Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To examine the clinical features and genetic profiles of patients with thyroid peroxidase(TPO) gene mutations and provide diagnostic guidance for clinicians.Methods:A retrospective review of four patients with TPO mutations treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2014 to December 2023. Data on demographics, clinical manifestation, genotypes, treatment, and prognosis of these patients were analyzed.Results:Two males and two females, aged 13 to 27 years at diagnosis, presented with goiter as the initial symptom, with three cases menifesting during puberty. Laboratory findings showed mildly elevated or upper-limit-normal serum thyroid-stimulating hormone(TSH) levels, significantly increased free triiodothyronine/free thyroxine(FT 3/FT 4) ratios, and elevated thyroglobulin(TG) levels. Genetic testing revealed compound heterozygous pathogenic or likely pathogenic TPO mutations. Despite regular levothyroxine(L-T 4) therapy, goiter persisted. Three patients required thyroidectomy due to cosmetic or compressive symptoms, with pathology showing follicular hyperplasia. Conclusion:TPO mutations are characterized by adolescent-onset goiter, elevated FT 3/FT 4 ratios, and normal to high TSH. Genetic testing confirms the diagnosis. L-T 4 offers limited improvement, and surgery is often needed.

Objective To evaluate the diagnostic value of prostate health index(PHI)and prostate health index density(PHID)in identifying intermediate-to high-risk prostate cancer(PCa).Methods Clinical data of 160 treatment-na?ve patients with highly suspected PCa,who underwent initial prostate biopsy in our hospital during Jul.2022 and Feb.2024,were retrospectively analyzed.Data included age,body mass index(BMI),prostate volume(PV),total prostate-specific antigen(tPSA),free PSA(fPSA),[-2]proPSA(p2PSA),PHI and PHID.Biopsy-positive results were stratified according to the EAU D'Amico risk criteria.Receiver operating characteristic(ROC)curve and multivariate logistic regression analysis were employed to assess the diagnostic performance of PHI and PHID in predicting PCa and identifying intermediate-to high-risk PCa.Results There were statistically significant differences in tPSA,p2PSA,PHI and PHID between the negative and positive groups,as well as among the low-,medium-and high-risk groups(P＜0.01).Both PHI and PHID demonstrated good diagnostic performance in predicting PCa(AUC=0.820 8 and 0.875 7,respectively;all P＜0.001),and in identifying intermediate-to high-risk PCa(AUC=0.838 0 and 0.878 3,respectively;all P＜0.001).Compared to the baseline model,the incorporation of PHI and PHID individually into the multivariate model significantly improved the screening performance for PCa(AUC=0.910 and 0.898,respectively;all P＜0.001).Conclusion PHI and PHID exhibit high diagnostic efficacy in screening PCa,particularly in identifying intermediate-to high-risk disease.

This study aims to explore different construction methods for animal models of traditional Chinese medicine(TCM)syndromes and their advantages and disadvantages,to propose optimization strategies for existing problems in current construction methods,and to provide reference for constructing animal models of TCM syndromes that both preserve the essence of TCM syndromes and conform to modern scientific research standards.Using"traditional Chinese medicine","syndrome",and"animal model"as key words,articles related to animal models of TCM syndromes from CNKI,Wanfang,and VIP databases are searched and reviewed.Then the theoretical basis,technical characteristics,and existing problems of the main construction methods of current TCM syndrome animal models are systematically sorted out,and corresponding optimization measures are proposed for the existing problems.The construction methods of TCM syndrome animal models include TCM etiology and pathogenesis construction,modern medical etiology and pathology construction,and integration of TCM and Western medicine for diseases and syndromes.The TCM etiology and pathogenesis construction method is guided by a holistic perspective,constructing syndrome models by simulating external factors such as six pathogenic factors and emotional disorders.Although it conforms to TCM theoretical connotation and has simple operation and strong controllability,this method has problems such as low modeling success rate and poor etiology-syndrome fit.The modern medical etiology and pathology construction method is based on microscopic pathological mechanisms,adopting highly controllable technical means such as drug intervention and surgical modeling.Although it has the characteristics of clear objective indicators and excellent reproducibility,this method has defects such as deviation from the essence of TCM"syndrome"and insufficient safety.The integrated TCM-Western medicine disease-syndrome method shows significant complementarity in syndrome essence restoration degree and technical feasibility,achieves systematic integration of TCM basic theories and clinical syndrome differentiation thinking in methodology,and integrates the objective evaluation system of modern medicine,improving the clinical consistency between Western medicine pathological mechanisms and TCM syndrome evolution patterns.However,this method still faces common challenges such as ambiguous syndrome identification standards and distortion of disease progression simulation.The construction of TCM syndrome animal models faces challenges such as poor theoretical adaptability and poor technical standardization,but has irreplaceable value in verifying the efficacy of prescriptions and promoting the internationalization of TCM.In the future,the construction of TCM syndrome animal models should be optimized through measures such as optimizing animal selection,improving the theoretical basis of preparation methods,standardizing the setting of modeling factors,and clarifying the standard for modeling success.

This study aims to explore different construction methods for animal models of traditional Chinese medicine(TCM)syndromes and their advantages and disadvantages,to propose optimization strategies for existing problems in current construction methods,and to provide reference for constructing animal models of TCM syndromes that both preserve the essence of TCM syndromes and conform to modern scientific research standards.Using"traditional Chinese medicine","syndrome",and"animal model"as key words,articles related to animal models of TCM syndromes from CNKI,Wanfang,and VIP databases are searched and reviewed.Then the theoretical basis,technical characteristics,and existing problems of the main construction methods of current TCM syndrome animal models are systematically sorted out,and corresponding optimization measures are proposed for the existing problems.The construction methods of TCM syndrome animal models include TCM etiology and pathogenesis construction,modern medical etiology and pathology construction,and integration of TCM and Western medicine for diseases and syndromes.The TCM etiology and pathogenesis construction method is guided by a holistic perspective,constructing syndrome models by simulating external factors such as six pathogenic factors and emotional disorders.Although it conforms to TCM theoretical connotation and has simple operation and strong controllability,this method has problems such as low modeling success rate and poor etiology-syndrome fit.The modern medical etiology and pathology construction method is based on microscopic pathological mechanisms,adopting highly controllable technical means such as drug intervention and surgical modeling.Although it has the characteristics of clear objective indicators and excellent reproducibility,this method has defects such as deviation from the essence of TCM"syndrome"and insufficient safety.The integrated TCM-Western medicine disease-syndrome method shows significant complementarity in syndrome essence restoration degree and technical feasibility,achieves systematic integration of TCM basic theories and clinical syndrome differentiation thinking in methodology,and integrates the objective evaluation system of modern medicine,improving the clinical consistency between Western medicine pathological mechanisms and TCM syndrome evolution patterns.However,this method still faces common challenges such as ambiguous syndrome identification standards and distortion of disease progression simulation.The construction of TCM syndrome animal models faces challenges such as poor theoretical adaptability and poor technical standardization,but has irreplaceable value in verifying the efficacy of prescriptions and promoting the internationalization of TCM.In the future,the construction of TCM syndrome animal models should be optimized through measures such as optimizing animal selection,improving the theoretical basis of preparation methods,standardizing the setting of modeling factors,and clarifying the standard for modeling success.

Objective To evaluate the diagnostic value of prostate health index(PHI)and prostate health index density(PHID)in identifying intermediate-to high-risk prostate cancer(PCa).Methods Clinical data of 160 treatment-na?ve patients with highly suspected PCa,who underwent initial prostate biopsy in our hospital during Jul.2022 and Feb.2024,were retrospectively analyzed.Data included age,body mass index(BMI),prostate volume(PV),total prostate-specific antigen(tPSA),free PSA(fPSA),[-2]proPSA(p2PSA),PHI and PHID.Biopsy-positive results were stratified according to the EAU D'Amico risk criteria.Receiver operating characteristic(ROC)curve and multivariate logistic regression analysis were employed to assess the diagnostic performance of PHI and PHID in predicting PCa and identifying intermediate-to high-risk PCa.Results There were statistically significant differences in tPSA,p2PSA,PHI and PHID between the negative and positive groups,as well as among the low-,medium-and high-risk groups(P＜0.01).Both PHI and PHID demonstrated good diagnostic performance in predicting PCa(AUC=0.820 8 and 0.875 7,respectively;all P＜0.001),and in identifying intermediate-to high-risk PCa(AUC=0.838 0 and 0.878 3,respectively;all P＜0.001).Compared to the baseline model,the incorporation of PHI and PHID individually into the multivariate model significantly improved the screening performance for PCa(AUC=0.910 and 0.898,respectively;all P＜0.001).Conclusion PHI and PHID exhibit high diagnostic efficacy in screening PCa,particularly in identifying intermediate-to high-risk disease.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To examine the clinical features and genetic profiles of patients with thyroid peroxidase(TPO) gene mutations and provide diagnostic guidance for clinicians.Methods:A retrospective review of four patients with TPO mutations treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2014 to December 2023. Data on demographics, clinical manifestation, genotypes, treatment, and prognosis of these patients were analyzed.Results:Two males and two females, aged 13 to 27 years at diagnosis, presented with goiter as the initial symptom, with three cases menifesting during puberty. Laboratory findings showed mildly elevated or upper-limit-normal serum thyroid-stimulating hormone(TSH) levels, significantly increased free triiodothyronine/free thyroxine(FT 3/FT 4) ratios, and elevated thyroglobulin(TG) levels. Genetic testing revealed compound heterozygous pathogenic or likely pathogenic TPO mutations. Despite regular levothyroxine(L-T 4) therapy, goiter persisted. Three patients required thyroidectomy due to cosmetic or compressive symptoms, with pathology showing follicular hyperplasia. Conclusion:TPO mutations are characterized by adolescent-onset goiter, elevated FT 3/FT 4 ratios, and normal to high TSH. Genetic testing confirms the diagnosis. L-T 4 offers limited improvement, and surgery is often needed.

Objective:To investigate the impact of early removal of nasogastric tubes on functional recovery after total gastrectomy for gastric cancer patients, to provide scientific evidence for enhanced recovery after surgery strategies in gastric cancer.Methods:A retrospective cohort study was conducted on 102 gastric cancer patients who underwent total gastrectomy at Beijing Friendship Hospital affiliated with the Capital Medical University from March 2018 to July 2022. Patients were divided into two groups based on whether the gastric tube was removed within 24 hours post-operation: the early removal group (within 24 hours, 55 patients) and the non-early removal group (beyond 24 hours, 47 patients). The recovery outcomes, including time to first flatus, time to fluid intake, length of hospital stay, and the incidence of postoperative complications, were compared between the two groups. Non-normally distributed data were expressed as M( Q1, Q3) and compared using the Wilcoxon rank-sum test. Categorical data were expressed as frequencies or percentages and compared using the chi-square test or Fisher′s exact test. To minimize the impact of potential confounders, multivariable linear regression and logistic regression analyses adjusted for propensity scores were further employed to compare quantitative and qualitative data between the groups. Statistical analyses were performed using R software. Results:The exhaust time, water intake time, and hospital stay in the early removal group were 3.0(2.0, 3.5) days, 4.0(3.0, 5.0) days, and 7.0(7.0, 8.0) days, respectively, while those in the non-early removal group were 4.0(3.0, 5.0) days, 6.0(5.0, 7.0) days, and 8.0(7.5, 11.0) days, respectively. Statistically significant differences were observed between the two groups ( P<0.05). However, there was no significant difference in the incidence of postoperative complications between the two groups (5.45% vs 17.02%, P=0.060). Propensity score-adjusted regression analysis suggested that early tube removal might reduce the risk of postoperative complications ( P=0.042). Conclusion:Early removal of nasogastric tubes can significantly accelerate functional recovery after total gastrectomy for gastric cancer patients and may reduce the risk of postoperative complications, providing important clinical guidance for enhanced recovery after surgery management in gastric cancer.

Objective To discuss the current status of the discharge readiness in patients with Budd-Chiari syndrome undergoing interventional therapy,and to analyze its influencing factors.Methods A cross-sectional survey in 150 patients with Budd-Chiari syndrome,who were admitted to the Department of Interventional Radiology of a certain grade Ⅲ-A hospital in Xuzhou City of China between September 2022 and September 2023,was conducted.The revised Discharge Preparation Scale,the Discharge Guidance Quality Scale,and the self-designed general data collection form were used as the study tools.Results The results of the survey showed that the mean discharge readiness score in the 150 patients with Budd-Chiari syndrome undergoing interventional therapy was(102.59±7.88)points,and the quality of discharge guidance,education level,and per capita monthly household income,and the current disease status were the key factors affecting the patient's readiness for discharge(P＜0.001).Conclusion The overall level of readiness for discharge in patients with Budd-Chiari syndrome undergoing interventional therapy is high,but nurses should make key assessment of the current disease status,the discharge intentions and concerns of patients with low-education level and low-income,based on which give targeted health guidance so as to improve patient's readiness for discharge.(J Intervent Radiol,2024,33:674-678)