Diabetic foot ulcer （DFU） is one of the most severe and costly complications of diabetes， with its refractory nature largely attributed to the persistent vicious cycle of inflammation and oxidative stress. Conventional single-target therapeutic strategies often fail to effectively break this cycle. Traditional Chinese medicine （TCM）， leveraging its unique philosophy of ''holistic regulation and multi-target intervention''， has demonstrated significant advantages in promoting DFU healing. This review introduced a ''systemic intervention'' perspective to systematically elucidate how TCM， through multi-component synergistic networks， precisely deconstructs and intervenes in this pathological loop. Firstly， this study provided an in-depth analysis of how， under hyperglycemic conditions， the crosstalk between the nuclear factor-kappa B （NF-κB） and NOD-like receptor family pyrin domain-containing protein 3 （NLRP3） inflammasome pathways， the imbalance in macrophage polarization and the disruption of redox homeostasis interact to form a self-sustaining vicious cycle that impedes wound repair. Subsequently， the core content systematically discussed the strategies by which TCM breaks this deadlock： （1） Active ingredients from single herbs （e.g.， luteolin and astragaloside Ⅳ） can precisely modulate key nodes such as the phosphatidylinositol 3‑kinase/protein kinase B （PI3K/Akt） and TLR4/NF-κB pathways， thereby suppressing inflammation and oxidative stress. （2） Classical compound formulas （e.g.， Simiao Yong'an decoction and Taohong Siwu decoction） synergistically improve microcirculation and the immune microenvironment through multi-component cooperation. （3） External preparations （e.g.， Shengji Yuhong Ointment and Jinhuang powder） potently exert local anti-inflammatory and pro-repair effects by activating pathways such as nuclear factor erythroid 2-related factor 2/heme oxygenase 1 （Nrf2/HO-1）. Collectively， these three modalities embody a synergistic mechanism characterized by ''internal treatment modulating the internal milieu to address the root cause， and external treatment targeting the lesion to alleviate symptoms''.” Existing clinical evidence has confirmed that the aforementioned multi-target interventions can effectively promote healing and improve symptoms. However， this field still faces persistent challenges， including an unclear material basis for the efficacy of compound formulas， and insufficient standardization in quality control and clinical protocols. These challenges stem from the inherent tension between the complex systems-based characteristics of TCM and the requirements of modern standardization. Future efforts urgently require to leverage cutting-edge technologies， such as network pharmacology， spatial multi-omics， and artificial intelligence to propel the paradigm shift in the prevention and treatment of DFU with TCM from ''empirical multi-target approaches'' toward ''precise systems regulation''. This will provide a theoretical foundation for developing innovative strategies for managing difficult-to-heal wounds based on an integrated traditional Chinese and Western medicine approach.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective To discuss the effect of main organ-preserving pancreatectomy operations on the postoperative complications and the long-term quality of life.Methods The clinical data of 320 patients undergoing pancreatic surgery from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University were retrospectively analyzed and all the patients were divided into traditional pancreatectomy surgery group and organ-preserving pancreatectomy surgery group.The traditional pancreatectomy surgery group included pancreaticoduodenectomy (PD),distal pancreatectomy (DP),and laparoscopic distal pancreatectomy (LDP);and the organ-preserving pancreatectomy surgery group included pylorus-preserving pancreaticoduodenectomy (PPPD),spleen-preserving distal pancreatectomy (SPDP),enucleation pancreatectomy (EP),and middle-preserving pancreatectomy (MSP).Face to face clinic visit or telephone follow-up was scheduled every three months until May 31,2017.The operation time,intraoperative hemorrhage,intraoperative blood transfusion,postoperative complications (hemorrhage,pancreatic fistula,biliary fistula,abdominal infection,delayed gastric emptying),postoperative hospitalization stay,secondary surgery and the survival status within 30 days after surgery,the pancreatic endocrine function,exocrine function and the long-term quality of life were recorded.Results The operation time,intraoperative hemorrhage and intraoperative blood transfusion were not statistically different between PD and PPPD groups,DP and SPDP groups,LDP and LSPDP groups,DP and MSP groups,and DP and EP groups,respectively (all P values ＞0.05).Compared with MSP group,the hospitalization time in DP group was shorter [(18.61 ±12.46)d vs (26.88 ± 15.22)d],the occurrence rate of postoperative pancreatic fistula (24.07％ vs 56.25％),bleeding (3.70％ vs 25.00％),abdominal infection (1.85％ vs 18.75％),delayed gastric emptying (5.56％ vs 31.25％),secondary surgery (0 vs 25.00％),and glycemic control rate were decreased (27.78％ vs 0),and all the differences were statistically significant (all P values ＜ 0.05).After discharge,the incidence of chronic diarrhea in the PD group was higher than that in the PPPD group (17.31％ vs 2.08％).The fatigue in the DP group was higher than that in the SPDP,MSP and EP groups,and fatigue,social function,overall health score of the LDP group were lower than those in LSPDP group;emotional function in the DP group was better than that in MSP group,and all the differences were statistically significant (all P values ＜ 0.05).Conclusions The organ-preserving pancreatectomy can reduce the trauma of the operation,postoperative complications and postoperative pancreatic endocrine and exocrine dysfunction,and improve the long-term quality of life.

Objective To investigate the expression of early growth response protein 1 (Egr-1),NGFI-A binding protein 2 (Nab2) and caveolin 1 (Cav-1) in normal skin,flat-cicatrix and hypertrophic scar,and explore its role in the formation of hypertrophic scar.Methods The expression of Egr-1,Nab2 and Cav-1 protein in 9 normal skin tissues,8 flat-cicatrix tissues and 9 hypertrophic scar tissues were examined with immunohistochemistry SP method and were analyzed statistically.Results The expression of Egr-1 in epidermal cells of hypertrophic scar was significantly higher than that in normal skin and flat scar tissue.The expression of Egr-1 increased in the course of scar proliferation.The distribution patterns of Nab2 were different from Egr-1.The expression of Egr-1 was increased,while expression of Nab2 was decreased.The expression of Cav-1 in normal skin and flat-cicatrix was significantly higher than that in hypertrophic scar.Conclusions The expression of Egr-1,Nab2 and Cav-1 is closely related to the formation of hypertrophic scar,and the up-regulated expression of Egr-1 and the deficient expression of Nab2 and Cav-1 may be the indicators of the progress of formation of hypertrophic scar.

Objective To investigate the expression of early growth response protein 1 (Egr-1),NGFI-A binding protein 2 (Nab2) and caveolin 1 (Cav-1) in normal skin,flat-cicatrix and hypertrophic scar,and explore its role in the formation of hypertrophic scar.Methods The expression of Egr-1,Nab2 and Cav-1 protein in 9 normal skin tissues,8 flat-cicatrix tissues and 9 hypertrophic scar tissues were examined with immunohistochemistry SP method and were analyzed statistically.Results The expression of Egr-1 in epidermal cells of hypertrophic scar was significantly higher than that in normal skin and flat scar tissue.The expression of Egr-1 increased in the course of scar proliferation.The distribution patterns of Nab2 were different from Egr-1.The expression of Egr-1 was increased,while expression of Nab2 was decreased.The expression of Cav-1 in normal skin and flat-cicatrix was significantly higher than that in hypertrophic scar.Conclusions The expression of Egr-1,Nab2 and Cav-1 is closely related to the formation of hypertrophic scar,and the up-regulated expression of Egr-1 and the deficient expression of Nab2 and Cav-1 may be the indicators of the progress of formation of hypertrophic scar.

Objective To study the correlation between renal function and arterial stiffness of Uighur population over 35 years old in Xinjiang area. Methods From October 2007 to March 2010, four-stage stratified random sampling method was applied to collect a total of 4312 Uighur people over 35 years old in Urumqi, Karamay, Fukang, Turpan area, Hotan prefecture, Yili Kazak autonomous prefecture and Altai prefecture. The data of these 4312 general urban and rural Uygur residents were complete. Simplified MDRD formula was used to calculate the estimate glomerular filtration rate (eGFR). Arm-ankle pulse wave velocity (b-aPWV) of both sides was measured and the average value was used in correlation analysis with eCFR, and then the associated risk factors were adjusted. Results The eGFR was negatively correlated with b-aPWV (r=-0.174, P<0.01). Multiple linear regression showed that after adjusting some risk factors such as age, sex, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, uric acid, fasting blood glucose, total cholesterol, triglycerides, low density lipoprotein, eGFR was still negatively correlated with b-aPWV (P=0.012). Conclusions In Uygur population over 35 years old in Xinjiang, the glomerular filtration rate is negatively correlated with arterial stiffness.