Objective:To investigate the curative effects of the ulnar artery perforator flap carrying 2 and more perforators of same source artery on reconstruction of defects in hand.Methods:A retrospective observational study was conducted on 13 patients with hand injuries combined with bone or tendon exposure and met the inclusion criteria of the study were admitted to the Department of Hand Surgery, Wuxi NO.9 People’s Hospital Affiliated to Soochow University between April 2022 and September 2023. The patients were 8 males and 5 females with a mean age of 45.7 (25-67) years. Seven hand injuries were caused by mechanical crushing, 2 by hot crushing and 4 by machine strangulation. After debridement, the sizes of defect were found at 5.4 cm×5.1 cm to 8.2 cm×7.5 cm. Dopplor ultrasound was applied to locate the perforators before surgery. Perforator flaps carrying cutaneous branches of ulnar artery proximal to the wrist were designed for reconstruction of the defects in hand. The flaps were 6.0 cm×5.5 cm-8.5 cm×8.0 cm in size. Donor sites were covered by the ulnar artery perforator flaps sized 5.3 cm×2.7 cm-8.2 cm×4.0 cm and carryied 2 and more perforators of the same source artery. During harvest of the flaps, the number and calibre of perforators carried by flap, the calibre of the main trunk of the superior carpal branch of the ulnar artery and the length of its pedicle were recorded. A total of 35 perforators with 0.35-0.95 mm in calibre carried by 13 perforator flaps of ulnar artery were successfully retained. Five of the 13 flaps carried the perforators with a calibre smaller than 0.50 mm. Overall, there were 7 flaps with 2 perforators per flap, 4 with 3 perforators per flap, 1 with 4 perforators and 1 with 5 perforators. The cutaneous branch of ulnar artery in a caliber of 0.75-1.35 mm and proximal to the wrist was dissected as the vascular pedicle with 30.0-45.0 mm in length. All patients were included in the schedueled postoperative at outpatient clinic to observe the appearance and sensation of the flaps, and the occurrence of complication.Results:All flaps survived and the wounds healed at first intention without vascular compromises, wound dehiscence or obvious swelling. All patients received 8 - 20 months of follow-up, with 15 months in average. Flaps presented good appearance and colour, with soft texture and without bloating. TPD of the first flap was 8-18 mm, with an average of 10.5 mm±0.5 mm and that of the second or relay flap was 7-15 mm, with an average of 9.5 mm±0.5 mm. According to British Medical Research Council (BMRC) system, the sensory evaluation of the recipient sites achieved S 4 in 5 flaps, S 3 in 9 flaps and S 2 in 12 flaps. Conclusion:The ulnar artery perforator flap with 2 and more perforators of the same source artery has sufficient and reliable blood supply and is effective in reconstruction of hand defects.

Objective:To investigate the curative effects of the ulnar artery perforator flap carrying 2 and more perforators of same source artery on reconstruction of defects in hand.Methods:A retrospective observational study was conducted on 13 patients with hand injuries combined with bone or tendon exposure and met the inclusion criteria of the study were admitted to the Department of Hand Surgery, Wuxi NO.9 People’s Hospital Affiliated to Soochow University between April 2022 and September 2023. The patients were 8 males and 5 females with a mean age of 45.7 (25-67) years. Seven hand injuries were caused by mechanical crushing, 2 by hot crushing and 4 by machine strangulation. After debridement, the sizes of defect were found at 5.4 cm×5.1 cm to 8.2 cm×7.5 cm. Dopplor ultrasound was applied to locate the perforators before surgery. Perforator flaps carrying cutaneous branches of ulnar artery proximal to the wrist were designed for reconstruction of the defects in hand. The flaps were 6.0 cm×5.5 cm-8.5 cm×8.0 cm in size. Donor sites were covered by the ulnar artery perforator flaps sized 5.3 cm×2.7 cm-8.2 cm×4.0 cm and carryied 2 and more perforators of the same source artery. During harvest of the flaps, the number and calibre of perforators carried by flap, the calibre of the main trunk of the superior carpal branch of the ulnar artery and the length of its pedicle were recorded. A total of 35 perforators with 0.35-0.95 mm in calibre carried by 13 perforator flaps of ulnar artery were successfully retained. Five of the 13 flaps carried the perforators with a calibre smaller than 0.50 mm. Overall, there were 7 flaps with 2 perforators per flap, 4 with 3 perforators per flap, 1 with 4 perforators and 1 with 5 perforators. The cutaneous branch of ulnar artery in a caliber of 0.75-1.35 mm and proximal to the wrist was dissected as the vascular pedicle with 30.0-45.0 mm in length. All patients were included in the schedueled postoperative at outpatient clinic to observe the appearance and sensation of the flaps, and the occurrence of complication.Results:All flaps survived and the wounds healed at first intention without vascular compromises, wound dehiscence or obvious swelling. All patients received 8 - 20 months of follow-up, with 15 months in average. Flaps presented good appearance and colour, with soft texture and without bloating. TPD of the first flap was 8-18 mm, with an average of 10.5 mm±0.5 mm and that of the second or relay flap was 7-15 mm, with an average of 9.5 mm±0.5 mm. According to British Medical Research Council (BMRC) system, the sensory evaluation of the recipient sites achieved S 4 in 5 flaps, S 3 in 9 flaps and S 2 in 12 flaps. Conclusion:The ulnar artery perforator flap with 2 and more perforators of the same source artery has sufficient and reliable blood supply and is effective in reconstruction of hand defects.

Objective To minimize variations in treatment outcomes of L5/S1 percutaneous intervertebral radiofrequency thermocoagulation(PIRFT)arising from physician proficiency and achieve precise quantitative risk assessment of the puncture paths.Methods We used a self-developed deep neural network DWT-UNet for automatic segmentation of the magnetic resonance(MR)images of the L5/S1 segments into 7 key structures:L5,S1,Ilium,Disc,N5,Dura mater,and Skin,based on which a needle insertion path planning environment was modeled.Six hard constraints and 6 soft constraints were proposed based on clinical criteria for needle insertion,and the physician's experience was quantified into weights using the analytic hierarchy process and incorporated into the risk function for needle insertion paths to enhance individual case adaptability.By leveraging the proposed skin entry point sampling sub-algorithm and Kambin's triangle projection area sub-algorithm in conjunction with the analytic hierarchy process,and employing various technologies such as ray tracing,CPU multi-threading,and GPU parallel computing,a puncture path was calculated that not only met clinical hard constraints but also optimized the overall soft constraints.Results A surgical team conducted a subjective evaluation of the 21 needle puncture paths planned by the algorithm,and all the paths met the clinical requirements,with 95.24%of them rated excellent or good.Compared with the physician's planning results,the plans generated by the algorithm showed inferior DIlium,DS1,and Depth(P<0.05)but much better DDura,DL5,DN5,and AKambin(P<0.05).In the 21 cases,the planning time of the algorithm averaged 7.97±3.73 s,much shorter than that by the physicians(typically beyond 10 min).Conclusion The multi-constraint optimal puncture path planning algorithm offers an efficient automated solution for PIRFT of the L5/S1 segments with great potentials for clinical application.

Objective To minimize variations in treatment outcomes of L5/S1 percutaneous intervertebral radiofrequency thermocoagulation(PIRFT)arising from physician proficiency and achieve precise quantitative risk assessment of the puncture paths.Methods We used a self-developed deep neural network DWT-UNet for automatic segmentation of the magnetic resonance(MR)images of the L5/S1 segments into 7 key structures:L5,S1,Ilium,Disc,N5,Dura mater,and Skin,based on which a needle insertion path planning environment was modeled.Six hard constraints and 6 soft constraints were proposed based on clinical criteria for needle insertion,and the physician's experience was quantified into weights using the analytic hierarchy process and incorporated into the risk function for needle insertion paths to enhance individual case adaptability.By leveraging the proposed skin entry point sampling sub-algorithm and Kambin's triangle projection area sub-algorithm in conjunction with the analytic hierarchy process,and employing various technologies such as ray tracing,CPU multi-threading,and GPU parallel computing,a puncture path was calculated that not only met clinical hard constraints but also optimized the overall soft constraints.Results A surgical team conducted a subjective evaluation of the 21 needle puncture paths planned by the algorithm,and all the paths met the clinical requirements,with 95.24%of them rated excellent or good.Compared with the physician's planning results,the plans generated by the algorithm showed inferior DIlium,DS1,and Depth(P<0.05)but much better DDura,DL5,DN5,and AKambin(P<0.05).In the 21 cases,the planning time of the algorithm averaged 7.97±3.73 s,much shorter than that by the physicians(typically beyond 10 min).Conclusion The multi-constraint optimal puncture path planning algorithm offers an efficient automated solution for PIRFT of the L5/S1 segments with great potentials for clinical application.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Diabetes retinopathy （DR） is an important cause that threatens the visual health of adults. There are some treatment methods of western medicine with definite efficacy， such as anti-vascular endothelial growth factor and laser photocoagulation， but they have many adverse reactions such as intraocular infection and visual field damage. Traditional Chinese medicine （TCM） therapies are safe and effective， which can complement western medicine. Phosphatidylinositol3-kinase （PI3K）/protein kinase B （Akt） signaling pathway regulates a range of processes including glucose metabolism， cell proliferation， and cell transcription and apoptosis， which is closely related to the occurrence and development of DR. Numerous studies have shown that TCM monomers can participate in maintaining the integrity of blood-retinal barrier and inhibiting retinal neovascularization and neurodegeneration in many aspects such as inhibiting oxidative stress and alleviating inflammatory reaction by regulating the PI3K/Akt pathway， so as to delay the progress of DR. Therefore， this study reviewed PI3K/Akt pathway and its relationship with DR， as well as the TCM monomers in interfering with DR based on PI3K/Akt pathway to provide some ideas for the prevention and treatment of DR in integrated TCM and western medicine.

Objective To evaluate the regulatory effects of lycopene on the key signaling receptors in human cutaneous squamous cell carcinoma cell line COLO16.Methods Cultured COLO16 cells were divided into 6 groups to be treated with lycopene at different concentrations of 0,5,10,15,20,and 25 μmol/L,respectively,for 24 hours (control group and 5,10,15,20,25 μmol/L lycopene groups),followed by estimation of the cell viability by lactate dehydrogenase (LDH) assay.Lycopene at a safe concentration was selected based on the LDH assay,and used for the determination of expression of signaling receptors,and Western blot analysis was performed to measure the expression of key signaling receptor proteins,including epidermal growth factor receptor (EGFR),glucocorticoid receptor (GR),retinoic acid receptor-alpha (RAR-α),retinoid X receptor-alpha (RXR-α),androgen receptor (AR) and progesterone receptor (PR).Statistical analysis was carried out by one-way analysis of variance (ANOVA),Tukey multiple comparison teat and Brown-Forsythe test with the SPSS software.Results After 24-hour treatment with lycopene at different concentrations,there were significant differences in the rate of cell death among these groups (F =13.116,P ＜ 0.05),and the rate of cell death in the 25 μmol/L lycopene group significantly differed from that in the control group (P ＜ 0.05).Therefor,lycopene at concentrations of 5,10 and 20 μmol/L were selected to treat COLO16 and HaCaT cells as well as human epidermal keratinocyte (HEK) for 24 hours in the following experiment.The treatment with lycopene significantly decreased the phosphorylation level of EGFR (P ＜ 0.05),but significantly increased the expression of GR protein (P ＜ 0.05),and showed no significant effects on the protein expression of RAR-α,RXR-α,AR,and PR in COLO16 cells.After 24-hour treatment with lycopene at concentrations of 5,10 and 20 μmol/L,there were no significant changes in the phosphorylation level of EGFR protein or the expression of GR protein in HaCaT cells and HEK (all P ＞ 0.05) compared with those without lycopene treatment.Conclusion Lycopene can decrease the viability of COLO16 cells,inhibit the activation of EGFR protein,and up-regulate the expression of GR,and these effects may be specific for tumor cells.

Objective To observe the effects of warm water bath active rewarming and passive rewarming on lung pathological injury and arterial blood gas of SD rats with hypothermia induced by prolonged seawater immersion.Methods One hundred male Sprague-Dawley rats were randomly divided into the normal control group (without any treatment) and the hypothermia group (seawater immersion at 20 ℃ for 24 h),The animals in the passive rewarming groups 1,2,3 and 4,each consisting of 10,had seawater immersion at 20 ℃for 24 h and received passive rewarming,and then they were respectively executed at 0,3,6 and 12 hours after rewarming,The animals in the active rewarming groups 1,2,3 and 4,each consisting of 10,underwent seawater immersion at 20 ℃ for 24 h and received active rewarming,and then they were sacrificed at 0,3,6and 12 hours after rewarming,Changes in lung pathology,arterial blood gas and other indicators were detected in all the animal groups.Results Both warm water bath active rewarming and passive rewarming all could help to restore lung injury and blood gas abnormality in rats with hypothermia induced by prolonged seawater immersion.Compared with that of the passive rewarming group [6 h:(7.6 ± 2.2) scores,12 h:(5.3 _± 1.3)scores],the recovery of lung pathological injury in warm water bath rewarming group was obviously better at 6 h(5.8 ± 1.2) scores and 12 h(3.8 ± 1.4) scores after rewarming,with statistical significance (P ＜ 0.05),and actual bicarbonate recovery was even better at 6 h after rewarming,also with statistical significance (P ＜0.05).Conclusions Compared with passive rewarming,warm water bath rewarming could significantly alleviate lung injury and arterial blood gas abnormality in hypothermic rats induced by prolonged seawater immersion,and it might produce even better effect on the prevention of rewarming-related acute respiratory distress syndrome.

Objective To study the effects of active rewarming and passive rewarming on pulmonary oxidative stress and inflammatory response in rats with hypothermia induced by acute severe seawater immersion.Methods Sixty-four male healthy SD rats were randomly divided into the normal control group , the low temperature immersion group , the active rewarming group and the passive rewarming group . In accordance with rewarming time points , the two rewarming groups were further subdivided into the 2 h, 6 h and 12 h rewarming groups , each consisting of 8 animals.Effects of 2 different rewarming methods on lung oxygen free radicals ( MDA, SOD, GSH-PX) and serum inflammatory factors ( IL-6, IL-1β, TNF-a) were compared between the groups.Results (1) The MDA level [(2.84 ±0.46) nmol/mg pro] of the lungs in the 2 h active rewarming group was significantly higher than that of the 2 h passive rewarming group (P<0.05), and the MDA levels [(1.98 ±0.35) nmol/mg pro, (1.84 ±0.38) nmol/mg pro] of the 6 h and 12 h passive rewarming groups were slightly higher than those [(1.68 ±0.19) nmol/mg pro,(1.54 ±0.17) nmol/mg pro] of the 6 h and 12 h passive rewarming groups (P<0.05).(2) The SOD activity in the lungs of the 2 h and 6 h active rewarming groups was slightly higher than that of the 2 h and 6 h passive rewarming groups(P>0.05). The SOD activity in the lungs of the 12 h active rewarming group was higher than that of the 12 h passive rewarming group(P>0.05).(3) The GSH-PX activity in the lungs of the 2 h active rewarming group was slightly higher than that of the 2 h passive rewarming group(P>0.05).The GSH-PX activity in the lungs of the 6 h and 12 h active rewarming group was significantly higher than that of the 6 h and 12 h passive rewarming group(P<0.05).(4) The serum IL-1βand IL-6 levels of the 2 h passive rewarming group were obviously higher that those of the 2 h active rewarming group(P<0.05).The serum IL-1βand IL-6 levels in the 6 h and 12 h passive rewarming groups were slightly higher than those of the 6 h and 12 h active rewarming groups ( P<0.05).(5) The serum TNF-a levels of the 2 h, 6 h and 12 h passive rewarming groups were slightly higher that those of the 2 h, 6 h and 12 h active rewarming groups (P<0.05).Conclusion As compared with the active rewarming group , the activation of oxidative stress and inflammatory response in the passive rewarming group might worsen pulmonary lesion of the rats with hypothermia induced by acute severe seawater immersion .

Objective To observe the effects of warm water bath active rewarming and passive rewarming on lung pathological injury and arterial blood gas of SD rats with hypothermia induced by prolonged seawater immersion.Methods One hundred male Sprague-Dawley rats were randomly divided into the normal control group (without any treatment) and the hypothermia group (seawater immersion at 20 ℃ for 24 h),The animals in the passive rewarming groups 1,2,3 and 4,each consisting of 10,had seawater immersion at 20 ℃for 24 h and received passive rewarming,and then they were respectively executed at 0,3,6 and 12 hours after rewarming,The animals in the active rewarming groups 1,2,3 and 4,each consisting of 10,underwent seawater immersion at 20 ℃ for 24 h and received active rewarming,and then they were sacrificed at 0,3,6and 12 hours after rewarming,Changes in lung pathology,arterial blood gas and other indicators were detected in all the animal groups.Results Both warm water bath active rewarming and passive rewarming all could help to restore lung injury and blood gas abnormality in rats with hypothermia induced by prolonged seawater immersion.Compared with that of the passive rewarming group [6 h:(7.6 ± 2.2) scores,12 h:(5.3 _± 1.3)scores],the recovery of lung pathological injury in warm water bath rewarming group was obviously better at 6 h(5.8 ± 1.2) scores and 12 h(3.8 ± 1.4) scores after rewarming,with statistical significance (P ＜ 0.05),and actual bicarbonate recovery was even better at 6 h after rewarming,also with statistical significance (P ＜0.05).Conclusions Compared with passive rewarming,warm water bath rewarming could significantly alleviate lung injury and arterial blood gas abnormality in hypothermic rats induced by prolonged seawater immersion,and it might produce even better effect on the prevention of rewarming-related acute respiratory distress syndrome.