Objective:To explore the repair methods and effects of refractory wounds in patients after spinal internal fixation operation .Methods:The study was a retrospective observational study. From November 2020 to October 2023, 10 patients with refractory wounds after spinal internal fixation operation were admitted to the Department of Burns and Plastic Surgery of Changde Hospital of Xiangya School of Medicine of Central South University. They were 3 males and 7 females, aged 35 to 68 years. There were 6 cases of thoracolumbar tuberculosis, 3 cases of thoracolumbar fracture, and 1 case of recurrent sacrococcygeal chordoma with skin, soft tissue, and bone defects after radical resection. The wound areas after debridement were 6.0 cm×1.5 cm to 27.0 cm×6.5 cm. The wound repair operation was decided to perform in the primary stage or in the secondary stage according to the wound situation. Two patients with type Ⅰ wounds were treated with debridement, direct suture, and continuous irrigation and drainage with catheter after operation. Eight patients with type Ⅱ wounds were repaired with local flaps (including rotation flap with dermis-fat flap at the end), muscle flaps, or muscle flaps combined with local flaps. The flap sizes were 10.0 cm×5.0 cm to 27.0 cm×14.0 cm, and the sizes of muscle flap were 8.0 cm×5.0 cm×4.0 cm to 17.0 cm×9.5 cm×2.0 cm. The wounds in flap donor areas were sutured directly. The wound treatment methods of patients with type Ⅱ wounds were recorded. The wound healing was observed after operation. The infection and recurrence of wounds, the retention of internal fixation materials, and spinal motor function were observed during follow-up.Results:Among patients with type Ⅱ wounds, there were 3 cases applied with local flaps (including 1 case with rotation flap with dermis-fat flap at the end), 3 cases with muscle flaps (including 1 case with latissimus dorsi muscle flap and 2 cases with erector spinal muscle flaps), and 2 cases with muscle flaps (1 case with latissimus dorsi muscle flap and 1 case with erector spinal muscle flap) combined with local flaps. Only 1 case with secondary defects after radical surgery of sacrococcygeal chordoma had poor wound healing which healed after dressing change, and the wounds of the remaining 9 cases all healed well. During the follow-up of 4 to 18 months, no infection or recurrence of local wounds developed in 10 patients, the internal fixation materials were not loosening, and there was no significant limitation in spinal motor function.Conclusions:For refractory wounds after spinal internal fixation operation, according to the wound type of patients, debridement, suture, irrigation, and drainage in the primary stage, or transplantation of local flaps, muscle flaps, muscle flaps combined with local flaps are performed in the primary stage or in the secondary stage. These methods are proved to have reliable therapeutic effects, not only repairing the wounds, but also retaining the internal fixation materials.

Objectives:To investigate the association between normal-weight central obesity with new-onset cardiovascular disease and all-cause mortality risk. Methods:A prospective cohort study was conducted,selecting a total of 93885 participants from the Kailuan Study who had their first physical examination in 2006-2007.According to waist circumference (central obesity:male waist circumference ≥90 cm,female waist circumference ≥85 cm;no central obesity:male waist circumference<90 cm,female waist circumference<85 cm) and body mass index (BMI,normal weight:18.5 kg/m2≤BMI<24.0 kg/m2;overweight/obesity:BMI ≥24.0 kg/m2),the participants were divided into 4 groups:normal weight no central obesity group (G1 group),normal weight central obesity group (G2 group),overweight/obesity no central obesity group (G3 group) and overweight/central obesity group (G4 group);Using the Kaplan-Meier method,the cumulative incidence of new-onset cardiovascular diseases (including hemorrhagic stroke,ischemic stroke and myocardial infarction) and all-cause mortality in different groups was calculated,and the Log-rank test was used for intergroup comparisons.Furthermore,the associations between the different groups and the risk of new-onset cardiovascular diseases and all-cause mortality were analyzed using the multivariate Cox proportional hazard regression model. Results:After a median follow-up of 14.97 (14.55,15.17) years,the cumulative incidence of new-onset cardiovascular diseases in G1 group,G2 group,G3 group and G4 group was 7.62％,10.84％,8.67％,12.91％ respectively (log-rank P<0.05) and the cumulative incidence of all-cause mortality was 12.83％,19.72％,10.65％,16.33％ respectively (log-rank P<0.01).After adjusting for confounding factors,Cox regression analysis showed that the HR (95％CI) of new-onset cardiovascular diseases in G2 group,G3 group and G4 group were 1.14 (1.04-1.25),1.07 (1.01-1.14),1.27 (1.21-1.34),respectively compared with G1 group (all P<0.05).The HR (95％CI) of all-cause mortality were 1.06 (1.00-1.14),0.90 (0.85-0.95),0.97 (0.93-1.01) compared with G1 group,and P values were 0.07,<0.01,0.15,respectively.The results of sensitivity analysis were consistent with the above major studies after excluding overweight/obesity and cancer participants during follow-up. Conclusions:Normal-weight central obesity increases the risk of new-onset cardiovascular diseases and all-cause mortality.

Objective:To explore the strategy of how to select an effective flap for reconstruction of the surgical defect in clavicular region after resection of malignant tumour and care for the aesthetic appearance of the flap donor site.Methods:A retrospective observational study was conducted. Twenty-three patients with soft tissue malignant tumour in clavicle region were treated, from March 2017 to April 2023, in the Department of Burn and Plastic Surgery of Changde Hospital, Xiangya School of Medicine, Central South University (the First People’s Hospital of Changde). The patients were 13 males and 10 females, aged 21 to 72 years old. Ten patients were of dermatofibrosarcoma protuberans, 6 of fibrosarcoma, 3 of squamous cell carcinoma of skin, 3 of undifferentiated pleomorphic sarcoma and 1 of mucinous adenocarcinoma. Nine patients had the first surgery and 14 were with tumour recurrence and had previousely received one or more surgery in other hospitals. The tumour size ranged from 2.0 cm×4.5 cm×1.0 cm to 10.0 cm×16.0 cm×3.0 cm. After radical resection, the sizes of surgical defect ranged from 9.0 cm×12.0 cm to 16.0 cm×22.0 cm. All the clavicular soft tissue malignancies had radical resection, and the secondary surgical defects were further modified to reduce the short and long dimensions of the defects. Flaps were selected according to the short dimension, depth and skin elasticity of the flap donor site. Of the 23 patients, 3 were treated with free inguinal flaps, 9 with ipsilateral pedicled latissimus dorsi flaps or thoracodorsal artery perforator flaps, 5 with free deep inferior epigastric artery perforator flap (DIEPF), 5 with free anterolateral thigh flap (ALTF) and 1 with free rectus abdominis flap. The modified defects sized 5.0 cm × 11.0 cm-12.0 cm×19.0 cm after the suture of margin and base of the defects (defects were reduced and modified). The flap sizes were 7.0 cm×13.0 cm-14.0 cm×23.0 cm. After surgery, the wound healing was observed through the visits of outpatient clinic, and telephone and WeChat interviews. According to the nature of the tumours, the patients were regularly reviewed at outpatient clinic to determine the local recurrence and metastasis of the tumour.Results:One pedicled latissimus dorsi myocutaneous flap was found with a greater tension after surgery. After partial removal of sutures and dressing changes, the secondary suture was performed 1 week later and the wound healed smoothly. A postoperative venous crisis was discovered in a free ALTF. It was monitored and re-anastomosed within 24 hours after surgery, and the flap survived and the wound healed smoothly. Otherwise, the rest of flaps achieved good blood supply and the wounds at the recipient and donor sites healed in one stage. In the postoperative follow-up, all flaps in the clavicular region were found good in appearance with no obvious swelling, and the donor sites healed well without scar contracture or dysfunction. One patient with a squamous cell carcinoma died of lung metastasis at 13 months after surgery. The rest of patients were found no tumour recurrence and had completed postoperative follow-up.Conclusion:After radical resection of malignant soft tissue tumours in the clavicular region, appropriate flaps were selected according to the size (short diameter) and depth of the modified defects, as well as the skin elasticity and relaxation of the flap donor site, hence to facilitate the direct suture of the flap donor site. It not only effectively reconstructs the surgical defect in clavicular region, but also minimises the damage to the flap donor site and achieves an aesthetic appearance at the flap donor site.

Objective: To explore the characteristics of overweight children s attention bias to food cues, so as to provide a theoretical basis for the behavior and life intervention of overweight children. Methods: From September to October 2017, 28 normal weight children and 28 overweight children in grades 3 to 4 of a primary school in Shenyang were screened by body mass index (BMI). The point detection paradigm was used to evaluate the attention bias of overweight children to food cues. Results: There was no significant difference between overweight children and control children in the score of attention bias to food cues [ F (1,52)=0.01, P> 0.05 , ηp 2 <0.01]; there was significant difference between overweight children and normal weight children in the score of facilitated attention to food cues[ F (1,52)=5.94, P<0.05, ηp 2 =0.10], normal weight children had higher score of facilitated attention to food cues than that of overweight children; there was significant difference between overweight children and normal weight children in the score of difficulty in disengaging to food cues[ F (1,52)=7.74, P<0.05, ηp 2 =0.13], overweight children had higher score of difficulty in disengaging to food cues than that of normal weight children. Conclusion Compared with normal weight children, overweight children didn t have higher attention bias to food cues; in the specific indicators of attention bias to food cues, normal weight children are more alert to food cues, while overweight children are more difficult to remove attention from food cues.

Objective:To study the antibacterial properties and in vivo and vitro biocompatibility of Cu-Fe-Zn alloy microfilament dressings, and to evaluate their wound healing promoting effect through clinical application.Methods:We evaluated the comprehensive antibacterial performance of dressings in vitro using plate counting method; After co culturing the extract of Cu-Fe-Zn alloy microfilament dressings with epidermal cells (HaCaT) and fibroblasts (NIH-3T3), their in-vitro biocompatibility was determined through the cell counting kit-8 (CCK-8) test; Further, Cu-Fe-Zn alloy microfilament dressing was applied to the wound surface of diabetes mice to test the biocompatibility of the material in vivo; Through a prospective randomized controlled trial, 50 burn and trauma patients admitted to the Burn and Plastic Surgery Department of the Third Xiangya Hospital of Central South University were selected and divided into an observation group of 25 patients and a control group of 25 patients. The observation group was treated with Cu-Fe-Zn alloy microfilament dressing, and the control group was treated with silver nanoparticle antibacterial dressing. The wound healing time and wound treatment effect of the two groups were compared.Results:The Cu 2+ release concentration of Cu-Fe-Zn alloy microfilament dressings detected by inductively coupled plasma-mass spectrometry (ICP-MS) was 1.3 μ g/ml, which had the effect of promoting the proliferation of HaCaT and NIH-3T3 cells (all P<0.05). The antibacterial rate of Cu-Fe-Zn alloy microfilament dressing against pseudomonas aeruginosa, escherichia coli and staphylococcus aureus reached 100%. The wound healing rate [(87.39±1.83)%] of diabetes mice treated with Cu-Fe-Zn alloy microfilament dressing was significantly higher than that of the control group [(58.66±3.54)%, P<0.05]. The inflammatory response of the wound tissue was relatively mild and the wound margin matrix was intact. The wound healing time of 25 patients treated with Cu-Fe-Zn alloy microfilament dressing [(23.52±10.02)d] was shorter than that of the control group [(40.84±21.22)d] ( t=17.159, P<0.001), and the overall treatment response rate of patients (96%) was significantly higher than that of the control group patients (64%) (χ 2=8.472, P=0.015). Conclusions:Cu-Fe-Zn alloy microfilament dressings have good antibacterial properties and biocompatibility, and have significant therapeutic effects on promoting wound healing. They not only effectively promote wound healing but also exert anti infection effects, and are expected to be a new type of wound repair dressing.

Objective: To construct the full-length prokaryotic expression plasmid of the wild type of androgen receptor (AR) and the truncated body of four functional domains，and to identify the fusion protein by Western blot and electrophoretic mobility shift assay ( EMSA) ． Methods: Based on the pGEX-4T-1 vector ，the recombinant plasmids were constructed to express the full-length and functional domains of AR. IPTG was used to induce the expression of the recombinant proteins，which were isolated and purified by glutathione sepharose 4B beads under the optimized condition．The specific protein expression in the bacterial lysate and the purified protein isolated with glutathione sepharose 4B beads was identified by Western blot with AR antibody and GST labeled antibody．The purified protein was incubated with a fluorescent probe of the virus，and the complex was detected by electrophoresis in a non-denaturing gel. Results : The prokaryotic recombinant plasmids of full length and three functional domain truncated AR were successfully constructed．The recombinant clones were identified by using bacterial culture as a template，and further verified by double enzyme digestion．It showed that there were identical bands in the same sizes as the inserted fragments．The nucleotide and the amino acid sequences were aligned to the reference sequence in NCBI GenBank．The GST fusion protein，GST-AR-NTD + DBD (96 ku) and GST-AR-NTD (86 ku) were successfully induced and verified． The purified protein could be directly combined with the viral genome DNA． Conclusion The prokaryotic expression conditions of truncated AR plasmid from the same gene sequence are different．The purified AR protein can be used to understand the direct interaction mechanism between functional domains of AR and other molecules.

OBJECTIVE To establish and optimize tablets adding mechanism of automatic tablet dispensing machine in the inpatient pharmacy, realize tablets checking and fine management for tablets inventory and expiration date in process of tablets adding, reduce incidence of errors, improve work efficiency, and ensure the safety of tablets use for patients. METHODS Intelligent software combined with barcode scanning technology was used to carry out intelligent intervention on the error-prone link in the process of tablets adding of automatic drug dispensing machine. The error ratio of tablets adding(%), average of daily tablets adding time(min), error ratio of tablets quantity in monthly inventory check(%) were compared before and after intelligent intervention. RESULTS Compared with before optimization, the error ratio of tablets adding decreased from 0.11 % to 0%, average of daily tablets adding time decreased from (96.50±21.84)min to (64.23±19.59)min(P<0.01), which saved 32.27 min on average, and error ratio of tablets quantity in monthly inventory check decreased from (9.42±1.13)% to (3.42±0.88)%(P<0.01) after optimizing the dosing process of the automatic drug dispensing machine. CONCLUSION The optimized process of tablets adding of automatic drug dispensing machine is simple and rapid to operate, which has high accuracy. The tablets inventory and expiration date can be tracked and managed in real time, which ensures the safety of tablets use for patients, promotes development of digital pharmacy management system, and improves quality of pharmaceutical care.

Crohn disease is prone to complications such as intestinal fibrosis, stenosis, and even intestinal obstruction, with limited treatment options and unsatisfactory results. Its pathogenesis involves genetic, immune, environmental, and gut microbiota aspects. Exploring early predictive factors for intestinal fibrosis stenosis in Crohn disease plays an important role in early disease prediction, disease assessment, treatment evaluation, and recurrence monitoring. This article provides a series of reviews on the current biomarkers of Crohn disease-related intestinal fibrosis.

Objective:This study aimed to investigate the clinical characteristics of patients diagnosed with primary hemophagocytic lymphohistiocytosis (pHLH) associated with perforin gene deficiency.Methods:We retrospectively analyzed the clinical data of 16 pHLH patients associated with perforin gene deficiency at Beijing Friendship Hospital, Capital Medical University, from April 2014 to August 2021. The mutation sites, mutation types, family history, clinical characteristics, and prognosis of the patients were assessed.Results:A total of 16 patients, including ten males and six females, with a median onset age of 17.5 years (range: 4-42 years), were enrolled in this study. Sixteen different mutations were identified, consisting of 11 missense mutations, one nonsense mutation, two frameshift mutations, and two in-frame mutations. All patients harbored at least one deleterious missense mutation, with the most common mutation sites being c.1349C>T (p.T450M) and c.503G>A (p.S168N). Decreased natural killer (NK) cell activity was observed in 11 patients, reduced perforin protein expression in ten patients, concurrent Epstein-Barr virus (EBV) infection at onset in eight patients, a family history in two patients, and central nervous system involvement in four patients. Eleven cases underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), with eight cases surviving. The median survival time of non-transplanted patients was eight months (range: 4-18 months), while that of transplanted patients was reported as "not reached".Conclusions:Emphasizing the diagnosis of pHLH in adults with perforin gene deficiency. In addition, it should be noted that EBV infection can potentially act as a triggering factor in such disease, and allo-HSCT exerts a substantial effect on the prognosis of patients.

ObjectiveBased on the antidepressant activity， the optimal ratio of Rehmanniae Radix and Lilii Bulbus in Baihe Dihuangtang was optimized and its possible mechanism was preliminarily explored. MethodA total of 100 male mice were randomly divided into normal group， model group， Rehmanniae Radix single decoction group， Lilii Bulbus single decoction group， and 5 different ratios of Baihe Dihuangtang group （Rehmanniae Radix-Lilii Bulbus 5∶6， 5∶5 ， 5∶4， 5∶3， 5∶2）， fluoxetine hydrochloride group. Except for the normal group， the remaining 9 groups were treated with chronic unpredictable mild stress method （CUMS） for 21 consecutive days to establish the depression mouse model.The Rehmanniae Radix single decoction group， Lilii Bulbus single decoction group and 5 different ratios of Baihe Dihuangtang group were administered with corresponding drugs at a dose of 2 g·kg^-1 respectively， and fluoxetine hydrochloride group was administered fluoxetine hydrochloride at a dose of 0.01 g·kg^-1， the normal group and the model group were respectively given an equal volume of normal saline by gavage for 21 consecutive days. The antidepressant effect of Baihe Dihuangtang with different ratios was evaluated by behavioral experiments. Western blot was used to detect the expression levels of brain-derived neurotrophic factor （BDNF） and tyrosine kinase receptor B （TrkB） in hippocampus. The level of total superoxide dismutase （SOD） in hippocampus was detected by hydroxylamine method. The level of reduced glutathione （GSH） in hippocampus was detected by spectrophotometric method. The levels of glutathione peroxidase （GPX） and glutathione S-transferase （GST） in hippocampus was detected by colorimetric method. The level of malondialdehyde （MDA） in hippocampus was detected by thiobarbituric acid method， and preliminary exploration of its antidepressant mechanism. ResultCUMS caused a significant decrease in the preference rate of sugar water and a significant prolongation of forced swimming and tail suspension immobility time （P<0.01）， while the different ratios of Baihe Dihuangtang and the single decoction of Rehmanniae Radix and Lilii Bulbus were significantly reversed to varying degrees. Abnormalities of the above indicators were observed （P<0.05， P<0.01）， especially when the ratio of 5∶6 had the most obvious effect on the above indicators， Moreover， CUMS caused the hippocampal BDNF and the expression of TrkB， SOD and glutathione antioxidant-related indexes were significantly decreased （P<0.01）， and the levels of lipid peroxidation product MDA was significantly increased （P<0.01）. However， the superior ratio of Baihe Dihuangtang （Rehmanniae Radix-Lilii Bulbus 5∶6， 5∶5， 5∶4） and the single decoction of Rehmanniae Radix and Lilii Bulbus significantly reversed the abnormality of the above indicators to varying degrees （P<0.05， P<0.01）. ConclusionIn summary， 5 different ratios of Baihe Dihuangtang and the single decoction of Rehmanniae Radix and Lilii Bulbus can produce antidepressant effect， especially when the ratio of 5∶6 had the most obvious effect on the above indicators， and the antidepressant effect gradually weakens with the proportion of Lilii Bulbus in the recipe decreases， and its mechanism may involve enhancing the nutritional level and antioxidant defense ability of hippocampal central nervous system.