Diabetic foot ulcer (DFU) have emerged as a serious global health issue due to its high rates of occurrence, disability, and mortality. DFU exhibit an exceptionally high recurrence rate, driven by a combination of behavioral and biological factors, leading to the recognition of fully epithelialized ulcers as being in "remission" rather than cured. However, the pathogenic factors underlying recurrent DFU (RDFU) remain poorly understood. This review examines the epidemiological characteristics and pathophysiological mechanisms of RDFU. Key mechanisms include neuropathy, angiopathy, epigenetic modifications, and metabolic memory. Research demonstrates that RDFU development results from the interplay of multiple factors: hyperglycemia-induced metabolic abnormalities, chronic inflammatory responses, vascular and neurological damage, as well as dysregulated epigenetic control. These factors interact synergistically, creating a vicious cycle that increases the risk of recurrence and delays recovery. By synthesizing current knowledge, this review aims to provide a foundation for future research and clinical management of RDFU. The insights presented support the development of personalized treatment strategies and effective preventive measures to reduce recurrence and improve patient outcomes.

Objective:To analyze clinical indicators and imaging data of hospitalized pneumonia patients and develop prediction models for length of hospital stay based on CT radiomics features and clinical indicators.Methods:Patients admitted to the First Clinical School of Hainan Medical University for pneumonia treatment between November 2020 and May 2024 were enrolled. Clinical data and CT imaging were collected, and radiomics features were extracted. Patients were divided into three groups based on the length of stay (<8 d, 8-28 d,>28 d, and poor prognosis). Three prediction models were constructed using logistic regression (LR): clinical features model, imaging features model and a combined clinical and imaging features model. The predictive performance of three models was evaluated using the area under the receiver operating characteristic (ROC) curve and DeLong test, followed by feature analysis. The Kappa test was used to compare the consistency of the overall classification.Results:A total of 343 subjects were included, with an average age of 61.46±20.98 years. The area under the curve (AUC) values of the combined model in different hospitalization duration classifications (<8 d, 8-28 d,>28 d, and poor prognosis) were 0.73, 0.65 and 0.78 in the training set, and 0.71, 0.65 and 0.76 in the validation set, respectively. The AUC values of the clinical feature model in different hospitalization duration classifications were 0.63, 0.64 and 0.73 in the training set, and 0.60, 0.52 and 0.63 in the validation set, respectively. The AUC values of the imaging feature model in different hospitalization duration classifications (<8 d, 8-28 d,>28 d, and poor prognosis) were 0.67, 0.66 and 0.73 in the training set, and 0.68, 0.54 and 0.66 in the validation set, respectively. The DeLong test results showed that the combined model outperformed other models in hospitalization duration classification (validation set AUC, all P<0.05, Bonferroni correction). Kappa test results showed that the combined model achieved the highest consistency between predicted classifications and actual hospitalization classifications ( K=0.615). Shape features, texture features and clinical features all contributed proportionally to the combined model. Conclusion:The combined model integrating radiomics features with clinical indicators can significantly enhance the predictive efficacy for the length of hospitalization in pneumonia patients.

Objective To develop and validate an efficient and simple liquid chromatography with tandem mass spectrometry(LC-MS/MS)method for determination of polymyxin E in human plasma,and apply the established method in therapeutic drug monitoring(TDM)of polymyxin E.Methods The LC-MS/MS platform was based on AB SCIEX HPLC-4500MD system.Gradient elution was performed with 0.2％formic acid in water and 0.2％formic acid in acetonitrile.Phenomenex Kinetex XB-C18 column(100 mm × 2.1 mm,2.6 μm)were used.The analytes were detected by electrospray ionization(ESI)positive multiple reaction monitoring mode.The ion pairs for analytes(polymyxins E1,E2)and internal standard(polymyxins B1)were m/z 390.7→101.3,m/z 386.0→101.2,and m/z 402.3→101.2,respectively.Plasma samples were processed with protein precipitation method.Results Polymyxin E1 and E2 showed good linearity in the range of 0.031 2-6.24 mg/L and 0.006 15-1.23 mg/L,respectively.The within-run accuracy of polymyxin E1 and E2 in plasma ranged from 89.4％to 99.8％and 91.5％to 108.2％,respectively,while the between-run accuracy ranged from 91.8％to 104.7％and 95.6％to 105.2％,respectively.The within-run precision of polymyxin E1 and E2 in plasma ranged from 4.9％to 8.9％and 2.8％to 8.5％,respectively,while the between-run precision ranged from 4.1％to 7.6％and 4.2％to 9.8％,respectively.The average internal standard normalized matrix effect factors of polymyxins E1 and E2 were 96.9％-111.2％and 106.1％-112.8％in blank plasma samples from 6 different sources,102.5％-106.8％and 98.8％-105.2％in lipemic plasma,respectively,107.8％-108.9％and 106.9％-1 07.4％in hemolyzed plasma,respectively.The precision of matrix effects was less than 15.0％.The average recovery rate was 102.9％-107.5％for polymyxin E1 and E2,and 107.0％for internal standard polymyxin B1.The precision was less than 3.7％.Conclusions In this study,a simple and efficient LC-MS/MS method was established for determination of polymyxin E1 and E2 in human plasma,which is reliable in the therapeutic drug monitoring and pharmacokinetic study of polymyxin E.

Objective To develop and validate an efficient and simple liquid chromatography with tandem mass spectrometry(LC-MS/MS)method for determination of polymyxin E in human plasma,and apply the established method in therapeutic drug monitoring(TDM)of polymyxin E.Methods The LC-MS/MS platform was based on AB SCIEX HPLC-4500MD system.Gradient elution was performed with 0.2％formic acid in water and 0.2％formic acid in acetonitrile.Phenomenex Kinetex XB-C18 column(100 mm × 2.1 mm,2.6 μm)were used.The analytes were detected by electrospray ionization(ESI)positive multiple reaction monitoring mode.The ion pairs for analytes(polymyxins E1,E2)and internal standard(polymyxins B1)were m/z 390.7→101.3,m/z 386.0→101.2,and m/z 402.3→101.2,respectively.Plasma samples were processed with protein precipitation method.Results Polymyxin E1 and E2 showed good linearity in the range of 0.031 2-6.24 mg/L and 0.006 15-1.23 mg/L,respectively.The within-run accuracy of polymyxin E1 and E2 in plasma ranged from 89.4％to 99.8％and 91.5％to 108.2％,respectively,while the between-run accuracy ranged from 91.8％to 104.7％and 95.6％to 105.2％,respectively.The within-run precision of polymyxin E1 and E2 in plasma ranged from 4.9％to 8.9％and 2.8％to 8.5％,respectively,while the between-run precision ranged from 4.1％to 7.6％and 4.2％to 9.8％,respectively.The average internal standard normalized matrix effect factors of polymyxins E1 and E2 were 96.9％-111.2％and 106.1％-112.8％in blank plasma samples from 6 different sources,102.5％-106.8％and 98.8％-105.2％in lipemic plasma,respectively,107.8％-108.9％and 106.9％-1 07.4％in hemolyzed plasma,respectively.The precision of matrix effects was less than 15.0％.The average recovery rate was 102.9％-107.5％for polymyxin E1 and E2,and 107.0％for internal standard polymyxin B1.The precision was less than 3.7％.Conclusions In this study,a simple and efficient LC-MS/MS method was established for determination of polymyxin E1 and E2 in human plasma,which is reliable in the therapeutic drug monitoring and pharmacokinetic study of polymyxin E.

Objective:To investigate the efficacy of the patient and family-centered care (PFCC) model in malignant tumor children with peripherally inserted central catheter (PICC) .Methods:Convenience sampling was used to select 136 malignant tumor children with PICC admitted to the Second Affiliated Hospital of Wenzhou Medical University and their families from May 2023 to May 2024 as study subjects. The subjects were divided into an intervention group and a control group of 68 cases each. Control group implemented routine PICC care, and intervention group carried out care based on PFCC model on the basis of control group. Children's self-management ability, catheter maintenance compliance and family satisfaction with nursing were compared between the two groups.Results:A total of 128 children and their families were finally included, 65 in intervention group and 63 in control group. After intervention, the knowledge, attitude, and practice dimension scores and total scores of self-management ability of children in both groups were higher than those before intervention, and the knowledge, attitude, and practice dimension scores and total scores of intervention group were higher than those of control group, with statistically significant differences (all P<0.05) . The excellent rate of catheter maintenance compliance and the nursing satisfaction of the children's families in intervention group were higher than those in control group after intervention, and the differences were statistically significant (all P<0.05) . Conclusions:The application of the PFCC model to malignant tumor children with PICC can enhance children's self-management ability and catheter maintenance compliance, and improve family satisfaction with nursing.

Objective:To analyze clinical indicators and imaging data of hospitalized pneumonia patients and develop prediction models for length of hospital stay based on CT radiomics features and clinical indicators.Methods:Patients admitted to the First Clinical School of Hainan Medical University for pneumonia treatment between November 2020 and May 2024 were enrolled. Clinical data and CT imaging were collected, and radiomics features were extracted. Patients were divided into three groups based on the length of stay (<8 d, 8-28 d,>28 d, and poor prognosis). Three prediction models were constructed using logistic regression (LR): clinical features model, imaging features model and a combined clinical and imaging features model. The predictive performance of three models was evaluated using the area under the receiver operating characteristic (ROC) curve and DeLong test, followed by feature analysis. The Kappa test was used to compare the consistency of the overall classification.Results:A total of 343 subjects were included, with an average age of 61.46±20.98 years. The area under the curve (AUC) values of the combined model in different hospitalization duration classifications (<8 d, 8-28 d,>28 d, and poor prognosis) were 0.73, 0.65 and 0.78 in the training set, and 0.71, 0.65 and 0.76 in the validation set, respectively. The AUC values of the clinical feature model in different hospitalization duration classifications were 0.63, 0.64 and 0.73 in the training set, and 0.60, 0.52 and 0.63 in the validation set, respectively. The AUC values of the imaging feature model in different hospitalization duration classifications (<8 d, 8-28 d,>28 d, and poor prognosis) were 0.67, 0.66 and 0.73 in the training set, and 0.68, 0.54 and 0.66 in the validation set, respectively. The DeLong test results showed that the combined model outperformed other models in hospitalization duration classification (validation set AUC, all P<0.05, Bonferroni correction). Kappa test results showed that the combined model achieved the highest consistency between predicted classifications and actual hospitalization classifications ( K=0.615). Shape features, texture features and clinical features all contributed proportionally to the combined model. Conclusion:The combined model integrating radiomics features with clinical indicators can significantly enhance the predictive efficacy for the length of hospitalization in pneumonia patients.

Objective:To investigate the prevalence of and risk factors associated with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and high-risk human papillomavirus (HPV) coinfections among patients with newly diagnosed syphilis at a hospital in Nanjing. Methods:A cross-sectional study was conducted on patients with newly diagnosed syphilis at the STD Clinic, Hospital of Dermatology, Chinese Academy of Medical Sciences in Nanjing, China from May 2023 to April 2024. Urethral, cervical or rectal swabs were collected according to the gender and types of sexual behavior of the patients. Screening tests for CT, NG and HPV infections were then performed by nucleic acid amplification testing. High-risk HPV testing was performed only in female patients. Univariate analysis was carried out to investigate risk factors associated with CT infection. The chi-square test, chi-square test with continuity correction, or Fisher's exact test was chosen based on the sample size and expected values.Results:A total of 111 newly diagnosed syphilis patients with test specimens were collected, including 71 males (64%) and 40 females (36%), and their ages ranged from 16 to 87 years; there were 82 patients with early syphilis and 29 with late latent syphilis; the number of sexual partners in the past 3 months ranged from 0 to 3. Among the 60 male patients with early syphilis, 1 (1.7%) was co-infected with NG, and 12 (20%) with CT; among the 16 men who have sex with men, 7 (43.8%) were co-infected with CT, while 5 (11.4%) of the 44 heterosexual patients were co-infected with CT, showing a significant difference in CT infection rates between the two groups ( χ2 = 5.80, P = 0.016). Among the 22 female patients with early syphilis, 1 (4.5%) was co-infected with NG, and 8 (36.4%) with CT; among the 12 female patients aged < 25 years, 8 (66.7%) were infected with CT, while none of the 7 patients aged 25-44 years or the 3 patients aged ≥ 45 years were infected with CT, showing a significant difference in CT infection rates among the 3 age groups ( P = 0.005) ; among the 16 female patients with 1 sexual partner in the past 3 months, 3 were infected with CT, while 5 were infected with CT in the 6 female patients with 2-3 sexual partners in the past 3 months, with a significant difference in CT infection rates between the two groups ( P = 0.011). Out of the 40 female patients with syphilis, 16 (40%) were co-infected with high-risk HPV; the HPV infection rates did not differ among different age groups (age groups of < 25 years, 25-44 years, ≥ 45 years: 8/14, 2/9, 6/17, respectively; P = 0.265) . Conclusion:The CT infection rate was relatively high in patients with newly diagnosed early syphilis, and a relatively high infection rate of high-risk HPV was observed in female patients with syphilis aged < 25 years.

Objective:To investigate the prevalence of and risk factors associated with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and high-risk human papillomavirus (HPV) coinfections among patients with newly diagnosed syphilis at a hospital in Nanjing. Methods:A cross-sectional study was conducted on patients with newly diagnosed syphilis at the STD Clinic, Hospital of Dermatology, Chinese Academy of Medical Sciences in Nanjing, China from May 2023 to April 2024. Urethral, cervical or rectal swabs were collected according to the gender and types of sexual behavior of the patients. Screening tests for CT, NG and HPV infections were then performed by nucleic acid amplification testing. High-risk HPV testing was performed only in female patients. Univariate analysis was carried out to investigate risk factors associated with CT infection. The chi-square test, chi-square test with continuity correction, or Fisher's exact test was chosen based on the sample size and expected values.Results:A total of 111 newly diagnosed syphilis patients with test specimens were collected, including 71 males (64%) and 40 females (36%), and their ages ranged from 16 to 87 years; there were 82 patients with early syphilis and 29 with late latent syphilis; the number of sexual partners in the past 3 months ranged from 0 to 3. Among the 60 male patients with early syphilis, 1 (1.7%) was co-infected with NG, and 12 (20%) with CT; among the 16 men who have sex with men, 7 (43.8%) were co-infected with CT, while 5 (11.4%) of the 44 heterosexual patients were co-infected with CT, showing a significant difference in CT infection rates between the two groups ( χ2 = 5.80, P = 0.016). Among the 22 female patients with early syphilis, 1 (4.5%) was co-infected with NG, and 8 (36.4%) with CT; among the 12 female patients aged < 25 years, 8 (66.7%) were infected with CT, while none of the 7 patients aged 25-44 years or the 3 patients aged ≥ 45 years were infected with CT, showing a significant difference in CT infection rates among the 3 age groups ( P = 0.005) ; among the 16 female patients with 1 sexual partner in the past 3 months, 3 were infected with CT, while 5 were infected with CT in the 6 female patients with 2-3 sexual partners in the past 3 months, with a significant difference in CT infection rates between the two groups ( P = 0.011). Out of the 40 female patients with syphilis, 16 (40%) were co-infected with high-risk HPV; the HPV infection rates did not differ among different age groups (age groups of < 25 years, 25-44 years, ≥ 45 years: 8/14, 2/9, 6/17, respectively; P = 0.265) . Conclusion:The CT infection rate was relatively high in patients with newly diagnosed early syphilis, and a relatively high infection rate of high-risk HPV was observed in female patients with syphilis aged < 25 years.

Diabetic foot ulcer (DFU) have emerged as a serious global health issue due to its high rates of occurrence, disability, and mortality. DFU exhibit an exceptionally high recurrence rate, driven by a combination of behavioral and biological factors, leading to the recognition of fully epithelialized ulcers as being in "remission" rather than cured. However, the pathogenic factors underlying recurrent DFU (RDFU) remain poorly understood. This review examines the epidemiological characteristics and pathophysiological mechanisms of RDFU. Key mechanisms include neuropathy, angiopathy, epigenetic modifications, and metabolic memory. Research demonstrates that RDFU development results from the interplay of multiple factors: hyperglycemia-induced metabolic abnormalities, chronic inflammatory responses, vascular and neurological damage, as well as dysregulated epigenetic control. These factors interact synergistically, creating a vicious cycle that increases the risk of recurrence and delays recovery. By synthesizing current knowledge, this review aims to provide a foundation for future research and clinical management of RDFU. The insights presented support the development of personalized treatment strategies and effective preventive measures to reduce recurrence and improve patient outcomes.

Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory condition with chronic and relapsing manifestations and is characterized by a disturbance in the interplay between the intestinal microbiota, the gut, and the brain. The microbiota-gut-brain axis involves interactions among the nervous system, the neuroendocrine system, the gut microbiota, and the host immune system. Increasing published data indicate that psychological stress exacerbates the severity of IBD due to its negative effects on the microbiota-gut-brain axis, including alterations in the stress response of the hypothalamic-pituitary-adrenal (HPA) axis, the balance between the sympathetic nervous system and vagus nerves, the homeostasis of the intestinal flora and metabolites, and normal intestinal immunity and permeability. Although the current evidence is insufficient, psychotropic agents, psychotherapies, and interventions targeting the microbiota-gut-brain axis show the potential to improve symptoms and quality of life in IBD patients. Therefore, further studies that translate recent findings into therapeutic approaches that improve both physical and psychological well-being are needed.
Humans ; Inflammatory Bowel Diseases/metabolism* ; Stress, Psychological/microbiology* ; Gastrointestinal Microbiome/physiology* ; Brain/metabolism* ; Hypothalamo-Hypophyseal System ; Pituitary-Adrenal System ; Animals