Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

OBJECTIVE To investigate the efficacy and safety of ropivacaine combined with oxycodone for the analgesia of iliac fascia nerve block in patients undergoing hip replacement.METHODS Sixty-six patients who underwent hip replacement at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from October 2023 to April 2024 were selected and randomly divided into observation group and control group,with 33 cases in each group.Before induction of anesthesia,ultrasound-guided iliac fascial nerve block was performed.Patients in the observation group were treated with 0.33%ropivacaine+0.1 mg/kg oxycodone injection mixture 30 mL,and patients in the control group were treated with 0.33%ropivacaine injection 30 mL.The time of first postoperative rescue analgesia,24 h postoperative analgesic drug consumption,sensory block and motor block effective and maintenance time,satisfaction degree,numerical rating scale(NRS)pain score,Ramsay sedation score,muscle strength score,heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),sleep score,anxiety score,and the occurrence of adverse reactions in the two groups were all recorded.RESULTS Compared with the control group,the first rescue analgesia time after operation was significantly prolonged in the observation group,and 24 h postoperative analgesic drug consumption after operation decreased;the effective time of sensory block was significantly shortened,and the maintenance time of sensory block was significantly prolonged,and the satisfaction score was higher;the NRS pain score after iliac fascia nerve block was lower,HR and MAP were lower,and the anxiety score and sleep score 24 and 48 h after operation were lower(P＜0.05).In terms of safety,patients in both groups had adverse reactions after operation,such as hypertension,nausea,vomiting,and dizziness,but there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).CONCLUSIONS Oxycodone combined with ropivacaine shows good efficacy and safety for iliac fascial nerve block analgesia in patients undergoing hip replacement,can significantly prolong the analgesic time of ropivacaine,reduce postoperative analgesic drug consumption,improve the sleep quality of patients,and promote the rapid recovery of patients.

Objective To systematically review the risk prediction models for intradialytic hypotension in maintenance hemodialysis patients,with a view to provide references for clinical practice.Methods PubMed,Embase,Web of Science,Cochrane Library,CINAHL,CNKI,VIP,Wanfang and CBM were searched from inception to May 29,2023.2 reviewers independently screened the literature,extracted information and assessed methodological quality using the Prediction Model Risk of Bias Assessment Tool.Results A total of 20 studies and 25 models were included with the sample size of 68～9 292 cases and the incidence of outcome events of 2.1～51％.Baseline systolic blood pressure,age,ultrafiltration rate,diabetes and dialysis duration were the top 5 predictors of repeated reporting of the models.20 models reported the area under the curve of ranging from 0.649 to 0.969,and 5 models reported calibration metrics.There were 9 internal validations and 4 combined internal and external validation models.The overall applicability of the 20 studies was good,but all had a high risk of bias,mainly in data analysis.Conclusion Research on risk prediction models for intradialytic hypotension in maintenance hemodialysis patients is still in the developmental stage.Future studies should improve the research design and reporting process,and validation studies of existing models should be carried out to further evaluate the effectiveness and feasibility in clinical practice.

Objective:To summarize the best evidence for the management of lower urinary tract dysfunction (LUTD) in total hysterectomy patients, so as to provide evidence-based basis for clinical practice.Methods:According to the "6S" pyramid model, literature related to the management of LUTD in total hysterectomy patients was successively searched from guide websites, evidence-based websites, professional websites and comprehensive databases. The search deadline was from the establishment of the databases to March 31, 2023. Two researchers evaluated the quality of the included literature, extracted evidence and recommended the level of evidence.Results:A total of 14 articles were included, including one clinical decision, two evidence summaries, three guidelines, one expert consensus and seven systematic evaluations. A total of 25 pieces of evidence were summarized from four aspects, such as symptom assessment, urinary tract management, symptom intervention and health education.Conclusions:Medical staff should manage lower urinary tract dysfunction in patients undergoing total hysterectomy based on evidence-based evidence to prevent or reduce the occurrence of lower urinary tract dysfunction in patients.

OBJECTIVE To explore the efficacy and safety of intra-articular injection of ropivacaine combined with alfentanil for postoperative analgesia in patients who underwent knee arthroscopic surgery. METHODS A total of 60 patients who underwent knee arthroscopic surgery were collected from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from March to September in 2022， and then divided into trial group and control group with random number table method， with 30 cases in each group. The control group received intra-articular injection of 0.25% ropivacaine 50 mg， and the trial group received intra-articular injection of 0.25% ropivacaine 50 mg+alfentanil 0.15 μg/kg.The first postoperative remedial analgesia time， the total amount of postoperative remedial drugs， numerical rating scale at rest （NRS-R） scores， numerical rating scale at movement （NRS-M） scores， heart rate， mean arterial blood pressure， and pulse oxygen saturation during exercise at different monitoring time points after surgery， the incidence of adverse drug reactions such as hypotension， respiratory depression， nausea， and vomiting after surgery were compared between 2 groups. RESULTS Compared with the control group， the first postoperative remedial analgesia time was significantly longer in the trial group， and the total amount of postoperative remedial drugs was significantly reduced （P＜0.001）. The trial group had lower NRS-R and NRS-M scores at each monitoring time point， with statistically significant differences （P＜0.001）， and there was an interactive effect between time and groups （P＜0.001）. The changes in heart rate， mean arterial blood pressure， and pulse oxygen saturation of patients in the trial group were relatively small， with no statistically significant differences （P＞0.05）， and there was no interactive effect between time and groups （P＞0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups， such as postoperative hypotension， respiratory depression， nausea， vomiting （P＞0.05）. CONCLUSIONS The intra- articular injection of ropivacaine combined with alfentanil shows good efficacy and safety for post-knee arthroscopic analgesia， and significantly prolongs the analgesic duration of ropivacaine.

BACKGROUND: High-energy vibration is easy to damage non-cavity organs of the body and the damage effect is remarkable, but few studies concern the process of high-energy vibration-induced injury.
OBJECTIVE: To understand physiological, biochemical and pathological changes of animal bodies after high-energy vibration-induced injury.
METHODS: A total of 32 dogs were randomly divided into four groups. Dogs in the mild vibration injury group, moderate vibration injury group and severe vibration injury group received 700, 1 000, and 2 100 m/s2 vibration. Dogs in the control group were considered as normal controls. Within 14 days after vibration, serum K+, Ca2+, Zn2+, S100β, and neuron specific enolase concentrations were detected. Immunohistochemical staining was observed in the spinal cord and the brain.
RESULTS AND CONCLUSION: Serum K+, Ca2+, Zn2+concentrations showed a regular change in the three vibration injury group, and no evident change was found immediately after vibration injury. K+ concentrations reached a minimum at 0.5 day after vibration injury. Ca2+ concentrations reached a minimum at 1 day after vibration injury. Zn2+concentrations reached a minimum at 0.5 or 1 day. Above concentrations gradual y increased and became normal at 14 days. Serum neuron specific enolase and S100β expression increased at 0.5 day after vibration in the three vibration injury groups, peaked at 1 day, gradual y diminished, and recovered to a normal level or higher level at 14 days. In the three vibration groups, bleeding point of contact position and hedge position could be found in the spinal cord and brain. The degree of bleeding was more significant when kil ed instantly after vibration compared with that at 14 days. S100β, glial fibril ary acidic protein and neuron specific enolase expression increased in the spinal cord and brain.

Marine microorganisms,which live in special biotic environment,have been proven to be potential in producing novel bioactive substances.In past three decades,nearly 300 new compounds have been isolated and determined from marine fungi,and most of them showed antitumor,antibacterial and antiviral activities.This paper reviewed new advances in the studies of antitumor compounds from marine fungi in the recent ten years.