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 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.

Objective

To investigate the clinical effects of personalized abdominal pedicled thin flaps in repairing complex wounds of the hand.

Methods

From January 2015 to December 2023， a total of 85 cases with complex hand wounds who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA， including 48 males and 37 females， aged from 8 to 66（35.25±16.23） years.A total of 199 personalized abdominal pedicled thin flaps were designed according to the conditions of the wounds and abdominal donor sites.Among the 85 cases， wounds were repaired with differently shaped flaps in 74 cases， with flap perforation to create modified bipedicled flaps in 6 cases， and with segmental ligation to narrow abdominal delayed flap pedicle in 5 cases.Flap survival， time for pedicle division， number of surgeries， donor site healing， flap appearance and texture， flap two-point discrimination， hand appearance and function， and scar condition at the donor and recipient sites were observed.

Results

After surgery， all 199 flaps survived successfully.For those repaired with differently shaped flaps， the average time for pedicle division was 13.8 days， the number of surgeries was two， direct suturing was performed in 60 cases （81.08%） and partial suturing combined with skin grafting in 14 cases for the donor sites， and all wounds healed primarily.For those repaired with flap perforation to create modified bipedicled flaps， the average time for pedicle division was 15.5 days，the number of surgeries was 2-4， direct suturing was performed in 2 cases and skin grafting were performed in 4 cases， with all wounds healing well.For those repaired with segmental ligation to narrow abdominal delayed flap pedicle， the average time for pedicle division was 17.0 days， the number of surgeries was 3 or 4， and partial suturing combined with small skin grafting were performed for the donor sites in the 5 cases.Follow-up of 6 months to 6 years indicated that the flaps exhibited good appearance and soft texture， except that 5 flaps were slightly swollen and underwent thinning.At the final follow-up， the two-point discrimination of the flaps was 6 to 14 mm， the excellent and good rate of hand function assessment was 97.65%， and the scars at the donor and recipient sites were mild.

Conclusion

Personalized abdominal pedicled thin flaps， including differently shaped flaps， flap perforation to create modified bipedicled flaps， and segmental ligation to narrow abdominal delayed flap pedicle， have high flap survival rate， short treatment course， good hand appearance and functional recovery， and minimal donor site damage， so it is an effective method for repairing complex hand wounds.

Objective

To observe the application efficacy of pedicle perforator flap in the repair of deep tissue exposed wounds such as tendons or bones in the hands， feet， and ankles.

Methods

From May 2020 to April 2023， 47 cases of deep exposed wounds such as tendons or bones in the hands， feet， and ankles who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA， including 29 males and 18 females， aged 25-68 years.There were 20 cases of hand wounds （3 cases each had 2 wounds with exposed tendons in the hand） and 27 cases of foot and ankle wounds.The wound area after debridement ranged from 1.0 cm×2.0 cm to 12.0 cm×6.0 cm.The pedicle perforator flaps were used for repair， of which proper digital artery perforator flaps were used in 12 cases， metacarpophal dorsal artery perforator flaps were used in 8 cases， peroneal artery perforator flaps were used in 12 cases， posterior tibial artery perforator flaps were used in 12 cases， and the first plantar metatarsal artery perforator flaps were used in 3 cases.The flap incision area ranged from 1.2 cm×2.5 cm to 13.0 cm×6.5 cm.The donor sites of flaps were repaired with sutures or skin grafting.The survival of flaps and wound healing of the donor sites were observed after surgery.During follow-up， the appearance of the flap and the wound recovery of the donor sites were observed， and complications such as bone nonunion and osteomyelitis were observed in the patients with fractures，observed the scar condition of the surgical area.At the last follow-up， the hand function of the patients were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association，and the foot function of the patients were evaluated according to the scoring standards of American Orthopedic Foot and Ankle Society （AOFAS）.

Results

A total of 50 pedicle perforator flaps were used in 47 patients，of which 45 flaps survived completely， 2 proper digital artery perforator flaps and 1 posterior tibial artery perforator flap with poor returnand and superficial tissue necrosis occurred at distal end of flap were healed by dressing change in the later stage， and 1 posterior tibial artery perforator flap and 1 the first plantar metatarsal artery perforator flap were partially necrotic and repaired by adjacent flap metastasis again.Eighteen donor sites were directly sutured， and 32 donor sites were repaired by skin grafting， all the donor sites were healed in one stage.After 6-18 months of follow-up， the appearance of the flaps were good， the texture and color of the flap were similar to those of the surrounding skin，and was not obviously bloated in appearance， only 2 peroneal artery perforator flaps and 2 posterior tibial artery perforator flaps were readmitted to the hospital for flap thinning surgery， and the scar hyperplasia in the donor sites was not obvious.There were 14 cases with excellent hand function and 6 cases with good hand function， the foot and ankle function of the affected limb was evaluated as excellent in 21 cases， good in 6 cases， and no complications such as nonunion or osteomyelitis occurred in patients with fractures.

Conclusion

The pedicle perforator flap using in the repair of deep tissue exposed wounds in the hands， feet and ankles has the advantages of flexible design， high utilization rate of flap tissue， the texture is similar to that of the affected area， and the same field of view in the surgical area， and the appearance and function recover well.

Objective

To construct the strategy of arteriovenous catheterization and maintenance in extensive burn wounds， provide reference for improving the standardization and quality of arteriovenous catheterization nursing.

Methods

Based on literature research and brainstorming， the expert consultation questionnaire for the strategy of arteriovenous catheterization and maintenance in extensive burn wounds was preliminarily constructed.After two rounds of Delphi expert consultation， the weight of each index was calculated by hierarchical analysis and the consistency test was conducted.

Results

The effective recovery rates of the two rounds of expert consultation questionnaires were 100%， the expert authority coefficient was 0.923 to 0.933， and the Kendall's coefficient of concordance was 0.260 and 0.351 （P＜0.01）， which passed the consistency test.Finally， the strategy of arteriovenous catheterization and maintenance in extensive burn wounds was constructed， including three primary indicators， 15 secondary indicators and 75 tertiary indicators.

Conclusion

The construction method of arteriovenous catheterization and maintenance strategy of extensive burn wounds is scientific and reasonable， and the index content is specialized and practical， which is conducive to improving the standardization and quality of arteriovenous catheterization nursing of burn wounds.

Objective

To observe the effect of the shoulder joint home rehabilitation exercise program after arthroscopic shoulder surgery on subacromial impingement syndrome （SIS） patients' pain level，quality of life and adherence.

Methods

A total of 68 patients with SIS who underwent shoulder arthroscopic surgery in the Department of Orthopedics， Beijing Tiantan Hospital，Capital Medical University from October 2022 to December 2023 were selected.Based on literature review and expert discussion， a home rehabilitation exercise program for shoulder joints was constructed.The general information， visual analogue scale （VAS）， Constant-Murley shoulder joint scale （CMS） and exercise compliance were collected before and 6 weeks after surgery.The rehabilitation effect of the two groups was compared.

Results

Patients were divided into the conforming group （31 cases） and the non-conforming group （37 cases）.There were no significant differences in age，sex， body mass index （BMI）， preoperative VAS and preoperative CMS scores between the qualified group and the unqualified group.The results at 6 weeks post-operation showed that both the qualified group and the the unqualified group experienced reductions in VAS neck and VAS shoulder scores.After 6 weeks， the CMS score of the qualified group （74.19±9.55） points was significantly different from that of the unqualified group（39.00±12.55） points （P＜0.05）.Moreover， the comforming group showed a more significant improvement in CMS compared to the non-conforming group （P＜0.05）.Patients exercising 5-6 times per week constitued the majority in the conforming group.

Conclusion

The home rehabilitation exercise program of shoulder joint after shoulder arthroscopy can reduce the pain of neck and shoulder， improve the quality of life， and have a certain rehabilitation effect.

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 investigate the role and preliminary mechanism of high mobility group protein B1 （HMGB1） in liver injury following delayed resuscitation in rats with severe burns.

Methods

Thirty-two male Sprague-Dawley （SD） rats were randomly divided into sham group， immediate resuscitation group，delayed resuscitation group， and delayed resuscitation+HMGB1-neutralizing antibody group，with 8 rats in each group.A 30% total body surface area （TBSA） full-thickness burn model was established by immersing the rats' dorsum in 98 ℃ water for 12 seconds.Sham group rats were immersed in 37 ℃ water for 12 seconds.The immediate resuscitation group received intraperitoneal injection of lactated Ringer's solution （4 ml·kg^-1·1%TBSA^-1）immediately after injury， while the delayed resuscitation group and delayed resuscitation+HMGB1-neutralizing antibody group received the same fluid at 6 hours post-injury.The sham group received no resuscitation.Blood and liver tissue samples were collected at 24 hours post-injury.Serum HMGB1 levels were analyzed via enzymelinked immunosorbent assay （ELISA）.Serum aspartate aminotransferase （AST） and alanine aminotransferase（ALT） levels were measured using an automated biochemical analyzer.Hematoxylin-eosin （HE） staining was used to assess liver histopathology.Immunohistochemistry was employed to assess the expression of HMGB1 and transforming growth factor-beta （TGF-β） in liver tissues.Western blotting was utilized to quantify the expression of B-cell lymphoma-2 （Bcl-2） and Bcl-2-associated X protein （Bax）.Immunofluorescence staining was utilized for the detection of tumor necrosis factor-alpha （TNF-α） expression.

Results

Compared to the sham group， HMGB1 levels in serum and liver tissues， and serum ALT， AST levels were significantly elevated in the immediate resuscitation group （P＜0.05）.Compared to the immediate resuscitation group， the delayed resuscitation group showed further increases in HMGB1 and serum ALT， AST levels （P＜0.001）.Compared to the delayed resuscitation group， HMGB1 levels in serum and liver tissues， and serum ALT， AST levels in the delayed resuscitation+HMGB1-neutralizing antibody group were significantly reduced （P＜0.05）.Histologically，the sham group exhibited normal hepatocyte morphology and no inflammation.The immediate resuscitation group exhibited mild liver injury， with the basic preservation of the hepatic lobule structure.In this group，liver cells exhibited mild edema or cytoplasmic swelling， and no obvious necrosis or inflammatory response was observed.The delayed resuscitation group showed disordered cell arrangement， diffuse fatty degeneration，and moderate inflammation in liver tissues， while the delayed resuscitation + HMGB1-neutralizing antibody group exhibited reduced fat deposition and mild inflammation.Compared to the delayed resuscitation burn group， the liver tissue injury scores and TNF-α expression were lower in the delayed resuscitation + HMGB1-neutralizing antibody group （P＜0.05）， with no significant change in TGF-β （P＞0.05）.Compared with the delayed resuscitation group， the expression of the anti-apoptotic protein Bcl-2 in the liver tissue of the delayed resuscitation + HMGB1-neutralizing antibody group was significantly increased （P=0.009）， while the expression of the pro-apoptotic protein Bax was significantly decreased （P=0.021）.

Conclusion

HMGB1 mediates liver injury after delayed resuscitation in severe burns， potentially by facilitating apoptosis and inflammatory responses.

The abuse of antibiotics and other factors may lead to the failure of wound treatment.Developing innovative and effective therapeutic approaches is of great significance for reducing infectionrelated mortality and improving patient outcomes.Photodynamic therapy （PDT） is a novel method for wound repair， which utilizes photosensitizers combined with specific light sources to irradiate tissues， generating free radicals or reactive oxygen species that induce cell death.PDT promotes wound healing through multiple mechanisms， including killing bacteria， alleviating inflammation， stimulating fibroblast proliferation， and increasing transforming growth factor （TGF-β） levels.Based on these mechanisms， PDT demonstrates promising efficacy in promoting wound healing and tissue remodeling.This article primarily summarizes the basic components of photodynamic therapy and its clinical applications in burn wounds， diabetic ulcers，pressure ulcers， scar wounds， and other types of wounds.

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.

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.