD4+expression levels and the risk of poor prognosis.An unconditional logistic regression model was used to analyze the multiplicative interaction effect of CTLA-4+CD4+expression levels and clinical staging on prognosis prediction.Restricted cubic spline analysis was used to investigate the relationship between CTLA-4+CD4+expression levels and poor patient prognosis.Results:Significant differences were observed in tumor diameter,ECOG score,lesion multiplicity,lymph node metastasis,tumor differentiation degree,ER,PR,HER2,Ki-67,CA125,CA153,and CEA among patients with different clinical stages(P<0.05).Significant differences were also observed in CD3+,CD4+,CD8+,and CTLA-4+CD4+(P<0.05).As the clinical stage increased,the proportions of CD3+,CD4+,and CD8+decreased,while the proportion of CTLA-4 on the surface of CD4+T cells increased(P<0.05).Significant differences were observed in clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,ER,PR,HER2,and CTLA-4+CD4+among patients with different prognosis groups(P<0.05).Hierarchical regression analysis indicated that clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,and HER2 had a significant positive impact on CTLA-4+CD4+(P<0.05),while ER and PR had a significant negative impact on CTLA-4+CD4+(P<0.05).Logistic regression analysis showed that CTLA-4+CD4+was positively correlated with poor prognosis(P<0.05).CTLA-4+CD4+and clinical stage had multiplicative and additive interactions on prognosis.Regardless of the clinical stage,CTLA-4+CD4+on the surface of CD4+T cells was significantly positively correlated with poor prognosis.Conclusion:The expression level of CTLA-4+CD4+in patients with advanced breast cancer is significantly elevated,playing a crucial role in the clinical pathological characteristics of breast cancer.An elevated level may indicate a poor prognosis.

Obejective Based on the Citespace software,this study aims to comb the research hotspots and core contents of the development process of the TMD field in China,and carefully understand the research evolution process of the Temporo-mandibular Disorders(TMD)related fields in China,clarify its development timeline.Methods Using CNKI as the database source,through CiteSpace 6.1R6,we completed keyword co-occurrence,keyword clustering and emergence,and timeline knowledge mapping,and conducted a retrospective analysis of TMD-related literature published in China.Results A total of 2,034 domestic articles related to TMD were counted,and the development characteristics were obtained through data analysis:the treatment methods of TMD had evolved from combining traditional Chinese and Western medicine to Western medicine taking the dominant position,the research population had evolved from special populations to the general population,the focus had shifted from TMD itself to TMD-related and concurrent diseases,and the scope of research had continued to expand.Conclusions The development of literature on TMD disease has gone through three different periods,and there has been a significant shift in the research hotspots of TMD in China.The popularization rate of disease knowledge in TMD is not high,and further education needs to be provided to the general public.

Objective Explored the clinical efficacy and mechanism of improved CO2 fractional laser on treatment for refractory wounds.Methods A total of 122 patients with refractory wounds who were admitted to the hospital from May 2022 to May 2024 were selected and randomly divided into a conventional group(conventional dressing change treatment+photodynamic therapy+conventional CO2 fractional laser treatment)and an improved group(conventional dressing change treatment+photodynamic therapy+improved CO2 fractional laser treatment)by lottery,with 61 cases in each group.The serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)levels,the number of wound bacteria before treatment and after 1,2,and 3 weeks of treatment were compared between the two groups.The wound healing rates after 1,2,and 3 weeks of treatment were compared between the two groups.The clinical efficacy of the two groups was compared.The levels of wound exudate basic fibroblast growth factor(bFGF)and angiopoietin-1(Ang-1)before treatment and after 1,2,and 3 weeks of treat-ment were compared.The adverse reactions of the two groups were compared.Results Repeated measures analy-sis of variance showed that there were an interaction effect between groups and over time in the serum CRP and ESR levels,the number of wound bacteria in both groups(P<0.05).There were no significant differences in the serum CRP and ESR levels and the number of wound bacteria between the two groups before treatment(P>0.05).The serum CRP and ESR levels and the number of wound bacteria in the improved group were lower than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the wound healing rates of both groups(P<0.05).The wound healing rates in the improved group were higher than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).The total clinical effective rate of the improved group was higher than that of the conventional group(P<0.05).Repeated measures analysis of variance showed that there was an inter-action effect between groups and over time in the levels of bFGF and Ang-1 in wound exudates of both groups(P<0.05).There was no significant difference in the levels of bFGF and Ang-1 in wound exudates between the two groups before treatment(P>0.05).The levels of bFGF and Ang-1 in wound exudates in the improved group were higher than those in the conventional group after 1,2,and 3 weeks of treatment(P<0.05).There were no signifi-cant differences in the incidence of pain,pruritus and rash between the two groups(P>0.05).Conclusions In the treatment of refractory wounds,the combination of improved CO2 fractional laser and photodynamic therapy could promote the secretion of wound exudate growth factors,inhibit wound bacterial growth and inflammatory response,accelerate wound healing,and improve clinical efficacy,with high safety.The mechanism of action is related to the promotion of wound exudate growth factor secretion.

Objective:To investigate the distribution characteristics of CTLA-4 on the surface of CD4+T cells in patients with breast cancer at different stages,and to evaluate its predictive value for the efficacy of radical mastectomy.Methods:A retrospective study was conducted on 200 breast cancer patients admitted between January 2020 and December 2022.Patients were divided into four groups based on clinical staging:stage Ⅰ(64 cases),stage Ⅱ(57 cases),stage Ⅲ(43 cases),and stage Ⅳ(36 cases).The clinical pathological characteristics of the four groups were compared,and the expression level of CTLA-4 on the surface of CD4+T cells in peripheral venous blood(CTLA-4+CD4+)was detected.Patients were divided into a poor prognosis group(52 cases)and a good prognosis group(148 cases)based on their prognosis,and the clinical pathological characteristics of the two groups were compared.A stratified regression model was used to analyze the relationship between CTLA-4+CD4+expression levels and different clinical characteristics.Logistic regression analysis was employed to evaluate the independent correlation between CTLA-4+CD4+expression levels and the risk of poor prognosis.An unconditional logistic regression model was used to analyze the multiplicative interaction effect of CTLA-4+CD4+expression levels and clinical staging on prognosis prediction.Restricted cubic spline analysis was used to investigate the relationship between CTLA-4+CD4+expression levels and poor patient prognosis.Results:Significant differences were observed in tumor diameter,ECOG score,lesion multiplicity,lymph node metastasis,tumor differentiation degree,ER,PR,HER2,Ki-67,CA125,CA153,and CEA among patients with different clinical stages(P<0.05).Significant differences were also observed in CD3+,CD4+,CD8+,and CTLA-4+CD4+(P<0.05).As the clinical stage increased,the proportions of CD3+,CD4+,and CD8+decreased,while the proportion of CTLA-4 on the surface of CD4+T cells increased(P<0.05).Significant differences were observed in clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,ER,PR,HER2,and CTLA-4+CD4+among patients with different prognosis groups(P<0.05).Hierarchical regression analysis indicated that clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,and HER2 had a significant positive impact on CTLA-4+CD4+(P<0.05),while ER and PR had a significant negative impact on CTLA-4+CD4+(P<0.05).Logistic regression analysis showed that CTLA-4+CD4+was positively correlated with poor prognosis(P<0.05).CTLA-4+CD4+and clinical stage had multiplicative and additive interactions on prognosis.Regardless of the clinical stage,CTLA-4+CD4+on the surface of CD4+T cells was significantly positively correlated with poor prognosis.Conclusion:The expression level of CTLA-4+CD4+in patients with advanced breast cancer is significantly elevated,playing a crucial role in the clinical pathological characteristics of breast cancer.An elevated level may indicate a poor prognosis.

Objective:To study the correlation between spontaneous cerebrospinal fluid rhinorrhea and increased intracranial pressure.Methods:Clinical data of patients with spontaneous cerebrospinal fluid rhinorrhea treated in the Department of Otorhinolaryngology of the Provincial Hospital of Shandong First Medical University from January 2019 to December 2023 and their epidemiology, clinical symptoms and signs, preoperative cerebrospinal fluid pressure, imaging data, leakage site, repair method and the presence or absebce of increased intracranial pressure were analysed. SPSS 23.0 software was used for statistical analysis.Results:Of the 57 patients with cerebrospinal fluid nasolacrimal leakage, 84.2%(48/57) were females and 15.8%(9/57) were males; 80.7%(46/57) were between 40 and 60 years old; and overweight and obese patients accounted for 75.4%(43/57). Of 57 patients, 35 patients received cranial MRI+magnetic resonance venography, and among them, 12(34.3%) patients were clinically with headache symptoms; the incidences of empty pterygoid and venous sinus stenosis were 40.0%(14/35) and 51.4%(18/35), respectively; and 33 patients underwent preoperative lumbar puncture examination, of whom 25(75.8%) patients had the increased cerebrospinal fluid pressure and 1 patient had idiopathic intracranial hypertension. All 57 patients underwent dural repair of the skull base, the postoperative follow-up period ranged from 3 to 60 months, and the success rate of surgery was 94.7%. The success rate was 100% in female patients and 33.3%(3/9) in male patients, including one with surgical failure receiving reoperation and two with postoperative recurrence in other areas of the skull base, with significant difference in the success rate of surgery between males and females (χ 2=16.890, P<0.001). Conclusions:Most patients with spontaneous cerebrospinal fluid rhinorrhea have the increased cerebrospinal fluid pressures, but very few fulfil the diagnosis of idiopathic intracranial hypertension. The success rate of surgical repair alone is high, but some recurrences still exist, especially in male patients.

Objective: To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection. Methods: Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method. Results: Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33). Conclusion Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient′s life.

Gastrointestinal Microbiome ; Gastrointestinal Tract ; microbiology ; Humans ; Hypersensitivity ; microbiology

Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.