Development of extramural health care for chronic wounds is still in its infancy in China, and thus it is urgent and vital to establish a correct concept and practicable principles. The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds. (1) The patient needs to do self-assessment of the wound by using available simple methods; (2) The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound; (3) Professionals evaluate the existing treatment strategies; (4) Etiological treatments are given by professionals; (5) Patients buy needed dressings via the more convenient ways from pharmacies, e-commerce platform or others; (6) Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions; (7) Both professionals and the patient pay attention to complications to prevent adverse outcomes; (8) Professionals strengthen the public education on wound care and integrated rehabilitation. This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.
Humans ; Wound Healing ; Health Facilities ; Delivery of Health Care ; China ; Wounds and Injuries/therapy*

Objective: To explore the association between sleep duration and the risk of frailty among the elderly over 80 years old in China. Methods: Using the data from five surveys of the China Elderly Health Influencing Factors Follow-up Survey (CLHLS) (2005, 2008-2009, 2011-2012, 2014, and 2017-2018), 7 024 elderly people aged 80 years and above were selected as the study subjects. Questionnaires and physical examinations were used to collect information on sleep time, general demographic characteristics, functional status, physical signs, and illness. The frailty state was evaluated based on a frailty index that included 39 variables. The Cox proportional risk regression model was used to analyze the correlation between sleep time and the risk of frailty occurrence. A restricted cubic spline function was used to analyze the dose-response relationship between sleep time and the risk of frailty occurrence. The likelihood ratio test was used to analyze the interaction between age, gender, sleep quality, cognitive impairment, and sleep duration. Results: The age M (Q₁, Q₃) of 7 024 subjects was 87 (82, 92) years old, with a total of 3 435 (48.9%) patients experiencing frailty. The results of restricted cubic spline function analysis showed that there was an approximate U-shaped relationship between sleep time and the risk of frailty. When sleep time was 6.5-8.5 hours, the elderly had the lowest risk of frailty; Multivariate Cox proportional risk regression model analysis showed that compared to 6.5-8.5 hours of sleep, long sleep duration (>8.5 hours) increased the risk of frailty by 13% (HR: 1.13; 95%CI: 1.04-1.22). Conclusion: There is a nonlinear association between sleep time and the risk of frailty in the elderly.
Aged ; Humans ; Aged, 80 and over ; Frailty/epidemiology* ; Sleep Duration ; Prospective Studies ; Sleep/physiology* ; China/epidemiology*

Objective    To explore the mechanism of dihydrouridine synthase 4-like (DUS4L) on the development of lung adenocarcinoma (LUAD). Methods    The RNA-seq expression data of LUAD was downloaded from The Cancer Genome Atlas (TCGA), and the relationship between its clinical pathological characteristics and DUS4L mRNA expression was evaluated. The effect of DUS4L knockdown on the proliferation of A549 cells was detected by EDU proliferation assay. The gene expression profile of lung adenocarcinoma A549 cells in the DUS4L knockdown group (KD group) and control group (NC group) was detected by transcriptome sequencing technique. The differential genes were screened by DESeq2. ClusterProfiler was used to perform GO functional enrichment analysis of differential genes. Results    The expression of DUS4L mRNA in LUAD tissues was higher than that in normal tissues, and the up-regulation of DUS4L was related to the clinical pathological characteristics of LUAD patients. EDU proliferation assay suggested that knocking down DUS4L could inhibit the proliferation of A549 cells. A total of 456 differential genes were screened, including 289 up-regulated genes and 167 down-regulated genes [|log2(fold change)|>1 and Padj<0.05]. STC2 and TRIB3 were significantly down-regulated (P<0.05). Differential genes were mainly involved in the production of interleukin-8, angiogenesis, vascular endothelial cell proliferation and other biological pathways. Conclusion    DUS4L can widely regulate the gene expression of LUAD cells, which provides a new idea for further studying the function and role of DUS4L in the occurrence and development of LUAD and finding new therapeutic targets for LUAD.

Aortic Valve/surgery* ; Aortic Valve Stenosis/surgery* ; Humans ; Transcatheter Aortic Valve Replacement

Humans ; Kidney/pathology* ; Plasmacytoma/pathology*

This study investigated the protective effects of Moutan Cortex polysaccharides components(MCPC) on the renal tissues of diabetic nephropathy(DN) rats and explored their regulation effect on inflammatory response and oxidative stress. The DN rat model was induced by high-glucose and high-fat diet combined with streptozotocin(STZ), and then the rats were randomly divided into control group, model group, positive group and MCPC high(120 mg·kg~(-1)·d~(-1)), low(60 mg·kg~(-1)·d~(-1)) dose groups. After 12 weeks treatment, blood was taken from the orbit of the rats, and then they were sacrificed before the kidney tissues were collected. The serum and tissues were detected for related biochemical indicators and pathological changes of the kidney. Immunohistochemical methods were used to determine the expression of FN and ColⅣ in the kidney tissue of DN rats. Compared with the model group, blood glucose, serum creatinine, blood urea nitrogen and 24 h urine protein in the MCPC high-dose group were significantly reduced(P<0.01). The results of HE, PAS, Masson staining showed that glomerular basement membrane thickening, Bowman's capsule narrowing and inflammatory cell infiltration in DN rats were improved in the MCPC high-dose group; the activity of T-SOD and GSH-Px in serum significantly increased(P<0.001), and the expression level of FN significantly decreased(P<0.001). The high-dose MCPC treatment could effectively inhibit the abnormal expression of Col Ⅳ(P<0.001) and significantly reduce the levels of AGEs and RAGE in serum(P<0.001), the content of VCAM-1 and IL-1β in serum(P<0.001), and the levels of IL-1β mRNA in kidney tissue(P<0.001), but failed to effectively reduce VCAM-1 mRNA levels in kidney tissues. The high-dose MCPC could significantly improve pathological injury of renal tissue and related renal indicators in DN rats, and achieve renal protection in DN rats mainly by regulating oxidative stress and inflammatory factors.
Animals ; Diabetes Mellitus, Experimental/genetics* ; Diabetic Nephropathies/genetics* ; Drugs, Chinese Herbal ; Kidney ; Paeonia ; Polysaccharides/pharmacology* ; Rats

BACKGROUND: Lung cancer is the cancer with the highest mortality at home and abroad at present. The detection of lung nodules is a key step to reducing the mortality of lung cancer. Artificial intelligence-assisted diagnosis system presents as the state of the art in the area of nodule detection, differentiation between benign and malignant and diagnosis of invasive subtypes, however, a validation with clinical data is necessary for further application. Therefore, the aim of this study is to evaluate the effectiveness of artificial intelligence-assisted diagnosis system in predicting the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules. METHODS: Clinical data of 223 patients with early-stage lung adenocarcinoma appearing as pulmonary nodules admitted to the Lanzhou University Second Hospital from January 1st, 2016 to December 31th, 2021 were retrospectively analyzed, which were divided into invasive adenocarcinoma group (n=170) and non-invasive adenocarcinoma group (n=53), and the non-invasive adenocarcinoma group was subdivided into minimally invasive adenocarcinoma group (n=31) and preinvasive lesions group (n=22). The malignant probability and imaging characteristics of each group were compared to analyze their predictive ability for the invasive subtypes of early-stage lung adenocarcinoma. The concordance between qualitative diagnostic results of artificial intelligence-assisted diagnosis of the invasive subtypes of early-stage lung adenocarcinoma and postoperative pathology was then analyzed. RESULTS: In different invasive subtypes of early-stage lung adenocarcinoma, the mean CT value of pulmonary nodules (P<0.001), diameter (P<0.001), volume (P<0.001), malignant probability (P<0.001), pleural retraction sign (P<0.001), lobulation (P<0.001), spiculation (P<0.001) were significantly different. At the same time, it was also found that with the increased invasiveness of different invasive subtypes of early-stage lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. On the issue of binary classification, the sensitivity, specificity, and area under the curve (AUC) values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 81.76%, 92.45% and 0.871 respectively. On the issue of three classification, the accuracy, recall rate, F1 score, and AUC values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 83.86%, 85.03%, 76.46% and 0.879 respectively. CONCLUSIONS Artificial intelligence-assisted diagnosis system could predict the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules, and has a certain predictive value. With the optimization of algorithms and the improvement of data, it may provide guidance for individualized treatment of patients.
Adenocarcinoma/pathology* ; Adenocarcinoma of Lung/pathology* ; Artificial Intelligence ; Humans ; Lung Neoplasms/pathology* ; Multiple Pulmonary Nodules ; Neoplasm Invasiveness ; Retrospective Studies

OBJECTIVE: To evaluate the protective function of Babao Dan (BBD) on 5-flurouracil (5-FU)-induced intestinal mucositis (IM) and uncover the underlying mechanism. METHODS: A total of 18 male mice were randomly divided into 3 groups by a random number table, including control, 5-FU and 5-FU combined BBD groups, 6 mice in each group. A single intraperitoneal injection of 5-FU (150 mg/kg) was performed in 5-FU and 5-FU combined BBD groups on day 0. Mice in 5-FU combined BBD group were gavaged with BBD (250 mg/kg) daily from day 1 to 6. Mice in the control group were gavaged with saline solution for 6 days. The body weight and diarrhea index of mice were recorded daily. On the 7th day, the blood from the heart of mice was collected to analyze the proportional changes of immunological cells, and the mice were subsequently euthanized by mild anesthesia with 2% pentobarbital sodium. Colorectal lengths and villus heights were measured. Intestinal-cellular apoptosis and proliferation were evaluated by Tunel assay and immunohistochemical staining of proliferating cell nuclear antigen, respectively. Immunohistochemistry and Western blot were performed to investigate the expressions of components in Wnt/β-catenin pathway (Wnt3, LRP5, β-catenin, c-Myc, LRG5 and CD44). RESULTS: BBD obviously alleviated 5-FU-induced body weight loss and diarrhea, and reversed the decrease in the number of white blood cells, including monocyte, granulocyte and lymphocyte, and platelet (P<0.01). The shortening of colon caused by 5-FU was also reversed by BBD (P<0.01). Moreover, BBD inhibited apoptosis and promoted proliferation in jejunum tissues so as to reduce the intestinal mucosal damage and improve the integrity of villus and crypts. Mechanically, the expression levels of Wnt/β -catenin mediators such as Wnt3, LRP5, β-catenin were upregulated by BBD, activating the transcription of c-Myc, LRG5 and CD44 (P<0.01). CONCLUSIONS BBD attenuates the adverse effects induced by 5-FU via Wnt/β-catenin pathway, suggesting it may act as a potential agent against chemotherapy-induced intestinal mucositis.
Animals ; Male ; Mice ; Antineoplastic Agents/therapeutic use* ; beta Catenin/metabolism* ; Diarrhea/drug therapy* ; Fluorouracil/pharmacology* ; Intestinal Mucosa ; Mucositis/metabolism* ; Pentobarbital/therapeutic use* ; Proliferating Cell Nuclear Antigen/metabolism* ; Saline Solution

Objective:To observe the effect of Dredging Correcting Manipulation on cblC methylmalonic aciduria (MMA). Methods:From October, 2017 to October, 2018, 72 children with cblC MMA combined with growth retardation were divided into control group (n = 36) and experimental group (n = 36) according to the consent of their parents. The control group accepted routine medicine, and the experimental group received Dredging Correcting Manipulation in addition. The Griffiths Development Scale-Chinese version (GDS-C) was used to evaluate the two groups before and after treatment. At the same time, body length, body mass and head circumference were measured. Results:Six cases in the control group and five cases in the experimental group were dropped out. There was no significant difference in the development quotients of GDS-C in gross movement, personal and social, hearing and speech, hand-eye coordination, operation and total quotient between two groups before treatment (P > 0.05). After treatment, all the development quotients increased in both groups (t > 6.110, P < 0.001), and the development quotients of GDS-C in gross movement, personal and social, hand-eye coordination and total quotient were higher in the experimental group than in the control group (t > 2.154, P < 0.05), as well as the body length (t = 2.027, P < 0.05). Conclusion:Dredging Correcting Manipulation can promote the neuropsychological and physical development of children with cblC MMA combined with retardation.

Objective:To evaluate the efficacy of artificial intelligence assisted pulmonary nodule diagnosis system in detection pulmonary nodule and predicting the malignant probability of pulmonary nodule.Methods:A retrospectively analyze the clinical data of 199 patients with lung nodules in the Thoracic Surgery Department of Lanzhou University Second Hospital from May 2016 to July 2020. The preoperative chest CT was imported into the artificial intelligence system to record the detected lung nodules, to measure nodal diameter and density classification and malignant probability prediction value of each nodule. The detection rate of pulmonary nodules by artificial intelligence system was calculated, and the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of artificial intelligence system in the differential diagnosis of benign and malignant pulmonary nodules were calculated and compared with manual film reading. and the sensitivity and specificity in the differential diagnosis of benign and malignant pulmonary nodules under the condition of different size and density of pulmonary nodules.Results:A total of 204 pulmonary nodules were pathologically diagnosed by surgical resection, and the detection rate of pulmonary nodules by artificial intelligence system was 100%. The artificial intelligence system can distinguish benign and malignant pulmonary nodules with a sensitivity of 95.83%(95% CI: 0.8967-0.9883), specificity 25.00%(95% CI: 0.1717-0.3425), and a positive likelihood ratio of 1.27(95% CI: 1.14-1.44), negative likelihood ratio 0.17(95% CI: 0.06-0.46), Manual reading for the differentiation of benign and malignant pulmonary nodules has a sensitivity of 87.36%(95% CI: 0.7850-0.9352), specificity 72.17%(95% CI: 0.6214-0.8079), and a positive likelihood ratio of 3.14(95% CI: 2.26-4.37), the negative likelihood ratio is 0.18(95% CI: 0.10-0.31). 5mm≤diameter of pulmonary nodule<10 mm, sensitivity 100%(95% CI: 0.6637-1.0000), specificity 50.00%(95% CI: 0.01258-0.98740), 10 mm≤diameter of pulmonary nodule <20 mm, sensitivity 94.29%(95% CI: 0.8084-0.9930), specificity 29.83%(95% CI: 0.1843-0.4340), 20 mm≤ diameter of pulmonary nodule ≤30 mm, sensitivity 96.15%(95% CI: 0.8679-0.9953), specificity 18.37%(95% CI: 0.0876-0.9953), sensitivity of subsolid lung nodules: 100%(95% CI: 0.9051-1.0000), specificity 20.00%(95% CI: 0.0051-0.7164), solid lung nodule sensitivity 93.22%(95% CI: 0.8354-0.9812), specificity 25.24%(95% CI: 0.1720-0.3476). Conclusion:The artificial intelligence assistant diagnosis system of pulmonary nodules has a strong performance in the detection of pulmonary nodules, but it can not meet the clinical requirements in the differentiation of benign and malignant pulmonary nodules. At present, the artificial intelligence system can be used as an auxiliary tool for doctors to detect pulmonary nodules and assist in the diagnosis of benign and malignant pulmonary nodules.