IL-12p40 and sRAGE in serum correlate with chemically induced cleft palate in mice

Cleft palate (CP), a congenital defect in the oral and maxillofacial regions, is difficult to detect prenatally. This study investigated the correlation between differentially expressed proteins in serum and CP induced by all-trans retinoic acid (atRA) and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in mice. We studied 80 mice in the following groups: male mice (male; n = 6), nonpregnant female control mice (NP-CRL; n = 6), healthy pregnant controls (P-CRL; Con; n = 24), pregnant mice with CP induced by atRA (n = 24), or pregnant mice with CP induced by TCDD (TCDD; n = 20). Pregnant mice were given with atRA (100 mg/kg) or TCDD (40 μg/kg), or corn oil by oral gavage at E10.5. The serum samples were collected and eight proteins-including interleukin (IL)-12p40, IL-12p70, receptor for advanced glycation end products (RAGE), interferon (IFN)-γ, IFN-β, IL-10, leukemia inhibitory factor (LIF), and epiregulin-were detected by enzyme-linked immunosorbent assay. Placental tissues were immunostained for IL-12p40 and RAGE from stages E13.5 to E16.5. In P-CRL mice, serum IL-12p40 was significantly increased at E13.5 and declined over E14.5-E16.5. P-CRL had lower IFN-γ levels at E13.5 compared with NP-CRL. The CP groups showed lower concentrations of IL-12p40 at E13.5-E14.5 and clearly higher concentrations of soluble RAGE (sRAGE) at E13.5 when compared with P-CRL. IL-12p40 immunostaining clearly decreased in placental tissue sections obtained from E13.5 to E14.5 in both CP groups. These findings suggest that reduced levels of IL-12p40 and increased levels of sRAGE in serum may be correlated with chemically induced CP in mice, but further studies would be required to establish this.

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia

PURPOSE

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17 years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy.

METHODS

From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed.

RESULTS

All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15 min (8-25 min) for 557 unilateral hernias and 21 min (14-36 min) for 233 bilateral hernias. The mean postoperative stay was 20 h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42 months. No obvious scar was present postoperatively.

CONCLUSION

Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

New insights on the energy transfer mechanisms of Eu-doped CdS quantum dots

Eu-doped CdS quantum dots with the Eu dopant concentration in the range of 0.5–10% and zinc blende structure were successfully synthesized by a wet chemical method in the noncoordinating solvent.

MiR-128 promotes the apoptosis of glioma cells via binding to NEK2

OBJECTIVE

The aim of this study was to explore whether miR-128 could promote the apoptosis of glioma cells by targeting NIMA related kinase-2 (NEK2), thus participating in the occurrence and progression of glioma.

PATIENTS AND METHODS

Expression levels of miR-128 and NEK2 in glioma tissues and normal brain tissues were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relationship between miR-128 expression, tumor size and stage of glioma was analyzed. The effect of miR-128 on the apoptosis of glioma cells was detected by flow cytometry and Western blot, respectively. Dual-luciferase reporter gene assay was applied to verify the binding condition of miR-128 and NEK2. Meanwhile, rescue experiments were conducted to determine whether miR-128 could promote the apoptosis of glioma cells by targeting NEK2.

RESULTS

The expression level of miR-128 in glioma tissues was significantly lower than that of normal brain tissues. However, NEK2 was highly expressed in glioma tissues. MiR-128 expression was correlated to tumor size and malignant level of glioma, whereas not related to age and gender of glioma patients. Meanwhile, overexpression of miR-128 promoted the apoptosis of U87 cells, upregulated protein levels of cleaved Caspase-3 and BCL2-associated X (Bax), and downregulated B-cell lymphoma-2 (Bcl-2). Dual-luciferase reporter gene assay indicated that miR-128 directly bound to NEK2. Further rescue experiments suggested that NEK2 overexpression partially reversed the effect of miR-128 on the apoptosis of glioma cells.

CONCLUSIONS

Downregulated miR-128 inhibited the apoptosis of glioma cells via targeting NEK2.

Effect of bronchial artery embolisation on the management of tuberculosis-related haemoptysis

OBJECTIVE: To identify risk factors influencing outcomes of bronchial arterial embolisation (BAE) in tuberculosis (TB) related haemoptysis.METHODS: A cohort of 207 patients underwent BAE for TB-related haemoptysis between March 2014 and March 2018. The clinical data were reviewed. Follow-up ranged from 24 to 1749 days.RESULTS: Immediate haemostasis rate was 94.2%; aggressive pleural thickening (PT) was found to be a risk factor for haemoptysis (P = 0.000, OR 22.52). Cumulative recurrence-free rates were respectively 98.5%, 94.8%, 88.7%, 79.9%, 68.5%, 65.7% and 62.7% for 1, 3, 6, 12, 24, 36 and 48 months. Respectively 8 and 15 patients recovered from pneumonectomy and re-BAE. However, five patients required a third BAE. The Cox regression analysis indicated that aggressive PT (P = 0.000), diabetes mellitus (DM) (P = 0.018) and pulmonary fungal infection (PFI) (P = 0.001) were independent risk factors for recurrence. The death rate following BAE was 9.2%; aggressive PT was a risk factor (P = 0.000, OR 8.14).CONCLUSION: BAE is effective for TB-related haemoptysis in most cases. Aggressive PT, DM and PFI are independent risk factors influencing the prognosis following BAE. PFI and DM should be well managed, while proper surgery should be considered for aggressive PT.

Prevalence and incidence of systemic lupus erythematosus and associated outcomes in the 2009-2016 US Medicare population

OBJECTIVES

We aimed to update data on the prevalence and incidence of systemic lupus erythematosus (SLE) in the Medicare population and describe associated outcomes.

METHODS

This observational study used Medicare 20% random sample data 2007-2016 to estimate SLE prevalence and incidence 2009-2016. The study population included patients aged ≥18 years (stratified by <65 and ≥65 years) with Medicare fee-for-service coverage. The SLE definition was based on a published and validated algorithm. All-cause death, hospitalizations, and kidney disease incidence were defined for a prevalent SLE cohort 2011-2015. Unadjusted event rates during 5-year follow-up were reported per 100 patient-years.

RESULTS

The study included > 5 million eligible patients for each year 2009-2016. There were 19,518 (10,898, aged ≥65; 8620, aged <65) in 2016, extrapolated to 97,590 (54,490 aged ≥65; 43,100 aged <65) in the overall 2016 Medicare population. Age- and sex-adjusted prevalence rates (per 100,000 Medicare population) ranged from 301.1 in 2009 to 366.6 in 2016, all ages, and 184.0-239.9, ≥65 years. There were 2614 (1844 aged ≥65; 770 aged <65) incident patients in 2016; age-/sex-adjusted incidence rates (per 100,000 Medicare population) ranged from 46.9 in 2009 to 49.0 in 2016, all ages, and 37.5-40.8, ≥65. Five-year unadjusted mortality, elderly vs. younger, was 8.8 vs. 3.8, morbidity 34.5 vs. 32.4, and kidney disease incidence 19.8 vs. 18.0 per 100 patient-years.

CONCLUSIONS

Prevalence rates steadily increased while incidence was relatively stable 2009-2016. Our data should be interpreted with caution due to our elderly study population.

Clinical outcomes and predictive relapse factors of IgG4-related disease following treatment: a long-term cohort study

OBJECTIVES

The aim of this study was to investigate the predictive factors for relapse of IgG4-related disease (IgG4-RD) and observe the long-term clinical outcomes in patients with IgG4-RD.

METHODS

We included in the present analysis 122 patients who were newly diagnosed with IgG4-RD, treated with glucocorticoid (GC) monotherapy or GC and immunosuppressant combination therapy, and followed for at least 3 years. Clinical relapse, response and side effects were recorded.

RESULTS

The cumulative relapse rates of patients in this study were 10.66%, 22.95% and 27.87% at 12, 24 and 36 months, respectively. Complete drug withdrawal was an independent risk factor for disease relapse. Higher serum IgG4 concentrations, involvement of more organs, higher IgG4 RI scores and elevation of eosinophils at baseline were closely associated with disease relapse. Re-elevation of serum IgG4 concentrations and low GC maintenance dosage during the follow-up period were significantly associated with clinical relapse. The GC dosage should be more than 6.25 mg day^-1 as monotherapy during the maintenance stage; moreover, combining with immunosuppressants can reduce the GC dosage. Adding GC or immunosuppressants for patients with re-elevation of serum IgG4 levels could prevent later disease relapse. No serious complications were noted during long-term follow-up.

CONCLUSIONS

The combination of GC with immunosuppressants was more effective than GC monotherapy during the steroid tapering and maintenance stages. Higher serum IgG4 levels, involvement of more organs, higher IgG4 RI scores, history of allergy, eosinophil elevation at baseline, re-elevation of serum IgG4 levels and lower GC maintenance dosage at follow-up might be predictive of relapse.

Smart identification of psoriasis by images using convolutional neural networks: a case study in China

BACKGROUND

Psoriasis is a chronic inflammatory skin disease, which holds a high incidence in China. However, professional dermatologists who can diagnose psoriasis early and correctly are insufficient in China, especially in the rural areas. A smart approach to identify psoriasis by pictures would be highly adaptable countrywide and could play a useful role in early diagnosis and regular treatment of psoriasis.

OBJECTIVES

Design and evaluation of a smart psoriasis identification system based on clinical images (without relying on a dermatoscope) that works effectively similar to a dermatologist.

METHODS

A set of deep learning models using convolutional neural networks (CNNs) was explored and compared in the system for automatic identification of psoriasis. The work was carried out on a standardized dermatological dataset with 8021 clinical images of 9 common disorders including psoriasis along with full electronic medical records of patients built over the last 9 years in China. A two-stage deep neural network was designed and developed to identify psoriasis. In the first stage, a multilabel classifier was trained to learn the visual patterns for each individual skin disease. In the second stage, the output of the first stage was utilized to distinguish psoriasis from other skin diseases.

RESULTS

The area under the curve (AUC) of the two-stage model reached 0.981 ± 0.015, which outperforms a single-stage model. And, the classifier showed superior performance (missed diagnosis rate: 0.03, misdiagnosis rate: 0.04) than 25 Chinese dermatologists (missed diagnosis rate: 0.19, misdiagnosis rate: 0.10) in the diagnosis of psoriasis on 100 clinical images.

CONCLUSIONS

Using clinical images to identify psoriasis is feasible and effective based on CNNs, which also builds a solid technical base for smart care of skin diseases especially psoriasis using mobile/tablet applications for teledermatology in China.

Body mass index cut-off points for predicting chronic non-communicable disease should differ by gender and age group

OBJECTIVES

The objective of this study to determine whether body mass index (BMI) in different genders and age groups need different thresholds when predicting chronic non-communicable diseases (CNCDs).

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data were obtained from the China Health and Nutrition Survey conducted in 2009. Sequential sample cluster analysis was used to group age according to BMI. Propensity score matching was used to eliminate the influence of age. Receiver operating characteristic curve based on gender and age group was used to evaluate the cut-off values and efficiency of BMI in each group.

RESULTS

A total of 8469 individuals were enrolled in this study. Results of sequential sample cluster analyses showed age was divided into three groups: 18-39, 40-59 and 60-99 years. There were significant differences in the distribution of BMI among the three groups for both males and females (P < 0.001). Statistical differences were observed in the distribution of BMI between genders in the 18-39- and 60-99-year-old age groups (P < 0.001). For men, the cut-off values of BMI were ≥25 kg/m², ≥24 kg/m² and ≥23 kg/m² in the 18-39, 40-59 and 60-99 years old groups, respectively; for women, the corresponding cut-off points were ≥25 kg/m², ≥23 kg/m² and ≥25 kg/m² in groups.

CONCLUSIONS

The thresholds for BMI might be different between gender and age group. In addition, it might not be suitable to determine cut-off values of BMI to predict CNCDs for people aged ≥60 years.

Vascular endothelial growth factor A/Vascular endothelial growth factor receptor 2 axis promotes human dental pulp stem cell migration via the FAK/PI3K/Akt and p38 MAPK signalling pathways

AIM

To investigate the effects of vascular endothelial growth factor A (VEGFA) and the underlying molecular mechanisms on the migration of human dental pulp stem cells (hDPSCs).

METHODOLOGY

The expression of VEGFA in inflammatory pulp tissue and lipopolysaccharide (LPS)-stimulated dental pulp cells was examined by immunofluorescence staining and qRT-PCR. The migration of hDPSCs was detected using transwell migration and wound healing assays. The activation of FAK, PI3K, Akt and p38 signalling was evaluated by Western blot analysis. Silence RNA (siRNA) technology was utilized to knockdown the expression of VEGFR1 (Flt-1) and VEGFR2 (Flk-1/KDR). PF573228 (inhibitor of FAK), LY294002 (inhibitor of PI3K), SB203580 (inhibitor of p38) and SU5416 (inhibitor of VEGFR2) were employed to investigate the effect of VEGFA on the migratory mechanism of hDPSCs. Data were analysed statistically using the Student's t-test or one-way ANOVA.

RESULTS

The expression levels of VEGFA in inflammatory pulp tissue in vivo and LPS-stimulated dental pulp cells in vitro were significantly greater than those in the control groups (P < 0.05). Vascular endothelial growth factor A promoted the migration of hDPSCs in a concentration-dependent manner. Several signalling pathways, including FAK, PI3K, Akt and p38, were activated by VEGFA in a dose- and time-dependent manner in hDPSCs. The VEGFA-induced migration of hDPSCs was significantly inhibited with drug inhibitors such as PF573228, LY294002, SB203580 or SU5416 (P < 0.05). These signalling pathways activated by VEGFA stimulation were significantly suppressed by pre-treatment with inhibitor of VEGFR2 (SU5416) or transfection with siRNA of VRGFR2 (P < 0.05) but not VEGFR1 siRNA.

CONCLUSIONS

Vascular endothelial growth factor A/VEGFR2 axis promoted the migration of hDPSCs via the FAK/PI3K/Akt and p38 MAPK signalling pathways. These findings reveal a novel molecular mechanism for cell migration of hDPSCs, which may contribute to the remodelling of pulp tissue and dentine.

Lipopolysaccharide-induced DNA damage response activates nuclear factor κB signalling pathway via GATA4 in dental pulp cells

AIM

To investigate the role of GATA-binding protein 4 (GATA4) in the inflammatory response induced by DNA double-strand breaks (DSBs) in human dental pulp cells (hDPCs).

METHODOLOGY

Lipopolysaccharide (LPS) was used for stimulating inflammation in dental pulp tissue in vivo and hDPCs in vitro. Expression levels of GATA4 and γ-H2A.X (a marker for DSBs) were detected at different stages of pulpitis in a rat model and human pulp tissues by immunohistochemistry. Real-time quantitative polymerase chain reaction and Western blot were performed to assess expression of GATA4 and γ-H2A.X and the activation of nuclear factor κB (NF-κB) in hDPCs stimulated by LPS. The comet assay was used for detecting the extent of DSBs in hDPCs. Immunocytochemistry and Western blot were utilized to evaluate expression of γ-H2A.X and GATA4 and activation of NF-κB in hDPCs pre-treated with inhibitors of DNA damage response or transfected with GATA4 small interfering RNA before the treatment of LPS. Data were analysed statistically using one-way anova or Kruskal-Wallis tests.

RESULTS

The expression of GATA4 and activation of DNA damage response and NF-κB in inflamed pulp tissue and LPS-treated hDPCs were identified. Significantly decreased expression of GATA4 and significantly decreased inflammatory processes in hDPCs were demonstrated via suppression of DNA damage response (P < 0.05). In GATA4-knockdown cells, the expression of γ-H2A.X did not change, but nuclear translocation of p65 was significantly suppressed (P < 0.05) upon induction by LPS.

CONCLUSIONS

Lipopolysaccharide-induced DSBs activated the NF-κB signalling pathway in hDPCs, and GATA4 acts as a positive moderator of the progress. The involvement of GATA4 in this pathology may serve as a therapeutic target in pulpitis.

InAs/GaAs quantum dot semiconductor saturable absorber for controllable dual-wavelength passively Q-switched fiber laser

We experimentally demonstrate the first use of 1550-nm InAs/GaAs quantum dot semiconductor saturable absorber mirror (QD-SESAM) in the dual-wavelength passively Q-switched (QS) erbium doped fiber (EDF) laser. The dual-wavelength QS lasing was obtained at a pump threshold of 180 mW with the average output power of 2.2 mW and the spacing between the two lasing wavelengths is 14 nm. A large absorption ranging from 1520 to 1590 nm has been realized when no substrate rotation was employed during the molecular beam epitaxy growth of the QD-SESAM indicating the potential to generate a 60 nm spacing of the dual-wavelength QS lasing peaks by changing the positions in the QD-SESAM and replacing EDF by co-doped fiber as gain medium. These results have provided a new opportunity towards achieving the stable and wide wavelength-tunable dual-modes fiber lasers.

Li(Cd,Mn)P: a new cadmium based diluted ferromagnetic semiconductor with independent spin & charge doping

We report a new diluted ferromagnetic semiconductor Li_1+y(Cd,Mn)P, wherein carrier is doped via excess Li while spin is doped by isovalence substitution of Mn²⁺ into Cd²⁺. The extended Cd 4d-orbitals lead to more itinerant characters of Li_1+y(Cd,Mn)P than that of analogous Li_1+y(Zn,Mn)P. A higher Curie temperature of 45 K than that for Li_1+y(Zn,Mn)P is obtained in Li_1+y(Cd,Mn)P polycrystalline samples by Arrott plot technique. The p-type carriers are determined by Hall effect measurements. The first principle calculations and X-ray diffraction measurements indicate that occupation of excess Li is at Cd sites rather than the interstitial site. Consequently holes are doped by excess Li substitution. More interestingly Li_1+y(Cd,Mn)P shows a very low coercive field (<100 Oe) and giant negative magnetoresistance (~80%) in ferromagnetic state that will benefit potential spintronics applications.

[Effects of allogeneic skin fibroblasts on promoting wound healing of diabetic mice and the mechanism]

Objective: To explore effects of allogeneic skin fibroblast (Fb) on promoting wound healing of diabetic mice and the mechanism. Methods: (1) Experiment 1. Ten diabetic mice and ten normal mice were chosen and sacrificed to collect back skin tissue. Suspension of the fourth generation of normal skin Fb and diabetic skin Fb were made. Another 27 diabetic mice were collected and divided into phosphate buffered saline (PBS) group, normal skin Fb group, and diabetic skin Fb group with random number table, with 9 mice in each group. Full-thickness skin defect wounds with area of 1 cm×1 cm were made on back of each mouse. Immediately after injury, 4 corners of wound of mice in normal skin Fb group and diabetic skin Fb group were injected with normal skin Fb and diabetic skin Fb suspension of 200 μL, respectively. Mice in PBS group were injected with the same amount of PBS at the same position. On post injury day (PID) 3, 7, 10, 14, and 17, surviving mice in the three groups were collected for gross wound observation and wound healing rate was calculated. On PID 7 and 14, 3 mice in each group were taken after gross wound observation to collect wound skin tissue. Percentage of Ki67 positive cell in wound tissue was detected by immunofluorescence method. Microvessel density (MVD) of wound tissue was detected by immunohistochemistry. Collagen fiber deposition of wound tissue was detected by Masson staining. (2) Experiment 2. Ten diabetic mice and ten normal mice were collected to make primary and the fourth generation normal skin Fb, and primary and the fourth generation diabetic skin Fb with the same method as in experiment 1. Apoptosis rate of Fb was detected by flow cytometry. The mRNA expressions and protein expressions of transforming growth factor β(1) (TGF-β(1)), advanced glycation end products (AGE), matrix metalloproteinase 9 (MMP-9), and neurokinin 1 (NK-1) of Fb were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction and Western blotting, respectively. Data were processed with analysis of variance of factorial design, one-way analysis of variance, and LSD-t test. Results: (1) The drying and scab growing speeds of wounds of mice in normal skin Fb group and diabetic skin Fb group at each time point post injury were faster than those of mice in PBS group. On PID 17, wound healing rate of mice in normal skin Fb group was close to that of mice in PBS group (t=3.45, P>0.05). At other time points, wound healing rate of mice in normal skin Fb group and diabetic skin Fb group was significantly higher than that of mice in PBS group, respectively (t=9.15, 10.25, 35.28, 6.79, 8.37, 10.69, 22.53, 6.70, 4.47, P<0.05 or P<0.01). On PID 7 and 14, wound healing rate of mice in normal skin Fb group was significantly higher than that of mice in diabetic skin Fb group (t=4.41, 4.16, P<0.05). On PID 7 and 14, percentages of Ki67 positive cells in wound tissue of mice in normal skin Fb group and diabetic skin Fb group were significantly higher than that of mice in PBS group (t=20.89, 31.82, 4.86, 29.53, P<0.05 or P<0.01); percentages of Ki67 positive cells in wound tissue of mice in normal skin Fb group were significantly higher than those of mice in diabetic skin Fb group (t=8.78, 13.51, P<0.05 or P<0.01). On PID 7 and 14, MVD of wound tissue of mice in normal skin Fb group and diabetic skin Fb group was significantly higher than that of mice in PBS group (t=26.92, 56.42, 10.36, 26.85, P<0.01). On PID 14, MVD of wound tissue of mice in normal skin Fb group was significantly higher than that of mice in diabetic skin Fb group (t=8.61, P<0.01). On PID 7 and 14, the amount of collagen fiber deposition of wound tissue of mice in normal skin Fb group was significantly higher than that of mice in diabetic skin Fb group and PBS group, respectively (t=10.09, 5.48, 4.77, 3.14, P<0.05 or P<0.01). (2) Apoptosis rate of primary normal skin Fb was (5.61±0.18)%, which was close to that of normal skin Fb of the fourth generation [(6.48±0.16)%, t=1.44, P=0.06]. Apoptosis rate of primary diabetic skin Fb was (26.25±0.56)%, which was significantly higher than that of primary normal skin Fb (t=36.61, P<0.01) and close to that of diabetic skin Fb of the fourth generation [(25.68±0.93)%, t=0.91, P=0.41]. The mRNA expressions of TGF-β(1) and NK-1 of primary normal skin Fb were significantly higher than those of primary diabetic skin Fb (t=25.25, 273.30, P<0.01). The mRNA expressions of AGE and MMP-9 of primary normal skin Fb were significantly lower than those of primary diabetic skin Fb (t=23.01, 8.84, P<0.05 or P<0.01). The mRNA expressions of TGF-β(1), AGE, and NK-1 in primary diabetic skin Fb were significantly higher than those of diabetic skin Fb of the fourth generation (t=4.34, 22.84, 12.10, P<0.05 or P<0.01). The protein expression of TGF-β(1) and NK-1 of primary normal skin Fb were significantly higher than those of primary diabetic skin Fb (t=4.61, 8.53, P<0.05). The protein expressions of AGE and MMP-9 of primary normal skin Fb were significantly lower than those of primary diabetic skin Fb (t=10.22, 29.90, P<0.01). The protein expressions of AGE and NK-1 of primary diabetic skin Fb were significantly higher than those of diabetic skin Fb of the fourth generation (t=8.09, 4.36, P<0.05 or P<0.01). Conclusions: Allogeneic skin Fb can promote wound healing through promoting Fb proliferation, angiogenesis, collagen fiber deposition in wound of diabetic mice. When diabetic skin Fb of mice is cultured in vitro away from diabetic microenvironment, cell activity can't return to normal levels, and the effects of diabetic skin Fb on promoting wound healing is not as good as normal skin Fb.

Key factors determining variations in RNA interference efficacy mediated by different double-stranded RNA lengths in Tribolium castaneum

Double-stranded RNA (dsRNA) length may affect RNA interference (RNAi) efficacy. Herein, variation in RNAi efficacy associated with dsRNA molecular length was confirmed via comparison of knockdown results following dsRNA injection into Tribolium castaneum. Through in vitro experiments with T. castaneum midgut, dsRNA accumulation in the midgut, degradation by midgut homogenates and persistence in haemolymph after injection were tested to determine the causes of RNAi efficacy variation. The comparative efficacies of dsRNAs were 480 bp ≈ 240 bp > 120 bp > 60 bp >> 21 bp. The combined midgut dsRNA accumulation and midgut homogenate-induced degradation analyses suggested cellular uptake to be the key barrier for 21 bp dsRNA functioning, but was likely not the main determinant of the variation in longer dsRNAs' (≥60 bp) bioactivity. In vitro RNAi experiment with T. castaneum midgut showed that long dsRNAs all significantly depleted the expression of corresponding genes, suggesting little variation in intracellular RNAi machinery's affinity for different dsRNA lengths. In vivo haemolymph content dynamics of different dsRNAs following injection indicated higher persistence of longer dsRNAs. In addition, comparison of the in vivo and in vitro RNAi efficacy also indicated the importance of haemolymph degradation. Thus, the varied efficacy of long dsRNAs resulted from their degradation by nucleases, which varied with dsRNA length.

[Application of stretched exponential diffusion-weighted imaging model in quantitative diagnosis of nonalcoholic fatty liver disease: in a rabbit model]

Objective: To evaluate the feasibility of diffusion parameters obtained from mono-exponential and stretched exponential diffusion-weighted imaging models in staging of nonalcoholic fatty liver disease and compare the diagnosis ability of nonalcoholic steatohepatitis. Methods: Thirty-two 12 -week-old male New Zealand rabbits, about 2.5 kg of each, were randomly divided into five groups. To obtained different severity groups of NAFLD, a variety of diet (from standard to high-fat, high cholesterol chow) were feed for different periods before liver diffusion imaging was performed by using 3.0 T MR imaging system (Discovery 750W GE health care), the value of ADC, stretched exponential model parameters distributed diffusion coefficient (DDC) and α (water molecular diffusion heterogeneity index) were measured. Liver specimens were obtained for pathological grading (NAFLD activity scoring system). The diffusion parameters of each group of NAFLD were compared by ANOVA, LSD-t test was utilized to pairwise comparison between different grades of NAFLD. Spearman rank correlation analysis was used to evaluate the correlation between ADC, DDC, α and different severity groups of NAFLD. ROC curve was compared to evaluate the diagnostic efficiency of MR parameters for NASH. Results: α was significant different between borderline and NASH groups (0.65±0.05 vs 0.72±0.07; P<0.05); ADC and DDC showed no statistical difference between borderline and NASH groups (ADC:(1.09±0.14)×10(-3) vs (1.04±0.24)×10(-3) mm(2)/s; DDC: (0.73±0.08)×10(-3) vs (0.66±0.19)×10(-3) mm(2)/s; P>0.05); ADC and DDC were negatively correlated with NAFLD, and the correlation coefficients were -0.552, -0.596, respectively (P<0.05). α was found to be positively correlated with advancement of NAFLD, the correlation coefficient was 0.729 (P<0.05).In terms of the diagnostic efficiency of NASH, the AUC of ADC, DDC and α were 0.736, 0.784, 0.900, respectively, α was significantly greater than ADC in diagnosis of NASH (P<0.05). Conclusion: Stretched exponential model parameter α (water molecular diffusion heterogeneity index) could be utilized to identify NAFLD. α may provide more information and improve the staging of NASH compared with conventional diffusion parameters.

Low frequency, weak MCP-1 secretion and exhausted immune status of peripheral monocytes were associated with progression of severe enterovirus A71-infected hand, foot and mouth disease

A minority of hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) results in severe neural complications. However, whether monocyte-mediated immunity is involved in the disease progression of HFMD remains unknown. One hundred and twenty mild and 103 severe HFMD patients were recruited and enzyme-linked immunosorbent assay (ELISA), flow cytometry and Transwell culture were performed in the study. Peripheral monocyte counts were lower in both absolute counts and frequencies in severe cases compared to mild cases. After screening 10 monocyte-related cytokines by ELISA, only monocyte chemoattractant protein-1 (MCP-1) was found at higher levels in sera of mild cases compared to those with severe symptoms. Monocytes purified from mild cases produced more MCP-1 than the cells from severe patients when stimulated in vitro. We observed that immune exhaustion markers programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) were highly regulated on the surface of monocytes from severe cases compared to mild cases. PD-L1 blockade induced a higher production of MCP-1 in the supernatant of a Transwell system. The production of MCP-1 also increased following PD-L1 blockade of purified monocytes activated by granulocyte-macrophage colony-stimulating factor (GM-CSF) combined with R848 or EV-A71 virus. Our results indicate that absolute count, frequency and levels of MCP-1 secretion of peripheral monocytes, together with their immune status, probably contribute to differential disease prognosis in EV-A71-associated HFMD.

Abstract P2-14-18: Achiveing rapid intrao-operative diagnosis during breast cancer surgery using high-reloution full-field optical coherence imaging and dynamic cell imaging

Background: Intraoperative pathological diagnosis such as frozen section and imprint cytology is not routinely recommended in clinical practice because of time and accuracy concerns. Full-field optical coherence tomography (FF-OCT) is a new optical imaging technique that could generate sectioning tomogram from fresh tissue and provide depiction of the morphological structure and pathological changes in minutes without conventional tissue preparation, slicing, and staining, and dynamic cell imaging (DCI) added the viability information of cells/tissue, which could be more important in cancer diagnosis. This study was to evaluate the feasibility and diagnostic value of FF-OCT and DCI in breast lesions and lymph node specimens during breast cancer surgery.

Methods: We evaluated normal breast tissue, benign breast lesions, breast cancer and axillary lymph node specimens from 107 patients using FF-OCT and DCI. After the optical assessment, the tissue was paraffin embedded and sent to conventional H&E diagnosis. The similar layer of OCT and H&E images were compared and diagnostic criteria were generated. The diagnostic sensitivity and specificity by two trained surgeons without pathology diagnosis experience were evaluated.

Results: A total of 194 specimens were examined, including 143 breast tissue(101 malignant and 42 benign/normal) and 51 lymph nodes(26 metastatic and 25 non-metastatic). On FF-OCT and DCI, normal morphological structures such as adipose, collagen, mammary ducts, and lobules in breast tissue and lymphoid follicle and hilum in lymph nodes were easily recognized. Breast cancer characteristics on H&E imaging correspond to collagen distortion, focal hypointensity, micro-calcification, clustered or linear lively cells et etc on FF-OCT or DCI, which could also be easily distinguished. We included the previously mentioned features to build diagnosis criteria for cancer on FF-OCT and DCI. The average acquisition time is 14±11 minutes. The sensitivity and specificity for breast cancer diagnosis were 92.1% and 94.3% respectively. The sensitivity and specificity for lymph node involvement were 92.3% and 84% respectively.

Conclusion: The time- and tissue-saving optical imaging technique yielded high accuracy that was comparable to that of traditional intraoperative and postoperative pathological diagnosis in breast cancer and lymph node metastasis. These results implied the promising application in the intraoperative evaluation and possible decrease of the re-excision rate for breast cancer surgery.

Citation Format: Yang H, Zhang S, Guo J, Xie F, Tong F, Cao Y, Liu P, Zhou B, Cheng L, Liu M, Wang S, Peng Y, Wang C, Yang Y, Ma Y, Chen D, Shen D, Wang S. Achiveing rapid intrao-operative diagnosis during breast cancer surgery using high-reloution full-field optical coherence imaging and dynamic cell imaging [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-18.

Abstract P3-03-16: Intraoperative evaluation of sentinel lymph nodes after neoadjuvant systemic therapy in breast cancer

Introduction:

Intraoperative evaluation of sentinel lymph nodes (SLN) in breast cancer patients are performed using Touch preparation (TP) and/or frozen section (FS). Touch preparation for intraoperative evaluation of SLN is quick and known to be a highly sensitive and specific method for detection of metastasis. Detecting metastases in SLN intraoperatively can be challenging in patients who receive neoadjuvant systemic therapy (NST). In our hospitals, we have been routinely evaluating SLN intraoperatively in patients who have undergone (NST), including those with known metastasis to an axillary lymph node (LN) prior to therapy.

Objective:

To compare the sensitivity and specificity of TP and frozen section (FS) in the intraoperative evaluation of SLN in the neoadjuvant setting.

Material and Methods:

This retrospective review study was approved by the institutional review board. Four hundred ninety-eight SLN from 142 patients were included in this study. The intraoperative results for TP and FS were compared with the final pathology results. Relevant clinical and pathological findings such as type of surgery, tumor grade, histologic subtype, and size of metastasis were reviewed.

Results:

Of the 498 SLN evaluated intraoperatively, 341 were by TP only, 57 by FS only and 100 by both.

Of the 341 SLN examined by TP only, 313 (92%) were interpreted as negative and 28 (8%) as positive for carcinoma intraoperatively. Eighteen LN turned out to be false negative (FN) with no false positives (FP) (sensitivity=62%, specificity=100%). In the false negative cases, 12 LN had micrometastasis, 6 macrometastasis and 1 showed isolated tumor cells (ITC). The size of the macrometastatic ranged from 3 mm to 10 mm.

Of the 57 LN examined by FS only, 48 were true negative and 9 were true positive (sensitivity=100%, specificity=100%).

Of the 100 LN evaluated by both TP and FS, 59 were interpreted as negative and 41 as positive for carcinoma. There were 8 false negatives and 1 false positive (sensitivity=83%, specificity=98%). Of the 8 false negatives, 7 showed micrometastasis and 1 LN had ITC.

Discussion:

In neoadjuvant cases, both the primary tumor as well as lymph node metastases can show therapy effect such as fibrosis, necrosis and/or histiocytic aggregates. Evaluating SLN in NST cases can be challenging secondary to these effects. The TP slides are often paucicellular in SLN with treatment effect. Residual tumor cells are often trapped in a fibrotic scar and do not transfer onto the TP slide leading to low sensitivity. Therefore, for optimal intraoperative evaluation of SLN in NST cases, frozen section with or without touch preparation, is recommended.

Citation Format: Sahoo S, Mir M, Sarode V, Fang Y, Peng Y, Gwin K, Hwang H. Intraoperative evaluation of sentinel lymph nodes after neoadjuvant systemic therapy in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-16.

Abstract P3-03-43: Incorporation of MSKCC nomogram to guide the application of intra-operative sentinel lymph node frozen section evaluation in patients with early breast cancer

Background and Objectives:

Although de-escalation of axillary surgery becomes more popular, axillary lymph node dissection (ALND) is still the standard care for sentinel lymph node(SLN) positive patients not meeting the criteria of ACOSOG Z0011 in many hospitals, and frozen section (FS) of SLN is one of the valuble intra-operative assesments to avoid axilla re-operation although it was controversial due to accuracy and efficiency concerns. This study was to assess the performance of selective use of frozen section evaluation guided by MSKCC lymph node metastasis risk prediction nomogram to optimize the proceudure to be more accurate and cost effective.

Methods:

Surgical pathology records of consecutive 2582 biopsies in 2552 patients breast cancer patients from 2011 to 2017 were reviewed, intra-operative frozen section diagnosis were compared to post-operative paraffin reports. We calculated the sensitivity, specificity, accuracy and FNR for different MSKCC risk, the axilla re-operation rate with or without FS and the number needed to treat (NNT) to avoid second ALND was also analyzed.

Results:

The sensitivity, specificity, and FNR of FS were 84.7%, 99.9%, and 15.3% respectively. The axilla re-operation rates were significantly decreased if FS was done(4.7%±0.4% with FS versus 35.8%±5.8% without FS, P&lt;0.001). The estimated axilla re-operation rate without FS was positively correlated with MSKCC risk(r=0.99, P&lt;0.001), while NNT to avoid second ALND by FS were negatively correlated with MSKCC risk(r=-0.98, P&lt;0.001). When patients were divided into four groups according to quartile MSKCC risk, the axilla re-excisional rates were 18.4%, 25.1%, 38.7%, 58.7% without FS, while 4.8%, 3.2%, 5.6%, 3.2% with FS, and NNT correspondingly decreased from 7.3, 4.5, 3.0 to 1.8. An decision-making algorithm for application of FS was proposed.

Conclusion:

Stratified decision-making algorithm based on MSKCC prediction model improved the efficiency of FS to avoid axilla re-operatioin in patients undergoing sentinel lymph node biopsy. We recommend FS be restricted to patients with MSKCC risk higher than 0.5 who do not meet ACOSOG Z0011 criteria.

Citation Format: Yang H, Wang S, Shen D, Cao Y, Tong F, Chen D, Liu P, Peng Y. Incorporation of MSKCC nomogram to guide the application of intra-operative sentinel lymph node frozen section evaluation in patients with early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-43.

[Detection ofmethylated genes related to allergic rhinitis and establishment of methylation profile]

Objective:The aim of this study is to detect differentially methylated genes to allergic rhinitis (AR) based on methylation chip, and to analyze the relationship between DNA methylation and AR.Method:Illumina methylation chip were made by normal inferior turbinate mucous tissue obtained from patients(n=19) and healthy individuals(n=11). Detection of differential the sites of methylated genes, Gene Ontology enrichment, KEGG pathway enrichment database and literature search were used to analysis.Result:There were 94 aberrant methylation sites in patients with AR, including 51 hypermethylation sites (e.g. ST7,LCE2D,ATRIP genes) and 43 hypomethylation sites (e.g. PIK3CG, TLR6, IL-4 genes). The results of Gene Ontology enrichment and KEGG pathway enrichment indicates the DNA methylation has relative trend with AR, and DNA methylation of ST7, LCE2D, PIK3CG genes may be associated with AR, but the results of GO analysis and KEGG analysis were statistically significant. Moreover, literature search prompts that DNA methylation of TLR6 gene and IL-4 gene may be associated with AR.Conclusion:Varying degrees of methylated genes from inferior turbinate mucous tissue based on high-flux methylation chip hint gene methylation is an important cause of AR. The relationship between them needs further verification.

Association of serum galectin-3 with risks of death and vascular events in acute ischaemic stroke patients: the role of hyperglycemia

BACKGROUND AND PURPOSE

Whether the association between galectin-3 and stroke outcome is modified by fasting plasma glucose (FPG) is unknown. The aim was to evaluate the prognostic effect of galectin-3 amongst ischaemic stroke patients stratified by FPG.

METHODS

In all, 3082 ischaemic stroke patients were included in this study and serum galectin-3 was tested at baseline. The primary outcome was a composite outcome of death and vascular events, and secondary outcomes were death, stroke recurrence and vascular events within 1 year after stroke.

RESULTS

Increased galectin-3 was significantly associated with the primary outcome, stroke recurrence and vascular events in the patients with hyperglycemia but not in those with normoglycemia (P for interaction < 0.05 for all). The multivariate-adjusted hazard ratios (95% confidence intervals) were 1.72 (1.05-2.84), 2.64 (1.14-6.12) and 2.68 (1.33-5.38) for the primary outcome, stroke recurrence and vascular events, respectively. A linear association between galectin-3 and the primary outcome was observed in hyperglycemic patients (P for linearity = 0.007).

CONCLUSION

Increased galectin-3 was associated with the primary outcome, stroke recurrence and vascular events within 1 year after stroke in the patients with hyperglycemia, suggesting that galectin-3 may be an important prognostic factor for ischaemic stroke patients with hyperglycemia.

[Exploration of thrombus histological composition and clinical effect in mechanical thrombectomy of acute ischemic stroke]

Objective: To explore histological composition of thrombus and clinical effect in mechanical thrombectomy of acute ischemic stroke. Methods: From March 2017 to August 2017 at the Institutes of Biology and Medical Sciences of Soochow University, hematoxylin and eosin (HE) staining was used to quantitatively analyze the composition of thrombus in 58 cases with acute ischemic stroke. The differences in components of thrombus with different TOAST classifications were compared, meanwhile, clinical data such as surgical process and prognosis were also analyzed. Results: (1) Baseline data: the age of arteriosclerosis was significantly lower than that of cardiogenic (P<0.05). There was statistically significant differences in onset to admission between the two types of stroke of other undetermined etiology (SUE) and Cardioembolism (CE) (P<0.05). (2) Histological composition of thrombus: there were no significant differences in fibrin and red blood cells (RBC) between the two types of SUE and CE thrombus (P>0.05). There were more RBC in LAA thrombus and more fibrin in CE thrombus (P<0.05). (3) Intraoperative data: the time of admission to recanalization of type LAA was longer than that of type CE (P<0.05). (4) Prognosis: there was no significant difference in the good prognosis between the two types of SUE and CE (P>0.05). It is the same between the types of LAA and CE (P>0.05). Conclusions: LAA thrombus contains more RBC, and cardiogenic thrombus contains more fibrin. Cryptogenic thrombus has the same composition with cardioembolism. The results may help to choose appropriate recanalization technique in different TOAST stroke and have guiding significance for the secondary prevention of SUE stroke.

Prevalence of the cardiovascular health status in adults: A systematic review and meta-analysis

BACKGROUND AND AIMS

The American Heart Association has outlined seven cardiovascular health (CVH) metrics, including smoking, body mass index, physical activity, dietary pattern, total cholesterol, and fasting plasma glucose, to define and monitor CVH status. Our study was to evaluate the global CVH in adults.

METHODS AND RESULTS

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles for studies published between 1 January 2010 and 30 June 2018. Included studies should report the proportions of ideal status for the seven CVH metrics and/or provide the prevalence of overall poor (having 0-2 ideal metrics) or ideal (having 5-7 ideal metrics) CVH status in adults. 88 articles were identified: 75 for the prevalence of ideal CVH metrics, 58 for the proportion of overall poor CVH status, and 55 for the proportion of overall ideal CVH status. Smoking had the highest prevalence of ideal status (69.1%) while dietary pattern has the lowest (12.1%). 32.2% and 19.6% of participants had overall poor and ideal CVH, respectively. Females and young adults had better CVH status when compared to males and older adults. There existed regional variations in ideal CVH metrics and overall CVH status. The overall CVH status had improved over study time.

CONCLUSION

The prevalence of ideal status was low for some metrics, such as dietary pattern, and the overall CVH status was still unsatisfactory. We should continue to measure the CVH status and carry out lifestyle interventions to improve the CVH status in the whole population.

[Screening of differentially expressed genes of allergic rhinitis with asthma]

Objective:To detect the differentially expressed genes of allergic rhinitis(AR) with asthma and screen the pathogenic genes. Method: Eight nasal mucosa tissue samples from patients with nasal septum deviation (healthy control group), eight nasal mucosa tissue samples from patients with allergic rhinitis（AR） and eight nasal mucosa tissue samples from patients with AR and asthma were collected. Allergy & Asthma PCR Array was used to analyze allergy related genes expression level. Result: Compared to the control group, there are 84 related genes were found and 15 genes were up-regulated, 69 genes were down-regulated. Furthermore, there are 17 genes（ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21） differentially expressed. Compared AR with asthma group to the AR group, there was 1 gene differentially expressed(RORC). Conclusion: ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21 are the possible pathogenic genes of AR with asthma. RORC may be the specific marker gene in asthma induced by allergic rhinitis.

[Detection of differentially expressed gene of allergic rhinitis based on RT² profiler PCR array]

Objective:The aim of this study is to detect differentially expressed gene of allergic rhinitis (AR) based on RT² profiler PCR array. Method:The real-time PCR array containing 84 genes were used to compare inferior turbinate samples obtained from AR patients (n=8) and healthy individuals (n=8). Result:The results showed that 67 genes were down regulated and 17 genes were up regulated in AR inferior turbinate after analysis of 84 genes related to allergy and asthma. STAT6 and BCL6 were recognized as differentially expressed genes. Conclusion:The real-time PCR array can provide new insight into the pathophysiological processes involved in AR.

Sleep duration and the risk of osteoporosis among middle-aged and elderly adults: a dose-response meta-analysis

It remains unclear how many hours of sleep are associated with the lowest risk of osteoporosis. This meta-analysis was performed to assess the dose-response relationship between sleep duration and risk of osteoporosis. PubMed and Web of Science were searched from inception to December 3, 2017, supplemented by manual searches of the bibliographies of retrieved articles. Data were pooled using fixed- and random-effects models. Restricted cubic spline analysis with four knots was used to model the sleep duration and osteoporosis association. Four cross-sectional studies with eight records were eligible for inclusion in the meta-analysis. A U-shaped dose-response relationship was observed between sleep duration and risk of osteoporosis, with the lowest risk observed at a sleep duration category of 8-9 h per day. Compared with 8-h sleep duration per day, the pooled odds ratio for osteoporosis were 1.03 (95% CI 1.01-1.06) for each 1-h reduction among individuals with shorter sleep duration and 1.01 (95% CI 1.00-1.02) for each 1-h increment among individuals with longer sleep duration. Our dose-response meta-analysis shows a U-shaped relationship between sleep duration and risk of osteoporosis, with the lowest osteoporosis risk at about 8 h per day of sleep duration. Both short and long sleep duration is associated with a significantly increased risk of osteoporosis in the middle-aged and elderly adults, appropriate sleep duration could help for delay or prevention of osteoporosis.

Effects of high pressure on the ferromagnetism and in-plane electrical transport of (Ba0.904K0.096)(Zn0.805Mn0.195)2As2 single crystal

Pressure technique is an effective way to modify magnetic properties of diluted magnetic semiconductors (DMS). Based on single crystal, in-plane electrical transport properties of a new generation DMS (Ba_0.904K_0.096)(Zn_0.805Mn_0.195)₂As₂ have been measured with hydrostatic pressure up to 1.8 GPa. Magnetic properties of the single crystal sample are effectively tuned by pressure. Upon compression, the in-plane resistivity initially decreases but then increases when pressure is higher than 1.2 GPa. First principle calculations suggest that decrease of the resistivity is due to enhancement of density of state at Femi energy while increase of the resistivity under higher pressure is caused by distorted MnAs₄ tetrahedra. We reveal that the configuration of the MnAs₄ tetrahedra and strength of interlayer As-As bonding are of importance to ferromagnetic coupling of (Ba,K)(Zn,Mn)₂As₂.

[Advances in the research of mesenchymal stem cells in chronic wounds]

Skin is the largest organ in the body, with a variety of functions, such as thermoregulation, physical barriers, and sensory transmission, etc. Therefore, to restore the function after injury as soon as possible is particularly important. Mesenchymal stem cells (MSCs) are derived from mesoderm, and can differentiate into a variety of tissues, such as cartilaginous tissue, myoideum, and adipose tissue. Weak immunogenicity of MSCs make them become the ideal seed cells of tissue engineering. MSCs have a wide range of sources, including known sources of bone marrow, skin, placenta, and adipose tissue, etc. MSCs from different sources also have many different mechanisms in wound repair. This article reviews the recent researches on MSCs in the treatment of chronic wounds, so as to explore new ideas for the clinical treatment of chronic wounds.