Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

Objective:To investigate the clinical efficacy of stamp skin grafting combined with vacuum sealing drainage in the treatment of diabetic foot ulcers.Methods:A prospective study was conducted involving 80 patients with diabetic foot ulcers admitted to Lishui Central Hospital from January 2020 to December 2022. The patients were divided into an observation group and a control group, with 40 patients in each group, using a random number table method. The control group received treatment with vacuum-sealing drainage technology, while the observation group was treated with stamp skin grafting combined with vacuum sealing drainage. The two groups were compared based on several perioperative indicators, including wound healing time, length of hospital stay, number of dressing changes, and progress of granulation tissue growth. Pain levels were assessed using the Visual Analog Scale. Additionally, dorsalis pedis blood flow dynamics were evaluated, focusing on the diameter of the dorsalis pedis artery and arterial blood flow velocity. Foot function was assessed using the Maryland Foot Function Scale. The occurrence of postoperative complications was recorded.Results:The wound healing time and length of hospital stay in the observation group were (21.54 ± 5.32) days and (27.08 ± 5.97) days, respectively, which were significantly shorter than those in the control group [(26.69 ± 5.66) days, (31.49 ± 6.80) days, t = 4.19, 3.08, both P < 0.05]. The number of dressing changes in the observation group was (5.11 ± 1.14), which was significantly fewer than that in the control group [(8.07 ± 1.59), t = 9.56, P < 0.001]. The progress of granulation tissue growth in the observation group [(3.12 ± 0.64) mm] was faster that in the control group [(2.09 ± 0.48) mm, t = 8.14, P < 0.001]. At 1, 2, and 3 months post-surgery, the Visual Analog Scale scores for the observation group were (3.52 ± 0.65), (2.33 ± 0.42), and (1.40 ± 0.26), respectively, which were significantly lower than those in the control group [(3.96 ± 0.71), (2.74 ± 0.44), (1.78 ± 0.34), t = 2.89, 4.26, 5.615, all P < 0.05). At 3 months post-surgery, the diameter of the dorsalis pedis artery and arterial blood flow velocity in the observation group were (2.64 ± 0.44) mm and (36.42 ± 6.28) cm/s, respectively, which were greater than those in control group [(2.18 ± 0.41) mm, (30.97 ± 5.33) cm/s, t = 4.83, 4.18, both P < 0.001]. At 3 months post-surgery, the scores for pain, foot function, appearance, and range of motion in the observation group were (39.28 ± 6.70), (48.10 ± 7.22), (7.94 ± 1.54), and (12.15 ± 2.35), respectively, which were significantly higher than those in the control group [(33.46 ± 6.89), (43.08 ± 6.68), (5.38 ± 1.06), and (10.69 ± 2.16), t = 3.83, 3.22, 8.66, 2.89, all P < 0.05]. There was no statistically significant difference in the overall incidence of postoperative complications, including skin flap necrosis/dislocation, hematoma accumulation, infection, and ulcer recurrence, between the two groups ( P > 0.05). Conclusions:Stamp skin grafting combined with vacuum sealing drainage can significantly accelerate wound healing in patients with diabetic foot ulcers, reduce postoperative pain, improve dorsalis pedis blood flow dynamics, enhance foot function, and demonstrate good safety.

Objective:To investigate the clinical efficacy of stamp skin grafting combined with vacuum sealing drainage in the treatment of diabetic foot ulcers.Methods:A prospective study was conducted involving 80 patients with diabetic foot ulcers admitted to Lishui Central Hospital from January 2020 to December 2022. The patients were divided into an observation group and a control group, with 40 patients in each group, using a random number table method. The control group received treatment with vacuum-sealing drainage technology, while the observation group was treated with stamp skin grafting combined with vacuum sealing drainage. The two groups were compared based on several perioperative indicators, including wound healing time, length of hospital stay, number of dressing changes, and progress of granulation tissue growth. Pain levels were assessed using the Visual Analog Scale. Additionally, dorsalis pedis blood flow dynamics were evaluated, focusing on the diameter of the dorsalis pedis artery and arterial blood flow velocity. Foot function was assessed using the Maryland Foot Function Scale. The occurrence of postoperative complications was recorded.Results:The wound healing time and length of hospital stay in the observation group were (21.54 ± 5.32) days and (27.08 ± 5.97) days, respectively, which were significantly shorter than those in the control group [(26.69 ± 5.66) days, (31.49 ± 6.80) days, t = 4.19, 3.08, both P < 0.05]. The number of dressing changes in the observation group was (5.11 ± 1.14), which was significantly fewer than that in the control group [(8.07 ± 1.59), t = 9.56, P < 0.001]. The progress of granulation tissue growth in the observation group [(3.12 ± 0.64) mm] was faster that in the control group [(2.09 ± 0.48) mm, t = 8.14, P < 0.001]. At 1, 2, and 3 months post-surgery, the Visual Analog Scale scores for the observation group were (3.52 ± 0.65), (2.33 ± 0.42), and (1.40 ± 0.26), respectively, which were significantly lower than those in the control group [(3.96 ± 0.71), (2.74 ± 0.44), (1.78 ± 0.34), t = 2.89, 4.26, 5.615, all P < 0.05). At 3 months post-surgery, the diameter of the dorsalis pedis artery and arterial blood flow velocity in the observation group were (2.64 ± 0.44) mm and (36.42 ± 6.28) cm/s, respectively, which were greater than those in control group [(2.18 ± 0.41) mm, (30.97 ± 5.33) cm/s, t = 4.83, 4.18, both P < 0.001]. At 3 months post-surgery, the scores for pain, foot function, appearance, and range of motion in the observation group were (39.28 ± 6.70), (48.10 ± 7.22), (7.94 ± 1.54), and (12.15 ± 2.35), respectively, which were significantly higher than those in the control group [(33.46 ± 6.89), (43.08 ± 6.68), (5.38 ± 1.06), and (10.69 ± 2.16), t = 3.83, 3.22, 8.66, 2.89, all P < 0.05]. There was no statistically significant difference in the overall incidence of postoperative complications, including skin flap necrosis/dislocation, hematoma accumulation, infection, and ulcer recurrence, between the two groups ( P > 0.05). Conclusions:Stamp skin grafting combined with vacuum sealing drainage can significantly accelerate wound healing in patients with diabetic foot ulcers, reduce postoperative pain, improve dorsalis pedis blood flow dynamics, enhance foot function, and demonstrate good safety.

ObjectiveTo investigate the relationship between Jiaotai pill (JTP), its main component berberine (BBR), and the serotonin (5-HT) system in regulating islet hormone secretion and alleviating pancreatic β-cell dysfunction during type 2 diabetes mellitus (T2DM) progression.MethodsT2DM rat model was established using a high-fat diet and streptozotocin injection. JTP, BBR, and Metformin were intragastrically administered for 35 days. The analyzed indices included blood glucose, blood lipids, islet hormones, and proteins related to 5-HT synthesis, secretion, and transport. Additionally, an in vitro model of glucose injury in islet cells was established to study the effects of JTP and BBR on islet hormone secretion following tryptophan hydroxylase 1 (TPH1) inhibition.ResultsJTP and BBR significantly improved blood glucose and lipid levels and islet morphology in T2DM rats. Both models exhibited reduced islet 5-HT levels and impaired islet hormone secretion. However, the administration of JTP and BBR reversed these effects. Furthermore, JTP and BBR upregulated the expression of TPH1(P = .0194, P = .0413) transglutaminase 2 (TGase2; P = .0492, P = .0349), serotonin transporter (SERT, P = .0090), and 5- hydroxytryptamine 1F receptor (5-HT1FR) in the islet 5-HT pathway (P = .0194). In the cell model, the regulatory effects of JTP and BBR on islet hormone levels were significantly weakened after TPH1 inhibition (P = .001), suggesting that JTP and BBR influence islet hormone secretion through the pancreatic 5-HT system.ConclusionThe islet 5-HT system is correlated with islet hormone secretion dysfunction in T2DM. JTP and BBR can improve islet hormone secretion by activating the TPH1/TGase2/SERT/5-HT1FR pathway in the islet 5-HT system in T2DM rats.

Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

Objective:To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF) in series to repair large area soft tissue defects of forearm.Methods:The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction) Surgery, Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed, including 8 males and 3 females. Aged 36 to 68 years old, with an average of 48 years old. VSD treatment was performed after debridement, and until fresh removed 3 to 5 days after the operation. Until the wound was fresh. The wound was repaired with free bilateral ALTF in series until fresh. The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm. The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm. The series of bilateral flaps: One of the flaps was used as the proximal flap, and its vascular pedicle was anastomosed with the arteries and veins of the recipient area. The other flap was used as the distal flap, and the arteries and veins between the 2 ALTFs on both sides were anastomosed. The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery. The flap and the surrounding skin of the recipient area were sutured immediately. The donor sites of the flap was closed directly. Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results:All the flaps successfully survived after the surgery. The postoperative follow-up lasted for 6-18 months, 12 months in average. The flaps survived well with good soft texture, without swelling, the capillary reaction time was normal, without surface ulceration, in rosy colour and restored protective sensations. The hand function of the affected limb recovered well. The wound at donor sites healed well without complications. At the last follow-up, the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the result was 7 in excellent and 4 in good. The patients were satisfied with the flap and the therapeutic effect.Conclusion:The free bilateral ALTF in series can be used to repair a wound surface with large area, and the donor site can be closed at the same time. It is an effective method to repair large soft tissue defect of forearm.

Lysyl oxidase (LOX) family is a group of copper-containing amine oxidases composed of LOX and LOX-like proteins (LOXL1, LOXL2, LOXL3, and LOXL4). It is overexpressed in tumor tissue and promotes tumor metastasis through covalent cross-linking of extracellular matrix, with the functions of cell growth control, tumor inhibition, senescence, and chemotaxis. In recent years, more and more evidence has shown that LOX family members play a key role in the pathogenesis of hepatocellular carcinoma (HCC), suggesting that they have great potential as therapeutic targets. This article reviews the role of LOX family members in the development and progression of HCC and the intervention effect of traditional Chinese medicine extracts on HCC by regulating LOX family, in order to provide a reference for further research on the prevention and treatment of HCC.

Macrophages, as important immune cells, are involved in the key processes that maintain the homeostasis of intrahepatic microenvironment. Recent studies have shown that different liver diseases can induce macrophage polarization (MPP) and form M1 and M2 phenotypes with mutual antagonism. The former promotes the clearance of pathogens and inhibits tumor progression, while the latter exerts an anti-inflammatory effect and promotes tissue repair. However, there are significant differences in the mechanism of action and phenotypic switching of MPP in different liver diseases or at different pathological stages of the disease. This article focuses on the origin and polarization characteristics of intrahepatic macrophages and summarizes the research advances in the role of MPP in the pathogenesis and therapeutic drugs of non-neoplastic liver diseases such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and liver fibrosis, in order to explore the potential of MPP in regulating the immune response and inflammatory response of liver diseases.

Acute-on-chronic liver failure (ACLF) is a life-threatening disease with a high risk of multiple organ failure, sepsis, and death. ACLF activates innate and acquired immune responses in human body and thus leads to the progression of persistent systemic inflammatory response syndrome and multiple organ dysfunction, leading to the high mortality rate of this disease. Dysregulated immune response plays a key role in disease progression, and immunotherapy may help to target immune-mediated organ damage and inhibit the progression of liver failure. This article reviews the role and mechanism of drugs and means with a potential immune regulatory effect in ACLF, in order to provide a reference for immunotherapy for ACLF.

At present, hepatic encephalopathy has a relatively high mortality and thus greatly affects patients’ quality of life. This article describes the changes of intestinal flora in patients with hepatic encephalopathy and analyzes the mechanism of action of intestinal flora in hepatic encephalopathy and related treatment methods. It is pointed out that the development of hepatic encephalopathy is closely associated with intestinal flora, and clinical treatment by regulating intestinal flora has achieved a marked effect in patients with hepatic encephalopathy. In the future, the research on intestinal flora in patients with hepatic encephalopathy can be deepened to provide better regimens for the treatment of hepatic encephalopathy.