Objective To investigate the current status of quality of life and its influencing factors in elderly patients with minor amputations of the diabetic foot,providing a basis for medical staff to formulate intervention strategies.Methods A convergent mixed study design was used.A single-centre cross-sectional survey research method was used to select 168 elderly patients with minor amputation of the diabetic foot admitted to the Department of Wound Repair of a tertiary-level hospital in Beijing from May 2022 to May 2024 for questionnaire surveys and multivariate linear regression analyses of factors affecting the quality of life.During the same period,15 patients were selected for semi-structured interviews using purposive sampling based on ternary interaction determinism.Results Quantitative findings:A total of 167 valid questionnaires were retrieved,and the recovery rate of valid questionnaires was 99.4％.the total quality of life score of 167 respondents was(84.22±12.49)scores;the results of multivariate linear regression analyses showed that age and self-care ability were the independent risk factors affecting the quality of life of patients with minor amputation of the diabetic foot(P＜0.05).Qualitative findings:a total of 3 themes were extracted based on the triadic interactive determinism,including subject level,environmental level and behavioural level.Mixed findings:age and amputation affect the physical and mental state of patients and hinders quality of life improvement;limited work and life,and scarce external resources;the level of self-care ability restricts self-management behaviours and makes it difficult to improve quality of life.Conclusion Elderly patients with minor amputations of the diabetic foot have impaired physiological and psychological health to some degree,and healthcare professionals should be concerned about the negative impact of minor amputations on elderly diabetic foot patients,while also focusing on their individual needs and providing support.

Purpose To investigate the clinicopathological characteristics,immunophenotype,high-risk human papillomavirus(hrHPV)infection status,treatment,and prognosis of cervical carcinoma exhibiting adenoid cystic car-cinoma(ACC)features.Methods Clinical data from 10 cases of cervical cancer with ACC features were collected.A retrospective analysis was proformed on the patients'clinicopathological data,histological features,and immunopheno-type(EnVision method),along with in situ hybridization detection of hrHPV E6/E7 mRNA covering 18 hrHPV types.Results The median age of the patients was 67.5 years,comprising 4 biopsy specimens and 6 surgical specimens.Except for 2 cases detected incidentally during physical examination,the remaining 8 cases presented with unexplained vaginal bleeding or contact bleeding.The mean tumor diameter was 4.5 cm(range:2.5 to 9.0 cm),and tumor stages were available for 8 patients(5 cases in stage Ⅰ and 1 case each in stages Ⅱ,Ⅲ,and Ⅳ).The follow-up period was 8 to 42 months,excluding 1 case lost to follow-up,2 cases(Ⅲ C1 and ⅣB)died within 1 year after surgery.Histologi-cally,4 cases exhibited pure ACC morphology,while 5 cases were mixed carcinomas(combined with squamous cell carcinoma,adenoid basal cell carcinoma,high-grade neuroendocrine carcinoma,or carcinosarcoma,respectively).The characteristic ACC morphology manifested as cribriform,pseudo-glandular,tubular,trabecular,and/or solid pat-terns with one case mixed carcinoma's lymph node metastasis showing only ACC morphology.Immunohistochemically,all 10 tumors exhibited diffuse strong positivity for p16 and p63,a high Ki67 proliferation index(40％to 90％),and wild-type p53 expression,and in 50％of cases,only a minority of cells were positive for c-MYB.Additionally,SOX10 was positive in 8 of 9 cases and CD117 was positive in 7 of 10 cases,respectively.In situ hybridization for hrHPV E6/E7 mRNA confirmed the presence of transcriptionally active HPV infection in all cases.Conclusion Cervical cancer with ACC features is rare,and predominantly occurs in postmenopausal elderly women.It represents an HPV-associat-ed high-grade carcinoma in which clinical stage is a critical prognostic factor.Immunohistochemical staining for CD117 and SOX10 aids in the pathological diagnosis of this tumor type.

Objective:To analyze the factors influencing the prognoses of stroke survivors with pseudobulbar palsy (PBP) dysphagia and construct a prediction model.Methods:Data on two hundred and fifty-one stroke survivors with PBP dysphagia were collected and analyzed retrospectively. The subjects were divided into a good prognosis group ( n=164) and a poor prognosis group ( n=87) according to the results of Kubota water swallowing tests administered at discharge. Their clinical data were analyzed using univariate correlation analysis, and the statistically significant independent variables found were further analyzed using multivariate logistic regression to obtain the important predictors of prognosis. R software was then used to assemble the useful factors into a nomogram prediction model. The area under the receiver operating characteristics (ROC) curve was employed to verify the model′s predictive power. Results:According to the univariate correlation analysis, significant differences were found between the two groups′ average National Institutes of Health Stroke Scale (NIHSS) scores, mouth opening grades and ages. The multivariate logistic regression analysis showed that NIHSS score, mouth opening grade and age could be useful and independent predictors of poor prognosis. The ROC curve analysis showed that the area under the curve for the nomogram model was 0.727, with a sensitivity of 59.8% and a specificity of 81.6%, suggesting that the model had good predictive power and was properly calibrated.Conclusions:NIHSS score, mouth opening grade and age are independent predictors of prognosis for stroke patients with PBP dysphagia. The nomogram model constructed in this study is of great value in developing a prognosis for such patients, which is helpful in the prevention and treatment of post-stroke dysphagia.

Purpose To investigate the clinicopathological characteristics,immunophenotype,high-risk human papillomavirus(hrHPV)infection status,treatment,and prognosis of cervical carcinoma exhibiting adenoid cystic car-cinoma(ACC)features.Methods Clinical data from 10 cases of cervical cancer with ACC features were collected.A retrospective analysis was proformed on the patients'clinicopathological data,histological features,and immunopheno-type(EnVision method),along with in situ hybridization detection of hrHPV E6/E7 mRNA covering 18 hrHPV types.Results The median age of the patients was 67.5 years,comprising 4 biopsy specimens and 6 surgical specimens.Except for 2 cases detected incidentally during physical examination,the remaining 8 cases presented with unexplained vaginal bleeding or contact bleeding.The mean tumor diameter was 4.5 cm(range:2.5 to 9.0 cm),and tumor stages were available for 8 patients(5 cases in stage Ⅰ and 1 case each in stages Ⅱ,Ⅲ,and Ⅳ).The follow-up period was 8 to 42 months,excluding 1 case lost to follow-up,2 cases(Ⅲ C1 and ⅣB)died within 1 year after surgery.Histologi-cally,4 cases exhibited pure ACC morphology,while 5 cases were mixed carcinomas(combined with squamous cell carcinoma,adenoid basal cell carcinoma,high-grade neuroendocrine carcinoma,or carcinosarcoma,respectively).The characteristic ACC morphology manifested as cribriform,pseudo-glandular,tubular,trabecular,and/or solid pat-terns with one case mixed carcinoma's lymph node metastasis showing only ACC morphology.Immunohistochemically,all 10 tumors exhibited diffuse strong positivity for p16 and p63,a high Ki67 proliferation index(40％to 90％),and wild-type p53 expression,and in 50％of cases,only a minority of cells were positive for c-MYB.Additionally,SOX10 was positive in 8 of 9 cases and CD117 was positive in 7 of 10 cases,respectively.In situ hybridization for hrHPV E6/E7 mRNA confirmed the presence of transcriptionally active HPV infection in all cases.Conclusion Cervical cancer with ACC features is rare,and predominantly occurs in postmenopausal elderly women.It represents an HPV-associat-ed high-grade carcinoma in which clinical stage is a critical prognostic factor.Immunohistochemical staining for CD117 and SOX10 aids in the pathological diagnosis of this tumor type.

Objective:To analyze the factors influencing the prognoses of stroke survivors with pseudobulbar palsy (PBP) dysphagia and construct a prediction model.Methods:Data on two hundred and fifty-one stroke survivors with PBP dysphagia were collected and analyzed retrospectively. The subjects were divided into a good prognosis group ( n=164) and a poor prognosis group ( n=87) according to the results of Kubota water swallowing tests administered at discharge. Their clinical data were analyzed using univariate correlation analysis, and the statistically significant independent variables found were further analyzed using multivariate logistic regression to obtain the important predictors of prognosis. R software was then used to assemble the useful factors into a nomogram prediction model. The area under the receiver operating characteristics (ROC) curve was employed to verify the model′s predictive power. Results:According to the univariate correlation analysis, significant differences were found between the two groups′ average National Institutes of Health Stroke Scale (NIHSS) scores, mouth opening grades and ages. The multivariate logistic regression analysis showed that NIHSS score, mouth opening grade and age could be useful and independent predictors of poor prognosis. The ROC curve analysis showed that the area under the curve for the nomogram model was 0.727, with a sensitivity of 59.8% and a specificity of 81.6%, suggesting that the model had good predictive power and was properly calibrated.Conclusions:NIHSS score, mouth opening grade and age are independent predictors of prognosis for stroke patients with PBP dysphagia. The nomogram model constructed in this study is of great value in developing a prognosis for such patients, which is helpful in the prevention and treatment of post-stroke dysphagia.

Objective To investigate the current status of quality of life and its influencing factors in elderly patients with minor amputations of the diabetic foot,providing a basis for medical staff to formulate intervention strategies.Methods A convergent mixed study design was used.A single-centre cross-sectional survey research method was used to select 168 elderly patients with minor amputation of the diabetic foot admitted to the Department of Wound Repair of a tertiary-level hospital in Beijing from May 2022 to May 2024 for questionnaire surveys and multivariate linear regression analyses of factors affecting the quality of life.During the same period,15 patients were selected for semi-structured interviews using purposive sampling based on ternary interaction determinism.Results Quantitative findings:A total of 167 valid questionnaires were retrieved,and the recovery rate of valid questionnaires was 99.4％.the total quality of life score of 167 respondents was(84.22±12.49)scores;the results of multivariate linear regression analyses showed that age and self-care ability were the independent risk factors affecting the quality of life of patients with minor amputation of the diabetic foot(P＜0.05).Qualitative findings:a total of 3 themes were extracted based on the triadic interactive determinism,including subject level,environmental level and behavioural level.Mixed findings:age and amputation affect the physical and mental state of patients and hinders quality of life improvement;limited work and life,and scarce external resources;the level of self-care ability restricts self-management behaviours and makes it difficult to improve quality of life.Conclusion Elderly patients with minor amputations of the diabetic foot have impaired physiological and psychological health to some degree,and healthcare professionals should be concerned about the negative impact of minor amputations on elderly diabetic foot patients,while also focusing on their individual needs and providing support.

Objective To investigate the effects of Forkhead box protein O3a(FoxO3a)on M2 polarization and ferroptosis of macrophages in allergic rhinitis(AR).Methods Nasal lavage fluids were collected from 30 patients with AR and 30 healthy volunteers,while nasal mucosa samples were obtained from 3 AR patients and 3 healthy volunteers.The levels of FoxO3a in nasal lavage fluids were detected by ELISA.M0 macrophages were transfected with siRNA negative control plasmid(si-Con),siRNA FoxO3a plasmid(si-FoxO3a),pcDNA3.1-vector,or pcDNA3.1-FoxO3a plasmid,and then induced to polarize towards M2 type by interleukin-4(IL-4).M0 macrophages were set as the control group,IL-4 model group,IL-4+si-Con group,IL-4+si-FoxO3a group,IL-4+si-FoxO3a+nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385 group,IL-4+pcDNA3.1-vector group,and IL-4+pcDNA3.1-FoxO3a group.A co-culture system of M0 macrophages and human nasal epithelial cells(NECs)was established,and then divided into the NECs+M0 macrophages(control group),NECs+M2 macrophages(IL-4 model group),NECs+si-FoxO3a-transfected macrophages(IL-4+si-FoxO3a group)and NECs+si-FoxO3a-transfected macrophages+ML385(IL-4+si-FoxO3a+ML385 group).Apoptosis of NECs was detected by flow cytometry.C57BL/6 mice were divided into normal group,AR model group and shRNA-FoxO3a adeno-associated virus(AAV-sh-FoxO3a)group.HE staining was used to observe histopathological changes in nasal mucosa tissue,and flow cytometry was used to detect the proportion of M2 macrophages in mouse nasal lavage fluids.The levels of IL-5,IL-13 and NECs mucin 5AC(MUC5AC)in mouse nasal lavage fluids were detected by ELISA;Western blot was used to detect the levels of FoxO3a,IL-10,arginase 1(Arg-1),Nrf2,heme oxygenase-1(HO-1),and glutathione peroxidase 4(GPX4).Results Compared with the normal,the expression of FoxO3a was increased in nasal lavage fluids and nasal mucosa tissues of AR patients.Compared with the control group,the proportion of M2 macrophages and the levels of FoxO3a were increased in the IL-4 model group,while the expression levels of Nrf-2,HO-1 and GPX4 were decreased,and the levels of Fe2+and malondialdehyde(MDA)were increased(P<0.05).Compared with the IL-4 model group,these indicators were reversed in the IL-4+si-FoxO3a group.Compared with the IL-4 model group,the proportion of M2 macrophages was increased in the IL-4+pcDNA3.1-FoxO3a group.In the co-culture system,compared with the IL-4 model group,the apoptosis of NECs and MUC5AC secretion were decreased in the IL-4+si-FoxO3a group(P<0.05).ML385 reversed the protective effect of si-FoxO3a on NECs.Mice in the AAV-sh-FoxO3a group showed reduced nasal mucosa tissue damage,decreased levels of IL-5 and IL-13 in nasal lavage fluids,and a lower number of M2 macrophages,decreased level of FoxO3a in M2 macrophages,while increased expression of GPX4,Nrf2 and HO-1.Conclusion Interference with FoxO3a protein expression can inhibit macrophage ferroptosis,suppress M2 polarization,and reduce NECs damage,which is related to the activation of the Nrf-2/HO-1 signaling pathway in macrophages.

Objective To investigate the effects of Forkhead box protein O3a(FoxO3a)on M2 polarization and ferroptosis of macrophages in allergic rhinitis(AR).Methods Nasal lavage fluids were collected from 30 patients with AR and 30 healthy volunteers,while nasal mucosa samples were obtained from 3 AR patients and 3 healthy volunteers.The levels of FoxO3a in nasal lavage fluids were detected by ELISA.M0 macrophages were transfected with siRNA negative control plasmid(si-Con),siRNA FoxO3a plasmid(si-FoxO3a),pcDNA3.1-vector,or pcDNA3.1-FoxO3a plasmid,and then induced to polarize towards M2 type by interleukin-4(IL-4).M0 macrophages were set as the control group,IL-4 model group,IL-4+si-Con group,IL-4+si-FoxO3a group,IL-4+si-FoxO3a+nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385 group,IL-4+pcDNA3.1-vector group,and IL-4+pcDNA3.1-FoxO3a group.A co-culture system of M0 macrophages and human nasal epithelial cells(NECs)was established,and then divided into the NECs+M0 macrophages(control group),NECs+M2 macrophages(IL-4 model group),NECs+si-FoxO3a-transfected macrophages(IL-4+si-FoxO3a group)and NECs+si-FoxO3a-transfected macrophages+ML385(IL-4+si-FoxO3a+ML385 group).Apoptosis of NECs was detected by flow cytometry.C57BL/6 mice were divided into normal group,AR model group and shRNA-FoxO3a adeno-associated virus(AAV-sh-FoxO3a)group.HE staining was used to observe histopathological changes in nasal mucosa tissue,and flow cytometry was used to detect the proportion of M2 macrophages in mouse nasal lavage fluids.The levels of IL-5,IL-13 and NECs mucin 5AC(MUC5AC)in mouse nasal lavage fluids were detected by ELISA;Western blot was used to detect the levels of FoxO3a,IL-10,arginase 1(Arg-1),Nrf2,heme oxygenase-1(HO-1),and glutathione peroxidase 4(GPX4).Results Compared with the normal,the expression of FoxO3a was increased in nasal lavage fluids and nasal mucosa tissues of AR patients.Compared with the control group,the proportion of M2 macrophages and the levels of FoxO3a were increased in the IL-4 model group,while the expression levels of Nrf-2,HO-1 and GPX4 were decreased,and the levels of Fe2+and malondialdehyde(MDA)were increased(P<0.05).Compared with the IL-4 model group,these indicators were reversed in the IL-4+si-FoxO3a group.Compared with the IL-4 model group,the proportion of M2 macrophages was increased in the IL-4+pcDNA3.1-FoxO3a group.In the co-culture system,compared with the IL-4 model group,the apoptosis of NECs and MUC5AC secretion were decreased in the IL-4+si-FoxO3a group(P<0.05).ML385 reversed the protective effect of si-FoxO3a on NECs.Mice in the AAV-sh-FoxO3a group showed reduced nasal mucosa tissue damage,decreased levels of IL-5 and IL-13 in nasal lavage fluids,and a lower number of M2 macrophages,decreased level of FoxO3a in M2 macrophages,while increased expression of GPX4,Nrf2 and HO-1.Conclusion Interference with FoxO3a protein expression can inhibit macrophage ferroptosis,suppress M2 polarization,and reduce NECs damage,which is related to the activation of the Nrf-2/HO-1 signaling pathway in macrophages.

Objective:To investigate the clinical effect of the anterolateral thigh perforator chimeric flap in the treatment of the wound of diabetic foot ulcer (DFU) .Methods:From January, 2018 to December, 2019, 14 cases wound of DFU of type II diabetic were treated by anterolateral thigh chimeric perforator flap. The patients were 10 males and 4 females, at 49 to 58 years old. Of the 14 patients, 10 with simple peripheral neuropathy, 4 with peripheral neuropathy complicated with vascular disease, and none with single vascular disease. With strict control of patients' blood glucose, antibiotics blended bone cement was applied or filled onto grade 2 or higher grade Wagner's DFU after debridement. In addition, the anterolateral thigh chimeric perforator flap was transferred 2 to 3 weeks later. The size of flap was 8 cm×3 cm-27 cm×7 cm. Regular followed-up were made after surgery.Results:Thirteen flaps survived in one stage after surgery. The other 1 flap had venous vascular crisis, and survived completely after active exploration. The patients were followed-up for 6-12 months. All the flaps survived well in good shape and texture. The donor and recipient areas healed well. The functional recoveries of the DF were satisfactory.Conclusion:Application of anterolateral thigh perforator chimeric flap in repair of the refractory wound of DF achieves a good clinical outcome and effectively improves the life quality of patients.

Objective:To explore the current status of quality of life in domestic patients with extremely severe burns during the rehabilitation period and its influencing factors, so as to provide guidance for early clinical psychological intervention and continuous nursing.Methods:From June 2016 to June 2020, convenience sampling was adopted to select 168 patients with extremely severe burns admitted to the Burn Department of 22 ClassⅢ Grade A hospitals in China as the research subject for questionnaire survey. The questionnaire included the Burn Specific Health Scale-Chinese Version and the General Information Questionnaire. Multiple linear regression analysis was used to determine the factors affecting the quality of life of patients with extremely severe burns during the rehabilitation period.Results:The initial quality of life score for patients with extremely severe burns during the rehabilitation period was (157.27±30.61) , and the final quality of life score was (49.14±9.56) . The final scores of the quality of life in each field were ranked from high to low in the order of social relations, general health, physical function, and mental health. Multiple linear regression analysis showed that the factors affecting the quality of life of patients with extremely severe burns during the rehabilitation period included gender, age, education level, marital status and source of expenses ( P<0.05) . Conclusions:The quality of life of patients with extremely severe burns in my country during the rehabilitation period is at a relatively low level. Nurses should strengthen the psychological intervention of patients during hospitalization and carry out continuous nursing according to the relevant factors that affect the quality of life of patients.