Objective: To investigate the seroepidemiological characteristics of hepatitis B among outpatients in medical institutions in Jiaxing City, Zhejiang Province, so as to provide a reference for formulating region-specific hepatitis B prevention and control strategies. Methods: From April to June 2024, outpatients were selected as study subjects from sentinel medical institutions in Jiaxing City. Information such as gender and age was collected. Venous blood samples were obtained and serological markers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb) were tested. Positive rates of hepatitis B virus (HBV) serological markers were analyzed by genders and ages. Results: A total of 1 468 outpatients were included, among whom 721 were males (49.11%) and 747 were females (50.89%). The mean age was (46.41±19.66) years. The positive rates of HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb were 7.29%, 44.75%, 1.84%, 23.50%, and 42.03%, respectively. The HBcAb positive rate in males was significantly higher than in females (46.05% vs. 38.15%, P<0.05), while no statistically significant gender differences were observed in the positive rates of other four HBV serological markers (all P>0.05). Except for HBsAb, the positive rates of the other four HBV serological markers showed statistically significant differences across different age groups (all P<0.05). Pairwise comparisons results showed that the HBsAg positive rates in age groups of 20-<40 years and 40-<60 years were 9.48% and 9.57%, respectively, which were higher than those in age groups of <20 years (1.43%) and &ge;60 years (2.75%) (all P<0.05). A total of 17 HBV serological marker patterns were observed, among which the proportion of all markers negative was the highest, at 39.65%. The proportions of "small three positive" (HBsAg+, HBeAb+, HBcAb+) and "large three positive" (HBsAg+, HBeAg+, HBcAb+) patterns were 4.77% and 1.50%, respectively. Among HBsAg-positive individuals, the proportions of the "small three positive" pattern across age groups were 0, 45.45%, 90.00%, and 81.82%, while those of the "large three positive" were 0, 36.36%, 5.00%, and 0, with statistically significant differences across age groups (both P<0.05). Conclusions The positive rate of HBsAg among outpatients in medical institutions in Jiaxing City is relatively high, with a notable proportion of individuals showing either no immunity or non-response to vaccination. It is recommended to strengthen hepatitis B immunization efforts among the population aged 20-<60 years, and to enhance monitoring and interventional treatment for "small three positive" and "large three positive" patterns.

Objective:To investigate the clinical efficacy of combination of a Flow-through anterolateral thigh myocutaneous flap with a contralateral great saphenous vein grafting in reconstruction of Gustilo ⅢC foot and ankle injury in emergency surgery.Methods:This retrospective study analysed the clinical data of 9 patients who were admitted in the Department of Wound Repair Surgery, Suzhou Ruihua Orthopaedic Hospital between September 2021 and October 2023. All patients were diagnosed with Gustilo ⅢC foot and ankle injury and met the predefined inclusion criteria. The average age of the patients was 45 (26-64) years. The mean of Mangled Extremity Severity Score (MESS) was 8.2 points, with a range from 5 to 10 points. The wound area after debridement ranged from 15.5 cm×6.0 cm to 24.5 cm×12.5 cm, with the vascular occlusion or defect at 4.0-20.0 (mean, 6.3) cm in length. The size of the flap was 16.5 cm×7.0 cm-25.5 cm×13.5 cm. During surgery, segments of the great saphenous vein were excised in the length of 5.0-21.0 cm, at an approximately 6.5 cm in length. The Flow-through anterolateral thigh myocutaneous flap was employed to reconstruct the soft tissue defect and to establish vascular connections between the anterior or posterior tibial arteries and veins, with the vessels carried by the flap. Additionally, the contralateral great saphenous vein was taken to bridge the posterior or anterior tibial arteries and veins. Follow-ups were carried out by outpatient visits, telephone calls and WeChat interviews. The flap viability, limb blood circulation, wound healing at both donor and recipient sites, as well as functional recovery of the affected limbs was observed. Sensation recovery of the flap was assessed according to the rating standard established by the British Medical Research Council (BMRC) , while the function recovery of foot and ankle was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale.Results:All flaps successfully survived without vascular complication. Eight affected limbs were effectively cured, while a calf that had an infection and necrosis of a long segment of tibia and fibula was amputated below-the-knee in the stage-II surgery. One of the donor sites of flap was covered with a medium-thickness skin graft from lower abdomen due to the large size of the flap, while the other donor sites were directly sutured and healed at first intention. One patient developed postoperative bone infection, which was successfully treated through re-debridement and antibiotic bone cement filling. Another patient experienced partial necrosis at the distal hallux due to a prolonged limb ischemia, and a stump repair surgery was performed. All patients were entered into the postoperative follow-up for 15.3 (6-24) months. At the final follow-up visit, satisfactory colour and texture were observed on all flaps, although minor oedema was present. Donor sites healed well and the donor limb function was not affected. Sensory evaluation rated S 2 in 5 flaps and S 3 in 3 flaps according to BMRC. Functional assessment of foot and ankle of the affected limb yielded excellent in 2 patients, good in 5 patients and fair in 1 patient according to AOFAS. Conclusion:Flow-through anterolateral thigh myocutaneous flap combined with a contralateral great saphenous vein grafting enables one-stage reconstruction for soft tissue defect and blood circulation of the affected limb. It is a good method in the treatment of Gustilo ⅢC foot and ankle injury in emergency surgery.

Objective:To explore the clinical effects of free bilateral turbocharged anterolateral thigh flaps in tandem in repairing extensive wounds in the foot and ankle.Methods:The study was a retrospective observational study. From April 2020 to June 2023, 12 patients with extensive wounds in the foot and ankle who met the inclusion criteria were admitted to the Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 8 males and 4 females, aged 21 to 65 years. The wound area after debridement ranged from 27 cm×14 cm to 37 cm×20 cm. The bilateral perforator flaps pedicled with either oblique or descending branches of the lateral circumflex femoral artery were designed and harvested based on the size and shape of the wounds. The individual flap incision area ranged from 16 cm×9 cm to 34 cm×12 cm. The non-homologous perforator of the flap on the one side was turbocharged by anastomosing it with the gross muscular branch or main vessel of the oblique or descending branch of the lateral circumflex femoral artery from the flap. Subsequently, the proximal end of the oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein from the flap on the one side were connected end-to-end with either the anterior tibial artery and vein, posterior tibial artery and vein, or dorsal foot artery and vein in the recipient area, the distal end of the oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein from the flap on the one side were anastomosed end-to-end with a source vessel originating from flap on the other side. The wounds in the flap donor areas were sutured directly. The number and source of perforators carried by the flaps and the duration of the flap repair surgery were recorded. The survival of the flap, the occurrence of vascular crisis, and the wound healing at both donor and recipient areas were observed after surgery. The flap condition, appearance and function of the affected limb were observed during follow-up. At the last follow-up, the sensory function of the flap was assessed using the British Medical Research Council's sensory rating standard, the foot and ankle function of the affected limb was evaluated according to the American Orthopedic Foot and Ankle Society scoring standard.Results:A total 24 flaps were successfully harvested, carrying 60 perforators, including 34 perforators from the oblique branch of the lateral circumflex femoral artery, 24 perforators from the descending branch of the lateral circumflex femoral artery, one perforator from the transverse branch of the lateral circumflex femoral artery, and one perforator from the direct branch of the femoral artery. The duration of the flap repair surgery ranged from 4.2 to 9.0 hours. The flaps of 12 patients exhibited complete survival after surgery. A total of two flaps of two patients experienced venous crisis after surgery but survived through emergency exploration. One patient encountered undesirable wound healing at the donor area of flap on the one side after surgery, which healed after dressing change, debridement, and suturing. The remaining patients' donor area wounds healed. Two patients displayed impaired wound healing in the recipient area, which improved after dressing change and resection of residual sequestrum, and the wounds in the recipient area of other patients healed successfully. During the follow-up of 4-26 months, the flaps demonstrated favorable color and texture, slight edematous appearance, and partial sensory recovery, as well as good aesthetic and functional restoration of the affected limbs. At the last follow-up, the sensory function of the flap was assessed as grade S2 in 9 cases and grade S3 in 3 cases; the foot and ankle function of the affected limb was evaluated as excellent in two cases, good in 9 cases, and fair in one case.Conclusions:The bilateral turbocharged anterolateral thigh flaps have numerous sources of perforators. By implementing supercharging of non-homologous perforators within the flap, the vascular supply to the flap is turbocharged, thereby mitigating the risk of extensive flap necrosis. The flap is an effective approach for repairing extensive wounds in the foot and ankle, resulting in improved function of the affected limb after repair.

Objective To explore the molecular mechanism by which SOS Ras/Rac guanine nucleotide exchange factor 1-intronic transcript 1(SOS1-IT1)affects enhancer of zeste homolog 2(EZH2)protein expression in endometrial cancer cells Ishikawa and RL95-2.Methods Lentiviral transfection of short hairpin RNA(shRNA)and overexpression plasmid were used in Ishikawa and RL95-2 cell lines to knock down and overexpress SOS1-IT1.The mechanism of EZH2 expression regulation was studied using Real-time PCR,Western blotting,and chromatin immunoprecipitation.Results The expression of SOS1-IT1 and EZH2 genes was positively correlated in endometrial cancer tissues.Knocking down SOS1-IT1 significantly reduces the expression of EZH2,inhibited the proliferation and migration of Ishikawa and RL95-2 cells,and could reduced the acetylation of histone H3 at position 27(H3K27)and the enrichment of CREB binding protein(CBP)in the EZH2 gene promoter region.Overexpression of SOS1-IT1 could increased the expression of EZH2 and enhance the acetylation of H3K27 and the enrichment of CBP.CBP could bind to SOS1-IT1 RNA,and this binding ability was weakened when CBP was knocked down.Conclusion SOS1-IT1 can promote the expression level of EZH2 in endometrial cancer cells Ishikawa and RL95-2 by regulating the acetylation modification level of the EZH2 gene promoter region,thereby affecting the proliferation and migration ability of endometrial cancer cells.

Objective To investigate the efficacy of Castor branching stent in treating Stanford type B aortic dissection(TBAD)involving aortic arch.Methods The clinical data of 18 patients with Stanford TBAD,who were treated with Castor branching stent at the Suining Municipal Central Hospital of China from January 2020 to January 2022,were retrospectively analyzed.Results The main bracket and branch bracket of Castor branching stent were successfully released in all the 18 patients with a surgical success rate of 100％,and no internal leakage occurred during operation.During the perioperative period,there were neither aorta-related deaths nor serious complications such as stroke,upper limb ischemia,internal leakage,or stent displacement.The patients were followed up for(14.7±8.3)months,no aorta-related death,stroke,upper limb ischemia,internal leakage,or stent displacement was observed,the blood flow of the left subclavian artery(LSA)was unobstructed,but there was thrombosis formation within the false lumen of the covered stent segment.Conclusion The Castor branching stent has the advantages of reasonable release mode,accurate positioning,effective isolation of the first rupture of Stanford TBAD and reconstruction of LSA,with no serious short-term complications.However,further follow-up observation is needed before its long-term efficacy can be clarified.

BACKGROUND:Stand-alone oblique lateral interbody fusion has a high rate of complications of fusion segment sink.Oblique lateral interbody fusion with posterior fixation can provide stable support,but intraoperative position changes and double incisions weaken the advantages of this technique.Oblique lateral interbody fusion combined with lateral plate fixation can achieve one-stage decompression in the same incision,while the lateral internal fixation provides stable support. OBJECTIVE:To analyze the short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in the treatment of single-level lumbar degenerative disease. METHODS:The clinical data of 34 patients with single-level lumbar degenerative disease treated with oblique lateral interbody fusion combined with lateral plate fixation were collected from May 2020 to October 2022.Among them,14 were males and 20 were females aged from 41 to 72 years at the mean age of(58.6±9.9)years.There were 11 cases of lumbar spondylolisthesis(Ⅰ°),7 cases of lumbar disc herniation with segmental instability,and 16 cases of lumbar spinal stenosis.Operation time,blood loss,and complications were recorded.Visual analog scale scores of lumbago,radiative pain of both lower limbs,and Oswestry disability index scores were evaluated before surgery,3 months after surgery,and the last follow-up.Dural sac cross-sectional area,intervertebral height,and intervertebral fusion were measured and observed. RESULTS AND CONCLUSION:(1)The 34 patients were followed up for 14-36 months,with an average of(21.3±5.2)months.(2)The operation time ranged from 50 to 92 minutes,with an average of(68.5±11.1)minutes.Intraoperative blood loss was 50-170 mL,with an average of(71.6±25.3)mL.(3)Compared with the preoperative results,the visual analog scale scores and Oswestry disability index scores were significantly decreased at 3 months after surgery and at the last follow-up(P<0.001),and the maximum Oswestry disability index scores were improved by nearly 50％.(4)Bone fusion was achieved in all patients during half-year follow-up.The overall complication rate was 21％(7/34),including 1 case of plate displacement,3 cases of cage subsidence,1 case of psoas weakness,and 2 cases of anterior thigh pain.(5)It is concluded that oblique lateral interbody fusion combined with lateral plate fixation for the treatment of lumbar degenerative diseases has the characteristics of less blood loss,short operation time,rapid postoperative recovery,and significant short-term clinical efficacy with the stable support to a certain extent.The long-term curative effect needs further follow-up observation.

Aim To explore the mechanism of baicalin combined with heat stimulation in treating acute lym-phoblastic leukemia(ALL)based on network pharma-cology and in vitro experiments.Methods The CCK-8 assay was used to screen the suitable conditions for heat stimulation to interfere ALL cell lines Jurkat,CCRF-CEM,Hut-78 and a normal lymphocyte HMy2.CIR,and the effects of baicalin combined with heat stimulation on the proliferation of three ALL cell lines and a normal lymphocyte were tested.The key targets of baicalin combined with fever stimulation for the treatment of ALL were obtained based on network phar-macological analysis,and the potential mechanisms were predicted by gene ontology(GO)annotation and kyoto encyclopedia of genes and genomes(KEGG)en-richment.The expression levels of TNF-α,AKT1,TYMS and CASP3 mRNA in ALL cell lines Jurkat and CCRF-CEM were examined by RT-qPCR with baicalin alone and baicalin combined with heat stimulation.Results The optimal conditions for heat stimulation to intervene ALL cells were 41 ℃ for 24 h,and heat stimulation combined with baicalin synergistically inhibited the growth of ALL cell lines and effectively reduced the cy-totoxicity of baicalin.Based on the network pharmaco-logical analysis,55 intersecting targets of baicalin with ALL diseases and 77 intersecting targets of baicalin with fever were obtained.The results of GO annotation and KEGG enrichment suggested that baicalin com-bined with fever stimulation to intervene ALL might be associated with influencing intracellular reactive oxygen species metabolism,DNA transcription and apoptotic processes involved in cysteine enzymes.Apoptosis,TNF and IL-17 signaling pathways were the key pathways for baicalin combined with heat stimulation in treating ALL.Under heat stimulation at 41 ℃ using SDHA gene as housekeeping gene,in vitro experiments showed that baicalin significantly up-regulated the expression of TNF-α and CASP3,and down-regulated the expression of TYMS in ALL cells.Conclusions Based on net-work pharmacologic analyses and in vitro experiments,baicalin combined with heat stimulation can regulate TNF-α and CASP3 gene levels in ALL cells and de-stroy cellular structure to promote cell apoptosis,thus synergistically treating ALL.

AIM To optimize the formulation process for Qingyan Zhitong Granules,and to conduct quality control.METHODS With drug-excipient ratio,ethanol concentration,ethanol consumption and drying temperature as influencing factors,comprehensive score for molding rate,dissolution rate,moisture absorption rate and repose angle as an evaluation index,the formulation process was optimized by Box-Behnken response surface method combined with entropy weighting method on the basis of Plackett-Burman design.The physical fingerprints and HPLC fingerprints were established,after which TLC was adopted in the qualitative identification of Lonicerae japonicae Flos,Forsythiae Fructus,Arctii Fructus and Prunellae Spica,HPLC was used for the content determination of chlorogenic acid,glycyrrhizin,luteoloside A,rosmarinic acid,arctiin,forsythoside and baicalin.RESULTS The optimal conditions were determined to be 1∶1 for drug-excipient ratio,95％for ethanol concentration,3.75 mL for ethanol consumption,67.5 ℃ for drying temperature,and 10 min for drying time,the comprehensive score was 97.717 8.The clear TLC spots demonstrated good reproducible without negative interference.The contents of chlorogenic acid,arctiin and baicalin were not less than 6,5 and 3 mg in 1 g preparation.The physical fingerprints for 5 batches of samples displayed the similarities of more than 0.99.There were 23 common peaks in the fingerprints for 15 batches of samples with the similarities of more than 0.98,7 of which were identified.CONCLUSION This stable and feasible method can provide basis for the industrial production and quality evaluation of Qingyan Zhitong Granules.

Objective To screen the mutations of ABCC8 gene in probands of maturity-onset diabetes of the young pedigrees,and investigate it sgenetic and clinical characteristics.Methods Whole exome sequencing were performed to screen ABCC8 mutations in 56 MODY probands who were admitted to Department of Endocrinology and Metabolism,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2021 to December 2023.The mutations were verified by Sanger sequencing,and all participants were genotyped.Clinical phenotypes of the mutation carriers were compared with non-DM controls within the families.The identified mutations were evaluated by bioinformatic softwires.Then the pharmacogenomic characteristics of the mutation carriers were analyzed.Results Two heterozygous mutations D655V and R825Q were identified in two MODY probands and their families respectively,and the D655V was a novel mutation.Bioinformatics studies showed that both mutations were deleterious and pathogenic.In comparison with non-DM controls in the two families,mutation carriers with diabetes exhibited significantly lower fasting insulin/fasting plasma glucose,two-hour postprandial insulin/two-hour postprandial insulin plasma glucose,homeostatic model assessment-β(P<0.05).Treatment with oral hypoglycemic agents such as metformin or insulin in these mutation carriers resulted in a moderate reduction in plasma glucose levels.However,switching to targeted Sulfonylurea's(SUs)proved to be more effective.Conclusions In this study,the prevalence of MODY12 is 3.6%in these MODY pedigrees.The remarkable hypoglycemic efficacy of SUs suggests that both D655V and R825Q were activating mutations of ABCC8,and maybe the cause of MODY12 characterized by impaired insulin secretion.

Objective:To investigate the clinical efficacy of combination of a Flow-through anterolateral thigh myocutaneous flap with a contralateral great saphenous vein grafting in reconstruction of Gustilo ⅢC foot and ankle injury in emergency surgery.Methods:This retrospective study analysed the clinical data of 9 patients who were admitted in the Department of Wound Repair Surgery, Suzhou Ruihua Orthopaedic Hospital between September 2021 and October 2023. All patients were diagnosed with Gustilo ⅢC foot and ankle injury and met the predefined inclusion criteria. The average age of the patients was 45 (26-64) years. The mean of Mangled Extremity Severity Score (MESS) was 8.2 points, with a range from 5 to 10 points. The wound area after debridement ranged from 15.5 cm×6.0 cm to 24.5 cm×12.5 cm, with the vascular occlusion or defect at 4.0-20.0 (mean, 6.3) cm in length. The size of the flap was 16.5 cm×7.0 cm-25.5 cm×13.5 cm. During surgery, segments of the great saphenous vein were excised in the length of 5.0-21.0 cm, at an approximately 6.5 cm in length. The Flow-through anterolateral thigh myocutaneous flap was employed to reconstruct the soft tissue defect and to establish vascular connections between the anterior or posterior tibial arteries and veins, with the vessels carried by the flap. Additionally, the contralateral great saphenous vein was taken to bridge the posterior or anterior tibial arteries and veins. Follow-ups were carried out by outpatient visits, telephone calls and WeChat interviews. The flap viability, limb blood circulation, wound healing at both donor and recipient sites, as well as functional recovery of the affected limbs was observed. Sensation recovery of the flap was assessed according to the rating standard established by the British Medical Research Council (BMRC) , while the function recovery of foot and ankle was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale.Results:All flaps successfully survived without vascular complication. Eight affected limbs were effectively cured, while a calf that had an infection and necrosis of a long segment of tibia and fibula was amputated below-the-knee in the stage-II surgery. One of the donor sites of flap was covered with a medium-thickness skin graft from lower abdomen due to the large size of the flap, while the other donor sites were directly sutured and healed at first intention. One patient developed postoperative bone infection, which was successfully treated through re-debridement and antibiotic bone cement filling. Another patient experienced partial necrosis at the distal hallux due to a prolonged limb ischemia, and a stump repair surgery was performed. All patients were entered into the postoperative follow-up for 15.3 (6-24) months. At the final follow-up visit, satisfactory colour and texture were observed on all flaps, although minor oedema was present. Donor sites healed well and the donor limb function was not affected. Sensory evaluation rated S 2 in 5 flaps and S 3 in 3 flaps according to BMRC. Functional assessment of foot and ankle of the affected limb yielded excellent in 2 patients, good in 5 patients and fair in 1 patient according to AOFAS. Conclusion:Flow-through anterolateral thigh myocutaneous flap combined with a contralateral great saphenous vein grafting enables one-stage reconstruction for soft tissue defect and blood circulation of the affected limb. It is a good method in the treatment of Gustilo ⅢC foot and ankle injury in emergency surgery.