Objective:To investigate the efficacy of a decellularized extracellular matrix (dECM)-quaternized chitosan (QCS)-gelatin (Gel) composite scaffold loaded with growth factors in repairing diabetic foot wounds in a rat model.Methods:A dECM-QCS-Gel composite scaffold (referred to as GDQ scaffold) was fabricated using a 3D bioprinter. Forty 8-week-old male Sprague-Dawley (SD) rats were selected to establish a diabetic foot wound model with a diameter of approximately 1 cm. Based on the treatment methods for diabetic foot wounds, the rats were divided into five groups: Control group (no treatment), Exosome group (wound covered with exosome suspension), Exosome+GDQ group (wound covered with GDQ scaffold loaded with exosome suspension), GDQ group (wound covered with GDQ scaffold alone), and Growth factor+GDQ group (wound covered with GDQ scaffold loaded with recombinant human basic fibroblast growth factor suspension). The wound healing rate was measured. Histological analysis was performed by HE staining and Masson staining. ELISA kits were used to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-10 in wound tissues from each group. Protein expression levels of MIP-1 and MIP-2 genes were also assessed.Results:The wound healing rate of the growth factor+GDQ group on the 21st d was 94.89%±1.21%, which was higher than that of the exosome+GDQ group ( P<0.05). With increasing repair time, the expression levels of TNF-α, IL-1β and IL-6 in each group all decreased, while IL-10 increased in all groups ( P<0.05). Among them, the exosome+GDQ group (TNF-α: 46.54±1.26 pg/ml, IL-1β: 225.79±7.29 pg/ml, IL-6: 142.81±4.02 pg/ml and IL-10: 117.36±0.95 pg/ml, P<0.001) and the growth factor+GDQ group (TNF-α : 40.01±1.64 pg/ml, IL-1β: 209.15±2.98 pg/ml, IL-6: 138.50±2.61 pg/ml and IL-10: 127.66±1.23 pg/ml, P<0.05); The levels of TNF-α and IL-1β in the exosome+GDQ group were both lower than those in the exosome+GDQ group ( P<0.05), and IL-10 was higher than that in the exosome+GDQ group ( P<0.05). On the 7th d the control group showed the highest expression levels of MIP-1α and MIP-2. All other groups had lower levels, with the growth factor+GDQ group showing the lowest among them. On the 21st d, the inflammatory protein expression in the growth factor+GDQ group had further decreased and remained lower than in all other experimental groups. Conclusions:The GDQ composite scaffold, when combined with bioactive factors, can synergistically reduce inflammation in diabetic foot wounds and promote wound healing. The scaffold loaded with basic fibroblast growth factor demonstrated superior therapeutic efficacy compared to the scaffold loaded with exosomes.

BACKGROUND:With the increasing degree of population aging in China,the incidence of osteoporosis is rising annually.This growing demand for screening and diagnosis poses significant challenges to the healthcare system,increasing the time costs,financial burdens,and radiation exposure risks for patients.OBJECTIVE:To develop a novel interpretable prediction method based on traditional CT examination data and demographic data,aiming to reduce the number of patient examinations and enable multiple screenings from one examination.METHODS:A two-stage interpretable framework for osteoporosis prediction was designed.In the first stage,a human-computer collaborative method was used for annotating CT images,with an innovative vertebra 7-point CT value measurement technique.Patient's sex and age were used as key demographic features to enrich the model's input.In the second stage,the LightGBM model was enhanced by SHapley Additive exPlanations for quantitative analysis of feature importance,improving the interpretability of predictions and increasing clinical trust.Systematic experiments validated the effectiveness of the framework and the stability of the optimal feature set through the comparative analysis of different feature combinations with six machine learning models.To further assess the generalization ability of the model,the model was further tested on an external dataset.RESULTS AND CONCLUSION:The experiment compared six machine learning models suitable for medical applications,and the results showed that LightGBM model achieved an F1 score of 0.902 2 and an area under the curve of 0.938 7,outperforming the other models.In terms of interpretability,the clinical application credibility and operability of the model was increased by ranking and visualizing the contribution of input features to the results.Additionally,this study realized a prototype system,and testing results indicated that the system is user-friendly,capable of quickly processing data to provide prediction results,with visualized outcomes demonstrating good interpretability.This system effectively assists doctors in clinical decision-making and provides robust support for the screening and preliminary diagnosis of osteoporosis.

Objective:To investigate the efficacy of a decellularized extracellular matrix (dECM)-quaternized chitosan (QCS)-gelatin (Gel) composite scaffold loaded with growth factors in repairing diabetic foot wounds in a rat model.Methods:A dECM-QCS-Gel composite scaffold (referred to as GDQ scaffold) was fabricated using a 3D bioprinter. Forty 8-week-old male Sprague-Dawley (SD) rats were selected to establish a diabetic foot wound model with a diameter of approximately 1 cm. Based on the treatment methods for diabetic foot wounds, the rats were divided into five groups: Control group (no treatment), Exosome group (wound covered with exosome suspension), Exosome+GDQ group (wound covered with GDQ scaffold loaded with exosome suspension), GDQ group (wound covered with GDQ scaffold alone), and Growth factor+GDQ group (wound covered with GDQ scaffold loaded with recombinant human basic fibroblast growth factor suspension). The wound healing rate was measured. Histological analysis was performed by HE staining and Masson staining. ELISA kits were used to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-10 in wound tissues from each group. Protein expression levels of MIP-1 and MIP-2 genes were also assessed.Results:The wound healing rate of the growth factor+GDQ group on the 21st d was 94.89%±1.21%, which was higher than that of the exosome+GDQ group ( P<0.05). With increasing repair time, the expression levels of TNF-α, IL-1β and IL-6 in each group all decreased, while IL-10 increased in all groups ( P<0.05). Among them, the exosome+GDQ group (TNF-α: 46.54±1.26 pg/ml, IL-1β: 225.79±7.29 pg/ml, IL-6: 142.81±4.02 pg/ml and IL-10: 117.36±0.95 pg/ml, P<0.001) and the growth factor+GDQ group (TNF-α : 40.01±1.64 pg/ml, IL-1β: 209.15±2.98 pg/ml, IL-6: 138.50±2.61 pg/ml and IL-10: 127.66±1.23 pg/ml, P<0.05); The levels of TNF-α and IL-1β in the exosome+GDQ group were both lower than those in the exosome+GDQ group ( P<0.05), and IL-10 was higher than that in the exosome+GDQ group ( P<0.05). On the 7th d the control group showed the highest expression levels of MIP-1α and MIP-2. All other groups had lower levels, with the growth factor+GDQ group showing the lowest among them. On the 21st d, the inflammatory protein expression in the growth factor+GDQ group had further decreased and remained lower than in all other experimental groups. Conclusions:The GDQ composite scaffold, when combined with bioactive factors, can synergistically reduce inflammation in diabetic foot wounds and promote wound healing. The scaffold loaded with basic fibroblast growth factor demonstrated superior therapeutic efficacy compared to the scaffold loaded with exosomes.

BACKGROUND:With the increasing degree of population aging in China,the incidence of osteoporosis is rising annually.This growing demand for screening and diagnosis poses significant challenges to the healthcare system,increasing the time costs,financial burdens,and radiation exposure risks for patients.OBJECTIVE:To develop a novel interpretable prediction method based on traditional CT examination data and demographic data,aiming to reduce the number of patient examinations and enable multiple screenings from one examination.METHODS:A two-stage interpretable framework for osteoporosis prediction was designed.In the first stage,a human-computer collaborative method was used for annotating CT images,with an innovative vertebra 7-point CT value measurement technique.Patient's sex and age were used as key demographic features to enrich the model's input.In the second stage,the LightGBM model was enhanced by SHapley Additive exPlanations for quantitative analysis of feature importance,improving the interpretability of predictions and increasing clinical trust.Systematic experiments validated the effectiveness of the framework and the stability of the optimal feature set through the comparative analysis of different feature combinations with six machine learning models.To further assess the generalization ability of the model,the model was further tested on an external dataset.RESULTS AND CONCLUSION:The experiment compared six machine learning models suitable for medical applications,and the results showed that LightGBM model achieved an F1 score of 0.902 2 and an area under the curve of 0.938 7,outperforming the other models.In terms of interpretability,the clinical application credibility and operability of the model was increased by ranking and visualizing the contribution of input features to the results.Additionally,this study realized a prototype system,and testing results indicated that the system is user-friendly,capable of quickly processing data to provide prediction results,with visualized outcomes demonstrating good interpretability.This system effectively assists doctors in clinical decision-making and provides robust support for the screening and preliminary diagnosis of osteoporosis.

Objective:Exploring the clinical efficacy of using ultra-thin lobulated anterolateral thigh perforator flap(ALTPF) with retrograde separation of perforating vessels from the superficial and deep junction layer of the superficial fascia to repair large soft tissue defects in the foot.Methods:From August 2021 to November 2022, 8 patients (5 males and 3 females) were admitted to the Second Department of Hand and Foot Surgery, the Affiliated Central Hospital of Dalian University of Technology. The patients were 28 to 52 years old in age. The soft tissue defects were located in dorsal and plantar foot. At the plantar foot, the wound involved the weight-bearing area with explosion of bone, tendon or internal fixtures. The area of soft tissue defects was 6.0 cm × 5.0 cm - 16.0 cm × 8.0 cm, and the sizes of ALTPF were 8.0 cm ×5.5 cm - 18.0 cm × 8.5 cm. Preoperative high frequency CUD combined with CTA angiography were employed to locate the 2 flap perforator vessels. By keeping the perforator vessels at center and according to the soft tissue defect area and the wound shape, an ALTPF with a proper size and shape was designed in anterolateral thigh. The perforator were separated in the boundary layer between superficial and deep fascia, where it helped to obviously thin the flap. After the flap was harvested, it was further lobulated between the 2 perforators into 2 lobes after having confirmed the effective blood supply. Finally the lobulated ALTPF was transferred to covered the defect in foot. Cautions should be taken to ensure that the flap covered the weight-bearing area of foot. All the donor sites were directly sutured. Postoperative follow-up was conducted to observe the survival of flaps and the functional recovery of the reconstructed site, also to evaluate the clinical effect. Postoperative follow-up included outpatient visits and reviews over WeChat or telephone. Recovery of the ankle motor function was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hind foot score scale.Results:All 8 ALTPF survived. Over 6 to 18 months (10.8 months in average) of follow-up, the transferred flaps had good blood supply, soft in texture, with good elasticity and thin in appearance. Appearance and function of donor sites recovered well, except 1 patient who had mild scar hyperplasia. The plantar flap had good abrasion resistance. No flap damage, bleeding or granulation tissue hyperplasia occurred when walking. The mean score of AOFAS ankle-hind foot score achieved 95.6.Conclusion:The application of ultra-thin lobulated ALTPF with retrograde separation of perforating vessels from the superficial fascia at the junction layer for repairing large soft tissue defects in the foot has good clinical efficacy.

Objective:To retrospectively analyze the treatment of 25 cases of lower necrotizing fasciitis.Methods:A total of 25 patients with lower limb necrotizing fasciitis (13 males and 12 females), with mean age 63 years old (48-75 years old) in Dalian Municipal Central Hospital from September 2016 to December 2020. After admission, the patient′s general physical condition was strictly evaluated, the relevant preoperative examination was improved, and the necrotizing fasciitis laboratory risk index (LRINEC) score was performed. In the absence of surgical contraindication, multiple debridement was performed, leaving the necrotic tissue removed for general bacterial culture and drug sensitivity test in parallel. After debridement, eight patients showed a large area of skin necrosis, and amputation was selected. The other 17 patients chose limb protection treatment after debridement, and adopted debridement and free skin grafting. After surgery, patients were encouraged to strengthen rehabilitation exercise to restore limb function to the maximum extent.Results:With followed up 0.6 to 3.0 years, with an average of 1.8 years. Methods include outpatient return visit, WeChat contact or telephone inquiry. The skin survived in 17 patients with mean healing time (27.5 ± 6.9) d. Eighteen patients were multiple bacterial infections and seven patients were single bacterial infections. All patients had no joint dysfunction caused by scar contracture, and reinfection in the skin grafting area.Conclusions:Necrotizing fasciitis requires early diagnosis and early treatment, with correct choice of treatment method is closely related to the patient′s prognosis.

Objective: To investigate the efficacy of modified Quyuan decoction in the treatment of Children upper airway cough symptom complex with syndrome of phlegm and heat accumulated in lung. Methods: Eighty-two Children with upper airway cough symptom complex who met the inclusion criteria were randomly divided into 2 groups with 41 in each group. In the control group, monteluster sodium chewing tablets were taken orally and budesonide suspension was inhaled. The observation group took modified Quyuan decoction on the basis of the control group. Both groups were treated continuously for 2 weeks and followed up for 6 months. The levels of interleukin (IL)-8 and IL-13 were detected by double-antibody-sandwich ELISA, and the symptoms and signs were scored before and after treatment, as well as the symptoms of phlegm, heat and stagnation of lung, cough and pharynx. The efficacy was evaluated and recurrence rate was recorded. Results: The total effective rate 95.12% (39/41) in the observation group was obviously higher than 75.61% (31/41) in the control group (χ²=4.783, P=0.029). After treatment, the serum level of IL-8 (51.61 ± 5.94 ng/L vs. 71.25 ± 7.99 ng/L, t=12.631) and IL-13 (27.62 ± 3.20 ng/L vs. 34.91 ± 4.01 ng/L, t=9.099) in the observation group were significantly lower than those in the control group (P<0.01). After treatment, the scores of cough, nasal obstruction, runny nose, nasal itching, expectoration, sneezing, secretion of posterior pharyngeal wall and pharyngeal mucosa in the observation group were all significantly lower than those in the control group (t values were 7.762, 6.831, 6.217, 6.944, 6.408, 6.212, 7.268, 7.109, all Ps<0.01). The scores of cough, expectoration, blood in sputum, chest pain, dry mouth and fever were significantly lower than those of the control group (t values were 9.439, 6.831, 6.982, 10.115, 12.031 and 10.443, all Ps<0.01). Scores of daytime and nighttime cough symptoms were significantly lower than those of the control group (t values were 7.012, 7.241, respectively, all Ps<0.01). The scores of pharyngeal pain, pharyngeal dryness and pharyngeal foreign body sensation were significantly lower than those of the control group (t values were 6.003, 6.106, 6.318, respectively, all Ps<0.01). In the 6 months' follow-up observation, the recurrence rate was 17.7% (3/17) in the observation group and 53.9% (7/13) in the control group, and the difference between the two groups was statistically significant (χ²=4.344, P=0.037). Conclusions The modified Quyuan decoction combined with conventional western medicine can improve the symptoms and signs of upper airway cough symptom complex of children with syndrome of phlegm and heat accumulated in lung.

Objective:To establish an HPLC method with post-column derivation for the determination of aflatoxin B1 in edible vegetable oil. Methods:An advanced biotechnology-immunoaffinity column was used for the extraction of aflatoxin Bl from the samples, and an HPLC method with post-column derivation was applied to detect aflatoxin Bl in edible vegetable oil, and the results were com-pared with those of the national standard thin layer fluorescence method. Results:The linear range of aflatoxin Bl was 10. 2-51. 0 ng · ml-1(r=0. 9996), the average recovery was 87. 3%(RSD=0. 96%, n=6), and the detection limit was 1 μg · kg-1. Conclu-sion:The method is simple, rapid and sensitive, which can be used as a promoted conventional method for the detection of a large number of samples.

Objective To investigate the therapeutic mechanism of Dan Hong in a rat model of cervical spondylotic myelopathy (CSM).Methods Thirty Sprague-Dawley rats were divided into an experimental group (n=10),aCSM modelgroup (n=10),and acontrol group (n=10).The CSM model group received a Dan Hong injection,while the control and experimental groups received an injection of an equivalent volume of physiological saline.The motor function of the rats was assessed before administration and at 4 weeks after administration,at which time the rats were sacrificed.The expression of cytokines and bcl-2 was detected by ELISA and Westem blotting.Results Four weeks after treatment,the number of oblique plates in the experimental group increased.Additionally,the expression of cytokines (IL-6 and TNF-α) in the CSM model group was higher and the expression of bcl-2 was lower.Conclusion Dan Hong injection can reduce the inflammatory response and reduce cell apoptosis in CSM.

Objective To investigate the causes and remedial measures of the failure of continuous epidural for labor analgesia. Methods Nine hundred and fifty-two primiparas who received voluntary labor analgesia were selected. They received epidural block in the L2-3 interspace, and epidural catheter was inserted 4 cm into the epidural space. The method of labor analgesia was continuous intravenous injection combined with self controlled analgesia. The visual analogue score (VAS) >5 scores was analgesia failure. Withdrawing the epidural catheter 1 to 2 cm and replacement of the catheter or changing to subarachnoid space combined with epidural block was used to rescue the analgesia failure. The production process progress and satisfaction rate of postpartum 24 h were recorded. Results The analgesia failure was in 144 cases, and the analgesia failure rate was 15.1%(144/952), among which the epidural catheter was inserted into blood vessels in 47 cases, the epidural catheter was blocked by a blood clot in 13 cases, the epidural catheter bent in 9 cases, the unilateral block or partial block was in 31 cases, the epidural catheter migrated in 37 cases, the catheters left the epidural cavity in 5 cases, and dural puncture was in 2 cases. Eighty-seven cases were treated by withdrawing the epidural catheter 1 to 2 cm, 48 cases were treated by replacement of the catheter, and 9 cases were treated by changing to subarachnoid space combined with epidural block. The satisfaction rate of postpartum 24 h was 96.7%(921/952). Conclusions The failure of continuous epidural block for labor analgesia is higher. According to the different causes, the most of the failures could be rescued by withdrawing the epidural catheter 1 to 2 cm, replacement of the catheter or changing to subarachnoid space combined with epidural block.