OBJECTIVE: The self-defined multidisciplinary (endocrinology, vascular surgery, and orthopedics) scoring system (EMO scoring system for short) was designed. The feasibility of the EMO scoring system to guide the proximal tibial transverse transport (TTT) for diabetic foot wounds was preliminarily explored. METHODS: Based on the current commonly used clinical criteria for diabetic foot judgment, expert consensus, guidelines, and related research progress in the treatment of diabetic foot wounds, combined with clinical experience, a set of EMO scoring systems including endocrinology, vascular surgery, and orthopedics was formulated. The criteria for selecting conservative treatment, TTT after baseline improvement, and TTT based on scoring results was proposed. A total of 56 patients with diabetic foot wounds who were admitted between September 2017 and July 2022 and met the selection criteria was taken as the study subjects. Among them, 28 patients were treated with TTT and 28 patients were treated conservatively. The patients were graded according to the EMO scoring system, the corresponding treatment methods were selected, and the actual treatment methods and results of the patients were compared. RESULTS: The EMO scoring system was formed through literature retrieval and clinical experiences. The system included three criteria, namely endocrinology (E), macrovascular disease (M), and orthopedics (O), which were divided into multiple subtypes according to the relevant evaluation items, and finally the diabetic foot wound was divided into 8 types, which correspondingly selected TTT, TTT after baseline improvement, and conservative treatment. All 56 patients were followed up 12 months after treatment. Among them, the wound healing rate of the TTT group was 85.71% (24/28), which was higher than that of the conservative treatment group [53.57% (15/28)]. At 12 week after treatment, CT angiography showed that there were more small blood vessels in the wound and ipsilateral limb in TTT group than in the conservative treatment group. Based on the EMO scoring system, 14 of the 56 patients needed conservative treatment, 29 patients needed TTT, and 13 patients needed TTT after baseline improvement. Compared with the clinical data of the patients, the wound healing rate of the patients judged to be TTT was 75.86% (22/29), of which 21 cases were actually treated with TTT, and the healing rate was 90.48%; 8 patients were treated conservatively, and the healing rate was 37.50%. The wound healing rate of the patients judged to be conservative treatment was 92.86% (13/14), of which 1 case was actually treated with TTT, and the healing rate was 100%; 13 cases were treated conservatively, and the healing rate was 92.31%; 1 case experienced minor amputation. The wound healing rate of the patients judged to TTT after baseline improvement was only 30.77% (4/13), of which 6 cases were actually treated with TTT, and the healing rate was 66.67%; 7 cases were treated conservatively, and the healing rate was 0. CONCLUSION EMO scoring system can comprehensively evaluate the diabetic foot wounds, and make personalized judgment on whether TTT treatment is feasible, so as to improve the level of diabetic foot wound treatment and the prognosis of patients.
Humans ; Diabetic Foot/therapy* ; Feasibility Studies ; Male ; Female ; Middle Aged ; Aged ; Tibia/surgery* ; Wound Healing ; Adult ; Treatment Outcome ; Conservative Treatment

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Objective To investigate effect of dexmedetomidine on safety,validity and superiority in patients undergoing scoliosis surgery under propofol sufentanil anesthesia.Methods Forty patients undcrgoing elective posterior scoliosis surgery were randomly divided into groups D and C (n =10 each).Dexmedetomidine 0.8 μg/kg followed by 0.2 μg/(kg · h) and equal volume were infused at the 10 min before anesthesia induction in two groups,respectively.Hemodynamic parameters were observed at the 10 min before anesthesia induction (T1),3 min (T2) after anesthesia induction,1 min (T3) after intubation,at the beginning of wake-up test (T4),at the end of the test (T5),and 6 min (T6) after deepen anesthesia,respectively.Meanwhile the wake-up time,hemodynamic parameters,success rate of arousal,incidence agitation,and the bleeding volume during the test were also recorded.Results Successive rate of arousal awakening time between two groups had no statistical significance (P ＞ 0.05).Less incidence of agitation was found in group D compared to group C (P ＜ 0.05).The bleeding volume during the test was significantly less in group D (P ＜ 0.05).The hemodynamics was more smoothly during the operation in group D compared to group C (P ＜ 0.05).Conclusions Dexmedetomidine auxiliary propofol and sufentanil anesthesia can effectively implement intraoperative wake-up,reduce the amount of bleeding,and the incidence of agitation during the wake-up.The hemodynamics was more smoothly.

ObjectiveTo investigate the profile of Th17/Treg balance in the peripheral blood of patients with systemic lupus erythematosus (SLE).MethodsThirty-two SLE patients in active disease were selected and 30 SLE patients in remission were included in this study.The control group was consisted of 25healthy individuals.The expressions of IL-17 and FoxP3 on CD4+ T cells in the peripheral blood were assessed by flow cytometry and the mRNA levels of these two cytokines were examined by quantitative PCR respectively.ANOVA was used for statistical analysis.ResultsThe percentage of CD4+IL-17+ T cells and IL-17mRNA expression of the active group were significantly higher than those of the remission group and control group[(l.0l±0.22)％,(2.04±0.63)vs (0.48±0.16)％,(1.12±0.34) vs (0.41±0.12)％,1; P＜0.01].There was no difference between the remission group and control group(P＞0.05).However,the percentage of CI4+FoxP3 + T cells and FoxP3 mRNA expression of the active group were significantly lower than those of the remission group and control group [(2.36±t0.54)％,(0.42±0.16) vs (4.34±0.95)％,(0.87±t0.28) vs (5.09±11.17)％,1; P＜0.01 ],and there was also significant differencesbetween the remission group and control group(P＜0.05).ConclusionThl7/Treg balance shift may exist in the peripheral blood of patients with SLE and the degree of imbalance may be related to disease activity of SLE.

AIM: To investigate the effect of compound rhubarb preparation (Kintop) in preventing obesity in rats and its probable mechanism involved. METHODS: Twenty-six newborn SD rats were randomly grouped as rhubarb preparation plus high-energy forage group( n= 8), high-energy forage control group( n= 8) and ordinary forage control group( n= 10). The rats in rhubarb preparation plus high-energy forage group and high-energy forage control group were fed with high-energy forage and those in ordinary forage control group were fed with ordinary forage. The rats in rhubarb preparation plus high-energy forage group were administered by compound rhubarb preparation (40 mg?100 g -1 body weight?d -1 ) from 9th to 17th week. The dynamic changes in body weight, celiac fat weight and adipocytes size were measured. Immunohistochemical analysis of leptin in celiac adipocytes (ABC method) and measurement of serum leptin level (RID method) were performed. RESULTS: The body weight and the wet weights of celiac fat were lower, their adipocytes were smaller and immunohistochemical stainings of leptin were weaker in rhubarb preparation plus high-energy forage group than those in high-energy forage control group. There was an obvious positive correlation between the expression of leptin and celiac fat tissue weight( r= 0.8663, P