Objective To compare the clinical efficacy, safety, and patient’ prognosis of catheter-directed thrombolysis (CDT) via anterior tibial vein and popliteal vein approaches in the treatment of acute lower extremity deep vein thrombosis (DVT). Methods A retrospective analysis was conducted on the clinical data of 195 patients diagnosed with acute mixed lower extremity DVT and treated with CDT in the Department of Interventional and Vascular Surgery, Affiliated Hospital of Nantong University from January 2020 to December 2023. Patients were divided into an observation group (anterior tibial vein approach, n＝97) and a control group (popliteal vein approach, n＝98) according to the puncture route. Baseline data, thrombolysis-related indices (urokinase dosage, coagulation function indices), efficacy measures (degree of thrombus dissolution, leg circumference difference, visual analogue scale [VAS] score, venous clinical severity score [VCSS]), recovery parameters (time to ambulation, length of hospital stay), complication rates, and long-term prognosis measures (Villalta score, incidence of post-thrombotic syndrome [PTS]) were compared between the two groups. Results There was no statistically significant difference in urokinase dosage and levels of coagulation function indices between the two groups. Postoperatively, the leg circumference difference at 15 cm below the knee, VAS score, and VCSS score were significantly lower in the observation group than in the control group (P＝0.001). The observation group had higher grade Ⅲ dissolution rates in the popliteal and anterior tibial veins compared to the control group (P＜0.05), while differences of dissolution rates in the iliac and femoral veins were not statistically significant. The observation group had shorter length of hospital stay and earlier ambulation times than the control group (P＝0.001). There were no significant differences in complication rates, Villalta scores, or PTS incidence between the two groups. Conclusions CDT via the anterior tibial vein puncture approach for acute mixed lower extremity DVT is superior to the popliteal vein approach in promoting resolution of lower extremity swelling, alleviating pain, improving venous clinical symptoms, and achieving higher thrombus dissolution rates in the popliteal and anterior tibial veins. It also enables faster recovery and demonstrates good safety.

Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Aromatic Chinese medicinal essential oils are volatile oils extracted from aromatic Chinese herbs， which can prevent and treat respiratory infectious diseases through multiple synergistic mechanisms including pathogen inhibition， immune regulation， and inflammatory response regulation. Essential oils are primarily used externally on the body to prevent infections and alleviate symptoms through methods like inhalation， smearing， topical application， bathing， gargling or as a suppository. They can also be utilized in the environment for disinfection and air purification， through methods like diffusion， vaporization， or spraying. The external application of essential oils extracted from Chinese aromatic herbs has the advantages of convenience， quick absorption， and simultaneous influence on both the body and mind. However， there are still challenges and deficiencies in aspects such as the positioning of functions， indications， safety， and the research on the mechanism of action. It has been proposed to combine the theory of aromatic Chinese medicinals with the characteristics of essential oils， and formulate prescriptions of Chinese medicinal essential oils under the principles of traditional Chinese medicine syndrome differentiation， and prevent and treat respiratory infectious diseases efficiently， accurately， and safely， thereby expanding the clinical application of aromatic Chinese medicinals and the preventive theory of traditional Chinese medicine.

In recent decades,the incidence of human papillomavirus(HPV)-associated oropharyngeal squamous cell carcinoma(OPSCC)has shown a marked increase.Significant changes have also occurred in the OPSCC diagnosis and treatment paradigm.Deter-mining HPV status prior to treatment is now essential,and radiotherapy/chemotherapy,immunotherapy,and minimally invasive surgical techniques have progressively emerged as key modalities for managing OPSCC.However,alongside these paradigm shifts,a comprehen-sive technical consensus guiding the entire diagnostic and therapeutic process for OPSCC patients is currently lacking.Given China's large population base and the rising incidence of OPSCC,an expert panel convened to develop a clinical technical consensus on OPSCC diagno-sis and management tailored to China's specific context.This consensus aims to further enhance and standardize understanding of OPSCC management techniques among relevant healthcare professionals.

Background and Aims:Laparoscopic pancreaticoduodenectomy(LPD)has become a preferred approach for periampullary tumors,yet delayed gastric emptying(DGE)remains a frequent complication that hampers postoperative recovery.The nasojejunal feeding tube(NJT)is commonly used for early enteral nutrition,but its impact on DGE is controversial.This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods:A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed.Patients were divided into two groups based on intraoperative NJT placement(NJT group,n=200;non-NJT group,n=119).The incidence of DGE and postoperative outcomes were compared.Multivariate logistic regression and propensity score matching(PSM)were performed to identify independent risk factors for DGE.Results:The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group(36.5%vs.21.8%,P=0.006).NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs(both P<0.05).Multivariate analysis revealed intraoperative NJT placement(OR=1.960,95%CI=1.142-3.363,P=0.015)and intraoperative blood loss>400 mL(OR=1.921,95%CI=1.155-3.194,P=0.012)as independent risk factors for DGE.These findings were consistent after PSM.Conclusions:Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE,prolonged hospitalization,and increased medical costs.Routine NJT placement should therefore be avoided,and individualized strategies should be adopted to minimize postoperative complications and enhance recovery.

Oral squamous cell carcinoma(OSCC)is a malignant lesion originating from the oral mucosal squamous epithelium,account-ing for over 80％of oral and maxillofacial malignancies.Key etiological factors include tobacco,alcohol abuse,and betel quid chewing.In China,its incidence has shown an overall upward trend,posing a significant threat to public health.OSCC exhibits high local invasive-ness,making early diagnosis critical for improving prognosis.Its clinical management requires close multidisciplinary collaboration among oral and maxillofacial surgery,head and neck surgery,radiation oncology,medical oncology,reconstructive surgery,radiology,patholo-gy,and nutritional support teams.Given the increasing disease burden of OSCC and rapid development of multidisciplinary collaborative models,an expert panel has formulated this integrated management consensus based on evidence-based medicine and extensive deliber-ation.Centered on the'Prevention-Screening-Diagnosis-Treatment-Rehabilitation'framework,the consensus provides comprehensive guidance for the entire disease course of OSCC patients,aiming to standardize clinical practice.

This article reviews the progress of clinical research on abnormal sounds after ceramic-on-ceramic total hip arthroplasty, with a focus on analyzing the differences between the third-generation and fourth-generation ceramic prostheses. Abnormal sounds generally refer to high-pitched audible sounds (such as creaking, clicking, etc.) during hip joint movement after surgery, which are considered possible precursors to prosthesis fragmentation (for example, patients with abnormal sounds have more ceramic particles in the joint fluid, and some are accompanied by prosthesis fragmentation). The fundamental frequency of abnormal sounds in the third-generation ceramic prostheses ranges from 400 to 7 500 Hz (approximately 1 500 Hz in males and 2 500 Hz in females), while the acoustic characteristics of the fourth-generation ones remain unclear. The reported occurrence time of abnormal sounds varies significantly among different studies, with an average of 6.4 to 40 months after surgery. This variation may be influenced by patient characteristics, surgical technique, and prosthesis type. Abnormal sounds are considered a possible early indicator of prosthesis fragmentation; for instance, higher concentrations of ceramic particles have been detected in the synovial fluid of affected patients, and some cases have been accompanied by prosthesis fracture. The incidence of abnormal sounds with the fourth-generation prostheses ranges from 3.8% to 46.6% (with a follow-up period exceeding 10 years), while the third-generation shows rates of 0% to 19.7% with no difference between the two generations. Although the fourth-generation prostheses are superior to the third-generation in material toughness (flexural strength>1 380 MPa) and hardness, they still fail to solve the problem of abnormal sounds, and the incidence may increase with the extension of the follow-up time (for example, in some studies, the incidence at 10-year follow-up is higher than that at 5-year follow-up). Abnormal sounds are mostly associated with movements such as extreme flexion (e.g., squatting) and walking. Different sound properties (such as friction sound) correspond to specific inducing movements and locations, among which friction sound requires vigilance against the risk of prosthesis fragmentation. The risk factors include patient-related factors (height, weight, activity level, etc.), surgical factors (prosthesis position angle), and prosthesis-related factors (design, diameter, neck length, etc.). Proposed mechanisms include abnormal edge loading, stripe wear, femoral neck impingement, wear particle generation, and prosthesis mismatch. Adverse outcomes include decreased patient satisfaction with life, revision surgery (with an incidence of 0.2% to 4.65%), and prosthesis fragmentation. Currently, there are still controversies in research. Future studies need to focus on special patient groups, surgical techniques (such as robot-assisted surgery), and the optimization of prosthesis materials and designs (such as gradient structures and surface coatings) to reduce the incidence of abnormal sounds.

Objective:To investigate the efficacy of virtual simulation-guided unilateral locking plate combined with Jail screw technique for double column tibial plateau fractures involving the posterolateral plateau.Methods:A retrospective case series study was conducted to analyze the clinical data of 32 patients with double column tibial plateau fractures involving the posterolateral plateau admitted to Nanjing Drum Tower Hospital Group Suqian Hospital from March 2018 to March 2022, including 20 males and 12 females, aged 37-69 years [(47.5±6.9)years]. According to AO/OTA classification, the fractures were classified as type 41B in 17 patients and type 41C in 15. According to the three-column classification, the fractures were classified as lateral column+posterior column in 17 patients and medial column+posterior column in 15. Virtual simulation technique was used to simulate surgical operation before surgery. After reduction, the patients′ tibial plateau mirror models of the healthy side were used to simulate the implantation of internal fixators on the affected side. The position data of the placed internal fixators were obtained to guide the personalized treatment with unilateral locking plate combined with Jail screw technique. The total number of Jail screws, average number of Jail screws, distribution and accuracy of screw placement, operative duration, intraoperative blood loss, and fracture healing status were recorded. The posterior tibial plateau angle (PTSA), proximal medial tibial angle (MPTA) and Rasmussen anatomical score were compared before operation, at 1, 3, 6, 12 months after operation and at the last follow-up. The Lysholm scores at 6, 12 months after operation and at the last follow-up were used to evaluate the knee function. At the last follow-up, the knee range of motion was measured. Postoperative complications were observed.Results:All the patients were followed up for 28-36 months [(30.7±2.3)months]. The total number of Jail screws inserted was 48, with an average of (1.5±0.5) screws. In the sagittal direction, 1-2 Jail screws were inserted in each patient, with an accuracy rate of 88% (42/48). The operative duration was 78-116 minutes [(98.7±10.5)minutes]. The intraoperative blood loss was 70-120 ml [(96.6±15.6)ml]. All the fractures had healing of stage I, with a healing time of 4-7 months [(5.4±0.9)months]. At 1, 3, 6, 12 months after operation and at last follow-up, the PTSA, MPTA, and Rasmussen anatomical scores were significantly improved when compared with those before operation ( P<0.05), while there was no statistically significant difference between those at various postoperative time points ( P>0.05). The Lysholm knee scores were (83.6±3.9)points, (88.5±3.6)points, and (93.7±2.6)points at 6, 12 months after operation, and at the last follow-up, respectively, which were gradually increased with the passage of the follow-up time ( P<0.05). The range of motion was (121.4±4.6)° in flexion and was 0.0(0.0, 3.0)° in extension at the last follow-up. Two patients had superficial wound infection and 1 had wound dehiscence after operation, which recovered with dressing change or debridement and suturing. No deep infection, vascular injury or nerve damage occurred. Conclusions:The virtual simulation-guided unilateral locking plate combined with Jail screw technique has the advantages of high accuracy of screw placement, shorter operative duration, less intraoperative blood loss, satisfactory fracture reduction, favorable recovery of knee function and range of motion, and fewer postoperative complications in the treatment of double column tibial plateau fractures involving the posterolateral plateau.

Objective:To assess medication adherence and identify independent associated factors among elderly patients with multimorbidity attending the Department of General Practice at Zhoukou Central Hospital.Methods:This cross-sectional study enrolled 380 elderly patients with multimorbidity through convenience and snowball sampling between March 2023 and March 2024. Face-to-face interviews were conducted with the subjects through community general practice clinics and resident group discussions. The survey covered the subjects′ general clinical information and medication adherence. Medication adherence was assessed using the Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analyzed independent factors of medication adherence in elderly patients with multimorbidity.Results:A total of 380 patients were included in the analysis, with an mean age of (71.57±7.58) years, and 211 (55.5%) were males. Only 50 patients (13.2%) demonstrated good adherence. Multivariate logistic regression revealed lower adherence in ages 60-69 vs.≥80 ( OR=4.595, 95% CI:1.730-12.207, P=0.002), higher adherence in high school and above education vs. primary/illiterate ( OR=0.278, 95% CI:0.082-0.944, P=0.040), reduced adherence with increased household responsibility ( OR=3.684, 95% CI:1.799-7.543, P<0.001). Conclusions:Medication adherence was suboptimal among elderly patients with multimorbidity attending the Department of General Practice at Zhoukou Central Hospital. Age, education, and household responsibility burden were independent predictors for medication adherence.

This article reviews the progress of clinical research on abnormal sounds after ceramic-on-ceramic total hip arthroplasty, with a focus on analyzing the differences between the third-generation and fourth-generation ceramic prostheses. Abnormal sounds generally refer to high-pitched audible sounds (such as creaking, clicking, etc.) during hip joint movement after surgery, which are considered possible precursors to prosthesis fragmentation (for example, patients with abnormal sounds have more ceramic particles in the joint fluid, and some are accompanied by prosthesis fragmentation). The fundamental frequency of abnormal sounds in the third-generation ceramic prostheses ranges from 400 to 7 500 Hz (approximately 1 500 Hz in males and 2 500 Hz in females), while the acoustic characteristics of the fourth-generation ones remain unclear. The reported occurrence time of abnormal sounds varies significantly among different studies, with an average of 6.4 to 40 months after surgery. This variation may be influenced by patient characteristics, surgical technique, and prosthesis type. Abnormal sounds are considered a possible early indicator of prosthesis fragmentation; for instance, higher concentrations of ceramic particles have been detected in the synovial fluid of affected patients, and some cases have been accompanied by prosthesis fracture. The incidence of abnormal sounds with the fourth-generation prostheses ranges from 3.8% to 46.6% (with a follow-up period exceeding 10 years), while the third-generation shows rates of 0% to 19.7% with no difference between the two generations. Although the fourth-generation prostheses are superior to the third-generation in material toughness (flexural strength>1 380 MPa) and hardness, they still fail to solve the problem of abnormal sounds, and the incidence may increase with the extension of the follow-up time (for example, in some studies, the incidence at 10-year follow-up is higher than that at 5-year follow-up). Abnormal sounds are mostly associated with movements such as extreme flexion (e.g., squatting) and walking. Different sound properties (such as friction sound) correspond to specific inducing movements and locations, among which friction sound requires vigilance against the risk of prosthesis fragmentation. The risk factors include patient-related factors (height, weight, activity level, etc.), surgical factors (prosthesis position angle), and prosthesis-related factors (design, diameter, neck length, etc.). Proposed mechanisms include abnormal edge loading, stripe wear, femoral neck impingement, wear particle generation, and prosthesis mismatch. Adverse outcomes include decreased patient satisfaction with life, revision surgery (with an incidence of 0.2% to 4.65%), and prosthesis fragmentation. Currently, there are still controversies in research. Future studies need to focus on special patient groups, surgical techniques (such as robot-assisted surgery), and the optimization of prosthesis materials and designs (such as gradient structures and surface coatings) to reduce the incidence of abnormal sounds.