Objective·To compare the effectiveness of hydrodynamic debridement versus conventional debridement in the treatment of burn wounds through a systematic review,focusing on differences in time to complete healing after graft,time to debride a 1%total body surface area(TBSA)wound,hospitalization duration,skin graft survival rate at 7 d post-surgery,secondary debridement rate,and positive rate of bacterial culture of wound exudate at 3 d post-surgery,aiming to select a more effective debridement method for burn wounds requiring debridement.Methods·A systematic literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,CNKI,SinoMed,China Science and Technology Journal Database,and Wanfang Database,for studies comparing hydrodynamic debridement and conventional debridement in the treatment of burns.The search included articles published in Chinese and English,and the search period was from the inception of the databases to October 1,2024.The study type was randomized controlled trials(RCTs).After literature search and screening,the included studies was evaluated for quality,and relevant data were extracted.Qualitative variables were presented as relative risk(RR),and quantitative variables as mean difference(MD).Forest plots were created by using RevMan 5.4 software with fixed-or random-effects models.Funnel plots were generated and Egger's test was performed by using Stata 14.0 software.Results·Fifteen high-quality RCTs were included in this study,involving 1 261 patients with burn injuries requiring debridement.The analysis results showed that compared to the conventional debridement group,the hydrodynamic debridement group had significantly shorter time to complete healing after graft(MD=-3.29,95%CI-3.88?-2.70,P<0.001),shorter time required to debride a 1%TBSA wound(MD=-0.63,95%CI-0.76?-0.50,P<0.001),and reduced hospitalization duration(MD=-4.22,95%CI-6.17?-2.28,P<0.001).The skin graft survival rate at 7 d post-surgery in the hydrodynamic debridement group(MD=8.62,95%CI 7.21?10.04,P<0.001)was significantly higher,while the secondary debridement rate(RR=0.21,95%CI 0.12?0.37,P<0.001)and the positive rate of bacterial culture of wound exudate at 3 d post-surgery(RR=0.30,95%CI 0.17?0.53,P<0.001)were significantly lower compared with the conventional debridement group.There was no statistically significant difference in the postoperative infections rates between the two groups(RR=1.06,95%CI 0.66?1.69,P=0.820).Conclusion·In the treatment of burn wounds,hydrodynamic debridement outperforms traditional debridement.In the management of burn wounds,hydrodynamic debridement outperforms conventional debridement by shortening debridement and hospitalization durations,reducing the need for secondary debridement,decreasing early bacterial colonization,and improving skin graft survival.In terms of postoperative infection risk,no significant difference was observed between the two methods,indicating comparable safety profiles.

OBJECTIVE To establish an ultra performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)method for determination of dexmedetomidine(DEX)in plasma of beagle dogs and evaluate the pharmacokinetics and sedation after nasal,buccal and sublingual mucosal admin-istration.METHODS A UPLC-MS/MS method was established and validated for dertermination of DEX in plasma of beagle dogs.DEX was administered to the nasal cavity,buccal and sublingual mucous membranes of beagle dogs,respectively.Blood samples were collected at different time points.The plasma concentration of DEX was measured by the established UPLC-MS/MS method.Pharmacokinetic parameters were fitted by Phoenix software and the sedative effect at different mucous membrane sites was evaluated in conjunction with behavioral and Ramsay scores.RESULTS The linearity of DEX was fine within the range of 0.05-100 μg·L-1(r>0.999),which was validated methodologically to meet the requirements of quantitative detection.The plasma concentration of the drug peaked the fastest with nasal administration.Tmax was 0.25 h,Cmax(4.43±1.19)μg·L-1,and the AUC0-6h was(8.92±2.07)μg·h·L-1,compared with 0.92 and 1 h,(2.87±0.69),(2.70±0.41)μg·L-1,and(7.99±1.77),(7.01±2.09)μg·h·L-1 with buccal and sublingual administration.Nasal administration had the fastest onset at 7 min,with a Ramsay score of 4,and sedation lasted for 36 min,compared with 33 and 35 min,and 38 and 37 min for buccal and sublingual administration.CONCLUSION The proposed method is sensitive,reliable and applicable to quantitative analysis of DEX in plasma of beagle dogs.Administration of DEX to the nasal cavity mucosa has a faster onset and a better sedative effect than to the buccal and sublingual mucosa.

OBJECTIVE To establish an ultra performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)method for determination of dexmedetomidine(DEX)in plasma of beagle dogs and evaluate the pharmacokinetics and sedation after nasal,buccal and sublingual mucosal admin-istration.METHODS A UPLC-MS/MS method was established and validated for dertermination of DEX in plasma of beagle dogs.DEX was administered to the nasal cavity,buccal and sublingual mucous membranes of beagle dogs,respectively.Blood samples were collected at different time points.The plasma concentration of DEX was measured by the established UPLC-MS/MS method.Pharmacokinetic parameters were fitted by Phoenix software and the sedative effect at different mucous membrane sites was evaluated in conjunction with behavioral and Ramsay scores.RESULTS The linearity of DEX was fine within the range of 0.05-100 μg·L-1(r>0.999),which was validated methodologically to meet the requirements of quantitative detection.The plasma concentration of the drug peaked the fastest with nasal administration.Tmax was 0.25 h,Cmax(4.43±1.19)μg·L-1,and the AUC0-6h was(8.92±2.07)μg·h·L-1,compared with 0.92 and 1 h,(2.87±0.69),(2.70±0.41)μg·L-1,and(7.99±1.77),(7.01±2.09)μg·h·L-1 with buccal and sublingual administration.Nasal administration had the fastest onset at 7 min,with a Ramsay score of 4,and sedation lasted for 36 min,compared with 33 and 35 min,and 38 and 37 min for buccal and sublingual administration.CONCLUSION The proposed method is sensitive,reliable and applicable to quantitative analysis of DEX in plasma of beagle dogs.Administration of DEX to the nasal cavity mucosa has a faster onset and a better sedative effect than to the buccal and sublingual mucosa.

Objective·To compare the effectiveness of hydrodynamic debridement versus conventional debridement in the treatment of burn wounds through a systematic review,focusing on differences in time to complete healing after graft,time to debride a 1%total body surface area(TBSA)wound,hospitalization duration,skin graft survival rate at 7 d post-surgery,secondary debridement rate,and positive rate of bacterial culture of wound exudate at 3 d post-surgery,aiming to select a more effective debridement method for burn wounds requiring debridement.Methods·A systematic literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,CNKI,SinoMed,China Science and Technology Journal Database,and Wanfang Database,for studies comparing hydrodynamic debridement and conventional debridement in the treatment of burns.The search included articles published in Chinese and English,and the search period was from the inception of the databases to October 1,2024.The study type was randomized controlled trials(RCTs).After literature search and screening,the included studies was evaluated for quality,and relevant data were extracted.Qualitative variables were presented as relative risk(RR),and quantitative variables as mean difference(MD).Forest plots were created by using RevMan 5.4 software with fixed-or random-effects models.Funnel plots were generated and Egger's test was performed by using Stata 14.0 software.Results·Fifteen high-quality RCTs were included in this study,involving 1 261 patients with burn injuries requiring debridement.The analysis results showed that compared to the conventional debridement group,the hydrodynamic debridement group had significantly shorter time to complete healing after graft(MD=-3.29,95%CI-3.88?-2.70,P<0.001),shorter time required to debride a 1%TBSA wound(MD=-0.63,95%CI-0.76?-0.50,P<0.001),and reduced hospitalization duration(MD=-4.22,95%CI-6.17?-2.28,P<0.001).The skin graft survival rate at 7 d post-surgery in the hydrodynamic debridement group(MD=8.62,95%CI 7.21?10.04,P<0.001)was significantly higher,while the secondary debridement rate(RR=0.21,95%CI 0.12?0.37,P<0.001)and the positive rate of bacterial culture of wound exudate at 3 d post-surgery(RR=0.30,95%CI 0.17?0.53,P<0.001)were significantly lower compared with the conventional debridement group.There was no statistically significant difference in the postoperative infections rates between the two groups(RR=1.06,95%CI 0.66?1.69,P=0.820).Conclusion·In the treatment of burn wounds,hydrodynamic debridement outperforms traditional debridement.In the management of burn wounds,hydrodynamic debridement outperforms conventional debridement by shortening debridement and hospitalization durations,reducing the need for secondary debridement,decreasing early bacterial colonization,and improving skin graft survival.In terms of postoperative infection risk,no significant difference was observed between the two methods,indicating comparable safety profiles.

Headache has high incidence and disability rates.The burden of headache in China has become an in-creasingly serious social problem.However,the diagnostic level of headache disorders varies among physicians due to the complexity of etiological classification.In order to help clinicians effectively improve the accuracy of clinical diagnosis,the Chinese People's Liberation Army(PLA)General Hospital led the development of the Clinical Decision Support Sys-tem(CDSS)for headache,and CDSS 2.0 has already been able to achieve a satisfactory diagnostic accuracy rate for head-ache.The Chinese PLA General Hospital has initiated the headache prevention and control base and system construction project in China.The application of CDSS to assist teaching in headache specialist training practice is an important means of headache specialist training.With the help of the CDSS system,neurologists are trained in headache specialty.Through the learning function of the CDSS,physicians can better understand the path of headache inquiry,improve the ability to identify secondary headache,be familiar with the ICHD-3 diagnostic criteria,learn standard headache cases,and improve the ability to employ standard treatment.In this paper,we will comprehensively discuss the role of the CDSS in the training of headache specialists and provide a summary and reflection,in order to provide a reference for the further development and improvement of headache specialist training in China.

BACKGROUND:Shujin Jiannao Prescription is an empirical formula for the treatment of cerebral palsy in Dongzhimen Hospital,Beijing University of Chinese Medicine,with clear clinical efficacy,but the specific mechanism needs to be elucidated. OBJECTIVE:To explore the possible mechanism of Shujin Jiannao Prescription in treating cerebral palsy. METHODS:Sixty-four 7-day-old Sprague-Dawley rats were randomly divided into a normal group(n=12)and a model group(n=52).An animal model was established by the Rice-Vannucci method.After successful modeling,52 model rats were randomly divided into control model group(n=12),minocycline group,and the low-,medium-,and high-dose groups of the Shujin Jiannao Prescription(n=10 per group).Rats in the minocycline group were given 40 mg/kg·d minocycline by gavage;rats in the low-,medium,and high-dose groups were given 4,8,and 16 g/kg·d Shujin Jiannao Prescription granules by gavage,respectively;and rats in the normal group and control model group were given an equal dose of normal saline by gavage.Medication in each group was given once a day for 1 week.The rats in each group were evaluated behaviorally using suspension test,abnormal involuntary movement score,and Bederson score.The pathological changes of the cerebral cortex were observed by hematoxylin-eosin staining.The levels of tumor necrosis factor α,interleukin 1β,and interleukin 10 in the cerebral cortex were determined using ELISA.The positive expressions of Janus kinase 2(JAK2),phosphorylated Janus kinase 2(p-JAK2),phosphorylated signal transducer and activator of transcription 3(p-STAT3)in the cerebral cortex were detected using immunohistochemistry.The protein expression levels of JAK2,p-JAK2,and p-STAT3 were detected using western blot. RESULTS AND CONCLUSION:Compared with the normal group,the suspension test score and involuntary movement score were decreased in the control model group(P＜0.01 or P＜0.05).The pathological results showed structural disruption of nerve cells,formation of large numbers of vacuoles,cell swelling,and increased intercellular space in the control model group.In addition,the expressions of tumor necrosis factor α and interleukin 1β in the cerebral cortex were significantly increased(P＜0.01),the expression of interleukin 10 was decreased(P＜0.05),and the protein expressions of JAK2,p-JAK2,and p-STAT3 in the cerebral cortex were significantly increased(P＜0.01)in the control model group compared with the normal group.Compared with the model group,minocycline and Shujin Jiannao Prescription at each dose could improve the behavioral indexes of rats(P＜0.01 or P＜0.05)and ischemic-hypoxic pathological changes were attenuated,with only a small amount of necrotic nerve cells and a few vacuoles,and reduced intercellular space.Moreover,the expressions of tumor necrosis factor α and interleukin 1β in the cerebral cortex were decreased in each drug group compared with the control model group(P＜0.05),while the protein expressions of JAK2,p-JAK2,and p-STAT3 in the cerebral cortex were significantly decreased(P＜0.01).The most obvious improvement was observed in the high-dose Shujin Jiannao Prescription group.To conclude,Shujin Jiannao Prescription can inhibit inflammation in the cerebral cortex of rats with hypoxic-ischemic brain injury.The mechanism may be related to the regulation of the JAK2/STAT3 signaling pathway.

ObjectiveTo explore the mechanism of Tangbikang granules （TBK） against diabetic peripheral neuropathy （DPN） based on network pharmacology and in-vivo experiment. MethodThe active components in medicinals of TBK and their target genes were searched from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）. The active components of the medicinals which are not included in TCMSP were searched from previous research. After the analysis of drug-likeness by SwissADME， the target genes of them were predicted with SwissTargetPrediction. DPN-related target genes were retrieved from GeneCards. The common targets of the disease and the prescription were the hub genes of TBK against DPN， which were uploaded to Metascape for Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis. High-sugar and high-fat diet and low-dose streptozotocin （STZ， ip） were employed to induce diabetes in rats， and then the model rats were respectively treated with low-dose （0.625 g·kg^-1）， medium-dose （1.25 g·kg^-1）， and high-dose （2.5 g·kg^-1） TBK for 12 weeks. Sensory nerve conduction velocity （SNCV） was evaluated. After hematoxylin and eosin （HE） staining， the sciatic nerve was observed under light microscope to examine the nerve damage. Real-time PCR was performed to detect the gene expression of adenosine monophosphate-activated protein kinase （AMPK） pathway-related targets in rat sciatic nerve， and Western blot to measure the protein expression of AMPK and phosphorylated （p）-AMPK in rat sciatic nerve. ResultThe main active components of TBK， such as quercetin， kaempferol， β-sitosterol， leech pteridine A， stigmasterol， and baicalein were screened out， mainly acting on interleukin-6 （IL-6）， tumor necrosis factor （TNF）， protein kinase B （Akt）， JUN， and HSP90AA1 and signaling pathways such as AMPK， nuclear factor-κB （NF-κB）， and Janus kinase/signal transducer and activator of transcription （JAK/STAT）. Molecular docking results showed that β-sitosterol and stigmasterol had high binding affinity with IL-6， TNF， JUN， and HSP90AA1. As for the animal experiment， compared with the normal group， model group had low SNCV of sciatic nerve （P<0.01）， disordered and loose myelinated nerve fibers with axonotmesis and demyelinization， low mRNA expression of AMPKα， AMPKβ， peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）， Sirtuin 3 （SirT3）， mitochondrial transcription factor A （TFAM）， and low p-AMPK/AMPK ratio in sciatic nerve （P<0.05， P<0.01）. Compared with the model group， TBK of the three doses raised the SNCV （P<0.01）， restored nerve morphology and nerve compactness， and increased the mRNA expression of AMPKα， AMPKβ， PGC-1α， SirT3， and TFAM （P<0.05， P<0.01）. The ratio of p-AMPK/AMPK in the high-dose and medium-dose TBK groups was higher than that in the model group （P<0.01）， while the protein expression in the low-dose TBK group was insignificantly different from that in the model group. ConclusionTBK exerts therapeutic effect on DPN through multiple pathways and targets. The mechanism is that it activates and regulates AMPK/PGC-1α/SirT3 signaling， which lays a basis for further study of TBK in the treatment of DPN.

Objective:To explore the value of the Pfirrmann grading standard for disc degeneration in the quantification of heterotopic ossification (HO) after artificial cervical disc replacement (ACDR).Methods:Data of 120 patients who underwent ACDR from January 2009 to December 2016 were retrospectively analyzed. There were 88 males and 32 females with an average age of 43.86±8.69 (range, 27-67) years old. There were 100 single-level replacements (9 Hybrid cases) and 20 double-level replacements (3 Hybrid cases). The occurrence of HO was observed by lateral radiographs of the cervical spine. The HO severity was assessed using the McAfee rating system. Degeneration degrees of cervical intervertebral discs were evaluated by the Pfirrmann grading standard based on the preoperative cervical MRI. The weighted Kappa test was used to analyze the consistency of evaluations between different observers of the Pfirrmann scoring system and the McAfee grading system. Pfirrmann scores for preoperative disc degeneration in the HO and non-HO groups were compared using the t-test. The chi-square test was used to analyze the effect of the Pfirrmann score on the incidence of postoperative segmental HO. The correlation between Pfirrmann score and McAfee grade, as well as postoperative ROM of HO group were analyzed by the Spearman rank-sum test. Quantitative indicators for risks of HO after ACDR surgery were proposed based on the incidence of segment HO in different Pfirrmann score groups. Results:One hundred and twenty patients were followed up for an average of 74.08±28.05 (range, 31-125) months. Based on statistics of cases 2 years after surgery, the overall HO incidence was 31.67% (38/120). The HO incidence was 27% (27/100) and 55% (11/20) for single-level and double-level replacements, respectively. There were 46 replacement segments in the HO group and 94 replacement segments in the non-HO group. The Pfirrmann score of HO group (3.17±1.08) was 25.80% significantly higher than that of the non-HO group (2.52±0.98) ( t=3.46, P=0.01). The incidence of HO in the replacement segment increased significantly with the preoperative Pfirrmann score ( χ2=12.44, P=0.01). The Pfirrmann score of the intervertebral disc in the HO group had a significant positive correlation with the McAfee grade ( R=0.54, P=0.01) and a significant negative correlation with the ROM ( R=-0.75, P=0.01). At 2 years after the operation, when the Pfirrmann score of the intervertebral disc was less than 3, the incidence of HO in the replacement segment was 20.55%(15/73); when the Pfirrmann score was equal to 3, the incidence of HO was 38.46% (10/26); when the Pfirrmann score was greater than 3, HO incidence was 51.22% (21/41). Conclusion:The Pfirrmann score of cervical disc degeneration was significantly related to the incidence of HO, McAfee grade, and ROM in the postoperative replacement segment. The Pfirrmann score of cervical disc degeneration can be used as a quantitativeindicator of HO risk in ACDR.

Objective To explore the diagnostic value of MR elastography and diffusion?weighted imaging in patients with liver fibrosis in the context of chronic hepatitis B. Methods Twenty?four patients with chronic hepatitis B, whose course of liver disease was more than 6 months and hepatitis B surface antigen was positive, were prospectively enrolled in the First Affiliated Hospital of Soochow University from July to December 2017. All of the patients underwent abdominal transient elastography (TE), routine MRI, magnetic resonance elastography (MRE) and DWI examination, TE and MRI were performed within one week. TE liver stiffness was measured, the MRE liver stiffness and ADC value were measured on MR imagings. All patients were divided into three groups: mild and non fibrosis (F0 to 1), significant fibrosis(F2 to 3) and cirrhosis (F4), according to the recommended standard of FibroTouch. Correlation between TE liver stiffness, MRE liver stiffness and ADC values were identified by using Spearman correlation test. The difference of the MRE liver stiffness and ADC value among the three groups was tested using independent sample t test. The overall predictive ability of MRE and DWI in assessment of liver fibrosis and cirrhosis was analyzed by constructing ROC curve. Results TE and MRI were successfully performed in all subjects, and the image quality was good. The MRE liver stiffness in mild and non fibrosis, significant fibrosis and cirrhosis was (2.32±0.31),(3.43±1.05),(4.77±0.68) kPa with statistically significant difference(F=61.690, P<0.01). The ADC values in three groups were (1.31 ± 0.14)×10-3, (1.23 ± 0.15)×10-3,(1.22±0.12)×10-3mm2/s without significant difference(F=1.074,P=0.360). The TE liver stiffness in three groups was (5.61±1.05),(9.56±0.57),(17.25±3.55)kPa, respectively, there was significant correlation between the MRE liver stiffness and the TE liver stiffness(t=0.858, P<0.01), but no significant correlation between the TE liver stiffness and the ADC value was found (r=-0.326,P=0.120). The area under ROC of MRE liver stiffness in diagnosing liver fibrosis grade (≥F2 and F4) was 0.96 and 1.00 respectively, while the AUC of ADC value was less than 0.70, which were 0.67 and 0.62 respectively. Conclusion MRE is a non?invasive promising tool for assessing liver fibrosis with chronic hepatitis B, while DWI has limited role.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis. However, there is increasing evidence in the literature for secondary SUNCT being attributable to certain known lesions. We explored the possible neurobiological mechanism underlying SUNCT based on all reported cases of secondary SUNCT for which detailed information is available. Here we report a case of neuromyelitis optica spectrum disorders that had typical symptoms of SUNCT that might have been attributable to involvement of the spinal nucleus of the trigeminal nerve. We also review cases of secondary SUNCT reported in the English-language literature and analyze them for demographic characteristics, clinical features, response to treatment, and imaging findings. The literature review shows that secondary SUNCT can derive from a neoplasm, vascular disease, trauma, infection, inflammation, or congenital malformation. The pons with involvement of the trigeminal root entry zone was the most commonly affected region for inducing secondary SUNCT. In conclusion, the neurobiology of secondary SUNCT includes structures such as the nucleus and the trigeminal nerve with its branches, suggesting that some cases of primary SUNCT have underlying mechanisms that are related to existing focal damage that cannot be visualized.
Headache Disorders ; Headache* ; Inflammation ; Neurobiology ; Neuromyelitis Optica ; Pons ; Tears* ; Trigeminal Nerve ; Vascular Neoplasms