Objective To investigate the effect of dihydroartemisinin(DHA)on the inflammatory response and skin wound healing in diabetic rats.Methods The ointment was prepared with Carbomer 980,Tween-80,glycerol,ultrapure water and sodium hydroxide as a base.DHA and ethyl nipagin were added and stirred evenly,resulting in DHA ointment.Fifty SPF-grade SD rats were used to create a diabetic rat model by intraperitoneal injection of streptozotocin,and 44 rats were successfully modelled.Whole skin defect wounds were created on the back of rats by using a 2.0 cm diameter circular punch.Thirty-six dorsal wounds were randomly divided into 4 groups(n=9)by the random number table.Then the wounds were applied respectively with 5%DHA,10%DHA,15%DHA and ointment base(control group)once a day for 14 consecutive days.On the 3th,7th and 14th days,the wound healing was observed,the specimens were cut from 0.2 cm of wound margin and would tissue,the histological changes were observed by HE staining.Collagen changes were observed by Masson staining,and the concentrations of interleukin 6(IL-6),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)were detected by ELISA.The other eight rats were randomly divided into 10%DHA group and control group.The tissue was cut from the wound on the 7th day,and transcriptome sequencing was performed by high-throughput sequencing technology to screen the differentially expressed genes(DEGs)between the two groups.Gene ontology(GO)functional enrichment analysis as well as kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis were performed.Data were analyzed by one-way ANOVA using SPSS 27.0 statistical software.Results The different concentrations of DHA groups showed better wound healing rates than the control group.The 10%DHA group has the most significant effect(P＜0.05).Compared with the control group,each DHA group showed a decrease in inflammatory cell infiltration and an increase in collagen fibre area on the 7th and 14th days(P＜0.05).The expressions of IL-6 and TNF-α in each DHA group were significantly lower than those in the control group(P＜0.05),while the expression of IL-10 was significantly higher than that in the control group(P＜0.05).Differential gene volcano map showed that the 10%DHA group remarkably up-regulated anti-inflammatory and antibacterial genes such as hypoxia inducible factor 1α(Hif-1α),Smad homolog 12(Smad12)and β-defensin 4(Defb4).The GO functional enrichment analysis indicated that the 10%DHA group was significantly enriched in inflammatory response,immune response and defense response to bacterium.The KEGG enrichment analysis showed that the 10%DHA group was significantly enriched in chemokine signaling pathway,NOD-like receptor signaling pathway and so on.Conclusion DHA may inhibit excessive inflammatory responses by modulating inflammatory factors,anti-inflammatory and antimicrobial genes,chemokine signaling pathway and NOD-like receptor signaling pathway as well as reducing inflammatory cell infiltration,thereby enhancing wound healing.

Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People's Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For"C"-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis ≤30％,improved tortuosity,and no occurrence of stroke within 1-3d after surgery.Postoperative complications,including stroke,myocardial infarction,hoarseness,surgical site bleeding,swelling,and poor wound healing,were also observed.Follow-up carotid ultrasound was performed at 1,6,and 12 months to monitor for restenosis(peak systolic velocity＞220 cm/s or＞70％reduction in vessel diameter).Results Among the 9 patients,4 were males and 5 were females;the age ranged from 61 to 74 years,with an average of(67±4)years.3 cases had asymptomatic severe stenosis,3 cases had symptomatic moderate stenosis,and 3 cases had symptomatic severe stenosis.There were 9 cases of previous hypertension,5 cases of diabetes,6 cases of hyperlipidemia,4 cases of coronary heart disease,5 cases of smoking,and 4 cases of drinking.There were 5 cases of ICA"C"-shaped tortuosity,2 cases of coiling of the ICA,1 case of both ICA and ECA tortuosity,and 1 case CCA tortuosity.All 9 patients successfully underwent surgery.Postoperative neck CTA within 1-3 d demonstrated patency of the operated carotid artery and improvement in vascular tortuosity in all cases,with duplex ultrasound showing favorable hemodynamic status.No postoperative complications were observed.Follow-up at 1,6,and 12 months revealed no restenosis in any of the patients.Conclusions Microsurgical surgery is an effective method for treating carotid artery stenosis complicated by tortuosity.Detailed preoperative evaluation and selection of appropriate surgical techniques are essential.This study is a single-center study with a small sample size,and the findings require further validation through multi-center,large-scale research.

Objective To explore the microsurgical treatment strategies for patients with carotid artery stenosis complicated by tortuosity.Methods A retrospective study was conducted on 9 patients with carotid artery stenosis and tortuosity who underwent microsurgical treatment in the Department of Neurosurgery,the Second People's Hospital of Liaocheng,from June 2019 to August 2023.Patient demographics and clinical data,including sex,age,initial admission diagnosis,clinical symptoms,risk factors for carotid artery stenosis(hypertension,diabetes,hyperlipidemia,smoking,drinking),pre-operative and contralateral vascular imaging were collected.According to the type of vascular tortuosity,three surgical methods were employed:(1)For"C"-shaped tortuosity of the internal carotid artery(ICA),the ICA was divided obliquely at the carotid bifurcation,and eversion carotid endarterectomy was performed.Then ICA was opened longitudinally along its medial side,the common carotid artery(CCA)was extended proximally along its lateral border.The ICA was end-to-side anastomosis anastomosed to the CCA.(2)For coiling of the ICA,the ICA was divided obliquely at the carotid bifurcation and eversion carotid endarterectomy was completed.The redundant segment of the ICA origin was resected,and an end-to-side anastomosis between the ICA and CCA was performed.(3)For cases of kinking of both the ICA and external carotid artery(ECA),or kinking of the CCA,the technique was performed by transection of the CCA,and then eversion carotid endarterectomy was performed,and part of the CCA was resected.After downward mobilization of the ICA and ECA,an end-to-end anastomosis of the CCA was carried out.Postoperatively,all patients underwent neck CT angiography(CTA)and duplex ultrasound examination within 1-3d to assess carotid patency,tortuosity improvement,and hemodynamic changes.Surgical success was defined as residual stenosis ≤30％,improved tortuosity,and no occurrence of stroke within 1-3d after surgery.Postoperative complications,including stroke,myocardial infarction,hoarseness,surgical site bleeding,swelling,and poor wound healing,were also observed.Follow-up carotid ultrasound was performed at 1,6,and 12 months to monitor for restenosis(peak systolic velocity＞220 cm/s or＞70％reduction in vessel diameter).Results Among the 9 patients,4 were males and 5 were females;the age ranged from 61 to 74 years,with an average of(67±4)years.3 cases had asymptomatic severe stenosis,3 cases had symptomatic moderate stenosis,and 3 cases had symptomatic severe stenosis.There were 9 cases of previous hypertension,5 cases of diabetes,6 cases of hyperlipidemia,4 cases of coronary heart disease,5 cases of smoking,and 4 cases of drinking.There were 5 cases of ICA"C"-shaped tortuosity,2 cases of coiling of the ICA,1 case of both ICA and ECA tortuosity,and 1 case CCA tortuosity.All 9 patients successfully underwent surgery.Postoperative neck CTA within 1-3 d demonstrated patency of the operated carotid artery and improvement in vascular tortuosity in all cases,with duplex ultrasound showing favorable hemodynamic status.No postoperative complications were observed.Follow-up at 1,6,and 12 months revealed no restenosis in any of the patients.Conclusions Microsurgical surgery is an effective method for treating carotid artery stenosis complicated by tortuosity.Detailed preoperative evaluation and selection of appropriate surgical techniques are essential.This study is a single-center study with a small sample size,and the findings require further validation through multi-center,large-scale research.