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 evaluate the feasibility of using the domestic ArcherQA system for fast and simplified independent verification of CyberKnife (CK) stereotactic radiotherapy (SRT) plans.Methods:SRT plans of 57 patients treated with CK at Tianjin Medical University Cancer Institute and Hospital from August 2021 to August 2022 were retrospectively analyzed, including 15 intracranial, 30 pulmonary, and 12 abdominal tumors cases. Point-dose and planar-dose verifications were performed using an ionization chamber and radiochromic films embedded in a homogeneous phantom, and the results were compared with those calculated by the treatment planning system (TPS). The localization CT images and corresponding SRT plans were imported into the ArcherQA system for independent dose verification and analysis. The correlation between ArcherQA results and phantom measurements was analyzed, with comparisons of target mean dose differences and γ pass rates.Results:Phantom measurement results showed, the measured point-dose differences for intracranial, lung, and abdominal plans were -0.94% ± 3.22%, 1.92% ± 2.05%, and 2.12% ± 0.77%, respectively. The mean dose differences in target dose calculation between ArcherQA and TPS: intracranial in the gross tumor volume (GTV) regions were 0.34% ± 2.21%, lung tumor GTV were -2.47% ± 2.46%, and abdominal tumor GTV were 0.80% ± 2.61%, respectively. Among them, the abdominal GTV region showed the highest correlation between ArcherQA and measured results ( r=0.78). The average two-dimensional γ pass rates (2 mm/2%, threshold=10%) measured using phantom films were 95.92% ± 2.35% for intracranial, 95.70% ± 2.74% for lung, and 96.74% ± 3.41% for abdominal tumors plans, respectively. The three-dimensional ArcherQA results showed comparable γ pass rates (1 mm/2%, threshold=10%) for lung and abdominal GTV and PTV regions, with similar medians and data dispersion to film measurements. Conclusions:The ArcherQA system enables rapid and efficient independent dose verification of CK SRT plans without the need for additional hardware. The verification results show good correlation with phantom measurements, supporting its potential as an auxiliary quality assurance tool in clinical CK SRT implementation.

Objective To evaluate the diagnostic performance of the minimum-cost-path-based CT angiography-derived fractional flow reserve(MCP-FFR)and the deep learning-driven CT angiography-derived fractional flow reserve(DeepCL-FFR),and to particularly explore the potential value of the DeepCL algorithm in improving diagnostic accuracy within the"gray zone."Methods A retrospective analysis was conducted on 151 coronary vessels from 109 patients with coronary artery disease,who were hospitalized at the General Hospital of the People's Liberation Army between January 2020 and June 2021.Pearson correlation and Bland-Altman plots were employed to assess the correlation and agreement of the two CT-FFR methods with invasive FFR.A CT-FFR range of 0.70-0.80 was defined as the diagnostic"gray zone."The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value for detecting hemodynamic abnormalities were calculated and analyzed.The DeLong test was used to compare the areas under the receiver operating characteristic curves(AUC)between the two CT-FFR calculation methods.Results Both CT-FFR methods exhibited a positive correlation with invasive FFR(MCP-FFR:r=0.75,P＜0.001;DeepCL-FFR:r=0.86,P＜0.001)and showed good agreement(MCP-FFR:mean difference=0.010,P=0.351;DeepCL-FFR:mean difference=-0.003,P=0.772).Both DeepCL-FFR(AUC 0.97,95％CI 0.94-0.99)and MCP-FFR(AUC 0.92,95％CI 0.88-0.97)demonstrated favorable diagnostic performance for detecting hemodynamic abnormalities(P=0.122).In the"gray zone"for hemodynamic abnormality,the diagnostic accuracy of MCP-FFR was 68.8％,whereas DeepCL-FFR increased it to 89.7％.DeepCL-FFR also exhibited superior diagnostic performance(AUC 0.89,95％CI 0.73-0.99)within the"gray zone,"which was significantly higher than that of MCP-FFR(AUC 0.71,95％CI 0.54-0.87)(P＜0.001).Conclusions The deep learning-driven coronary centerline extraction algorithm,DeepCL,demonstrates superior diagnostic performance in CT-FFR for detecting hemodynamic abnormalities,particularly by significantly improving diagnostic accuracy in the"gray zone."

Objectives:To investigate the clinical characteristics and prognosis of patients with pulmonary arterial hypertension(PAH)concomitant with obstructive sleep apnea(OSA).Methods:We analyzed the data of 208 patients diagnosed with PAH in the Pulmonary Vascular Diseases Ward of our hospital from September 2019 to August 2024,who underwent sleep breathing monitoring and echocardiography during hospitalization.Three clusters were identified:Cluster 1(n=121)had no OSA and mildly elevated N-terminal pro-B-type natriuretic peptide(NT-proBNP),Cluster 2(n=71)exhibited mild OSA and mildly elevated NT-proBNP,and Cluster 3(n=16)presented with moderate to severe OSA along with significantly elevated NT-proBNP.Results:The mean age of this patient cohort was(39±12)years,mean body mass index was(21.74±3.67)kg/m2,and 27.9%patients were male.Sixty-five patients(31.3%)had OSA.The echocardiographic indicators reflecting the structural function of the heart chambers and hemodynamic parameters in patients with PAH showed a significant correlation with nocturnal hypoxia.Compared to Cluster 1,patients in Cluster 2 and Cluster 3 had wider pulmonary arteries and inferior vena cava diameters,larger right ventricular diameters,higher pulmonary artery pressure,higher pulmonary vascular resistance,and lower cardiac index(all P<0.05).Cluster 3 patients had a significantly higher risk of death(log-rank P=0.022).Conclusions:Thirty-one percent of PAH patients in this study had concomitant OSA.PAH patients with significantly elevated NT-proBNP and comorbid moderate-to-severe OSA had a significantly higher risk of death compared to those with only mild or without OSA without significantly elevated NT-proBNP.Management strategies that address both PAH and OSA might be effective in improving the outcomes of these patients.

Objectives:To investigate the clinical characteristics and prognosis of patients with pulmonary arterial hypertension(PAH)concomitant with obstructive sleep apnea(OSA).Methods:We analyzed the data of 208 patients diagnosed with PAH in the Pulmonary Vascular Diseases Ward of our hospital from September 2019 to August 2024,who underwent sleep breathing monitoring and echocardiography during hospitalization.Three clusters were identified:Cluster 1(n=121)had no OSA and mildly elevated N-terminal pro-B-type natriuretic peptide(NT-proBNP),Cluster 2(n=71)exhibited mild OSA and mildly elevated NT-proBNP,and Cluster 3(n=16)presented with moderate to severe OSA along with significantly elevated NT-proBNP.Results:The mean age of this patient cohort was(39±12)years,mean body mass index was(21.74±3.67)kg/m2,and 27.9%patients were male.Sixty-five patients(31.3%)had OSA.The echocardiographic indicators reflecting the structural function of the heart chambers and hemodynamic parameters in patients with PAH showed a significant correlation with nocturnal hypoxia.Compared to Cluster 1,patients in Cluster 2 and Cluster 3 had wider pulmonary arteries and inferior vena cava diameters,larger right ventricular diameters,higher pulmonary artery pressure,higher pulmonary vascular resistance,and lower cardiac index(all P<0.05).Cluster 3 patients had a significantly higher risk of death(log-rank P=0.022).Conclusions:Thirty-one percent of PAH patients in this study had concomitant OSA.PAH patients with significantly elevated NT-proBNP and comorbid moderate-to-severe OSA had a significantly higher risk of death compared to those with only mild or without OSA without significantly elevated NT-proBNP.Management strategies that address both PAH and OSA might be effective in improving the outcomes of these patients.

Objective To evaluate the diagnostic performance of the minimum-cost-path-based CT angiography-derived fractional flow reserve(MCP-FFR)and the deep learning-driven CT angiography-derived fractional flow reserve(DeepCL-FFR),and to particularly explore the potential value of the DeepCL algorithm in improving diagnostic accuracy within the"gray zone."Methods A retrospective analysis was conducted on 151 coronary vessels from 109 patients with coronary artery disease,who were hospitalized at the General Hospital of the People's Liberation Army between January 2020 and June 2021.Pearson correlation and Bland-Altman plots were employed to assess the correlation and agreement of the two CT-FFR methods with invasive FFR.A CT-FFR range of 0.70-0.80 was defined as the diagnostic"gray zone."The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value for detecting hemodynamic abnormalities were calculated and analyzed.The DeLong test was used to compare the areas under the receiver operating characteristic curves(AUC)between the two CT-FFR calculation methods.Results Both CT-FFR methods exhibited a positive correlation with invasive FFR(MCP-FFR:r=0.75,P＜0.001;DeepCL-FFR:r=0.86,P＜0.001)and showed good agreement(MCP-FFR:mean difference=0.010,P=0.351;DeepCL-FFR:mean difference=-0.003,P=0.772).Both DeepCL-FFR(AUC 0.97,95％CI 0.94-0.99)and MCP-FFR(AUC 0.92,95％CI 0.88-0.97)demonstrated favorable diagnostic performance for detecting hemodynamic abnormalities(P=0.122).In the"gray zone"for hemodynamic abnormality,the diagnostic accuracy of MCP-FFR was 68.8％,whereas DeepCL-FFR increased it to 89.7％.DeepCL-FFR also exhibited superior diagnostic performance(AUC 0.89,95％CI 0.73-0.99)within the"gray zone,"which was significantly higher than that of MCP-FFR(AUC 0.71,95％CI 0.54-0.87)(P＜0.001).Conclusions The deep learning-driven coronary centerline extraction algorithm,DeepCL,demonstrates superior diagnostic performance in CT-FFR for detecting hemodynamic abnormalities,particularly by significantly improving diagnostic accuracy in the"gray zone."

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 evaluate the feasibility of using the domestic ArcherQA system for fast and simplified independent verification of CyberKnife (CK) stereotactic radiotherapy (SRT) plans.Methods:SRT plans of 57 patients treated with CK at Tianjin Medical University Cancer Institute and Hospital from August 2021 to August 2022 were retrospectively analyzed, including 15 intracranial, 30 pulmonary, and 12 abdominal tumors cases. Point-dose and planar-dose verifications were performed using an ionization chamber and radiochromic films embedded in a homogeneous phantom, and the results were compared with those calculated by the treatment planning system (TPS). The localization CT images and corresponding SRT plans were imported into the ArcherQA system for independent dose verification and analysis. The correlation between ArcherQA results and phantom measurements was analyzed, with comparisons of target mean dose differences and γ pass rates.Results:Phantom measurement results showed, the measured point-dose differences for intracranial, lung, and abdominal plans were -0.94% ± 3.22%, 1.92% ± 2.05%, and 2.12% ± 0.77%, respectively. The mean dose differences in target dose calculation between ArcherQA and TPS: intracranial in the gross tumor volume (GTV) regions were 0.34% ± 2.21%, lung tumor GTV were -2.47% ± 2.46%, and abdominal tumor GTV were 0.80% ± 2.61%, respectively. Among them, the abdominal GTV region showed the highest correlation between ArcherQA and measured results ( r=0.78). The average two-dimensional γ pass rates (2 mm/2%, threshold=10%) measured using phantom films were 95.92% ± 2.35% for intracranial, 95.70% ± 2.74% for lung, and 96.74% ± 3.41% for abdominal tumors plans, respectively. The three-dimensional ArcherQA results showed comparable γ pass rates (1 mm/2%, threshold=10%) for lung and abdominal GTV and PTV regions, with similar medians and data dispersion to film measurements. Conclusions:The ArcherQA system enables rapid and efficient independent dose verification of CK SRT plans without the need for additional hardware. The verification results show good correlation with phantom measurements, supporting its potential as an auxiliary quality assurance tool in clinical CK SRT implementation.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the mitochondrial dysfunction in glaucoma-related optic nerve injury and its effect on the apoptosis of retinal ganglion cells(RGCs).Methods The RGC-5 cells were incubated under elevated pressure(70 mmHg,1 kPa=7.5 mmHg)on the basis of standard atmospheric pressure(100 kPa)for 12 h,24 h,and 48 h,respective-ly.The RGC-5 cells cultured under the standard atmospheric pressure were selected as the blank group.The apoptosis of RGC-5 cells was detected through Annexin V/PI staining.The mitochondrial membrane potential(MMP)and reactive oxy-gen species(ROS)level were measured using the JC-1 staining and DCFH-DA fluorescent probe.The expression levels of B cell lymphoma-2(BCL-2)protein,BCL-2-associated X(BAX)protein,cleaved Caspase-3,and cytochrome C(CytC)pro-tein were detected using Western blot.Results Compared with the blank group,the MMP in the 12 h,24 h and 48 h groups significantly decreased(all P＜0.05).Compared with the blank group,the cell apoptosis and ROS level in the 24 h and 48 h groups significantly increased(all P＜0.05),while there was no statistically significant difference in the cell apop-tosis and ROS level between the 12 h group and the blank group(both P＞0.05).Compared with the blank group,the rela-tive expression levels of cleaved Caspase-3 and BAX protein in the 24 h and 48 h groups significantly increased(all P＜0.05),while the relative expression levels of cleaved Caspase-3 and BAX protein in the 12 h group showed no significant difference(both P＞0.05).Compared with the blank group,the relative expression level of BCL-2 protein in the 12 h,24 h and 48 h groups decreased,and the differences were statistically significant(all P＜0.05).Compared with the blank group,the relative expression level of Cyt C protein in the 48 h group significantly increased(P＜0.05),while the relative expression level of Cyt C protein in the 12 h and 24 h groups showed no significant difference(both P＞0.05).Conclu-sion After culture at 70 mmHg pressure,RGC-5 cells show increased apoptosis and mitochondrial dysfunction.The mito-chondrial damage at the early stage of stress injury may be closely related to exogenous apoptosis pathways.