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.

ObjectiveTo improve the quality and service performance of community visual health services in Shanghai, and to establish a set of reasonable and effective evaluation index system for community visual health services. MethodsCentered on the national and Shanghai-based visual health policies and based on the current status and development trends of community visual health service program in Shanghai, the candidate indicators were formed through literature review and expert interviews, firstly. The framework of an evaluation index system was formulated through qualitative research successively, which was further revised and perfected using the Delphi method. Coefficient weights were calculated using the analytic hierarchy process (AHP), culminating in the establishment of the community visual health evaluation index system, lastly. ResultsA total of 22 visual health experts from district-level center for disease control, hospital ophthalmology and leaders in charging of visual health service in community health centers participated in the Delphi questionnaire survey, with a questionnaire recovery rate of 100% and an expert authority coefficient of 0.86, indicating high credibility. After a round of correspondence to experts’ importance ratings and discussions, a comprehensive evaluation index system comprising 3 primary indicators, 12 secondary indicators, and 47 tertiary indicators, along with 5 additional indicators, was finalized. ConclusionAn index system tailored to effective evaluation for community visual health initiatives was drawn up in this study, which can promote the capacity building in community eye health services, facilitating the high-quality development of visual health courses, and enhancing residents’ eye health.

The regulation of gut flora metabo-lites-short-chain fatty acids(SCFAs),NLRP3 inflam-matory vesicles,and interactions has been shown to play a key role in many diseases.While chronic kidney disease(CKD)is a common progressive dis-ease whose pathogenesis is related to the reduc-tion of SCFAs,a metabolite of intestinal flora,and the over-activation of NLRP3 inflammatory vesicles.In this paper,we summarize the role of SCFAs and NLRP3 inflammatory pathway in the pathogenesis of CKD,and sort out the research on the interven-tion of traditional Chinese medicine(TCM)in this inflammatory pathway in the treatment of CKD in recent years,so as to provide the direction and ideas for the exact mechanism of TCM in the treat-ment of CKD.

The regulation of gut flora metabo-lites-short-chain fatty acids(SCFAs),NLRP3 inflam-matory vesicles,and interactions has been shown to play a key role in many diseases.While chronic kidney disease(CKD)is a common progressive dis-ease whose pathogenesis is related to the reduc-tion of SCFAs,a metabolite of intestinal flora,and the over-activation of NLRP3 inflammatory vesicles.In this paper,we summarize the role of SCFAs and NLRP3 inflammatory pathway in the pathogenesis of CKD,and sort out the research on the interven-tion of traditional Chinese medicine(TCM)in this inflammatory pathway in the treatment of CKD in recent years,so as to provide the direction and ideas for the exact mechanism of TCM in the treat-ment of CKD.

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.

This paper analyzes the literature on virtual reality(VR)technology interventions for autistic children published from 2014 to 2022.It shows that different VR systems in these studies have improved different symptoms of autism,and points out the feasibility of VR technology interventions for autistic children.

Objective:To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma.Methods:A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results:The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant( Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion:Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Objective:To investigate the value of flattening filter-free (FFF) mode in postoperative deep inspiration breath-hold (DIBH) intensigy-modulated radiotherapy for left breast cancer.Methods:A retrospective case series study was conducted. Clinical data of 21 patients with left breast cancer who underwent DIBH intensity-modulated radiotherapy after modified radical surgery in Meizhou People's Hospital from January 2021 to December 2022 were retrospectively analyzed. On the DIBH-mode CT of each patient, the 7-field intensity-modulation plan was designed using the plan developed in the 6 MV FFF-mode (FFF group) or the plan developed in the 6 MV flattening filter (FF)-mode (FF group). The target areas and organs at risk, dosimetric and biological parameters, and dose validation results were compared between the two plans.Results:Twenty-one patients were female with the age [ M ( Q1, Q3)] of 47 years old (32 years old, 61 years old). The percentage of target areas receiving 95% of the prescribed dose (V 95%) was (95.9±0.8)% and (95.7±1.9)% in the FF and FFF groups ( t = 2.98, P = 0.089), and the maximum dose was (5 401±251) cGy and (5 424±201) cGy ( t = 2.85, P = 0.181), the fitness indices were 0.88±0.05 and 0.87±0.06 ( t = 0.32, P = 0.562), the homogeneity indices were 1.06±0.01 and 1.07±0.02 ( t = 2.91, P = 0.009), the equivalent uniform doses (EUD) were (51.81±0.21) Gy and (51.97±0.20) Gy ( t = 0.51, P = 0.309), and the tumor control probability (TCP) was (99.68±0.01)% and (99.61±0.02)% ( t = 0.81, P = 0.560). The plans of the FFF group and the FF group were compliant, and the doses of all organs at risk to be irradiated were within the clinically acceptable range, and the radiation doses in the FFF group in the left lung [5 Gy irradiated volume (V 5 Gy), mean dose (D mean), EUD and normal tissue complication rate (NTCP)], right lung (V 5 Gy and D mean), heart (V 10 Gy, D mean, EUD and NTCP), and right breast (V 5 Gy, D mean and EUD) were differently lower than those in the FF group, and the differences were statistically significant (all P < 0.05). The monitor units in the FFF and FF groups were (984±132) MU and (751±145) MU ( t = -1.25, P < 0.001), and the total beam-on time was (1.4±0.3) min and (2.2±0.4) min ( t = 0.68, P < 0.001); individual field beam-on time was (12±7) s and (16±10) s ( t = 2.68, P = 0.001), and the beam-on time for each field in patients of the FFF group was less than 25 s; γ pass rates were (97.1±2.8)% and (97.6±2.1)% ( t = 0.59, P = 0.484). Conclusions:In the intensity-modulated radiotherapy of left breast cancer, the radiation dose of the energy to the critical organs in FFF mode is lower and has higher dose rate and shorter treatment time. FFF combined with DIBH technique has positive clinical significance in the intensity-modulated radiotherapy of breast cancer.

Objective In order to clarify the identification path and the followed principles in this kind of pathological-related medical damage identification,explore the prevention and resolution ideas of pathological medical disputes in the medical and health departments,and build a path for the people's court to hear the cases of pathological medical injury liability disputes.Methods Taking the judgement of medical damage liability disputes that took effect in 2019-2023 and published on the judgement document network as a sample,conduct a retrospective analysis in terms of the site of lesion,medical fault,the consequences of the damage,the causal relationship and the degree of cause(degree of participation),the degree of accident classification and responsibility,the selection of appraisal method,and the acceptancde of appraisal opinions.Results From the analysis of the lesion site,there is a high proportion of misdiagnosis in breast,lung,thyroid,skin and uterus;from the analysis of medical fault,58.4%of delayed treatment and 41.6%of overtreatment due to improper selection of treatment plan;from the analysis of the consequences of damage,the consequences of death only account for about 20%.Most of them are in the category of living appraisal;from the analysis of responsibility division,medical institutions bear secondary reasons,accounting for 30.3%;from the analysis of appraisal and acceptance,medical damage identification methods are mostly used,and the court's acceptance of appraisal opinions reaches 92.1%.Conclusion(1)There are more pathological disputes involving women's bodies,and misdiagnosis is the most in the type of fault;(2)Forensic clinical professional appraisers can also participate in the identification of medical damage involving pathological diagnosis;(3)For cases of medical damage liability disputes involving pathological diagnosis and the consequences of death,the cause of death should be identified;(4)Medical damage identification should be in accordance with the principle of peer review.