Objective To study the effectiveness of combining antidepressant drug with high-frequency repeated transcranial magnetic stimulation(rTMS)in treating adolescent depression and explore its impact on electroencephalogram.Methods 60 cases of adolescent depression,who admitted to Department of Psychiatry,the First Affiliated Hospital of Kunming Medical University from September to December 2024 were selected and randomly divided into control group and observation group,with 30 cases in each group.Patients of control group were treated with selective serotonin reuptake inhibitor(SSRI),while patients of observation group received the same SSRI treatment in addition to high-frequency rTMS.The treatment lasted for 2 weeks.Both groups were assessed by using 24-item Hamilton depression rating scale(HAMD-24)and depression self-rating scale for children(DSRSC)before the start of treatment and at the end of two weeks of treatment.Adverse reactions were recorded throughout the treatment,and electroencephalogram monitoring was taken before and after treatment.Results Observation group showed a significantly higher treatment response rate compared to control group(P<0.05).After two weeks of treatment,HAMD-24 and DSRSC scores in observation group were notably lower than those in control group(P<0.01).Both groups exhibited improvements in brain wave power(δ,θ,α,β)after treatment(P<0.05),with observation group demonstrating superior β wave power compared to control group(P<0.01).Additionally,a negative correlation was found between α and β wave power in the left frontal region and DSRSC scores in observation group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Compared with SSRI treatment,rTMS combined with SSRI treatment can more effectively improve depressive symptoms,increase α and β brainwave power,and the combination therapy does not increase the incidence of adverse reactions,demonstrating good safety.

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.

Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8+T cell immune infiltration and immune suppression.We constructed a CD8+T cells related risk score model to pre-dict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8+T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS2,and TN-FRSF1B was constructed.The risk score model was well validated through an independent external validation co-hort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differ-ences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P＜0.0001)and lower CD8+T cells infiltration(P＜0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P＜0.01).Drug sensitivity a-nalysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene mod-el was verified by immunohistochemistry.In summary,the establishment and validation of a CD8+T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.

Objective To explore the impact of"knowledge-attitude-practice"(KAP)training mode on head nur-ses' core competency in healthcare-associated infection(HAI)prevention and control in a tertiary first-class general hospital.Methods Head nurses of 113 departments in a tertiary first-class general hospital were taken as the re-search objects.Guided by problems and demands,HAI training was conducted using the KAP training mode.The training was divided into two stages:a stage with problems of infection control and investigation of knowledge de-mands,as well as a stage with KAP training mode implementation.It included theoretical lectures,visits and lear-ning,and supervision on rectification.Scores of theory,supervision,and core competency of head nurses before training,1 month and 6 months after training were compared by the analysis of variance.SPSS 26.0 statistical soft-ware was used for analysis.Results The top three infection control problems in this hospital were hand hygiene,prevention and control of infection with multidrug-resistant organisms,as well as HAI prevention and control in the wards.The top three training modules required urgently by the head nurses were occupational exposure and self-protection,principles of medical waste disposal,as well as prevention and control of HAI in the wards.Both scores of theory and supervision after training were higher than those before training,with statistically significant diffe-rences(both P＜0.01).The core competencies of the head nurses were at a high level.After implementing KAP training mode,the scores of dimensions in critical thought and research,clinical nursing,leadership,and profe-ssional development,as well as the overall score of core competencies were all higher than before training.Diffe-rences were all statistically significant(all P＜0.05).The overall scores of dimensions in legal and ethical practice,education and consultation,as well as interpersonal relationship were all higher than before training,but the diffe-rences were not statistically significant(all P＞0.05).Conclusion KAP training mode can significantly improve the scores of theory,supervision,and core competencies of head nurses,and can be further promoted and applied in head nurses' infection control training.

Objective To explore the impact of"knowledge-attitude-practice"(KAP)training mode on head nur-ses' core competency in healthcare-associated infection(HAI)prevention and control in a tertiary first-class general hospital.Methods Head nurses of 113 departments in a tertiary first-class general hospital were taken as the re-search objects.Guided by problems and demands,HAI training was conducted using the KAP training mode.The training was divided into two stages:a stage with problems of infection control and investigation of knowledge de-mands,as well as a stage with KAP training mode implementation.It included theoretical lectures,visits and lear-ning,and supervision on rectification.Scores of theory,supervision,and core competency of head nurses before training,1 month and 6 months after training were compared by the analysis of variance.SPSS 26.0 statistical soft-ware was used for analysis.Results The top three infection control problems in this hospital were hand hygiene,prevention and control of infection with multidrug-resistant organisms,as well as HAI prevention and control in the wards.The top three training modules required urgently by the head nurses were occupational exposure and self-protection,principles of medical waste disposal,as well as prevention and control of HAI in the wards.Both scores of theory and supervision after training were higher than those before training,with statistically significant diffe-rences(both P＜0.01).The core competencies of the head nurses were at a high level.After implementing KAP training mode,the scores of dimensions in critical thought and research,clinical nursing,leadership,and profe-ssional development,as well as the overall score of core competencies were all higher than before training.Diffe-rences were all statistically significant(all P＜0.05).The overall scores of dimensions in legal and ethical practice,education and consultation,as well as interpersonal relationship were all higher than before training,but the diffe-rences were not statistically significant(all P＞0.05).Conclusion KAP training mode can significantly improve the scores of theory,supervision,and core competencies of head nurses,and can be further promoted and applied in head nurses' infection control training.

Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8+T cell immune infiltration and immune suppression.We constructed a CD8+T cells related risk score model to pre-dict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8+T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS2,and TN-FRSF1B was constructed.The risk score model was well validated through an independent external validation co-hort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differ-ences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P＜0.0001)and lower CD8+T cells infiltration(P＜0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P＜0.01).Drug sensitivity a-nalysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene mod-el was verified by immunohistochemistry.In summary,the establishment and validation of a CD8+T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.

Objective To study the effectiveness of combining antidepressant drug with high-frequency repeated transcranial magnetic stimulation(rTMS)in treating adolescent depression and explore its impact on electroencephalogram.Methods 60 cases of adolescent depression,who admitted to Department of Psychiatry,the First Affiliated Hospital of Kunming Medical University from September to December 2024 were selected and randomly divided into control group and observation group,with 30 cases in each group.Patients of control group were treated with selective serotonin reuptake inhibitor(SSRI),while patients of observation group received the same SSRI treatment in addition to high-frequency rTMS.The treatment lasted for 2 weeks.Both groups were assessed by using 24-item Hamilton depression rating scale(HAMD-24)and depression self-rating scale for children(DSRSC)before the start of treatment and at the end of two weeks of treatment.Adverse reactions were recorded throughout the treatment,and electroencephalogram monitoring was taken before and after treatment.Results Observation group showed a significantly higher treatment response rate compared to control group(P<0.05).After two weeks of treatment,HAMD-24 and DSRSC scores in observation group were notably lower than those in control group(P<0.01).Both groups exhibited improvements in brain wave power(δ,θ,α,β)after treatment(P<0.05),with observation group demonstrating superior β wave power compared to control group(P<0.01).Additionally,a negative correlation was found between α and β wave power in the left frontal region and DSRSC scores in observation group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Compared with SSRI treatment,rTMS combined with SSRI treatment can more effectively improve depressive symptoms,increase α and β brainwave power,and the combination therapy does not increase the incidence of adverse reactions,demonstrating good safety.

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.

As the comprehensive reform of public hospitals enters a more challenging phase,the conventional extensive operation management no longer fulfills the requirements of high-quality development.This article investigates the current challen-ges in hospital operation management under the DIP payment system,proposes an optimized pathway as well as an outline for practical implementation.The proposed pathway suggests implementing a closed-loop resource allocation strategy integrating budg-et and performance based on disease groups and scores,establishing a cost management mechanism for enhancing resource effi-ciency,and development of a performance distribution system for stimulating self-management motivation among personnel.Addi-tionally,the article suggests the establishment of a Management Information System,aiming to provide practical references for en-hancing operational management capabilities in public hospitals under the DIP payment mode.

Objective:To investigate the effect of nuclear factor-erythroid 2-related factor 2 (Nrf2) gene on the proliferation and apoptosis of colorectal adenocarcinoma cells in vitro, and the role of Nrf2 gene in regulation of epithelial-mesenchymal transition (EMT) pathway.Methods:Three Nrf2 small interfering RNA (siRNA) sequences were designed and synthesized, namely siRNA-223, siRNA-538 and siRNA-756, and the unrelated sequences were designed and synthesized. The plasmids carrying various siRNA sequences of Nrf2 were constructed, and the plasmids carrying siRNA sequences and the plasmids carrying unrelated sequences were transfected into human colorectal adenocarcinoma Caco-2 cells, namely interference group and empty vector group, respectively. Additionally, Caco-2 cells without any treatment were used as the control group. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting (WB) methods were used to detect the relative expression of Nrf2 gene in transcription and translation levels in each group of cells, in order to verify the interference effect of Nrf2; the siRNA with the best interference effect was selected for subsequent experiments. CCK-8 method was used to detect the proliferation ability of each group of cells (expressed as absorbance value); RT-qPCR was used to detect the relative expression of EMT pathway-related factors [vimentin (Vim), N-cadherin (N-cad) and E-cadherin (E-cad)] in transcription level in each group of cells; WB method was used to detect the expression of pro-apoptotic protein Bax in each group of cells.Results:The results of RT-qPCR and WB methods showed that compared with the control group and the empty group, the relative expression of Nrf2 gene in transcription and translation levels in Caco-2 cells of the siRNA-756 interference group were the lowest, and the differences were statistically significant (all P < 0.05). The CCK-8 results showed that the absorbance values of Caco-2 cells in the control group, empty group and siRNA-756 interference group after 48 hours of culture were (100±5)%, (94±4)% and (82±5)%, respectively; compared with the control group and the empty group, the siRNA-756 interference group had lower absorbance value, and the differences were statistically significant (all P < 0.05). The results of RT-qPCR method showed that the relative expression of Vim and N-cad in transcription level in the siRNA-756 interference group were higher than those in the control group and the empty vector group, and the differences were statistically significant (all P < 0.05); the relative expression of E-cad in transcription level was lower than those in the control group and the empty vector group, and the differences were statistically significant (both P < 0.05). The results of WB method showed that the relative expression of Bax protein in the siRNA-756 interference group was higher than that in the control group, and the difference was statistically significant ( P < 0.05). Conclusions:Interference with Nrf2 expression in vitro can weaken the proliferation and anti-apoptotic abilities of human colorectal adenocarcinoma Caco-2 cells. The mechanism may be that Nrf2 regulates the expression of Vim, N-cad and E-Cad in the EMT pathway to enhance the EMT ability of tumor cells.