BACKGROUND: Diabetic foot is a complex condition with high incidence, recurrence, mortality, and disability rates. Current treatments for diabetic foot ulcers are often insufficient. This study was conducted to identify potential therapeutic targets for diabetic foot. METHODS: Datasets related to diabetic foot and diabetic skin were retrieved from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using R software. Enrichment analysis was conducted to screen for critical gene functions and pathways. A protein interaction network was constructed to identify node genes corresponding to key proteins. The DEGs and node genes were overlapped to pinpoint target genes. Plasma and chronic ulcer samples from diabetic and non-diabetic individuals were collected. Western blotting, immunohistochemistry, and enzyme-linked immunosorbent assays were performed to verify the S100 calcium binding protein A9 (S100A9), inflammatory cytokine, and related pathway protein levels. Hematoxylin and eosin staining was used to measure epidermal layer thickness. RESULTS: In total, 283 common DEGs and 42 node genes in diabetic foot ulcers were identified. Forty-three genes were differentially expressed in the skin of diabetic and non-diabetic individuals. The overlapping of the most significant DEGs and node genes led to the identification of S100A9 as a target gene. The S100A9 level was significantly higher in diabetic than in non-diabetic plasma (178.40 ± 44.65 ng/mL vs. 40.84 ± 18.86 ng/mL) and in chronic ulcers, and the wound healing time correlated positively with the plasma S100A9 level. The levels of inflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-1, and IL-6) and related pathway proteins (phospho-extracellular signal regulated kinase [ERK], phospho-p38, phospho-p65, and p-protein kinase B [Akt]) were also elevated. The epidermal layer was notably thinner in chronic diabetic ulcers than in non-diabetic skin (24.17 ± 25.60 μm vs. 412.00 ± 181.60 μm). CONCLUSIONS S100A9 was significantly upregulated in diabetic foot and was associated with prolonged wound healing. S100A9 may impair diabetic wound healing by disrupting local inflammatory responses and skin re-epithelialization.
Calgranulin B/therapeutic use* ; Diabetic Foot/metabolism* ; Humans ; Datasets as Topic ; Computational Biology ; Mice, Inbred C57BL ; Animals ; Mice ; Protein Interaction Maps ; Immunohistochemistry

Objective To construct a prognostic model for uterine corpus endometrial carcinoma(UCEC)using the prognosis-associated ADME genes involved in controlling drug absorption,distribution,metabolism,and excretion(ADME),providing a reference for predicting the prognosis of UCEC and tumor treatment.Methods The gene expression and clinical information data of UCEC were obtained from the TCGA and ICGC databases.Prognosis-related ADME genes were screened using the univariate Cox regression analysis.Least absolute shrinkage and selection operator(LASSO)regression was used to identify optimal prognostic genes,and then a risk score model was constructed.Kaplan-Meier curve and receiver operating characteristic(ROC)curve were constructed to assess predictive capability.R software was used to perform differentially expressed genes anal-ysis,functional enrichment analysis.Results A nine-gene signature(DHRS7B,CYP46A1,SLCO4C1,NR1I2,SLC16A1,SLCO3A1,ARSA,ABCC5,MGST2)was used for constructing a risk score model.Survival analysis showed that the survival time in high-risk patients was significantly shorter than in low-risk patients(the train set:P＜0.001;the test set:P=0.032).The are-as under the ROC curve of the train set and the test set for ROC at 1,3,5 years were 0.792,0.724,0.712,and 0.651,0.620,0.677,respectively.Univariate and multivariate Cox regression analysis showed that the risk score was an independent risk factor for UCEC(HR=1.77,P=0.035).In addition,there was a significant difference in the miRNA-mediated silencing and regulation of sprouting angiogenesis pathways between the high-risk and low-risk score groups.Conclusion The prognosis model con-structed with nine key ADME genes may have the potential to be used for predicting the survival prognosis of patients with UCEC.

Objective:To identify the risk factors for massive blood transfusion in pediatric living donor liver transplantation.Methods:The medical data of children underwent living donor liver transplantation in our hospital from April 2006 to April 2019 were retrospectively collected.Massive transfusion was defined as the administration of red blood cells > 1 fold of the total blood volume (70 ml/kg) during operation.Patients were assigned to massive transfusion group and non-massive transfusion group according to the volume of blood transfused during operation.Binary logistic regression analysis was used to identify the risk factors for massive blood transfusion during living liver transplantation.Results:A total of 95 pediatric patients were enrolled in this study, with 18 cases in massive transfusion group and 77 cases in non-massive transfusion group.The incidence of massive blood transfusion was 19% during operation.The results of logistic regression analysis showed that preoperative survival status of " hospitalization" ( OR=49.816, 95% CI 2.945-842.59, P=0.007), increased serum Cr concentrations ( OR=1.046, 95% CI 1.007-1.086, P=0.021), increased Pediatric End-Stage Liver Disease (PELD) or Model for End-Stage Liver Disease (MELD) score ( OR=1.215, 95% CI 1.046-1.411, P=0.011) and prolonged operation time( OR=1.623, 95% CI 1.133-2.327, P=0.008) were the independent risk factors for intraoperative massive blood transfusion in living donor liver transplantation, while increased recipient weight ( OR=0.856, 95% CI 0.761-0.962, P=0.009) was a protective factor for intraoperative massive blood transfusion. Conclusions:Preoperative survival status of " hospitalization", increased PELD or MELD score and prolonged operation time are independent risk factors, while increased pediatric weight is a protective factor for massive blood transfusion in pediatric living donor liver transplantation.

Femtosecond laser small incision lenticule extraction (SMILE) with different residual stromal thicknesses (RST) is set to investigate its effect on corneal biomechanical properties of rabbits in vivo. In this study, 24 healthy adult Japanese rabbits were randomly divided into group A and B. The RST of group A was set 30% of the corneal central thickness (CCT), and the RST of group B was 50% of the CCT. The thickness of the corneal cap in both groups was set one third of CCT. Corneal visualization Scheimpflug technology (Corvis ST) and Pentacam three-dimensional anterior segment analyzer were used to determine corneal biomechanical and morphological parameters before surgery, and 1 week, 1 month and 3 months after surgery. Pearson correlation analysis was used to analyze factors affecting corneal biomechanical parameters after SMILE. The results showed that the corneal stiffness of group A was significantly higher than that of group B at 1 week and 1 month after surgery, and most biomechanical parameters returned to preoperative levels at 3 months postoperatively. The results of correlation analysis showed that postoperative CCT and RST were the main factors affecting corneal biomechanical parameters after SMILE. There was no significant difference in corneal posterior surface height (PE) between 3 months after surgery and before surgery in both two groups. It indicates that although the ability to resist deformation of cornea decreases in SMILE with thicker corneal cap and less RST, there is no tendency to keratoconus, which may be related to the preservation of more anterior stromal layer.
Animals ; Biomechanical Phenomena ; Cornea/surgery* ; Postoperative Period ; Rabbits

Objective:To summarize and compare the characteristics of oral microbiota in women during the preconception period and the third trimester.Methods:This retrospective cohort study involved 55 women who were recruited in the Preconceptional Offspring Trajectory Study (PLOTS) conducted by Fudan University and followed up to the third trimester in the Maternal and Child Health Care Hospital of Jiading District of Shanghai from September 2016 to December 2019. A total of 110 unstimulated saliva samples were collected in the preconception period ( n=55) and the third trimester ( n=55). Features of oral microbiota in the samples were analyzed by 16S rRNA gene-based sequencing. Moreover, the related factors were also analyzed. Paired t test or Wilcoxon matched-pairs signed-ranks test were used to analyze the differences in α-diversity during preconception and the third trimester; t test, analysis of variance (ANOVA), Kruskal-Wallis test and Mann-Whitney U test for comparison between groups with different characteristics and permutational multivariate analysis of variance (PerMANOVA) for β-diversity were used; Linear discriminant analysis (LDA) effect size (LEfSe 1.0) was used to identify the iconic oral flora. Results:(1) The Ace index of oral microbiota was significantly lower in the third trimester than that in the preconception period [661.14(578.15-752.85) vs 730.64 (632.40-911.00), T=1 077.00, P=0.010]. There was also a significance difference in β-diversity ( F=12.539, R2=0.104, P=0.001). Some species such as Saccharibacteria_TM7_G3, Prevotella_7, Absconditabacteria_SR1_G1, Porphyromonas, Ruminococcaceae_UCG_014, Prevotella, Peptostreptococcus, Prevotella_2, Alloprevotella, Parvimonas, Solobacterium and Eubacterium_nodatum_group in saliva were statistically more abundant in the third trimester than those in the preconception period (all P<0.05). (2) The third-trimester Shannon index was lower among those with lower income [5.44 (5.08-5.77) vs 5.75 (5.44-6.12), U=219.00, P=0.029] and those with gargle habit after meal or dessert [5.36 (4.91-5.48) vs 5.72 (5.44-6.05), U=374.00, P=0.046]. Conclusions:The features of oral microbiota vary in women during the preconception period and the third trimester. There is a significant increase in the abundance of oral pathogenic and opportunistic bacteria in the third trimester.

Objective:To discuss the surgical strategies for anteromedial tibial plateau compression fracture complicated with posterolateral corner injury.Methods:From 2015 January to 2020 July, 18 patients with anteromedial tibial plateau compression fracture complicated with posterolateral corner injury were admitted to Department Ⅲ of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine. They were 11 males and 7 females, aged from 28 to 57 years (average, 38.6 years). By the CT three-column theory, all their fractures were medial column ones; by the Fanelli classification, there were 5 cases of type B and 13 cases of type C. Seventeen patients with fresh fracture were treated with arthroscopic ligament reconstruction and meniscus repair followed by primary reduction and fixation of tibial plateau fracture. The one patient with obsolete injury was treated with high tibial osteotomy around the knee joint and reconstruction of the anterior cruciate ligament. Recorded were the patients' fracture healing time, knee Lysholm score, joint range of motion and complications.Results:The 17 patients with fresh injuries were followed up for 12 to 24 months (average, 18.4 months). Their fracture healing time ranged from 12 to 24 weeks (average, 17.7 weeks). By one year after surgery, their knee extension reached 0° and their knee flexion from 120° to 135° (average, 131.9°); their knee Lysholm scores ranged from 88 to 95 points (average, 91.2 points). The one patient with old injuries was followed up for 18 months, with fracture healing time of 18 weeks, knee range of motion from 0° to 120° and knee Lysholm score of 86 points by one year after operation. None of the patients reported such complications as neurovascular injury, wound infection, internal fixation failure or nonunion.Conclusion:For anteromedial tibial plateau compression fracture complicated with posterolateral corner injury, primary repair and reconstruction can restore knee joint stability, leading to fine therapeutic outcomes.

Objective:To evaluate the aesthetic outcome of the pretarsal orbicularis-tarsus fixation technique in incisional double eyelid blepharoplasty.Methods:Postoperative results were evaluated from 798 patients who underwent the orbicularis-tarsus fixation blepharoplasty from January 2015 to December 2018. Based on an incisional maneuver, soft tissue was carefully removed to expose the superior edge of tarsus, then the pretarsal orbicularis oculi muscle was anchored on the tarsus. For skin closure, both skin margins, a small bite of subcutaneous tissue and the pretarsal fascia were interruptedly sutured to enhance cicatricial adhesion.Results:All patients successfully underwent double eyelidplasty using this modified technique. The follow-up period ranged from two to forty-six months, with a mean period of twenty months. Ninety-six percent of the patients were satisfied with postoperative outcomes. Twenty-two cases of palpebral fold asymmetry and ten cases of unsatisfactory fold formation near the inner canthus were encountered. However, all the defects had been well improved by minor revisions. No supratarsal crease drooping or disappearing, suture spitting out, scar hypertrophy or crease depression were observed postoperatively.Conclusions:The orbicularis-tarsus fixation method is a reliable technique for double eyelid plasty. It enables high feasibility and long-lasting result, with lower risk of postoperative complications.

Objective: This study is to investigate the outcome of unilateral cleft lip repairment using trilobate flap and nasal-labial muscle tension system reconstruction. Methods: From January 2015 to December 2017, 264 children with unilateral cleft lip were performed cheiloplasty. For all the patients, trilobate flap was adopted. The tension lines group among nasal-labial muscles were reconstructed following a three-dimensional pattern. Long-term results were evaluated using postoperative photos. Three measurements were collected, to compare the nasolabial contour on the cleft side and noncleft side. Results: Six to 12 months follow-up was completed in 112 patients. Asymmetry percentage of lip height was (2.98±1.65)%, while nostril width ratio was 1.02±0.05, and nostril height ratio was 0.94±0.04. Aesthetic contour of vermillion and philtrum were satisfied. Conclusions Trilobate flap technique combined with the reconstruction of nasal-labial muscle tension system have reliable effect on unilateral cleft lip repair. With proper application, satisfactory and stable outcomes can be achieved.

Objective To evaluate the lipid-lowering effect of 10 mg policosanol versus an equal dose of atorvastatinin patients with dyslipidemia.Method Databases such as VIP,Wanfang,CNKI,Cochrance Library,PubMed,Web of Science and EMBASE were searched for random control trials(RCT) and controlled clinical trials (CCT) of 10 mg policosanol versus an equal dose of atorvastatinin their lipid-lowering effects.The quality was assessed by Cochrance Handbook 5.1.0 or Newcastle-Ottawa scale (NOS).The study related data were analyzed statistically with RevMan 5.2 software.4 RCTs were selected.257 patients were included in the trials.130 cases were in 10 mg policosanol group and 127 cases belonged to 10 mg atorvastatin group.Results Results of Meta-analysis show that TC[SMD=0.84,95%CI(0.41,1.27),P=0.000 1] and LDL-C[SMD=0.68,95%CI(0.28,1.09),P=0.001] were reduced more effectively in 10 mg atorvastatin group than in 10 mg policosanol group.HDL-C[SMD=0.27,95%CI(0.02,0.51),P=0.03] was elevated more in 10 mg policosanol group than 10 mg atorvastatin group.Both groups showed no statistic difference(P=0.42) in TG [SMD=0.10,95% CI:(-0.41,0.35),P=0.42].Conclusion The lipid-lowering efficacy of 10 mg atorvastatin is better than equal dose of policosanolin patients with dyslipidemia.Dose increase of policosanol should be considered to ensure the efficacy when policosanol was used tore place atorvastatin therapy.This study had some shortcomings, such as limited study numbers and small sample size.The reliability of this study should be verified from high-quality,multi-center RCTS with large samples.

Objective To evaluate the clinical efficacy of arthroscopic treatment of tibial intercondylar eminence avulsion fracture in pediatric patients without epiphyseal interference.Methods From February 2010 to February 2014,18 children patients with avulsion fracture of tibial eminence were admitted.They were 12 boys and 6 girls,from 7 to 14 years of age (average,10.4 years).Four cases were complicated with meniscus injury and 2 with medial collateral ligament injury.The mean time from injury to surgery was 4.5 days (range,from 2 to 7 days).According to Meyers-McKeever classification,13 children were type Ⅱ and 5 type Ⅲ.They were treated with Ultrabraid sutures arthroscopically.After reposition,the bone fragments were fixated to the distal epiphysis of tibial tubercle through the inferior of transverse ligament of knee to avoid epiphyseal injury.Anterior drawer test,Lanchman test,pivot shift test and Lysholm knee scoring were conducted at all clinical follow-up visits to assess functional recovery.Results All children were followed up from 10 to 24 months (average,15 months).The X-ray examination demonstrated bone union in all cases.At the end of follow-up,all children achieved satisfactory recovery of range of motion without complications like joint stiffness,joint relaxation,dysfunction or epiphyseal injury.The anterior drawer test,Lanchman test and pivot shift test were all negative at the last follow-up.The mean Lysholm knee scores improved significantly from preoperative 45.6 ± 7.4 to 92.4 ± 5.8 at the final follow-up (t =-25.403,P ＜ 0.01).Conclusions Bone reposition under arthroscopy with suture fixation is reliable and minimally invasive in the treatment of avulsion fractures of tibial intercondylar eminence in pediatric patients.