Objective To evaluate the association between cervical insufficiency(CI)and spontaneous preterm birth(SPB),and to investigate the predictive value of shear wave elastography(SWE),cervical length(CL),and anterior cervical angle(ACA)in identifying SPB resulting from CI.Methods This study recruited 786 pregnant women who attended prenatal outpatient clinics or were hospitalized for treatment at the Affiliated Hospital of Nantong University and the Maternity Hospital affiliated with Jiangnan University from June 2023 to January 2024.Among these participants,723 were full-term pregnancies and 63 were preterm pregnancies.Cervical SWEI,CL,and cervical ACA were measured using a Mindray Resona R9 Pro/Eagus R9s ultrasound device equipped with shear wave elasticity imaging software.Additionally,the participants were categorized into four gestational age groups:19-23+6 weeks,24-27+6 weeks,28-33+6 weeks,and 34-36+6 weeks,to evaluate the relationship between gestational age and ultrasound parameters.Results The mean CL in the preterm group was 25.4 mm,significantly shorter than the 29.7 mm observed in the full-term group(P<0.001).The ACA in the preterm group was 121°,which was significantly higher than the 99° in the full-term group(P<0.001).Additionally,SWE values were significantly lower in the preterm group compared to the full-term group at all measured cervical sites:anterior external os(AE)6.47 kPa versus 9.91 kPa(P<0.001),anterior internal os(AI)10.98 kPa versus 18.62 kPa(P<0.001),posterior internal os(PI)11.32 kPa versus 21.09 kPa(P<0.001),and posterior external os(PE)8.16 kPa versus 13.24 kPa(P<0.001).A significant negative correlation was found between CL and gestational age(r=-0.278,P=0.001).The combined predictive indicators demonstrated high accuracy and specificity for predicting preterm birth,with an area under the curve(AUC)of 0.952,sensitivity of 95%,and specificity of 86%.Conclusions The integration of cervical SWE,CL measurement,and assessment of the angle of ACA can substantially enhance the predictive accuracy for SPB due to CI.This multimodal approach offers clinicians a more robust and precise tool for identifying high-risk pregnancies,enabling timely interventions that can reduce the incidence of preterm birth and improve maternal and neonatal outcomes.

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes. Current treatment methods typically focus on controlling blood glucose levels, routine care, anti-infection, debridement, and other aspects. However, these approaches have not consistently yielded satisfactory results. Adipose-derived stem cells (ADSCs) are characterized by their diverse sources, ease of acquisition, and low immunogenicity, making them a prominent topic of research area in the field of stem cells. ADSCs have emerged as a new strategy for the treatment of DFUs. This review aims to describe the pathophysiological characteristics of diabetic foot ulcers, the advantages and biological functions of ADSCs, and their mechanisms for promoting wound healing in DFUs, thereby providing a theoretical basis for the clinical application of ADSCs in the treatment of DFUs.

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 evaluate the association between cervical insufficiency(CI)and spontaneous preterm birth(SPB),and to investigate the predictive value of shear wave elastography(SWE),cervical length(CL),and anterior cervical angle(ACA)in identifying SPB resulting from CI.Methods This study recruited 786 pregnant women who attended prenatal outpatient clinics or were hospitalized for treatment at the Affiliated Hospital of Nantong University and the Maternity Hospital affiliated with Jiangnan University from June 2023 to January 2024.Among these participants,723 were full-term pregnancies and 63 were preterm pregnancies.Cervical SWEI,CL,and cervical ACA were measured using a Mindray Resona R9 Pro/Eagus R9s ultrasound device equipped with shear wave elasticity imaging software.Additionally,the participants were categorized into four gestational age groups:19-23+6 weeks,24-27+6 weeks,28-33+6 weeks,and 34-36+6 weeks,to evaluate the relationship between gestational age and ultrasound parameters.Results The mean CL in the preterm group was 25.4 mm,significantly shorter than the 29.7 mm observed in the full-term group(P<0.001).The ACA in the preterm group was 121°,which was significantly higher than the 99° in the full-term group(P<0.001).Additionally,SWE values were significantly lower in the preterm group compared to the full-term group at all measured cervical sites:anterior external os(AE)6.47 kPa versus 9.91 kPa(P<0.001),anterior internal os(AI)10.98 kPa versus 18.62 kPa(P<0.001),posterior internal os(PI)11.32 kPa versus 21.09 kPa(P<0.001),and posterior external os(PE)8.16 kPa versus 13.24 kPa(P<0.001).A significant negative correlation was found between CL and gestational age(r=-0.278,P=0.001).The combined predictive indicators demonstrated high accuracy and specificity for predicting preterm birth,with an area under the curve(AUC)of 0.952,sensitivity of 95%,and specificity of 86%.Conclusions The integration of cervical SWE,CL measurement,and assessment of the angle of ACA can substantially enhance the predictive accuracy for SPB due to CI.This multimodal approach offers clinicians a more robust and precise tool for identifying high-risk pregnancies,enabling timely interventions that can reduce the incidence of preterm birth and improve maternal and neonatal outcomes.

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.

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes. The current treatment method usually focus on blood glucose controlling, routine care, anti-infection, debridement and other aspects, but still have not achieved good result . Adipose-derived stem cells (ADSCs) possess the characteristics of a wide range of sources, easy acquisition, and low immunogenicity, making them hot topics of research area in the field of stem cell. ADSCs has become a new strategy for the treatment of DFUs . This review aims to describe the pathophysiological characteristics of diabetic foot ulcers, the advantages and biological function of ADSCs and their mechanisms of promoting DFUs wound healing, to provide a theoretical basis for the clinical application of ADSCs in the treatment of DFUs.

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes. The current treatment method usually focus on blood glucose controlling, routine care, anti-infection, debridement and other aspects, but still have not achieved good result . Adipose-derived stem cells (ADSCs) possess the characteristics of a wide range of sources, easy acquisition, and low immunogenicity, making them hot topics of research area in the field of stem cell. ADSCs has become a new strategy for the treatment of DFUs . This review aims to describe the pathophysiological characteristics of diabetic foot ulcers, the advantages and biological function of ADSCs and their mechanisms of promoting DFUs wound healing, to provide a theoretical basis for the clinical application of ADSCs in the treatment of DFUs.

Objective:To explore effects of different lower limb placement angles on venous drainage among patients undergoing thoracolumbar surgery in prone position.Methods:From January 2017 to January 2018, we selected patients underwent elective thoracolumbar surgery in prone position of Operating Room in Beijing Hospital as research objects. According to the need of surgery, it was divided into 51 cases in low-angle group and 54 cases in traditional-angle group. We compared effects of different lower limb placement angles on patients by taking the changes of lower limb venous blood flow under ultrasound before and after surgery as main observation indicators and taking changes of lower limb skin temperature and leg circumference as the secondary observation indicator.Results:There were statistical differences in the changes of blood flow on the left and right popliteal veins, the left and right posterior tibial veins of patients under ultrasound between two groups before and after surgery ( P<0.05) . There were no statistical differences in the changes of the leg circumference of 10 cm above the left and right ankles and the changes of the leg circumference of 15 cm above the left and right patellae of patients between two groups ( P>0.05) ; there was also no statistical difference in the change of bilateral skin temperature ( P>0.05) . Conclusions:The lower limb placement angles among patients undergoing thoracolumbar surgery in prone position may affect the venous drainage which nurses of Operating Room should pay attention to when placing positions.

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.

Objective To analyze the clinical characteristics and gene mutations of 56 patients with congenital hyperinsulinism(CHI)and to provide a theoretical basis for clinical diagnosis and treatment of CHI.Methods Fifty-six children who were diagnosed as CHI between February 2002 and January 2016 in Beijing Children's Hospital Affiliated to Capital Medical University were selected as research subjects.A retrospective study was done about the clinical data and the treatment procedures of the 56 patients,such as perinatal conditions,clinical manifestations,laboratory data,treatments,prognosis and so on.Polymerase chain reaction(PCR)-DNA technology or next-generation sequencing technology was used to analyze the CHI relevant genes of the 56 patients.Results Thirty of the 56 patients carried CHI gene mutation.(1)Twenty-three of 56 patients(41.0％)carried ABCC8/KCNJ11 gene mutations:4 of 23 patients carried complex heterozygous mutation,1 of 23 patients carried both ABCC8 and KCNJ11 gene mutation,1 of 23 patients carried maternally inherited ABCC8 gene mutation,12 of 23 patients carried paternally inherited ABCC8 gene mutation,1 of 23 patients carried paternally inherited KCNJ11 gene mutation,3 of 23 patients carried de novo ABCC8 gene mutation,1 of 23 patients had unknown genetic way,19 of 23 patients were treated with Diazoxide,2 of 19 patients were responsive to Diazoxide,7 of 19 patients were unresponsive to Diazoxide and 10 of 19 patients were uncertain to Diazoxide.(2)Five of 56 patients(8.9％)carried GLUD1 gene mutation,4 of 5 patients were treated with Diazoxide and they were all responsive to Diazoxide.(3)One of 56 patients(1.7％)carried de novo GCK gene mutation,responsive to Diazoxide treatment.(4)One of 56 patients(1.7％)carried maternally inherited SLC16A1 gene mutation,responsive to Diazo-xide treatment.Conclusions The ABCC8 gene and GLUD1 gene mutation are the main causative genes of CHI.The GCK gene and SLC16A1 gene mutation are in the minority.Most ABCC8 gene and KCNJ11 gene mutation are unresponsive to Diazoxide treatment.