OBJECTIVE: To explore clinical characteristics, lesion sites and correlation differences of different types of diabetic foot gangrene, and to provide evidence-based basis for clinical classification of diabetic foot gangrene. METHODS: A retrospective analysis was conducted on 266 patients with newly diagnosed diabetic foot gangrene who were admitted from January 2018 to December 2018, including 183 males and 83 females, aged from 35 to 92 years old with an average of (69.55±10.84) years old, and they were divided into wet gangrene group and dry gangrene group according to the different natures of gangrene. There were 139 patients in wet gangrene group, including 98 males and 41 females, aged from 35 to 90 years old with an average of (68.95±10.93) years old. There were 127 patients in dry gangrene group, including 85 males and 42 females, aged from 38 to 92 years old with an average of (70.21±10.75) years old. Body mass index (BMI), waist-to-hip ratio (WHR), body temperature, skin temperature difference between the affected and healthy sides of the lower extremities, and Wagner grade between two groups were recorded to evaluate symptoms and signs. The white blood cell count (WBC), neutrophil percentage (NEUT%), and C-reactive protein (C-reactive protein), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and interleukin-6 (IL-6) in peripheral blood between two groups were detected and compared to evaluate the infection status;the severity of diabetic peripheral neuropathy (DPN) was evaluated by using Toronto Clinical Scoring System (TCSS);the degree of pain in patients with diabetic foot gangrene was evaluated by numerical rating scale (NRS); ankle-brachial index (ABI) and popliteal artery blood flow velocity were used to evaluate the degree of arterial lesions. Spearman correlation analysis was used to analyze the correlations between gangrene TCSS, ABI and age, BMI, WHR, body temperature, calf skin temperature difference, WBC, NEUT%, CRP, ESR, PCT, IL-6, NRS, and Wagner classification indicators. RESULTS: The body temperature, skin temperature difference between the affected and healthy sides of the lower extremities, Wagner grade, WBC, NEUT%, CRP, ESR, PCT, IL-6, TCSS score, ABI, and popliteal artery blood flow velocity in wet gangrene group were higher than those in dry gangrene group (P<0.01), and BMI, WHR, and NRS score in dry gangrene group were higher than those in wet gangrene group;the differences were all statistically significant (P<0.01). The results of Spearman correlation analysis showed TCSS score of gangrene patients was correlated with body temperature (r=0.214), calf skin temperature difference (r=0.364), WBC (r=0.240), NEUT% (r=0.291), CRP (r=0.347), ESR (r=0.167), PCT (r=0.241), IL-6 (r=0.316), and popliteal fossa arterial blood flow velocity (r=0.261) and Wagner grade (r=0.273) were positively correlated, and the differences were statistically significant (P<0.01). ABI was negatively correlated with age (r=-0.183), BMI (r=-0.252), WHR (r=-0.288), and NRS score (r=-0.354), and the differences were statistically significant (P<0.01). CONCLUSION Diabetic foot gangrene is an extremely difficult and critical disease. Wet gangrene has a significant synergic effect with infection and neuropathy, while dry gangrene is closely related to vascular occlusion. The main contradiction of gangrene could be revealed through blood vessels, nerves and infection, providing evidence-based basis for the selection of debridement timing, anti-infection strategies and revascularization, with the aim of reducing the risk of amputation.
Humans ; Male ; Female ; Aged ; Middle Aged ; Diabetic Foot/diagnosis* ; Aged, 80 and over ; Adult ; Retrospective Studies ; Gangrene/physiopathology* ; C-Reactive Protein

Objective To address the issue of motion misclassification caused by individual gait differences and fixed time window data extraction in motion intention recognition for intelligent lower limb prostheses,this study proposes a motion intention recognition method based on adaptive temporal alignment.Methods In lower limb motion analysis,for continuous gait cycle data,inter-class variability across different steady-state modes was utilized to detect gait pattern consistency through inter-cycle frame differencing.For samples identified as single steady-state modes,the dynamic time warping algorithm was introduced to align adjacent mo-tion sequences,thereby reducing individual variability.Haar wavelet 4-level decomposition was applied to ex-tract low-frequency coefficients for feature vector construction,and classification was performed using a support vector machine.The experimental protocol was designed as follows:three inertial measurement units were used to collect lower limb acceleration and angular velocity data from subjects performing thirteen locomotion modes.The test subjects included ten healthy participants and one transtibial amputee.The locomotion modes consisted of five steady-state modes(level walking,stair ascent,stair descent,ramp ascent,and ramp descent)and eight transition modes(mutual transitions between level walking and stair ascent/descent,as well as ramp ascent/de-scent).Results Simulation tests on ten healthy individuals and one amputee showed recognition accuracies of 99.24%and 100%for five steady-state modes,and 98.51%and 89.11%for all thirteen motion modes,respectively.Conclusion This study proposes an adaptive temporal alignment-based motion intention recognition method.The pro-posed approach effectively reduces the interference of individual gait variability on feature representation,en-hances the consistency and discriminability of gait features,and ultimately improves recognition performance.

Objective To investigate the effect of modified dorsal palmar artery flap in repairing skin defect of hand.Methods A prospective study was conducted on 78 patients with hand skin defects in our hospital from May 2018 to May 2023,who were randomly divided into a control group(n=39)and a study group(n=39)using a random number table method.The control group was given conventional flap repair,while the study group was given modified dorsal metacarpal artery flap repair.The surgical conditions,flap blood supply,motor function of the affected finger,sensory function,postoperative complications and appearance satisfaction of the two groups were compared.Results The operation time,hospital stay and wound healing time of the research group were(110.28±17.65)minutes,(8.94±1.76)d and(14.39±3.82)d,respectively.Which were shorter than the control group[(121.43±15.94)min,(10.13±1.88)d,and(16.51±4.07)d,respectively].The intraoperative blood loss in the research group was(38.12±7.81)ml,which was lower than that of the control group[(42.59±7.43)ml].The elasticity scores of the study group at 1 month,3 months,and 6 months after surgery were(1.31±0.28),(2.34±0.31),and(2.81±0.08),respectively,which were higher than those of the control group[(1.12±0.25),(2.05±0.28),and(2.59±0.17),respectively].The capillary filling time scores were(1.24±0.26),(2.42±0.27),and(2.75±0.12),respectively,which were higher than those of the control group(1.06±0.23),(2.13±0.25),and(2.43±0.27),respectively;the excellent and good rate of motor function of the affected fingers in the study group was 97.44％,which was higher than that of the control group(79.49％),the incidence of complications was 5.13％,which was lower than that of the control group(23.08％),the appearance satisfaction rate was 89.74％,which was higher than that of the control group(71.79％)(P＜0.05).Conclusion The modified dorsal palmar artery flap for the treatment of hand skin defects can optimize the operation process,improve the local blood flow of the flap,promote the recovery of finger motor function and sensory function,enhance the appearance effect and reduce the risk of complications.

Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

Objective To investigate the effect of modified dorsal palmar artery flap in repairing skin defect of hand.Methods A prospective study was conducted on 78 patients with hand skin defects in our hospital from May 2018 to May 2023,who were randomly divided into a control group(n=39)and a study group(n=39)using a random number table method.The control group was given conventional flap repair,while the study group was given modified dorsal metacarpal artery flap repair.The surgical conditions,flap blood supply,motor function of the affected finger,sensory function,postoperative complications and appearance satisfaction of the two groups were compared.Results The operation time,hospital stay and wound healing time of the research group were(110.28±17.65)minutes,(8.94±1.76)d and(14.39±3.82)d,respectively.Which were shorter than the control group[(121.43±15.94)min,(10.13±1.88)d,and(16.51±4.07)d,respectively].The intraoperative blood loss in the research group was(38.12±7.81)ml,which was lower than that of the control group[(42.59±7.43)ml].The elasticity scores of the study group at 1 month,3 months,and 6 months after surgery were(1.31±0.28),(2.34±0.31),and(2.81±0.08),respectively,which were higher than those of the control group[(1.12±0.25),(2.05±0.28),and(2.59±0.17),respectively].The capillary filling time scores were(1.24±0.26),(2.42±0.27),and(2.75±0.12),respectively,which were higher than those of the control group(1.06±0.23),(2.13±0.25),and(2.43±0.27),respectively;the excellent and good rate of motor function of the affected fingers in the study group was 97.44％,which was higher than that of the control group(79.49％),the incidence of complications was 5.13％,which was lower than that of the control group(23.08％),the appearance satisfaction rate was 89.74％,which was higher than that of the control group(71.79％)(P＜0.05).Conclusion The modified dorsal palmar artery flap for the treatment of hand skin defects can optimize the operation process,improve the local blood flow of the flap,promote the recovery of finger motor function and sensory function,enhance the appearance effect and reduce the risk of complications.

Objective To address the issue of motion misclassification caused by individual gait differences and fixed time window data extraction in motion intention recognition for intelligent lower limb prostheses,this study proposes a motion intention recognition method based on adaptive temporal alignment.Methods In lower limb motion analysis,for continuous gait cycle data,inter-class variability across different steady-state modes was utilized to detect gait pattern consistency through inter-cycle frame differencing.For samples identified as single steady-state modes,the dynamic time warping algorithm was introduced to align adjacent mo-tion sequences,thereby reducing individual variability.Haar wavelet 4-level decomposition was applied to ex-tract low-frequency coefficients for feature vector construction,and classification was performed using a support vector machine.The experimental protocol was designed as follows:three inertial measurement units were used to collect lower limb acceleration and angular velocity data from subjects performing thirteen locomotion modes.The test subjects included ten healthy participants and one transtibial amputee.The locomotion modes consisted of five steady-state modes(level walking,stair ascent,stair descent,ramp ascent,and ramp descent)and eight transition modes(mutual transitions between level walking and stair ascent/descent,as well as ramp ascent/de-scent).Results Simulation tests on ten healthy individuals and one amputee showed recognition accuracies of 99.24%and 100%for five steady-state modes,and 98.51%and 89.11%for all thirteen motion modes,respectively.Conclusion This study proposes an adaptive temporal alignment-based motion intention recognition method.The pro-posed approach effectively reduces the interference of individual gait variability on feature representation,en-hances the consistency and discriminability of gait features,and ultimately improves recognition performance.

Aim To investigate the role of metabolites of eicosapentaenoic acid (EPA) in promoting the transdifferentiation of pancreatic α cells to β cells. Methods Male C57BL/6J mice were injected intraperitoneally with 60 mg/kg streptozocin (STZ) for five consecutive days to establish a type 1 diabetes (T1DM) mouse model. After two weeks, they were randomly divided into model groups and 97% EPA diet intervention group, 75% fish oil (50% EPA +25% DHA) diet intervention group, and random blood glucose was detected every week; after the model expired, the regeneration of pancreatic β cells in mouse pancreas was observed by immunofluorescence staining. The islets of mice (obtained by crossing GCG

Objective To understand the present situation of the standardization of separate serving chopsticks and ladles provided by catering service providers in Shanghai,and to analyze the influencing factors.Methods A total of 971 catering service providers from extra large,medium and small restaurant in 16 administrative districts of Shanghai were investigated with a self-designed questionnaire using stratified two-stage sampling method between Sep and Nov 2023,mainly concentrate on thesituation and reasons of providing separate serving chopsticks and ladles and their compliance with standards.Logistic regression was used to explore the influencing factors.Results Among the 971 units surveyed,there were 911 catering service(93.8%)providers that provided separate serving chopsticks and ladles.The main reason for providing separate serving chopsticks and ladles is for improving high quality of catering service.Binary Logistic analysis showed that catering service providers with large scale restaurant(large:OR=2.08,95%CI:2.03-2.12;medium:OR=1.99,95%CI:1.96-2.02),good quantitative level of food safety(OR=1.84,95%CI:1.83-1.85),named Shanghai Green Restaurant(OR=1.11,95%CI:1.09-1.12),known as time-honored brand(OR=1.20,95%CI:1.17-1.22),regularly acceptance of law enforcement inspections(OR=6.99,95%CI:6.91-7.07),knowledge of relevant regulation(OR=5.77,95%CI:5.70-5.85)and more channels for understanding standards(OR=1.23,95%CI:1.21-1.25)were more likely to provide separate serving chopsticks and ladles.The situation that strictly follow the fully standard requirements of separate serving chopsticks and ladles to provide 8 types of catering conducts was unsatisfactory(14.1%).Logistic analysis showed that catering service providers with large scale restaurant(extra large:OR=6.42,95%CI:2.52-16.33;large:OR=4.29,95%CI:2.24-8.21;medium:OR=3.21,95%CI:1.76-5.87)and the provision of separate serving chopsticks and ladles for more than 3 years(OR=3.1,95%CI:1.09-9.02)had a higher percentage of providing separate serving chopsticks and ladles in accordance with specification.Conclusion The overall provision of separate serving chopsticks and ladles by catering service providers in Shanghai is satisfactory.The scale of restaurant,quantitative level of food safety and named Shanghai Green Restaurant are possible main factors for providing separate serving chopsticks and ladles of catering service providers.However,the implementation is not good according to the standardization.The different scale of restaurant and the time of the provision of separate chopsticks and ladles are possible factors for providing separate serving chopsticks and ladles in accordance with specification.

Plague,caused by Yersinia pestis,is a zoonotic disease that infects both humans and animals.Y.pestis not only encodes various virulence factors that can disrupt host immune signaling but also can modify its lipopolysaccharide(LPS)struc-ture,thereby evading host immune surveillance and potently suppressing the host's immune response,in an important molecu-lar mechanism underlying its high pathogenicity.The LPS of Y.pestis lacks an O antigen,and its lipid A structure possesses a unique temperature transition regulatory mechanism.At different temperatures,Y.pestis forms lipid A with different numbers of acyl side chains,which plays a pivotal role in the evasion of host innate immune recognition and clearance.Here,we present a comprehensive review of research progress in the biosynthetic regulation,structural variation,and immune escape mechanism of Y.pestis LPS,to provide a reference for the study of the molecular mechanisms of pathogens using LPS structural modifica-tions to elude host innate immune defenses.