Objective To explore the role and potential mechanism of Astragali Radix-derived extracelluar vesicles(EVs)-like particles(AR-EVLP)in diabetic wound healing,providing a novel therapeutic drug mode and theoretical basis for traditional Chinese medicine in treating diabetic skin ulcers.Methods AR-EVLP was extracted using ultracentrifugation.Untargeted metabolomics was used to analyze the potential active components of AR-EVLP,and the main active substances in AR-EVLP were identified by comparison with the Herb database.The targets of the active components were obtained through the Swiss Target Prediction database and the TCMSP database.Targets related to diabetic wound healing were obtained from the GeneCards database.Key targets were identified by intersecting drug targets and disease targets.GO functional annotation and KEGG pathway enrichment analysis were performed using the DAVID database.Based on the pathway enrichment results,a"drug components-targets-pathways"diagram was constructed to identify core targets.Molecular docking and visualization were performed using Autodock and PyMOL software.Results Formononetin was identified as the main active component in AR-EVLP,with 66 key targets related to diabetes and wound healing,including 15 key node proteins such as SRC,CASP3 and JUN.GO functional enrichment analysis suggested that formononetin can regulate biological processes such as protein phosphorylation and gene expression.KEGG pathway enrichment analysis indicated potential involvement in multiple signaling pathways,including VEGF and TNF.Seven targets,including PIK3CA,JUN and MAPK14,were identified as core targets for formononetin.Molecular docking showed that formononetin had the strongest binding affinity with MAPK14.Conclusion AR-EVLP may be a potential effective drug mode for the treatment of diabetic wound healing.

【Objective】 To investigate the protective effects of aflexible sleeve penile protection device on reducing postoperative pain and wound edema in patients after circumcision. 【Methods】 A total of 54 patients who underwent circumcision at Yan’an Branch of Peking University Third Hospital during Feb.1 and May 31, 2023 were enrolled.The patients were randomly divided into the experimental group and control group, with 27 patients in either groups.Patients in the experimental group were treated with a flexible sleeve penis protection device after surgery, and patients in the control group were treated with traditional gauze bandage after surgery.Postoperative pain, wound edema and complications were compared between the two groups. 【Results】 In terms of pain, the visual analogue scale of the experimental group was significantly lower at 6 hours [(1.7±0.9) vs.(3.3±1.9), P<0.001] and 2 days [(2.0±1.3) vs.(3.3±1.3), P<0.001] after surgery than that of the control group, but there were no statistically significant differences between the two groups on the 4th and 7th postoperative days (P>0.05).In terms of edema, the edema score of the experimental group was significantly lower than that of the control group on the 2nd postoperative day [(2.0±1.0) vs.(4.0±0.8), P<0.001] , the 4th postoperative day [(1.5±1.2) vs.(2.6±0.9), P<0.001] , and the 7th postoperative day [(0.9±1.3) vs.(2.3±1.5), P<0.001] .There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). 【Conclusion】 The flexible sleeve penile protection device has significant effects of reducing early postoperative pain and reducing edema in patients undergoing circumcision.

Objective:To explore the application value of ventilator management path based on three-dimensional quality evaluation model in ventilator management. Methods:Based on the structure-process-outcome model (referred to as the three-dimensional quality evaluation model),the evaluation index system of ventilator service management was developed. The service quality algorithm was used to conduct comprehensive evaluation of service quality,and the structural optimization,process strengthening and outcome-oriented measures of ventilator equipment service management were developed. A total of 62 ventilators in clinical use in General Hospital of the Western Theater Command of the PLA from January to June 2023 were selected,and the 50 ventilators used from January to March adopted the conventional experience management model (referred to as experience management model),the 50 ventilators (including 38 in use in the experience management model) from April to June adopted the ventilator management path based on three-dimensional quality evaluation model (referred to as the model management model). The self-made satisfaction questionnaire was used to investigate the satisfaction of ventilator patients with equipment service quality,and the comprehensive evaluation difference score of equipment service quality and equipment operation quality of the two management modes were compared. Results:The comprehensive evaluation difference scores of equipment structure service quality,process service quality and outcome service quality of the model management mode were (0.08±0.06) points,(0.11±0.07) points and (0.05±0.04) points,respectively,which were lower than those of the experience management mode,the difference was statistically significant (Z=2.290,2.024,2.724,P<0.05). The average satisfaction of patients on ventilator therapy in the ICU wards of the department of respiratory and critical care medicine,department of intensive care unit,department of emergency and other departments was (95.66±1.74)％,(96.51±1.37)％,(95.93±1.67)％ and (96.56±1.28)％,respectively,which were higher than those of the experience management mode,the difference was statistically significant (Z=3.624,3.854,3.368,2.799,P<0.05). The average start-up operation rate and quality inspection pass rate of ventilator equipment were (95.38±1.67)％and (95.44±1.71)％,respectively,which were higher than those of experience management mode;the average failure rate was (1.23±0.98)％,which was lower than that of experience management mode,the difference was statistically significant (Z=2.219,2.733,3.005,P<0.05). Conclusion:The application of ventilator management path based on three-dimensional quality evaluation model can improve the quality of ventilator clinical service,enhance the satisfaction of clinical service,and improve the operation quality of equipment.

Objective:To explore the application value of ventilator management path based on three-dimensional quality evaluation model in ventilator management. Methods:Based on the structure-process-outcome model (referred to as the three-dimensional quality evaluation model),the evaluation index system of ventilator service management was developed. The service quality algorithm was used to conduct comprehensive evaluation of service quality,and the structural optimization,process strengthening and outcome-oriented measures of ventilator equipment service management were developed. A total of 62 ventilators in clinical use in General Hospital of the Western Theater Command of the PLA from January to June 2023 were selected,and the 50 ventilators used from January to March adopted the conventional experience management model (referred to as experience management model),the 50 ventilators (including 38 in use in the experience management model) from April to June adopted the ventilator management path based on three-dimensional quality evaluation model (referred to as the model management model). The self-made satisfaction questionnaire was used to investigate the satisfaction of ventilator patients with equipment service quality,and the comprehensive evaluation difference score of equipment service quality and equipment operation quality of the two management modes were compared. Results:The comprehensive evaluation difference scores of equipment structure service quality,process service quality and outcome service quality of the model management mode were (0.08±0.06) points,(0.11±0.07) points and (0.05±0.04) points,respectively,which were lower than those of the experience management mode,the difference was statistically significant (Z=2.290,2.024,2.724,P<0.05). The average satisfaction of patients on ventilator therapy in the ICU wards of the department of respiratory and critical care medicine,department of intensive care unit,department of emergency and other departments was (95.66±1.74)％,(96.51±1.37)％,(95.93±1.67)％ and (96.56±1.28)％,respectively,which were higher than those of the experience management mode,the difference was statistically significant (Z=3.624,3.854,3.368,2.799,P<0.05). The average start-up operation rate and quality inspection pass rate of ventilator equipment were (95.38±1.67)％and (95.44±1.71)％,respectively,which were higher than those of experience management mode;the average failure rate was (1.23±0.98)％,which was lower than that of experience management mode,the difference was statistically significant (Z=2.219,2.733,3.005,P<0.05). Conclusion:The application of ventilator management path based on three-dimensional quality evaluation model can improve the quality of ventilator clinical service,enhance the satisfaction of clinical service,and improve the operation quality of equipment.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.

Objective To observe the effect of pre-hospital and intra-hospital collaborative ther-apeutic model in the treatment of patients with acute cerebral infarction.Methods A total of 67 pa-tients with acute cerebral infarction were selected as the research objects,and they were divided into observation group(n=37)and control group(n=30)according to the therapeutic model.The con-trol group was conducted with the traditional therapeutic model,while the observation group was con-ducted with the pre-hospital and intra-hospital collaborative therapeutic model.The time efficiency of intravenous thrombolysis,early recovery of nerve function and oxidative stress indexes were compared between the two groups.Results There was no significant difference in the time from onset to visit between the two groups(P＞0.05);the time from seeing a doctor to thrombolysis and the time from seeing a doctor to signing the informed consent for intravenous thrombolysis in the observation group were significantly shorter than those in the control group(P＜0.05).On the hospital admission,there was no significant difference in the National Institutes of Health Stroke Scale(NIHSS)score be-tween the two groups(P＞0.05);at the time points of 7 days after admission and 90 days after thrombolysis,the NIHSS scores of patients in the observation group were significantly lower than that in the control group(P＜0.05).There were no significant differences in the levels of serum glutathione peroxidase(GSH-Px)and malonaldehyde(MDA)between the two groups(P＞0.05);the level of serum superoxide dismutase(SOD)in the observation group was significantly higher than that in the control group(P＜0.05).One patient died in the control group,with a mortality rate of 3.33％;no patient died in the observation group.Conclusion Pre-hospital and intra-hospital collaborative therapeutic model can effectively improve the time efficiency of intravenous thrombolysis for patients with acute cerebral infarction,alleviate the neurological damage,and reduce degree of oxidative stress reaction and death risk.

Objective To observe the effect of pre-hospital and intra-hospital collaborative ther-apeutic model in the treatment of patients with acute cerebral infarction.Methods A total of 67 pa-tients with acute cerebral infarction were selected as the research objects,and they were divided into observation group(n=37)and control group(n=30)according to the therapeutic model.The con-trol group was conducted with the traditional therapeutic model,while the observation group was con-ducted with the pre-hospital and intra-hospital collaborative therapeutic model.The time efficiency of intravenous thrombolysis,early recovery of nerve function and oxidative stress indexes were compared between the two groups.Results There was no significant difference in the time from onset to visit between the two groups(P＞0.05);the time from seeing a doctor to thrombolysis and the time from seeing a doctor to signing the informed consent for intravenous thrombolysis in the observation group were significantly shorter than those in the control group(P＜0.05).On the hospital admission,there was no significant difference in the National Institutes of Health Stroke Scale(NIHSS)score be-tween the two groups(P＞0.05);at the time points of 7 days after admission and 90 days after thrombolysis,the NIHSS scores of patients in the observation group were significantly lower than that in the control group(P＜0.05).There were no significant differences in the levels of serum glutathione peroxidase(GSH-Px)and malonaldehyde(MDA)between the two groups(P＞0.05);the level of serum superoxide dismutase(SOD)in the observation group was significantly higher than that in the control group(P＜0.05).One patient died in the control group,with a mortality rate of 3.33％;no patient died in the observation group.Conclusion Pre-hospital and intra-hospital collaborative therapeutic model can effectively improve the time efficiency of intravenous thrombolysis for patients with acute cerebral infarction,alleviate the neurological damage,and reduce degree of oxidative stress reaction and death risk.

Objective To research the effect to the semen quality of the three operation methods of superiority of highly selective varicocele high ligation,transinguinal canal and laparoseopic of renovated polomo management of varicocele.Methods 561 patients in our hospital who charged by infertility had the operation were analyzed retrospectively and were recruited with primary varicocele above grade II for this study.These patients were divided into three group according to three kinds of operation methods of varicocele :group A was treated with highly selective varicocele high ligation and had 300 patients;group B was treated with transinguinal canal operation and had 181 patients; and group C was treated by laparescopic of renovated polomo operation with 80 patients.Through the comparing of the fertility ability of the three operation methods,to evaluate the therapeutic effect of the three methods.Results The increasing rates of the quality of semen in group B was higher than other groups if patients' ages were lower than 30.The increasing rates of the quality of semen in every group was also higher if patients' ages were lower than 30.No difference was found between three groups in natural conception rate (P＞0.05).Conclusion The methods of highly selective varieecele high ligation would be a better choice in the management of patients with primary varicecele because of higher quality of semen.

Objective To compare the therapeutic effects of 3 operative options with selective high level ligation of spermatic veins, transinguinal canal and renovated Potomo's laparoscopic manage-ment of varicocele. Methods From January 1990 to November 2006, 1075 primary varicocele above grade Ⅱ patients accepted the operations, of them, 685 patients had follow up data and were recruited into this study. These patients were divided into 3 groups according to the operative methods:group A (n=369) was treated with open selective high level ligation of spermatic veins, group B (n=218) was treated with open transinguinal canal operation, and group C (n=98) was treated by renovated Polo-mo's laparoscopic management of varicocele. The complications of the 3 operative methods were com-pared, such as recurrence rate, testicular atrophy rate, scrotal edema rate and semen analysis. The therapeutic effects of these 3 methods were evaluated. Results The recurrence rates of the 3 groups were 3.3%, 7.3% and 5.1%, respectively. Group A had significantly lower recurrence rate than group B, P<0.05. The testicular atrophy rates of 3 groups were 0.5%, 17.9% and 9.2%, respec-tively. There were significant differences among the 3 groups (P<0.05). The scrotal edema rates of the 3 groups were 1.4%, 17.4% and 16.3%, respectively. Group B and C had higher risk of scrotal edema than group A, P<0.05. For patients with ages younger than 30, the improved semen quality rate in group A was higher than in group B and C. The improved semen quality rate in each group of patients younger than 30 was higher than patients with age over 30. Conclusion The open selective high level ligation of spermatic veins is the best choice in the treatment for patients with primary sper-matic varicocele.

This study aims at the mechanism of foveola formation in bovine trabecular bone under fatigue process and its relation with biomechanical pathogenesis of senile osteoporosis. The scanning electron microscope equipped with fatigue stage was used to observe fatigue micro injury accumulation of cancellous bone. The massive foveola formation in the laminal bone of vertical trabeculae was found in the tensile fatigue test. There existed the collagen avulsion in the foveola. The massive foveola formation was also observed in the lamina bone of the horizontal trabeculae in the compressive fatigue test. The bone collagen fibers were protracted, debound with hydroxyapatite crystal, and then avulsed under tensile and bending stresses. Finally the retraction of the avulsed collagen fibers brought on the massive formation of foveolae in lamina bone. The mechanical capacity of bone also declined greatly. We infer that the direct mineralization of avulsed collagen and foveola in lamina bone would be one of the main processes of self repair in vivo, which brings on the increase in fragility and stiffness of trabeculae of senile osteoporotic bone along with the agelong accumulation of collagen fatigue injury and foveola formation in the lamina bone.
Animals ; Bone and Bones ; pathology ; ultrastructure ; Cattle ; Collagen ; ultrastructure ; Compressive Strength ; Durapatite ; chemistry ; In Vitro Techniques ; Microscopy, Electron, Scanning ; Models, Biological ; Stress, Mechanical ; Tensile Strength