Objective:To explore the clinical application of three-dimensional CT angiography (3D-CTA) in repair of limb wounds with free lateral thoracic perforator flaps.Methods:A retrospective study was conducted to analyze the clinical data of 61 patients with limb soft tissue defects who had been treated at The Third Department of Orthopedics, Xingtai General Hospital of North China Medical and Health Group from January 2018 to September 2022. There were 37 males and 24 females with an age of (43.9±12.0) years. Thirty-three left and 28 right sides were injured. Soft tissue defects ranged from 4.0 cm × 3.0 cm to 17.0 cm × 8.0 cm, and flap areas from 5.0 cm × 4.0 cm to 18.0 cm × 9.0 cm. The patients were divided into 2 groups according to the different preoperative vascular exploration methods: an ultrasound group of 30 cases subjected to ultrasound Doppler examination and a 3D-CTA group of 31 cases subjected to 3D-CTA examination. The preoperative findings were compared with those of intraoperative exploration in the 2 groups. The operation time, flap survival rate, patient satisfaction with trauma repair, sensory recovery of the flap area, and the excellent and good rate of the donor area were also compared between the 2 groups.Results:The differences in preoperative general data between the 2 groups were not statistically significant, indicating the 2 groups were comparable ( P>0.05). In the ultrasound group, the inraoperative classification of the lateral thoracic perforator flaps showed a low concordance with preoperative classification (Kappa coefficient of 0.104, P=0.088). In the 3D-CTA group, the classification of lateral thoracic perforator flaps was consistent with the preoperative 3D-CTA examination (Kappa coefficient of 1.00, P<0.001). The preoperative measurements in the 3D-CTA group found that the diameter at the origin of the lateral thoracic artery was (1.2±0.3) mm, the vascular pedicle length (8.1±2.1) cm, and the diameter at the perforator exit (0.6±0.2) mm; the preoperative surface positioning at the perforator exit found that the perforator exit was (1.6±0.3) cm above the horizontal line of the subscapular angle and (5.3±1.4) cm outside the vertical line of the subscapular angle. These measurements were similar to the intraoperative ones [(1.1±0.3) mm, (8.3±2.4) cm, (0.7±0.2) mm, (1.5±0.4) cm, and (5.2±1.5) cm], showing no significant differences ( P>0.05). In contrast, the preoperative measurements of the above indexes in the ultrasound group did not coincide with the actual intraoperative measurements, and the differences were all statistically significant ( P<0.05). The operation time, flap survival rate, rate of patient satisfaction with wound repair, rate of sensory recovery in the flap area, and the excellence and good rate of the donor area in the 3D-CTA group were (52.9±16.7) min, 100.0% (31/31), 96.8% (30/31), 83.9% (26/31), and 87.1% (27/31), respectively, which were significantly better than those in the ultrasound group [(76.3±21.4) min, 86.7% (26/30), 76.7% (23/30), 60.0% (18/30), 63.3% (20/30)] ( P<0.05). Conclusions:As preoperative 3D-CTA examination can clarify the types and anatomical characteristics of the lateral thoracic artery and its perforators, it helps the design and harvest of the lateral thoracic perforator flaps. Compared with the ultrasound Doppler examination, preoperative 3D-CTA examination shortens operation time, raises survival rate of the flaps, and facilitates recovery of the appearance and function of the limb wounds, and leads to little impact on the donor site.

The S100 protein family is a key component of damage-associated molecular patterns(DAMP), which play a vital role in regulating inflammation in the body's innate immune response. S100A8/S100A9 proteins play a wide range of antibacterial and anti-infective functions in many diseases, and promote the occurrence and development of the body's immune and inflammatory responses. In various retinal degenerative diseases, S100A8/S100A9 proteins are significantly upregulated at the transcription and translation stages, promoting the activation of inflammatory factors in ocular tissues, the activation and recruitment of immune cells such as macrophages and neutrophils, and the occurrence and development of ocular inflammation. This review aimsat explaining the biological functions of S100A8/S100A9 proteins and their roles and possible mechanisms in retinal degenerative diseases such as diabetic retinopathy, age-related macular degeneration and ischemic retinopathy.

Objective:To explore the cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound.Methods:This study was a retrospective historical control study. From February 2017 to October 2019, 20 patients who were admitted to the Third Department of Orthopedics of Xingtai General Hospital of North China Medical and Health Group (hereinafter referred to as our department), met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested based on the surgeon's clinical experience were selected as control group, including 16 males and 4 females, aged (37±5) years. From November 2019 to December 2022, 21 patients who were admitted to our department, met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested under the assistance of color Doppler ultrasound were selected as ultrasound-assisted group, including 15 males and 6 females, aged (38±6) years. After debridement, the area of skin and soft tissue defects of extremities ranged 5.0 cm×4.0 cm to 19.0 cm×8.0 cm, and the area of thoracodorsal artery perforator flaps ranged 6.0 cm×5.0 cm to 20.0 cm×9.0 cm. The wounds in flap donor sites were closed directly. For patients in ultrasound-assisted group, the time and cost required for color Doppler ultrasound examination were recorded, and the number, type, and location of thoracodorsal artery perforator vessels detected by preoperative color Doppler ultrasound were compared with those of intraoperative actual detection. The time required for complete flap harvest of patients in 2 groups was recorded. On postoperative day (POD) 1, 3, 5, 7, and 14, the blood perfusion of flaps in the 2 groups of patients was assessed using a flap perfusion assessment scale. On POD 14, flap survival of patients in 2 groups was observed, and the percentage of flap survival area was calculated. In postoperative 6 months, satisfaction of patients with the treatment outcome in the 2 groups was assessed using 5-grade Likert scale, and the satisfaction rate was calculated.Results:For patients in ultrasound-assisted group, the time required for preoperative color Doppler ultrasound examination was (10.5±2.3) min, and the cost was 120 yuan; 21 thoracodorsal artery perforator vessels were detected and marked using preoperative color Doppler ultrasound, including 8 (38.10%) type 1 perforator vessels, 10 (47.62%) type 2 perforator vessels, and 3 (14.29%) type 3 perforator vessels; the number, type, and location of thoracodorsal artery perforator vessels detected preoperatively were consistent with those detected intraoperatively. The time required for complete flap harvest of patients in ultrasound-assisted group was (41±10) min, which was significantly shorter than (63±12) min in control group ( t=6.32, P<0.05). On POD 1, 3, 5, 7, and 14, the blood perfusion scores of flaps of patients in ultrasound-assisted group were significantly better than those in control group (with t values of 6.67, 7.48, 8.03, 8.75, and 7.99, respectively P<0.05). On POD 14, only one patient in ultrasound-assisted group had partial flap necrosis and 6 patients in control group had complete or partial necrosis of the flap; the percentage of flap survival area of patients in ultrasound-assisted group was (99±8)%, which was significantly higher than (87±8)% in control group ( t=4.57, P<0.05). In postoperative 6 months, there was no significant difference in the satisfaction rate of patients with the treatment outcome between the two groups ( P>0.05). Conclusions:Preoperative color Doppler ultrasound is highly accurate in detecting the number, type, and location of perforator vessels. The cutting scheme of ultrathin thoracodorsal artery perforator flaps can be designed according to the different types of perforator vessels, with shorted flap cutting time and improved flap survival rate.

Objective To explore the diagnostic value of acetic acid indigocarmine mixture(AIM)sandwich staining combined with flexile spectral imaging color enhancement(FICE)technology for colonoscopic Pit pattern classification for colorectal lesions.Methods 100 patients with colorectal lesions from June 2022 to October 2023 were selected as the research subjects,and 222 lesions;Patients were examined using conventional endoscopy,FICE,AIM sandwich staining+FICE,and the detection status and pathological type of Pit pattern classification were recorded.Calculate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Pit pattern classification diagnosis under different modes.Kappa was used to evaluate the consistency between Pit pattern classification and pathological examination under different modes.Evaluate diagnostic effectiveness using receiver operator characteristic curve(ROC curve).Results Compared with ordinary endoscopy(74.32％),FICE technology(92.34％)and AIM staining+FICE(97.30％)detected more lesions that matched the pathological results through Pit pattern classification,and AIM sandwich staining+FICE detected more than FICE,the differences were statistically significant(P＜0.05).Compared with ordinary endoscopy,the diagnostic accuracy of FICE and AIM staining+FICE for colorectal carcinoma lesions were higher,and AIM sandwich staining+FICE higher than FICE,the differences were statistically significant(P＜0.05).Compared with ordinary endoscopy,the diagnostic accuracy of FICE and AIM sandwich staining+FICE for early colorectal cancer were higher,the differences were statistically significant(P＜0.05).The area under the curve(AUC)predicted by ordinary endoscopy,FICE and AIM sandwich staining+FICE for colorectal carcinoma lesions were 0.815(95％CI:0.711～0.859),0.881(95％CI:0.752～0.904),and 0.933(95％CI:0.793～0.961),respectively;The AUC predicted by ordinary endoscopy,FICE and AIM sandwich staining+FICE for early colorectal cancer were 0.850(95％CI:0.720～0.866),0.938(95％CI:0.764～0.951),and 0.947(95％CI:0.803～0.972),respectively.For predicting colorectal carcinoma lesions and early colorectal cancer,the Youden index of AIM staining+FICE technology was the highest,with values of 0.955 and 0.968,respectively.Conclusion Under AIM sandwich staining+FICE,Pit pattern classification can detect more carcinoma lesions and early colorectal cancer,with high diagnostic accuracy and effective improvement of endoscopic diagnosis and treatment quality.

Social anxiety disorder has a significant negative impact on individuals'social interaction and normal life,and childhood trauma plays an important role in the occurrence and development of SAD.Childhood trauma affects the development of self-awareness,impairs the ability of information processing,hinders the normal development of prefrontal cortex-limbic system loop and default mode network,and causes abnormal secretion of glucocorticoid and oxytocin,which leads to individuals'inability to correctly understand social clues and reasonably regulate emotions,and thus unable to produce adaptive emotional and behavioral responses in social situations,which may lead to SAD.In conclusion,childhood trauma has a lasting adverse effect on social function from both psychological and physiological aspects.

Objective To explore the research hotspots on systemic lupus erythematosus(SLE)in pregnancy based on the bibliometric analysis of the related articles published from 2018 to 2023 and provide di-rections for the future research in this field.Methods PubMed,Web of Science,and Embase were searched for the articles on SLE in pregnancy that were published from January 1,2018 to December 31,2023.VOSviewer was used to visualize the high-frequency keywords in the selected articles.Results A total of 266 articles were selected,from which 25 high-frequency keywords were extracted.The bibliometric analysis showed that the available studies about SLE in pregnancy mainly focused on maternal complications,maternal and fetal outcomes,and medica-tions.The studies were limited regarding the predictors,autoimmunity,immunotherapy,and long-term outcomes of offspring.Conclusion Maternal complications,maternal and fetal outcomes,and medications are currently hotspots in the research on SLE in pregnancy,while predictors,autoimmunity,immunotherapy,and long-term outcomes of offspring may become future research directions.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.

Objective Based on the comparison and analysis of Raman spectra of liver meridian(including other meridian)and non-liver meridian(other meridian excluding liver meridian)traditional Chinese medicine,the accurate quantitative characterization data of liver meridian was obtained,and the liver meridian identification model was established and analyzed.Methods Taking 120 non-liver meridian(other meridian excluding liver meridian)traditional Chinese medicines(TCMs)as blank control and 120 liver-meridian(including other meridian)TCMs as experimental medicines,Raman spectra of 240 TCMs were obtained after sample pretreatment and Raman spectroscopy detection,and then quantified in units of 1 cm-1.Then combined with Random Forest(Random Forest,RF),Artificial Neural Network(Artificial Neural Network,ANN)and other algorithms,we constructed the identification models of quantized characterization of liver meridian.Results Compared with non-liver meridian(other meridian excluding liver meridian)TCMs,the Raman spectra of the liver meridian TCM were generally lower in the whole detection range,especially in the range of 200-1100 cm-1.The quantized Raman spectrogram data combined with ANN presented the best discrimination results with accuracy,precision>0.871,the receiver operating characteristic curve(ROC)was drawn and the area under ROC curve(AUC)was obtained,with AUC>0.921.Conclusion The Raman spectrogram of TCMs has significant correlation with liver meridian,which can be used as a whole quantized characterization of liver meridian.Combined with ANN,Raman spectrogram can carry out identification analysis efficiently and accurately,which is conducive to solving the bottleneck problem of lacking accurate data on medicinal properties and enriching the scientific connotation of attributing meridians.

In this study, the effects of two plant growth-promoting bacteria Klebsiella michiganensis TS8 and Lelliottia Jeotgali MR2 on the growth and cadmium (Cd) uptake of Arabidopsis thaliana under Cd stress were explored. A wild-type Arabidopsis thaliana was selected as the experimental plant and was planted at different Cd concentrations. MR2 and TS8 bacterial suspensions were sprayed onto the rhizospheric soil during the planting process. The initial Cd concentration of the bought soil was 14.17 mg/kg, which was used as the pot soil of the low-concentration Cd treatment group (LC). The concentration of soil Cd at high-concentration Cd treatment group (HC) were 200 mg/kg higher than that at LC group. Compared with the control group, MR2 suspension significantly promoted the growth of A. thaliana at both low and high concentrations, while TS8 strain and MR2_TS8 mixture only exhibited growth-promoting effect at high concentration. However, it was noteworthy that, TS8 suspension significantly reduced the Cd content in the underground parts of A. thaliana (60% and 59%), and significantly improved the Cd content in the aboveground parts of A. thaliana (234% and 35%) at both low and high concentrations. In addition, at low concentration, both single strain and mixed strains significantly improved the transformation from reducible Cd to acid-extractable Cd in soil, promoted Cd intake, and thereby reduced the total Cd content in soil. Therefore, the rational application of plant growth-promoting bacteria may improve crop yield and remediate Cd contamination in soil.
Arabidopsis ; Bacteria ; Biodegradation, Environmental ; Cadmium/pharmacology* ; Enterobacteriaceae ; Klebsiella ; Plant Roots/chemistry* ; Soil ; Soil Pollutants