Objective:To explore the clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers (DFUs) under a multi-disciplinary team (MDT) cooperation model.Methods:The study was a retrospective observational study. From June 2018 to December 2022, 49 DFU patients who met the inclusion criteria were admitted to the Department of Hand and Foot Microscopy and Wound Repair Surgery of Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), including 28 males and 21 females, aged from 47 to 68 years, with type 2 diabetes history period ranging from 6 months to 21 years. Under a MDT cooperation model, the physicians from department of endocrinology comprehensively assessed the patients, stabilized the patients' general condition, and controlled their complications, the surgeons from department of vascular surgery assessed and improved the patients' lower limb blood supply, the physicians from department of infectious diseases provided anti-infection treatment plans, the physicians from department of anesthesiology and perioperative medicine assessed the patients' perioperative risk and ensured their perioperative safety, and according to the patients' condition, the physicians from departments such as cardiology, neurology, nutrition, and rehabilitation actively and timely participated in the treatment. The surgeons from department of hand and foot microscopy and wound repair surgery prepared the wound base and used free anterolateral thigh perforator flaps to repair the wounds. After once or multiple debridement in the first stage, the wound area ranged from 5.0 cm×4.5 cm to 17.0 cm×10.0 cm. After once or twice vacuum sealing drainage treatment, the free anterolateral thigh perforator flaps were used to repair the wounds with incision area of 6 cm×5 cm to 18 cm×11 cm in the second stage. The descending branches of lateral circumflex femoral artery and the accompanying veins of flaps were anastomosed to the arteries and veins in the recipient sites, respectively. The wounds in the flap donor sites were sutured directly. After surgery, whether the patient's perioperative period was stable, the survival of flaps, the healing of wounds in the flap donor and recipient sites were observed. During the follow-up, the texture and appearance of flaps, whether there was a new ulcer, and the patient's walking ability were observed.Results:All the patients had stable perioperative period. Among them, the flaps in 46 patients survived successfully; the flaps in 2 patients developed complete necrosis, including 1 case whose ulcer was healed after repair of pedicled flap from the lower leg, and 1 case who underwent amputation of the lower leg; the flap in 1 patient developed partial necrosis, which was healed after dressing change and skin grafting. The wounds in the flap donor and recipient sites healed well. During the postoperative follow-up of 6-24 months, the flaps had good texture and appearance with no new ulcers, and the patients had no obvious impairment in daily walk.Conclusions:The MDT cooperation model can sufficiently ensure the perioperative safety of DFU patients. The free anterolateral thigh perforator flaps can repair the DFU wounds achieving good clinical effects with high flap survival rate and decreased amputation rate.

Objective To develop and evaluate the equivalence of the Mandarin test material for tracking of noise tolerance(TNT)test.Methods Six different speech materials were developed(themes including daily life,entertainment,family,festivals,outdoors,and school).Four-minute TNT tests were measured in 21 normal hear-ing subjects using six different test materials.For each session,the tolerable noise level(TNL)and TNT scores were acquired and calculated for 3 time windows(31～240 s,31～120 s,151～240 s).Results Statistic analysis showed significant differences in the TNL(F=43.611,P＜0.05)among the normal hearing listeners.There were statistically significant differences in standardize z-scored TNT scores of the six different materials in the three time windows(P＜0.05).Post-hoc comparisons revealed that all significant differences involved the family and daily life themes.Conclusion Entertainment,festival,outdoors and school themed test materials can serve as the materials of Mandarin tracking of noise tolerance test and can be appied in research and clinical testing.

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Objective:To evaluate the feasibility of coronary artery calcium (CAC) detection, quantification and risk classification using ultra-low-dose chest CT (ULD-CT) combined with a calcium-aware algorithm.Methods:A total of 115 patients were prospectively enrolled from April to October 2022 at Zhejiang Provincial People′s Hospital, who underwent a standard calcium scoring CT (CACS-CT) scan followed by an additional ULD-CT scan. CACS-CT adopted a prospective ECG-triggered sequence scan with a tube voltage of 120 kVp, and the reconstruction algorithm with Qr36 (group CACS-CT Qr). ULD-CT adopted non-ECG-triggered high-pitch scan with a tube voltage of Sn 100 kVp, and the standard algorithm Qr36 (group ULD-CT Qr) and calcium-aware algorithm Sa36 (group ULD-CT Sa) were respectively used to reconstruct two groups of images. Taking the CAC detection of CACS-CT as a reference, the accuracy of ULD-CT for detecting CAC was calculated, and kappa was used to evaluate the agreement of CAC detection between scanning protocols. The agreement of CACS quantification between scanning protocols was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots, and the agreement of risk classification between scanning protocols was assessed using weighted kappa. Results:The CAC was found in 66.96% (77/115) of patients in CACS-CT Qr. Taking the CAC detection in CACS-CT Qr as a reference, the sensitivity of CAC detection in ULD-CT Qr and ULD-CT Sa was 96.1% and 97.4%, respectively, and the specificity was 94.73% (k= 0.902, 0.921). The CACS for ULD-CT Qr and ULD-CT Sa was lower than that for CACS-CT Qr (3.6, 6.2 vs. 8.5; P< 0.001), but strongly correlated with CACS for CACS-CT Qr ( r= 0.983, P< 0.001). The mean difference in CACS for ULD-CT Sa and CACS-CT Qr was smaller (12.33), and the agreement was better (ICC= 0.992). The agreement of risk classifications between ULD-CT Sa and CACS-CT Qr was relatively high (weighted k= 0.936), and the reclassification rate (6.08%) was relatively low. The effective radiation dose for ULD-CT was reduced by approximately 77.22% compared with that for CACS-CT. Conclusions:It is feasible to evaluate CACS using Non-ECG-triggered ULD-CT combined with a calcium-aware algorithm.

Objective:To investigate the effects of circ_000543 derived from hypoxic exosomes on proliferation and invasion of breast cancer (BC) cells.Methods:Bioinformatic website was used to predict the abnormal expression of circ_000543 in BC tissue and the transcription factor that might regulate circ_000543. Double luciferase report experiment and ChIP assay were used to confirm the regulation relationship between YY1 and circ_000543. Exosomes were separated from normal BC cells and BC cells under hypoxic condition, and qRT-PCR was adopted to detect the expression of circ_000543 in exosomes. The expression of circ_000543 and YY1 in exosomes was intervened and the exosomes were cocultured with BC cells under normoxia. CCK8 and Transwell assay was used to detect the proliferation and invasive ability individually.Results:qRT-PCR experiment found that, compared with MCF-10A cells (1±0.11) and exosomes isolated from normoxic cells (1±0.10), circ_000543 expression was up-regulated in BC cells (1.59±0.13) and exosomes derived from cells under hypoxic condition (1.63±0.12) ( t=6.001, P=0.004; t=6.986, P=0.002). Exosomes derived from cells under hypoxic condition promoted proliferation and invasion of BC cells under normoxia. Inhibition of circ_000543 partially offset the effects of exosomes. YY1 induced the expression of circ_000543 in BC cells as a transcription factor. The expression of circ_000543 was inhibited when YY1 expression was down-regulated; at the same time, down-regulation of YY1 inhibited the effects of exosomes on proliferation and invasion of BC cells. Conclusion:The transcription factor YY1 promoted proliferation and invasion of BC cells by inducing hypoxic breast cancer-derived exosomal circ_000543.

Objective:To investigate the effect of methyltransferase like 14 (METTL14) on the proliferation and invasion of breast cancer (BC) cells by regulating cyclin L2 (Cyclin L2, CCNL2) through m6A modification.Methods:Cancer tissues and paracancerous tissues of BC patients in Yantaishan hospital were collected from Aug. 2018 to Feb. 2020. The expression levels of m6A, METTL14 and CCNL2 in tissues were detected by high performance liquid chromatography/mass spectrometry (HPLC/MS) and qRT-PCR. Dual-luciferase reporter assay, qRT-PCR, and western blot were used to verify the regulatory relationship between METTL14 and CCNL2. RIP experiments verified the regulatory relationship between YTH domain-containing family protein (YTHDF2) and CCNL2. Cell viability was detected by MTT method, and cell invasion ability was detected by Transwell.Results:Compared with normal cells (0.24±0.02) and tissues (0.18±0.02) , BC cells MCF-10A (0.47±0.03, t=11.05, P<0.001) and HS-578T (0.41±0.03, t=8.17, P=0.001) and BC tissues (0.39±0.02, t=12.86, P<0.001) m6A level increased. Compared with normal tissues (1.00±0.26) (0.84±0.07) , METTL14 mRNA (1.57±0.28, t=13.50, P<0.001) and protein levels (1.66±0.11, t=10.89, P<0.001) in BC tissues were significantly increased high. Compared with the control group (100.00±10.11) (1.00±0.12) , the BC cell invasion ability (54.15±6.21, t=6.69, P=0.003) and activity (0.64±0.06, t=4.65, P=0.010) were weakened. Compared with the control group (100±11.05) (1±0.13) , the BC cell invasion ability (175.31±13.45, t=7.49, P=0.002) and activity (2.16±0.16, t=9.75, P=0.002) in the METTL14 overexpression group were enhanced, and the effects of METTL14 on cell invasion (137.41±12.64, t=3.56, P=0.024) and activity (1.64±0.15, t=5.59, P=0.005) were partially reversed after m6A inhibitor treatment change. Compared with normal tissues, CCNL2 expression was down-regulated in BC tissues, and the interaction between CCNL2 and METTL14 was confirmed. Compared with the control group (1.00±0.1) (0.64±0.05) , knockdown of METTL14 could make CCNL2 mRNA (1.67±0.05) . 0.13, t=7.08, P=0.002) and protein (1.09±0.09, t=7.57, P=0.002) were up-regulated. METTL14 knockout enhanced the stability of CCNL2 mRNA through a YTHDF2-dependent pathway, compared with sh-METTL14 group (50.47±5.16) (0.52±0.05) , BC cell invasion ability of sh-METTL14+sh-CCNL2 group (71.69±6.41, t=4.47, P=0.011) and activity (0.64±0.05, t=2.94, P=0.042) were improved. Conclusion:METTL14 inhibits the expression of CCNL2 through m6A modification to enhance the invasion and activity of BC cells.

Objective: To explore the value of 4D-CTA based on computed tomography dynamic angiography for preoperative evaluation of meningioma. Methods: Totally 34 patients with intracranial meningioma underwent cranial dynamic volume CT scan. Then 3D-CTA and 4D-CTA related post-processing were performed. The difference of tumor size, tumor feeding artery and the relationship of tumor and skull, passing artery and peripheral venous system showed with 3D-CTA and 4D-CTA were compared. Results: There was no significant difference between 3D-CTA and 4D-CTA in evaluating tumor size and tumor feeding artery (both P> 0.05). The percentage of definite draining veins evaluated with 3D-CTA was 70.59% (24/34), lower than that with 4D-CTA (94.12% [32/34], P< 0.05). The accuracy of 3D-CTA and 4D-CTA for evaluating the relationship between tumor and skull was 91.18% (31/34) and 97.06% (33/34), and the accuracy of for evaluating the relationship between tumor and passing artery was 87.50% (21/24) and 95.83% (23/24), respectively (both P> 0.05). Conclusion: CT dynamic angiography can accurately evaluate the size of meningioma, the feeding artery and relationship with surrounding tissue, therefore providing comprehensive preoperative information of meningioma.

Objective:To apply the best evidence of phaseⅠ cardiac rehabilitation after coronary artery bypass grafting (CABG) into clinical practice and evaluate its effects.Methods:Following the Australian Jonna Briggs Institute (JBI) clinical evidence program and evidence transformational practice application system, the evidence of phaseⅠ cardiac rehabilitation exercise after CABG was retrieved, screened and evaluated, and the review indicators were formulated. From September 2019 to February 2020, 41 nurses and 109 CABG patients from the Cardiovascular Surgery Ward of the Affiliated Hospital of Qingdao University were selected. The data of 56 patients were collected before the application of the best evidence, and those of 53 patients were collected after the application of the best evidence. The implementation rate of the review indicators, the degree of knowledge of the best evidence among nurses and patients, the Six Minute Walk Test (6MWT) distance and the left ventricular ejection fraction (LVEF) before and after the application of the best evidence were compared.Results:After the application of the evidence, the nurses' implementation rate of the 13 review indicators of phaseⅠ cardiac rehabilitation exercises was improved, and the difference was statistically significant ( P<0.05) ; the nurses' exercise knowledge score increased from (53.66±14.01) points to (71.59±14.93) points; the patients' exercise knowledge score increased from (26.22±17.46) points to (60.49±15.52) points, and the differences were statistically significant ( t=-5.61, -9.40; P<0.01) . After the application of the evidence, the patients' 6MWT distance increased from (241.82±72.05) m to (246.25±69.26) m, and the difference was statistically significant ( t=-2.238, P<0.05) ; however, there was no statistically significant difference in LVEF before and after the application of the evidence ( P>0.05) . Conclusions:The clinical application of the best evidence for phase I cardiac rehabilitation exercises in CABG patients can standardize nurses' behaviors, improve nurses and patients' knowledge of evidence, and increase the 6MWT distance of CABG patients.

Objective To compare the efficacy and safety of turning holmium laser enucleation of the prostate (THoLEP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods A retrospective analysis of 532 patients with BPH surgery from January 2016 to December 2017 was performed,including 289 cases of transurethral resection of holmium laser enucleation (THoLEP) and 43 cases of transurethral holmium laser enucleation (HoLEP).Cases with incomplete data were excluded.Finally,100 patients were enrolled and divided into THoLEP group and HoLEP.The mean ages of patients in the THoLEP group and the HoLEP group were (74.6 ± 8.2) years and (75.3 ± 7.7) years,respectively.The prostate weights were (52.3 ± 23.1) g and (52.6 ± 22.7) g,respectively.International prostate symptom scores (IPSS) were (22.8 ± 1.3) and (23.1 ± 1.6),and the quality of life score (QOL) scores were (4.4 ± 0.5) and (4.3 ± 0.8),respectively.The rate of mximum flow rate (Qmax) was (5.9 ± 2.7) ml/s and (6.3 ± 2.8) mL/s,respectively.The residual urine volume was (149.3 ± 8.7) ml and (145.3 ± 9.7) ml,respectively.There was no significant difference between the two groups (P ＞ 0.05).Results Compared with HoLEP group,THoLEP group showed shorter operation time [(44 ± 13) min vs.(61 ± 15) min,P ＜ 0.05] and less intraoperative bleeding [(101.6 ± 13.2) ml vs.(119.9 ± 18.0) ml,P ＜ 0.05].The weight of the resected tissue in the THoLEP group was slightly larger than that in the HoLEP group,however the difference was not statistically significant [(30.5 ± 9.5) g vs.(28.7 ± 8.5) g] (P ＞ 0.05).The incidence of transient urinary incontinence in THoLEP group was less than that in HoLEP group [2 and 4 cases,P ＜ 0.05].There were no cases of urinary incontinence in both groups after 3 months,and no permanent urinary incontinence in both groups.THoLEP was slightly better than HoLEP group,but the difference was not statistically significant (P ＞0.05).Conclusions Compared with HoLEP,THoLEP has similar short-term results,and has more advantages in shortening the operation time,reducing intraoperative bleeding and transient urinary incontinence.It is a safer and effective method for the treatment of benign prostatic hyperplasia.

Both raw and vinegar products of the rhizome of Curcuma phaeocaulis are common drugs for promoting blood circulation and removing blood stasis in traditional Chinese medicine,which could be reflected in the inhibition of tail thrombosis in mice. As the traditional processing theory instructs,vinegar tastes sour and bitter,but can activate blood circulation and remove stasis after being infiltrated into the rhizome of C. phaeocaulis as an excipient. In this study,under the help of the ultrafast liquid chromatography-quadrupole time-offlight mass spectrometry( UFLC-Q-TOF-MS),the spectrum-effect relationship between the inhibition of tail thrombosis in mice and the rhizome of C. phaeocaulis both before and after the vinegar processing,were established to explore the functional changes of blood circulation and stasis after vinegar process. Based on the peak area from the fingerprint of UFLC-Q-TOF-MS of the alcohol extracts from the raw and vinegar-processed rhizome of C. phaeocaulis and their efficacy for inhibiting tail thrombosis,the correlation between the chromatography of UFLC-Q-TOF-MS and the inhibition of tail thrombosis in mice were analyzed by orthogonal partial least squares discriminant analysis( OPLS-DA) method. The results,produced by Simca-P software,showed that effective components consisted of eight peaks 16,24( aromadendrene oxide),3,11,22( dehydro-α-curcumene),19[( R)-(-)-α-curcumene],23 and 10 from the fingerprint,making great contribution to distinguish C. phaeocaulis raw products and the corresponding vinegar processed products. Therefore,from the perspective of inhibiting the formation of tail thrombosis in mice,the marker components could be found through the spectrum-effect relationship to distinguish C.phaeocaulis raw and vinegar products. This study provided new basis to explain the difference between the raw and the processed products of traditional Chinese medicine in the functional change of promoting blood circulation and removing blood stasis.
Acetic Acid ; Animals ; Chromatography, High Pressure Liquid ; Curcuma ; chemistry ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Mass Spectrometry ; Mice ; Rhizome ; chemistry ; Thrombosis ; drug therapy