This study provides a comprehensive review of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging, encompassing its fundamental principles, clinical applications, contemporary research, and future prospects for clinical translation. The section on foundational theory discusses the underlying physical mechanisms, the use of radiopharmaceuticals, and the technological evolution of imaging systems. Clinical applications are thoroughly examined across the three primary domains: cardiovascular, neurological, and oncological pathologies. Despite considerable advancements, persistent challenges remain in optimizing radiation doses, improving diagnostic accuracy, and achieving cost-effective implementation. Additionally, this review highlights the emerging potential of novel radiotracers for SPECT/CT imaging and explores its transformative role in radioligand-based theranostics and personalized medicine. By synthesizing current research, this review aims to serve as a comprehensive reference to guide future technological innovations and clinical applications of SPECT/CT imaging.

Fire-, heat-, and hot substance-related injuries represent a significant global health burden but are often understudied. Previous research has typically focused on macro-level trends, neglecting the underlying causes of these changes. Our study addresses this gap by using advanced methodologies, particularly focusing on regional disease trends during the 2019 to 2021 pandemic period, and proposes targeted interventions based on these insights. Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized incidence (ASIR), prevalence, mortality, and Disability-Adjusted Life Years attributed to fire, heat, and hot substances. Trends were quantified via estimated annual percentage change, while risk factors, decomposition analysis, and health inequalities were assessed. Future burden from 2022 to 2050 was projected using a Bayesian age-period-cohort model. In 2021, fire, heat, and hot substances caused an estimated 9198,164 incident cases globally (95% uncertainty interval (UI): 7592, 028-10,784,350), with an ASIR of 118.82 per 100,000 population (95% UI: 97.49-139.41), showing a decline from 1990 levels. However, the rate of decline slowed significantly between 2019 and 2021. Southern Latin America had the highest regional ASIR (484.32; 95% UI: 401.38-560.57), while Lesotho saw the greatest ASIR increase (EAPC = 0.70%). Health inequities worsened between 2019 and 2021 (-155.2892-28.0021), with the disease burden shifting towards lower Socio-demographic Index regions. Epidemiological changes contributed 573.43% to the global decrease in incidence. Occupational injuries were the leading risk factor. Projections suggest that from 2021 to 2050, the ASIR will decrease by 41.77%, while prevalence cases will increase slightly by 12.53%. While the overall epidemiological trends of fire-, heat-, and hot substance-related injuries remain favorable, the observed plateau in nonfatal burden reduction during 2019 to 2021 underscores the need for more comprehensive and targeted healthcare policies. Moving forward, public health strategies must adopt an integrated "education-prevention-treatment" approach that specifically targets 3 high-risk groups: Children aged 0 to 14 years (developmental vulnerability); Older adults (age-related physiological risks); Populations in low-SDI regions (health system limitations). This demographic-specific framework will be essential for addressing the evolving epidemiology of thermal injuries in the coming decades.

Burns impose a substantial global health burden, prompting the World Health Organization to develop its 2008 plan for burn prevention and care, which emphasizes the need for accurate epidemiological data to guide resource allocation across prevention, acute care, and rehabilitation. Using GBD 2021 data, we analyzed age-standardized incidence, prevalence, and years-lived-with-disability rates for burns. Trends were assessed via estimated annual percentage changes (EAPC) and joinpoint regression. We also performed decomposition, frontier, and health inequality analyses, and used an autoregressive integrated moving average (ARIMA) model to project future trends. In 2021, approximately 15 million new burn cases occurred globally. The age-standardized incidence rate (ASIR) declined more rapidly after 2008 (Annual Percentage Change = -1.82) than before. A significant inverse correlation was observed between the disability rate (ASYR) and Socio-demographic Index (SDI) (ρ = -0.11), alongside widening health inequity. Projections indicate a 26.2% global ASIR decrease by 2036, with modest declines in both Low- and High-SDI regions. The decline in burn burden accelerated after 2008, yet its benefits remain inequitably distributed, underscoring the need for nursing-led interventions.

AIM:This study aimed to explore the efficacy of anterolateral thigh perforator (ALTP) flap and peroneal artery perforator (PAP) flap transplantation and their influence on levels of pain and wound growth factors in elderly patients with soft tissue defects caused by foot trauma. METHODS:A total of 98 elderly patients with foot trauma who underwent flap transplantation in the hospital from January 2022 to January 2024 were collected and analyzed retrospectively. Patients were divided into the ALTP group (n = 45, receiving ALTP flap transplantation) and the PAP group (n = 53, receiving PAP flap transplantation). Visual analogue scale (VAS) and American orthopedic foot and ankle society (AOFAS) score were used to assess the pain and functional outcome. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to test the levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hypoxia inducible factor 1 (HIF-1) in wound fluid. RESULTS:The wound size in the ALTP group was larger than that in the PAP group (p < 0.001). Longer operative time, hospitalization time and greater intraoperative blood loss were noted in the ALTP group than in the PAP group (p < 0.001). Linear regression analysis showed that the surgical method was the main factor affecting operative time, hospitalization time and intraoperative blood loss (p < 0.001). The necrosis rate in the ALTP group (13.33%) was higher than that in the PAP group (3.77%), but the difference was not statistically significant (p = 0.176). Compared with the ALTP group, the VAS score of the PAP group was markedly reduced at 3 days and 1 week after surgery, and 1 month after follow-up (p < 0.001). 3 days after surgery, the levels of VEGF and bFGF of the PAP group were significantly increased compared with the ALTP group (p < 0.001). 1 week after surgery, the levels of bFGF of the PAP group were higher compared with the ALTP group (p = 0.003). The total incidence rate of complications in the ALTP group (25/44, 56.82%) was significantly higher than that in the PAP group (7/53, 13.21%) (p < 0.001). And multivariate logistic regression analysis showed that ALTP was the independent influencing factors for complications (p < 0.001). At 6 months after surgery, there was no significant difference in AOFAS scores between the two groups (p = 0.078). CONCLUSIONS:ALTP and PAP flap transplantation were both suitable for the reconstruction of soft tissue defects caused by foot trauma in elderly patients, with the latter associated with shorter surgical time and hospitalization time, as well as better wound healing, less postoperative pain and fewer complications.

Background:Snakebite-induced organ dysfunction emerging as the primary determinant of morbidity and mortality. This study aims to explore the prognostic value of red blood cell distribution width (RDW) to platelet ratio (RPR) on multi-organ dysfunction (MODS) in patients with snake bites. Methods:A retrospective study included 637 patients with snakebite between 2015 and 2020 from two hospitals in Anhui province, China. Data were collected at two time points: on the 1st-day and the 5th-day after treatment. All patients were divided into two groups according to the presence or absence of MODS. T-tests, chi-square tests, and univariate and multivariate logistical analyses were used to identify the prognostic factors for the development of MODS. Results:56 (8.8%) patients developed MODS following snakebite. Logistics analyses indicated that from being bitten at the hospital, the 1st-day of red blood cell distribution width-to-platelet ratio (RPR) and creatinine (CR) levels, and the 5th-day of aspartate aminotransferase (AST) were significantly associated with the development of MODS. The sensitivity and the specificity of the 1st-day RPR were calculated by the received operating characteristic curve (AUC=0.720, 95% CI, 0.642-0.798). The 1st day RPR=0.110 and the 5th day RPR=0.085. Conclusion:The study found that the RPR is an independent risk factor for predicting multi-organ dysfunction in patients with snake bites. The 1st-day RPR >0.110 is prone to be a new independent predictive factor for the development of MODS after snakebite.

Objective:The recurrence rate of post-tuberculosis chronic pulmonary aspergillosis (post-TB CPA) is alarmingly high. This study aims to establish a risk prediction model utilizing machine learning algorithms to forecast the one-year recurrence risk of post-TB CPA. Methods:This retrospective study included all patients diagnosed with pulmonary tuberculosis complicated by chronic pulmonary aspergillosis at Wuhan Pulmonary Hospital in 2022. Ultimately, 220 patients were included for the significance analysis.The Least Absolute Shrinkage and Selection Operator LASSO regression analysis was utilized to select 8 variables associated with the recurrence of tuberculosis complicated by chronic pulmonary aspergillosis. Four machine learning algorithms were compared to predict the recurrence risk in patients with this complication, with their performance evaluated using the receiver operating characteristic curve, area under the curve (AUC), calibration curve analysis, and decision curve analysis. Results:LASSO regression analysis identified chronic obstructive pulmonary disease (COPD), chronic fibrotic pulmonary aspergillosis (CFPA), progressive pleural hypertrophy, fungal culture results, age, disease duration, emphysema and treatment duration as factors related to the recurrence risk of tuberculosis complicated by chronic pulmonary aspergillosis. The logistic regression model demonstrated the best performance, it outperformed the other three models by achieving the highest AUC of 0.779 on the internal validation set and 0.819 in the test cohort. The calibration curve indicated a strong correlation between the actual and predicted probabilities, while the decision curve analysis revealed significant clinical benefits. Discussion:In this study, we developed a disease recurrence prediction model using machine learning techniques. This model aims to assist clinicians in identifying the most relevant risk factors associated with the recurrence of tuberculosis complicated by chronic pulmonary aspergillus. It facilitates the formulation of targeted and effective re-examination plans for discharged patients, ultimately reducing the recurrence rate after discharge and enhancing the quality of life for these patients.

Chronic wound treatment poses a substantial challenge to healthcare systems. Certain herbal medicines have demonstrated clinical efficacy in promoting chronic wound healing, yet their therapeutic mechanisms at the molecular level remain elusive due to their complex composition and multifaceted nature. In this study, Ba-Hao ointment (BHO), a sophisticated herbal formulation with diverse ingredients, is selected as a model to precisely investigate its wound-healing mechanism. Network pharmacology analysis and molecular docking simulations reveal that BHO specifically interacts with key wound-healing proteins, including vascular endothelial growth factor A (VEGFA), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β), suggesting its ability to modulate critical biological pathways involved in inflammation and tissue regeneration. Experimental validation further demonstrates that BHO significantly promotes cell proliferation, suppresses bacterial infection, and enhances the expression of essential growth factors such as epidermal growth factor (EGF) and VEGFA in normal human dermal fibroblasts (NHDF), all of which are vital for effective wound healing. In vivo studies confirm that BHO accelerates wound closure, reduces inflammation, and promotes the development of well-organized granulation tissue via activation of the PI3K-Akt signaling pathway. This study is interesting since it unveils BHO's molecular role in chronic wound healing, furthering herbal medicine development and insights.

OBJECTIVE:To investigate the feasibility and prognostic implications of assessing volume status during early fluid resuscitation in septic patients based on estimated plasma volume status (ePVS). METHODS:A prospective study was conducted. Patients with sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of Kunming Medical University from March to December in 2023 were enrolled. The general information and laboratory indicators at ICU admission were recorded, and ePVS, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation II (APACHE II) score were calculated. The vital signs, arterial blood gas analysis and volume status related indicators before liquid resuscitation (T0h) and 3 hours (T3h) and 6 hours (T6h) of fluid resuscitation were recorded. The diameter and variability of the inferior vena cava (IVC) were measured by ultrasound, and ePVS, percentage change value of estimated plasma volume status (ΔePVS%), difference in central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO2), and lactate clearance rate (LCR) were calculated. Patients were divided into sepsis group and septic shock group based on the diagnosis at ICU admission, and septic patients were subdivided into survival group and death group based on their 28-day survival status. The differences in clinical data between the groups were compared. The correlation between ePVS or ΔePVS% and volume status related indicators during early liquid resuscitation was analyzed by Spearman rank sum correlation test. The predictive value of each variable for 28-day survival in patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve), and 28-day death risk factors were analyzed by Logistic regression method. RESULTS:Fifty-four septic patients were enrolled in the final analysis, including 17 with sepsis and 37 with septic shock; 34 survived at 28 days and 20 died, with a 28-day survival rate of 63.0%. Compared with the sepsis group, the septic shock group had a lower venous ePVS at ICU admission [dL/g: 4.96 (3.67, 7.15) vs. 7.55 (4.36, 10.07), P < 0.05]. Compared with the death group, the survival group had higher T6h arterial and venous ΔePVS%, and albumin [Alb; T6h arterial ΔePVS% (%): 11.57% (-1.82%, 31.35%) vs. 0.48% (-5.67%, 6.02%), T6h venous ΔePVS%: 9.62% (3.59%, 25.75%) vs. 1.52% (-9.65%, 7.72%), Alb (g/L): 27.57±4.15 vs. 23.77±6.97, all P < 0.05], lower SOFA score, APACHE II score, AST, T0h Lac, and T3h and T6h norepinephrine dosage [SOFA score: 9.00 (8.00, 10.00) vs. 11.50 (9.25, 14.50), APACHE II score: 18.00 (14.75, 21.25) vs. 25.50 (21.00, 30.00), AST (U/L): 34.09 (23.20, 56.64) vs. 79.24 (25.34, 196.59), T0h Lac (mmol/L): 1.75 (1.40, 2.93) vs. 3.25 (2.33, 5.30), norepinephrine dosage (mg): 0.98 (< 0.01, 3.10) vs. 4.60 (1.05, 8.55) at T3h, 1.82 (0.38, 5.30) vs. 8.20 (2.80, 17.73) at T6h, all P < 0.05]. While there were no significantly differences in other basic data and ePVS at all of the time points before and after resuscitation between the two groups. Correlation analysis showed that T6h venous ePVS was significantly positively correlated with T6h IVC variability in septic patients (r = 0.360, P < 0.05), T0h arterial ePVS was significantly negatively correlated with T3h and T6h liquid intake volume (r1 = -0.367, r2 = -0.280, both P < 0.05), and venous ePVS at ICU admission was significantly positively correlated with NT-proBNP at ICU admission (r = 0.409, P < 0.05). T6h venous ΔePVS% was significantly positively correlated with T3h liquid intake volume and T6h LCR (r1 = 0.286, r2 = 0.286, both P < 0.05), and significantly negatively correlated with T6h urine volume and T6h change value of Pcv-aCO2 (ΔPcv-aCO2; r1 = -0.321, r2 = -0.371, both P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of T6h venous ΔePVS% for predicting 28-day survival in septic patients was 0.726 [95% confidence interval (95%CI) was 0.578-0.875, P = 0.006], with a sensitivity of 82.4%, a specificity of 60.0%, and an optimal cut-off value of 3.09%. Binary multifactorial Logistic regression analysis showed that an increase in T6h venous ΔePVS% was a protective factor for 28-day death in patients with sepsis on early fluid resuscitation [odds ratio (OR) = 0.900, 95%CI was 0.834-0.972, P = 0.007]. CONCLUSIONS:ePVS may have potential for assessing the volume status of septic patients during early fluid resuscitation. The ΔePVS% during early fluid resuscitation may help to identify septic patients with a poor prognosis.

AbstractBackground and AimsTo assess patient comfort, wound healing, and scarring at the 6‐month follow‐up of split‐skin graft donor sites treated with Ba‐Hao burn ointment (BHBO) gauze, a compound preparation of traditional Chinese medicine since 1970s, compared with petrolatum gauze.MethodsThirty patients admitted to the Department of Burns of the First Affiliated Hospital of Anhui Medical University between September 2021 and September 2022 participated in this randomized, prospective, self‐control clinical study. After harvesting the split skin, donor sites were divided into two parts along the midline. BHBO gauze was applied to half of the donor wounds, and petrolatum gauze was applied to the other half. The wound healing time, pain scores on the postoperative Days 3, 6, and 9, and Vancouver Scar Scale (VSS) score at the 6‐month follow‐up were assessed.ResultsThe wound healing time was significantly shorter in the BHBO group than in the control group (10.07 ± 1.48 days vs. 11.50 ± 1.74 days, p < 0.001). On postoperative Days 3 and 6, the pain scores quantified by visual analog scores were significantly lower in the BHBO group than in the control group (5.33 ± 1.54 and 4.17 ± 1.51, respectively vs. 7.57 ± 1.41 and 5.20 ± 1.47, respectively). The difference in the visual analog scale score on postoperative Day 9 between the groups was not significant (p > 0.05). Microbiological assessment revealed the absence of bacterial contamination in both groups. At the 6‐month follow up, the VSS score was significantly lower in the BHBO group (6.67 ± 1.92) than in the control group (9.57 ± 1.55).ConclusionBHBO resulted in faster donor‐site healing, reduced postoperative pain, and improved scar quality at the 6‐month follow‐up than petrolatum gauze alone.

Introduction: One of the most common traumatic injuries, burn injuries lead to at least 180,000 deaths each year worldwide. Massive burns result in severe tissue loss and increase the rate of infection. Eschar excision with skin grafting is the gold standard of treatments for massive burns. Retaining dermis tissue is the key to ensuring the survival of skin grafts and rapidly closing exposed tissues. Traditional eschar excision with Humby or Weck knife controls the depth of excision until the dermis, but ensuring the accuracy of excision is challenging. Hydrosurgery minimizes damage to uninjured tissues during the removal of necrotic tissues. A foot pedal is used to adjust debridement depth for precise debridement. To figure out the clinical advantages and risks of using hydrosurgery in treating massive burns, this study has been conducted. Method: Forty-two patients with massive burns and total body surface area (TBSA) of > 30% were treated at the First Affiliated Hospital of Anhui Medical University from May 2020 to January 2023. They underwent hydrosurgical eschar excision with MEEK microskin graft (n = 23) or tangential excision with MEEK microskin graft (n = 19). Result: No statistically significant differences (p > 0.05) in the following demographics were found between the two groups: age, weight, TBSA, deep-partial-thickness burn, gender, inhalation injury, shock, excision area, and MEEK ratio. By contrast, statistically significant differences in per unit area of operation time, per unit area of operation spending, hospitalization cost, hospitalization duration, wound-healing time, skin graft survival, and scar quality were found between hydrosurgical excision group with MEEK microskin graft and conventional excision group with MEEK microskin graft. Conclusion: The hydrosurgical excision system showed better clinical effects for patients with massive burns. (c) 2024 Elsevier Ltd and ISBI. All rights reserved.

Sleep deficiency is associated with intestinal inflammatory conditions and is increasingly recognized as a public health concern worldwide. However, the effects of sleep deficiency on intestinal goblet cells (GCs), which play a major role in intestinal barrier formation, remain elusive. Herein, the effects of sleep deprivation on intestinal GCs were determined using a sleep-deprivation mouse model. Sleep deprivation impaired the intestinal mucosal barrier and decreased the expression of tight junction proteins. According to single-cell RNA sequencing and histologic assessments, sleep deprivation significantly reduced GC numbers and mucin protein levels in intestinal tissues. Furthermore, sleep deprivation initiated endoplasmic reticulum stress by activating transcription factor 6 and binding Ig protein. Treatment with melatonin, an endoplasmic reticulum stress regulator, significantly alleviated endoplasmic reticulum stress responses in intestinal GCs. In addition, melatonin increased the villus length, reduced the crypt depth, and restored intestinal barrier function in mice with sleep deprivation. Overall, the findings revealed that sleep deprivation could impair intestinal mucosal barrier integrity and GC function. Targeting endoplasmic reticulum stress could represent an ideal strategy for treating sleep deficiency-induced gastrointestinal disorders.

ObjectiveResearch indicates that long noncoding RNAs (lncRNAs) contribute significantly to fibrotic diseases. Although lncRNAs may play a role in hypertrophic scars after burns, its mechanisms remain poorly understood.MethodsUsing chip technology, we compared the lncRNA expression profiles of burn patients and healthy controls (HCs). Microarray results were examined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) to verify their reliability.The biological functions of differentially expressed mRNAs and the relationships between genes and signaling pathways were investigated by Gene Ontology (GO) and pathway analyses, respectively.ResultsIn contrast with HCs, it was found that 2738 lncRNAs (1628 upregulated) and 2166 mRNAs (1395 upregulated) were differentially expressed in hypertrophic scars after burn. Results from RT-PCR were consistent with those from microarray. GO and pathway analyses revealed that the differentially expressed mRNAs are mainly associated with processes related to cytokine secretion in the immune system, notch signaling, and MAPK signaling.ConclusionThe lncRNA expression profiles of hypertrophic scars after burn changed significantly compared with HCs. It was believed that the transcripts could be used as potential targets for inhibiting abnormal scar formation in burn patients.

Abstract Objective Treatment of the ischial tuberosity pressure ulcer remains a surgical challenge. Ischial-located flap reconstruction shares a high risk of wound dehiscence and recurrence. The aim of this study was to design a surgical procedure of the external fixation as a novel option for a modified reconstruction of ischial tuberosity sore. Methods Ten spastic paraparesis patients with ischial tuberosity pressure ulcers were enrolled in this study from June 2018 to March 2021. The defects occurred secondary to spinal injury (6 patients), ankylosing spondylitis (2 patients), infantile paralysis (1 patient) and Parkinson's syndrome (1 patient). The ischiogluteal bursa and lesioned part of ischial tuberosity were excised in all cases. The gluteus maximus muscle flaps ranged in size from 2cm × 8cm to 10cm × 10cm. The simple external fixation using stainless-steel suture tying over sterile gauze were applied to ensure the extermination of dead space and fixation of the gluteus maximus muscle flap. Results The obtained outcomes were satisfactory functionally and aesthetically. Pressure ulcers in 10 patients were completely healed without major problems, except one patient developed a new skin ulcer one week after discharge, which eventually healed after being reoperated the same procedure. All patients were satisfied with the application of the external fixation and proposed flaps. Conclusion In this series of 10 patients, all gluteus maximus muscle flaps were fixed and adhered to ischial tuberosity effectively and the pressure wounds were closed well when patients discharged.

Purpose: Corneal alkali burns can progress to corneal epithelial defects, inflammation, scarring, and angiogenesis, potentially leading to blindness. Therefore, we examined the therapeutic effects of a novel ophthalmic solution (ZK002) on wound healing in alkali-burned rat corneas.Methods: In this study, we attempted to treat alkali-exposed rat corneas using topical application of either an ophthalmic solution with ZK002 or an anti-vascular endothelial growth factor agent for 14 days. We evaluated corneal edema, corneal neovascularization area, and histological changes. We also assessed the inflammatory (MMP-9, MMP-2, and interleukin113) and angiogenic (vascular endothelial growth factor receptor 2, VEGFR2) markers. Levels of inflammatory (matrix metalloproteinase (MMP)-9, MMP-2, and interleukin-113), profibrotic (alpha-smooth muscle actin, alpha-SMA; transforming growth factor-132,TGF-132), and angiogenic (vascular endothelial growth factor-receptor 2, VEGFR2) factors, as well as peroxisome proliferator-activated receptor gamma (PPAR gamma) mRNA expression, were measured.Results: The analyses showed that alkali exposure caused an increase in corneal edema and fibrosis with corneal neovascularization. The accumulation of alpha-smooth muscle actin-positive myofibroblasts and the deposition of transforming growth factor-132 on the alkali-exposed corneas were noted on day 14. The mRNA expression levels of interleukin-113, MMP-9, MMP-2, VEGFR2, and profibrotic factors were decreased in the ZK002 group compared with the control group during the early period of corneal alkali burns on day 14. However, the expression level of PPAR gamma mRNA was increased in the ZK002 group.Conclusions: ZK002 decreased the fibrotic reaction and prevented neovascularization in the cornea after an alkali burn. Therefore, the novel ophthalmic solution ZK002 could be a potentially promising therapeutic clinical treatment for corneal wound healing.

The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut-off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single-factor and multiple-factor COX regression. Kaplan-Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662-0.860, P < .001), 0.687 (95% CI, 0.554-0.820, P = .003) respectively, and the optimal cut-off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan-Meier survival analysis showed that there was a significant difference in the 90-day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log-rank: 24.162; P < .001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90-day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log-rank: 14.404; P < .001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90-day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors.

Introduction: Patients with extremely severe burns often require rapid wound closure with a tangential excision or escharectomy combined with a skin graft to reduce life-threatening complications such as infection. Traditional tangential excision surgery using the Watson or Humby knife does not allow accurate excision of necrotic tissue and often removes too much active tissue, which is detrimental to the rapid healing of the wound. Importantly, the Versajet hydrosurgical system, with its smaller handle, allows for more precise excision of necrotic burn tissue and preserves more active dermal tissue, positively affecting wound healing and scarring. This study compared the safety and efficacy of hydrosurgical combined with autologous skin grafting to conventional excision combined with auto-logous skin grafting in patients with extremely severe burn.Methods: Information of sixty burn patients with total body surface area (TBSA) > 50 % treated at the first affiliated hospital of Anhui Medical University from January 2019 to August 2022 were analyzed. The patients were divided into a conventional debridement group (n = 37) and a hydrosurgical debridement group (n = 23) according to the approach used. The hydrosurgical debridement group and the conventional debridement group were compared from the difference between the duration of the first debridement surgery, wound healing time, the changes of red blood cells and hemoglobin concentration post-operative, total blood transfusion, hospitalization cost, skin grafting frequency, procalcitonin, wound bacterial culture, albumin and prealbumin.Results: Information on age, gender, weight, inhalation injury, hypovolemic shock, pre-operative procalcitonin, preoperative albumin, preoperative prealbumin, the operation frequency (n >= 3), preoperative trauma culture and postoperative trauma culture were compared between both groups (P > 0.05). Operative time and wound healing time were significantly shorter in patients with hydrosurgical debridement combined with autologous skin grafting than those in the control group (P < 0.05), while hospitalization costs were not significantly different between the two groups (P > 0.05). The changes of red blood cells and hemoglobin concentration during the postoperative period in the hydrosurgical debridement group were less significantly than those in the conventional debridement group (P < 0.05). The total amount of red blood cells transfused during hospitalization was significantly lower in the hydrosurgical debridement group than that in the conventional debridement group (P < 0.05), but the total amount of fresh frozen plasma transfused during hospitalization was not statistically significant between the two groups (P > 0.05). Albumin on the third day after surgery and prealbumin on the first, third and fifth day after surgery improved more significantly than those in the control group (P < 0.05), however, there were no significant differences between the two groups in al-bumin on the first and fifth postoperative days (P > 0.05). The PCT level in the conventional debridement group was significantly higher than that in the hydrosurgical debridement group on the first, third and fifth days after surgery(P < 0.05). Conclusion: The hydrosurgical debridement group presented with shorter operative time, less blood loss during surgery, faster postoperative nutritional recovery, less postoperative inflammatory response and faster wounds healing, and did not increase the hospitalization cost, postoperative bacterial culture of the wounds and the number of skin grafting surgeries. In patients with extremely severe burn, hydrosurgical debridement combined with autologous skin grafting group is safer and more effective than those in the conventional debridement combined with autologous skin grafting group.(c) 2023 Elsevier Ltd and ISBI. All rights reserved.

在我国加快建设创新型国家、推进健康中国规划的背景下,拓展创新创业思维、提高创新创业能力是医学院校培养高质量人才的重中之重,创新创业教育平台的创造性转化和创新性发展极大地促进了高校学生创新能力的培养. 本文从创新创业教育融入医学生培养全程、组建多元化的创新创业实训师资团队、融入医学专业课程、完善创新创业训练平台四个方面探讨新格局下医学院校创新创业教育发展方向.

An association between the methylenetetrahydrofolate reductase (MTHFR) C667T genotype and the risk of colorectal cancer, as well as a link between MTHFR gene polymorphism and thrombosis, have been revealed. However, the connection between MTHFR gene polymorphism and the risk of thrombosis in patients with colorectal cancer has remained to be fully elucidated. The present study investigated the link between MTHFR gene polymorphism and basic clinical data, postoperative D-dimer (DDi), postoperative thromboelastogram and postoperative thrombosis in 591 patients who underwent surgery for colorectal cancer. Postoperative DDi, thromboelastogram and postoperative thrombosis were not significantly different among patients with colorectal cancer and different MTHFR genotypes. While the results were 'negative', the present study may help physicians understand that it is not necessary to detect MTHFR polymorphism for therapeutic purposes. Regarding the danger of venous thrombosis, more focus should be placed on the standardized procedural enforcement system for deep vein thrombosis prevention for patients undergoing pelvic and abdominal surgery.

Background and objective Retreatment pulmonary tuberculosis (PTB) still accounts for a large proportion of tuberculosis, and the treatment outcome is unfavorable. The recurrence of retreatment PTB based on long-term follow-up has not been well demonstrated. This study aimed to evaluate effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis. Methods This multicenter cohort study was conducted in 29 hospitals from 23 regions of China from July 1, 2009, to December 31, 2020. Patients were divided into two treatment regimen groups including experimental group [modified regimen (4H-Rt2-E-Z-S(Lfx)/4H-Rt2-E)]and control group [standard regimen (2H-R-E-Z-S/6H-R-E or 3H-R-E-Z/6H-R-E)]. The patients enrolled were followed up of 56 months after successful treatment. We compared the treatment success rate, treatment failure rate, adverse reaction rate, and recurrence rate between two regimens. Multivariate Cox regression model was used to identify the potential risk factors for recurrence after successful treatment with proportional hazards assumptions tested for all variables. Results A total of 381 patients with retreatment PTB were enrolled, including 244 (64.0%) in the experimental group and 137 (36.0%) in the control group. Overall, the treatment success rate was significant higher in the experimental group than control group (84.0 vs. 74.5%, P = 0.024); no difference was observed in adverse reactions between the two groups (25.8 vs. 21.2%, P > 0.05). A total of 307 patients completed the 56 months of follow-up, including 205 with the modified regimen and 102 with the standard regimen. Among these, 10 cases (3.3%) relapsed, including 3 in the experimental group and 7 in the control group (1.5% vs 6.9%, P = 0.035). Reduced risks of recurrence were observed in patients treated with the modified regimen compared with the standard regimen, and the adjusted hazard ratio was 0.19 (0.04–0.77). Conclusion The modified retreatment regimen had more favorable treatment effects, including higher treatment success rate and lower recurrence rate in patients with retreated drug-sensitive PTB.