Tophaceous wound represent a severe complication of end-stage gout, characterized by the deposition of monosodium urate (MSU) crystals leading to localized tissue ischemia, chronic inflammation, and non-healing ulcers. The pathological mechanism involves the formation of MSU crystals under persistent hyperuricemia, inflammatory encapsulation, and mechanical compression of the vascular system due to tophus enlarge-ment, ultimately resulting in chronic non-healing ulcers. This article consolidates current evidence to outline an integrated management strategy for such wounds, combining systemic metabolic control with localized interventions. Effective treatment depends on maintaining serum uric acid levels below 300 μmol/L through urate-lowering agents, including conventional drugs and novel urate transporter 1 inhibitors such as AR882, complemented by anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs and glucocorticoids to alleviate pain and reduce inflammation. Topical agents and advanced dressings are utilized to support healing and manage exudate. Debridement, which encompasses sharp, ultrasonic, and micro-techniques, is essential for removing necrotic tissue and MSU deposits, with efficacy assessed via local uric acid monitoring. Surgical reconstructions, including skin flap grafting and tendon or ligament reconstruction, are indicated for significant tissue loss or functional impairment. Long-term management emphasizes continuous metabolic control, personalized rehabilitation, and lifestyle modification. The comprehensive treatment of tophaceous wounds requires multidisciplinary collaboration to balance local repair and systemic regulation for improved prognosis. Future research directions include gene therapy to regulate purine metabolism and artificial intelligence-assisted personalized treatment plans, to achieve precision medicine for tophaceous wounds.
Humans ; Wound Healing ; Gout/therapy* ; Uric Acid/blood* ; Debridement

Objective To explore the efficacy of goal management training(GMT)on core symptoms and mental status in college students with attention deficit hyperactivity disorder(ADHD)inattentive type.Methods Delphi method was used to construct a GMT program for college students with inattentive ADHD.Then,totally 68 college students with inattentive ADHD were recruited through advertisements published by hospitals and universities(Second Affiliated Hospital of Army Medical University,and 3 universities in Chongqing from March to June 2024.The subjects were randomly divided into an intervention group(n=34)and a control group(n=34).The intervention group received GMT for 2 h,once a week,for 7 weeks,and the control group did not receive training for the time being.The 2 groups were evaluated within 1 week before and in 7 weeks after intervention by using Adult ADHD Self-Report Scale(ASRS),Dysregulation of Emotions Rating Scale(DERS),Generalized Anxiety Disorde-7(GAD-7),Patient Health Questionnaire-9(PHQ-9),Self-Compassion Scale(SCS),and Satisfaction with Life Scale(SWLS).Results ① The expert authority coefficient(Cr)of 2 rounds of expert consultation was 0.83,with a questionnaire recovery rate of 100%and 95%,respectively,the Kendall's coordination coefficient was 0.081(P<0.01)and 0.226(P<0.01),and the coefficient of variation was<0.3,indicating the results of the expert consultation were reliable.The constructed GMT program includes 1 first-level indicator,7 second-level indicators,and 20 third-level indicators.② After 7 weeks of GMT intervention,the interaction between the 2 groups and time showed that the experimental group obtained significant improvements than the control group in terms of inattention symptoms(Wald Chi-square=28.35,P<0.001),dysregulation of emotions(Wald Chi-square=23.81,P<0.001),anxiety(Wald Chi-square=22.79,P<0.001),depression(Wald Chi-square=20.52,P<0.001),self-compassion(Wald Chi-square=9.36,P<0.01),and life satisfaction(Wald Chi-square=3.97,P<0.05).Conclusion GMT intervention can significantly improve the core symptoms of college students with inattentive ADHD,reduce anxiety and depression levels,enhance their emotion regulation and self-compassion abilities,and improve their life satisfaction.

Objective To explore the effects of 1 800 MHz electromagnetic radiation(EMR)on cognitive function of 3xTg-AD and 57C mice,providing a theoretical basis for the potential impacts of electromagnetic radiation on the human body.Methods A total of 12 3xTg-AD transgenic mice and 12 wild-type C57 mice were selected as research subjects.The one-month-old mice were divided into four groups:RF WT,Control WT,RF AD,and Control AD,with 6 mice in each group.The 1 800 MHz EMR exposure experiments were conducted from 20:00 to 8:00 the next day for a duration of 5 months.After the exposure,a water maze test was conducted to evaluate the effects of EMR on spatial learning and memory abilities of 3xTg AD mice,along with measurements of body weight,brain weight,and calculation of the brain-to-body ratio.Finally,Western Blot technique was used to measure the levels of APP,NR1,and NR2A in hippocampal tissue to analyze effects of 1 800 MHz EMR on the cognitive function of 3xTg AD mice.Results Under 1 800 MHz EMR exposure,there were no statistically significant differences in Morris water maze spatial learning ability among the four groups(P>0.05).However,longer escape time,greater swimming distances,and more crossings of target quadrant were exhibited in the RF AD group compared to the other groups(P<0.05).Western Blot results showed that the APP protein levels in 3xTg AD mice was higher than those in C57 mice(P<0.05).The expression levels of NR1 protein in the WT group was higher than those in the AD group(P<0.05);in the AD group,the RF AD group had higher levels than the Control WT group(P<0.05),and the NR2A protein levels in the Control WT group were higher than in the other groups(P<0.05).Conclusion Prolonged exposure to 1 800 MHz EMR can affect the learning and cognitive function of both 3xTg AD and C57 mice.

In recent years, group psychological training has become one of the most important skills that must be mastered by psychological workers in colleges and universities. However, there are problems with its teaching models, such as unreasonable course content, insufficient autonomous practice, and the lack of teaching competency assessment. Based on the theory of modules of employable skills (MES), we have constructed the core modules of group psychological training on teaching course content and skills, and in accordance with the BOPPPS teaching model, we have achieved satisfying teaching effects though the teaching practice of "bridge-in-theory and discussion-teaching practice and supervision-effectiveness assessment and summarization", in which the trainees have made objective progress in theory application, scheme design, and skill practice, with a high degree of subjective self-satisfaction. According to the problems found in the teaching practice, we will further improve the model by optimizing the modules, innovating teaching implementation methods, refining competency assessment standards, and strengthen the overall integration with medical education in order to better meet the needs of the development of psychological service in colleges and universities.

Objective To investigate the value of multiparametric magnetic resonance imaging(MRI)texture analysis based on T2 weighted image(T2WI),diffusion weighted imaging(DWI),and dynamic contrast enhanced-MRI(DCE-MRI)in predicting the axillary lymph node status of small-sized invasive ductal carcinoma(IDC)of the breast.Methods A retrospective analysis was conducted on the medical records of 139 patients with newly diagnosed IDC,who were treated at Taizhou Central Hospital from January 2018 to June 2023.Based on the postoperative pathological results,the patients were divided into two groups:85 cases without axillary lymph node metastasis and 54 cases with axillary lymph node metastasis.All patients underwent preoperative MRI examination,including sequences such as T2WI,DWI,and DCE-MRI.After delineating the region of interest(ROI)on the slice with the largest tumor diameter in each sequence,texture analysis was performed using Firevoxel software,which yielded five major parameters,including mean,standard deviation,skewness,kurtosis,and entropy.Univariate analysis was employed to evaluate the effectiveness of each parameter in distinguishing the axillary lymph node status.Variables that showed significant results in the univariate analysis were then included in binary Logistic regression analysis to explore the relationship between these parameters and lymph node metastasis status.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated.Results Significant differences were observed between the two groups in the entropy and mean values of the ROI delineated on the DCE-MRI sequence,as well as the skewness of the T2WI(P<0.001).Among these texture parameters,the entropy of the DCE-MRI sequence showed the highest AUC value of 0.719 in the univariate analysis.Multivariate analysis of the selected parameters yielded an optimal diagnostic model,with an AUC of 0.769 in differentiating lymph node metastasis from non-metastasis.Conclusion Texture analysis of small-sized breast cancer based on multiparametric MRI can effectively predict the preoperative axillary lymph node status of breast cancer.

Objective:To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF).Methods:220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ2 test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results:There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P ?

Objective:To investigate the characteristics of anxiety and depression of postgraduates in military medical university under public health emergencies.Methods:By means of self-rating anxiety scale (SAS) and self-rating depression scale (SDS), 944 postgraduate students of a military medical university were investigated to analyze their characteristics of anxiety and depression. SPSS 25.0 was used to statistically analyze the collected data.Results:①The positive rates of anxiety and depression were respectively 8.03% and 8.25%. ②The positive rate of anxiety of male postgraduates was significantly higher than that of female postgraduates ( P=0.035). ③The positive rate of anxiety of serviceman students was significantly higher than that of civilian students ( P=0.022). ④There was no statistical difference in the positive rates of anxiety and depression among postgraduates in different areas ( P > 0.05). ⑤The levels of anxiety and depression of left-behind children were significantly higher than those of unleft-behind children ( P=0.000, P=0.018). ⑥The levels of anxiety and depression of postgraduate students were lower than those of undergraduate students ( P=0.000, P=0.002). Conclusion:Under the outbreak of public health emergencies, anxiety and depression occur in the postgraduates. To strengthen the mental health maintenance of postgraduates in military medical university during the outbreak, it is necessary to pay more attention on the mental health of military students, males and who were left-behind children before.

OBJECTIVES: There is less clinical data on multiple myeloma (MM) in China, and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma (NDMM) patients in Hunan Province during 1 year, to understand the real clinical features and treatment outcome for Hunan Province patients with MM, and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM. METHODS: The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31, 2019 were collected and analyzed, including baseline data, treatment regimens, duration of treatment, and adverse reactions. The clinical characteristics, treatment, and safety of patients were analyzed by SPSS 21.0. RESULTS: Among the 529 NDMM patients, the age was 33-90 (median 64) years and the male-female ratio was 1.38꞉1. The clinical features ranged from high to low were as follows: Bone pain (77.7%), anemia (66.8%), renal insufficiency (40.6%), hypercalcemia (15.1%). Typing: IgG 46.5%, IgA 24.6%, IgD 2.6%, IgM 0.8%, light chain 15.7%, double clone 3.0%, no secretion 0.6%, absence 6.2%. Staging: Durie-Salmon stage I, II, and III were 4.5%, 10.6%, 77.3%, respectively, and 40 cases (7.6%) missed this data. International Staging System (ISS) stage I, II, and III were 10.4%, 24.4%, and 47.6%, respectively, and 93 cases (17.6%) were missing. Revised International Staging System (R-ISS) stage I, II, and III were 5.5%, 27.0%, 23.1%, respectively, and 235 cases (44.4%) missed this data. Among the 98 NDMM patients in the Third Xiangya Hospital, Central South University, Durie-Salmon (DS) stage missing 2.0%, ISS stage missing 12.3%, and R-ISS stage missing 12.3%.Treatment: Among the 529 patients,475 received treatment, the rate of treatment was 89.8%; 67.4% of the patients were able to complete four courses of chemotherapy at induction phase, 90.3% of the patients received proteasome inhibitor based combination chemotherapy regimen more than once, 67.2% received immunomodulator based regimen more than once, and 59.8% of the patients received proteasome inhibitor and immunomodulator based combination chemotherapy regimen more than once. Curative: Overall response rate (ORR) and high quality response rate (HQR) of the 4-course group were better than those of the 2-course group (ORR: 85% vs 65%, P=0.006; HQR: 68.3% vs 24.0%, P<0.001). The HQR of the standard chemotherapy group was better than that of the non-standard chemotherapy group (65.1% vs 48.2%, P=0.035). Adverse reactions during treatment included hematologic toxicity (17.5%), peripheral neuropathy (24.8%), gastrointestinal adverse events (23.8%), pulmonary infection (25.9%), herpes zoster (4.6%), and venous thrombotic events (1.7%). CONCLUSIONS In 2019, the missed diagnosis rate of MM patients was high, the medium age of diagnosis was older, and the accuracy of patient diagnosis was not high. There is a great difference among medical centers, especially in the stage and risk stratified, nearly half of NDMM patients are not diagnosed with R-ISS stage; the lack of cytogenetic data needs to be supplemented by follow-up studies. A high proportion of patients with NDMM present with bone pain and anemia.Patients received treatment have higher use of chemotherapy regimens containing proteasome inhibitors and/or immunomodulators, but there is a significant gap among different medical centers, and standardized treatment needs to be strengthened. The safety during chemotherapy is controllable.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Female ; Humans ; Immunologic Factors/therapeutic use* ; Male ; Middle Aged ; Multiple Myeloma/therapy* ; Neoplasm Staging ; Pain ; Prognosis ; Proteasome Inhibitors/therapeutic use*

Objective:To explore the risk factors of surgical site infection after posterior lumbar interbody fusion and internal fixation in elderly patients with lumbar degenerative diseases.Methods:The clinical data of elderly patients who underwent posterior lumbar interbody fusion and internal fixation for degenerative diseases of lumbar spine in Department of Orthopedics, Shanxi Bethune Hospital from January 2019 to December 2021 were retrospectively analyzed.Eighteen elderly patients with postoperative incision infection were included into the infection group, and according to the ratio of 1∶3, 54 elderly patients without incision infection during the same period were randomly selected and included in the non-infection group.The general data of patients, surgical related data and perioperative laboratory indexes were compared between groups using univariate analysis.The screened out indicators with close correlation with incision infection and with significantly statistical significance were included in binary Logistic regression analysis.Risk factors related to postoperative incision infection were analyzed by receiver operating characteristic curve(ROC).The quantitative data of risk factors related to postoperative incision infection were selected for receiver operating characteristic curve(ROC)analysis.Results:When comparing the infected versus non-infected groups, the operative time was(197.1±39.5)min vs.(171.4±37.2)min, preoperative lymphoid count was(1.6±0.5)×10 9/L vs.(1.9±0.6)×10 9/L, and postoperative neutrophil count was[(7.2(6.2-9.5)×10 9/L vs.6.3(4.8-7.2)×10 9/L], percentage of neutrophils(82.5±8.8), % vs.(71.1±6.7), percentage of lymphocytes(1.1±0.6)×10 9/L vs.(1.7±0.7)×10 9/L, percentage of lymphocytes(11.0±5.6)% vs.(19.8±6.0)%, number of neutrophils vs.Lymphocyte count ratio(NLR)[8.5(5.2-15.0) vs.3.6(2.6-4.9)]and serum albumin concentration(31.4±2.5)g/L vs.(33.3±2.4)g/L, all P<0.05).Logistic regression analysis showed that diabetes mellitus( OR=6.649, 95% CI: 1.233-35.853), operation time( OR=1.025, 95% CI: 1.004-1.047), and percentage of postoperative neutrophils( OR=1.261, 95% CI: 1.125-1.414)were independent risk factors of incision infection after posterior interbody fusion and internal fixation in patients with lumbar degenerative diseases(all P<0.05).ROC analysis showed that the area under the curve of operation time was 0.680, and the cut-off value was 177.5 min.The area under the curve of the percentage of neutrophils after operation was 0.841, and the cut-off value was 78.85%. Conclusions:In patients with posterior interbody fusion and internal fixation for lumbar degenerative diseases complicated with diabetes, long operation time, and increased percentage of neutrophils after surgery can independently increase the risk of incision infection.

Objective:To explore the imaging features and clinical effect of accordion maneuver in promoting the bone healing at the docking site after tibial transport under ultrasonic monitoring.Methods:Retrospective analysis was conducted on the clinical data of 16 patients with tibial bone transport who were admitted to the Department of Orthopedics, the second Hospital of Shanxi Medical University from May 2018 to October 2019. All the patients were treated with accordion maneuver to promote bone healing at the docking site under ultrasound monitoring. There were 14 males and 2 females, aged (45.3±14.3) years (range: 6 to 61 years). Before tibial bone transport, the length of the tibial defect of 16 patients was (6.0±2.6) cm (range: 2.0 to 12.1 cm). The operation steps of accordion maneuver were as follows: pressurization for 2 weeks, suspension for 12 days, distraction for 2 weeks, retraction for 2 weeks, and then stop the operation to consolidate the bone mineralization. During accordion treatment, ultrasound was used to monitor the size of hematoma, Adler grade of blood flow signal and the changes of new callus in and around the docking site. X-ray was performed to monitor bone healing at the docking site. Pearson correlation coefficient was used to analyze the correlation between the size of hematoma, the resistance index of blood flow signal and the bone healing time of the docking site. Paley healing criterion was used to evaluate the bone healing and functional recovery of the patients.Results:During accordion maneuver, ultrasound examination showed that the Adler grade of blood flow signals around the docking site increased gradually before retraction and then decreased gradually, but the degree of callus mineralization continued to increase gradually. After 2 weeks of pressure on the docking site, hematoma was observed in 14 patients by ultrasound examination. X-ray showed that all docking sites had bony healing, with the healing time of (30.8±4.9) weeks (range: 23 to 40 weeks).The size of the hematoma was negatively correlated with the healing time of the docking site ( r=-0.819, P<0.01). No hematoma was found in 2 patients, and after continuous observation for 20 weeks, there was still no obvious callus connection at the docking site. After bone cortical removal, ultrasound examination showed hematoma formed at the docking site. Accordion maneuver was continued, and the docking site healed at 30 and 32 weeks after surgery, respectively. There was a negative linear correlation between hematoma size at 2 weeks of compression and the blood flow resistance index at 2 weeks of retraction in 16 patients ( r=-0.801, P<0.01). The patients were followed-up for (14.5±3.2) months (range: 10.6 to 20.2 months). At the last follow-up, 12 patients were evaluated as excellent and 4 were evaluated as good by Paley healing criteria. Conclusion:The distraction and compression stress applied in accordion maneuver can promote bone healing at the docking site, and ultrasound can monitor early signs of bone healing at the docking site to help determine the tendency of bone healing.