Objective:To investigate the clinical efficacy of minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture.Methods:A retrospective study was conducted to analyze the 12 patients with delayed union or nonunion of scaphoid fracture who had been treated at Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University from March 2021 to December 2023. They were 11 males and 1 female, with an age of (29.9±13.8) years and an interval from injury to surgery of (5.1±2.6) months. They were all treated by minimally invasive percutaneous internal fixation with 2 hollow compression screws. The visual analogue scale (VAS), grip strength (percentage of the affected side to the healthy side), wrist range of motion, modified Mayo wrist score and other data were recorded and compared between pre-surgery and the last follow-up. The incidence of complications was recorded.Results:Follow-up for all patients lasted for (20.8±8.9) months. All patients achieved bony union after (10.1±3.2) weeks with no complications like infection. No post-surgery imaging revealed screw misplacement or penetration. At the last follow-up, the VAS pain score was 0 (0, 1) point, the wrist grip strength 100.6%±7.2%, the wrist flexion 88.3°±2.5°, the wrist dorsiflexion 88.5°±2.2°, and the modified Mayo wrist score (98.3±2.5) points, all significantly better than the pre-surgery values [4 (4, 5) points, 69.1%±16.0%, 61.3°±13.5°, 64.7°±9.1°, and (61.7±10.1) points] (all P < 0.05). Conclusion:In the treatment of delayed union or nonunion of scaphoid fracture, minimally invasive percutaneous internal fixation with double screws shows advantages of minimal invasion, quick fracture healing, fine functional recovery, and no need of bone grafting.

Due to its high sensitivity and non-destructive nature, Raman spectroscopy has become an essential analytical tool in biopharmaceutical analysis and drug development. Despite of the computational demands, data requirements, or ethical considerations, artificial intelligence (AI) and particularly deep learning algorithms has further advanced Raman spectroscopy by enhancing data processing, feature extraction, and model optimization, which not only improves the accuracy and efficiency of Raman spectroscopy detection, but also greatly expands its range of application. AI-guided Raman spectroscopy has numerous applications in biomedicine, including characterizing drug structures, analyzing drug forms, controlling drug quality, identifying components, and studying drug-biomolecule interactions. AI-guided Raman spectroscopy has also revolutionized biomedical research and clinical diagnostics, particularly in disease early diagnosis and treatment optimization. Therefore, AI methods are crucial to advancing Raman spectroscopy in biopharmaceutical research and clinical diagnostics, offering new perspectives and tools for disease treatment and pharmaceutical process control. In summary, integrating AI and Raman spectroscopy in biomedicine has significantly improved analytical capabilities, offering innovative approaches for research and clinical applications.

Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons. This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak. This patient had experienced prolonged sepsis and multiple surgical traumas. Upon admission to our department, exploratory surgery revealed extensive bowel edema and adhesions, an anastomotic leak, and abdominal contamination with infection. In accordance with the principles of damage control surgery, the anastomotic leak was exteriorized, the abdomen was left open, and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection. Negative pressure wound therapy was used to manage the open abdomen, and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula. After granulation of the abdominal wound, split-thickness skin grafting was performed. The enteroatmospheric fistula was converted into an enterocutaneous fistula. A 3D-printed stoma baseplate was used to manage the digestive fistula. Concurrently, enhanced parenteral and enteral nutritional support was provided. Six months later, the patient successfully underwent definitive fistula resection and abdominal wall defect repair.

Objective:To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE).Methods:This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data.Results:A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment.Conclusions:VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Objective To investigate the therapeutic effect of hypericin on acute pancreatitis(AP)in mice and its effect on NLRP3 inflammasome signaling pathway.Methods The AP model in mice was established with caerulein(CER).The mice were divided into the normal control group,the model group(AP group),the low-dose HY group(CER+HY 5 mg/kg group),the medium-dose HY group(CER+HY 10 mg/kg group)and the high-dose HY group(CER+HY 20 mg/kg group),with 10 mice in each group.The 266-6 mouse pancreatic acinar cancer cells were treated with cholecystokinin(CCK)and divided into the control group,the AP group,the CCK+HY 1 μmol/L group,the CCK+HY 2 μmol/L group and the CCK+HY 4 μmol/L group.The activities of amylase(AMS),lipase,trypsin and myeloperoxidase(MPO)in the serum of each group of mice,and levels of inflammatory factors interleukin(IL)-1β and tumor necrosis factor(TNF)-α were detected by enzyme-linked immunosorbent assay(ELISA).The expression of NOD-like receptor family protein 3(NLRP3)was detected by Western blot assay.The mRNA levels of NLRP3,caspase(Caspase)-1,IL-1β,TNF-α and IL-18 in pancreatic tissue of mice were detected by real-time quantitative PCR(q-PCR).The cell survival rate of cells in each group was detected by CCK8 method.The mRNA expression levels of NLRP3,Caspase-1 and IL-18 in each group of cells were detected by q-PCR.Results Compared with the normal control group,the levels of AMS,lipase,MPO,trypsin,IL-1β and TNF-α in serum of the model group,and the mRNA and protein expression levels of NLRP3,IL-1β,TNF-α,IL-18 and Caspase-1 in pancreatic tissue were increased(P＜0.01).Compared with the model group,the levels of AMS,IL-1β and TNF-α,the enzymatic activity of trypsin in serum,and the mRNA levels of IL-1β,TNF-α,IL-18 and Caspase-1 in pancreatic tissue were decreased in the low-,medium-and high-dose HY groups.The serum levels of lipase and MPO and the mRNA expression levels of NLRP3 in pancreatic tissue were decreased in the medium-and high-dose HY groups(P＜0.05).Compared with the AP group,the cell survival rates were increased in the CCK+HY 1 μmol/L group,the CCK+HY 2 μmol/L group and the CCK+HY 4 μmol/L group,and the mRNA levels of NLRP3,IL-18 and Caspase-1 were decreased in a dose-dependent manner(P＜0.05).Conclusion Hypericin can effectively treat AP in vivo and in vitro,and its therapeutic effect may be related to the regulation of NLRP3 inflammasome signaling pathway.

Objective To investigate the therapeutic effect of hypericin on acute pancreatitis(AP)in mice and its effect on NLRP3 inflammasome signaling pathway.Methods The AP model in mice was established with caerulein(CER).The mice were divided into the normal control group,the model group(AP group),the low-dose HY group(CER+HY 5 mg/kg group),the medium-dose HY group(CER+HY 10 mg/kg group)and the high-dose HY group(CER+HY 20 mg/kg group),with 10 mice in each group.The 266-6 mouse pancreatic acinar cancer cells were treated with cholecystokinin(CCK)and divided into the control group,the AP group,the CCK+HY 1 μmol/L group,the CCK+HY 2 μmol/L group and the CCK+HY 4 μmol/L group.The activities of amylase(AMS),lipase,trypsin and myeloperoxidase(MPO)in the serum of each group of mice,and levels of inflammatory factors interleukin(IL)-1β and tumor necrosis factor(TNF)-α were detected by enzyme-linked immunosorbent assay(ELISA).The expression of NOD-like receptor family protein 3(NLRP3)was detected by Western blot assay.The mRNA levels of NLRP3,caspase(Caspase)-1,IL-1β,TNF-α and IL-18 in pancreatic tissue of mice were detected by real-time quantitative PCR(q-PCR).The cell survival rate of cells in each group was detected by CCK8 method.The mRNA expression levels of NLRP3,Caspase-1 and IL-18 in each group of cells were detected by q-PCR.Results Compared with the normal control group,the levels of AMS,lipase,MPO,trypsin,IL-1β and TNF-α in serum of the model group,and the mRNA and protein expression levels of NLRP3,IL-1β,TNF-α,IL-18 and Caspase-1 in pancreatic tissue were increased(P＜0.01).Compared with the model group,the levels of AMS,IL-1β and TNF-α,the enzymatic activity of trypsin in serum,and the mRNA levels of IL-1β,TNF-α,IL-18 and Caspase-1 in pancreatic tissue were decreased in the low-,medium-and high-dose HY groups.The serum levels of lipase and MPO and the mRNA expression levels of NLRP3 in pancreatic tissue were decreased in the medium-and high-dose HY groups(P＜0.05).Compared with the AP group,the cell survival rates were increased in the CCK+HY 1 μmol/L group,the CCK+HY 2 μmol/L group and the CCK+HY 4 μmol/L group,and the mRNA levels of NLRP3,IL-18 and Caspase-1 were decreased in a dose-dependent manner(P＜0.05).Conclusion Hypericin can effectively treat AP in vivo and in vitro,and its therapeutic effect may be related to the regulation of NLRP3 inflammasome signaling pathway.

Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons. This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak. This patient had experienced prolonged sepsis and multiple surgical traumas. Upon admission to our department, exploratory surgery revealed extensive bowel edema and adhesions, an anastomotic leak, and abdominal contamination with infection. In accordance with the principles of damage control surgery, the anastomotic leak was exteriorized, the abdomen was left open, and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection. Negative pressure wound therapy was used to manage the open abdomen, and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula. After granulation of the abdominal wound, split-thickness skin grafting was performed. The enteroatmospheric fistula was converted into an enterocutaneous fistula. A 3D-printed stoma baseplate was used to manage the digestive fistula. Concurrently, enhanced parenteral and enteral nutritional support was provided. Six months later, the patient successfully underwent definitive fistula resection and abdominal wall defect repair.

Objective:To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE).Methods:This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data.Results:A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment.Conclusions:VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Objective:To investigate the clinical efficacy of minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture.Methods:A retrospective study was conducted to analyze the 12 patients with delayed union or nonunion of scaphoid fracture who had been treated at Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University from March 2021 to December 2023. They were 11 males and 1 female, with an age of (29.9±13.8) years and an interval from injury to surgery of (5.1±2.6) months. They were all treated by minimally invasive percutaneous internal fixation with 2 hollow compression screws. The visual analogue scale (VAS), grip strength (percentage of the affected side to the healthy side), wrist range of motion, modified Mayo wrist score and other data were recorded and compared between pre-surgery and the last follow-up. The incidence of complications was recorded.Results:Follow-up for all patients lasted for (20.8±8.9) months. All patients achieved bony union after (10.1±3.2) weeks with no complications like infection. No post-surgery imaging revealed screw misplacement or penetration. At the last follow-up, the VAS pain score was 0 (0, 1) point, the wrist grip strength 100.6%±7.2%, the wrist flexion 88.3°±2.5°, the wrist dorsiflexion 88.5°±2.2°, and the modified Mayo wrist score (98.3±2.5) points, all significantly better than the pre-surgery values [4 (4, 5) points, 69.1%±16.0%, 61.3°±13.5°, 64.7°±9.1°, and (61.7±10.1) points] (all P < 0.05). Conclusion:In the treatment of delayed union or nonunion of scaphoid fracture, minimally invasive percutaneous internal fixation with double screws shows advantages of minimal invasion, quick fracture healing, fine functional recovery, and no need of bone grafting.

Objective:To investigate the safety and efficacy of balloon pulmonary angioplasty (BPA) for residual pulmonary hypertension (PH) of chronic thromboembolic pulmonary hypertension(CTEPH) after pulmonary endarterectomy (PEA).Methods:Patients diagnosed as PH after PEA in China-Japan Friendship Hospital from Oct 2016 to Jun 2022 were included. The indication for BPA was decided on the basis of a consensus of the multi-disciplinary team for all patients with CTEPH. Before treatment, the patient′s exercise tolerance and pulmonary artery flow parameters were evaluated. A comparative analysis of various parameters before BPA treatment and at the last BPA was conducted. 6-min walk distance (6MWD) was analyzed using the paired Wilcoxon test; N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary arterial pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were compared using the paired-samples t-test. WHO functional class was compared using McNemar′s test. Results:Twenty patients with a total of 130 vessels underwent 46 sessions of BPA treatment. The postoperative 6-minute walk distance (6MWD) [447 (415, 485) m] showed a significant improvement compared to the preoperative baseline [389 (335, 470) m] ( Z=6.52, P<0.05), Postoperative mixed venous oxygen saturation (72.0%±1.9%) showed a significant improvement compared to the preoperative levels (64.0%±2.7%) ( t=2.14, P<0.05).Postoperatively, plasma NT-proBNP [(351.9±129.9) pg/ml], mPAP [(24.2±1.9) mmHg], and PVR [(3.0±1.4) WU] significantly decreased compared to preoperative levels [(982.5±426.2) pg/ml, (33±2.1) mmHg, (8.0±1.6) WU)] ( t=3.38, 1.22, 2.10, P<0.05 for all). Postoperatively, there was a significant improvement in WHO functional class (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 14, 4, 2, 0 cases) compared to preoperative status (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 0, 13, 5, 2 cases) ( χ2=20.17, P<0.05). Four cases of pulmonary artery dissection and one episode of hemoptysis occurred postoperatively, with no other complications reported. Conclusions:BPA can significantly improve exercise tolerance and hemodynamic parameters for residual PH after PEA. BPA is a relatively safe and effective treatment for residual PH after PEA.