Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity.  We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France ; 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid. p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) , and revealed right-side diverticulosis in AC  and left-side diverticulosis in E . These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC.  AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%;  Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet. There are considerable geographic variations in the prevalence of colonic diverticular disease (DD). It is common in Western countries, with an estimated prevalence that ranges from 45%  to 60% iSeveral factors have been associated with an increased risk of DD and its complications, including advanced age, gender, obesity, and dietary fiber intake , 14–17. The diverticular disease remains mainly asymptomatic; however, in 25% of individuals, it will develop as a symptomatic disease. The pathogenesis of symptomatic and complicated DD remains uncertain but involves at least in part, genetic predisposition, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility .Preliminary data supported that ethnicity and genetic background may be implicated in the anatomical distribution and presentation of colonic DD . DivertiThe present study was performed prospectively in a Caribbean population and involved a control group of Europeans. To better characterize the role of ethnicity and people migration in DD, the comparison of African Caribbeans to Europeans, because they are exposed to a similar environment , could be useful.The aim was to compare the anatomical presentation as the first endpoint and the severity of colonic DD as the secondary endpoint, both as a function of the ethnic group. Moreover, a dedicated endoscopic grid was used to obtain precise insights into DD.This noninterventional study was conducted prospectively in the gastroenterology departments at the University Hospital of Guadeloupe (center 1) and La Roche-sur-Yon Regional Hospital, Vendée (center 2), two tertiary referral centers for gastrointestinal bleeding . Center Eligible patients were screened between March 9, 2013, and March 9, 2015, during which they were admitted for lower gastrointestinal hemorrhage (LGIH); this was defined as rectal bleeding and a normal upper endoscopy if the hemoglobin level was lower than 10 g/dl at admission, or melena with normal upper endoscopic findings. The included patients were 18 years or with a diagnosis of diverticular hemorrhage (DH), defined as (1) presumptive if colonic diverticula were present and no other obvious lesions could explain the bleeding or (2) definitive because active bleeding, an adherent clot, or a nonbleeding visible vessel was observed from diverticula . They unDuring the colonoscopy, a senior endoscopist (with more than 5 years of experience) completed a detailed endoscopic grid, which reported the size and number of diverticula in each colonic segment . The distribution of diverticula in the colon was assigned to one of four conventional categories for the disease according to the classification developed by Golder et al. : left-siA CT scan was performed in patients with a hemoglobin level lower than 10 g/dl at admission. For those with a diagnosis already determined by a colonoscopy carried out within the past three years, the evaluation was considered to be complete and no additional colonoscopy was required. In the absence of these diagnostic criteria, a complete colonoscopy (satisfactory preparation and complete examination up to the cecum) was performed. For patients with an incomplete colonoscopy due to a technical failure or severe comorbidities contraindicating analgesia, exploration was completed by means of a CT scan.The CT scans were reinterpreted by two senior radiologists specialized in abdominal radiology at each center. These two senior radiologists, SD and PM, assessed the number of diverticula in each colonic segment according to the four-point graded scale used for the endoscopic grid. The size of the diverticula on the CT scan was defined as large when greater than 1 centimeter and giant when greater than 2 centimeters .Severe active hemorrhage was defined by a pulse rate higher than 100 bpm and/or a systolic arterial blood pressure lower than 90 mmHg and/or more than 6 units of packed red blood cells transfused during the same period of hospitalization in a context of persistent bleeding. The therapeutic strategy consisted of medical management with appropriate transfusion support and procoagulant agents associated with endoscopic hemostasis, when possible. Surgical colon resection of the diseased segment or subtotal colectomy was performed in case of more than 10 units of packed red blood cells transfused with a failure of endoscopic hemostasis.The following clinical and biological data were recorded at admission: age, gender, body mass index, comorbidities, past LGIH, use of anticoagulant, antiplatelet, or nonsteroidal anti-inflammatory drugs, type of bleeding , systolic and diastolic blood pressure, heart rate, hemoglobin level, platelet level, and prothrombin time. During hospitalization, the numbers of packed blood cell units and hemostatic endoscopic or surgical procedures were recorded. The average daily consumption of fruits, vegetables, and whole grain food was assessed following a qualitative dietary questionnaire prospectively completed by a dietitian during a face-to-face patient interview. This questionnaire assessed the frequency of fruits, vegetables, and whole grain foods  usually consumed per day, per week, or per month and was completed in the two centers. The starchy foods, a representative of carbohydrate intake, were also reported qualitatively and compared in the two populations, as starchy foods are quite popular in the Caribbean islands' eating habits.p values <0.05 were considered to be significant. All authors had access to the study data and reviewed and approved the final manuscript.The statistical analysis was performed using SAS software . Means and standard deviations were calculated for continuous variables, medians for skewed distributions of continuous variables, and proportions for categorical data. We determined the distribution of diverticula at the group level. Spearman's correlation was used to assess the association between participant characteristics and the distribution of diverticula by location. We estimated odds ratios and 95% confidence intervals using the nonparametric Mann–Whitney test for quantitative variables, while the chi-square test or Fisher's exact test was used for qualitative variables. All tests of significance were two-tailed, and Overall, 274 patients were screened for LGIH: 220 in center 1 and 54 in center 2 . Of themp=0.001). Median PT ratios and platelet counts did not differ between the two groups.Similar characteristics were found in groups AC and E with respect to age, gender, previous history of LGIH, body mass index, dietary habits, and the prescription of platelet aggregation inhibitors, oral or subcutaneous anticoagulants, antihypertensive, antidiabetic, or non-steroidal anti-inflammatory drugs . Vitaminp=0.02), a higher proportion of those with a high pulse rate , and a higher proportion of nadir hemoglobin rates lower than 8 g/dl  or those requiring blood transfusions  than Europeans.African Caribbeans had significantly lower systolic blood pressure values (117 (100–130) vs. 127 (110–138); p=0.19, in groups AC vs. E, respectively. Moreover, DH was treated endoscopically in three patients (2.33%) vs. 0 (0%), p=0.44, or surgically in eight patients (6.2%) vs. 1 (2.5%), p=0.32, respectively, and no radiological embolization procedures were performed. Surgical management consisted in one right hemicolectomy (CT scan with contrast blush), two left hemicolectomies, and five subtotal colectomies (severe hemorrhage without contrast blush) in group AC, vs. one left hemicolectomy in group E.Almost all patients were managed medically, i.e., 123 (95.4%) vs. 40 (100%), n = 67 during hospitalization, n = 17 during the three years before hospitalization) and 25 patients from group E (80.6%); or (2) a partial colonoscopy associated with a CT scan or virtual colonoscopy in 22 (20.8%) and 6 (19.4%) patients, respectively.As shown in p < 0.0001; including 73.6% vs. 35.5% pancolonic forms; p=0.0002, 8.5% vs. 3.2% isolated right-side DD; p=0.03, and 8.5% vs. 3.2% bipolar forms; p=0.03. Inversely, in group E, diverticula were localized in the left-side colon in 96.8% of patients, including isolated left-side DD  in the majority of cases , mainly included into pancolonic DD  in group AC and isolated left-side DD in group E . There was no difference in the presence and number of diverticula in the right-side and in the left one in AC, while Europeans were clearly characterized by left colon diverticula  or more than 100 diverticula in one segment  was significantly higher in group AC vs. group E (p=0.004).The number of patients with more than ten diverticula in the left colon  and third  generations of diverticula developed deeper in the colonic wall were observed  and the median classes of diverticula were also higher in African Caribbeans than Europeans, in both the right and left-sides of the colon. These data confirm a tendency toward a higher proportion of diverticula in the colon of African Caribbeans, whatever the segment.The risk of having a higher number of diverticula among African descent than Europeans was controversial between the two studies, according to the studies of Golder et al.  and PeerNumerous questions remain regarding the genesis of DD. Some studies have shown that changes to the colonic wall may affect the pathogenesis of colonic DD . ChangesNevertheless, it might be interesting to conduct a study on the structural characteristics of supportive connective tissue and their genetic background in populations from different ethnic groups.The clinical severity of DD has been evaluated in three retrospective studies that included 30 to 40 Africans, and DH was the most common complication (in more than 50%) –13. EstiOur study has shown a right-sided involvement and pancolonic forms of diverticula in African Caribbeans compared to the left-sided localization in Europeans, and particularly the greater endoscopic and clinical severity of DH in African Caribbeans. This particular presentation is probably related to the genetic background of their African ascendance as opposed to the environment. Patient management should be adapted to this particular presentation of DD in African Caribbeans, and the possibility of more frequent subtotal colectomies should be discussed in cases of severe hemorrhage. In view of the fact that DH occurs most frequently in elderly patients with comorbidities and multiple medications, it is now essential to determine specific prognostic markers for this condition.


NIN, ABHD12B, WHAMM, AP3B2, and SIGLEC5 with chronic periodontitis. The study’s objective was to investigate different molecular patterns and evolutionary forces acting on the mentioned genes. The investigation of molecular patterns encompasses the study of compositional parameters, expression profile, physical properties of genes, codon preferences, degree of codon bias, determination of the most influential codons, and assessment of actions of evolutionary forces, such as mutations and natural selection. The overall compositional analysis revealed the dominance of A and G nucleotides compared to T and C. A relatively low codon usage bias is observed. The CTG codon is the most overused codon, followed by TCC. The genes, AP3B2 and SIGLEC5, preferred GC-ending codons, while NIN, ABHD12B, and WHAMM preferred AT-ending codons. The presence of directional mutational force and natural selection was found to operate codon usage in genes envisaged, and selective forces were dominant over mutational forces. Apart from mutation and selection forces, compositional constraints also played imperative roles. The study enriched our knowledge of specific molecular patterns associated with the set of genes significantly associated with chronic periodontitis. Further studies are warranted to identify more genetic signatures associated with the disease.Genome-wide association studies showed the relationship of  NIN and SIGLEC5 genes are associated with CP susceptibility [NIN, ABHD12B, WHAMM, and AP3B2) showed significant association with CP [A study on the global burden of diseases, injuries, and risk factors  demonstrtibility . Gene-ce with CP . Amino acids are the protein molecule’s basic unit, and a codon encodes for an amino acid. Except for methionine and tryptophan, all the amino acids are encoded by two or more codons, and such codons are called synonymous codons. In any organism, all the synonymous codons are not used equally, and there is unequal usage of a codon in any gene, tissue, or organism and is called codon usage bias. Codon bias can be gene-specific , speciesNIN, ABHD12B, WHAMM, AP3B2, and SIGLEC5. The function of the NIN gene includes correct positioning and anchoring of microtubule minus ends. ABHD12B regulates immune and neurological processes, WHAMM participates in Arp2/3-mediated actin polymerization, AP3B2 is involved in neurotransmitter release, and SIGLEC5 performs sialic-acid dependent cell binding. Since the underlying molecular mechanisms of periodontitis are still unclear, the effects of the NIN, ABHD12B, WHAMM, AP3B2, and SIGLEC5 genes on periodontitis have not been elucidated [Periodontitis affects 11% of the world’s population and poses a tremendous public health challenge . Studiesucidated .The study provides insight into various factors influencing codon bias. The study also elucidates the over- or under-represented codons and the codons having maximum influence in codon usage. Additionally, the study will help identify molecular signatures associated with the CP-associated genes and design synthetic gene constructs for gene therapy purposes to manipulate gene expression levels, where an aberrant gene expression level is responsible for ailments.http://www.ncbi.nlm.nih.gov accessed on 20 March 2022). Upon investigating the literature, we found only five genes responsible for CP . Therefore, we considered all the protein-encoding transcripts for the mentioned genes. The criteria set for the transcripts were that they must be initiated with a start codon and ended with a stop codon and should be devoid of bases other than A, T, C, and G. There were eight, seven, six, five, and four numbers of transcripts that fulfilled the criteria set for NIN, ABHD12B, WHAMM, AP3B2, and SIGLEC5 genes, respectively.In this study, the coding transcripts of the genes (S1) associated with CP were retrieved from the National Center for Biotechnology Information (NCBI) GenBank database  were determined. Overall %AT and %AT3 and %GC and %GC3 were also determined. Analyses of %GC3 (GC composition at the third codon position) and %GC12 (composition at the first and second codon) were also done. %GC3 helps evaluate the compositional and codon bias .RSCU is the ratio of the observed frequency of codons to the expected frequency of the codon . All traCAI is a measure to estimate protein expression levels and determine the effect of natural selection that helps shape the codon usage pattern in transcripts . If all ENc is a commonly used indicator of codon usage bias . The valThe intra-strand base composition theoretically should be A = T and G = C which is called the type 2 parity rule or PR2, and violation of this rule is expected in amino acids encoded by four codons . It is pRegression analysis between %GC3 and %GC12 (mean %GC1 and %GC2) is a standard method to explore the effects of natural selection and mutation pressure . It detehttps://www.originlab.com/demodownload.aspx, accessed on 19 September 2022).PCA is a commonly employed multivariate statistical technique to analyze the trends in codon usage patterns. Here, we used PCA to obtain significant trends in the transcripts of genes associated with enhanced risk of CP. The method reduces the original variables to a lower number of principal components without losing its information. Each transcript is represented as a 59-dimensional vector . Finally, we took the top two principal components with the most significant variance. We performed PCA analysis using Origin18 software , which indicates that the directional mutational forces are working on all GC contents at all three codon positions [A significant positive correlation has been observed between the %GC12 and %GC3 contents  played the main role in determining codon usage  is suggestive of the action of directional mutation force at all three codon positions and is in concordance with the earlier studies [The present study’s average ENc value was 52.35 ± 5.01, indicating a comparatively lower codon usage bias in the envisaged genes. In other diseases associated with human disorders, such as Alzheimer’s, ENc was 48.84 . The res studies . →C transition rates, resulting in more CTG codons [SIGLEC5 and AP3B2 and NIN, ABHD12B, and WHAMM transcripts. It indicated that the codon usage pattern was similar for the SIGLEC5 and AP3B2 gene transcripts, and a slightly different pattern was followed by the NIN, ABHD12B, and WHAMM gene transcripts.RSCU analyses reveal the overrepresented, underrepresented, and randomly used codons in any given gene. Our analysis revealed that codon CTG is the most overrepresented codon in most transcripts. CTG codon is overrepresented in genes common to immunodeficiency and cancer . Higher G codons . Out of G codons . Thus, oSIGLEC5, AP3B2, NIN, ABHD12B, and WHAMM, in our study are associated with the CP, and gene product quantities influence the pathobiology. We have observed in our work that both the protein expression and physical properties are affected by changes in codon usage; therefore, altering codon usage may also manipulate the gene expression pattern. A synthetic biology approach where a gene can be recoded to obtain the desired gene expression level might be helpful. Using the technology, both the upregulation and downregulation of gene expression are possible. The recoded gene may be inserted in CP patients, and the mutated copy of the gene might be exchanged using genome editing tools, such as CRISPR/Cas9 [CP negatively influences glycemic control. Diabetes coupled with CP increases cardiorenal mortality risk . The CP SPR/Cas9 . The codPeriodontitis is a complex chronic inflammatory disorder caused by various factors acting simultaneously. Most of them are related to the immune fitness of the host. Further studies of genetic and epigenetic alterations in DNA might affect the genetic blueprint of the host immune response. Our study imparts partial knowledge of molecular signatures associated with the set of genes significantly associated with CP. Further studies are warranted to identify more genetic signatures associated with the disease.CP is a chronic disorder and has shown an association with poor glycemic index, atherosclerosis, hair loss, liver inflammation, arthritis, respiratory problems, anxiety, and other mood disorders. Therefore, knowledge of codon usage and other molecular features in genes responsible for CP may help in gene augmentation through gene therapy with a recoded gene sequence so that gene expression levels may be modulated and brought to a normal level and CP-associated pathophysiology may be alleviated.


To compare the efficacy of transvaginal repair and hysteroscopic resection in improving niche associated postmenstrual spotting.The improvement rate of postmenstrual spotting in women who underwent transvaginal repair or hysteroscopic resection treatment was assessed retrospectively in patients accepted at the Niche Sub-Specialty Clinic in International Peace Maternity and Child Health Hospital between June 2017 and June 2019. Postoperative spotting symptom within one year after surgery, pre- and postoperative anatomical indicators, women' satisfaction with menstruation and other perioperative parameters were compared between the two groups.P < 0.05). The total days of spotting improved significantly at the 3rd month after surgery but did not change over time within one year in each group (P > 0.05). After surgery, the disappearance rates of the niche are 68% in transvaginal group and 38% in hysteroscopic group, however, hysteroscopic resection had shorter operative time and hospitalization duration, less complications, and lower hospitalization costs.68 patients in the transvaginal group and 70 patients in the hysteroscopic group were included for analysis. The improvement rate of postmenstrual spotting in the transvaginal group at the 3rd, 6th, 9th, and 12th months after surgery was 87%, 88%, 84%, and 85%, significantly higher than 61%, 68%, 66%, and 68% in the hysteroscopic group, respectively (Both treatments can improve the spotting symptom and anatomical structures of uterine lower segments with niches. Transvaginal repair is better in thickening the residual myometrium than hysteroscopic resection, however, hysteroscopic resection has shorter operative time and hospitalization duration, less complications, and lower hospitalization costs. Some reports described postmenstrual spotting in 29%–82% of patients with niche , 10, maiTo date, guidelines for niche treatment are lacking, and the clinical treatment of niche-related spotting includes drug therapy and surgical treatments. Drug therapy can improve the postmenstrual spotting symptom of the niche but with obvious limitations, including the inability to restore the anatomy of the uterus, high recurrence rate after drug withdrawal, and significant side effects from long-term therapy. Surgical treatment is usually regarded as the optional treatment of the niche, including repair and resection. Repair surgery includes transvaginal repair, laparoscopic repair, and transabdominal repair surgery. Among them, transvaginal repair is the least invasive method with no scarring of the abdomen after surgery owing to the use of a natural orifice. Furthermore, transvaginal repair provides direct access to the cavity of the niche, complete resection of tissues surrounding the niche and full-thickness closure, improving the niche-related symptoms and quality of life –21. HystTreatments of the niche worldwide, regardless of the surgical procedures used, are poorly reported, and the post-operative outcomes remains unsatisfactory. The latest systematic review  includedTherefore, here we compared the efficacy of transvaginal repair and hysteroscopic resection in improving niche-related postmenstrual spotting symptoms based on different observation time points after surgery and anatomical indicators.2.2.1.In this retrospective cohort study, all women with niche who were diagnosed and treated at the Niche Sub-Specialty Clinic in the International Peace Maternity and Child Health Hospital (IPMCH) affiliated to Shanghai Jiao Tong University School of Medicine between June 2017 and June 2019 were included. Only women with the surgical history of transvaginal niche repair or hysteroscopic niche resection were included for analysis.The inclusion criteria were as follows: (1) history of at least one CS; (2) existence of the symptom of postmenstrual spotting, defined as the presence of brown discharges for ≥2 days immediately after menstruation or intermenstrual bleeding for ≥2 days; and (3) the defect in the lower anterior uterine segment with at least a 2-mm depth by transvaginal ultrasonography (TVUS) and the residual myometrium thickness (RMT) between at least 2.2 mm. The exclusion criteria were as follows: (1) presence of abnormal menstruation before CS; (2) history of placement of a levonorgestrel intrauterine system or abnormal blood coagulation function or endocrine disease; (3) long-term use of oral contraceptives or gonadotropin-releasing hormone agonists; (4) presence of postoperative pathology-confirmed endometrial disease, such as submucosal fibroids, endometrial cancer, and abnormal endometrial hyperplasia; and (5) non-attendance for the routine outpatient visits.In our sub-specialty clinic, all the women with niche who have received surgical or medical managements were followed by routine outpatient visits every three months for at least one year.2.2.The diagnosis of niche was based on medical history, clinical symptoms, and TVUS findings. Assessment of the spotting symptoms in our institute included self-reported days of spotting, visual analog scale (VAS) score for discomfort experienced with spotting, and Likert scale score  for mensBefore surgery, all patients underwent TVUS to assess the size of the niche and the relationship with the surrounding organs according to a standardized protocol . The par2.3.To avoid the injury of bladder, all patients were evaluated by imaging before surgery and received surgery under general anesthesia by skilled gynecologists who had performed more than 300 transvaginal repair and hysteroscopic resection. Before surgery, patient's bladder was emptied. After surgery, 150 ml of methylene blue diluent filled the bladder to assess bladder integrity. In hysteroscopic surgery group, RMT was greater than 2.5 mm in most patients, with only seven patients' whose RMT ranging from 2.2 to 2.5 mm.The procedure for transvaginal repair was as follows: the woman was positioned in lithotomy position, the bladder emptied and 80–100 ml of physiological saline solution containing epinephrine injected to the vesicocervical space  to create a separated space . Subsequvia endoscopy, and amount of blood accumulated in the vagina.The procedure for hysteroscopic resection was as follows: the woman was positioned in lithotomy position, the cervix was exposed and expanded using 4–9 Hager's. Subsequently, diagnostic curettage was performed for pathological examination. Next, under the hysteroscope, the niche was seen above the inner opening of the anterior cervix of the uterus and protrudes into the cavity of the serous surface of the uterus . It may The postoperative managements were as follows: The transvaginal group received intravenous antibiotics (cefuroxime sodium 3.0 g * 2 days), and the hysteroscopic group received oral antibiotics (levofloxacin 0.4 g * 3 days) to prevent infection. The patients in the transvaginal group, with normal postoperative temperature normal urination regular bowel movement and without complaints of discomfort, were discharged from the hospital. Those in the hysteroscopic group were discharged after being observed for several hours without complaints of discomfort.2.4.All data were obtained from the electronic medical record system stored in the database of the sub-specialty clinic. The preoperative baseline data included the patients' age, gravidity, parity, number of CSs, time since last CS, self-reported days of spotting, VAS score for discomfort from spotting, and Likert scale score for menstrual satisfaction. The perioperative data included operation time, intraoperative blood loss, complications, hospitalization duration, and hospitalization costs. The postoperative indicators included self-reported days of spotting, VAS score for discomfort from spotting, and Likert scale score for menstrual satisfaction. In this study, improved spotting symptom was defined as shortening postmenstrual spotting duration byat least 4 days compared with the baseline ; the imp2.5.The primary outcome was postoperative improvement rate of postmenstrual spotting at the 3rd, 6th, 9th, and 12th month after surgery between the two groups. Secondary outcomes were the comparison of pre- and postoperative anatomical indicators, VAS score for discomfort from spotting, Likert scale score for menstrual satisfaction，and perioperative parameters including operation time, intraoperative blood loss, operative complications, hospitalization duration, and hospitalization costs.2.6.P-values of <0.05 were considered statistically significant.All statistical tests were conducted using SPSS version 23 . Normality of the distributions was assessed by inspection of histograms and quantile-quantile plots. Normally distributed continuous variables are presented as mean ± SD and non-normally distributed continuous variables are presented as median . The continuous variables were compared between the groups using the student's t-test or Mann-Whitney U test, as appropriate. Categorical variables were compared using the chi-square test or Fisher's exact test. The generalized estimating equation (GEE) was used to perform statistical analysis on the median of the spotting days repeatedly measured within one year after surgery to obtain a valid standard error. 2.7.The flow chart of the study is shown in 2.8.P > 0.05).As shown in 2.9.2.9.1.P < 0.05). At all four observation time points within one year after surgery, the median total of spotting days in the transvaginal group decreased by 8.0, 7.0, 7.0, and 8.0 days compared to baseline, which was significantly higher than 5.0, 5.0, 6.0, and 6.0 days in the hysteroscopic group. The median number of spotting days improved significantly at the 3rd month after surgery and did not change over time in each group , In the transvaginal group, 68% of the niche cases (42/62) resolved; the remaining 20 cases still showed niches. The median L, W, and D of these niches significantly decreased compared with the preoperative values (P < 0.05), the median L of the niches significantly increased compared with the preoperative value (P < 0.05); however, the median W and D of the niches were not significantly different before and after surgery .At the 6th month after surgery, six and ten women had no record of TVUS in the transvaginal group and hysteroscopic group, respectively. In the transvaginal group, the median RMT increased from 2.9 mm preoperatively to 8.0 mm postoperatively  has the data about their pregnancies. In the vaginal repair group, one patient achieved pregnancy at the 3th month after surgery with a successful cesarean delivery at 372.9.3.n = 1), bladder injury (n = 1), urinary tract infection (n = 1), and vaginal incision infection (n = 1); no complications were observed in the hysteroscopic group. Compared to the transvaginal group, the hysteroscopic group had a shorter operative time, less intraoperative blood loss, shorter hospitalization duration, and lower hospitalization costs . It is important to note that the resolution of symptoms and complete anatomic correction of the defect are not correlated. At 6th-month after hysteroscopic resection, only 38% of the niche cases (23/60) were completely resolved, but symptoms were resolved in 68% (46/70) cases.As seen on TVUS, transvaginal repair helps restore the anatomical structure of the lower uterine segment. Interestingly, hysteroscopic resection can sometimes improve some values of anatomical indicators. Hysteroscopic surgery does not use suture technology, which theoretically is mostly related to the attenuated lower uterine segment tissue by electrocuting the outflow or inflow tract of the niche, electrocauterizing abnormal tissue in the niche cavity, and destroying the endometrium and fibrous tissue on the entire surface. Therefore, this problem remains controversial among many researchers. Our investigation revealed that the median width of the niches after surgery significantly decreased compared with the preoperative value. The median RMT increased from 3.2 mm before surgery to 3,7 mm after surgery. The possible reason for this phenomenon is the use of electrical equipment to destroy the entire endometrium of the niche cavity surface and fibrous tissue, inducing serious damage to the tissues in the niche cavity, and regeneration of fibrous scar tissue to fill the niche cavity. Previously, Zeller A et al., also shTo date, there is a lack of supporting evidence for, the postoperative observation interval and observation endpoint of niches remain controversial. In 2016, Zhou et al.  followedOur study had a longer observation time after surgery than previous studies, and it not only analyzed the improvement rate of the two procedures in relation to the bleeding symptom but also the effect of time on the improvement indices of the spotting days for the first time. Moreover, subjective evaluation indicators of postmenstrual spotting for the niche were used. The improvement of the anatomical indicators between the two groups before and after surgery was also compared, which was not satisfactorily investigated in previous studies. Several limitations of the present study should also be considered. First, the sample size was relatively small as a result of the retrospective analysis. Second, because most of the patients did not seek conception, we could not assess the outcomes in subsequent pregnancy delivery. Third, the degree of acceptance for the performance of contrast-enhanced sonography in China is low; thus, ultrasonography was performed to measure the corresponding parameters, which might have contributed to a certain rate of missed diagnoses. A consensus statement suggested  that recBoth surgical procedures could improve spotting symptom and anatomical structures of the niches, but transvaginal repair was superior to hysteroscopic resection. Therefore, during the preoperative conversation on the treatment for women with the niche, physicians and patients can go through the decision-making process together, considering the results of our study  for an informed agreement on treatment choice. Additionally, the 3rd month after surgery can be set as a reliable timepoint for observing to assess symptom improvement indicators of niche. Therefore, we suggest that if the symptoms remain unimproved three months after surgery, additional measures should be considered. Thirdly, the improvement of anatomical indicators of the transvaginal repair are significantly better than those of the hysteroscopic resection. However, the choice of the best surgical procedure is also based on a comprehensive consideration of the woman's future fertility desires.Both procedures have proven to be effective in reducing niche related postmenstrual spotting duration. Transvaginal repair is superior to hysteroscopic resection, and the postoperative spotting days did not change onwards in each treatment, unlike the treatment of levonorgestrel-releasing intrauterine device . For the4.Transvaginal repair is better than hysteroscopic resection in improving postmenstrual spotting and the anatomical indicators of the lower uterus. But hysteroscopic resection had the advantages of less operative complications, hospitalization duration and costs. Women with the niche can select the surgical treatment referring to our results for shared decision making with physicians.


Burkholderia cepacia was the main bacteria in the early and middle stage of ulcer exudate and Staphylococcus epidermidis in the late stage. This study provides basic data for further elucidation of the molecular mechanism of diabetic foot.Scorpion peptides have good therapeutic effect on chronic ulcer of diabetic foot, but the related pharmacological mechanism has remained unclear. The different proteins and bacteria present in ulcer exudates from chronic diabetic foot patients, treated with scorpion antimicrobial peptide at different stages, were analyzed using isobaric tags for quantification-labeled proteomics and bacteriological methods. According to the mass spectrometry data, a total of 1865 proteins were identified qualitatively, and the number of the different proteins was 130 (mid/early), 401 (late/early), and 310 . In addition, functional annotation, cluster analysis of effects and the analysis of signal pathway, transcription regulation, and protein-protein interaction network were carried out. The results showed that the biochemical changes of wound microenvironment during the treatment involved activated biological functions such as protein synthesis, cell proliferation, differentiation, migration, movement, and survival. Inhibited biological functions such as cell death, inflammatory response, immune diseases, and bacterial growth were also involved. Bacteriological analysis showed that  Diabetic foot is an ulcer and/or deep tissue destruction and infection which caused by neuropathy of lower extremity and various degrees of peripheral vascular lesions . It is oin vitro and accelerated diabetic wound healing in vivo [Wound healing is a complex cascade process involving repair, regeneration, and remodeling of damaged tissue, related to many growth factors and their receptors, extracellular matrix molecules as well as different proteases and their inhibitors. Many studies have identified the important roles of these molecules in the response –10. Diab in vivo . In addi in vivo . Althoug in vivo .As a liquid biopsy, extravasate reflects the metabolism of wounds and can effectively identify various factors involved in the restoration of injured skin or those associated with unrestored skin injury –17. In rMesobuthus martensii can specifically inhibit Gram-positive bacteria, and it can also inhibit the growth of methicillin-resistant Staphylococcus aureus and other methicillin-resistant bacteria [in vitro and developed it into gel preparation. Three patients with diabetic foot treated with this scorpion antibacterial peptide gel were observed. The exudates from chronic foot wounds were collected at different stages of treatment . Bacteriological and isobaric tags for relative and absolute quantitation (iTRAQ)-labeled quantitative proteomics analyses were performed on these exudates.Scorpion venom is a complex mixture containing many bioactive substances with potential medicinal value. Scorpion antibacterial peptide in the venom of bacteria . In this2, 10 cm2, and 6 cm2 .μm membrane), and the filtrate was collected. BCA protein was quantified and packed separately. The exudate samples of three patients in the same sampling period  were merged. The final four groups of samples were A group (serum), B group (early exudate), C group (middle exudate), and D group (late exudate). The samples of each group were frozen at -80°C until use.According to the ulcer condition of foot wound and the progress of treatment, patients were sampled in three stages: early, middle, and late. The treatment schedule was after the first debridement for each patient at admission, and as the starting point, debridement medication was given to the patient every 5-6 days, lasting about 15 days, and a total of 3-4 treatments were carried out. The wound was washed with water and the residual liquid was dried with sterile gauze. The exudate was drained; a PVA sponge was used to cover the wound, and the outer layer was covered with sterile gauze. After 30 min, the sponge was taken out and wetted with 2-3 ml enzyme inhibitor . The sponge was transferred into a 50 ml centrifugal tube and centrifuged  to collect the exudates. The leachate was transferred into a new 1.5 ml EP tube and centrifuged again  to get the supernatant. The supernatant was filtered  contained 0.8 ml gel storage solution (30% Acr-Bis) concentrated gel, 1.25 ml stacking gel buffer  0.027 ml 10% AP, 0.006 ml TEMED, and 2.95 ml ddH2O [μg) was diluted with sample buffer and denatured for 10 min. Next, it was centrifuged at 10,000 g at indoor temperature for 10 min. The supernatant was collected and subjected to electrophoresis. The separating and stacking gels were run at constant currents of 25 mA and 45 mA, respectively. After electrophoresis, the gels were stained using Coomassie blue and destained with solution containing 10% acetic acid, 30% methanol, and 60% water [Separation gel  contained 7.5 ml gel storage solution (30% Acr-Bis), 3.95 ml separation gel buffer , 0.15 ml 10% AP, 0.006 ml TEMED, and 3.4 ml ddHml ddH2O . The sol0% water .μl was taken from each group onto an uncoated LB plate and overnight incubation was carried out at 37°C. Next, the colonies were counted, and the spots were picked up in 500 ml of LB liquid medium. After the reculture for 6 to 8 h, 30% glycerol was added to preserve the strains, which were stored at -20°C and part of which were sent to China Center for Type Culture Collection for identification of strains (16S rDNA sequencing).The cotton swab dipped in the exudates of chronic ulcer wound of diabetic foot patients was fully stirred in 5 ml LB medium to release bacteria into the liquid medium. The bacterial medium was diluted properly . A volume of 100 Four groups  of freeze-dried samples (50 mg each) were dissolved in 500 ml PBS. ProteoMiner kit was used for separation according to manufacturer's instructions. SDS-PAGE was used to analyze the protein and detect the depletion effect of the kit on serum high-abundance proteins in the exudates.μg) were reduced and alkylated, and then purified by trichloroacetic acid (TCA)/acetone precipitation method [The protein concentrations were quantified using a BCA Protein Assay Kit. Protein samples  and then separated by ultrahigh performance liquid chromatography (with an X Bridge C18 reversed-phase column). Linear gradient was used for separation; buffer B (20 mM ammonium formate dissolved in 90% acetonitrile and adjusted by ammonium hydroxide to pH 10) increased from 5% to 35% within 40 min, and then the column was rebalanced for 15 min under the initial conditions. The flow rate of the column was kept at 200  reserve , 33.μl solution C (0.1% Formic acid aqueous solution) and then analyzed by nanoLC-ESI-Q-Exactive MS/MS. The experimental equipment was a Q-Exactive mass spectrometer connected to Nano ultrahigh performance liquid chromatography (nanoRPLC) and equipped with electrospray ionization (ESI) [μL polypeptide sample was loaded onto a C18 precolumn  for desalting for 3 min (flow rate 10 μL/min), and it was then separated on an analytical C18 column . The linear gradient was used for elution. The solution D (acetonitrile containing 0.1% formic acid) was increased from 2% to 40% within 100 min, and then the column was rebalanced for 15 min under initial conditions at a flow rate of 300 nL/min and column temperature of 40°C. The elution sample was injected into the mass spectrometer by electrospray ionization (ESI) at a voltage of 1.9 kV [Each elution peak component was suspended in 30 on (ESI) . A 5 μL f 1.9 kV .Proteowizard (version 3.0.9490) was used to extract, deconvolute, and deisotope the Tandem Mass Spectrometry data files. The extracted MS/MS spectra were searched with Mascot  . The firWe used Scaffold  to control and integrate the MS/MS matched peptide segments and protein identification results. The standard for quality control of peptide segments was that the false positive rate was less than 1% based on Scafold Local FDR algorithm, which was acceptable for identification of peptide segments. The standard of protein identification was that each protein matched at least two specific peptide segments, and the false positive rate was less than 1%. Protein information which contained the same peptide segments and cannot be distinguished by MS/MS analysis alone was assembled by Occam's razor rule.P < 0.05 was significantly statistical. In this study, the total number of quantitative spectrograms was 52 660, accounting for 90% of identified spectrograms (58194).Scaffold Q+  software was used to analyze the quantitative data of peptide segments and proteins. The iTRAQ quantitative intensity of multiple peptide segments of the same protein was normalized and used for the corresponding protein. The intensity of the two reference channels was normalized and the average value was taken as the basis for comparing all groups. We chose 1.3 times of different quantitative value as difference threshold. Using ANOVA test, Ingenuity Pathway Analysis  and Genecards Gene Analytics  were used to analyze the function, pathway, interaction annotation, and enrichment of differentially expressed proteins.We focused on the clinical treatment of three patients with diabetic foot and sampled them at different stages of treatment. After treatment, the physiological condition of ulcer wound was significantly improved; the inflammation reaction of the wound was alleviated, and the suppuration and redness subsided. At the same time, the granulation tissue grew inside the wound; the edge skin contracted inward; the wound area was reduced, and the infection was alleviated. After about 20-30 days of treatment, all the three patients had successful skin transplantation.4-7 CFU/ml, and the changes in early, middle, and late stages initially decreased and then increased  was counted to reflect the change in the number of living bacteria in the exudates. As shown in ncreased ; in patincreased ; in patie stages . Subseque stages –3. 16S rIn order to visualize the changes in exudate proteins at different treatment periods, SDS-PAGE electrophoresis was performed on all the samples. As shown in Exudates contained many serum high-abundance proteins, such as apolipoprotein APO family, complement protein CO family, fibronectin FIB family, and albumin. Therefore, in order to improve the identification of low-abundance proteins by mass spectrometry, we first carried out a reduction of serum high-abundance protein before quantitative proteomic analysis to reduce the content of these proteins . After treatment, the high abundant proteins in the four groups of samples were effectively removed, and the low abundant proteins were effectively concentrated (with clear bands and deeper concentration). Concentrated eluent proteins were used for subsequent isotope labeling, chromatographic separation, mass spectrometry identification, and analysis.Four groups of iTRAQ labeled samples , B (early exudate), C (middle exudate), and D (late exudate)) were detected by mass spectrometry. Mascot, Scaffold, and IPA software were used to analyze the mass spectrometry data. According to the results of mass spectrometry of all the sample groups, 444494 MS/MS spectra were obtained. Qualitative identification criteria used each identified protein to obtain at least less than 1% of the false positive rate (FDR), two specific matched peptide fragments, less than 1% of the false positive rate of protein. According to the standard, we identified a total of 58194 spectra corresponding to 1865 proteins  . Quantitative data were analyzed using the criteria of 1.3-fold change and nonparametric test The differential proteins in the different groups were mainly upregulated. Specific to the corresponding molecule, the upregulation of S100-A7 (immune response and angiogenesis), S100-A2 , calmodulin-like protein 3, protocadherin-18 , 14-3-3 protein Sigma , tropomyosin alpha-4 chain (migration of skeleton and muscle cells), and 60S ribosomal protein L19 (protein synthesis) were clearer. The downregulation of collectin-10 (glycometabolic metabolites), complement C5, complement component C6, Mmannose-binding protein C (complement activation), grancalcin (inflammatory response), beta-Ala-His dipeptidase (carnosine hydrolysis and cell death), tumor necrosis factor-inducible gene 6 protein (cell death), and serum amyloid A-1 protein (immune response) was more evident.We used Ingenuity Pathway Analysis (IPA) software to annotate the function, signal pathway, and interaction analysis of differential proteins. Firstly, the annotations were made on 130 differential proteins in intermediate exudate (C group) compared with early exudate (B group) and 401 differential proteins in late exudate (D group) compared with early exudate (B group) in order to investigate their biological functions, toxicological functions, and regulatory functions. A total of 500 classifications (subcategories) in C/B group and 500 classifications (subcategories) in D/B group were annotated, but their reliability and the degree of activation/inhibition varied  from the differential proteins of C group (intermediate exudate) and B group (early exudate). The main activated physiological effects were cell movement  and migration , cell differentiation , body injury and regeneration system , tissue survival , protein synthesis , cell invasion , and skin formation . Inhibited functions included gangrene-induced cell death , leukocyte recruitment and inflammatory response , nerve cells , tissue cell death , and bacterial growth . In D group (late exudate) compared with B group (early exudate), most of the physiological effects of activation were similar to those of C/B group, such as protein synthesis, cell proliferation, differentiation, migration, movement, survival, invasion, and tissue survival. The inhibited physiological effects were similar to those of C/B group, such as cell death , inflammatory diseases, inflammatory reactions, immune disease, etc.As shown in In summary, these biological functions, which were clearly activated or inhibited, reflected the changes of microenvironment in the healing process of diabetic foot ulcer wounds (mid/early and late/early). In other words, the enhancement of protein synthesis, cell proliferation, differentiation, migration, and movement facilitates cell growth and survival as muscles, skin, blood vessels, and other tissues continued to form and survive. At the same time, cell and tissue death, inflammatory reaction, inflammatory disease-related molecules, and bacterial growth were reduced in the injured area. The comprehensive effects of all the biological processes mentioned above were conducive to the repair and healing of the injured area.P value) of each class was displayed. Each class contained multiple subclasses, and the extreme value was taken  ≈ 20), followed by inflammatory reactions, inflammatory diseases, and immune diseases  between 12 and 14), and other functions involved in free radical scavenging, cell movement, nervous system diseases, developmental disorders, body damage and abnormalities, genetic abnormalities, cell death and survival, cell morphology, formation and function of hair and skin, organ and tissue development, blood system development and function, immune cell recruitment, regenerative system diseases, etc. In the classification of differential proteins in D group (late exudate) and B group (early exudate), the number and reliability related to cell death and survival as well as skin diseases and health were the highest, followed by those related to posttranscriptional modification of RNA, infectious diseases, protein synthesis, and immune diseases. Inflammatory diseases, inflammatory reactions, body injury, gene expression, cell growth and differentiation, cell migration, connective tissue, skeletal tissue, muscle tissue disorders, developmental disorders, blood system development and function, immune cell recruitment, neurological diseases, and other related differential protein classification were also highly reliable. In summary, the middle and late-stage differential proteins were more involved in the functions of skin diseases and health, inflammatory reaction, immune diseases, and inflammatory diseases. Comparisons of other functions suggested that the reliability was approximately the same. Except in the late stage (D/B group), cell death and survival, cell growth and differentiation, gene expression, posttranscriptional modification of RNA, protein synthesis, body injury, and infectious diseases were higher than those in the middle stage (C/B group), which can be attributed to a higher number of differential proteins identified.The function classifications of Supplementary Table as taken . From FiIn summary, it was evident that the causes of chronic ulcer wound and nonunion in diabetic foot may be connected to abnormal cell death, abnormal development and regeneration of nerve, blood vessel, blood system, connective tissue, muscle tissue, excessive inflammation, inflammatory disease, and immune system disease. Bacterial and viral infections were also associated with chronic ulcer wound in diabetic foot. Therapeutic processes were the recovery and regeneration  and the decline  of physiological or pathological processes.Further, we analyzed the class and the descendants of annotations of differential proteins and their subclasses by Heatmap of clustering analysis . It was In the wound healing process of diabetic foot ulcer, tissue regeneration and recovery were more extensive in the midterm. In the late stage, cell and tissue death, cell division, and tissue regeneration as well as infection and inflammation were suppressed. At the same time, there were common activation and inhibition effects, and some of the biological effects were different in the middle and late stages. Moreover, significant differences also existed among some of the biological functions in the middle and late stages.P value) were larger, but no consistent activation or inhibition information were acute phase response signaling, completion system, glycolysis I, LXR/RXR activation, regulation of eIF4 and p70S6K Signaling, FXR/RXR Activation, gluconeogenesis I, adenine and adenosine salvage I, systemic lupus erythematosus signaling and mTOR signaling, etc. EIF2 signaling was the only pathway that was more significantly activated in D group (late exudate) than in B group (early exudate). There were many other pathway disorders  = 2 − 9) with no apparent consistent activation or inhibition information, such as regulation of eIF4 and p70S6K signaling, LXR/RXR activation, acute phase response signaling, completion system, mTOR signaling, FXR/RXR activation, glycogen Degradation II, etc.We performed classical signal pathway analysis of differential proteins  of pathway analysis was low; P value  was used as the judgment standard. The deeper the purple color, the more significant the effect of disorder of the pathway. As shown in In order to visualize the signal pathways involved, the histogram statistics of Supplementary Table To understand the transcriptional regulation of differential proteins, we analyzed the upstream regulatory factors of differential proteins , wound location, and size. After a certain period of clinical treatment, the wound was greatly repaired, and ultimately after autologous skin flap transplantation, the wounds of the three patients were basically healed. During the whole process, wound exudates at different stages reflected the changes in wound microenvironment and the biological and pathological processes involved. Conventional proteomics can only qualitatively identify the protein composition of a sample, but the disease process is often a dynamic change. In this case, quantitative analysis of protein components is particularly necessary. In addition to conventional drug therapy, surgical debridement and negative pressure suction, scorpion peptide antibacterial gel in the treatment process, may have a potential effect against excessive inflammation and purulent secretion, and they may promote granulation tissue growth and accelerate the healing of wounds in addition to killing pathogens . However, this is only based on clinical observation and medication experience. The specific mechanism of antibacterial peptide in this process needs to be elucidated.Burkholderia cepacia , is a human conditional pathogen in hospitals, which can cause sepsis, pneumonia, abscess, and wound infection, especially in elderly patients, patients with low immunity and being treated for trauma [Staphylococcus epidermidis, a Gram-positive bacterium, is a normal flora on the surface of human skin [Burkholderia cepacia decreased from early to middle stage, which may be as a result of a variety of treatments including the scorpion antimicrobial peptide. In the late stage, the main flora was Staphylococcus epidermidis, a normal parasitic bacterium on skin surface, and the number of Burkholderia cepacia CFU naturally increased.Bacteriological analysis of exudates showed that the number of pathogenic bacteria in wound site decreased; then, normal flora was observed in the late stage. We can conclude that scorpion antimicrobial peptide played an important role. r trauma . Staphylman skin . The maiThe SDS-PAGE separation of exudate proteins showed that there were differences in protein bands between the samples at different stages, and the components of exudate and serum were also different. Quantitative mass spectrometry data of exudate samples showed that the number of differential proteins in early, middle, and late stages was within the normal range, but there were 1153 differential proteins compared with the serum control group in the case of 1865 proteins identified. However, 600-800 differential proteins were usually identified in normal human serum, indicating a considerable difference. Therefore, in the follow-up data analysis process, we did not take the serum group into account, but only analyzed the differential proteins of the wound exudates at different periods, which was enough to reflect the dynamic process of the disease.P < 0.05; 130 differential proteins were identified from the middle-term exudates; 401 differential proteins were identified from the late exudates. There were 310 differential proteins identified which emerged concurrently in the middle and late stages. Specific differential proteins, such as S100 calcium binding proteins A2, A8, A7, and A6, were highly expressed in ulcer wounds, which was consistent with previous reports [Quantitative mass spectrometry with iTRAQ labeling can not only qualitatively analyze sample proteins but also analyze differential proteins between samples . Through reports . However reports , which wThe annotations of these differential proteins showed that the main activated effects in the middle and late stages included protein synthesis, cell proliferation, differentiation, migration, movement, invasion, and tissue survival. Cell death, inflammatory diseases, inflammatory reactions, and immune diseases were all inhibited. However, both activation and inhibition in the late stage involved more protein molecules and more specific classifications with higher reliability. This indicated that in the late stage, the wound exhibited a stronger and faster self-repairing effect. Overall, these biological functions, which were either activated or inhibited, reflected the microenvironment changes associated with the healing process of diabetic foot ulcer wounds. Skin diseases and health, inflammatory response, and immune diseases were more involved both in the middle and late stages. Heatmap and clustering analysis of differential proteins in exudates at different stages showed that in the wound healing process of diabetic foot ulcer, the midterm involved tissue regeneration and recovery, and the late stage involved the inhibition of cell and tissue death, slowing down cell division and tissue regeneration as well as the suppression of infection and inflammation. There were common activation and inhibition effects as well as significant biological effects in the middle and late stages. Finally, we conducted transcriptional regulation analysis and protein interaction network analysis, revealing the complex regulatory mechanism and interaction among differential proteins.In this study, through quantitative proteomic analysis, we confirmed that the causes of chronic ulcer wound and nonunion in diabetic foot may be related to abnormal cell death, abnormal development and regeneration of nerve, blood vessel, blood system, connective tissue, muscle tissue, excessive inflammatory reaction, inflammatory disease, immune system disease, and bacterial and viral infections. Therapeutic processes involved the recovery  and the decline  of these physiological or pathological processes. Although the specific targets and mechanisms of scorpion antimicrobial peptide in the treatment process still need to be verified by more in-depth and more specific experiments. The result of the proteomics analysis provided a differential protein molecular map of diabetic foot ulcer wounds, which provided some basic data and references to further elucidate the molecular mechanism of the development and treatment of the disease and identify diagnostic markers of healing in chronic wound.


The incidence of Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is increasing worldwide. The understanding of its prognosis has been progressively evolving and currently appears to be poorer than previously thought, which has attracted the attention of researchers. An attempt to recognize the awareness of this condition among the general population drove us to analyze the dissemination of this topic on TikTok, a popular short-video–based social media platform. We found a considerable number of videos on TTS on TikTok; however, the quality of the presented information remains unknown.The aim of this study was to analyze the quality and audience engagement of TTS-related videos on TikTok.Videos on the TikTok platform were explored on August 2, 2021 to identify those related to TTS by using 6 Chinese keywords. A total of 2549 videos were found, of which 80 met our inclusion criteria and were evaluated for their characteristics, content, quality, and reliability. The quality and reliability were rated using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria by 2 reviewers independently, and a score was assigned. Descriptive statistics were generated, and the Kruskal-Wallis test was used for statistical analysis. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video content, video quality, and author types.P<.05). TTS-related videos made by health care professionals accounted for 28% (22/80) of all the evaluated videos and had the highest DISCERN scores with an average of 40.59 out of 80. Multiple linear regression analysis showed that author types that identified as health professionals  and individual science communicators  were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes.The scores assigned to the selected video content were low with regard to the diagnosis (0.66/2) and management (0.34/2) of TTS. The evaluated videos were found to have an average score of 36.93 out of 80 on the DISCERN instrument and 1.51 out of 4 per the JAMA criteria. None of the evaluated videos met all the JAMA criteria. The quality of the relayed information varied by source (All We found that the quality of videos regarding TTS for patient education on TikTok is poor. Patients should be cautious about health-related information on TikTok. The formulation of a measure for video quality review is necessary, especially when the purpose of the published content is to educate and increase awareness on a health-related topic. P<.001) [Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is characterized by transient ventricular dysfunction with typical wall motion abnormalities ,2. The nP<.001) . The cliP<.001) ,6. GivenP<.001) ,8 have sP<.001) .The internet is a useful platform for effectively communicating new information, and many new technological applications have taken advantage of this to serve as a medium for patient education on health-related topics. Seeking web-based health information has become increasingly popular; many people rely on web-based resources to obtain health information and aid their medical decision-making . ResearcAlong with the quality of information, audience engagement is another key component of effective web-based health communication. Audience engagement in health-related topics has been studied in traditional social media platforms such as YouTube and Facebook -19. The Previous studies have yielded inconsistent conclusions on the impact of video quality on audience engagement. A study on videos of stroke on YouTube by Szmuda et al  showed tTikTok (DouYin in Chinese) is a short-video social app with a sizable userbase wherein individual users create and publicly post short videos on various subjects. Initially, when the platform first became popular, the video length was limited to short 60-second clips. However, with growing demand, the length was extended to allow up to 5-minute-long videoclips . TikTok The search was conducted on August 2, 2021, in China. Six specific hashtags（“#应激性心肌病” “#Takotsubo综合征” “#Takotsubo心肌病” “#心碎综合征” “#章鱼壶心肌病” “#心尖球形综合征”）that refer to TTS in Chinese were used to retrieve TikTok videos related to TTS. TikTok provides 3 ways to filter videos, that is, overall ranking, most recent, and most liked. Considering that most users use the default sorting option, “overall ranking,” we performed the search in TikTok under the discover mode using the “overall ranking” sort option. All the resultant videos for each keyword were retrieved and screened. The initial search returned 2549 videos , of which 80 videos met our criteria for analysis after screening. The exclusion criteria were as follows: (1) videos not related to TTS or lacking educational information, (2) duplicate videos, (3) videos not in Chinese, and (4) videos that were not original. Baseline characteristics were extracted directly from each video and the video author’s public TikTok profile on the same day of the data search. With respect to the video authors, we collected their account ID, inauguration unit, number of both followers and those they follow, overall number of posted videos, and likes obtained. Additionally, we further ascertained whether the public TikTok profile had photos, live broadcast information, and contact details. For each individual video, we also collected the uniform resource locator, the date posted, the number of likes, comments, reposts, and duration. Based on the abovementioned information and historical videos on their profile page, the TikTok authors were classified into 6 categories: (1) individual science communicators, (2) news agencies, (3) for-profit organizations, (4) health professionals, (5) nonprofit organizations, and, (6) general users. Furthermore, the content of each video was assessed for the following characteristics: use of characters, background music, emoji, flash, and video subtitles.We used the DISCERN instrument and Journal of the American Medical Association (JAMA) criteria to evaluate the quality of the selected TikTok videos. These instruments are commonly used standards for health information evaluation ,31. The All video contents evaluated using the DISCERN instrument, JAMA benchmarks, and the 6 questions from the studies of Goobie et al  were indP value <.05 was deemed statistically significant. In our paper, we use the number of likes as a proxy measure of audience engagement. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video quality and author types. The regression analysis was conducted on R , with a log transformation of the outcome variable audience engagement. This study did not involve human subjects, and hence, the study was not reviewed by the institutional review board.Descriptive statistics for continuous variables, including the mean, median, range, and standard deviation, were calculated. SPSS version 22.0 (IBM Corp) was used to perform data analysis. An intraclass correlation coefficient was used to assess the interrater agreement. The average agreement by intraclass correlation coefficient was 0.87 for content rating, 0.92 for DISCERN scales rating, and 0.88 for the JAMA benchmark rating. The average intraclass correlation coefficients for interrater agreements all exceeded the recommended value of 0.75, indicating that the ratings had good reliability . The KruThe average length of the evaluated videos was 59 seconds, with a maximum duration of 700 seconds and a minimum duration of 7 seconds. On average, a video received 5543 likes and 635 reposts. The majority of the videos  had the presence of people, 90% (72/80) had subtitles, and 70% (56/80) of the videos had background music. Approximately 19% (15/80) and 23% (18/80) of the videos had emojis and animations, respectively .With regard to content creation, users classified as health professionals posted the most videos , followed by general users , individual science communicators , news agencies , and for-profit organizations . Nonprofit organizations posted the fewest videos  . The aveThe average total score of Goobie et al’s  6-questiThe average score given for the videos on the DISCERN instrument by both raters was 36.93 out of 80, indicating that the overall quality of these videos was poor .Both raters agreed that 98% (78/80) of the videos provided the latest information, 43% (34/80) of the videos provided information regarding authorship, but none mentioned the disclosure statement. None of the videos met all the JAMA criteria. The average JAMA score was 1.51. By video author categories, an average score of 1.91 was obtained by health professionals, 1.08 by individual science communicators, 1.08 by general users, 1.77 by news agencies, 1.83 by for-profit organizations, and 2.00 by nonprofit organizations. Based on the Kruskal-Wallis test, there were statistically significant differences in content, DISCERN instrument scores, and the JAMA standard video assessment scores among the 6 author groups (P=.006) and individual science communicators  were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes  and had fewer thoughts related to the acute cardiac episode that interfered with their life (P<.001). It is still unclear whether awareness of TTS will change these perceptions, but an increase in awareness may certainly encourage individuals to adopt measures to mitigate individual stressors, which, in turn, may reduce the incidence of TTS. Some patients with TTS continue to experience symptoms despite resolution of the acute phase. Cardiac rehabilitation may be beneficial for these patients to improve the quality of life and reduce episodes of ongoing chest pain, but only few patients have been reported to receive cardiac rehabilitation owing to the lack of awareness among patients and even doctors [Growing evidence suggests that TTS is a severe cardiac disorder with a substantial mortality risk. A meta-analysis showed no difference in the in-hospital and long-term mortality between TTS and ACS . Long-te doctors . ImproviTo the best of our knowledge, this is the first study to analyze the quality of TTS-related videos on TikTok. As a popular social media platform, TikTok has the potential to become a valuable and influential platform to disseminate health information, especially in the context of the current COVID-19 pandemic ,43. In oNotably, videos created by health professionals also received the highest number of likes and reposts in our study, which is in contrast to the results of other prior studies. In previous studies evaluating videos on psoriasis and nephrolithiasis on YouTube, poor-quality videos received greater attention ,47. Our In terms of video content, we found that very few videos introduced the concept of diagnosis of TTS, and the display of reference information sources was not common, which remains an area to be addressed. The comprehensiveness and accuracy of the video content is a necessary prerequisite to ensure reliable transmission of information, especially when most TikTok users do not have the ability to differentiate health information for reliability. Therefore, we recommend that video producers provide sources of reference information. In addition, in the process of screening videos, we noticed that many videos showed the causes of TTS to be mainly emotional factors, and only a few videos emphasized physical factors, which are important and cannot be ignored. A retrospective study on patients with TTS showed that physical factors are considerable risk factors for in-patient mortality . It is aThrough multiple linear regression analysis, we found that, compared with videos made by general authors, those made by health professionals and individual science communicators were more likely to obtain likes. Interestingly, no correlation was found between audience engagement and a video’s DISCERN scores. The number of likes is commonly viewed as a collective filter and as an indicator of popularity, which may reflect video quality ,51,52. HOur study has some limitations. First, this was a cross-sectional study with a small sample size, despite attempts to include all relevant videos. Second, we only evaluated Chinese videos, which may not be representative in a global context. Future research studies can target characteristics of videos in various languages and regions. In addition, we utilized common standards that are currently used for health information video evaluation, namely, the DISCERN instrument and the JAMA criteria ,34. HoweP=.006) and individual science communicators (P=.01) were significant and independent determinants of consumer engagement (in terms of the number of likes). Our study indicates that the formulation of a measure to review video quality and reliability, especially with respect to health-related information dissemination on TikTok platform, is imperative and patients should be cautious when obtaining health-related information through TikTok. Medical professionals and individual science communicators should be encouraged to create high-quality health-related videos, which may potentially have higher audience engagement and promote health education.By analyzing the quality of TTS-related videos on TikTok, we found that videos produced by health professionals were found to have the highest DISCERN scores. However, the overall quality of the videos related to TTS on TikTok is poor. The multiple linear regression analysis showed that author type categories of health professionals (


Traditional bone defect treatments are limited by an insufficient supply of autologous bone, the immune rejection of allogeneic bone grafts, and high medical costs. To address this medical need, bone tissue engineering has emerged as a promising option. Among the existing tissue engineering materials, the use of electroactive scaffolds has become a common strategy in bone repair. However, single-function electroactive scaffolds are not sufficient for scientific research or clinical application. On the other hand, multifunctional electroactive scaffolds are often complicated and expensive to prepare. Therefore, we propose a new tissue engineering strategy that optimizes the electrical properties and biocompatibility of carbon-based materials. Here, a hydroxyapatite/carbon nanofiber (HAp/CNF) scaffold with optimal electrical activity was prepared by electrospinning HAp nanoparticle-incorporated polyvinylidene fluoride (PVDF) and then carbonizing the fibers. Biochemical assessments of the markers of osteogenesis in human adipose-derived stem cells (h-ADSCs) cultured on HAp/CNF scaffolds demonstrate that the material promoted the osteogenic differentiation of h-ADSCs in the absence of an osteogenic factor. The results of this study show that electroactive carbon materials with a fibrous structure can promote the osteogenic differentiation of h-ADSCs, providing a new strategy for the preparation and application of carbon-based materials in bone tissue engineering. Bone defects are gaps formed by erosion caused by severe trauma, infection, or other deleterious events. When the size of the bone defect exceeds the body’s ability to heal spontaneously, clinical treatment is needed . At presConsidering the limitations of transplantation, bone tissue engineering has been pursued as an effective alternative method to repair bone defects. Due to the bioelectric properties of native bone tissue, electroactive scaffolds loaded with different types of cells and growth factors have been used in the regeneration of bone defects ,5. CarboCarbon nanofibers have structures and mechanical properties that are similar to those of the natural extracellular matrix. At the same time, they also have excellent electrical activity. Carbon-based materials have been found to influence the adhesion and proliferation of cells , and theCarbon fiber scaffolds and electroactive scaffolds have been demonstrated to promote osteogenic differentiation. For instance, Naskar et al.  synthesi2+ [2+ concentrations leads to a dramatic increase in intracellular Ca2+ concentrations. In turn, the intracellular Ca2+ can activate signaling pathways, including those mediated by calcium/calmodulin-dependent protein kinase, which play key roles in multiple aspects of osteoblast proliferation and differentiation [Whereas carbon-based scaffolds have been used successfully to enhance cellular differentiation, the doping of these materials with other chemicals may provide additional benefits. Hydroxyapatite (HAp) is the main component of natural bone tissue . Studies2+ ,20. The ntiation ,22. In developing materials for use in bone engineering, the source of the stem cells is an important consideration. Bone marrow mesenchymal stem cells (BMSCs) are the most important source of cells in bone tissue engineering; however, as people age, the number and activity of BMSCs decreases significantly, making these cells unsuitable for the collection and extraction of autologous stem cells. Human adipose-derived stem cells (h-ADSCs), on the other hand, have a wide range of sources; their concentration in the plasma is more than 500 times higher than that of BMSCs, and they are relatively easy to extract ,25,26,272+ release in bone engineering, integrating electroactive carbon-based materials with Ca2+-releasing HAp nanostructures may provide a practical approach to inducing osteogenic differentiation of hADSCs without the need for biological or chemical induction. However, the preparation of such a multifunctional material has remained a challenge. In this study, we discuss a novel method to fabricate HAp-carbon hybrid nanofibers with an electroactivity that is compatible with use in biological applications, and this material was used as a cell scaffold to investigate the osteogenic differentiation of h-ADSCs in the absence of an osteogenic inducing factor. These nanofibers were prepared using an electrospinning method with an HAp-dispersed polyvinylidene fluoride (PVDF) solution as a precursor. The nanofibers were further processed using carbonization. In general, polyacrylonitrile (PAN) is the most popular polymer for making carbon (nano) fibers. However, the concentrated heat release in the pre-oxidation stage of PAN can easily lead to melting and shrinkage, so it is necessary to apply traction and other means to ensure the properties of the fiber [2+ in HAp. Therefore, the hydroxyapatite/carbon nanofiber films (HAp/CNF) prepared using this method were found to have a controllable pore size distribution, high electroactivity, large specific surface area, and controllable release of Ca2+. Based on the importance of both electroactivity and Cahe fiber . This leThe morphologies of PVDF and HAp/CNF at the micro- and nano-scales were characterized using SEM. Although agglomeration occurred after drying, the HAp after treatment with ultrasound and by grinding was observed to have a nanorod-like structure with a diameter of 30 to 60 nm a. This sIt is necessary to carry out the defluorination and cross-linking of the HAp/PVDF membrane before carbonization. As shown in After carbonization, the prepared HAp/CNF exhibited a complete three-dimensional (3D) fiber network structure. Compared with the PVDF and HAp/PVDF film, the fibers of the CNF and HAp/CNF expanded slightly after carbonization , which mThe crystal phase of HAp/CNF was analyzed using TEM . The lat2+. To detect the degree of graphitization of the carbon fibers, different materials were analyzed using Raman spectroscopy. Raman images of all materials showed two distinct D and G bands at 1320 and 1590 cm−1, respectively. With the increase in the amount of doped HAp, ID/IG gradually increased from 1.07 to 1.35, indicating that HAp doping increased the exposure of defects and that this exposure led to the formation of amorphous carbon  during carbonization, the carbonized fiber had a loose porous structure g, which s carbon i. XRD was also performed to investigate the crystal structures of CNF as well as HAp/CNF containing 1, 5, and 10% HAp. As shown in ct values of CNF and HAp/CNF with 1, 5, and 10% HAp were 10.4, 13.3, 9.2, and 12.8 Ω, respectively. The consistency of these values showed that doping with HAp had almost no effect on the Rct value of the carbon fiber. Therefore, we concluded that CNF and HAp/CNF have excellent electrical activity and thus have the potential to regulate stem cell differentiation. It has been confirmed that scaffolds with electrical activity can promote osteogenic differentiation ,32. ConsAs the hydrophilicity of materials can influence the adhesion and migration of cells , we evalIn short, these results demonstrate that CNF and HAp/CNF were successfully prepared, and the materials had excellent electroactivity. In addition, CNF and HAp/CNF with different HAp concentrations have similar degrees of graphitization and fiber structural properties. Therefore, the CNF and HAp/CNF prepared in this experiment were further evaluated for their ability to induce the osteogenic differentiation of h-ADSCs.To assess the cytotoxicity of the membranes, h-ADSCs were cultured on different samples, and cell proliferation was assessed using CCK-8 assays (S1), with cells cultured on a tissue culture plate serving as a control. The results shown in From the proliferation trends of cells, the materials have no obvious toxicity to cells. The slightly lower cell viability on the materials relative to the control may be attributed to the composition of the fiber membranes. As the membranes were composed of calcium and carbon, they may have promoted cell differentiation rather than cell proliferation. Previous studies have confirmed that decreasing cell proliferation is usually related to cell senescence, apoptosis, and differentiation ,35. TherTo further investigate the cytocompatibility of the membranes, an assay that detects live and dead cells was used to perform a quantitative evaluation. In this series of experiments, cells grown on the three HAp/CNF membranes with different HAp concentrations were used as the experimental groups, and cells grown on tissue culture plates were used as a control group. As shown in Immunofluorescence staining of F-actin was used to observe the cell morphologies of adhesive cells with different materials as substrates . After 7To further investigate these changes, SEM was used to analyze the morphological changes of h-ADSCs after culturing on different materials for 7 days. As shown in 2+ would accelerate the process of osteogenic differentiation.These morphological analyses reveal that the CNF and HAp/CNF membranes were biocompatible with h-ADSCs. In addition, these membranes, especially those containing HAp, were found to have the ability to influence the morphologies of h-ADSCs. Therefore, we speculated that the rough carbon fiber structures with certain electrical properties would promote the osteogenic differentiation of h-ADSCs. With the addition of HAp, the synergistic effect of CaAlkaline phosphatase (ALP) is an early phenotypic marker of osteogenic differentiation and can be used to assess the degree of the osteogenic differentiation of stem cells ,37. To eRUNX2 encodes runt-related transcription factor 2, which regulates osteoblast differentiation and plays an important role in bone formation, cartilage formation, and bone metabolism [OPN, is a glycoprotein that plays a key role in bone matrix mineralization [OCN, is important in the process of osteogenic differentiation and is considered to be a marker of the mineralization stage, which generally occurs at the end of osteoblast differentiation [The trend in the osteogenic differentiation of h-ADSCs cultured on different materials was further investigated by analyzing the expression of osteogenesis-related genes using q-PCR (S2.2). tabolism ,39. Ostelization ,41. Ostentiation . RUNX2 in h-ADSCs cultured on the CNF and different HAp/CNF materials for 7 days was substantially enhanced compared with the expression in the control cells. The culturing of cells on CNF, and 1, 5, and 10% HAp/CNF led to increases in RUNX2 expression of 23.3-, 15.8-, 12.2-, and 7.9-fold, respectively, relative to the expression in cells grown on tissue culture plastic. As shown in RUNX2 gene in cells grown on CNF, and 1, 5, and 10% HAp/CNF was increased 6.1-, 18.2-, 35-, and 24.4-fold, respectively, relative to the expression in cells grown under control conditions. The decrease in RUNX2 expression in cells grown on CNF correlated with an increase in the relative expression of OCN and was thus likely related to the entering of the final stage of osteogenic differentiation. Due to the lack of a source of Ca2+, the expression of RUNX2 could not be efficiently promoted after 14 days, so the expression of RUNX2 decreased. After 14 days of culture, the expression of the OPN in cells cultured on CNF and HAp/CNF materials were similar to those of OCN. In both cases, the expression levels of these genes were clearly increased in cells grown on synthetic materials compared to those grown on tissue culture plastic. At day 7 of culturing, the expression of OPN in cells cultured on CNF, and 1, 5, and 10% HAp/CNF were higher by 18.3-, 19.7-, 19.5-, and 7.0-fold, respectively, compared with expression in the control cells. In addition, the expression of OPN in cells cultured on different fiber membranes continued to increase through to day 14. The levels of expression of OPN in the cells grown on those materials were 6.8-, 26.6-, 26.6-, and 25.3-fold higher, respectively, than those of the control cells on day 7. The expression of OCN in cells grown on CNF was 2.5-fold higher than that of the control cells on day 7, whereas the gene expression levels in 1, 5, and 10% HAp/CNF were 9.6-, 7.7-, and 7.6-fold, relative to the control. The levels of expression of OCN in cells grown on CNF, and 1, 5, and 10% HAp/CNF were higher than those of the control cells after 14 days of culture. Compared with the control cells on day 7, the expression levels of both genes in the cells grown on CNF, and 1, 5, and 10% HAp/CNF on day 14 were increased by 19-, 20.3-, 20.2-, and 7.5-fold, respectively. As shown in 2+. Higher concentrations of HAp will release more Ca2+  staining. As 5% HAp/CNF led to the strongest induction of osteogenic differentiation according to the assays of the expression of osteogenesis-related genes, 5% HAp/CNF was selected for this set of experiments. Mineralized nodules are a marker of osteoblast differentiation and maturation, and the osteogenic function of osteoblasts. Accordingly, the observation of osteoblast mineralized nodules is a commonly used technique to verify osteoblast differentiation ,45. Here2+ on the material could lead to false positive results in the staining assay, but no red-stained calcium nodules appeared , sodium hydroxide (NaOH), sodium dihydrogen phosphate dihydrate (NaH2PO4·2H2O), 1, 4-Bis (aminomethyl) benzene, absolute ethanol, methanol, nitric acid, N-hexane, N,N-dimethylacetamide (DMF), and acetone were purchased from Sinopharm  and can be used directly without any further purification. Deionized water was used throughout this study.The following chemicals were used to synthesize CNF and HAp/CNF. PVDF powder (Solvay 6010) was purchased from commercial sources. Oleic acid, calcium chloride  and fetal bovine serum (FBS) were provided by Gibco . Penicillin-streptomycin  and phosphate buffered saline (PBS) (1×) pH 7.2 were purchased from SparkJade . In addition, 4% paraformaldehyde , 2.5% glutaraldehyde , Triton X-100, bovine serum albumin (BSA), BCA protein assay kit, ALP activity assay kit, and 2% Alizarin Red S (ARS) were purchased from Solarbio . Cell Counting Kit-8 (CCK-8) and rhodamine phalloidin were purchased from MedChemExpress  and Cytoskeleton , respectively. Primary antibodies for osteocalcin (OCN) and osteopontin (OPN) were purchased from Proteintech . Trizol reagent, 4′, 6-diamidino-2-phenylindole (DAPI), live/dead viability/cytotoxicity kit, and OCN and OPN secondary antibodies were purchased from Invitrogen .PVDF membranes were prepared as previously described . Briefly3 for 1 h, followed by a 6 h incubation in deionized water, a 2 h incubation in anhydrous methanol, and a 2 h incubation in N-hexane. This series of washes was repeated three times to remove residual byproduct particles.The membranes were subjected to cross-linking prior to high-temperature carbonization . Next, 1After cross-linking, the PVDF and HAp/PVDF nanofiber membranes were placed in a tubular furnace filled with argon. The furnace temperature was increased to 1000 °C at a rate of increase of 5 °C/min to produce the CNF and HAp/CNF membranes.Scanning electron microscopy (SEM), performed using a Regulus 8100 system (Hitachi High-Technologies Corporation), was used to characterize the material morphologies. Transmission electron microscopy (TEM), performed using an FEI Talos F200X system, was used to characterize lattices and perform elemental analyses of the materials. X-ray diffraction (XRD) information was recorded using a Rigaku Ultima IV X-ray diffractometer with CuKα (λ = 0.15406 nm) irradiation. The water contact angle of the samples was measured using a JC2000D2G contact angle measuring instrument . The degree of graphitization of CNF was examined using Raman spectroscopy . The resistivity was measured with an electrochemical workstation . 2, the medium was replaced with fresh complete growth medium, and the medium was then changed every two days. Details regarding the evaluation of cytocompatibility of CNF and HAp/CNF and the evaluation of osteogenic differentiation are available in the Cryopreserved h-ADSCs  were rapidly thawed, recovered in a 37 °C water bath, and cultured in 10 mL of α-minimal essential medium containing 1% penicillin–streptomycin and 10% FBS. After culturing the cells for 24 h at 37 °C in a humidified atmosphere with 5% CO2+ concentration using inductively coupled plasma mass spectrometry (ICP-MS) (Agilent ICPMS 7700).HAp/CNF membranes of the same size were placed in centrifuge tubes containing 3 mL of culture medium. The culture medium from days 1, 3, 5, and 7 were used to measure the Ca2+ is released gradually from the HAp-doped fiber along the porous structure. The results of the measurements of the differentiation of h-ADSCs show that these cells did not differentiate spontaneously on the tissue culture plastic, but they differentiated into osteocytes spontaneously on carbon nanowires. The induction of the osteogenic differentiation of h-ADSCs is due to the electrical activity of the material. Compared with CNF, HAp/CNF has a higher ability to induce the osteogenic differentiation of h-ADSCs. This ability comes from the combined action of the electrical activity of carbon fiber materials and the induction of Ca2+ osteogenesis. Therefore, this paper describes an inexpensive, simple, and rapid method for the preparation of carbon fiber materials, and it provides a new method for the application of carbon fiber materials in bone tissue engineering.HAp-doped PVDF fibers were prepared by electrospinning, and the fibrous bone tissue engineering scaffold material (HAp/CNF) was obtained after carbonization. The material has high electrical conductivity and a porous structure, and Ca