Background The widespread use of herbicides has led to environmental contamination and has implications for human health. The liver is an important organ for the detoxification of environmental pollutants; however, studies on the association between herbicide exposure and liver function are limited. Objectives To investigate the association between baseline serum herbicide levels and changes in liver enzyme levels and liver enzyme abnormalities over a 5-year period in middle-aged and older adults. Methods This study was based on a nested case-control population of type 2 diabetes established in the Dongfeng-Tongji cohort, with a total of 1388 subjects included in this study and followed up for 5 years. Epidemiological data were collected through questionnaires, and baseline serum concentrations of three herbicides (metolachlor, propham, and acetochlor) were measured by gas chromatography-triple quadrupole mass spectrometry. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were detected at baseline and follow-up visits. The associations between baseline serum herbicide levels and changes in AST and ALT over 5 years were assessed using linear regression models with herbicide levels categorized into quartiles, adjusting for age, sex, education level, smoking status, drinking status, physical activity, body mass index, and new-onset type 2 diabetes occurred during follow-up. The relationship between baseline serum herbicide levels and the risk of liver enzyme abnormalities during follow-up was further analyzed using logistic regression models. Results The positive rates of metolachlor, propham, and acetochlor were all higher than 80%, and their spiked rates of recovery ranged from 73.46% to 106.77%. The mean ± standard deviation of the age of subjects at baseline was (62.7±7.6) years, with 34.1% being male. The median serum levels of metolachlor, propham, and acetochlor at baseline were 0.05, 0.16, and 0.03 ng·mL⁻¹, respectively. There was no significant difference in baseline serum herbicide levels between the normal and abnormal liver enzyme groups at follow-up (P >0.05). The baseline liver enzyme levels and the changes in AST and ALT over 5 years in those who developed abnormal liver enzymes were significantly higher than those in the normal liver enzyme group (P <0.05). The linear regression analysis showed that the changes in AST increased progressively over 5 years in the second, third, and fourth quartiles of propham compared to the lowest quartile group (the second quartile: b=1.49, 95%CI: 0.10, 2.87; the third quartile: b=1.52, 95%CI: 0.14, 2.90; the fourth quartile: b=1.69, 95%CI: 0.31, 3.08; P <0.05). The associations of serum metolachlor and acetochlor with changes in AST were not significant. Additionally, no significant relationships were found between the three serum herbicides and the changes in ALT over 5 years or the risk of liver enzyme abnormalities. Conclusion Serum propham levels in middle-aged and older adults are positively associated with changes in liver enzyme AST, which may have an effect on liver function. More studies are needed to provide scientific evidence for the association between herbicide exposure and liver function.

Objective:To investigate the clinical efficacy of reconstruction with the hallux tissue flap for the fingertip defects of thumb and fingers based on the concept and technique of full reconstruction.Methods:From September 2022 to February 2023, the patients with thumb and fingertip defects who were reconstructed using the concept and technology of full reconstruction in Xuzhou Renci Hospital were respective analysised. Based on the degree of defect in the nail bed, bone, and soft tissue of the hand, a hallux osteo-onychocutaneous flap or hallux nail flap was designed and harvested from the same side of the toe, and free transplantation was performed to reconstruct the damaged fingertip. The wounds in the donor site that could not be sutured primarily were treated with dressing change. The surgical complications, the appearance of the reconstructed finger and donor site, Semmes-Weinstein monofilament (SWM) examination, 2-point discrimination (2PD) measurement, and patient satisfaction were regularly recorded. According to the functional evaluation criteria for thumb and finger reconstruction issued by the Hand Surgery of the Chinese Medical Association, the function of the reconstructed fingers was evaluated as excellent (13-15 points), good (9-12 points), fair (5-8 points), and poor (≤4 points). The patients were investigated whether they were satisfied with the outcomes.Results:A total of 8 patients (9 fingers) including 5 males and 3 females were enrolled. The average age was 32.4 years (range, 22-46 years). There were 1 thumb, 2 index fingers, 5 middle fingers, and 1 ring finger. 7 cases (8 fingers) were repaired with the hallux osteo-onychocutaneous flap, and 1 case (1 finger) was repaired with the hallux nail flap. All the reconstructed fingers survived uneventfully, and the recipient site healed primarily, and the donor site healed after dressing change, without infection and other complications. All the 8 patients (9 fingers) were followed up for 3-7 months. The nail plate of the donor site naturally grew and recovered nearly normal. Depression formation was observed at part of the deck junction of the recipient site, and scars were left in the pulp and fibular side of the hallux. At the final follow-up, the reconstructed fingers recovered protective sensation and tactile sense, and the 2PD of the reconstructed fingers was 9 mm and 10 mm in two cases. The SWM score was 3.60-4.31, mean 3.96. The results were the monofilament specifications and indicating the protective sensation was diminished. Functional evaluation of reconstructed fingers: 9 fingers in 8 cases scored 13-14 points, all reaching an excellent level. All patients were satisfied with the surgical results.Conclusion:Based on the concept and technology of full reconstruction, the fingertip defects of the thumb and finger can recover close to normal with the hallux tissue flap in the short-term, while ensuring the overall shape and function of the hallux donor area, achieving a balance between the donor and recipient areas, and achieving satisfactory clinical results.

Objective:To investigate the clinical efficacy of reconstruction with the hallux tissue flap for the fingertip defects of thumb and fingers based on the concept and technique of full reconstruction.Methods:From September 2022 to February 2023, the patients with thumb and fingertip defects who were reconstructed using the concept and technology of full reconstruction in Xuzhou Renci Hospital were respective analysised. Based on the degree of defect in the nail bed, bone, and soft tissue of the hand, a hallux osteo-onychocutaneous flap or hallux nail flap was designed and harvested from the same side of the toe, and free transplantation was performed to reconstruct the damaged fingertip. The wounds in the donor site that could not be sutured primarily were treated with dressing change. The surgical complications, the appearance of the reconstructed finger and donor site, Semmes-Weinstein monofilament (SWM) examination, 2-point discrimination (2PD) measurement, and patient satisfaction were regularly recorded. According to the functional evaluation criteria for thumb and finger reconstruction issued by the Hand Surgery of the Chinese Medical Association, the function of the reconstructed fingers was evaluated as excellent (13-15 points), good (9-12 points), fair (5-8 points), and poor (≤4 points). The patients were investigated whether they were satisfied with the outcomes.Results:A total of 8 patients (9 fingers) including 5 males and 3 females were enrolled. The average age was 32.4 years (range, 22-46 years). There were 1 thumb, 2 index fingers, 5 middle fingers, and 1 ring finger. 7 cases (8 fingers) were repaired with the hallux osteo-onychocutaneous flap, and 1 case (1 finger) was repaired with the hallux nail flap. All the reconstructed fingers survived uneventfully, and the recipient site healed primarily, and the donor site healed after dressing change, without infection and other complications. All the 8 patients (9 fingers) were followed up for 3-7 months. The nail plate of the donor site naturally grew and recovered nearly normal. Depression formation was observed at part of the deck junction of the recipient site, and scars were left in the pulp and fibular side of the hallux. At the final follow-up, the reconstructed fingers recovered protective sensation and tactile sense, and the 2PD of the reconstructed fingers was 9 mm and 10 mm in two cases. The SWM score was 3.60-4.31, mean 3.96. The results were the monofilament specifications and indicating the protective sensation was diminished. Functional evaluation of reconstructed fingers: 9 fingers in 8 cases scored 13-14 points, all reaching an excellent level. All patients were satisfied with the surgical results.Conclusion:Based on the concept and technology of full reconstruction, the fingertip defects of the thumb and finger can recover close to normal with the hallux tissue flap in the short-term, while ensuring the overall shape and function of the hallux donor area, achieving a balance between the donor and recipient areas, and achieving satisfactory clinical results.

Objective:To evaluate the influence of ankle acupuncture on the cognitive impairment caused by sevoflurane in elderly rats and the expression of hippocampal phosphorylated phospholipase Cγ (p-PLCγ).Methods:Fifteen SPF-grade healthy male Sprague-Dawley rats, aged 18 months, weighing 530-600 g, were allocated into 3 groups ( n=5 each) using a random number table method: sham surgery group (S group), cognitive dysfunction group (CD group) and ankle acupuncture group (A group). The cognitive dysfunction model was prepared by inhaling the mixture of 3% sevoflurane and air, with ankle acupuncture applied to the right hind limb 1-3 region for 30 min prior to anesthesia in A group. S group received sham stimulation. Two days later, the cognitive function was assessed using the Morris water maze test. The rats were subsequently sacrificed and hippocampal tissues were collected for microscopic examination of the pathological changes (using HE staining and Nissl staining) and for determination of the expression of p-PLCγ, phosphorylated calcium/calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ) and phosphorylated inositol-1, 4, 5-trisphosphate receptor (p-IP3R). Results:Compared with S group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, and the expression of p-PLCγ, p-CaMKII and p-IP3R was up-regulated in CD group and A group ( P<0.05). Compared with CD group, the escape latency was significantly shortened, the number of crossing the original platform quadrant was increased, and the expression of p-PLCγ, p-CaMKII and p-IP3R was down-regulated in A group ( P<0.05). The pathological changes were significantly reduced in A group compared with CD group. Conclusions:Ankle acupuncture can ameliorate cognitive dysfunction induced by sevoflurane in elderly rats, and the mechanism is related to inhibition of hippocampal p-PLCγ expression.

Brain size abnormality is correlated with an increased frequency of autism spectrum disorder (ASD) in offspring. Genetic analysis indicates that heterozygous mutations of the WD repeat domain 62 (WDR62) are associated with ASD. However, biological evidence is still lacking. Our study showed that Wdr62 knockout (KO) led to reduced brain size with impaired learning and memory, as well as ASD-like behaviors in mice. Interestingly, Wdr62 Nex-cKO mice (depletion of WDR62 in differentiated neurons) had a largely normal brain size but with aberrant social interactions and repetitive behaviors. WDR62 regulated dendritic spinogenesis and excitatory synaptic transmission in cortical pyramidal neurons. Finally, we revealed that retinoic acid gavages significantly alleviated ASD-like behaviors in mice with WDR62 haploinsufficiency, probably by complementing the expression of ASD and synapse-related genes. Our findings provide a new perspective on the relationship between the microcephaly gene WDR62 and ASD etiology that will benefit clinical diagnosis and intervention of ASD.
Mice ; Animals ; Microcephaly/genetics* ; Autistic Disorder/metabolism* ; Autism Spectrum Disorder/metabolism* ; Nerve Tissue Proteins/metabolism* ; Brain/metabolism* ; Mice, Knockout ; Cell Cycle Proteins/metabolism*

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Background: Red blood cell distribution width/platelet count ratio (RPR) is a reliable prognostic assessment indicator for numerous diseases. However, no studies to date have examined the relationship between RPR and the prognosis of diffuse large B-cell lymphoma (DLBCL).Therefore, this study aimed to investigate the correlation between RPR and the clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma. Methods: We retrospectively studied 143 patients with newly diagnosed DLBCL and used the median value as the RPR threshold. We also investigated the correlation of pretreatment RPR level with clinical characteristics and its impact on DLBCL prognosis. Results: Using the median value as the cut-off, patients with DLBCL were divided into a low RPR group (＜0.0549) and a high RPR group (≥0.0549). Patients in the high RPR group were older, had a later Ann Arbor stage, were prone to bone marrow invasion, and had a higher National Comprehensive Cancer Network International Prognostic Index score (P ＜ 0.05). A survival analysis showed that progression-free survival (PFS) (P =0.003) and overall survival (OS) (P ＜0.0001) were significantly shorter in the high versus low RPR group. A multifactorial Cox analysis showed that bone marrow invasion and elevated lactate dehydrogenase (LDH) were separate risk factors for PFS (P ＜0.05), while an RPR ≥0.0549 and elevated LDH were separate risk factors for OS (P ＜0.05). Conclusion A high RPR (≥0.0549) in patients with newly diagnosed DLBCL is an independent risk factor for a poor prognosis.

Because of the complex buildings, the wind flow and the pollution diffusion will be affected in the microscale such as urban neighborhood or the site of facility, the straight Gaussian plume model will not be available. Based on the Reynolds-Averaged Naiver-Stokes(RANS) method which was used to calculate the wind field with the Lagrange particle random walking model, the radioactive pollution diffusion model and microscale radiation environmental impact assessment software system were developed. This system can be used in the factory or city streets and other similar conditions for simulating radioactive pollutants diffusion behavior. The development of the system will provide technical tools for the microscale radiation environmental impact assessment in the future.

Objective:To investigate the clinical efficacy of robotic navigation and percutaneous internal fixation in the treatment of fresh undisplaced scaphoid lumbar fractures.Methods:From November 2019 to October 2020, 8 patients were treated at Department of Hand Surgery, Xuzhou Renci Hospital for fresh undisplaced scaphoid lumbar fractures. There were 7 males and one female with an average age of 27.5 years (from 18 to 42 years), and 5 left and 3 right cases. Navigation by a Tianji orthopedic robot was conducted to decide the positions for implantation of percutaneous Herbert screws to fixate the fractures. The bone healing was followed up by regular X-ray and CT examinations. The functional recovery was evaluated by Mayo wrist score, grip strength, pinch strength and wrist range of motion, and the wrist pain was evaluated by visual analogue scale (VAS).Results:All the 8 patients were followed up for a mean time of 12.8 months (from 6 to 19 months). All the wounds healed by the first intention without any inflammation or infection. CT examination at 3 months postoperation found that all the fracture ends got united. At the final follow-up, the average active motions of the injured wrist were: 67.9° in flexion, 64.1° in extension, 21.2° in radial deviation and 52.2° in unlar deviation, respectively. The average grip strength was recovered to 31.3 kg, reaching up to 85.2% (from 66.7% to 100.0%) of the contralateral wrist; the average pinch force was recovered to 19.5 kg, reaching up to 89.3% (from 77.8% to 100.0%) of the contralateral wrist. At the last follow-up, the Mayo wrist function scores averaged 97.5 (from 95 to 100) and all the 8 cases were excellent. The VAS pain score of the wrist averaged 0.88 (from 0 to 2).Conclusion:In the treatment of fresh undisplaced scaphoid lumbar fractures, navigation with a Tianji orthopedic robot can be used to visualize percutaneous minimally invasive screw fixation so that accurate positioning and precise screw placement are ensured, leading to rapid rehabilitation.