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.

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.

Electroencephalogram (EEG) is a non-invasive, high temporal-resolution technique for monitoring brain activity. However, affected by the volume conduction effect, EEG has a low spatial resolution and is difficult to locate brain neuronal activity precisely. The surface Laplacian (SL) technique obtains the Laplacian EEG (LEEG) by estimating the second-order spatial derivative of the scalp potential. LEEG can reflect the radial current activity under the scalp, with positive values indicating current flow from the brain to the scalp (“source”) and negative values indicating current flow from the scalp to the brain (“sink”). It attenuates signals from volume conduction, effectively improving the spatial resolution of EEG, and is expected to contribute to breakthroughs in neural engineering. This paper provides a systematic overview of the principles and development of SL technology. Currently, there are two implementation paths for SL technology: current source density algorithms (CSD) and concentric ring electrodes (CRE). CSD performs the Laplace transform of the EEG signals acquired by conventional disc electrodes to indirectly estimate the LEEG. It can be mainly classified into local methods, global methods, and realistic Laplacian methods. The global method is the most commonly used approach in CSD, which can achieve more accurate estimation compared with the local method, and it does not require additional imaging equipment compared with the realistic Laplacian method. CRE employs new concentric ring electrodes instead of the traditional disc electrodes, and measures the LEEG directly by differential acquisition of the multi-ring signals. Depending on the structure, it can be divided into bipolar CRE, quasi-bipolar CRE, tripolar CRE, and multi-pole CRE. The tripolar CRE is widely used due to its optimal detection performance. While ensuring the quality of signal acquisition, the complexity of its preamplifier is relatively acceptable. Here, this paper introduces the study of the SL technique in resting rhythms, visual-related potentials, movement-related potentials, and sensorimotor rhythms. These studies demonstrate that SL technology can improve signal quality and enhance signal characteristics, confirming its potential applications in neuroscientific research, disease diagnosis, visual pathway detection, and brain-computer interfaces. CSD is frequently utilized in applications such as neuroscientific research and disease detection, where high-precision estimation of LEEG is required. And CRE tends to be used in brain-computer interfaces, that have stringent requirements for real-time data processing. Finally, this paper summarizes the strengths and weaknesses of SL technology and envisages its future development. SL technology boasts advantages such as reference independence, high spatial resolution, high temporal resolution, enhanced source connectivity analysis, and noise suppression. However, it also has shortcomings that can be further improved. Theoretically, simulation experiments should be conducted to investigate the theoretical characteristics of SL technology. For CSD methods, the algorithm needs to be optimized to improve the precision of LEEG estimation, reduce dependence on the number of channels, and decrease computational complexity and time consumption. For CRE methods, the electrodes need to be designed with appropriate structures and sizes, and the low-noise, high common-mode rejection ratio preamplifier should be developed. We hope that this paper can promote the in-depth research and wide application of SL technology.

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.

Glutamine provides carbon and nitrogen to support the proliferation of cancer cells. However, the precise reason why cancer cells are particularly dependent on glutamine remains unclear. In this study, we report that glutamine modulates the tumor suppressor F-box and WD repeat domain-containing 7 (FBW7) to promote cancer cell proliferation and survival. Specifically, lysine 604 (K604) in the sixth of the 7 substrate-recruiting WD repeats of FBW7 undergoes glutaminylation (Gln-K604) by glutaminyl tRNA synthetase. Gln-K604 inhibits SCFFBW7-mediated degradation of c-Myc and Mcl-1, enhances glutamine utilization, and stimulates nucleotide and DNA biosynthesis through the activation of c-Myc. Additionally, Gln-K604 promotes resistance to apoptosis by activating Mcl-1. In contrast, SIRT1 deglutaminylates Gln-K604, thereby reversing its effects. Cancer cells lacking Gln-K604 exhibit overexpression of c-Myc and Mcl-1 and display resistance to chemotherapy-induced apoptosis. Silencing both c-MYC and MCL-1 in these cells sensitizes them to chemotherapy. These findings indicate that the glutamine-mediated signal via Gln-K604 is a key driver of cancer progression and suggest potential strategies for targeted cancer therapies based on varying Gln-K604 status.
Glutamine/metabolism* ; Myeloid Cell Leukemia Sequence 1 Protein/genetics* ; Humans ; Proto-Oncogene Proteins c-myc/genetics* ; Cell Proliferation ; Signal Transduction ; Neoplasms/pathology* ; F-Box-WD Repeat-Containing Protein 7/genetics* ; Cell Survival ; Cell Line, Tumor ; Apoptosis

Plutonium isotopes(238Pu,239Pu,240Pu and 241Pu)in the environment are important"fingerprint"nuclides in the study of nuclear activity traceability.The content of plutonium isotopes in the environmental metrics is usually very low,and the measurement of these isotopes,especially 238Pu,using mass spectrometry is seriously interfered with by the coexisting 238U.The analysis of several plutonium isotopes in soil usually requires combination of multiple measurement techniques,which leads to a long analysis time and large uncertainty in the isotope ratio.In this work,the hydrous titanium oxide(HTiO)precipitated by the hydrolysis of titanium oxydichloride(TiOCl2)under near-neutral condition was used to preconcentrate plutonium from the soil digestion solution,and the highly efficient decontamination of 238U in the sample was achieved by TK200 resin column chromatography with a decontamination factor of 108.Simulation resuts of density functional theory(DFT)showed that NH3 was considered as a promising reaction gas to eliminate the interference of 238U from 238Pu measurement using mass spectrometry due to the significant discrepancy of the chemical reactivity of U+and Pu+with the reactive gas NH3.Experiments confirmed that by optimizing the flow rates of collision gas(He)and reaction gas(NH3),the interference of 238U could be effectively suppressed,and the decontamination factor of 238U was 104.Combined with chemical separation,the overall decontamination factor of 238U could reach 1012 by using the developed method.By combining chemical separation and tandem quadrupole inductively coupled plasmon-mass spectrometry(ICP-MS/MS)measurement,the simultaneous determination of four ultra-trace plutonium isotopes in soil was realized,and the detection limit of plutonium isotopes was at the femtogram level.Analysis of the international standard reference materials(NIST-SRM-4357 and IAEA-384)showed that the established method could be successfully used for the accurate analysis of ultra-trace four plutonium isotopes(238Pu,239Pu,240Pu and 241Pu)in soil samples.

OBJECTIVE To investigate the serum toll-like receptor 4(TLR4),matrix metalloproteinase-3(MMP-3),in-terleukin-1β(IL-1β)and peripheral blood helper T-cell 17/regulatory T-cell(Th17/Treg)levels in patients with chronic periodontitis infected with porphyromonas gingivalis(Pg),as well as their diagnostic value of Pg infection in patients with chronic periodontitis.METHODS Totally 390 cases of patients with chronic periodontitis who at-tended Tianjin Stomatological Hospital from Jan.2022 to Jan.2024 were selected as the study subjects,and were divided into the infected group(113 cases)and the uninfected group(277 cases)according to Pg infection,and those patients in the infected group were further classified into the mild group(31 cases),the moderate group(45 cases),and the severe group(37 cases)according to the condition of the disease.Serum TLR4,MMP-3,IL-1β,and peripheral blood Th17/Treg levels were compared between the infected and uninfected groups and patients with different conditions of chronic periodontitis Pg infection,and the infected group was included in the positive and the uninfected group was included in the negative,and the receiver's operating characteristics(ROC)curves were plotted to obtain the area under the curve(AUC)to analyze the diagnostic value of single and combined de-tection of serum TLR4,MMP-3,and IL-1β,Peripheral blood Th17/Treg for Pg infection in patients with chronic periodontitis.RESULTS Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg levels in the infected group were(20.41±5.12)ng/ml,(6.12±2.03)μg/L,(10.24±2.19)μg/L and(0.32±0.10),higher than those in the uninfected group(P＜0.05).Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg levels in the se-vere group were(22.58±6.10)ng/ml,(8.12±2.67)μg/L,(12.49±3.10)μg/L and(0.52±0.15),higher than those in the moderate group[(14.78±3.44)ng/ml,(6.15±2.07)μg/L,(7.23±1.99)μg/L and(0.22±0.07)]and mild group(P＜0.05),which in the moderate group was higher than those in the mild group(P＜0.05).The results of ROC analysis showed that the AUC of serum TLR4,MMP-3,IL-1β,and peripheral blood Th17/Treg combined test for diagnosing Pg infection in patients with chronic periodontitis was 0.937,which was higher than that of the four single tests(P＜0.05).CONCLUSION Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg were highly expressed in chronic periodontitis patients infected with Pg,and all four indicators can participate in the progression of the disease,and the combined detection of these four indicators has a higher diagnostic value for Pg infection in patients with chronic periodontitis.

OBJECTIVE To investigate the serum toll-like receptor 4(TLR4),matrix metalloproteinase-3(MMP-3),in-terleukin-1β(IL-1β)and peripheral blood helper T-cell 17/regulatory T-cell(Th17/Treg)levels in patients with chronic periodontitis infected with porphyromonas gingivalis(Pg),as well as their diagnostic value of Pg infection in patients with chronic periodontitis.METHODS Totally 390 cases of patients with chronic periodontitis who at-tended Tianjin Stomatological Hospital from Jan.2022 to Jan.2024 were selected as the study subjects,and were divided into the infected group(113 cases)and the uninfected group(277 cases)according to Pg infection,and those patients in the infected group were further classified into the mild group(31 cases),the moderate group(45 cases),and the severe group(37 cases)according to the condition of the disease.Serum TLR4,MMP-3,IL-1β,and peripheral blood Th17/Treg levels were compared between the infected and uninfected groups and patients with different conditions of chronic periodontitis Pg infection,and the infected group was included in the positive and the uninfected group was included in the negative,and the receiver's operating characteristics(ROC)curves were plotted to obtain the area under the curve(AUC)to analyze the diagnostic value of single and combined de-tection of serum TLR4,MMP-3,and IL-1β,Peripheral blood Th17/Treg for Pg infection in patients with chronic periodontitis.RESULTS Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg levels in the infected group were(20.41±5.12)ng/ml,(6.12±2.03)μg/L,(10.24±2.19)μg/L and(0.32±0.10),higher than those in the uninfected group(P＜0.05).Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg levels in the se-vere group were(22.58±6.10)ng/ml,(8.12±2.67)μg/L,(12.49±3.10)μg/L and(0.52±0.15),higher than those in the moderate group[(14.78±3.44)ng/ml,(6.15±2.07)μg/L,(7.23±1.99)μg/L and(0.22±0.07)]and mild group(P＜0.05),which in the moderate group was higher than those in the mild group(P＜0.05).The results of ROC analysis showed that the AUC of serum TLR4,MMP-3,IL-1β,and peripheral blood Th17/Treg combined test for diagnosing Pg infection in patients with chronic periodontitis was 0.937,which was higher than that of the four single tests(P＜0.05).CONCLUSION Serum TLR4,MMP-3,IL-1β and peripheral blood Th17/Treg were highly expressed in chronic periodontitis patients infected with Pg,and all four indicators can participate in the progression of the disease,and the combined detection of these four indicators has a higher diagnostic value for Pg infection in patients with chronic periodontitis.

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.

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.