Objective To screening and validation of key genes for programmed cell death(PCD)in gout through bioinformatics and machine learning and immunoinfiltration analysis.Methods Gout-related datasets were obtained from the Gene Expression Omnibus(GEO)database,comprising the human gout dataset GSE160170 and murine gout dataset GSE190138,which served as the training cohort.Differentiall expression genes(DEGs)were screened with difference factor>2 and P<0.05.The DEGs of two data sets were intersected to obtain the common DEGs(co-DEGs).The co-DEGs were enriched by GO function and KEGG pathway analysis.The combination of co-DEGs and PCD related gene set was used to obtain PCD related DEGs.A PPI network was built in the STRING database.The key module genes were screened in Cytoscape's MCODE,the hub genes were screened in 12 algorithms built into the Cytohubba plugin,including Degree,MCC,DMNC,MCN,EPC,BottleNeck,EcCentricity,closness,Radiality,Betweeness,Stress and Clusteringcoefficoent,the common genes of the two was as candidate genes.The regression model of least absolute shrinkage and selection operator(LASSO)was used to screen key genes in the GSE160170 and GSE190138 data sets respectively,and the intersection of the two was adopted to obtain key genes.The diagnostic value of key genes in gout was evaluated by receiver operating characteristic(ROC)curve.The expression difference of gout related immune cells was investigated by single sample gene set enrichmemt analysis(ssGSEA)immunoinfiltration analysis.Finally,blood samples from 30 gout patients admitted to the Department of Rheumatology,Xi'an Fifth Hospital from February to April 2024 were collected as the experimental group,while blood samples from 30 healthy subjects were collected as the control group.RNA was extracted from the Peripheral blood mononuclear cell(PBMC).Quantitative real time polymerase chain reaction(RT-qPCR)was used to validate the expression of key genes in clinical samples.Results 53 common DEGs of GSE160170 and GSE190138 were obtained,among which 43 genes were up-regulated and 10 were down-regulated.GO and KEGG indicated that most genes were involved in cell death,apoptosis,interlenkin(IL)-17 signaling pathway,tumor necrosis facter(TNF)signaling pathway and nucleotide-binding oligomerization domain-(NOD)-like receptor signaling pathway.12 co-DEGs of programmed cell death and gout were obtained.A total of 7 candidate genes were screened.LASSO regression model screened 5 genes and 4 genes respectively in two datasets,and 3 key genes were abtained by the intersection of the two datasets,which were IL-6,plasminogen activator urokinase receptor(PLAUR)and NOD-like receptor thermal protein domain associated protein3(NLRP3).Validation within the training set revealed that all three genes attained perfect diagnostic performance for gout,with area under the ROC(AUC-ROC)curve values of 1.00.Immunoinfiltration analysis showed that the changes of activated CD4+T cells,activated CD8+T cells and natural killer cells were closely related to the occurrence and development of gout.In the clinical samples,compared with the control group,PLAUR,NLRP3 and IL-6 were highly expressed in gout patients,and the differences were statistically significant(t=18.852,9.633,8.293,all P＜0.05).Conclusion IL-6,PLAUR and NLRP3 provide potential biomarkers and therapeutic targets for the diagnosis and treatment of gout,offering new directions in this field.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To explore the related risk factors contributing to re-fracture after hip surgery in elderly patients.Methods:This retrospective analysis was conducted on the clinical data of 2 415 elderly individuals who underwent surgical treatment for hip fractures and were discharged from Shanghai Sixth People's Hospital between January 2016 and December 2021.Patients were grouped into re-fracture and non-re-fracture cohorts based on whether a second fracture occurred within three years after surgery.Demographics, clinical data, and postoperative functional rehabilitation outcomes of the two groups were collected, and univariate and multivariate logistic regression analyses were applied to identify the independent risk factors for re-fractures after surgery.Results:A total of 2, 000 patients who completed follow-up were included in the final analysis, aged 60~91 years, with a mean age of (75.4±8.2) years.Among them, 855 were male(42.75%), and the postoperative re-fracture incidence was 28.25% (565/2 000). Univariate analysis indicated that advanced age, fracture type at first onset, lower Harris scores, insufficient rehabilitation training, osteoporosis, diabetes, cerebrovascular disorders, visual impairment, and syncope were all significantly associated with re-fracture (all P<0.05), while gender differences were not statistically significant ( P>0.05). Multivariate regression confirmed the following as independent risk factors: age ≥75 years, postoperative Harris score <80, non-standard rehabilitation training, combined osteoporosis, diabetes, cerebrovascular disease, visual impairment, and syncope ( OR、 RR>1). Conclusions:Elderly patients are prone to re-fracture after hip surgery, and its occurrence is closely related to advanced age, inadequate functional rehabilitation, osteoporosis, and multiple internal medical comorbidities.In clinical practice, attention should be paid to standardized postoperative rehabilitation, systematic anti-osteoporotic therapy, and active intervention of comorbidities to reduce the incidence of re-fracture and improve the long-term prognosis of patients.

Objective:To explore the clinical efficacy of staged reconstruction with anterolateral thigh flap (ALTF) for wrist-forearm soft tissue defects of electrical burns.Methods:A retrospective observational study was conducted on 10 patients who had wrist-forearm soft tissue defects after electrical burns and were admitted in the Department of Burns, Zhengzhou First People's Hospital from January 2019 to December 2022. The patients were 6 males and 4 females, aged 8 to 64 years. All the patients were third-and-fourth degree electrical burns. Debridement was performed to remove the necrotic tissues around the wound in stage I surgery. Area of the wound after debridement ranged from 15 cm×11 cm to 31 cm×20 cm. According to the condition of wrist-forearm injury, the wounds with relatively mild injury were retained. Free ALTF was used to cover the wound surface. Size of the flaps ranged from 16 cm×12 cm to 32 cm×21 cm. The descending branch of lateral circumflex femoral artery and the accompanying veins carried by the flap were anastomosed end-to-end with the radial artery and vein or ulnar artery and vein in the recipient site, respectively. Conditions of other vessels were explored. The great saphenous veins in a length of 10-18 cm was used to bridge the occluded arteries. The donor sites were covered by medium thick skin grafts from trunk. After survival of the flap, stage Ⅱ surgery was carried out to debride the wound temporarily retained in stage I surgery and to thin the flap, then had all the wound covered with the thinned flap. Follow-ups were conducted at outpatient clinic, and via telephone and WeChat interviews. The limb salvage, flap survival, vascular compromise and other complications, as well as the donor site healing were observed. The wound coverage rate of the thinned flap. The appearance of flap, donor site scar hyperplasia, the patient satisfaction with the shape and function of the donor site at 6 months after the stage Ⅱ surgery were evaluated. Likert scale was employed to evaluate the patient satisfaction. The Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH) were used to evaluate the upper limb function in daily life of the patients.Results:The limb salvages in the 10 patients were all successful, and the flaps survived without any postoperative event of vascular compromise or other complication. One patient had mild cyanosis at the edges of flap after surgery and regressed at 7 days later. One flap had poor blood circulation and partial necrosis. The thinned flaps covered the wound completely after the stage-Ⅱ flap thinning surgery. The postoperative follow-up period was 6.0-7.0 months. All skin grafts in the donor sites survived well. The thinned flaps of stage Ⅱ surgery achieved 100% in wound coverage rate. At 6 months after surgery, the colour and texture of the flaps were about the same as those of the normal skin of the upper limb. There were linear scars in both of donor and recipient sites. Four patients were satisfactory to the postoperative appearance and function of the donor site and 6 patients were very satisfactory. MHQ scores were 49-82 (mean, 74) points; DASH scores were 27-45 (mean, 32) points.Conclusion:Reconstruction of the wounds in wrist-forearm soft tissue defects of electrical burns with ALTF in staged surgery, can improve the function and aesthetics of the wrist-forearm. It is a good method.

Objective To investigate the factors influencing the severity of cerebral white matter hyperintensity in hypertensive patients with acute cerebral infarction,and focus on the independ-ent roles of treatment adherence,advanced age,and multidimensional risk factors.Methods A single-center cross-sectional study was conducted on 262 hypertensive patients with acute cerebral infarction admitted to our department from January 2020 to June 2023.According to their score of Morisky Medication Adherence Scale(MMAS-8),they were divided into an adherence group(116 cases)and a non-adherence group(146 cases).Their demographic data,medical history,and blood pressure data were collected through electronic medical records.Fazekas score was assessed blind-ly to quantify the severity of white matter hyperintensity.MMAS-8 and Montreal Cognitive Assessment Scale(MoCA)were used to assess the behavioral indicators,and modified Rankin Scale(mRS)was employed to evaluate the neurological function.Univariate and multivariate logistic regression analyses were performed to screen the risk factors.Results There were statis-tical differences in marital status,mRS score and Fazekas score between the adherence group and the non-adherence group(P＜0.05,P＜0.01).The non-adherence group had significantly higher diastolic blood pressure than the adherence group[(87.29±7.51)mm Hg(1 mm Hg=0.133 kPa)vs(83.98±8.11)mm Hg,P=0.001].Univariate logistic regression analysis showed age of≥80 years,duration of hypertension≥5 years,systolic blood pressure,and MoCA score＜10 were no-tably correlated with severity of white matter hyperintensity(P＜0.01).Multivariate logistic re-gression analysis indicted that age of≥80 years(OR=3.305,95％CI:1.560-7.001,P=0.002),systolic blood pressure(OR=1.026,95％CI:1.008-1.044,P=0.003),MoCA score＜10(OR=5.210,95％CI:2.060-13.176,P=0.000),and treatment non-adherence(OR=2.380,95％CI:1.346-4.209,P=0.003)were independent risk factors for white matter hyperintensity severity,and duration of hypertension showed no significance in the multivariate model(P＞0.05).Conclusion Poor treatment adherence and advanced age are core factors for white matter hyper-intensity progression in hypertensive patients with acute cerebral infarction.

BACKGROUND:Large deep burn wounds are often accompanied by scar hyperplasia after healing,requiring transplantation of medium-thickness skin for repair,and the medium-thickness skin slices taken generally reach below the papillary layer of the dermis.If not handled correctly,complications such as delayed healing,ulceration,and post-healing pain and itching in the donor area can easily occur.Therefore,the repair of wounds in the donor area should be emphasized.OBJECTIVE:To observe the safety and practicability of autologous scalp repair of skin donor area in patients with deep burns and scarring.METHODS:Sixty patients with deep burn and scar hyperplasia admitted to the Burn Department of Zhengzhou First People's Hospital from January 2021 to September 2023 were selected as the study subjects.They all needed medium-thickness skin transplantation and repair,and were divided into study group(n=30)and control group(n=30)according to random systematic sampling method.The skin was taken from the patient's own medium-thickness skin on the leg or back.In the study group,the skin donor area was repaired with self-blade thick scalp replantation,and in the control group,the skin donor area was repaired with absorbent dressing.The wound healing rate and the time to complete epithelialization of the wound were observed and compared in the two groups 6 days after surgery.The pain of dressing change at 3 and 6 days after surgery and scar hyperplasia in the skin donor area at 6 months after surgery were compared between two groups.RESULTS AND CONCLUSION:Compared with the control group,the time to complete epithelialization of the wound was significantly lower in the study group(P<0.05),and the wound healing rate was significantly higher in the study group(P<0.05),the pain score for dressing change at 3 and 6 days after surgery was significantly lower in the study group(P<0.05),and the scar hyperplasia rate,scar score and itch score were also significantly lower in the study group(P<0.05)at 6 months after surgery.In conclusion,autologous scalp repair of the medium-thickness skin donor area can accelerate wound healing and reduce scar hyperplasia.

Objective:To summarize and analyze the clinical efficacy and experience of ultrasound-guided radiofrequency ablation (RFA) in the treatment of Kasabach-Merritt syndrome (KMS).Methods:A retrospective analysis was conducted on the data of pediatric patients with KMS who underwent ultrasound-guided RFA in Department of Hemangioma Surgery, the Third Affiliated Hospital of Zhengzhou University, between March 2018 and March 2024. Preoperative laboratory tests and imageological examination were performed. Under general anesthesia, the working tip of the RFA electrode needle was precisely reached the bottom of the lesion under ultrasound guidance. The electrode needle was then gradually withdrawn until the entire lesion area was covered by hyperechoic signals, indicating complete ablation. Postoperative symptomatic and supportive treatments, such as ice pack application and dressing changes, were administered to the surgical area. Platelet detection was performed immediately after the operation. Complications were closely monitored and regular follow-ups were carried out.Results:A total of 30 pediatric patients were included, comprising 14 males and 16 females, from 10 min to 5 months and 29 d after birth, with a median time of 6 d. Lesions were located in the limbs and trunk in 27 cases, and head and neck region in 3 cases, with lesion volumes ranged from 2.4 cm×2.3 cm×1.2 cm to 14.4 cm×9.3 cm×3.3 cm. The mean preoperative platelet count was 43×10 9/L, among them, the platelet values of 11 cases were (10-30) ×10 9/L, and those of 6 cases were lower than 10×10 9/L, other 13 cases with progressive thrombocytopenia. All patients successfully underwent RFA, achieving complete lesion ablation and normalization of platelet counts postoperatively. Platelet counts recovered to above 300×10 9/L in 15 patients, with no severe complications observed. The RFA area became slightly hardened within 7 d postoperatively but gradually returned to normal after consistent dressing changes for 2 weeks. During the follow-up period of 6 months to 2 years, complete lesion ablation was confirmed, with disappearance of the mass, no recurrence, good local function, mild local scar formation, and satisfactory cosmetic appearance. Conclusion:Ultrasound-guided RFA for KMS has advantages of favorable therapeutic outcomes, minimal tissue damage, no significant complications, and satisfactory cosmetic result.

Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on sleep structure and quality in children with autism spectrum disorder(ASD).Methods:Sixty children with ASD who met the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria were randomly assigned to rTMS treatment group and pseudo-treatment group.The rTMS group received bilateral low-frequency(0.5 Hz)stimulation,and the pseudo-treatment group received pseudo-stimulation at the same time and place.Sleep quality and autism symptoms were assessed at baseline,midpoint(15 sessions),and endpoint(30 sessions),using the Childhood Sleep Disorders Scale(SDSC)and the Behavior Rating Scale for Children with Autism Spectrum Disorders(ABC)before treatment,15 times and 30 times of intervention,and statistical analysis was performed.Results:There was no significant difference in SDSC factor and total score between the two groups before treatment(P＞0.05).After 15 and 30 treatments,the total scores of SDSC and all factors were lower in the rTMS group than in the pseudo-treatment group(P＜0.05).Repeated measurement ANOVA found that there was an interaction be-tween the groups and the number of interventions,that is,the scores of the two groups had different downward trends,and the decline of the treatment group was more obvious than that of the pseudo-treatment group.There was no significant difference in the interaction between ABC scale scores and intervention times(P＞0.05).Conclu-sion:Repetitive transcranial magnetic stimulation significantly improves the sleep structure and quality in children with autism spectrum disorder.

Objective:To summarize and analyze the clinical efficacy and experience of ultrasound-guided radiofrequency ablation (RFA) in the treatment of Kasabach-Merritt syndrome (KMS).Methods:A retrospective analysis was conducted on the data of pediatric patients with KMS who underwent ultrasound-guided RFA in Department of Hemangioma Surgery, the Third Affiliated Hospital of Zhengzhou University, between March 2018 and March 2024. Preoperative laboratory tests and imageological examination were performed. Under general anesthesia, the working tip of the RFA electrode needle was precisely reached the bottom of the lesion under ultrasound guidance. The electrode needle was then gradually withdrawn until the entire lesion area was covered by hyperechoic signals, indicating complete ablation. Postoperative symptomatic and supportive treatments, such as ice pack application and dressing changes, were administered to the surgical area. Platelet detection was performed immediately after the operation. Complications were closely monitored and regular follow-ups were carried out.Results:A total of 30 pediatric patients were included, comprising 14 males and 16 females, from 10 min to 5 months and 29 d after birth, with a median time of 6 d. Lesions were located in the limbs and trunk in 27 cases, and head and neck region in 3 cases, with lesion volumes ranged from 2.4 cm×2.3 cm×1.2 cm to 14.4 cm×9.3 cm×3.3 cm. The mean preoperative platelet count was 43×10 9/L, among them, the platelet values of 11 cases were (10-30) ×10 9/L, and those of 6 cases were lower than 10×10 9/L, other 13 cases with progressive thrombocytopenia. All patients successfully underwent RFA, achieving complete lesion ablation and normalization of platelet counts postoperatively. Platelet counts recovered to above 300×10 9/L in 15 patients, with no severe complications observed. The RFA area became slightly hardened within 7 d postoperatively but gradually returned to normal after consistent dressing changes for 2 weeks. During the follow-up period of 6 months to 2 years, complete lesion ablation was confirmed, with disappearance of the mass, no recurrence, good local function, mild local scar formation, and satisfactory cosmetic appearance. Conclusion:Ultrasound-guided RFA for KMS has advantages of favorable therapeutic outcomes, minimal tissue damage, no significant complications, and satisfactory cosmetic result.

Objective To investigate the factors influencing the severity of cerebral white matter hyperintensity in hypertensive patients with acute cerebral infarction,and focus on the independ-ent roles of treatment adherence,advanced age,and multidimensional risk factors.Methods A single-center cross-sectional study was conducted on 262 hypertensive patients with acute cerebral infarction admitted to our department from January 2020 to June 2023.According to their score of Morisky Medication Adherence Scale(MMAS-8),they were divided into an adherence group(116 cases)and a non-adherence group(146 cases).Their demographic data,medical history,and blood pressure data were collected through electronic medical records.Fazekas score was assessed blind-ly to quantify the severity of white matter hyperintensity.MMAS-8 and Montreal Cognitive Assessment Scale(MoCA)were used to assess the behavioral indicators,and modified Rankin Scale(mRS)was employed to evaluate the neurological function.Univariate and multivariate logistic regression analyses were performed to screen the risk factors.Results There were statis-tical differences in marital status,mRS score and Fazekas score between the adherence group and the non-adherence group(P＜0.05,P＜0.01).The non-adherence group had significantly higher diastolic blood pressure than the adherence group[(87.29±7.51)mm Hg(1 mm Hg=0.133 kPa)vs(83.98±8.11)mm Hg,P=0.001].Univariate logistic regression analysis showed age of≥80 years,duration of hypertension≥5 years,systolic blood pressure,and MoCA score＜10 were no-tably correlated with severity of white matter hyperintensity(P＜0.01).Multivariate logistic re-gression analysis indicted that age of≥80 years(OR=3.305,95％CI:1.560-7.001,P=0.002),systolic blood pressure(OR=1.026,95％CI:1.008-1.044,P=0.003),MoCA score＜10(OR=5.210,95％CI:2.060-13.176,P=0.000),and treatment non-adherence(OR=2.380,95％CI:1.346-4.209,P=0.003)were independent risk factors for white matter hyperintensity severity,and duration of hypertension showed no significance in the multivariate model(P＞0.05).Conclusion Poor treatment adherence and advanced age are core factors for white matter hyper-intensity progression in hypertensive patients with acute cerebral infarction.