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 effects and mechanism of Ferrostatin-1(Fer-1),a ferroptosis inhibitor,on myocardial ischemia-reperfusion injury(MIRI).Methods Rat H9c2 cardiomyocytes were ran-domly divided into five groups:Control group,H/R medium group,H/R medium+Fer-1 group,H/R medium+Nec-1 group,and H/R medium+emricasan group.Cell morphology was observed using electron mi-croscopy.Cell proliferation activity was assessed via CCK-8 assay and lactate dehydrogenase(LDH)release.I-ron ion levels were measured using an iron detection kit.Reactive oxygen species(ROS)and mitochondrial su-peroxide levels were detected by flow cytometry and MitoSOXTM fluorescence staining,respectively.Western blot was employed to analyze the expression of glutathione peroxidase 4(GPX4),acyl-CoA synthetase long-chain family member 4(ACSL4),nicotinamide adenine dinucleotide phosphate oxidase(NOX1),and cycloox-ygenase 2(COX2).Results Compared to the Control group,the H/R medium group exhibited significantly increased cytotoxicity(LDH levels)and reduced cell viability,with statistically significant differences(P<0.05).Treatment with Fer-1,Nec-1,or emricasan in the H/R medium group increased cell adherence,reduced vacuolization,enhanced cell viability,and decreased cytotoxicity(LDH relative releasing rate)compared to the H/R medium group.Intracellular ferrous iron and total iron levels were elevated in the H/R medium group compared to the Control group,with statistically significant differences(P<0.05),while Fer-1 treatment sig-nificantly reduced these levels(P<0.05).ROS levels were higher in the H/R medium group than in the Con-trol group,and Fer-1 treatment attenuated this increase(P<0.05).Western blot analysis revealed elevated ACSL4,NOX1,and COX2 levels,alongside reduced GPX4 levels,in the H/R medium group compared to the Control group,with statistically significant differences(P<0.05).Fer-1 treatment reversed these trends,de-creasing ACSL4,NOX1,and COX2 levels while increasing GPX4 expression,with statistically significant differences(P<0.05).Conclusion Ferroptosis plays a critical role in MIRI.Fer-1 mitigates oxidative stress injury and alleviates MIRI by inhibiting ferroptosis.

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 predictive value of white blood cell-to-hematocrit ratio (WBCHR) for in-hospital major adverse cardiovascular events (MACE) after reperfusion therapy in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A case-control study was conducted to retrospectively select 319 patients with first-time diagnosis of STEMI who underwent percutaneous coronary intervention (PCI). Patients were divided into MACE group (69 cases) and non-MACE group (250 cases) based on the occurrence of MACE during hospitalization. Clinical data, including general information, laboratory test indicators, echocardiography, and coronary angiography results, were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to explore the risk factors for in-hospital MACE after reperfusion therapy in STEMI patients. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of WBCHR for in-hospital MACE after reperfusion therapy in STEMI patients. Results The levels of fasting blood glucose, uric acid, creatinine, white blood cell count, neutrophil count, high-sensitivity C-reactive protein (hs-CRP), D-dimer, and WBCHR were significantly higher in the MACE group than in the non-MACE group, while red blood cell count, hemoglobin, hematocrit, and left ventricular ejection fraction were lower (P < 0.05). No significant differences were observed in age, gender, smoking history, hypertension history, diabetes history, door-to-wire (D2W) time, total cholesterol, triglycerides, and the number of diseased vessels between the two groups (P>0.05). Multivariate Logistic regression analysis revealed that elevated uric acid levels (OR=1.005; 95%CI, 1.002 to 1.009; P=0.004), decreased hemoglobin concentration (OR=0.964; 95%CI, 0.941 to 0.988; P=0.003), increased hs-CRP levels (OR=1.032; 95%CI, 1.009 to 1.056; P=0.007), and increased WBCHR (OR=1.455; 95%CI, 1.295 to 1.635; P < 0.001) were independent risk factors for in-hospital MACE after reperfusion therapy in STEMI patients. ROC curve analysis showed that the area under the curve of WBCHR for predicting in-hospital MACE after reperfusion therapy in STEMI patients was 0.855 (95%CI, 0.796 to 0.914, P < 0.001), with a sensitivity of 63.8% and a specificity of 99.6%. Conclusion WBCHR is an independent influencing factors of in-hospital MACE after reperfusion therapy in STEMI patients and has a high predictive value for in-hospital MACE in these patients.

Objective:To obtain the inter-fractional set-up errors of intensity-modulated radiotherapy (IMRT) of cervical cancer by cone-beam CT (CBCT), and to analyze the variations of the set-up errors on the cumulative dose deviation of the target volume.Methods:A total of 48 patients with cervical cancer who underwent IMRT were enrolled in this study, and the set-up errors of 696 CBCTs were obtained. The set-up errors were input into the treatment planning system, and the cumulative set-up error dose was obtained by superposing the set-up errors dose. The deviation percentage was calculated by the deviation formula and the standard planning dose.Results:The set-up errors caused the offset of isocenter distance by 0.58(0.36, 0.80) cm. Different statistical differences were noted between the cumulative set-up error dose and the standard planning dose by WilCoxon test. All the dose deviations in the target volume were reduced, and the differential dose volume histogram (DVH) appeared negatively skewed, and the peak value was declined. The DVH diagram shifted to the left with an inverse S-curve and the slope was increased. The HI deviation of the target volume from small to large were: CTV 1, CTV 2, GTV/CTV, CTV 3, CTV n, CTV all, and GTV nd; The HI deviation of the target volume were increased. Conclusions:The effect of set-up errors in IMRT of cervical cancer upon the cumulative doses of the target volume significantly differs. The cumulative dose of the target volume is reduced, and the uniformity of the target volume dose becomes worse. The uncertainty of the inter-fractional position leads to an increase or decrease in the the fractional doses of the target volume. The biological effect on tumor cells and the tumor recurrence remains to be investigated. In IMRT of cervical cancer, the CBCT position calibration is required before each treatment to ensure the dose accuracy of each structure in the target volume.

Objective To analyze the CT features of mycoplasma pneumonia(MP)in children,and to provide the reference for clinical diagnosis and treatment.Methods The clincal data of 125 cases with MP were analyzed retrospectively.Results There were 73 cases of unilateral lesions in the case of the right side of the lesion,and the left side of the lesion in 26 cases.The data showed that the incidence of left lesions was significantly less than the incidence of the right side of the lesion.The main manifestations of CT were large real changes shadow,patchy or nodular shadow,thickening of the bronchial vascular bundle,hilar lymph node enlargement,atelectasis,cavity,pleural effusion,and most of them were common.Conclusion The incidence of MP in children is more common in the lower right lung,and the imaging changes are diverse,but the most common is the large real change shadow,and improving the chest CT examination is helpful to the diagnosis of MP.

Objective To solve the problems in medical equipment utilization,supervision,management,clinical safety and etc.Methods A centralized management and sharing system of medical equipment was developed with functional requirements analysis,C/S architecture and programming.Results The system eliminated the needs for manual accounting and allocation,enhanced medical equipment usage rate and improved equipment borrowing procedure.Conclusion The system contributes to dynamic management and efficacy evaluation of medical equipment,so as the working efficiency can be increased while the costs can be decreased for manpower and materials.

Objective To study the prognostic influencing factors for intravenous thrombolysis combined with endovascular interventional therapy in patients with acute moderate to severe cerebral infarction. Methods From September 2013 to December 2015,the clinical data of 179 patients with moderate to severe acute cerebral infarction treated with intravenous thrombolysis combined with endovascular interventional therapy at the Cerebrovascular Disease Center,Shanghai Changhai Hospital were analyzed retrospectively. They were all treated with intravenous thrombolysis combined at least 1 endovascular interventional therapy (intra-arterial thrombolysis,mechanical thrombectomy or stenting)within 4. 5 h after onset. The patients with mRS ≤2 were divided into a good prognosis group (n = 71),those with 3≤mRS≤ 6 were divided into a poor prognosis group (n = 108)according to the modified Rankin Scale (mRS) scores after 3 months of treatment. The clinical data of both groups were analyzed,including age,sex,previous history,the National Institutes of Health Stroke Scale (NIHSS)score and Alberta stroke program early CT score (ASPECTS)immediately before and after treatment. The influencing factors of prognosis were further analyzed with multivariate Logistic regression analysis. Results The rate of good prognosis was 39. 7%(71 / 179). There were significant differences in age,history of transient ischemic attack at 1 week before the disease onset,the NIHSS score,and ASPECTS score before thrombolysis (62 ± 14 years vs. 71 ± 11 years,8. 4% (6 / 71)vs. 1. 9% (2 / 108),16 ± 6 vs. 19 ± 6,and 9. 5 ± 1. 0 vs. 8. 5 ± 1. 9,respectively;all P < 0. 05). There were no significantly difference in other stroke risk factors between the 2 groups (all P > 0. 05). There were significant differences in the NIHSS score immediately after treatment,24 h intracranial hemorrhage transformation,and intraparenchymal hemorrhage between the good prognosis group and the poor prognosis group (10 ± 3 vs. 15 ± 7,7. 0%[5 / 71]vs. 28. 7%[31 / 108],and 0 vs. 12. 0%[13 / 108];all P < 0. 01). Multivariate Logistic regression analysis showed that the age (OR,1. 047,95% CI 1. 014 -1. 081;P = 0. 005),NIHSS score immediately after treatment (OR,1. 121,95% CI 1. 050 -1. 196;P =0. 001)were the prognostic risk factors for intravenous thrombolysis combined with endovascular interven-tional therapy for moderate to severe cerebral infarction. The ASPECTS on admission (OR,0. 382,95% CI 0. 233 -0. 627;P < 0. 01)was the protective factor. Conclusions The age and the NIHSS score immediately after treatment are the prognostic risk factors for intravenous thrombolysis combined with endovascular inter-ventional therapy for moderate to severe cerebral infarction. With the increase of age and the NIHSS score after treatment,the prognosis of patients is even worse. With the increase of ASPECTS score at admission,the prognosis is better.

Objective To report a pedigree with X?linked dominant protoporphyria(XLDPP), and to detect 5?aminolevulinic acid synthetase 2(ALAS2)gene mutations in this pedigree. Methods A clinical investigation was performed in a pedigree with XLDPP, and relevant data were collected from family members. A next?generation sequencing method was applied to screen possible mutation sites, and Sanger sequencing was performed to determine pathogenic gene mutations. Dermoscopy was conducted to observe skin lesions in the patients with XLDPP, and the Fotofinder system and very high frequency (VHF) ultrasound system were utilized to assess the severity of photodamage. Liver and gallbladder ultrasonography as well as blood examination were performed for all the family members. Results A deletion mutation, c.1706?1709ΔAGTG, was detected in the ALAS2 gene on the X chromosomes of all the patients in this family, which led to replacement or loss of 19-20 C?terminal residues through transcriptional frameshifting, and eventually caused an increase in ALAS2 activity. In the patients with XLDPP, skin photodamage was relatively severe;protoporphyrin?induced hepatobiliary damage was observed and aggravated with age;anemia and iron deficiency occurred sometimes. Conclusion The deletion mutation c.1706?1709ΔAGTG of the ALAS2 gene may be the underlying cause of XLDPP in this pedigree.

Objective To investigate the diagnosis and treatment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods The clinical data of patients with pathologically verified IPMN who underwent surgical treatment between January 2006 to April 2014 in the First Affiliated Hospital of Harbin Medical University were studied retrospectively.There were 27 males and 21 females.The average age was (57.8 ± 8.8) years old.The average caliber of the main pancreatic duct was (1.1 ± 0.6) cm.The average size of the branch duct IPMN was (4.6 ± 1.5) cm.Results 35 patients underwent pancreaticoduodenectomy.Eight patients underwent distal pancreatectomy.Two patients underwent duodenum-preserving pancreatic head resection.Two patients underwent splenic-preserving distal pancreatectomy and one patient underwent total pancreatectomy.No patient died in perioperative period,and the median length of hospital stay after surgery was 14.3 days.Postoperative pathological examination revealed 5 (10.4％) adenoma,12 (25.0％) moderate-grade dysplasia,14 (29.2％) high-grade dysplasia and 17 (35.4％) invasive carcinoma.The postoperative complication rate was 22.9％.The mean follow up period for the noninvasive tumors was 48.9 months,with no recurrence or deaths.The mean follow up period of the invasive tumors was 43.2 months,with 1 death and no recurrence.Conclusions The indications for resection of IPMN should be based on treatment guidelines and on the patient' s general condition.It is suggested that the diagnosis and treatment of IPMN should be conducted in specialized pancreatic surgery centers.