Objective: To investigate the effect of loss of function of lanosterol synthase( LSS) gene on intestinal function in a mouse model of non-alcoholic fatty liver disease( NAFLD) induced by a high-fat diet． Methods: LSS gene heterozygous knockout C57 mice ( LSS + / －) were established using the CRISRP / Cas9 system．After being fed a high-fat diet with 60% fat content for 6 months，the fat deposition in liver tissues was detected by HE and Oil red O staining，the morphological changes of small intestine tissue were detected by HE staining．The changes in total cholesterol content in intestinal tissue were detected by kits．The gastrointestinal motility function of mice was detected by phenol red paste．The intestinal permeability was detected by Evans blue staining，and the expression of LSS，tight junction protein ( Claudin) -1，Claudin-5，cluster of differentiation 36 ( CD36) ，and Niemann-Pick type C1-like 1 protein ( NPC1L1) proteins in small intestinal tissues were detected by Western blot． Results : The results of HE and Oil red O staining of liver tissues showed that liver fat deposition in LSS gene heterozygous knockout mice was lower than that in wild-type mice in the high-fat diet group．The total cholesterol content in intestinal tis- sue of LSS gene heterozygous knockout mice decreased ( P ＜0. 01) ，but no morphological differences were ob- served between the two groups of mice by HE staining of intestinal tissues．The gastrointestinal motility function of LSS gene heterozygous knockout mice did not show significant changes．The intestinal permeability of LSS gene het- erozygous knockout mice in the high-fat diet group decreased as detected by Evans blue ( P＜0. 05) ．The expres- sion levels of Claudin-5 protein in the intestinal tissue of LSS gene heterozygous knockout mice in the high-fat diet group increased ( P ＜0. 05 ) ，while the expression of LSS protein in the intestinal tissues of LSS heterozygous knockout mice decreased ( P ＜0. 05) ． Conclusion In the NAFLD model induced by a high-fat diet，LSS gene heterozygous knockout reduces liver fat deposition induced by a high-fat diet and improves intestinal barrier function by regulating cholesterol metabolism in intestinal tissues and up-regulating the expression of Claudin-5．

A local context fusion based segmentation model which uses a local context attention mechanism to filter out irrelevant feature information and enhance the attention to important regions is presented for accurate polyp segmentation. The features at different scales are captured by multi-kernel dilated convolution for improving the accuracy of polyp boundary segmentation. Pyramid context selection module utilizes shallow encoder features to compensate for the low-level information lost by the deeper encoder,enabling the model to adapt to polyps of various sizes. The proposed model achieves accuracies of 97.67％,97.19％ and 99.23％ on Kvasir-SEG,EndoScene and CVC-ClinicDB datasets,respectively,with mIoU of 91.20％,88.31％ and 94.75％,respectively,exhibiting higher accuracy and generalizability than the existing classical methods and validating its superior performance in polyp segmentation. The proposed model can improve polyp segmentation accuracy and provide a more accurate aid for polyp segmentation.

A local context fusion based segmentation model which uses a local context attention mechanism to filter out irrelevant feature information and enhance the attention to important regions is presented for accurate polyp segmentation. The features at different scales are captured by multi-kernel dilated convolution for improving the accuracy of polyp boundary segmentation. Pyramid context selection module utilizes shallow encoder features to compensate for the low-level information lost by the deeper encoder,enabling the model to adapt to polyps of various sizes. The proposed model achieves accuracies of 97.67％,97.19％ and 99.23％ on Kvasir-SEG,EndoScene and CVC-ClinicDB datasets,respectively,with mIoU of 91.20％,88.31％ and 94.75％,respectively,exhibiting higher accuracy and generalizability than the existing classical methods and validating its superior performance in polyp segmentation. The proposed model can improve polyp segmentation accuracy and provide a more accurate aid for polyp segmentation.

Objective:To investigate the clinical characteristics and management status of children with Turner syndrome (TS) in China.Methods:As a cross-sectional study, 1 089 TS patients were included in the database of the National Collaborative Alliance for the Diagnosis and Treatment of Turner Syndrome from August 2019 to November 2023. Clinical characteristics (growth development, sexual development, organ anomalies, etc.), karyotypes, auxiliary examinations, and treatments were collected and analyzed.Results:Among the 1 089 TS cases, 809 were recorded karyotypes. The karyotype distribution was as follows: 45, X in 317 cases (39.2%), X chromosome structural variants (including partial deletions of p or q arm, ring chromosome, and marker chromosome) in 89 cases (11.0%), 45, X/46, XX mosaicism in 158 cases (19.5%), mosaicism with X chromosome structural variants in 209 cases (25.8%), and presence of Y chromosome material in 36 cases (4.4%). Among the 824 TS cases, the age of diagnosis was 9.7(6.4, 12.2) years, with a height standard deviation score (HtSDS) of -3.1±1.2. Five hundred and fifty three cases underwent growth hormone (GH) stimulation test, and 352 cases (63.7%) had GH peak values <10 μg/L and 75.9% (577/760) had low IGF1 levels, with IGF1 SDS ≤-2 accounting for 38.2% (290 cases). Among 471 cases aged ≥8 years, 132 cases (28.0%) showed spontaneous sexual development (mean bone age (11.0±1.7) years), 10 cases had spontaneous menarche (mean bone age (12.0±2.2) years), and 2 cases had regular menstrual cycles. Common physical features included cubitus valgus (311 cases (28.5%)), neck webbing (188 cases (17.2%)), low posterior hairline (185 cases (17.0%)), shield chest (153 cases (14.0%)), high arched palate (127 cases (11.6%)), short fourth metacarpal (43 cases (3.9%)), and spinal abnormalities (38 cases (3.5%)). Congenital cardiovascular and urogenital anomalies occurred in 91 cases (19.4%) and 66 cases (12.0%)respectively. Abdominal ultrasound in 33 cases (7.2%) indicated fatty liver, hepatomegaly, intrahepatic bile duct stones, and splenomegaly. Among 23 cases undergoing oral glucose tolerance test (OGTT) test, 2 were diagnosed with diabetes mellitus and 4 with impaired glucose tolerance. Following diagnosis, 669 cases (80.7%) received rhGH treatment at a chronological age of (9±4) years and bone age of (8.3±3.2) years. Additionally, 112 cases (19.4%) received sex hormone replacement therapy starting at the age of (14±4) years and bone age of (12.6±1.2) years.Conclusions:The karyotypes of 45, X and mosaicism were most common in Chinese children with TS. The clinical manifestations were mainly short stature and gonadal dysplasia. However, a few TS children could be in the normal range of height, and some cases among those aged of ≥8 years old had spontaneous sexual development. Some exhibited physical features, congenital cardiovascular and urogenital anomalies, and dysfunction of the hypothalamic-pituitary-IGF1 axis. Moreover, a few of them developed impaired glucose tolerance and diabetes mellitus. Following diagnosis, most of the patients received rhGH treatment, and a few of them received sex hormone replacement therapy.

Objective:To explore the clinical effect of reconstruction of soft tissue defect on the palmar side of 2 adjacent fingers with bilobed perforator flap of medial foot artery.Methods:From September 2020 to September 2023, 6 patients with soft tissue defects on the palmar side of 2 adjacent fingers were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. After admission, Doppler ultrasound scan was performed to locate the perforating branches of the deep and superficial branches of medial foot artery, as well as the course of medial foot artery. A bilobed flap with two perforating branches of medial foot artery was used to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. The perforators of medial foot artery were anastomosed with the proper palmar digital arteries, and the accompanying veins was anastomosed with the dorsal digital veins. The branches of saphenous nerve were anastomosed with the proper palmar digital nerves. The sizes of soft tissue defect were 4.5 cm×2.0 cm-3.0 cm×1.5 cm, and the flaps sized 5.0 cm×2.5 cm-3.5 cm×2.0 cm. All donor sites for the perforator flaps were covered by artificial dermis (4 patients) or autologous skin grafts (2 patients). Short and long-term follow-up for flap survival, flap shape, scar, and functions of interphalangeal joint and metacarpophalangeal joint function were evaluated in outpatient clinic and WeChat reviews.Results:All the bilobed perforator flaps of medial foot artery survived in 6 patients. There was no infection in the flap and donor area. Wounds in fingers and dornor sites in foot all healed well. Postoperative follow-up ranged 4-12 months, with an average of 9.3 months. The sensation of the palmar fingers recovered well with TPD at 7-10 mm and at 8.5 mm in average. The sensation recoveries were up to S 3-S 4. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of the Chinese Medical Association, 5 patients (10 fingers) were rated as excellent and 1 patient (2 fingers) as good. The donor sites healed well and walking, running, jumping, mountaineering and other food motions were not affected, and without any obvious discomfort. According to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hindfoot score, the ankle functions of 6 patients were evaluated as excellent. Conclusion:A bilobed perforator flap of medial foot artery is applied to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. It can simultaneously reconstruct 2 defects in a single surgery, and offer a fast functional recovery and aesthetical appearance.

Sulfur dioxide (SO2), a novel endogenous gas signaling molecule, is involved in the regulation of cardiac function. Exerting a key role in progression of hyperthyroidism-induced cardiomyopathy (HTC), myocardial fibrosis is mainly caused by myocardial apoptosis, leading to poor treatment outcomes and prognoses. This study aimed to investigate the effect of SO2 on the hyperthyroidism-induced myocardial fibrosis and the underlying regulatory mechanisms. Elisa, Masson staining, Western-Blot, transmission electron microscope, and immunofluorescence were employed to evaluate the myocardial interstitial collagen deposition, endoplasmic reticulum stress (ERS), apoptosis, changes in endogenous SO2 , and Hippo pathways from in vitro and in vivo experiments. The study results indicated that the hyperthyroidism-induced myocardial fibrosis was accompanied by decreased cardiac function, and down-regulated ERS, apoptosis, and endogenous SO2 -producing enzyme aspartate aminotransferase (AAT)1/2 in cardiac myocytes. In contrast, exogenous SO2 donors improved cardiac function, reduced myocardial interstitial collagen deposition, up-regulated AAT1/2, antagonized ERS and apoptosis, and inhibited excessive activation of Hippo pathway in hyperthyroid rats. In conclusion, the results herein suggested that SO2 inhibited the overactivation of the Hippo pathway, antagonized ERS and apoptosis, and alleviated myocardial fibrosis in hyperthyroid rats. Therefore, this study was expected to identify intervention targets and new strategies for prevention and treatment of HTC.

Objective:To explore the clinical effect of reconstruction of soft tissue defect on the palmar side of 2 adjacent fingers with bilobed perforator flap of medial foot artery.Methods:From September 2020 to September 2023, 6 patients with soft tissue defects on the palmar side of 2 adjacent fingers were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. After admission, Doppler ultrasound scan was performed to locate the perforating branches of the deep and superficial branches of medial foot artery, as well as the course of medial foot artery. A bilobed flap with two perforating branches of medial foot artery was used to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. The perforators of medial foot artery were anastomosed with the proper palmar digital arteries, and the accompanying veins was anastomosed with the dorsal digital veins. The branches of saphenous nerve were anastomosed with the proper palmar digital nerves. The sizes of soft tissue defect were 4.5 cm×2.0 cm-3.0 cm×1.5 cm, and the flaps sized 5.0 cm×2.5 cm-3.5 cm×2.0 cm. All donor sites for the perforator flaps were covered by artificial dermis (4 patients) or autologous skin grafts (2 patients). Short and long-term follow-up for flap survival, flap shape, scar, and functions of interphalangeal joint and metacarpophalangeal joint function were evaluated in outpatient clinic and WeChat reviews.Results:All the bilobed perforator flaps of medial foot artery survived in 6 patients. There was no infection in the flap and donor area. Wounds in fingers and dornor sites in foot all healed well. Postoperative follow-up ranged 4-12 months, with an average of 9.3 months. The sensation of the palmar fingers recovered well with TPD at 7-10 mm and at 8.5 mm in average. The sensation recoveries were up to S 3-S 4. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of the Chinese Medical Association, 5 patients (10 fingers) were rated as excellent and 1 patient (2 fingers) as good. The donor sites healed well and walking, running, jumping, mountaineering and other food motions were not affected, and without any obvious discomfort. According to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hindfoot score, the ankle functions of 6 patients were evaluated as excellent. Conclusion:A bilobed perforator flap of medial foot artery is applied to reconstruct the soft tissue defects on the palmar side of 2 adjacent fingers. It can simultaneously reconstruct 2 defects in a single surgery, and offer a fast functional recovery and aesthetical appearance.

Hypothyroidism alone can lead to myocardial fibrosis and result in heart failure, but traditional hormone replacement therapy does not improve the fibrotic situation. Hydrogen sulfide (H 2 S), a new gas signaling molecule, possesses antiinflammatory, antioxidant, and anti-fibrotic capabilities. Whether H 2 S could improve hypothyroidism-induced myocardial fibrosis are not yet studied. In our study, H 2 S could decrease collagen deposition in the myocardial tissue of rats caused by hypothyroidism. Furthermore, in hypothyroidism-induced rats, we found that H 2 S could enhance cystathionine-gamma-lyase (CSE), not cystathionine β-synthase (CBS), protein expressions. Finally, we noticed that H 2 S could elevate autophagy levels and inhibit the transforming growth factor-β1 (TGF-β1) signal transduction pathway. In conclusion, our experiments not only suggest that H 2 S could alleviate hypothyroidism-induced myocardial fibrosis by activating autophagy and suppressing TGF-β1/ SMAD family member 2 (Smad 2) signal transduction pathway, but also show that it can be used as a complementary treatment to conventional hormone therapy.

Objective:To explore the surgical procedure and effect of reconstruction of soft tissue defects in the distal segment of dorsal finger with a perforator(joint branch) flap of proper palmar digital artery combined with a dorsal metacarpal artery flap.Methods:From January 2019 to June 2022, 9 patients with soft tissue defects in distal dorsal finger, mostly with avulsion at the extensor tendon insertion point, were treated in Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University. The defect areas were 1.0 cm×1.0 cm-2.5 cm×2.0 cm. Steel wires were used to reconstruct the extensor tendon insertion point. The defects were reconstructed by a perforator(joint) flap of proximal phalanx artery and a dorsal metacarpal artery flap was used to repair the donor site for proximal flap. Postoperative follow-up and evaluation included flap survival, flap appearance, scars and function of interphalangeal and metacarpophalangeal joints, through outpatient clinical, WeChat and so on.Results:The flap of digital artery perforator (joint branch) and the fasciocutaneous flap of dorsal metacarpal artery all survived. One flap of the digital artery perforator(joint branch) appeared purple and tension blisters after surgery. The stitches of the pedicle of the flap were partially dismantled at 36-48 hours after surgery. The flap was then turned to ruddy in colour 7 days after surgery. The wounds of the distal finger joint and nail bed healed well without redness and infection. The postoperative follow-up lasted for 5 to 12 months, 9 months in average. The appearance, colour and texture of the skin at distal finger were similar to those at the dorsal proximal finger and dorsal palm. Sensation recovered well, all flaps exceeding S 3. The two-point resolution (TPD) was 8-10 mm, with an average of 9.5 mm. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 5 cases were in excellent and 4 in good. Conclusion:The perforator(joint branch) flap of proper palmar digital artery combined with a dorsal metacarpal artery flap is simple and safe treatment. It has a fast functional recovery with an aesthetic appearance in reconstruction of the soft tissue defect in distal segment of dorsal finger.

Objective:To investigate the clinical effect of bilateral anteriolateral thigh perforator flaps (ALTPF) pedicled with descending branch of lateral circumflex femoral artery in series on reconstruction of large soft tissue defects in lower limbs.Methods:A total of 9 patients with large soft tissue defects in lower limbs were selected in the study. The patients were 6 males and 3 females aged between 18 and 57 years old. They were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University from June 2018 to January 2023. Causes of injury: 4 of traffic accident, 2 of crushing, 2 of falling from height and 1 of explosion. Five patients had combined defects in dorsal feet and 4 with tibia fractures and anterior-and-posterior-tibial soft tissue defects. All affected limbs had tissue necroses and infections in various degrees. Deep tissue defects such as tendons, nerves, bones and joints or orthopaedic implants were exposed. The areas of soft tissue defects were 30 cm×14 cm-42 cm×14 cm. All the defects were reconstructed by the bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series. The size of proximal flaps was 25 cm×8 cm-33 cm×13 cm and 20 cm×7 cm-29 cm×13 cm for the distal flaps. Scheduled postoperative follow-ups were conducted to observe the survival of the transferred flaps and functional recovery of calfs and feet. Sensory recovery was assessed against British Medical Research Council (BMRC) criteria. Puno scoring was used to assess the functional recovery and the effectiveness of treatment.Results:All flaps survived and the donor sites healed well. One patient developed vascular compromise within 24 hours after surgery, but it was rectified after timely surgical exploration, however it left with a small area of necrosis at distal end of the flap. The necrosis and wound healed after skin grafting in stage-two surgery. Postoperative follow-up lasted for 8.3 months in average. Two patients underwent flap thinning in stage-two surgery due to bloating appearance, 2 patients had slightly bloated flaps at the calfs, and the rest of 5 patients had satisfactory flap appearance. Two patients received nerve reconstruction by anastomosis of the lateral femoral cutaneous nerves. At the final follow-up, the sensory recovery in 9 patients achieved S 2-S 3+ according to BMRC. The average Puno score achieved 88.36 point±5.36 point, of which 4 patients in excellent, 3 in good and 2 in fair. Conclusion:The use of bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series to reconstruct a large soft tissue defect in lower extremity has a good clinical value, and it has become one of the effective methods.