Objective To compare the therapeutic effects of modified Shenqi Maiwei Dihuang Decoction combined with Buzhong Yiqi Pill and Buzhong Yiqi pill alone in the patients with cold and heat mixed type di-abetic foot.Methods A total of 123 patients with cold and heat mixed type diabetic foot receiving the treat-ment in this hospital from April 2022 to December 2023 were selected and divided into the modified Shenqi Mai-Dihuang Decoction and Buzhong Yiqi Pill group(combined group,60 cases)and Buzhong Yiqi Pill group(monotherapy group,63 cases).The wound healing,mean blood flow amount of foot dorsal artery,blood glu-cose and changes in vascular diameter,inflammatory factors and vascular endothelial growth factor after 2 courses of treatment were compared betweeb the 2 groups.Results The ulcer reduction rate in the combina-tion group was significantly higher than that in the monotherapy group(P=0.001).The fasting blood glu-cose and 2 h postprandial blood glucose after treatment in the combination group all were lower than those in the monotherapy group(P=0.001).The average blood flow of foot dorsal artery after treatment in combina-tion group was higher than that in the monotherapy group,and the difference was statistically significant(P=0.013).There were 34 cases of Wagner grade 3 in the combined group and 33 cases of Wagner grade 3 in the monotherapy subgroup respectively.There was statistically significant difference in the CRP level between the two subgroups(P=0.045).Conclusion Shenqi Maiwei Dihuang Decoction combined with Buzhong Yiqi Pill in treating diabetic foot ulcer is more effective than Buzhong Yiqi Pill alone,moreover the safety is high.

Objective To investigate the effects of prolonged low-dose neutron-γ radiation on peripheral blood lymphocytes of logging workers. Methods The health information of workers in a logging company was collected by on-site blood sample collection and questionnaire survey. Individual doses of γ and neutron radiation were recorded using LiF elements and CR-39, respectively. Lymphocyte count in peripheral blood was measured by blood cytometer. Cell cycle and cyclins were detected by flow cytometry. Results The annual dose of some logging workers exceeded 5 mSv. Lymphocyte counts showed a difference of 15% between the group exposed to the lowest annual dose of 0–1 mSv (mean: 2.45 × 10⁹/L) and the group exposed to the highest annual dose of 5–25 mSv (mean: 2.08 × 10⁹/L). In comparison to pre-shift workers, logging workers exhibited a G1-phase arrest in the lymphocyte cycle, along with increased expression of cyclins p21 and CDK2. Conclusion Prolonged exposure to low-dose neutron-γ radiation leads to reduced lymphocyte counts as well as changes in lymphocyte cycle and cyclin expression.

Objective:To improve the ability of radiation health technical institutions for biological dose estimation.Methods:A total of 144 institutions nationwide, including the CDC, prevention and treatment center for occupational disease, colleges and universities, scientific research institutes, nuclear industry systems, and medical and physical examination institutions, were organized to carry out the intercomparison of national biological dose estimation capabilities in 2022. The institutions participating in the comparison were divided into two types of A and B, through the identification of chromosome aberrations, to estimate the irradiation dose (A) or chromosome aberration rate (B). The results were summarized and compared, and the main problems were analyzed and discussed.Results:There were 60 institutions in type A, 52 qualified institutions (including 12 excellent institutions) and 8 unqualified institutions, with a pass rate of 86.7% (20.0% excellent) and a failure rate of 13.3%. There were 84 institutions participating in the biological dose estimation comparison of type B, with 48 qualified institutions, and 36 unqualified institutions, the qualified rate was 57.1%, and the unqualified rate was 42.9%.Conclusions:Most of the institutions participating in type A comparison have the ability to estimate biological dose, and more than half of the institutions participating in type B comparison have the ability to analyze chromosome aberration. The overall ability of institutions participating in type A comparison is higher than in type B.

Objective To investigate the serum levels of soluble programmed death-1 (sPD-1) and soluble programmed death-ligand 1 (sPD-L1) in chronic hepatitis B (CHB) patients with clinical cure, the correlation between programmed death-1 (PD-1) and lymphocytes by flow cytometry, and the recovery of hepatitis B virus (HBV)-specific immunity. Methods A total of 26 CHB patients with clinical cure, 26 treatment-naïve CHB patients, and 26 healthy controls who were diagnosed at the outpatient service of Peking University First Hospital from January to May of 2022 were enrolled, and related clinical data and peripheral blood samples were collected. ELISA was used to measure the serum levels of sPD-1 and sPD-L1, and flow cytometry was used to measure the expression of PD-1 in peripheral blood lymphocytes. CHB patients with clinical cure were compared with the treatment-naïve CHB patients and the healthy controls. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups, and the chi-square test was used for comparison of categorical data between groups. The Pearson correlation analysis or the Spearman correlation analysis was used to investigate the correlation between two continuous variables. Results For the 26 CHB patients with clinical cure, the mean time of antiviral therapy was 8.33 years, with entecavir as the antiviral drug. The CHB patients with clinical cure had significantly higher levels of sPD-1 and sPD-L1 than the healthy controls ( P < 0.05) and significantly lower percentages of PD-1 + cells/lymphocytes and PD-1 + CD8 + T cells/lymphocytes than the treatment-naïve CHB patients ( P < 0.05). In the treatment-naïve CHB patients, the serum levels of sPD-1 and sPD-L1 were moderately negatively correlated with HBsAg level ( r =-0.524 and -0.583, both P < 0.05). The serum levels of sPD-1 and sPD-L1 were moderately positively correlated with PD-1 + CD8 + T cells/lymphocytes ( r =0.535 and 0.419, both P < 0.05). In the CHB patients with clinical cure, the serum levels of sPD-1 and sPD-L1 were not correlated with age, sex, alanine aminotransferase, T cells/lymphocytes, CD8 + T cells/lymphocytes, PD-1 + T cells/lymphocytes or PD-1 + CD8 + T cells/lymphocytes (all P > 0.05). Conclusion The serum levels of sPD-1 and sPD-L1 in treatment-naïve CHB patients are mainly associated with exhausted CD8 + T cells in peripheral blood, while there is no significant correlation between serum sPD-1/sPD-L1 and exhausted CD8 + T cells in peripheral blood in CHB patients with clinical cure.

Macrophages, as regulatory cells existing in all tissues, exhibit complex responses to radiation stimulation, including both common processes in response to infection and injury and unique polarization transformation. Radiation-related polarization determines the functional types of macrophages. After being exposed to different irradiations, macrophages are regulated by different cytokines, involving multiple signaling pathways. This leads to differential degrees of polarization. The review summarized the regulatory effects of radiation on the polarization and functions of macrophages in order to provide basis for theoretical research on immunity and clinical radiotherapy.

Objective:To explore the effects of tibial cortex transverse transport for long-term chronic wounds after serious lower limb trauma.Methods:From January 2016 to July 2021, 11 patients with long-term chronic wounds after lower limb trauma were treated at Department of Orthopedic Surgery, 920 Hospital of Joint Logistics Support Force of PLA. They were 7 males and 4 females, aged from 19 to 57 years (average, 32.3 years). There were 7 lesions of the popliteal artery and 4 ones of the anterior and posterior tibial arteries. The wound was located at the distal leg in 5 cases and at the foot and ankle in 6 ones. The wound size ranged from 3.2 cm × 2.8 cm to 9.5 cm × 7.3 cm. An external fixator for transverse transport was installed after the cortical bone fenestration was performed on the medial tibia more than 10 cm away from the wound surface, with a fenestration area of 5.0 cm × 1.8 cm. The wound was limitedly debrided, irrigated thoroughly and bandaged. Transverse transport began on the postoperative day 7, with the wounds opened for care and dressing change. The transverse transport lasted 25 days and the external fixators were dismantled 2 months after surgery. The healing of the wounds and incisions for transverse transport was observed.Results:The 11 patients were followed up for 3 to 20 months (average, 5.6 months). The wounds healed after 35 to 277 days. By the last follow-up, all the wounds healed without recurrence. Incision infection occurred in 2 patients, whose transverse transport was continued and wounds healed after local debridement; another patient suffered from poor incision healing, which responded gradually to decreased speed of transverse transport.Conclusion:Tibial cortex transverse transport can significantly improve the local blood supply and promote granulation and healing of long-term chronic wounds after serious trauma at the lower leg, foot and ankle.

Objective To analyze the biological dose estimation ability of the radiation health technology institutions nationwide from 2015 to 2017,and their development in recent years.Methods SPSS 19.0 software was used to analyze and pack the data involved in the 2015-2017 year assessments by using x2 test.Statistical analysis was conducted of qualification rate,excellent rate,participating units and dose estimation deviation distribution.Results The qualification rate gradually increased from 2015 to 2017.Compared with 2015,the passing rate significantly increased in 2017 with statistically significant difference(x2 =3.978,P ＜0.05).A total of 53 units participated in the biological dose assessment,of which 30 units were involved over the three consecutive years,accounting for 57％.In the distribution of the relative deviation of dose estimates made by the units participating in the three-year assessment,the proportion of estimated deviations in the range of 5％-10％ increased whereas those in the range of 15％-20％ and ＞ 20％ decreased.Conclusions During 2015-2017 year period the biological dose estimation ability of all units involved in the assessment nationwide was basically stable,with gradually improved test level,qualification rate and steady excellence rate.

Objective To explore the effects of high background radiation on the expressions of miR-16, miR-106b, miR-449a, miR-34a and let-7g in peripheral blood plasma of the residents .Methods Totally 110 healthy female long-term local residents aged over 50 years were randomly selected from the high background radiation area and the control area , while their age, body mass index(BMI) and other indicators were surveyed .The relative expression levels of miRNAs in peripheral blood plasma of these women were quantitatively detected by real-time fluorescence quantitative PCR ( RT-PCR) .Then t-test was used to analyze the cumulative dose , age and BMI between the high background and control group .Mann-Whitney U-test was used for statistical analysis of miRNA expression levels between two groups , and the multiple regression analysis was used finally .Results Compared with the control group , the cumulative dose of individuals in the high background group was about four times higher (t=42.803, P<0.05), and the levels of miR-16 and miR-106b in plasma of high background group were down-regulated, while the level of miR-449a was up-regulated ( Z =4.180, 2.422, 2.794, P <0.05 ).After controlling of confounding factors such as age and BMI , the expression levels of miR-16 and miR-106b were negatively correlated with the cumulative dose of individuals (P<0.05).On the contrary, no significant correlation was observed between the levels of miR-449a, miR-34a, let-7g and the individual cumulative dose (P>0.05).Conclusions miR-16 and miR-106b may serve as biomarkers for the early stage of low dose radiation health effects .

Objective To explore the classification system and outcomes of surgical treatment for terrible triad of the elbow.Methods Data of 42 patients with terrible triad elbow injuries who were surgically treated between 2009 and 2015 were retrospectively analyzed.There were 29 males and 13 females with a mean age of 47 years at the time of injury.42 patients of terrible triad injuries were classified into four types:type ⅠA,ⅠB,Ⅱ,Ⅲ,and Ⅳ injuries.Type ⅠA and Ⅱ injuries were treated through an isolated lateral approach,while type ⅠB,Ⅲ and Ⅳ injuries were treated by a combined lateral and anteromedial approach.Operative treatment consisted of repair or replacement of the radial head,repair of the lateral collateral ligament (LCL) and coronoid fracture fixation.Type ⅠA injuries were treated with radial head and LCL repair without coronoid fixation.Type Ⅳ elbow injuries were treated with medial collateral ligament (MCL) repair.Elbow functional status was evaluated using the Mayo elbow performance score (MEPS).Results There were three patients with type ⅠA injuries,7 patients type ⅠB injuries,15 type Ⅱ injuries,10 type Ⅲ injuries,and 7 type Ⅳ injuries.The average follow-up period was 30 months (range,24-56 months).All fractures of coronoid got union at average 11.5 months except for type ⅠA injuries.40 patients with fractures of radial head got union at average 12.4 months and two patients underwent radial head replacement without loosening.The mean flexion-extension arc was 107°±22°,the mean flexion contracture was 20°±10° and the mean flexion was 127°±14°.The average forearm rotation arc was 145°±14°,which included an average pronation of 73°±8° and an average supination of 71°±9°.The mean MEPS was 89±9 points (range,55-100 points),with excellent results in 24 elbows,good result in 17 and poor result in one;the excellence rate was 97％ (41/42).Thirteen patients had radiographic signs of arthrosis according to the Broberg-Morrey system (9 elbows were grade 1 and 4 were grade 2).5 patients had evidence of heterotopic ossification,of which four had minimal periarticular ossification and did not require additional surgery.The remaining patient showed significant heterotopic ossification and required an elbow release.1 patient with type Ⅲ injury developed transient median nerve paralysis and got full recovery after conservative treatment for 8 weeks.1 patient with type Ⅲ injury developed ulnar neuropathy and required an anterior ulnar nerve transposition.2 patients,who had shifting hardware but still achieved union,required a second surgery to remove the implant:one patient had a Kirschner wire shift from the radial head at 6 months after surgery,and the other had a loose screw in the coronoid process at one year after surgery.Conclusion Our classification system of terrible triad of the elbow may provide a guide for the selection of an ideal surgical approach and treatment modality.

Objective To report the clinical results of surgical treatment of fracture of the anteromedial facet of the coronoid process in terrible triad injury.Methods Of the 59 patients with terrible triad injury of the elbow,17 were surgically treated for fracture of the anteromedial facet of the coronoid process from July 2010 to July 2014.They were 12 men and 5 women,from 29 to 70 years of age (average,50 years).By the Mason classification for the radial head fractures,2 cases were type Ⅰ,13 type Ⅱ and 2 type Ⅲ;by the O'Driscoll classification for coronoid process fractures,one was type Ⅰ,14 were type Ⅱ and 2 type Ⅲ.All patients were treated through combined approaches.The lateral Kocher approach was used to fixate or replace the radial head and to repair the lateral ligament complex;the anteromedial approach was used to fixate the coronoid process fracture and to explore and repair the medial collateral ligament if necessary.Fracture union,implant loosening,ectopic ossification,regression and articular alignment were assessed on the postoperative X-rays.At final follow-ups,the elbow function was evaluated using Mayo elbow performance score (MEPS) and Broberg & Morrey grading system for traumatic arthritis.Results The average follow-up duration for the 17 patients was 32 months (range,from 24 to 60 months).Final follow-ups showed that the mean arc of flexion-extension was 97° (from 70° to 120°),the mean extension limitation 23° (from 0 to 40°),the mean arc of forearm rotation 139° (from 90° to 145°),the mean pronation 71° (from 60° to 90°)and the mean supination 67° (from 60° to 85°).The MEPT scores averaged 87 points (from 80 to 100 points),yielding 7 excellent,8 good and 2 fair cases.By the Broberg & Morrey grading,there were 4 cases of grade 1 and one of grade 2.No evidence of elbow instability,nonunion or implant failure was found.Ectopic ossification around the elbow happened in 4 cases,transient ulnar nerve palsy was found in one,and the Kirschner wire was removed operatively in 2 because it had loosened after fracture union.Conclusion The treatment of anteromedial coronoid fractures in terrible triad injury should be anatomically reduced through direct exposure and fixated rigidly.