Objective

To construct the rehabilitation care intervention plans for severe and extremely severe burn patients based on multiple perspectives， provide nursing basis for improving patients'quality of life during the rehabilitation period.

Methods

Based on the nursing program theory， welfare diversity theory， and ABC-X model， a preliminary rehabilitation care intervention plan for severe and extremely severe burn patients was developed through literature review and semi-structured interviews.The Delphi method was used for two rounds of expert consultations and formed the final intervention plans after summary.

Results

The response rates for the first and second rounds of questionnaires was 93.75% and 100%， respectively.The kendall's coefficient of concordance of expert consultations in the second round were 0.163-0.195 （P＜0.05）.The coefficients of variation of the indexes in the second round was＜0.25.The rehabilitation care intervention plans for severe and extremely severe burn patients were constructed，consisting of 61 items in four dimensions：burn rehabilitation assessment， rehabilitation care plan，rehabilitation care implementation， and rehabilitation care evaluation.

Conclusion

Multidimensional construction of rehabilitation care intervention plans for severe and extremely severe burn patients can provide more scientific， clear， and precise guidance for clinical nursing staff and patients， thereby improving the rehabilitation efficacy and quality of life of patients.

Macrophage-myofibroblast transformation（MMT） refers to pathological process in which macrophages transdifferentiate into myofibroblast （MFB） in specific inflammatory or injury microenvironments.Recent studies have identified MMT as a significant biological phenomenon in fibrotic diseases， involving intricate cellular interactions and activation of diverse signaling pathways.This article reviews the molecular mechanisms and potential therapeutic targets of MMT in fibrotic diseases of organs such as the kidney， heart，and lung， with the aim of providing new directions for the mechanistic research and targeted treatment of fibrotic diseases.

Wounds refer to the loss or disruption of the integrity of the skin or mucous membranes caused by various factors such as accidents，surgery，pressure，or disease.Wound dressings act as temporary skin substitutes following tissue damage and are essential therapeutic materials in wound management.Compared to traditional dressings， new dressings not only effectively cover wounds， absorb exudate， and maintain moisture but also possess various functions such as antimicrobial action， infection prevention，autolytic debridement， pain relief， and promotion of wounds healing， making them widely applicable in various clinical settings.Currently， there are many types of wound dressings available for clinical selection and under development， each with distinct advantages， disadvantages， and clinical indications.The application of wound dressings should be based on clinical needs， considering factors such as the nature of the wounds， patient symptoms， and cost-effectiveness.This article reviews and analyzes the characteristics，clinical applications， and research progress of the main used and newly developed types of new dressings，aiming to provide guidance and direction for the selection and functional optimization of clinical wound dressings.

Recent advancements in anatomical research on the knee joint have expanded the understanding of the medial patellofemoral complex （MPFC）， a structure comprising ligamentous tissues connecting the femur to both the patella and the quadriceps tendon.The MPFC primarily functions to prevent lateral patellar dislocation， involving key components such as the medial patellofemoral ligament （MPFL）and the medial quadriceps-tendon femoral ligament （MQTFL）.With continuous progress in anatomical，biomechanical， and clinical research， surgical techniques for MPFC reconstruction have been refined.Nonetheless， there remains debate over whether simultaneous reconstruction of both MPFL and MQTFL is warranted for patellar dislocation cases， and no consensus has been reached regarding the optimal surgical strategy for MPFC reconstruction.This review aims to provide a comprehensive overview of current research advancements in MPFC.

Objective

To explore the hub genes related to inflammation injury that changed significantly during the development of non-alcoholic fatty liver disease （NAFLD）.

Methods

A total of 98 patients with NAFLD were selected from the GSE167523 dataset in the Gene Expression Omnibus （GEO）database to calculate the inflammatory indices by performing the gene set variation analysis （GSVA）.Two separate groups of high-inflammatory indices and low-inflammatory indices were set up for comparison purposes.Using the limma software package in R language to identify differentially expressed genes （DEGs）between the groups.ClusterProfile software package in R language was used for gene ontology （GO）enrichment analysis and Kyoto encyclopedia of genes and genomes （KEGG） enrichment analysis on DEGs.Hub genes were screened by protein-protein interaction （PPI） network analysis using STRING database.Additionally， gene expression levels were validated in the GSE89632 and GSE130970 datasets.Used the ROC curves to evaluate the diagnostic ability of them and performed the miRNA and transcription factor regulatory network analysis.

Results

A total of 308 DEGs were identified， including 243 upregulated genes and 65 downregulated genes.The enrichment analysis results showed that these DEGs were mainly enriched in chemokine signaling pathways， interactions between viral proteins and cytokines， as well as cytokine receptor interactions.PPI network analysis showed that the key modules containing 16 genes， including TOP2A， MKI67，CDC20，DLGAP5，and MCM10.ROC curves analysis implied that these 16 hub genes were potential biomarkers of NAFLD.Among them， the expression of 11 hub genes showed statistically significant differences between control group and NAFLD group in the GSE89632 dataset， and between high inflammation indices group and low inflammation indices group in the GSE130970 dataset （P ＜0.05）.

Conclusion

Inflammation-related hub genes， such as TOP2A， CDC20， and HJURP， show promise as potential diagnostic and therapeutic targets for NAFLD.

Objective

To investigate the preparation process and clinical effect of gel platelet-rich plasma （PRP）in the treatment of skin ulcer in patients with systemic lupus erythematosus（SLE）.

Methods

A total of 35 female patients with systemic lupus erythematosus （SLE） accompanied by superficial ulcers，admitted to Department of Wound Repair，Xuzhou Renci Hospital from September 2017 to September 2024，were enrolled.The average age was 32 years （range 25-53 years）， and the duration of ulcers before admission ranged from 1 week to 7 months.The causes of ulcer formation were as follows.In 32 cases， the ulcers developed due to skin abrasions causedby trauma，which subsequently expanded into larger wounds.In 1 case， the ulcer resulted from necrosis and non-healing of the flap at the donor site of a hallux toenail flap used for middle finger reconstruction.And in 2 cases， the ulcers on the buttocks were caused by spontaneous rupture.On admission， the wound area ranged from 2.0 cm×3.5 cm to 7 cm×7 cm， with no exposed bones or tendons observed on the wound surface.After admission， a systemic condition assessment was performed，and rheumatology specialists were consulted to adjust the SLE treatment regimen.Following surgical debridement of the skin ulcers， the wound surface was covered with PRP gel to promote granulation tissue growth and epidermal epithelialization.Simultaneously， the wounds were treated with advanced wound dressings according to the moist wound healing theory.

Results

All 35 patients were treated according to the study plan， without skin grafting or flap repair or other operations covering the wound surface， and the wounds healed smoothly.

Conclusion

In the treatment of ulcers in patients with SLE after surgical debridement， platelet-rich plasma gel is applied to cover the wound surface， and the growth rate of granulation tissue at the wound base is rapid.Subsequently， new dressings are used for wound care，demonstrating significant therapeutic efficacy.This treatment has relatively low surgical difficulty and cost，making it easy to popularize in clinical practice.

Objective

To analyze the risk factors and develop a nomogram-based predictive model for early acute kidney injury （AKI） in patients with severe burns.

Methods

A retrospective analysis was conducted on 337 patients with severe burns （≥30% TBSA） admitted to Senior Department of Burns and Plastic Surgery in the Fourth Medical Center of PLA General Hospital between January 2015 and December 2023.The dataset was randomly split into a training set （70%） and a validation set （30%） using a fixed random seed （1222） to ensure reproducibility.Least absolute shrinkage and selection operator （LASSO） regression and multivariate logistic regression analyses were used to identify predictive variables for constructing the early AKI risk nomogram.The model's discriminative ability， calibration， and clinical utility were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis （DCA）.

Results

Greater body weight， larger burn area of above third-degree， presence of shock on admission， prolonged time from injury to hospital admission， and higher blood glucose and white blood cell counts within 48 hours of admission were independent risk factors for early AKI in patients with severe burns.The nomogram model， based on these six variables， achieved AUC values of 0.828 （95%CI： 0.770-0.886） in the training set and 0.826 （95%CI： 0.743-0.909） in the validation set.The calibration curve analysis yielded P-values of 0.787 and 0.125， indicating good agreement between predicted and observed outcomes.DCA demonstrated that the nomogram model provided a high net clinical benefit.

Conclusion

The nomogram prediction model score based on body weight， burn area of above third-degree， whether shock occurred at admission， time from injury to hospital admission， and blood glucose and white blood cell counts within 48 hours of admission can be used to predict early AKI in severe burn patients.

Radiation-induced pulmonary fibrosis （RIPF） is a severe and often irreversible complication in patients undergoing radiotherapy for thoracic malignancies.The underlying mechanisms remain incompletely understood and involes the participation of multiple cells and molecules.This process begins with the direct damage of radiation to lung tissuces cells， leading to apoptosis of epithelial cells and endothelial cells and triggering local inflammation.These cytokines recruit immune cells， amplifying the inflammatory cascade.Central to RIPF pathogenesis is the activation of fibroblasts by transforming growth factor-β （TGF-β），leading to excessive collagen synthesis and extracellular matrix deposition.Furthermore， damaged cells release key signaling molecules， such as TGF-β， tumor necrosis factor-α （TNF-α）， platelet-derived growth factor（PDGF） and vascular endothelial growth factor （VEGF）， which initiate signal transduction pathways and activate downstream pathways such as TGF-β/Smad3， PI3K/Akt， MAPK， and NF-κB， driving the expression of fibrosis-related genes and promoting the occurrence and development of fibrosis.Understanding the molecular mechanisms of RIPF can provide a theoretical foundation for its diagnosis， treatment， and prognosis.

The microenvironment of chronic wounds exhibits multiple abnormalities， among which temperature dysregulation is a critical factor impeding wound healing.Chronic wounds typically manifest hypothermic conditions due to impaired blood supply and oxygenation， whereas pathological conditions such as infection and inflammatory responses may induce localized hyperthermia.Systematic investigation of thermal characteristics across various chronic wound types holds significant clinical value for early warning，precise assessment， and prognostic prediction.Elucidation of temperature-mediated influence mechanisms in wound repair and development of targeted temperature modulation strategies could provide the foundation for individualized therapeutic approaches tailored to distinct pathological stages of chronic wounds， ultimately providing novel strategies to enhance tissue regeneration.

Shock is one of the most common complications in the early stage of severe burns.Fluid management is the cornerstone of anti-shock treatment.Timely and adequate fluid resuscitation is crucial for preventing the occurrence of burn shock， improving systemic circulation perfusion， and reducing functional damage to vital organs.It directly determines the risk of subsequent complications and the success rate of treatment.This article summarizes the research progress in recent years on the dosage， composition， route，and related monitoring indicators of fluid resuscitation in burn shock， providing new ideas for the research on burn shock.

Objective

To evaluate the correlation between paraspinal muscle cross sectional area，muscle density，and fat fraction at different levels with spinal pelvic parameters in elderly women with lumbar spinal stenosis.

Methods

A retrospective analysis was conducted of the clinical and imaging data of elderly female patients with lumbar spinal stenosis who were hospitalized in the Department of Spine Surgery at Beijing Jishuitan Hospital， Capital Medical University from November 2021 to April 2023.Thoracolumbar kyphosis angle（TLK），lumbar lordosis（LL），sacral slope（SS），pelvic incidence（PI），and pelvic tilt（PT） were measured on preoperative standing lateral lumbar spine X-ray images.The intervertebral disc degeneration and spinal canal stenosis were assessed on MRI images.The paraspinal muscle area（PSMA），muscle density，and fat fraction（FF） at the T12，L3，and L5 levels were measured on quantitative computed tomography（QCT）.Spearman correlation analysis and multiple linear regression models were used to analyze the correlation between paraspinal muscle parameters at different levels and spinal pelvic angles.

Results

A total of 96 elderly women with lumbar spinal stenosis were included，with age of 67.50±4.72 years.Correlation analysis showed significant associations between PSMA，PSMD at T12，L3，and L5 levels，and FF at the L5 level with LL and SS（P＜0.05）.After adjustment for confounding variables，PSMA at the T12 level remained significantly associated with LL and SS（β=-0.740 and 0.529，P＜0.05）.PSMD at the L3 and L5 levels were significantly associated with LL（β=0.608 and 0.494，P＜0.05）.

Conclusion

The study finds that paraspinal muscle cross sectional area， muscle density， and fat fraction are associated with spinopelvic parameters in elderly female patients with lumbar spinal stenosis.Specifically， a decreased PSMA at the T12 level is identified as an independent factor for LL and SS compensation， whereas reduced muscle density at the L3 and L5 levels are independent factors for LL reduction.These findings highlight the need to address the potential risk of sagittal imbalance in patients with reduced thoracolumbar paraspinal muscle mass when diagnosing and treating spinal degenerative diseases.Additionally， in the conservative management of early-stage spinal degeneration，targeted strengthening of the lower lumbar paraspinal muscles and thoracic posterior extensors should be emphasized to help prevent or slow down lumbar curvature regression and the onset of sagittal imbalance.

Objective

To establish a global-local feature hierarchical fusion image classification network model，improve the reliability and accuracy of burn and scald wound depth assessment.

Methods

A total of 619 wound images of burn and scald patients who were admitted to the Department of Burn and Plastic Surgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were collected.Two burn physicians with more than 3 years of work experience independently annotated the images using the image annotation tool LabelMe， and cross validated with other physicians in the department.The image set was divided into a training set， validation set， and test set in a ratio of 7∶2∶1， and the training set was expanded to obtain 2 598 images.Designed and constructed a global-local feature hierarchical fusion network HFNet for pre-training， learned the basic features of images and transferred them to the collected burn image classification dataset.Improved classification accuracy through parameter optimization and compared the precision， recall， F1 score， and inference time of the HFNet model with ConvNeXt， Swin-Transformer，UniFormer， and BiFormer models to evaluate its performance.

Results

Testing results showed that the precision of the HFNet model in the classification tasks of first-degree， second-degree， and third-degree burn wounds was 93.53%， 94.08%， and 86.52%， respectively， with a mean of 91.63%.The recall rates were 91.99%， 89.89%， and 92.71%， respectively， with a mean of 91.69%.The F1 index was 93.56%， 90.96%，and 90.46%， respectively， with a mean of 91.66%.The average accuracy was 92.75%， 91.94%， and 89.51%，respectively， with an average accuracy of 91.40%.The confusion matrix showed that the accuracy of the HFNet model in the classification tasks of first-degree， second-degree， and third-degree burn wounds was 90%，92%， and 93%， respectively.Compared to models such as BiFormer， the HFNet model achieved higher precision with moderate inference speed， striking a good overall balance between accuracy and computational efficiency.

Conclusion

The HFNet model enhances the accuracy and efficiency of burn depth assessment，providing burn specialists with precise classification information to rapidly determine the severity of burn injuries.Additionally， the model enables the accumulation of high-quality classification data， supporting further model optimization.

Objective

To systematically evaluate the relationship between frailty index （FI） and postoperative complications after lumbar spinal surgery.

Methods

This article retrieved relevant studies about the relationship between FI and postoperative complications after lumbar spinal surgery from PubMed，Cochrane Library， Web of Science， EMbase， CINAHL， CNKI， VIP database， Wanfang Medical Database and China Biomedical Literature Database.The retrieval time limit was from the establishment of the database to January 1， 2025.Two researchers independently conducted literature screening， quality evaluation， and data extraction.Stata 18.0 software was used for meta-analysis.

Results

A total of 14 articles were included.Meta-analysis results showed that frail patients had a higher risk of any postoperative complications after lumbar spinal surgery （OR=1.67，95% CI：1.38～2.01，P＜0.001）， death （OR=9.33，95%CI：1.41～61.71，P＜0.001）， pulmonary complications （OR=3.09，95%CI：2.36～4.05，P=0.341）， urinary complications （OR=1.74，95%CI：1.08～2.83，P=0.044），cardiac complications （OR=2.99，95%CI：2.36～3.80，P=0.941）， cardiovascular disease （OR=2.94，95%CI：2.12～4.07，P=0.983），sepsis （OR=1.92，95%CI：1.61～2.29，P=0.473），surgical site infections （OR=1.51，95%CI：1.29～1.76，P=0.741），postoperative transfusion （OR=1.36，95%CI：1.17～1.59，P=0.289）， readmission （OR=1.59，95%CI：1.23～2.06，P=0.284） and reoperation （OR=1.36，95%CI：1.07～1.73，P=0.294）， but there was no statistically significant association between preoperative frailty and postoperative gastrointestinal complications （OR=0.86，95%CI：0.55～1.37，P=0.396）， delirium （OR=1.33，95%CI：0.93～1.91，P=0.480） and deep vein thrombosis （OR=1.10，95%CI：0.89～1.36，P=0.915）.

Conclusion

Frail patients have a significantly higher risk of postoperative complications after lumbar surgery compared to non-frail patients.Medical and nursing staff should pay attention to the screening of patients' frailty and intervene as soon as possible to improve the prognosis of patients.

Objective

To explore the therapeutic effect of repairing fingertip defects with a tibial flap of the second toe of the foot using an improved vein harvesting method.

Methods

From June 2020 to June 2023， 18 cases （18 fingers） of small-area finger defects in Department of Hand Surgery， Suzhou Ruihua Orthopedics Hospital were repaired using a lateral tibial flap of the second toe of the foot with an improved vein harvesting method.Among them， there were 12 males and 6 females， aged from 22 to 56 years， with an average age of 33 years.During the surgery， a free second toe tibial flap was used to repair the wound.The flap was harvested using a modified vein harvesting method， with the flap designed to be located on the lateral tibial side of the second toe of the foot.Compared to traditional surgical methods， there was no dorsal foot incision.The lateral or bottom vein of the toe was harvested as the return vein of the flap， and the recipient area was anastomosed end-to-end with the digital artery and subcutaneous vein.The harvested area of the skin flap was from 1.5 cm×1.0 cm to 2.5 cm×1.9 cm.5 cases of skin flap donor site were directly sutured， while the rest underwent free skin grafting from the lower leg.The postoperative follow-up was evaluated using the Michigan hand function questionnaire to assess the recovery of hand function， and total active motion （TAM） was used to evaluate the recovery of finger joint range of motion.

Results

All 18 skin flaps in this group survived without any vascular crisis.Postoperative follow-up ranged from 6 months to 2 years， with an average of 13 months.3 cases had slightly bloated skin flaps and underwent flap repair surgery three months after surgery， while the remaining skin flaps did not undergo plastic surgery.The two-point discrimination of the skin flap was from 12 to 14 mm.The incisions in the foot donor area and calf healed primarily， and the skin grafts in the donor area survived smoothly without contracture or ulceration.The scars in the foot donor area were small， and there were no significant functional impairments in the foot and calf donor areas.According to the Michigan hand function questionnaire evaluation criteria， 11 patients were very satisfied with the overall appearance of their hands， and 7 patients expressed satisfaction.According to the TAM evaluation criteria for finger mobility， 18 cases were rated as excellent.

Conclusion

The clinical efficacy of repairing finger tip defects with a lateral tibial skin flap of the second toe using an improved vein harvesting method is good， with advantages such as convenient harvesting， minimal foot injury， and small scar formation in the donor area.