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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Objective:To explore a method for detecting recombinant human Annexin A11 (ANXA11) in serum exosomes of pancreatic cancer patients, and then primarily evaluate the clinical value of ANXA11 in pancreatic cancer patients.Methods:A prospective study was conducted and serum specimens from 70 patients diagnosed with PC, 15 patients diagnosed with benign pancreatic mass and 70 patients diagnosed with pancreatitis from the Affiliated Hospital of Nantong University were collected from December 2016 to July 2019. 70 healthy subjects during the same period were selected as control group. The abundance of ANXA11 in serum and exosomes-free serum were detected through parallel reaction monitoring (PRM) basing on high-resolution, high-precision mass spectrometer. Dot immunoblotting created by ourselves for detecting ANXA11 in exosomes and then the methodological evaluation were carried out. Levels of ANXA11 in exosomes in all subjects were statistically analyzed. Moreover, the areas under the curve (AUC) of receiver operating characteristic (ROC) curves were adopted to evaluate the diagnostic efficacy of ANXA11, CA19-9, CEA on PC. The relationship between ANXA11 and clinicopathological parameters as well as prognosis of PC patients was analyzed in the next moment. For analysis, the Mann-Whitney U test was used for comparing between either two groups, and the kruskal-wallis test was used for comparison among four groups. Results:The detection of serum exosome ANXA11 has high sensitivity and repeatability by the method of self-established dot immunoblotting. ANXA11 increased most significantly in the PC group, and the difference was statistically significant ( Hc=58.079, P<0.01) compared with other three groups. ROC curve analysis showed that the diagnostic performance of ANXA11(area under the curve (AUC=0.836) was higher than CEA (AUC=0.656) and equal to CA19-9 (AUC=0.870). The combination of ANXA11 and CA19-9 could improve the sensitivity of diagnosing PC and maintain good specificity. The level of serum exosome ANXA11 before treatment in PC patients was not related to age, gender, tumor size, tumor growth site, lymph node metastasis, distant metastasis and TNM stage ( Z values are 0.052,-0.285,-0.402,0.324,0.888,0.658,1.734, P>0.05). Furthermore, during the 10th day after surgical treatment, the level of ANXA11 showed no statistical difference compared with that before surgery ( Z value is -1.569, P=0.12). The survival time of PC patients was related to the presence of lymph node metastasis, distant metastasis, TNM staging and treatment protocols (χ 2 values are 9.354,6.086,9.389,16.998, P<0.05), while had no correlation with levels of CEA, CA19-9 and ANXA11 (χ 2 values are 1.516, 0.011, 0.159, P>0.05). Conclusions:This study successfully established an original method for detecting ANXA11 levels in serum exosomes of human. Serum exosomes ANXA11 combined with CA19-9 could improve the diagnostic sensitivity of PC.
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Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.
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Objective To investigate the therapeutic efficacy of tiotropium bromide powder inhalant combined with meglumine adenosine cyclophosphate in the treatment of acute exacerbation of chronic pulmonary heart disease.Methods A total of 148 cases of acute exacerbation of chronic pulmonary heart disease were divided into observation group (n =74) and control group (n =74).The observation group received tiotropium bromide powder inhalant combined with meglumine adenosine cyclophosphate,while the control group was given meglumine adenosine cyclophosphate.Results Before treatment,the forced expiratory volume in one second(FEV1),forced vital capacity(FVC),arterial oxygen tension(PaO2),arterial carbon dioxide partial pressure(PaCO2) and pH of the observation group were no significant differences [(1.27 ±0.44)L vs (1.24 ±0.47)L,(2.49 ±0.74)L vs (2.43 ±0.77) L,(51.6 ±6.6) mmHg vs (51.2 ±6.7) mmHg,(69.1 ± 8.4) mmHg vs (69.5 ± 8.7) mmHg,7.27 ± 0.03 vs 7.26 ± 0.04,P ＞ 0.05].After treatment,The FEV1,FVC,PaO2,PaCO2 and pH were significant differences between the 2 groups[(1.45 ±0.39)L vs (1.31 ±0.41)L,(2.71 ±0.63)L vs (2.49 ±0.54)L,(72.8 ±5.3) mmHg vs (62.5 ±6.2)mmHg,(47.7±5.7)mmHgvs (56.2±7.2)mmHg,7.34±0.02 vs7.31±0.03,t =2.13,2.28,10.86,-12.65,7.16,P ＜0.05].Before treatment,the Ⅰ ～ Ⅳ NYHA cardiac functional grading were no significant differences between the 2 groups(0,17.6％,47.3％,35.1％ vs 0,18.9％,44.6％,36.5％,P ＞0.05).After treatment,theⅠ ～ Ⅳ NYHA cardiac functional grading of the observation group were 25.7％,44.6％,20.3％,9.4％ respectively,and the NYHA cardiac functional grading of the observation group was significantly better than that of the control group(20.3％,27.0％,36.5％,16.2％,t =2.27,P ＜0.05).Conclusions The tiotropium bromide powder inhalant combined with meglumine adenosine cyclophosphate showed good therapeutic efficacy in the treatment of acute exacerbation of chronic pulmonary heart disease,and this combined treatment program is able to improve the heart and lung function simultaneously.