To evaluate the causal relationship between inflammatory factors， plasma metabolites and knee osteoarthritis （KOA） and the mediating effect of plasma metabolites in inflammatory factor-mediated KOA using Mendelian randomization （MR） system.
Methods
The genome-wide association study （GWAS） data of 91 inflammatory factors， 1 400 plasma metabolites and KOA were obtained from the public GWAS database.Two-sample MR analysis was used to evaluate the causal relationship between inflammatory factors， metabolites and KOA and KOA-related inflammatory factors and metabolites， and then the mediating effect of metabolites in inflammatory factor-mediated KOA was estimated.
Results
2 inflammatory factors （CD5， FGF-5） and 65 plasma metabolites were found to have significant causal relationships with KOA.Mediation analysis found that N-acetyl-1-methylhistidine had a 3.7% mediating effect ratio in the causal relationship between FGF-5 and KOA.
Conclusion
A variety of inflammatory factors and metabolites have a causal relationship with KOA， and the effect of metabolism on KOA should be paid attention to.The role of T cells in the prevention of KOA is confirmed， and the anti-inflammatory effect of leukocyte-rich platelet-rich plasma is explained from the genetic level.The potential of FGF pathway to prevent KOA is identified， which provides a reference for future studies of PRP components.
To explore the effect of low-frequency pulse electrical stimulation on the healing of deep partial-thickness burn wounds.
Methods
Sixty patients with deep partial-thickness burns who met the inclusion and exclusion criteria and were admitted to Department of Burns and Cutaneous Surgery， the First Affiliated Hospital of Air Force Medical University from March to December 2023 were enrolled.The patients were randomly divided into observation group and control group by random number table method，with 30 patients in each group.In both groups， 10 cm×10 cm deep partial-thickness burn wounds were selected as the test area.In the control group， patients were treated with 1% silver sulfadiazine cream on the wound surface once a day.On the basis of the same treatment in the control group， patients in the observation group were treated with low-frequency pulse electrical stimulation for 3 days using low-frequency electronic pulse therapy instrument， the frequency was 50 Hz，and the current intensity was 20 mA，once a day for 30 minutes each time.The blood flow perfusion in the wound was measured before treatment and at 1，2， and 3 days after treatment.The wound healing rate was calculated at 7， 10， and 14 days after treatment.The degree of pain during dressing change was assessed before treatment and at 3，7，and 14 days after treatment， and adverse events during treatment were recorded.
Results
Before treatment and on the first day after treatment， the wound blood perfusion values were （203.53±40.99）PU and （227.53±37.79）PU in the observation group， and（213.13±32.19）PU and （223.07±31.35）PU in the control group， there was no significant difference between the two groups （t=-1.009， 0.498； P=0.317， 0.620）.On the 2nd and 3rd day after treatment， the wound blood perfusion values of the observation group were （254.20±32.24）PU and （277.93±26.99）PU，which were significantly higher than（234.23±27.14）PU and（245.13±23.92）PU of the control group，the differences were statistically significant （t=2.595， 4.982； P＜0.05）.On the 7th，10th and 14th day after treatment，the wound healing rates of observation group were （16.70±4.68）%， （58.63±10.39）% and （89.03±10.72）%， which were higher than （12.33±4.19）%，（51.60±6.95）% and （82.10±7.12）% of the control group，the differences were statistically significant （t = 3.806， 3.038， 2.949； P ＜0.01）.Before treatment， VAS scores of the observation group and the control group were （7.87±1.25） points and （8.03±1.19） points， with no statistical significance （t=-0.529， P=0.599）.The VAS scores of the observation group were （4.23±0.94） points，（3.42±1.04） points and （1.57±0.89） points on the 3rd， 7th and 14th day after treatment， which were lower than （5.57±1.01） points， （4.27±0.98） points and （2.20±0.93） points of the control group， the differences were statistically significant （t=-5.316， -3.194， -2.692； P ＜0.01）.No adverse events occurred during treatment in both groups.
Conclusion
Low-frequency pulse electrical stimulation can significantly improve the early microcirculation of deep partial-thickness burn wounds， increase the wound healing rate， effectively relieve pain symptoms， and thereby promote the healing of deep partial-thickness burn wounds.
To observe the effect and safety of ulcer oil in the treatment of diabetic foot ulcer.
Methods
A total of 100 patients with diabetic foot who were admitted to the Department of Surgery of Traditional Chinese Medicine， China-Japan Friendship Hospital from September 2020 to September 2023 were enrolled and divided into observation group and control group randomly according to the random number table method， with 50 patients in each group.Both groups received standard treatment for diabetes mellitus，and the foot wounds were cleaned and treated with weekly dressing changes， which were performed two to three times.The observation group applied a topical ulcer oil in addition to the conventional treatment， while the control group applied a topical recombinant human epidermal growth factor in addition to the conventional treatment.The course of treatment for both groups was 12 weeks.At the 6th and 12th weeks of treatment， a comparison was made between the two groups in respect of the wound area， wound healing rate and proportion of patients with wound healing， traditional Chinese medicine syndrome score of the patients were calculated.Prior to and at the conclusion of the treatment period，the blood routine，liver and kidney function indexes of the two groups were evaluated.It was also necessary to observe whether any adverse events， such as an exacerbation of infection or an allergic reaction，occurred during the course of treatment in either group.
Results
Following the 6th and 12th weeks of treatment，no statistically significant differences were observed between the two groups in terms of wound area， wound healing rate， proportion of patients with wound healing， and total effective rate， as assessed by the efficacy of traditional Chinese medicine evidence （P＞0.05）.The observed differences in the levels of white blood cell count， red blood cell count， haemoglobin，platelet count， alanine transaminase， aspartate aminotransferase， total bilirubin， urea， blood glucose， and creatinine in the observation group were not statistically significant when compared with the levels recorded prior to the commencement of treatment （P＞0.05）.Following treatment， the red blood cell count and haemoglobin level of the observation group were found to be higher than those of the control group［（4.20±0.91）×1012/L vs （3.48±0.68）×1012/L，（123.07±19.29）g/L vs （102.56±19.68）g/L］，the differences were statistically significant （t=5.873，5.724； P＜0.001）.No adverse events were observed in either group during the course of treatment.
Conclusion
Ulcer oil can effectively promote the healing of diabetic foot ulcers and reduce the clinical symptoms of the patients，and has a better safety profile.
To explore the clinical effect of flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity.
Methods
From November 2017 to November 2023， 12 patients （12 fingers） with dorsal digital wound accompanied by mallet finger deformity were admitted to Hand Surgery Department of Suzhou Ruihua Orthopedic Hospital.There were 8 males and 4 females，aged from 21 to 63 years old.The wound areas ranged from 1.5 cm × 1.0 cm to 5.5 cm × 2.0 cm.All the wounds were repaired by the flaps，forearm venous flap with palmaris longus tendon was used in one patient， second toe lateral flaps were used in 6 patients， dorsal digital nerve fasciocutaneous pedicle flaps were used in 4 patients， and free superficial peroneal artery perforator flap was used in one patient.After intraoperative debridement，all patients had tendon defects.The extensor tendon insertion point was reconstructed by folding the palmaris longus tendon in a single-row three-point fixation，and Kirschner wires were implanted for the traction of the interphalangeal joint.Regular follow-up in the outpatient department was conducted， and the Crawford mallet finger efficacy evaluation system was used to evaluate the recovery of finger function during the follow-up.The comprehensive evaluation scale for skin flaps was used to assess the condition of the donor area and recipient area.
Results
All the 12 patients were satisfied with the treatment effect.The wounds healed in one stage.Patients were followed up for 3-15 months，with an average of 7 months.Mallet finger deformity had been corrected， and there was no pain during interphalangeal joint movement.According to the Crawford mallet finger efficacy evaluation system， 8 patients were excellent and 4 patients were good， with an excellent and good rate of 100%.According to the comprehensive evaluation scale for skin flaps， the results were rated as excellent in 9 patients and good in 3 patients， with an excellent and good rate of 100%.The sensation of skin flaps restored to S2-S3.The venous flap had mild pigmentation， the superficial peroneal artery perforator flap had a bulky appearance， which was significantly improved after thinning.The remaining flaps had a good appearance，and the donor area healed in one stage without functional impairment.
Conclusion
The use of skin flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity can achieve good clinical results.
To explore the effect of medial plantar flap combined with peroneal artery perforator flap in repairing the wound after resection of giant malignant melanoma on heel.
Methods
The clinical data of 9 patients with giant malignant melanoma on heel who met the inclusion and exclusion criteria and were admitted to the Department of Burn and Wound Repair， Hanzhong Central Hospital from May 2015 to May 2023 were retrospectively analyzed， including 7 males and 2 females， aged from 46 to 72 years.All patients were enlarged tumor resection， and the surgical margin was negative， and the area of wound ranged from 8 cm×9 cm to 12 cm×14 cm.The medial plantar flap was used to reconstruct the weight-bearing area，the flap area ranged from 5 cm×6 cm to 9 cm×11 cm.The peroneal artery perforator flap was used to cover the non-weight-bearing area， the flap area ranged from 10 cm×18 cm to 13 cm×24 cm.The survival of the flap and skin grafts were recorded.At the last follow-up， the appearance of the flap was recorded， the twopoint discrimination distance of the flap was measured，and the foot function was evaluated by Maryland foot function score.
Results
The flaps of 8 patients survived well， the peroneal artery perforator flap of one patient was partially necrotic， which was reconstructed with full thickness free skin graft after debridement.The patients were followed up for 6-36 months， no local recurrence or distant transfer was found， the flaps were not bloated， the texture and color were good.The medial plantar flap had normal sensation and the twopoint discrimination distance was 3-6 mm.The peroneal artery perforator flap had a two-point discrimination distance of 8-10 mm.The residual scar of skin graft in the donor site had no significant effect on foot function.The Maryland foot function score was （93.2±6.8）， 7 patients were excellent and 2 patients were good.The patients were satisfied with the appearance， and the function of the lower limb was not affected.
Conclusion
The medial plantar flap combined with peroneal artery perforator flap used in repairing the wounds after the resection of giant malignant melanoma on heel， can not only meet the functional and sensory recovery of the weight-bearing area，but also meet the needs of the skin flap coverage and appearance of the non-weight-bearing area of the heel.The postoperative appearance and function are good， and the method is simple and safe.
To investigate the clinical effect of antibiotic bone cement in the treatment of sternal osteomyelitis after cardiac surgery for patients with diabetes mellitus.
Methods
The clinical data of 23 diabetes mellitus patients with sternal osteomyelitis after cardiac surgery admitted to the Department of Burn and Skin Surgery， the First Affiliated Hospital of Air Force Medical University from March 2019 to February 2023 were retrospectively analyzed.All patients underwent bacterial culture of wound secretions.The antibiotic bone cement was filled after thorough debridement in one-stage operation.After 2 to 4 weeks，when there was no obvious exudation from the wound surface， the bone cement was taken out again， and the soft tissue on both sides of the wound was fully freed along the deep fascia layer to form a skin fascia flap，and the skin fascia flap on both sides were directly sutured.
Results
Among the 23 patients， the wound of 21 patients healed by first intention and no recurrence was found after a six-month follow-up.The wound of one patient dehisced about 1 cm after taking out the sutures， and healed after 7 days of dressing change.The wound of one patient ruptured again and formed sinus one month after discharge， and recovered after readmission.
Conclusion
The use of antibiotic bone cement is an effective method to treat sternal osteomyelitis after cardiac surgery in patients with diabetes mellitus.
Explore the clinical efficacy of endoscopic assisted incision of the transverse carpal ligament outside the carpal tunnel for the treatment of carpal tunnel syndrome， and evaluate the clinical effect of endoscopic single approach on postoperative palmar root pain and hand functional sensation recovery.
Methods
A retrospective analysis was conducted on 24 patients with carpal tunnel syndrome in Department of Hand Surgery of Xuzhou Renci Hospital from June 2021 to June 2023.A single transverse incision was made at the distal wrist crease， with simple expansion outside the carpal tunnel.The transverse ligament of the wrist was incised with endoscopic assistance， and postoperative palmar root pain， recovery of skin numbness in the median nerve innervation area， and thumb motor function were observed.The carpal tunnel syndrome assessment criteria recommended by Gu Yudong were applied to assess hand function and sensation.
Results
All 24 patients were followed up and their numbness symptoms improved one day after surgery.There was no infection in the incision and no columnar pain in the palm root.6 months after surgery，according to criteria of carpal tunnel syndrome， 19 cases were rated as excellent， 3 cases as good， and 2 cases as fair， with excellent and good rate of 91.67%.
Conclusion
The modified Okutsu method assisted by endoscopy is a safe and effective minimally invasive surgery for the treatment of carpal tunnel syndrome as a recommendable method， with reliable efficacy and short recovery time.
To demonstrate the clinical efficacy of Ilizarov ring external fixator combined with bone moving technique in treating severe tibial open comminuted fractures.
Methods
14 cases of severe Gustilo ⅢB tibia fractures admitted to Department of Trauma Orthopedics， Yuebei People's Hospital Affiliated to Shantou University from January 2019 to December 2022.Emergency surgery to crush the nonvital bone block， plate or Kirschner wire to fix the fibula， using Ilizarov ring external holder to fix the tibia.After debridement， the tibia was over 6.5 cm.The time of bone segment removal and fracture-end healing were recorded by regular follow-up after operation.Johner-Wruhs criteria were used to assess the function of the affected limb and Kofoed criteria to assess the function of the ankle joint.
Results
The average follow-up time for 14 patients was 14.50（11-23）months.The average time of relocation is 4.39（3-8）months and the average time of bone healing is 11.50 months.All the wounds healed well after bone migration， and the fracture end healed after autologous bone grafting and compression.In 2 cases， axial deviation of the displaced bone segment， and recovery after timely adjustment of the external fixator.2 cases showed osteogenesis insufficiency and healing after bone grafting.The Johner-Wruhs criteria showed 11 excellent and 3 good.And ankle functions showed 11 excellent， 2 good and 1 pass.
Conclusion
Ilizarov bone transfer technique yields benefits for tibia fracture with severe long open comminuted fracture， few operation times， short duration and good clinical effect.
To evaluate the clinical efficacy of collagenase ointment combined with hydrogel dressing in the treatment of deep partial-thickness burn wounds.
Methods
A total of 66 patients with deep partial-thickness burn wounds were admitted to Department of Burns， Tongren Hospital of Wuhan University & Wuhan Third Hospital from January 2022 to June 2023 who met the inclusion and exclusion criteria were enrolled as the study subjects.The patients were divided into observation group and control group according to random number table，with 33 patients in each group.The patients in the observation group received collagenase ointment combined with hydrogel dressing treatment， while the patients in the control group received iodine tincture vaseline gauze dressing treatment.The wound healing time， wound infection rate， necrotic tissue clearance rate， pain score， and modified Vancouver scar scale （mVSS） scores at 3 months and 12 months after treatment were recorded for both groups.
Results
The wound healing time in the observation group and the control group was （12.09±1.75）d and （12.97±1.88）d respectively， with no statistically significant difference （t=1.935， P=0.057）.No significant difference was found in wound infection rate between the two groups ［9.09%（3/33） vs 6.06%（2/33），P=1.000］.From day 5 to day 7 post-treatment，the necrotic tissue debridement rate in the observation group was （73.91±17.52）%， statistically higher than（58.91±13.30）% of the control group （t=3.916， P＜0.001）.From day 5 to day 7 post-treatment， the mVAS score during changing dressings was 1.94±1.17 in the observation group and 2.68±1.03 in the control group， with statistically significant difference （t= 3.475， P= 0.001）.At 3 months post-treatment， the thickness score on the mVSS scale in the observation group was 1.54±0.60， lower than 1.93±0.63 in the control group （t=2.198， P=0.032）， and the total mVSS score in the observation group was 8.73±1.71，lower than 9.85±1.65 in the control group， which was statistically different between the two groups（t=2.666，P=0.010）.At 12 months post-treatment， the total mVSS score in the observation group was 3.67±1.39， lower than 4.38±1.39 in the control group， with statistically significant difference （t=2.181， P=0.047）.There was no significant difference in sub-item scores of mVSS between the two groups（P＞0.05）.
Conclusion
The application of collagenase ointment combined with hydrogel dressing has good clinical efficacy in the treatment of deep partial-thickness burn wounds.It can effectively alleviate wound pain， reduce necrotic tissue， and inhibit scar hypertrophy.
To observe the effect of gelatin methacryloyl hydrogel loaded with exosomes from human adipose-derived stem cells on the proliferation and migration of human skin fibroblasts.
Methods
Human adipose-derived stem cells were isolated and cultured， and the expression of molecular markers on the surface was detected.Human adipose stem cell-derived exosomes were extracted by ultracentrifugation and identified by scanning electron microscopy and Nano-flow cytometry.Human skin fibroblasts were cultured， and immunofluorescence was performed to detect the internalization of the exosomes.The exosomes were added at concentrations of 1×107/ml， 1×108/ml， and 1×109/ml espectively to detect the effects of exosomes on the proliferation and migration of human skin fibroblasts.GelMA hydrogels were prepared at concentrations of 5%，10%，and 15%， and the microstructures of the hydrogels were observed by scanning electron microscopy and pore size was analyzed.The in vitro degradation rate of the hydrogels was measured.ELISA was used to detect the sustained-release rate of exosomes in the hydrogel.Human skin fibroblasts were co-cultured in the hydrogel， and live-dead cell staining was performed to detect the growth and proliferation of cells in the hydrogel.
Results
The electron microscopy and nanofluidic detection showed that the acquired particles were exosomes.Fluorescently labeled human adipose stem cell-derived exosomes could be internalized by human skin fibroblasts into the cytoplasm and nucleus.The concentrations of 1×107/ml，1×108/ml， and 1×109/ml of exosomes all promoted the proliferation and migration of human skin fibroblasts（F=3.579，P=0.021）.For proliferation， the effect of exosomes at concentrations of 1×108/ml and 1×109/ml was more substantial than that of 1×107/ml （P=0.048，P=0.005）.After 24 hours of treatment， there was no statistically significant difference in the effect of exosomes at concentrations of 1×108/ml and 1×109/ml on cell proliferation （P = 0.091， P = 0.083）.The in vitro degradation rate of GelMA hydrogel at concentrations of 5%， 10% and 15% decreased with the increase of concentration， the hydrogel at a concentration of 5% was better in releasing the exosomes in a slow and sustained manner.After culturing human skin fibroblasts in the 5% GelMA hydrogel， the cells grew and proliferated favorably in the hydrogel.
Conclusion
Human skin fibroblasts can internalize exosomes from human adipose-derived stem cells to promote their proliferation and migration.GelMA hydrogel with a concentration of 5% and loaded with exosomes from human adipose-derived stem cells （1×108/ml） can release exosomes slowly and continuously to promote the proliferation of human skin fibroblasts， and it can be used as a good bio-carrier for exosomes.
High-voltage electrical burns can often cause extensive soft tissue injury and severe vascular embolism， which can greatly damage the anatomical layers of the tissues.Especially when burns are combined with injuries such as muscle， tendon or nerves， the affected limbs may encounter a high risk of necrosis and difficult clinical repair.The high disability and amputation rates seriously affect the quality of life of patients.Repeated debridement， granulation cultivation and secondary skin grafting are widely used in traditional repairs， while complications are prone to occur， and poor aesthetics are one major drawback of those repairs.As microsurgical techniques develop， free perforator flap transplantation has become one of the important treatments for repairing soft tissue defects in electrical burns.The anterolateral thigh perforator flap has the strengths of constant blood vessels， a large resection range， good aesthetics， and small injury to the donor site.Therefore， it has been increasingly used in the repair of electric burn wounds.This article reviews the research progress on the application of the anterolateral thigh perforator flap in the treatment of electric burns.
Lung organoids are tissue analogues with a certain spatial structure formed by adult stem cells or pluripotent stem cells under 3D culture conditions， which can simulate the structure and function of human tissues to a certain extent.At present， lung organoids have been applied in the construction of lung injury disease models， especially in inhalation lung injury and lung injury caused by infectious diseases.This paper reviews the construction and application of organoids in lung injury disease models in recent years， in order to provide inspiration for the construction of more lung injury models.
With the development of society and the improvement of the medical system， the harm caused by chronic wounds such as long course of disease and high disability has gradually attracted people's attention.At present， the treatment means of chronic wounds are not clearly targeted， and the mechanism of their persistence is still not thoroughly studied.Because of its unique perspective， proteomics is expected to be an ideal tool for chronic wound research at this stage.The proteomics system with mass spectrometry as the core has become an important platform to study the mechanism of disease.This article reviews the progress of proteomics in chronic wounds such as diabetic foot， pressure ulcer， radiation and venous ulcer.
The healing of complex and hard-to-heal wounds is influenced by multiple factors，significantly impacting the patient's physical and mental health as well as social economic burden.Therefore，seeking innovative strategies to accelerate the healing process of these wounds is particularly important.Autologous platelet-rich plasma （PRP） has been widely recognized for its positive effect on wound healing，yet its clinical application is still limited due to various constraints.In contrast， allogeneic PRP， as a promising alternative approach，offers a new direction for clinical treatment.This review explores the mechanism of allogeneic PRP in promoting wound repair， presents clinical application examples in hard-toheal wounds， analyzes the safety and limitations of allogeneic PRP， and envisions its future development prospects.
Low back pain is a common clinical symptom with complex etiology.Intervertebral disc degeneration is considered to be one of the main causes of low back pain，but its mechanism is not well understood.Gut microbiota is an important part of the digestive tract which can affect host health through a range of metabolites and molecules，but whether gut microbiota is involved in disc degeneration has not been elucidated.Based on the summary of relevant literature， the correlation betweenintestinal flora and intervertebral disc degeneration and the mechanism of intestinal flora participating in intervertebral disc degeneration are summarized as follows.
Pathological cicatrix is common in plastic surgery and is usually categorized as hypertrophic scarring and keloids，the formation of which may result in hyperplasia and fibrosis of skin tissue.However， the formation of pathological scarring is an extremely complex process， mainly due to the excessive deposition of extracellular matrix （ECM） during wound healing.Pathological cicatrix leads to impaired quality of life and psychological well-being due to cosmetic deformities， itching， pain， and dyskinesia， but there are no definitive treatments to eliminate cicatrix.Stem cell-derived exosomes have potential influence as novel extracellular vesicles in scar formation and development.This paper is a review of the research progress of stem cell-derived exosomes in pathological cicatrix， including the mechanism of action in antiinflammatory effects， promotion of angiogenesis， and regulation of matrix remodeling for improving pathological cicatrix， as well as the current challenges and future directions.
