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 effect of oral contraceptive pretreatment on pregnancy outcome of modified long down-regulation protocol in in vitro fertilization and embryo transfer and intracytoplasmic sperm injection cycles. Methods:Totally 13 542 cycles were retrospectively analyzed in Reproductive Medicine Center of the 73th Group Military Hospital of PLA from January 2012 to December 2017. According to whether use oral contraceptives (OC) before down-regulation, they were divided into OC group (591 cases) and non-OC group (12 951 cases). After the variables between the two groups were balanced by the propensity score matching method, the number of oocytes obtained, number of mature oocytes, number of fertilized oocytes, number of high-quality embryos, estradiol level on human chorionic gonadotropin (hCG) trigger day, endometrial thickness on hCG trigger day, the clinical pregnancy rate and the live birth rate of the two groups were compared.Results:Before matching, the estradiol level on hCG triger day in OC group [3 118.00(2 529.00) ng/L] was lower than that in non-OC group [3 422.00(2 733.00) ng/L], with statistically significant difference ( P=0.001), there was no significant difference between OC group and non-OC group in the number of harvested oocytes and mature oocytes, fertilization number, number of viable embryos, endometrial thickness on hCG trigger day, the clinical pregnancy rate and the live birth rate. However, after adjusting for confounding factors through multi-factor logistics regression analysis, OC group was the negative factor to reduce the live birth rate compared with non-OC group (clinical pregnancy rate OR=0.83, 95% CI=0.68-1.02; live birth rate OR=0.82, with 95% CI=0.88-0.99). After matching, the clinical pregnancy rate and the live birth rate of OC group and non-OC group had no statistically significant differences (clinical pregnancy rate OR=0.94, 95% CI=0.75-1.14, P=0.59; live birth rate OR=0.91, 95% CI=0.74-1.13, P=0.38). A post-hoc power caculation demonstrated that the study sample size yielded >80% power to detect a no less than 3.7% difference between groups in the primary outcome. Conclusion:The pretreatment of oral contraceptives has no significant effect on the outcome of modified long down-regulation protocol.

Objective:To investigate the effect of oral contraceptive pretreatment on pregnancy outcome of modified long down-regulation protocol in in vitro fertilization and embryo transfer and intracytoplasmic sperm injection cycles. Methods:Totally 13 542 cycles were retrospectively analyzed in Reproductive Medicine Center of the 73th Group Military Hospital of PLA from January 2012 to December 2017. According to whether use oral contraceptives (OC) before down-regulation, they were divided into OC group (591 cases) and non-OC group (12 951 cases). After the variables between the two groups were balanced by the propensity score matching method, the number of oocytes obtained, number of mature oocytes, number of fertilized oocytes, number of high-quality embryos, estradiol level on human chorionic gonadotropin (hCG) trigger day, endometrial thickness on hCG trigger day, the clinical pregnancy rate and the live birth rate of the two groups were compared.Results:Before matching, the estradiol level on hCG triger day in OC group [3 118.00(2 529.00) ng/L] was lower than that in non-OC group [3 422.00(2 733.00) ng/L], with statistically significant difference ( P=0.001), there was no significant difference between OC group and non-OC group in the number of harvested oocytes and mature oocytes, fertilization number, number of viable embryos, endometrial thickness on hCG trigger day, the clinical pregnancy rate and the live birth rate. However, after adjusting for confounding factors through multi-factor logistics regression analysis, OC group was the negative factor to reduce the live birth rate compared with non-OC group (clinical pregnancy rate OR=0.83, 95% CI=0.68-1.02; live birth rate OR=0.82, with 95% CI=0.88-0.99). After matching, the clinical pregnancy rate and the live birth rate of OC group and non-OC group had no statistically significant differences (clinical pregnancy rate OR=0.94, 95% CI=0.75-1.14, P=0.59; live birth rate OR=0.91, 95% CI=0.74-1.13, P=0.38). A post-hoc power caculation demonstrated that the study sample size yielded >80% power to detect a no less than 3.7% difference between groups in the primary outcome. Conclusion:The pretreatment of oral contraceptives has no significant effect on the outcome of modified long down-regulation protocol.

Objective To investigate the infection situation of Pseudomonas aeruginosa (PA) in patients with the lower respira‐tory tract infection in the department of respiratory intensive care units (RICU ) in recent five years ,and to analyze the changing trend of antibacterial resistence ,in order to guide rational selection of antimicrobial agents .Methods Strains of bacteria were isola‐ted and identified from sputum specimen of patients in the department of RICU and common ward from Jul .2008 to Jul .2013 .The situations of PA infection and antibacterial resistence were analyzed ,and differences of infection rates of PA and antibacterial resis‐tence were compared between RICU and common ward .Results 517 strains of bacteria were detected from sputum specimens of patients in the department of RICU from 2008 to 2013 ,including 141 strains of PA (accounted for 27 .3% ) ,and ticarcilli/clavulanic acid(61 .0% ) was with the highest rate of resistance among 14 drugs and colistin B(9 .2% ) was with the lowest rate of resistance . 378 strains of bacterias were detected from sputum specimens of patients in common wards ,including 125 strians of PA(accounted for 33 .1% ) ,and ticarcilli/clavulanic acid(28 .0% ) was with the highest rates of resistance and colistin B (4 .0% ) was with the low‐est rate of resistance .Conclusion In recent 5 years ,PA might be one of the main pathogenic bacterias of respiratory tract infections in the depatment of RICU in this hospital ,and antibiotic resistance may increse gradually .The antibiotic resistance in the depatment of RICU may be higher than that in cionmon wards .Clinical effective measures should be taken to prevent nosocomial infection ,and rational use of antibiotics should be taken to reduce the emergence of resistant strains .

Objective To study normal hearing children's speech perception in Speech Spectrum -Shaped Noise (SSN) and Babble Noise (BN) using the Mandarin lexical neighborhood test .Methods Thirty -four children with normal hearing were included in this study and randomly assigned to the SSN group and the BN group .Each child was given the 12 lists of Mandarin lexical neighborhood test ,word recognition scores were acquired at different SNRs .Results SNR50 of dissyllablic easy word lists ,dissyllablic hard word lists ,monosyllable easy word lists , monosyllable hard word lists in SSN were -3 dB ,-0 .5 dB ,-1 dB and 3 .5 dB ,respectively ;SNR50 of the four categories lists in BN were -3 dB ,2 dB ,0 .5 dB and 10 dB ,respectively .Lexical effects had a significant influence on spoken word recognition in noise .Especially ,word recognition scores of easy words were higher than those of hard words ,dissyllablic words were better than monosyllable words .Conclusion The masking effects of babble noise on spoken speech perception are stronger than speech spectrum -shaped noise for 3-6 year-old normal hearing chil‐dren .Lexical effects also affet children's speech recognition in noise .

Objective:To establish and evaluate a newly established method of enzyme-linked immu-nosorbent assay (ELISA) for measuring human autoantibody to folate receptor (FR).Methods: Folate receptor was extracted and purified from healthy woman placenta tissues .The protein was coated on 96-well plates.Goat monoclonal antibody was used as detecting antibody to set up the indirect ELISA proce -dure.The sensitivity, precision and linearity of the method were evaluated .Further, the method was compared with the ELISA method with commercialized bovine folate binding protein ( FBP) by determi-ning autoantibody levels in 24 individuals .Results:The measuring range of the standard curve was from 6 .25 ×10 -4 to 8 ×10 -2 ( the IgG concentration of pooled plasma from healthy donors was defined as 1 ) . The lowest detectable level was 3.13 ×10 -4 .The intra-and inter-assay coefficients of variations were 2.74%-8.07% and 4.16% -8.23%, respectively.Linearity test results were considered within acceptable limits.The data from FBP-ELISA and FR-ELISA were highly correlated ( r=0.954, P <0.001);The value from FR-ELISA was higher by 14% than that from FBP-ELISA.Conclusion: The ELISA method for measuring human autoantibody IgG to folate receptor was successfully established using human FR as coating protein .The method is sensitive and repeatable and can be used in large-scale population study .

Objective A method was developed for the simultaneous determination of tryptophan(Trp) and its metabolites kynurenine(Kyn) and kynurenic acid(Kyna) by high performance liquid chromatography with fluorescence detection(HPLC-FD),and testing serum levels of Trp metabolites in systemic lupus erythematosus(SLE) patients.Methods Serum samples were deproteinized by equal volume of 0.624 mol/L perchloric acid.The analytical column was Hypersil C18 column,and the mobile phase was 0.20 mol/L zinc acetate,8.3 mmol/L acetic acid,and 2.5% acetonitrile;flow rate was 1.5 ml/min.The excitation and emission wave length of fluorescence detector were 365 nm and 480 nm in 0~11 min,344 nm and 404 nm in 11~15.5 min,254 nm and 404 nm in 15.5~20 min,respectively.Results The linear range of Trp was 0.610~196 ?mol/L,the detection limit was 0.005 ?mol/L,and the average recovery was 103.71%.The linear range of Kyn was 0.049~98 ?mol/L,the detection limit 0.025 ?mol/L,and the average recovery was 97.45%.The linear range of Kyna was 1.050~1047 ?mol/L,the detection limit was 0.050 nmol/L,and the average recovery was 100.60%.Inter-and intra-day precisions were both less than 5%.Phenylalanine,tyrosine,and 5-hydroxytryptamine had no interference.The assay was employed to analyze serum samples of SLE patients.The result showed significant difference in Trp,Kyn,and Kyna content,Kyn/Trp ratio between SLE patients and control group.Conclusions A new method was established for simultaneous determination of Trp,Kyn,and Kyna in serum.The method is simple,fast,sensitive,specific,and suitable for applicability to clinical measurement.

OBJECTIVETo evaluate the immunogenicity, safety, and dosage of a new inactivated hepatitis A vaccine administered to young adults.

METHODSOne hundred and four normal adult volunteers, seronegative for hepatitis A virus and hepatitis B surface antigen, were randomly assigned to one of three groups. The high-dose group received a primary dose of 1000 units of the new vaccine, the low-dose group received a primary dose of 500 units of the same vaccine, and the Havrix group received a primary dose of 1440 enzyme-linked immunosorbent assay units of Havrix, a licensed inactivated hepatitis A vaccine. All groups received a booster dose of the same vaccine 6 months after the primary dose. Local and systemic adverse reactions, seroconversion rates, and geometric mean titers of hepatitis A virus antibodies were measured in all three groups.

RESULTSLocal and systemic reaction types and rates were similar in all three groups after primary and booster doses, although local reactions were more frequent in the Havrix group following the primary dose. No serious adverse reactions occurred. One month after the primary dose, the seroconversion rate was 87.5% in the high-dose group, 70.0% in the low-dose group, and 50.0% in the Havrix group (P = 0.001, versus the high-dose group). At month 6 (before administration of the booster dose), seroconversion rates were 96.9% in the high-dose group, 65.0% in the low-dose group (P = 0.0029), and 68.8% in the Havrix group (P = 0.007). All subjects in all groups seroconverted by one month after receipt of the booster dose. Geometric mean titers were similar in all three groups at month 1, but were higher in the high-dose group (264 mIU/ml) than those in the Havrix group (135 mIU/ml) at month 6 (P = 0.0013). One month after the booster dose, geometric mean titers in the high-dose group (2747 mIU/ml) were higher than those in the low-dose group (1657 mIU/ml) (P = 0.0223) or in the Havrix group (1316 mIU/ml) (P = 0.01).

CONCLUSIONSThis new inactivated hepatitis A vaccine is immunogenic and safe; two doses of either 500 or 1000 units can induce hepatitis A virus antibodies well above the protection level.

Adolescent ; Adult ; Hepatitis A Vaccines ; adverse effects ; immunology ; Humans ; Vaccines, Attenuated ; adverse effects ; immunology