促进糖尿病患者足溃疡愈合的干预措施指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

创面处理的原则,包括清创、创面准备和使用涉及改变创面生理以促进愈合的新技术,在试图治愈慢性糖尿病相关的足溃疡时是至关重要的。此外,糖尿病相关的足溃疡的发病率和治疗成本不断上升,这就需要结合作为金标准的多学科治疗已有共识,运用高质量的疗效和成本效益证据来支持和加强慢性糖尿病相关的足溃疡创面愈合的干预措施。本指南是2023年国际糖尿病足工作组(IWGDF)针对促进糖尿病患者足溃疡愈合的干预措施的循证指南。它是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展、评价分级(GRADE)方法,以患者-干预-对照-结果(PICO)形式设计临床问题从而得出重要结果,进行系统综述,制定评判表汇总,并为每个问题撰写推荐和理由。每条推荐的形式都是基于系统综述中发现的证据,并使用GRADE评判汇总项目,包括理想和不理想的效果、证据的可信度、对患者的价值、所需的资源、成本效益、公平性、可行性和可接受性;我们制定的推荐由作者同意并由独立专家和利益相关者审查。根据系统综述和从证据到决策过程的结果,我们提出29条推荐。我们对使用干预措施改善糖尿病患者足溃疡的愈合提出了一些有条件的支持性推荐。这些推荐包括蔗糖八硫酸盐敷料的使用,对手术后的创面使用负压疗法,使用胎盘衍生产品,使用自体白细胞、血小板、纤维蛋白贴剂,使用局部氧疗,以及使用高压氧,但我们强调在任何情况下这些推荐应在单独应用最佳标准治疗无法治愈伤口且有资源可用于干预的情况下使用。这些关于创面愈合的推荐应该有助于提高糖尿病伴足溃疡患者的疗效,我们希望这些推荐能得到广泛的实施。然而,尽管作为推荐基础的许多证据的准确性正在提高,但总体上仍然很差,我们鼓励在这一领域进行更多、质量更好的试验,包括那些有关卫生经济学分析的试验。

Mesenchymal stem cells in wound healing:A bibliometric analysis as a powerful research tool

Bibliographic analysis is still very rarely used in experimental basic study papers.The comprehensive bibliometric analysis of scientific literature on research progress and challenges in stem cell therapy for diabetic chronic wounds,which was conducted in the work of Shi et al can be a case study and a source of valuable information for writing reviews and experimental papers in this field.Basic experimental studies on a role of mesenchymal stem cells(MSCs)in wound healing that are published in 2023-2024,such as Zhang et al in 2023,Hu et al in 2023,Wang et al in 2023 are certainly also subjects for applying this powerful tool to analyze current research,challenges and perspectives in this field.This is due to the fact that these studies have addressed a great variety of aspects of the application of MSCs for the treatment of chronic wounds,such as using both the cells themselves and their various products:Sponges,hydrogels,exosomes,and genetic constructions.Such a wide variety of directions in the field of study and biomedical application of MSCs requires a deep understanding of the current state of research in this area,which can be provided by bibliometric analysis.Thus,the use of such elements of bibliographic analysis as publication count by year and analysis of top-10 keywords calculated independently or cited from bibliometric analysis studies can be safely recommended for every basic study manuscripts,primarily for the“Introduction”section,and review.

Use of an immunocapture device to detect cytokine release in discrete brain regions

Production of proinflammatory cytokines in the central nervous system is a key process in the neuroinflammatory response to trauma,infection,and neurodegenerative diseases(Kumar,2019).These intercellular signaling molecules play multiple roles in the immune response in the central nervous system including the orchestration of the sickness response to innate immune perturbations in the brain(Dantzer et al.,2008).

糖尿病患者足溃疡减压指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

减轻组织的机械性压力在治愈糖尿病相关的足溃疡所需的多种干预措施中最为重要。本文是2023年国际糖尿病足工作组(IWGDF)发布的减压治疗促进糖尿病相关的足溃疡愈合的循证指南,也是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展和评价分级(GRADE)方法学,以患者-干预-比较-结局(patient-intervention-control-outcome,PICO)模式设计临床问题和重要结果,进行系统评价和Meta分析,制定评判表汇总,为每个问题编写推荐和理由。每项推荐都是基于系统综述中发现的证据,在无证据情况下则采用专家意见,以及对判断项目的GRADE等级总结进行仔细权衡,包括可预期和不可预期的影响、证据的确定性、患者价值、所需资源、成本效益、公平性、可行性和可接受性。为了治愈糖尿病患者神经性前足底或中足底溃疡,要使用不可拆卸的齐膝高减压装置作为首选减压干预措施。如果患者存在对不可拆卸减压装置的禁忌证或不能耐受,考虑使用可拆卸齐膝(或踝)高减压装置作为减压干预措施的第二选择。如果无可用的减压装置,考虑使用合适的鞋具结合毡制泡沫作为减压干预措施的第三选择。如果这种非手术减压治疗不能治愈前足底溃疡,可以考虑跟腱延长术、跖骨头切除术、关节置换术或跖骨截骨术。为了治疗继发于屈趾畸形的神经性足底或小趾远端溃疡,可行趾屈肌腱切开术。为了促进后足、非足底或并发感染或缺血的溃疡的愈合,提出了进一步的推荐。所有推荐都已在减压临床路径中进行了总结,以帮助促进本指南在临床实践中的实施。这些减压推荐将帮助医务人员为糖尿病相关的足溃疡患者提供最佳的治疗和预后,降低患者感染、住院和截肢的风险。

Alpha2-adrenergic receptor activation reinstates motor deficits in rats recovering from cortical injury

Norepinephrine plays an important role in motor functional recovery after a brain injury caused by ferrous chloride.Inhibition of norepinephrine release by clonidine is correlated with motor deficits after motor cortex injury.The aim of this study was to analyze the role ofα-adrenergic receptors in the restoration of motor deficits in recovering rats after brain damage.The rats were randomly assigned to the sham and injury groups and then treated with the following pharmacological agents at 3 hours before and 8 hours,3 days,and 20 days after ferrous chloride-induced cortical injury:saline,clonidine,efaroxan(a selective antagonist ofα-adrenergic receptors)and clonidine+efaroxan.The sensorimotor score,the immunohistochemical staining forα-adrenergic receptors,and norepinephrine levels were evaluated.Eight hours post-injury,the sensorimotor score and norepinephrine levels in the locus coeruleus of the injured rats decreased,and these effects were maintained 3 days post-injury.However,20 days later,clonidine administration diminished norepinephrine levels in the pons compared with the sham group.This effect was accompanied by sensorimotor deficits.These effects were blocked by efaroxan.In conclusion,an increase inα-adrenergic receptor levels was observed after injury.Clonidine restores motor deficits in rats recovering from cortical injury,an effect that was prevented by efaroxan.The underlying mechanisms involve the stimulation of hypersensitiveα-adrenergic receptors and inhibition of norepinephrine activity in the locus coeruleus.The results of this study suggest thatαreceptor agonists might restore deficits or impede rehabilitation in patients with brain injury,and therefore pharmacological therapies need to be prescribed cautiously to these patients.

探索大数据时代的航空维修之路

大数据技术应用于航空维修企业可以使企业实现客观的量化管理,对外洞察商机主动创造市场,对内科学管理高质、高效释放产能从而大幅提升企业的管理能力。通过对大数据平台的搭建清晰地勾画出未来航空维修的新景象以及智能维修作业的发展趋势,在航空维修的生产过程中高度的人机融合生产模式将翻开我国航空维修业的高科技、高智能的新篇章.

飞机维修计划和机务维修人为因素的若干研究

本文对干扰飞机维修计划和机务维修质量的多样化人为因素进行研究,具体是对飞机维修计划内涵有一定的认识以后,对飞机维修计划和机务维修的人为因素进行分别论述,例如在飞机维修计划维修卡编写环节以及工卡的执行进程中的人为因素,机务维修中机务工作者自体原因以及维修保障与管理的原因等,希望在提升飞机维修计划和机务维修工作效率方面有所帮助。

高校排名

介绍全球各主要媒体和学术机构的排行榜,收集归纳各方面对排行榜的反应和评论,分析排行榜对各方面的作用和影响。着重剖析各排行榜所存在的问题,以及由于排行榜引发的各校之间的不健康竞争等。并列举各种原因,说明为什么各个质量保证机构一般都不做排行榜。同时,也指出公众对质量保证机构及其工作非常陌生,质量论证对公众的作用极小。而排行榜却以通俗的形式容易为公众所接受。如果大学的质量靠排行榜设置的标准来评判其好坏,并力求符合这些标准的话,那么,这样发展下去,我们究竟是离开优质教育更近了,还是更远了呢?

S-adenosyl-methionine decreases ethanol-induced apoptosis in primary hepatocyte cultures by a c-Jun N-terminal kinase activity-independent mechanism

AIM： To determine the role of c-Jun N-terminal kinase （JNK） activity in ethanol-induced apoptosis and the modulation of this signaling cascade by S-Adenosylmethionine （AdoMet）. METHODS： Primary hepatocyte cultures were pretreated with 100 IJmol/L SP600125, a selective JNK inhibitor, 1 mL/L DMSO or 4 mmol/L AdoMet and then exposed to 100 mmo/L ethanol. Hepatocyte apoptosis was determined by the TUNEL and DNA ladder assays. JNK activity and its inhibition by SP600125 and AdoMet were determined by Western blot analysis of c-jun phosphorylation and Bid fragmentation. SP600125 and AdoMet effects on the apoptotic signaling pathway were determined by Western blot analysis of cytochrome c release and pro-caspase 3 fragmentation. The AdoMet effect on glutathione levels was measured by EIIman＇s method and reactive oxygen species （ROS） generation by cell cytometry. RESULTS： The exposure of hepatocytes to ethanol induced JNK activation, c-jun phosphorylation, Bid fragmentation, cytochrome c release and pro-caspase 3 cleavage; these effects were diminished by SP600125, and caused a significant decrease in ethanol-induced apoptosis （P〈 0.05）. AdoMet exerted an antioxidant effect maintaining glutathione levels and decreasing ROS generation, without a significant effect on JNK activity, and prevented cytochrome c release and pro-caspase 3 cleavage.CONCLUSION： The JNK signaling cascade is a key component of the proapoptotic signaling pathway induced by ethanol. JNK activation may be independent from ROS generation, since AdoMet which exerted antioxidant properties did not have a significant effect on JNK activity. JNK pathway modulator agents and AdoMet may be components of promising therapies for alcoholic liver disease （ALD） treatment.

国际糖尿病足工作组:糖尿病足溃疡减压指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

1999年,国际糖尿病足工作组(IWGDF)根据循证医学证据发表了采用减压治疗促进糖尿病足溃疡愈合的预防和管理指南,这一版指南是在此基础上的更新。我们遵循GRADE方法学,采用患者-干预-比较-结果(PICO)模式设计临床问题和关键的重要结局,对医学科学文献进行系统评价分析后撰写了建议并阐述其理由。这些建议是基于系统评价、专家意见(尚无有效证据时)的基础上建立,并在患者依从性、可行性、实用性以及干预的成本等方面进行了利弊权衡。针对糖尿病患者前足或中足底的溃疡愈合,我们建议不可拆卸齐膝高减压装置作为减压治疗的首选。若出现禁忌或患者不耐受不可拆卸减压装置,则可拆卸齐膝高和齐踝高减压装置可作为二线或三线减压治疗方法。合适的鞋袜结合泡沫毡垫可被视为四线减压治疗选择。如果非外科手术减压失败,我们建议通过外科减压干预以促进跖骨头和足趾溃疡愈合。我们还增加了采用减压治疗促进合并感染、缺血的复杂足溃疡和足跟溃疡愈合的新的推荐意见。减压是促进糖尿病神经性足底溃疡愈合诸多干预措施中最重要的手段。遵循这些建议将帮助医务人员和团队,为那些具有感染、住院和截肢风险的糖尿病足溃疡患者提供更好的治疗。

THE STUDIES ON WATERLOGGING DAMAGE IN JIANGHAN PLAIN USING DEM

The waterlogging damage is the pit to agriculture in plain and lake region. This damage is related to the groundwater, ancient lakes, soil, land use and negative landforms, the conventional technique is adopted to the study of this damage. In this paper, we suggest a new technical method, the technique is based on DEM, to study this problem. The DEM is developed on the ECLIPSE MV/ 10000 AOS/ VS system, and the estimation model of waterlogging loss is built on the historical data of the test region in Jianghan Plain. and then, the rice waterlogging loss of test region is estimated by them.

Non Convulsive Status Epilepticus: An Elusive Diagnosis

Absence status is the most common form of non-convulsive status epilepticus and is characterized by confusion with varying degrees of memory loss and cognitive impairment. Patients and Method: Three children were sent to neurological consultation due to behavioral alterations and a prolonged confused state;they were hospitalized and treated with sodium diphenylhydantoinate (DPH) IV at a dose of 10 mg/Kg. Results: The duration of symptoms varied from 6 months to 10 days. All three patients presented with global mental alterations, showing slowness in response and action. The electroencephalogram showed a pattern of slow, generalized stem and poly-stem-wavelengths of 3 - 4 Hz, which were registered for one hour. After the DPH bolus, the attack spontaneously ended in the 3 patients and upon examination all three presented with amnesia of the events occurring during the attack. In the follow-up, two of the patients did not experience further episodes and they showed normal scholastic achievement. The third patient however, after suffering a 6-month status epilepticus, failed the school year and finished his elementary education until the age of 15, experiencing similar difficulties with his secondary education. Discussion: Non-convulsive status epilepticus is more difficult to diagnose mainly because the manifestations are predominantly psychiatric and can be confused with other diseases or with an overdose of anti- convulsive drugs. A prolonged state of mental confusion, with no other explanation, should alert the attending physician to take an electroencephalogram in order to confirm the diagnosis. In our patients, DPH immediately controlled paroxysmal activity. We can therefore conclude that the problem is not in the treatment, but rather in making the correct diagnosis.

Effects of Fiber Volume on Modal Response of Through-Thickness Angle Interlock Textile Composites

Prior static studies of three-dimensionally woven carbon/epoxy textile composites show that large interlaminar normal and shear strains occur as a result of layer waviness under static compression loading. This study addresses the dynamic response of 3D through-thickness angle interlock textile composites, and how interaction between different layer waviness influences the modal frequencies. The samples have common as-woven textile architecture, but they are cured at varying compaction pressures to achieve varying levels of fiber volume and fiber architecture distortion. Samples produced have varying final cured laminate thickness, which allows observations on the influence of increased fiber volume (generally believed to improve mechanical performance) weighed against the increased fiber distortion (generally believed to decrease mechanical performance). The results obtained from this study show that no added damping was developed in the as-woven identical panels. Furthermore, a linear relation exists between modal frequency and thickness (fiber volume).

隧道双色温智能照明方案设计

在现有隧道照明控制(含调光)系统基础上,增加照明灯具双色温控制功能,不仅能实现节能减排,还可以根据不同环境实现灯具不同色温的混光调节,为隧道交通提供最佳的安全照明方式。

Sol-Gel Silica Matrix as Reservoir for Controlled Release of Paracetamol: Characterization and Kinetic Analysis

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are usually suitable candidates for the development of drug delivery devices. Sol-gel chemistry represents an easy method to obtain porous silica nanoparticles. Mesoporous silica nanomaterials have been widely used for drug delivery purposes. In this work we synthesized silica based materials using two molar alkoxide:water ratios 1:4 and 1:8, incorporating paracetamol to develop a nano-sized matrix for controlled release purposes. The samples exhibited different values for surface area, porosity, particle size and distinct punctual defects. Infrared and UV-visible spectroscopic studies were carried out to demonstrate the effect of water concentration and the adequate incorporation of paracetamol molecules. Nitrogen adsorption characterization was realized and the estimated BET surface values were from 532 to 825 m2/g. Kinetic analysis of drug release profiles was performed using the hyperbola model. Transmission electron micrographs showed that all the materials formed aggregates of small particles with size between 10 - 60 nm. Mesoporous SiO2 materials were proved to be a suitable system for controlled release of paracetamol.

STUDY ON HEMODYNAMICS OF ERECTION IN DIABETIC ERECTILE DYSFUNCTION

Objective To study the cavernosa hemodynamics in diabetic erectile dysfunction ( ED).Methods 22 diabetic and 35 psychic ED patients were studied by intracavernosum injection of a mixture papaver-ine and phentolamine (30/1mg) to assess the hemodynamics changes of the corpus cavernosum by means of colour duplex ultrasonography. Results The average hemodynamics data of the diabetic ED patients vs that of the psy-chogenic ED patients in terms of peak flow velocity (PFV):20. 06±7.15cm/s vs 35. 82±9. 41cm/s, end diastolic velocity (EDV) : 8. 82±0. 35cm/s vs 5. 51±0. 42cm/s,artery diameter (Ad) : 0. 78±0. 25cm vs 1. 01±0. 42cm, vein diameter ( Vd) : 1.05±0. 32mm vs 1.21±0. 45mm, resistance index(RI) : 0. 72±0. 28 vs 0. 98±0. 31,mean velocity of artery (MV):6. 71±0. 27cm/s vs 10. 31±3. 32cm/s, dorsal deep vein flow(DDVF) : 28. 81±6. 32cm/ s vs 25. 74±0. 58cm/s. Stasticstical differences existed in PFV, Ad,RI and MV(P <0. 01). The arterial wall is thick and rigid in diabetic ED patients. Conclusion Atheroscleorsis and veno-occlusive dysfunction of the corpus cavernosum are essential to the development of diabetic ED.

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior,law and human rights

The new prevalence data regarding the estimated global number of human immunodeficiency virus positive (HIV+) cases,i.e.,including people who are either aware or unaware of their HIV infection in 2010,lead many to wonder why the increase in incidence has reached today’s unprecedented level and escalated within such a short time.This,in spite of prevention campaigns in countries affected by HIV/acquired immune deficiency syndrome (AIDS) with their urgent messages aimed at preventing HIV transmission by promoting changes in individual’s behavior.This article analyzes the background of the prevention strategies,in particular their political,social and legal concepts in terms of human rights,and reveals traits of human behavior not considered thus far.A radical reappraisal is necessary,at social and legislative levels,as well as options additional to current concepts.When ethical issues come up,they become blamed for outmoded moralistic positions.However,ignoring the reality has led to dire consequences from prioritizing individual human rights over society’s collective need to prevent the spread of HIV.

Na,K-ATPase as a target for endogenous cardiotonic steroids:What’s the evidence?

With an exception of few reports,the plasma concentration of ouabain and mari-nobufagenin,mostly studied cardiotonic steroids(CTS)assessed by immunoassay techniques,is less than 1 nM.During the last 3 decades,the implication of these endogenous CTS in the path-ogenesis of hypertension and other volume-expanded disorders is widely disputed.The threshold for inhibition by CTS of human and rodent a1-Na,K-ATPase is~1 and 1000 nM,respectively,that rules out the functioning of endogenous CTS(ECTS)as natriuretic hormones and regulators of cell adhesion,cell-to-cell communication,gene transcription and transla-tion,which are mediated by dissipation of the transmembrane gradients of monovalent cat-ions.In several types of cells ouabain and marinobufagenin at concentrations corresponding to its plasma level activate Na,K-ATPase,decrease the[Na^(+)]i;/[K^(+)]i;-ratio and increase cell pro-liferation.Possible physiological significance and mechanism of non-canonical Na^(+)/K^(+)-depen-dent and Nai^(+)/Ki^(+)independent cell responses to CTS are discussed.