OBJECTIVES: To elucidate the underlying mechanisms of macrophage-mediated inflammation and tissue injury in diabetic foot ulcer (DFU). METHODS: Skin tissue samples were collected from patients with DFU and with non-DFU. A total of 79 272 high-quality cell transcriptomes were obtained using single-cell RNA sequencing. An unbiased clustering approach was employed to identify cell subpopulations. Seurat functions were used to identify differentially expressed genes between DFU and non-DFU groups, and gene ontology (GO) enrichment analysis was used to reveal gene function. Furthermore, cell-cell communication network construction and ligand-receptor interaction analysis were performed to reveal the mechanisms underlying cellular interactions and signaling regulation in the DFU microenvironment from multiple perspectives. RESULTS: The results revealed a significant expansion of myeloid cells in DFU tissues, alongside a marked reduction in structural cells such as endothelial cells, epithelial cells, and smooth muscle cells. Major cell types underwent functional reprogramming, characterized by immune activation and impaired tissue remodeling. Specifically, macrophages in DFU skin tissues exhibited a shift toward a pro-inflammatory M1 phenotype, with upregulation of genes associated with inflammation and oxidative stress. Cell communication analysis further demonstrated that M1 macrophages served as both primary signal receivers and influencers in the COMPLEMENT pathway mediated communication network, and as key signal senders and mediators in the secreted phosphoprotein 1 (SPP1) pathway mediated communication network, actively shaping the inflammatory microenvironment. Key ligand-receptor interactions driving macrophage signaling were identified, including C3-(ITGAM+ITGB2) and SPP1-CD44. CONCLUSIONS This study establishes a comprehensive single-cell atlas of DFU, revealing the role of macrophage-driven cellular networks in chronic inflammation and impaired healing. These findings may offer potential novel therapeutic targets for DFU treatment.
Humans ; Macrophages/immunology* ; Diabetic Foot/pathology* ; Single-Cell Analysis ; Transcriptome ; Gene Expression Profiling ; Inflammation ; Skin ; Cell Communication ; Signal Transduction ; Cellular Reprogramming

Objective:To investigate the degree of satisfaction with courses of postgraduates in medicine in a military medical university, and to discuss the problems existing in the offering and teaching of postgraduate medical courses as well as targeted measures.Methods:A self-made questionnaire was administered through the Questionnaire Star platform to 533 postgraduate students in a military medical university to investigate the basic situation, the types of courses offered during their study period, their opinions about and degree of satisfaction with the curriculum system, the teaching effectiveness of various courses, and suggestions for improvement in education. SPSS 23.0 was used to perform the chi-square test to analyze the relationship between variables.Results:Among the 533 students, 391 (73.32%) were satisfied with course offering ( χ2=9.64, P=0.008), and 399 (74.95%) were satisfied with course teaching ( χ2=7.60, P=0.022). Twenty-four (4.47%), 3 (6.25%), 3 (10.81%), and 2 (6.45%) students in clinical medicine, public health and preventive medicine, nursing, and pharmacy, respectively, believed that course offerings did not quite fit with their majors. The numbers of students who believed that general compulsory courses, major-specific compulsory courses, and elective courses offered were appropriate in number were 309 (57.97%), 371 (69.61%), and 409 (76.74%), respectively. For the design of the curriculum system, 399 (74.86%), 367 (68.85%), 362 (67.92%), 361 (67.73%), 355 (66.61%), 352 (66.05%), and 357 (66.98%) were satisfied with "basic theory coverage", "major-specific knowledge coverage", "research interest cultivation", "innovative thinking cultivation", "academic reporting ability cultivation", "practical ability cultivation", and "academic writing ability cultivation", respectively. The numbers of master's and doctoral students who believed that there were appropriate numbers of courses on methodology and experimental skills were 285 (71.07%) and 90 (68.18%), respectively. Conclusions:In view of the current situation of postgraduate medical courses, general basic courses should be further optimized in terms of the number and proportion of different types of courses, and major-specific required courses should pay more attention to the cultivation of postgraduates' ability and quality in addition to the coverage of basic theories. Curriculum ideology and politics for medical postgraduates should be highlighted.

Objective To investigate the relationship between non-high-density lipoprotein cho-lesterol(non-HDL-C)and cardiovascular disease(CVD)in maintenance hemodialysis(MHD)pa-tients.Methods A total of 124 MHD patients were enrolled and divided into CVD group(53 pa-tients)and non-CVD group(71 patients)based on the presence or absence of CVD.Clinical data be-tween the two groups were compared.Additionally,patients were divided into severe calcification group[coronary artery calcification score(C ACS)≥ 400,40 patients]and non-severe calcification group(CACS＜400,84 patients)based on CACS,and clinical data between these two groups were also compared.Multivariate Logistic regression analysis was used to explore the independent risk fac-tors for CVD in MHD patients,and the predictive performance of related indicators for CVD in MHD patients was assessed using receiver operating characteristic(ROC)curves.Results The levels of serum total cholesterol,low-density lipoprotein cholesterol(LDL-C),and non-HDL-C were higher,while the level of high-density lipoprotein cholesterol(HDL-C)was lower in the CVD group compared with the non-CVD group(P＜0.05).The levels of serum total cholesterol,LDL-C,and non-HDL-C were higher,and the level of HDL-C was lower in the severe calcification group compared with the non-severe calcification group(P＜0.05).Multivariate Logistic regression analysis showed that high levels of LDL-C and non-HDL-C were both independent risk factors for CVD in MHD patients(P＜0.05).ROC curve analysis showed that the areas under the curve for predicting CVD in MHD patients were 0.858 and 0.723 for non-HDL-C and LDL-C,respectively,and non-HDL-C had high-er specificity and Youden index than LDL-C.Conclusion Elevated non-HDL-C level is an inde-pendent risk factor and has high predictive performance for CVD in MHD patients.

Objective:To investigate the degree of satisfaction with courses of postgraduates in medicine in a military medical university, and to discuss the problems existing in the offering and teaching of postgraduate medical courses as well as targeted measures.Methods:A self-made questionnaire was administered through the Questionnaire Star platform to 533 postgraduate students in a military medical university to investigate the basic situation, the types of courses offered during their study period, their opinions about and degree of satisfaction with the curriculum system, the teaching effectiveness of various courses, and suggestions for improvement in education. SPSS 23.0 was used to perform the chi-square test to analyze the relationship between variables.Results:Among the 533 students, 391 (73.32%) were satisfied with course offering ( χ2=9.64, P=0.008), and 399 (74.95%) were satisfied with course teaching ( χ2=7.60, P=0.022). Twenty-four (4.47%), 3 (6.25%), 3 (10.81%), and 2 (6.45%) students in clinical medicine, public health and preventive medicine, nursing, and pharmacy, respectively, believed that course offerings did not quite fit with their majors. The numbers of students who believed that general compulsory courses, major-specific compulsory courses, and elective courses offered were appropriate in number were 309 (57.97%), 371 (69.61%), and 409 (76.74%), respectively. For the design of the curriculum system, 399 (74.86%), 367 (68.85%), 362 (67.92%), 361 (67.73%), 355 (66.61%), 352 (66.05%), and 357 (66.98%) were satisfied with "basic theory coverage", "major-specific knowledge coverage", "research interest cultivation", "innovative thinking cultivation", "academic reporting ability cultivation", "practical ability cultivation", and "academic writing ability cultivation", respectively. The numbers of master's and doctoral students who believed that there were appropriate numbers of courses on methodology and experimental skills were 285 (71.07%) and 90 (68.18%), respectively. Conclusions:In view of the current situation of postgraduate medical courses, general basic courses should be further optimized in terms of the number and proportion of different types of courses, and major-specific required courses should pay more attention to the cultivation of postgraduates' ability and quality in addition to the coverage of basic theories. Curriculum ideology and politics for medical postgraduates should be highlighted.

Professor Li Candong puts forward the"five differentiation"thinking in TCM:symptom differentiation,syndrome differentiation,disease differentiation,person differentiation and mechanism differentiation.This article discussed the thinking and method of application of classical prescriptions based on the mode of"five differentiation".Treatment based on symptom differentiation is a quick method of application of classic prescriptions,which includes searching for specific symptoms or symptom groups and according to special tongue images.Treatment based on syndrome differentiation is a commonly used method in classic prescriptions,distinguishing between primary and secondary syndromes and the authenticity of cold and heat.Treatment based on disease differentiation is the inherent meaning of classic prescriptions,which is mainly to distinguish six meridian diseases and special prescriptions for specific diseases.Treatment based on person differentiation embodies the individual differences in the use of classic prescriptions,which include age,gender,constitution and abdominal syndrome.Treatment based on mechanism differentiation is an ingenious method used by classic prescriptions.When practicing clinical medicine,we should adhere to the integrated mode of"five differentiation"in the application of classic prescriptions,comprehensively considering the five dimensions,in order to improve the accuracy and effectiveness of the application of classic prescriptions,reveal and improve the academic system of classic prescriptions,and better guide their clinical application.

Objective:To observe the clinical efficacy of auricular needle-embedding therapy for treating primary insomnia. Methods:A total of 63 patients were randomly divided into a conventional acupuncture group and an auricular needle-embedding group.The conventional acupuncture group received acupuncture at meridian points,while the auricular needle-embedding group received acupuncture at auricular points.Treatments were given once a day for 6 consecutive days,followed by a 1-day break,as a course of treatment.Both groups were treated for 2 courses.Before treatment,and after 1 course and 2 courses of treatment,the Pittsburgh sleep quality index(PSQI)score was assessed,and the efficacy was evaluated. Results:The cured and markedly effective rate and total effective rate of the auricular needle-embedding group were higher than those of the conventional acupuncture group,but there was no significant difference between the two groups(P>0.05).After 1 course of treatment,the PSQI global score and the scores of subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,and daytime dysfunction of both groups decreased compared with those before treatment(P<0.01);there was no statistical significance in comparing the PSQI global score and individual component scores between the two groups(P>0.05).After 2 courses of treatment,the PSQI global score and the scores of sleep latency and habitual sleep efficiency of the auricular needle-embedding group decreased compared with those after 1 course of treatment(P<0.01 or P<0.05),while only the score of sleep latency of the conventional acupuncture group decreased compared with that after 1 course of treatment(P<0.05);the PSQI global score and the scores of subjective sleep quality and sleep latency of the auricular needle-embedding group were lower than those of the conventional acupuncture group(P<0.05). Conclusion:Both therapies can improve insomnia.Compared to conventional acupuncture,auricular needle-embedding therapy demonstrates a therapeutic advantage in improving sleep latency and sleep quality,making it worthy of clinical promotion.

This paper mainly discusses the practical significance of the internal quality assurance system of graduate students in a military medical university based on training process management. The integrated internal quality assurance system follows the direction of three core steps—course learning, scientific research practice training, and dissertation writing, and highlights nine key points—learning foundation in admission education and training, knowledge acquisition in course learning, application ability in teaching and scientific research practice, innovation ability in academic activities and innovation competitions, topic selection quality in thesis proposal, training quality in mid-term assessment, paper quality in dissertation writing, output quality in thesis defense, and comprehensive quality in diploma awarding. Our exploration and practical experience is shared in this article.

Objective To study the characteristics of spontaneous speech pauses in individuals with mild to moderate Alzheimer's disease(AD).Methods A total of 20 patients with AD,exhibiting a Minimum Mental State Examination(MMSE)score ranging from 10 to 20 and a disease duration of 6 months to 5 years,were selected for the AD group.Twenty five cognitively normal and mentally healthy participants were chosen as the control group.Spontaneous speech was elicited from each participant,and 1-minute continuous audio recordings were used to tally pause counts categorized by duration into short pauses(0.25 s≤t＜0.50 s),medium pauses(0.50 s≤t＜0.90 s),long pauses(0.90 s≤t＜2.00 s),and silences(＞2.00 s).Mean values of each pause type were computed for in-ter-group and intra-group comparisons.Correlation and regression analyses between MMSE scores and pause counts were conducted within the AD group.Results Significant statistical differences were observed between the AD and control groups concerning the counts of short pauses,long pauses,and silences(P＜0.05).Within the AD group,significant differences were found in the counts of short pauses versus medium pauses and short pauses versus long pauses(P＜0.05).In the AD group,the count of medium pauses positively predicted MMSE scores(β=0.515,P＜0.05),whereas the count of silences negatively predicted MMSE scores(β=-0.626,P＜0.01).Conclusion Individuals with AD exhibit a higher frequency of longer duration pauses in spontaneous speech and a lower frequen-cy of shorter duration pauses.Higher cognitive functioning in AD patients is associated with increased occurrences of shorter pauses,whereas lower cognitive functioning is linked to more extended pauses.

The presence of high-level talents plays a crucial role in ensuring the successful establishment of national regional medical centers.It presents the high-level talent management experience of Henan Children's Hospital,aiming to facilitate the coordinated development of pediatrics in Central China.To address the practical challenges and difficulties encountered in high-level talent management within hospitals,lean talent management is achieved by standardizing the management structure,clarifying management objectives,refining the management mechanism,establishing a performance appraisal incentive system,and implementing an integrated'induction and utilization'management approach.These measures effectively facilitate the development of national children's regional medical centers.

Objective:To explore the correlation between endogenous sex hormone factors and sexual function in Chinese women.Methods:A total of 711 women who met the criteria were investigated in the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing Chaoyang District Taiyanggong Community Health Service Centre from April 2020 to March 2021. Sociodemographic data (data split into two groups according to educational background: high school or above and lower high school; and three categories based on marital relationship: satisfied, average, and dissatisfied) and serum levels of sex hormones were collected. Female sexual dysfunction (FSD) was evaluated using the female sexual function index (FSFI). Participants were divided into three groups according to the Stages of Reproductive Aging Workshop (STRAW+10): reproductive stage group, menopausal transition stage group and postmenopausal stage group. Spearman rank correlation analysis and multiple linear regression analyses were performed to determine the correlation between characteristics and scores of FSFI.Results:The multivariate logistic regression analysis revealed that postmenopausal stage, secondary education level, neutral and dissatisfied marital relations were significantly negatively correlated with total FSFI score (all P<0.01). Secondary education level, neutral and dissatisfied marital relations were negatively associated with nearly all FSFI domains apart from pain score (all P<0.05); postmenopausal stage was negatively associated with lubrication, satisfaction and pain (all P<0.05). FSH was negatively associated with all FSFI domain scores (all P<0.05). There was a significantly positive correlation between estradiol and scores of FSFI dimensions other than orgasm and satisfaction (all P<0.05). Total testosterone positively affected the score of total FSFI and desire (all P<0.05); free testosterone was positively related to orgasm ( P<0.05). Conclusion:Estradiol and total testosterone serve as protective factors for female sexual function.