Esophageal cancer is a prevalent malignant tumor of the digestive tract in China, and radical surgery remains the cornerstone of its comprehensive treatment. However, multifactorial challenges such as postoperative gastrointestinal tract reconstruction, traumatic stress, and tumor-related metabolic disturbances render esophageal cancer patients highly susceptible to malnutrition. Perioperative nutritional support therapy plays a crucial role in enhancing surgical safety, improving clinical outcomes, and elevating patients' quality of life by regulating metabolic homeostasis, preserving organ function, and optimizing the immune microenvironment. This article reviews the mechanisms underlying malnutrition in esophageal cancer, methods for nutritional status assessment, and precision intervention pathways based on multi-omics evaluations. The aim is to strengthen clinicians' awareness of standardized perioperative nutritional management for esophageal cancer patients and promote its clinical implementation, thereby facilitating postoperative recovery and improving long-term quality of life.

Objective:This study investigates the utility of ultrasound in diagnosing eosinophilic fasciitis (EF).Methods:A retrospective analysis was conducted on the clinical and ultrasound data of 109 EF patients seen at the center between January 1, 2006, and March 31, 2024. The diagnostic efficacy of ultrasound for EF was evaluated by comparing forearm fascia ultrasound findings among EF patients, systemic sclerosis (SSc) patients, and healthy controls (HC).Results:Among the 109 EF patients (male-to-female ratio 2.2︰1), the median age of onset was 36 (29, 48) years, with a median disease duration of 7 (3, 12) months. The study also included 20 SSc patients [median age 49 (35, 61) years] and 20 HC individuals [median age 48 (29, 54) years]. Ultrasound assessments of forearm fascia in EF patients revealed a median fascial thickness of 1.9 (1.4, 2.4) mm. The median fascial thickness was 0.8 (0.7, 0.9) mm in SSc patients and 0.7 (0.5, 0.9) mm in HC individuals. Fascial thickness in EF patients was greater than in SSc ( Z=-11.16, P<0.001) and HC groups ( Z=-11.87, P<0.001). There was a correlation between fascia thickness and C-reactive protein ( r=0.148, P=0.004), erythrocyte sedimentation rate ( r=0.143, P=0.005), and immunoglobulin G ( r=0.120, P=0.020) in EF patients. Receiver operating characteristic (ROC) curve analysis demonstrated a sensitivity of 84.0% and specificity of 95.9% for EF diagnosis, with an area under the curve (AUC) of 0.921 and a cut-off value of 1.005 mm. Conclusion:Ultrasound detection of forearm fascial thickening (>1 mm) aids in diagnosing eosinophilic fasciitis, indicating that ultrasound is a supplementary diagnostic tool for EF.

Objective To investigate the relationship between the radial-ulnar ratio,lateral lunate angle of radius and height loss of radius after palmar locking plate internal fixation for distal radius fractures.Methods A total of 158 patients with distal radius fractures treated with palmar locking plate internal fixation in our hospital from March 2020 to September 2023 were selected.According to the height of radius loss after operation,the patients were divided into non-radius loss group(41 cases,<2 mm),mild to moderate radius loss group(32 cases,2 to 5 mm)and severe radius loss group(85 cases,>5 mm),and the clinical data of patients in the three groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors affecting height loss of radius.Locally weighted scatterplot smoothing(LOWESS)method was used to analyze the two-dimensional curve relationship of continuous variables.Restricted cubic spline(RCS)and threshold effect were used to analyze the relationship between the radial-ulnar ratio,lateral lunate angle of radius and height loss of radius after operation.Results The age of patients in the severe radius loss group was significantly higher than those in the non-radius loss group and the mild to moderate radius loss group(P<0.05),and the age of patients in the mild to moderate radius loss group was significantly higher than that in the non-radius loss group(P<0.05).Female patients and patients with osteoporosis and fracture type C were more likely to have height loss of radius(P<0.05).There were significant differences in patient-rated wrist evaluation(PRWE)score,disabilities of the arm,shoulder and hand(DASH)score,dorsal extension,palmar curvature,ulnar deviation,radial deviation,radial-ulnar ratio,and lateral lunate angle of radius of patients at 3 and 6 months after operation among three groups(P<0.001).The first prediction model based on age,gender,osteoporosis,fracture type,PRWE score,DASH score,dorsal extension,palmar curvature,ulnar deviation,and radial deviation and the second prediction model based on age,gender,osteoporosis,fracture type,PRWE score,DASH score,dorsal extension,palmar curvature,ulnar deviation,radial deviation,radial-ulnar ratio,and lateral lunate angle of radius were subjected to Hosmer-Lemeshow test showed good goodness of fit.LOWESS analysis showed that age,PRWE score,DASH score,dorsal extension,palmar curvature,ulnar deviation,radial deviation,radial-ulnar ratio,and lateral lunate angle of radius had a certain nonlinear relationship with the height loss of radius.RCS and threshold effect analysis showed that the probability of postoperative radius loss increased with the increase of radial-ulnar ratio in patients with distal radius fractures and radial-ulnar ratio≥13.254(P<0.001).The probability of postoperative radius loss decreased with the increase of the lateral lunate angle of radius in patients with distal radius fractures and lateral lunate angle of radius≤11.068°(P<0.001).Conclusion There was a positive correlation between the radial-ulnar ratio and the height loss of radius,and a negative correlation between the lateral lunate angle of radius and the height loss of radius after palmar locking plate internal fixation for distal radius fractures.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:This study investigates the utility of ultrasound in diagnosing eosinophilic fasciitis (EF).Methods:A retrospective analysis was conducted on the clinical and ultrasound data of 109 EF patients seen at the center between January 1, 2006, and March 31, 2024. The diagnostic efficacy of ultrasound for EF was evaluated by comparing forearm fascia ultrasound findings among EF patients, systemic sclerosis (SSc) patients, and healthy controls (HC).Results:Among the 109 EF patients (male-to-female ratio 2.2︰1), the median age of onset was 36 (29, 48) years, with a median disease duration of 7 (3, 12) months. The study also included 20 SSc patients [median age 49 (35, 61) years] and 20 HC individuals [median age 48 (29, 54) years]. Ultrasound assessments of forearm fascia in EF patients revealed a median fascial thickness of 1.9 (1.4, 2.4) mm. The median fascial thickness was 0.8 (0.7, 0.9) mm in SSc patients and 0.7 (0.5, 0.9) mm in HC individuals. Fascial thickness in EF patients was greater than in SSc ( Z=-11.16, P<0.001) and HC groups ( Z=-11.87, P<0.001). There was a correlation between fascia thickness and C-reactive protein ( r=0.148, P=0.004), erythrocyte sedimentation rate ( r=0.143, P=0.005), and immunoglobulin G ( r=0.120, P=0.020) in EF patients. Receiver operating characteristic (ROC) curve analysis demonstrated a sensitivity of 84.0% and specificity of 95.9% for EF diagnosis, with an area under the curve (AUC) of 0.921 and a cut-off value of 1.005 mm. Conclusion:Ultrasound detection of forearm fascial thickening (>1 mm) aids in diagnosing eosinophilic fasciitis, indicating that ultrasound is a supplementary diagnostic tool for EF.

The advancement of surgical techniques enables effective treatment for many patients with oral and maxillofacial tumors.How-ever,post-surgery problems such as chewing,swallowing and speech difficulty may arise due to the defects in speech organs and inade-quate compensatory function of tissue flap repair.Speech disorders,in particular,isolate patients by making it difficult for them to com-municate with others,not only impact their quality of life but also potentially lead to psychological problems and social interaction disor-ders.Although the decline in life quality and other related issues caused by speech dysfunction due to surgery and radiotherapy or chemo-therapy have been widely recognized,there is currently no standardized and universally applicable assessment method and standardized re-habilitation treatment management guideline or consensus for speech disorders following oral and maxillofacial tumor surgery at home and abroad.Based on previous clinical practice,combined with the characteristics of speech disorders in patients after oral and maxillofacial tumor surgery,the clinical experience of the experts in maxillofacial tumor surgery and rehabilitation and the relevant domestic and foreign literature,relevant experts organized discussions and modifications,reach a consensus on core content such as the assessment of speech disorders and the implementation plan for early rehabilitation treatment management,providing a reference for clinical practice,in order to improve patients'speech-related life quality and enhance the assessment and rehabilitation treatment techniques for speech disorders after oral and maxillofacial tumor surgery.

Objective:To investigate the predictive value of color Doppler ultrasound combined with electrocardio-gram for right heart dys function in patients with pulmonary heart disease(PHD).Methods:A total of 100 PHD patients admitted in Dongcheng Branch of First Affiliated Hospital of Anhui Medical University between January 2020 and December 2023 were retrospectively analyzed.According to results of 6min walking test(6MWT),pa-tients were divided into good right heart function group(n=64,≥350m)and right heart dysfunction group(n=36,＜350m).The indexes of cardiac color ultrasound[isovolumic relaxation time(IVRT),isovolumetric contraction time(IVCT)and right ventricular Tei index],ECG[24h mean R-R interval standard deviation(SDNN),normal R-R interval standard deviation per 5min(SDANN)and the ratio of low frequency components to high frequency components(LF/HF)]were compared between two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of color Doppler ultrasound,ECG and their combination for right heart dys-function in PHD patients.Spearman correlation coefficient was used to analyze the association of color Doppler ul-trasound,ECG and their combination with right heart dysfunction in PHD patients.Results:Compared with those in good right heart function group,patients in right heart dysfunction group had significant higher IVRT[(120.64±14.08)ms vs.(97.87±10.93)ms],IVCT[(84.28±12.33)ms vs.(71.92±10.61)ms]and Tei index[(0.85±0.11)vs.(0.63±0.07)](P＜0.001 all),and significant lower SDNN[(75.52±12.58)ms vs.(85.58±11.75)ms],SDANN[(63.86±10.92)ms vs.(76.75±11.71)ms]and LF/HF[(1.33±0.19)vs.(1.84±0.27)](P＜0.001 all).ROC curve indicated that the AUC of color Doppler ultrasound combined ECG in diagnosing right heart dysfunction in PHD patients was 0.911(95％CI 0.838～0.959),which was significantly higher than those of color Doppler ultrasound[0.775(95％CI 0.681～0.853),Z=2.404,P=0.016]and ECG[0.688(95％CI 0.588～0.777),Z=3.968,P=0.001]alone.Spearman correlation analysis indicated that there was a significant positive correlation of color Doppler ultrasound(r=0.547),ECG(r=0.375)and their combination(r=0.810)with right heart dysfunction in PHD patients(P＜0.001 all),and the correlation between combined detection and right heart dysfunction in PHD patients was significantly higher.Conclusion:Color Doppler ultrasound combined with ECG possesses high diagnostic performance for right heart dysfunction in PHD patients.