Stroke, a major cerebrovascular disease, has high morbidity and mortality. Effective methods to reduce the risk and improve the prognosis are lacking. Currently, uric acid (UA) is associated with the pathological mechanism, prognosis, and therapy of stroke. UA plays pro/anti-oxidative and pro-inflammatory roles in vivo. The specific role of UA in stroke, which may have both neuroprotective and damaging effects, remains unclear. There is a U-shaped association between serum uric acid (SUA) levels and ischemic stroke (IS). UA therapy provides neuroprotection during reperfusion therapy for acute ischemic stroke (AIS). Urate-lowering therapy (ULT) plays a protective role in IS with hyperuricemia or gout. SUA levels are associated with the cerebrovascular injury mechanism, risk, and outcomes of hemorrhagic stroke. In this review, we summarize the current research on the role of UA in stroke, providing potential targets for its prediction and treatment.
Humans ; Uric Acid/metabolism* ; Stroke/drug therapy* ; Animals ; Hyperuricemia/drug therapy* ; Ischemic Stroke/blood* ; Biomarkers/blood*

Objective:To investigate the diagnostic efficacy of intraoperative direct sonication in periprosthetic joint infection (PJI).Methods:This is a retrospective case series study. The clinical data of 490 patients with PJI or aseptic prosthesis loosening after hip or knee arthroplasty admitted to the Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2023 were retrospectively analyzed. There were 209 male cases, 281 female cases, aged ( M(IQR)) 63 (19) years (range: 15 to 89 years). There were 328 cases of PJI (123 cases of traditional sonication, 205 cases of intraoperative direct sonication, and 204 cases had simultaneous intraoperative synovial fluid), and 162 patients of aseptic loosening (89 cases of traditional sonication, 73 cases of intraoperative direct sonication, and 96 cases had simultaneous intraoperative synovial fluid). The method of traditional sonication: the prosthesis components were placed in a sterile container, vortexed for 30 seconds, then placed in an ultrasound bath to sonication (frequency:(40±2) kHz, power density:(0.22±0.04) W/cm2) for 5 minutes, vortexed again for 30 seconds, and the resulting sonicate fluid was extracted for culture. The method of intraoperative direct sonication: during the operation, the surgical area, the prosthesis and the tissues around the prosthesis which were placed in a sterile container were respectively subjected to sonication for 5 minutes using a portable handheld ultrasonic cell disruptor device (frequency: 25 kHz, power density:(0.22±0.04) W/cm2), and the fluids before and after sonication were extracted for culture. The method of intraoperative synovial fluid: during the operation, the joint capsule was incised, and the synovial fluid was extracted under direct vision for culture. The sensitivity, specificity, positive and negative predictive values, Youden index, the effect of preoperative antimicrobial agents on culture results, and culture duration for different culture methods. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of these methods for PJI was compared using the χ2 test, the Wilcoxon signed-rank test, and other appropriate statistical methods. Results:The sensitivity of intraoperative direct sonication was significantly higher than that of intraoperative synovial fluid culture (89.8%(184/205) vs.56.9%(116/204), χ2=44.457, P<0.01) and traditional sonication (89.8%(184/205) vs.66.7%(82/123), χ2=121.588, P<0.01). However, its specificity was lower compared to intraoperative synovial fluid (87.5%(64/73) vs. 99.0%(95/96), χ2=9.491, P=0.002). The culture duration for intraoperative direct sonication was shorter than for intraoperative synovial fluid 87.0 (41.8) hours vs. 112.5 (78.5) hours, Z=-5.121, P<0.01) and traditional sonication (87.0 (41.8) hours vs. 119.0 (67.5) hours, Z=-7.119, P<0.01). Gram-positive bacteria (predominantly Staphylococcus aureus and Staphylococcus epidermidis) were the most common isolates across all three culture methods. Furthermore, intraoperative direct sonication was more likely to detect polymicrobial infections compared to traditional sonication (38.6% vs. 2.4%, χ2=37.223, P<0.01) and intraoperative synovial fluid (38.6% vs. 0.9%, χ2=55.527, P<0.01). The ROC curve revealed that the area under the curve of intraoperative direct sonication,intraoperative synovial fluid culture and traditional sonication were 0.886 (95% CI:0.843 to 0.930), 0.779 (95% CI:0.743 to 0.815) and 0.788 (95% CI: 0.736 to 0.839). Conclusions:Compared with intraoperative synovial fluid and traditional sonication, intraoperative direct sonication has excellent sensitivity, the shortest appropriate culture duration for pathogenic bacteria, and it is more likely to diagnose PJI patients with polymicrobial infections, having better diagnostic efficacy in the diagnosis of PJI.

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 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 diagnostic efficacy of intraoperative direct sonication in periprosthetic joint infection (PJI).Methods:This is a retrospective case series study. The clinical data of 490 patients with PJI or aseptic prosthesis loosening after hip or knee arthroplasty admitted to the Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2023 were retrospectively analyzed. There were 209 male cases, 281 female cases, aged ( M(IQR)) 63 (19) years (range: 15 to 89 years). There were 328 cases of PJI (123 cases of traditional sonication, 205 cases of intraoperative direct sonication, and 204 cases had simultaneous intraoperative synovial fluid), and 162 patients of aseptic loosening (89 cases of traditional sonication, 73 cases of intraoperative direct sonication, and 96 cases had simultaneous intraoperative synovial fluid). The method of traditional sonication: the prosthesis components were placed in a sterile container, vortexed for 30 seconds, then placed in an ultrasound bath to sonication (frequency:(40±2) kHz, power density:(0.22±0.04) W/cm2) for 5 minutes, vortexed again for 30 seconds, and the resulting sonicate fluid was extracted for culture. The method of intraoperative direct sonication: during the operation, the surgical area, the prosthesis and the tissues around the prosthesis which were placed in a sterile container were respectively subjected to sonication for 5 minutes using a portable handheld ultrasonic cell disruptor device (frequency: 25 kHz, power density:(0.22±0.04) W/cm2), and the fluids before and after sonication were extracted for culture. The method of intraoperative synovial fluid: during the operation, the joint capsule was incised, and the synovial fluid was extracted under direct vision for culture. The sensitivity, specificity, positive and negative predictive values, Youden index, the effect of preoperative antimicrobial agents on culture results, and culture duration for different culture methods. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of these methods for PJI was compared using the χ2 test, the Wilcoxon signed-rank test, and other appropriate statistical methods. Results:The sensitivity of intraoperative direct sonication was significantly higher than that of intraoperative synovial fluid culture (89.8%(184/205) vs.56.9%(116/204), χ2=44.457, P<0.01) and traditional sonication (89.8%(184/205) vs.66.7%(82/123), χ2=121.588, P<0.01). However, its specificity was lower compared to intraoperative synovial fluid (87.5%(64/73) vs. 99.0%(95/96), χ2=9.491, P=0.002). The culture duration for intraoperative direct sonication was shorter than for intraoperative synovial fluid 87.0 (41.8) hours vs. 112.5 (78.5) hours, Z=-5.121, P<0.01) and traditional sonication (87.0 (41.8) hours vs. 119.0 (67.5) hours, Z=-7.119, P<0.01). Gram-positive bacteria (predominantly Staphylococcus aureus and Staphylococcus epidermidis) were the most common isolates across all three culture methods. Furthermore, intraoperative direct sonication was more likely to detect polymicrobial infections compared to traditional sonication (38.6% vs. 2.4%, χ2=37.223, P<0.01) and intraoperative synovial fluid (38.6% vs. 0.9%, χ2=55.527, P<0.01). The ROC curve revealed that the area under the curve of intraoperative direct sonication,intraoperative synovial fluid culture and traditional sonication were 0.886 (95% CI:0.843 to 0.930), 0.779 (95% CI:0.743 to 0.815) and 0.788 (95% CI: 0.736 to 0.839). Conclusions:Compared with intraoperative synovial fluid and traditional sonication, intraoperative direct sonication has excellent sensitivity, the shortest appropriate culture duration for pathogenic bacteria, and it is more likely to diagnose PJI patients with polymicrobial infections, having better diagnostic efficacy in the diagnosis of PJI.

Ferroptosis is a kind of programmed cell death, involves multi-molecular and multi-signaling pathways, and the core processes is iron overload and lipid peroxidation. It affects cancer, neurological disease, cardiovascular disease, digestive system disease, and many other diseases. While, ischemia-reperfusion injury is an extremely complex pathological process, including ischemia-reperfusion injury of the heart, brain, liver and kidney, etc., which often occurs in shock, organ surgery and organ transplantation, seriously affecting human health, and there is no effective radical treatment. However, ferroptosis is closely related to ischemia-reperfusion injury so that it is possible to find the prevention and treatment measures of ischemia-reperfusion injury by exploring the internal relationship between them. Therefore, the author tries to summarize the signaling pathways of ferroptosis, and explores the relationship between ferroptosis and ischemia-reperfusion injury of heart, brain, liver and kidney by moderating the ferroptosis targets properly to find the effective ways to treat cancer, improve inflammation and relieve other diseases.

BACKGROUND:Nanocomposite hydrogel has great research prospects and application potential in the treatment of osteoarthritis. OBJECTIVE:To review the research progress of nanocomposite hydrogel in osteoarthritis and cartilage repair. METHODS:Databases such as CNKI and PubMed were searched.The English key words were"nanocomposite hydrogel,nanogel,osteoarthritis,cartage,physical encapsulation,electrostatic interaction,covalent crosslinking",and the Chinese key words were"nanocomposite hydrogel,nanogel,osteoarthritis,cartage,physical encapsulation,physical encapsulation,electrostatic effect,covalent cross-linking".After an initial screening of all articles based on inclusion and exclusion criteria,71 articles with high correlation were retained for review. RESULTS AND CONCLUSION:In cell or animal experiments,nanocomposite hydrogel has the effect of improving osteoarthritis.Nanocomposite hydrogel can promote cartilage repair,improve the internal environment of osteoarthritis,and achieve the therapeutic purpose of osteoarthritis by improving the mechanical environment between joints,carrying targeted drugs,and promoting the chondrogenesis of seed cells.At present,the research of nanocomposite hydrogel in osteoarthritis disease still has a huge space to play.It is expected to open up a new way for the clinical treatment of osteoarthritis by continuing to deepen the research of material preparation and actively carrying out cell and animal experiments.

Objective:To investigate the diagnostic value of erythrocyte sedimentation rate/C-reactive protein (ECR), fibrinogen and D-dimer in periprosthetic infection after artificial knee replacement.Methods:A total of 205 patients, including 62 males and 143 females, aged 66.9±9.5 years (range 26-84 years), who underwent revision of artificial knee joint at Department of Joint Surgery, The First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2021 were retrospectively collected.122 cases of periprosthetic joint infection (PJI), including 43 cases of acute infection; 79 cases of chronic infection (13 cases of chronic infection combined with rheumatoid arthritis were analyzed separately); there were 83 cases without PJI, including 73 cases of aseptic loosening, 8 cases of prosthesis dislocation and 2 cases of joint stiffness. Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, fibrinogen and D-dimer levels were examined before surgery, and the sensitivity and specificity of the indicators were calculated using the receiver operating characteristic (ROC) curve. The diagnostic value of different inflammatory markers was compared according to the area under curve (AUC).Results:The levels of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in acute PJI group were 2.47±2.91, 50 (38, 62) mm/1 h, 31.6 (13.9, 79.3) mg/L, 4.25±0.94 g/L, 763 (453, 1 157) ng/ml, respectively. The chronic PJI group was 3.06±2.95, 50 (34, 64) mm/1 h, 20.4(12.7, 43.3) mg/L, 4.19±0.91 g/L, 586 (317, 1 122) ng/ml, and the non-PJI group was 6.20±4.64, 22 (15, 34) mm/1 h, 4.6 (2.7, 7.74) mg/L, 3.10±0.59 g/L and 363 (181, 591)ng/ml were statistically significant ( P<0.05). The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in the acute PJI group were 0.82, 0.85, 0.90, 0.88, and 0.76, respectively.The optimal critical values were 2.89, 37.00 mm/1 h, 13.6 mg/L, 3.86 g/L, and 443.0 ng/ml, respectively, with sensitivity of 76.7%, 79.1%, 76.7%, 69.8%, and 82.4%, and specificity of 79.5%, 78.3%, 94.0%, 94.0%, 90.4%, and 63.8%, respectively. The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, D-dimer, and white blood cell count in the chronic PJI group were 0.77, 0.82, 0.87, 0.85, 0.67, and 0.63, respectively. The optimal critical values are 2.91, 33.00 mm/1 h, 10.9 mg/L, 4.01 g/L, 558.5 ng/ml, and 5.575×10 9 /L, respectively, with sensitivity of 68.2%, 78.8%, 81.8%, 63.6%, 57.9%, and 75.8%, and specificity of 79.5%, 73.5%, 88.0%, 95.2%, 72.5%, and 49.4%, respectively. Conclusion:Fibrinogen has a higher diagnostic value for knee joint PJI, followed by ECR, and D-dimer has the lowest diagnostic value for knee joint PJI.

Objective:To investigate the gender differences in serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet (PLT), fibrinogen (FIB) and D-dimer for the diagnosis of chronic periprosthetic joint infection (PJI).Methods:A total of 470 patients who underwent revision arthroplasty in the Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021 were retrospectively analyzed. According to gender and diagnosis, they were divided into four groups: 78 cases of male chronic PJI, 108 cases of male aseptic loosening, 95 cases of female chronic PJI, and 189 cases of female aseptic loosening. The serological results of CRP, ESR, PLT, FIB and D-dimer were collected before operation. The receiver operating characteristics (ROC) curves were used to determine the optimal cut-off values of CRP, ESR, PLT, FIB and D-dimer for the diagnosis of chronic PJI in different genders, and to calculate their sensitivity and specificity. The diagnostic efficacy of the index was analyzed by comparing the area under curve (AUC) of different indicators.Results:The levels of ESR, PLT and D-dimer in the male chronic PJI group were 43 (20.0, 52.5) mm/1 h, 249×10 9 (204×10 9, 306×10 9) /L, 449 (219,833) μg/L, respectively, which were lower than those in the female group of 56 (40, 65) mm/1 h, 295×10 9 (228×10 9, 364×10 9) /L, and 645 (345, 1 157) μg/L, with statistically significant differences ( Z=-4.17, P<0.001; Z=-2.17, P=0.030; Z=-2.82, P=0.005). The AUC of CRP in the male chronic PJI group was 0.841, which was higher than the AUC of the other four indicators; CRP was combined with ESR, PLT, FIB and D-dimer to establish a joint prediction model for male chronic PJI. The ROC curve showed that the combination of CRP+FIB had a maximum AUC [0.849, 95% CI (0.79, 0.91)], sensitivity of 80% and specificity of 86%. The AUC of CRP in the female chronic PJI group was 0.866, which was higher than the AUC of the other four indices; CRP was combined with ESR, PLT, FIB and D-dimer to establish a combined prediction model for female chronic PJI. The ROC curve showed that the combination of CRP+PLT had the maximum AUC [0.883, 95% CI (0.84, 0.93)], sensitivity of 87% and specificity of 79%. Conclusion:Serologic indicators in patients with chronic PJI are gender-specific. CRP combined with FIB has the highest diagnostic value for the chronic PJI in males, while CRP combined with PLT has the highest diagnostic value for the chronic PJI in females.

Objective:To investigate the diagnostic value of plasma fibrinogen (FIB) in chronic periprosthetic joint infection (PJI).Methods:A total of 470 patients who underwent revision hip and knee arthroplasty after primary hip and knee arthroplasty in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021 were retrospectively analyzed. According to the diagnosis of the disease, 173 patients (112 hips and 61 knees) were divided into chronic PJI group, including 78 males and 96 females, aged 65 (53, 72) years; and 297 patients (216 hips and 81 knees) were divided into aseptic loosening group, including 108 males and 189 females, aged 63 (50, 72) years. The preoperative levels of FIB, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and platelet were compared between the two groups, and the sensitivity and specificity of the diagnosis of chronic PJI were calculated. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values of FIB, CRP, ESR, platelet and D-dimer for the diagnosis of chronic PJI. The diagnostic efficacy of each indicator was analyzed by comparing the area under curve (AUC) and using a combined diagnostic test.Results:FIB, CRP, ESR, platelets and D-dimer in the chronic PJI group were 4.05 (3.52, 4.72) g/L, 19.5 (10.7, 40.0) mg/L, 50 (28, 60) mm/1 h, 270 (221, 351)×10 9 /L, 514 (261, 873) μg/L, respectively, which were higher than 3.25 (2.80, 3.63) g/L, 3.7 (2.0, 6.7) mg/L, 20 (12, 30) mm/1 h, 225 (182, 269)×10 9 /L, and 310 (167, 569) μg/L in sterile loosening group, with statistically significant differences ( P<0.05). The AUC of FIB, CRP, ESR, platelets and D-dimer in the diagnosis of chronic PJI were 0.78 (95% CI: 0.73, 0.82), 0.86 (95% CI: 0.82, 0.89), 0.80 (95% CI: 0.76, 0.85), 0.68 (95% CI: 0.63, 0.73), 0.64 (95% CI: 0.59, 0.69); the optimal cut-off values were 3.73 g/L, 9.64 mg/L, 39 mm/1 h, 280×10 9 /L, 624 μg/L; the sensitivity was 68%, 79%, 69%, 47%, 43%; the specificity was 81%, 85%, 85%, 81%, 79%, respectively. When CRP, ESR, FIB, platelets and D-dimer were combined sequentially to diagnose patients with chronic PJI, the sensitivity and specificity of the series test were 12.7% and 99.7%, and those of the parallel test were 100% and 37.3%. The combined diagnostic test showed that the maximum AUC of FIB combined with CRP was 0.85 (95% CI: 0.81, 0.89), with a sensitivity of 76% and a specificity of 89%. Conclusion:The clinical value of plasma FIB in the diagnosis of chronic PJI is not superior to that of CRP and ESR, but the combination of FIB and CRP can improve the specificity.