Acute pancreatitis (AP) is a common abdominal inflammatory disease, characterized by pancreatic autodigestion, acinar cell necrosis, and systemic inflammation. Currently, there is a lack of specific drugs in the treatment of AP. Traditional Chinese medicine (TCM) is an effective approach in the prevention and treatment of AP, with rheum being one of the key components in commonly used TCM formulas for treating AP. We screened emodin as the core active ingredient of rheum and developed a heparin-modified emodin carrier, EMO@ZIF-8/Heparin (HEZ), which specifically delivers emodin to the inflamed pancreatic tissue via CD44-targeted macrophage activation. The HEZ exhibited higher macrophage uptake efficiency in the inflammatory microenvironment, restored the mitochondrial membrane potential, alleviated oxidative stress, and effectively reduced the levels of cytokines in the AP cell model. Moreover, the formulation exhibited targeted enrichment and retention in the pancreas under AP conditions, blocking the systemic inflammatory amplification cascade, reducing approximately 50% of pathological damage in both pancreatic and lung tissues, decreasing the proportion of apoptotic pancreatic cells, and increasing the 15-day survival rate of AP mice from 15% to around 50%. Mechanistically, the formulation restored impaired macrophage mitochondrial function to a healthy state by inhibiting the JNK pathway. In summary, the multifunctional HEZ provides an upstream therapeutic strategy by targeting macrophages in AP, offering a novel and effective approach to potentially enhance AP treatment in the future.

BACKGROUND: The precise role of Galectin-9, an immune checkpoint protein involved in immune responses, in hepatocellular carcinoma (HCC) remains elusive. Importantly, the prognostic value of serum Galectin-9 has not been clarified, and its association with infiltrating immune characteristics was unclear. METHODS: The association between serum Galectin-9 concentration and HCC recurrence was analyzed in two cohorts of HCC patients (training 133; validation 97) who received curative resection during 2018 and 2019. Bioinformatic analyses, including WGCNA, GSEA, GO, KEGG, Hallmark, CIBERSORT, QUANTISEQ, ssGSEA and TISIDB, were performed to systematically demonstrate the expression pattern, immunomodulation role, and prognostic value of Galectin-9 in HCC. These findings were further validated by immunohistochemistry staining. RESULTS: Patients with high serum Galectin-9 levels had significantly shorter time to tumor recurrence (TTR; P < 0.001) in both cohorts, and serum Galectin-9 was identified as an independent predictor of HCC recurrence, even in patients with low-AFP or early-stage. Bioinformatic analyzes revealed high Galectin-9 expression is involved in immune-evasive and inflammatory signaling pathways. It correlated with increased infiltration of exhausted CD8 + T cells, Tregs, TAMs and MDSCs. Interestingly, we found Galectin-9 was predominantly expressed on macrophages rather than malignant cells, and showed positively association with serum Galectin-9 concentration according to IHC results. Concordantly, high serum Galectin-9 levels also reflected an immune-evasive microenvironment composed by extensive CD163 + and FOXP3 + cell infiltrates. CONCLUSIONS: Elevated serum Galectin-9 was a novel indicator for worse prognosis in HCC. The high expression of Galectin-9 may reflect the immunosuppressive environment by increasing CD163 + and FOXP3 + cell infiltrates.

Background Drug therapy plays an essential role in the management of hepatocellular carcinoma (HCC). Recently, the use of natural products to suppress tumor cells has emerged as a promising direction for drug development. Juglone, a natural compound, exhibits anticancer activities across various cancer types. However, the precise mechanism underlying the anticancer effect of juglone, especially in HCC, remains elusive. Purpose This study aimed to investigate the potential inhibitory effects of juglone on HCC and pan-cancer, as well as elucidate the underlying mechanism. Methods Cell Counting Kit-8 and colony formation assays were used to examine cell proliferation. Transwell and wound healing assays were used to evaluate cell migration. Cell cycle distribution was assessed by flow cytometry. The in vivo effect of juglone on HCC was evaluated by establishing the HCC xenograft mice model. RNA sequencing and inhibitors targeting diverse modes of programmed cell death were applied to uncover the form of juglone-induced cell death. Integrated transcriptomic, and proteomic analyses unveiled the underlying mechanism. The dual-luciferase reporter assay was employed to verify the findings. The pan-cancer value of juglone was assessed using TCGA database analysis and cellular assays. Results Juglone suppressed HCC growth via ferroptosis in vitro and in vivo, which is evidenced by increased levels of iron, lipid peroxidation (LPO), reactive oxygen species (ROS), malondialdehyde (MDA), and decreased levels of glutathione (GSH). Omic analyses, gene silencing and functional analyses showed the upregulated HMOX1 and FOSL1 were the key effector molecule and transcriptional factor in juglone-induced ferroptosis, respectively. The binding site of FOSL1 at the promoter of HMOX1 was identified. Juglone could induce ferroptosis in pan-cancer by activating the FOSL1-HMOX1 axis. Conclusion Our findings, for the first time, demonstrate that juglone effectively inhibits tumor growth by inducing FOSL1-HMOX1-dependent ferroptosis, thereby offering a promising strategy for the development of anticancer drugs.

To investigate the clinical characteristics and management of biliary complications in pediatric and adult patients who underwent choledochal cysts (CDCs) surgery in childhood. A retrospective cohort study was conducted at Beijing Tsinghua Changgung Hospital, including 34 patients who developed biliary complications after undergoing CDC surgery during childhood. Patients were stratified into two groups: Group A (childhood-onset, < 18 years, n = 14) and Group B (adult-onset, ≥ 18 years, n = 20). Clinical presentation, imaging, laboratory findings, surgical history and treatment were analyzed. The median interval from initial CDC surgery to complication onset was significantly shorter in Group A than in Group B (1.5 vs. 15.0 years; p < 0.001). The primary presentation of biliary complications in both groups were cholangitis, with no significant differences in liver function or bilirubin levels. Biliary strictures were the predominant cause in children (85.7

BackgroundHepatitis E virus (HEV)-associated renal injury is mainly reported in immunocompromised patients. Here we investigated HEV-associated renal injury in non-immunocompromised acute hepatitis E (AHE) patients and rabbits.MethodsA total of 35 non-immunocompromised AHE patients were tested for kidney function parameters and HEV markers. HEV3- and HEV4-infected rabbits were tested for alanine aminotransferase, creatinine (Cr), and HEV markers. HEV-associated renal injury and renal HEV replication were analyzed by histopathology and RT-qPCR.ResultsThe non-immunocompromised AHE patients all showed normal serum Cr, blood urea nitrogen (BUN), and urine acid (UA). However, 25% of non-immunocompromised AHE patients showed proteinuria. In the rabbit model, HEV replication was observed in kidney tissues. The HEV-infected rabbits showed a transient elevated Cr level. Renal injury, including focal lymphocytic infiltration and tubular protein casts, was observed in rabbits across acute, recovery, and chronic phases of HEV infection.ConclusionsProteinuria is not uncommon in non-immunocompromised AHE patients, indicating that HEV infection affects the kidney. We further proved that HEV can cause renal injury in a rabbit model.

The purpose of this study was to develop a new and more comprehensive classification system for portal vein (PV) variations using three-dimensional visualization and evaluation (3DVE) and to discuss the prevalence rates and clinical implications of the variants. The anatomies of PVs were tracked and analyzed by using three-dimensional visualization of CT images acquired between 2013 and 2022. Scans from 200 adults were evaluated and a total of 178 patients (N = 178) were included in the study. The new classification system, named BLB classification, was developed based on the level of the absent PV branch in each variant anatomy. Using the BLB classification system, PVs were divided into thirteen subtypes. Only 82.6–84.8

In 2019, China launched the "New Whole-Nation System" as a response to U.S. technical sanctions. However, long before that proclamation, the country had endeavored to strengthen the role of state-owned enterprises in pursuing technological breakthroughs in strategic industries. Can China succeed in utilizing SOEs for technological breakthroughs? Academic responses to the policy have bifurcated into skeptics and supporters. To help resolve the divergence, this article draws from the technological paradigm and focuses on the "technological cycle time" of particular industrial sectors. We argue that for "long-cycled technological sectors," relying on SOEs to promote technological upgrading is more feasible. China's recent technological catch-up in the commercial aircraft industry also demonstrates how the state-owned Commercial Aircraft Corporation of China (COMAC) has accumulated technological know-how by successfully acquiring patient capital, nurturing technical talents, and establishing long-term industrial networks. China's unique multiple ownership system can thus contribute to its transformation into a comprehensive technological giant.

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide. With the prevalence of overweight and obesity in the Chinese population, NAFLD is no longer a disease exclusive to Western developed countries, and has become one of the most common metabolic diseases in the world. The global prevalence of NAFLD is as high as 37.8%, and the prevalence of NAFLD in the Chinese population is 23.3%. In recent years, with the global epidemic of obesity and metabolic syndrome, the prevalence of NAFLD has gradually increased. The risk factors of NAFLD are closely related to obesity, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia and other diseases. When NAFLD co-exists with these metabolic diseases, it often increases the risk of cirrhosis, liver cancer, and even death. At the same time, it can aggravate other chronic liver diseases, promote disease progression, and is closely related to the occurrence and development of atherosclerosis and type 2 diabetes. With the progression of NAFLD disease, the related clinical burden and economic burden of NAFLD and its impact on patients' quality of life are becoming more and more serious. Therefore, early identification, early diagnosis, early prevention, early treatment and standardized management of NAFLD are conducive to the control of the risk of cirrhosis, liver cancer and cardiovascular diseases. This article will review the epidemiology, hazards, and related risk factors of NAFLD.

Since Facial Action Unit (AU) annotations require domain expertise, common AU datasets only contain a limited number of subjects. As a result, a crucial challenge for AU detection is addressing identity overfitting. We find that AUs and facial expressions are highly associated, and existing facial expression datasets often contain a large number of identities. In this paper, we aim to utilize the expression datasets without AU labels to facilitate AU detection. Specifically, we develop a novel AU detection framework aided by the Global-Local facial Expressions Embedding, dubbed GLEE-Net. Our GLEE-Net consists of three branches to extract identity-independent expression features for AU detection. We introduce a global branch for modeling the overall facial expression while eliminating the impacts of identities. We also design a local branch focusing on specific local face regions. The combined output of global and local branches is firstly pre-trained on an expression dataset as an identity-independent expression embedding, and then finetuned on AU datasets. Therefore, we significantly alleviate the issue of limited identities. Furthermore, we introduce a 3D global branch that extracts expression coefficients through 3D face reconstruction to consolidate 2D AU descriptions. Finally, a Transformer-based multi-label classifier is employed to fuse all the representations for AU detection. Extensive experiments demonstrate that our method significantly outperforms the state-of-the-art on the widely-used DISFA, BP4D and BP4D+ datasets.

As digital medicine has exerted profound influences upon diagnosis and treatment of hepatobiliary diseases, our study aims to investigate the accuracy of three-dimensional visualization and evaluation (3DVE) system in assessing the resectability of hilar cholangiocarcinoma (hCCA), and explores its potential clinical value. The discovery cohort, containing 111 patients from April 2013 to December 2019, was retrospectively included to determine resectability according to revised criteria for unresectability of hCCA. 3D visualization models were reconstructed to evaluate resectability parameters including biliary infiltration, vascular involvement, hepatic atrophy and metastasis. Evaluation accuracy were compared between contrast-enhanced CT and 3DVE. Logistic analysis was performed to identify independent risk factors of R0 resection. A new comprehensive 3DVE classification of hCCA based on factors influencing resectability was proposed to investigate its role in predicting R0 resection and prognosis. The main outcomes were also analyzed in cohort validation, including 34 patients from January 2020 to August 2022. 3DVE showed an accuracy rate of 91

Background:Postprandial dyslipidemia is a causative risk factor for cardiovascular disease. The majority of absorbed dietary lipids are packaged into chylomicron and then delivered to circulation. Previous studies showed that Surf4 (surfeit locus protein 4) mediates very low-density lipoprotein secretion from hepatocytes. Silencing hepatic Surf4 markedly reduces the development of atherosclerosis in different mouse models of atherosclerosis without causing hepatic steatosis. However, the role of Surf4 in chylomicron secretion is unknown. Methods:We developed inducible intestinal-specific Surf4 knockdown mice (Surf4(IKO)) using Vil1Cre-ERT2 and Surf4(flox) mice. Metabolic cages were used to monitor mouse metabolism. Enzymatic kits were employed to measure serum and tissue lipid levels. The expression of target genes was detected by qRT-PCR and Western Blot. Transmission electron microscopy and radiolabeled oleic acid were used to assess the structure of enterocytes and intestinal lipid absorption and secretion, respectively. Proteomics was performed to determine changes in protein expression in serum and jejunum. Results:Surf4(IKO) mice, especially male Surf4(IKO) mice, displayed significant body weight loss, increased mortality, and reduced metabolism. Surf4(IKO) mice exhibited lipid accumulation in enterocytes and impaired fat absorption and secretion. Lipid droplets and small lipid vacuoles were accumulated in the cytosol and the endoplasmic reticulum lumen of the enterocytes of Surf4(IKO) mice, respectively. Surf4 colocalized with apoB and co-immunoprecipitated with apoB48 in differentiated Caco-2 cells. Intestinal Surf4 deficiency also significantly reduced serum triglyceride, cholesterol, and free fatty acid levels in mice. Proteomics data revealed that diverse pathways were altered in Surf4(IKO) mice. In addition, Surf4(IKO) mice had mild liver damage, decreased liver size and weight, and reduced hepatic triglyceride levels. Conclusions:Our findings demonstrate that intestinal Surf4 plays an essential role in lipid absorption and chylomicron secretion and suggest that the therapeutic use of Surf4 inhibition requires highly cell/tissue-specific targeting.

Background: Hepatocellular carcinoma (HCC) was one of the most prevalent life-threatening cancers. Metastasis is the leading cause of cancer-related death in HCC. MiRNAs play essential roles in cancer metastasis. Methods: Expression of miR-652-3p in HCC was assessed. Function experiments of miR-652-3p and trinucleotide repeat-containing gene 6A protein (TNRC6A) were performed both in vitro and in vivo. mRNA sequencing, PCR, and western blot were performed to verify the target genes and pathway of miR-652-3p. The lung metastasis and xenograft cancer model in nude mice was established to investigate the effects of the miR-652-3p and TRNC6A on tumor metastasis in vivo. The relationship between the expression of the miR-652-3p, TNRC6A and the prognosis of HCC patients was analyzed. Results: Upregulated miR-652-3p was found in the tumor tissues of HCC, especially in metastatic HCC patients. Overexpression of miR-652-3p promoted and knockdown of miR-652-3p suppressed HCC metastasis both in vitro and in vivo. MiR-652-3p promoted HCC metastasis via regulating the EMT pathway. TNRC6A was identified as a direct target of miR-652-3p, and the knockdown of TNRC6A restored repressed EMT and HCC metastasis caused by the inhibition of miR-652-3p. Clinical results revealed that high expression of miR-652-3p and low expression of TNRC6A were positively correlated to shortened overall survival and disease-free survival in HCC patients. Conclusions: MiR-652-3p promotes EMT and HCC metastasis by inhibiting TNRC6A expression in HCC. MiR-652-3p and TNRC6A may serve as potential biomarkers to predict prognosis in HCC patients with metastasis. (c) 2022 Elsevier Inc. All rights reserved.

Background This study aims to propose a novel classification system to standardize the treatment of hepatolithiasis. Methods A hepatolithiasis classification named LHO was proposed to represent the distribution of stones in the segmental bile ducts and the hepatic atrophy associated with the stones (L), the existence of stones or strictures in the hilar bile duct (H), and dysfunction of the Oddi sphincter (O), which can be used to formulate ideal surgical protocols. One hundred and forty-seven primary hepatolithiasis patients treated between 2013 and 2018 were classified into different types and divided into two groups. If the patient's actual surgical procedure matched the ideal surgical protocol, the patients were included in the matching group; otherwise, patients were included in the nonmatching group. The rates of residual stones, recurrence, and a good quality of life (QOL) were analyzed among the patients in the matching and nonmatching groups and previous reports. Results According to the classification of each patient, 77.6% of the patients were included in the matching group, and 22.4% were included in the nonmatching group. The rates of residual stones, recurrence, and a good QOL were significantly better in the matching group than in the nonmatching group (9.6% vs. 27.3%; 8.0% vs. 35.0%; 89.5% vs. 65.4%); the rates of residual stones and a good QOL were also better than those in previous reports (9.6% vs. 19.1%; 89.5% vs. 61.6%). Conclusions The LHO classification can comprehensively reflect the key points of treatment, which is beneficial for formulating effective and standardized surgical plans of hepatolithiasis.

Abstract: Liquid biopsies in cancer have received considerable attention as new biomarkers and subjects of clinical translational research. Liquid biopsy-derived biomarkers, including circulating tumor cells, cell-free nucleic acids, exosomes, tumor-educated platelets, proteins, and metabolites, have shown enormous potential to improve the sensitivity and specificity in early diagnosis of multiple cancer types, including hepatocellular carcinoma (HCC). Several analytes are already used in HCC clinical trials and are currently under investigation with encouraging preliminary results. This article will review the latest studies on liquid biopsy for early diagnosis and screening of HCC and discuss the current advantages and challenges of liquid biopsies in tumor biomarkers and clinical applications. In the future, the validation of large prospective clinical studies, the development of standardized operating procedures, and the integration of other diagnostic tools will open new avenues for applying liquid biopsy in early cancer detection.

Ionic current rectification (ICR) phenomena conventionally occurs in nanopores which dimensions are compa-rable to the thickness of their electrical double layers. However, the microscale ICR in a micropore can also exist under some conditions. Here, the charged hydrogel filled conical micropore was constructed to realize microscale ICR. To better understand the micropore ICR, the influences of space charge density of the hydrogel, micropore geometry, the hydrogel filling length as well as the electrolyte concentration and pH were investigated. Furthermore, we developed a PEGDA-based hydrogel filled micropore sensing platform which sensing perfor-mance was enhanced due to the weakly charged PEGDA. The promyelocytic leukemia (PML)/retinoic acid re-ceptor alpha (RARA) fusion genes and adenosine triphosphate (ATP) were respectively used as model analytes and the measured detection limits of 0.1 pM were achieved. The successful realization of microscale ICR in a homogenous and functional hydrogel filled micropore suggests that the fabrication, characterization and oper-ation of ICR based devices can be more robust and facilitated for the wider applications.

Background: Patients with early gastric cancer (EGC) usually have a favorable prognosis. While local endoscopic resection benefits some EGC cases, metastasis in peri-gastric lymph nodes challenges its efficacy. Identifying concurrent lymph node metastasis (LNM) is crucial for determining endoscopic surgery feasibility. Pathological images provide rich tumor feature information. In this study, convolutional neural networks (CNNs) were employed to explore these images, assessing deep learning's potential in predicting LNM in EGC.Methods: In a multicenter retrospective study, digital slides of H&E-stained sections were collected from EGC-diagnosed patients and TCGA database. After gastrectomy and D2 lymph node dissection, LNM conditions were assessed. H&E-stained biopsy slides were analyzed using CNN models (Inception-V3, ResNet50, EfficientNet-B5, and a combined model) to predict LNM. Scores derived were assigned to tumor tissues, forming a histopathological biomarker—lymph node metastasis-score (LMS).Results: We curated 51,573 patches derived from 573 whole-slide images, representing 546 EGC patients. When analyzed based on area under the curve metrics, a superior model, known as the LNMNet, emerged. The LMS registered an AUC of 0.851 for the internal test cohort and 0.901, 0.911, 0.807, and 0.700 across three external test cohorts as well as the TCGA cohort, respectively. Patches with elevated LMS were significantly correlated with poorly differentiated tissues.Conclusion: We have introduced a deep learning-powered biomarker, the Lymph node metastasis-score (LMS), developed from histopathological imagery, which can predict LNM in EGC patients. The LNMNet model provides a novel strategy to assess the viability of endoscopic interventions, which will facilitate tailored treatments for EGC.Funding: This research was funded by National Natural Science Foundation of China (Award NO.81602049), and the grant recipient was Guanghua Li.Declaration of Interest: All the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Ethical Approval: The study was approved by the Ethics Committee of FAH-SYSU in China and followed the Declaration of Helsinki. Sample collection was authorized by the ethics board of each institution (Ethics Review [2022] No. 090).

Objective:To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors. Methods:120 patients with thyroid cancer admitted to Xi 'an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group（60 cases） and traditional open surgery group（60 cases）. The general operation conditions, postoperative complications and postoperative quality of life were compared between the two groups. Results:The intraoperative blood loss, indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group （P<0.05）, while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group （P<0.05）. There was no significant differences in VAS score at 24h after surgery, white blood cell count, TgAb （+） and temporary hypothyroidism between the two groups at 24 h after operation （P >0.05）. The CRP, total drainage volume, TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group, and the PTH and Tg were lower than those in the traditional open surgery group （P<0.05）.One case of hoarseness,2 cases of extremities numbness, 1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group, the total incidence of postoperative complications was 10.00%. Five cases of hoarseness, 11 cases of choking cough limbs numbness, 1 case of drinking water, 1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group, the total postoperative incidence of complications was 36.67%, the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group （P<0.05）. The total scores of physiological status, social/family status, emotional status, functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group （P<0.05）. Conclusion:The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery, fewer postoperative complications.The patient was well tolerated,with positive safety，this technique has high clinical application value.

To develop and validate a nomogram based on liver stiffness (LS) for predicting symptomatic post-hepatectomy (PHLF) in patients with hepatocellular carcinoma (HCC). A total of 266 patients with HCC were enrolled prospectively from three tertiary referral hospitals from August 2018 to April 2021. All patients underwent preoperative laboratory examination to obtain parameters of liver function. Two-dimensional shear wave elastography (2D-SWE) was performed to measure LS. Three-dimensional virtual resection obtained the different volumes including future liver remnant (FLR). A nomogram was developed by using logistic regression and determined by receiver operating characteristic (ROC) curve analysis and calibration curve analysis, which was validated internally and externally. A nomogram was constructed with the following variables: FLR ratio (FLR of total liver volume), LS greater than 9.5 kPa, Child–Pugh grade, and the presence of clinically significant portal hypertension (CSPH). This nomogram enabled differentiation of symptomatic PHLF in the derivation cohort (area under curve [AUC], 0.915), internal fivefold cross-validation (mean AUC, 0.918), internal validation cohort (AUC, 0.876) and external validation cohort (AUC, 0.845). The nomogram also showed good calibration in the derivation, internal validation, and external validation cohorts (Hosmer–Lemeshow goodness-of-fit test, p = 0.641, p = 0.06, and p = 0.127, respectively). Accordingly, the safe limit of the FLR ratio was stratified using the nomogram. An elevated level of LS was associated with the occurrence of symptomatic PHLF in HCC. A preoperative nomogram integrating LS, clinical and volumetric features was useful in predicting postoperative outcomes in patients with HCC, which might help surgeons in the management of HCC resection. A serial of the safe limit of the future liver remnant was proposed by a preoperative nomogram for hepatocellular carcinoma, which might help surgeons in ‘how much remnant is enough in liver resection’. • An elevated liver stiffness with the best cutoff value of 9.5 kPa was associated with the occurrence of symptomatic post-hepatectomy liver failure in hepatocellular carcinoma. • A nomogram based on both quality (Child–Pugh grade, liver stiffness, and portal hypertension) and quantity of future liver remnant was developed to predict symptomatic post-hepatectomy liver failure for HCC, which enabled good discrimination and calibration in both derivation and validation cohorts. • The safe limit of future liver remnant volume was stratified using the proposed nomogram, which might help surgeons in the management of HCC resection.

Background:Diabetic foot ulcer (DFU) is frequently difficult to heal and finally leads to amputation, resulting in high mortality rate in diabetic patients. To date, effective and optimal therapies are still lacking. This study aims to investigate the efficacy of integrated surgical wound treatment (ISWT) mode on diabetic foot wound.Methods:From January 2021 to December 2021, 13 diabetic foot patients with Wagner grade 3 to 4 were treated with ISWT mode, which combined TTT technique with debridement, induced membrane technique, vacuum sealing drainage (VSD) technique and skin grafting technique. The time of wound healing, the skin temperature at midpoint of dorsum of affected foot (T), visual analogue scale (VAS) score and ankle-brachial index (ABI) was measured before and after surgery. CTA examination of the lower extremity arteries was performed at the end of the cortex transport to evaluate the small arteriolar formation of the lower extremity. The complications occurred in each patient were recorded.Results:13 patients with age ranging from 45 to 66 years were followed up for 3 to 13 months. All patients healed completely without amputation being performed, no serious complications were found except for one case of nail channel infection. The mean healing time was 25.8 ± 7.8 days, with a range of 17 to 39 days. The mean time of carrying external fixation scaffolds and resuming walking was 71.8 ± 10.0 and 30.8 ± 9.1 days, with a range of 56 to 91 days and 18 to 45 days, respectively. The skin temperature at midpoint of dorsum of affected foot (T), VAS and ABI was all improved significantly at 3 months after surgery. Furthermore, CTA examination showed an increase in the number of lower extremity arteries and a thickening in the size of small arteriolar compared with those of pre-operative, and the collateral circulation of lower extremity was established and interweaved into a network.Conclusion:Integrated surgical treatment of diabetic foot wound can achieve satisfactory clinical results.