Objective To investigate the impact of hepatopancreatic ampulla features on difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on 800 patients who underwent ERCP from June 2023 to April 2024.Hepatopancreatic ampullary features were categorized endoscopically into four types:1)Non-protruding(n=544);2)Protruding(n=120);3)Diverticula or mucosal folds(n=96);4)Tortuosity or tumor involvement(n=40).Standard biliary cannulation was initiated in all cases,with failure defined as difficult cannulation.Advanced cannulation techniques were employed for all difficult cannulation cases[double-guidewire technique(DGT)or precutsphincterotomy(PST)].Success rates and procedural complications were recorded.Results Standard biliary cannulation outcomes,success rates 79.96％(435/544)in non-protruding vs.69.17％(83/120)in protruding,72.92％(70/96)in diverticula or mucosal folds,and 65.00％(26/40)in tortuosity or tumor groups(x2=10.90,P=0.012);Difficult cannulation rates 18.01％(98/544)in non-protruding vs.27.50％(33/120)in protruding,27.08％(26/96)in diverticula or mucosal folds,and 30.00％(12/40)in tortuosity or tumor groups(x2=10.41,P=0.015).In the subgroups,the rates of DGT intubation in the four groups were 11.95％(65/544),15.83％(19/120),12.50％(12/96),and 20.00％(8/40),respectively.There was no statistically significant difference in the success rate of DGT intubation between the groups(x2=6.96,P=0.073).In the subgroups,the PST intubation rates were 6.07％(33/544),11.67％(14/120),14.58％(14/96),and 10.00％(4/40),respectively.There was no statistically significant difference in the success rate of PST intubation between the groups(x2=5.54,P=0.136).Advanced cannulation techniques were used in 169 patients,DGT success rates of 94.23％(98/104)vs.PST at 89.23％(58/65)(x2=19.50,P=0.021);PEP incidence 18.34％(31/169)in difficult cannulation vs.2.61％(16/614)in standard group(x2=58.64,P=0.000);No significant difference in PEP between DGT(21.25％)and PST(13.85％)groups(x2=1.17,P=0.279).Conclusion Hepatopancreatic ampulla features influences biliary cannulation success.Non-protruding ampullae demonstrate optimal outcomes with standard techniques.Notably,DGT and PST are associated with elevated PEP risks in difficult cannulation.

Objective To investigate the impact of hepatopancreatic ampulla features on difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on 800 patients who underwent ERCP from June 2023 to April 2024.Hepatopancreatic ampullary features were categorized endoscopically into four types:1)Non-protruding(n=544);2)Protruding(n=120);3)Diverticula or mucosal folds(n=96);4)Tortuosity or tumor involvement(n=40).Standard biliary cannulation was initiated in all cases,with failure defined as difficult cannulation.Advanced cannulation techniques were employed for all difficult cannulation cases[double-guidewire technique(DGT)or precutsphincterotomy(PST)].Success rates and procedural complications were recorded.Results Standard biliary cannulation outcomes,success rates 79.96％(435/544)in non-protruding vs.69.17％(83/120)in protruding,72.92％(70/96)in diverticula or mucosal folds,and 65.00％(26/40)in tortuosity or tumor groups(x2=10.90,P=0.012);Difficult cannulation rates 18.01％(98/544)in non-protruding vs.27.50％(33/120)in protruding,27.08％(26/96)in diverticula or mucosal folds,and 30.00％(12/40)in tortuosity or tumor groups(x2=10.41,P=0.015).In the subgroups,the rates of DGT intubation in the four groups were 11.95％(65/544),15.83％(19/120),12.50％(12/96),and 20.00％(8/40),respectively.There was no statistically significant difference in the success rate of DGT intubation between the groups(x2=6.96,P=0.073).In the subgroups,the PST intubation rates were 6.07％(33/544),11.67％(14/120),14.58％(14/96),and 10.00％(4/40),respectively.There was no statistically significant difference in the success rate of PST intubation between the groups(x2=5.54,P=0.136).Advanced cannulation techniques were used in 169 patients,DGT success rates of 94.23％(98/104)vs.PST at 89.23％(58/65)(x2=19.50,P=0.021);PEP incidence 18.34％(31/169)in difficult cannulation vs.2.61％(16/614)in standard group(x2=58.64,P=0.000);No significant difference in PEP between DGT(21.25％)and PST(13.85％)groups(x2=1.17,P=0.279).Conclusion Hepatopancreatic ampulla features influences biliary cannulation success.Non-protruding ampullae demonstrate optimal outcomes with standard techniques.Notably,DGT and PST are associated with elevated PEP risks in difficult cannulation.

Objective To explore a better surgical approach for the surgical treatment of avulsion fractures of the posterior cruciate ligament of the tibial plateau.Methods From July 2014 to May 2024,A total of 29 cases of avulsion fractures at the insertion point of the posterior cruciate ligament of the tibial platform were admitted to our department.They were divided into two groups according to different surgical approaches.There were 16 cases in group A,which adopted the modified posterior approach,and 13 cases in group B,which adopted the conventional posterior approach.The therapeutic effects of the two groups of patients were evaluated by using the Lysholm knee score scale after surgery and the KOOS knee injury and osteoarthritis outcome scoring system.Results All patients were followed up for 12 to 14 months,with an average of(12.6±0.3)months.No serious adverse complications such as non-healing of the surgical site occurred in group A.In group B,there was 1 case of delayed wound healing and 8 cases of knee joint pain during movement.The Lysholm knee joint score and KOOS knee joint outcome score of patients in group A at 12 months after the operation were(88.65±9.23)points and(90.48±6.84)points respectively,and those in group B were(63.98±10.77)points and(69.37±9.01)points respectively.Both groups in group A were more satisfied than those in group B,and the difference was statistically significant(P＜0.05).Conclusion For patients with avulsion fractures of the insertion point of the posterior cruciate ligament of the tibial platform,the modified minimally invasive penetrating muscle approach on the posterior side of the knee joint can reduce related complications such as excessive intraoperative bleeding,internal relaxation of the knee joint,and poor postoperative wound healing,enabling early functional exercise for patients and achieving a better prognosis.

Objective To explore a better surgical approach for the surgical treatment of avulsion fractures of the posterior cruciate ligament of the tibial plateau.Methods From July 2014 to May 2024,A total of 29 cases of avulsion fractures at the insertion point of the posterior cruciate ligament of the tibial platform were admitted to our department.They were divided into two groups according to different surgical approaches.There were 16 cases in group A,which adopted the modified posterior approach,and 13 cases in group B,which adopted the conventional posterior approach.The therapeutic effects of the two groups of patients were evaluated by using the Lysholm knee score scale after surgery and the KOOS knee injury and osteoarthritis outcome scoring system.Results All patients were followed up for 12 to 14 months,with an average of(12.6±0.3)months.No serious adverse complications such as non-healing of the surgical site occurred in group A.In group B,there was 1 case of delayed wound healing and 8 cases of knee joint pain during movement.The Lysholm knee joint score and KOOS knee joint outcome score of patients in group A at 12 months after the operation were(88.65±9.23)points and(90.48±6.84)points respectively,and those in group B were(63.98±10.77)points and(69.37±9.01)points respectively.Both groups in group A were more satisfied than those in group B,and the difference was statistically significant(P＜0.05).Conclusion For patients with avulsion fractures of the insertion point of the posterior cruciate ligament of the tibial platform,the modified minimally invasive penetrating muscle approach on the posterior side of the knee joint can reduce related complications such as excessive intraoperative bleeding,internal relaxation of the knee joint,and poor postoperative wound healing,enabling early functional exercise for patients and achieving a better prognosis.

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.

The global myopia epidemic presents a significant public health challenge, necessitating diverse intervention strategies. The primary objective of myopia management is to achieve a dual therapeutic effect: providing children with clear, comfortable, and sustained vision, while also curbing rapid myopic progression to prevent high myopia. Optical interventions based on the theory of peripheral retinal defocus have become first-line treatments owing to their dual capacity for vision correction and axial elongation control. For children with myopia who show suboptimal response to defocus-based optical interventions, combination therapy has gradually emerged as a new clinical trend. Current combination strategies primarily include defocus-based optical interventions combined with low-concentration atropine, red-light therapy, and vision training, among others. This review summarizes available evidence on these three combination strategies, focusing on clinical efficacy, safety, and underlying mechanisms, with the aim of supporting evidence-based and personalized myopia management plans for clinicians.

Objective To investigate the associations between unilateral or bilateral hearing loss and 12 chronic diseases as well as multimorbidity among the oldest old in China,and to identify disparities in these associations of left-and right-side hearing loss with chronic diseases.Methods Totally 7 437 people aged ≥80 years old were selected from the Chinese Longitudinal Health and Longevity Survey(CLHLS)2018 cross-sectional data.With 12 chronic diseases and multimorbidity as outcome variables,the hearing loss as explanatory variable,socio-demographic characteristics,family factors,and lifestyle as covariates,the correlations of unilateral(left-or right-side)and bilateral hearing loss with chronic diseases and multimorbidity were analyzed using multivariate logistic regression model,and the trend analyses were carried out.Results There were 205(2.76％),227(3.05％)and 3 598(48.38％)old people with left-side,right-side and bilateral hearing loss,respectively.After adjusting for confounders,the oldest old with left-sided or bilateral hearing loss had a greater risk of multimorbidity compared with those with normal hearing function,with odds ratio(95％confidence interval)of 2.14(1.58-2.90)and 1.27(1.13-1.43),respectively,while no association between right-sided hearing loss and multimorbidity was observed(P＞0.05).Trend analysis showed that the risk of multimorbidity increased with hearing loss from none to unilateral and then to bilateral(P＜0.001).Conclusion Hearing loss may be related to the increased risk of multimorbidity in the oldest old,and the risk of those with bilateral hearing loss is higher.More attention should be paid to the prevention and treatment of hearing loss in the oldest old.

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 systematically analyze and identify key risk factors for postoperative pulmonary hemorrhage u-sing a combination of the random forest(RF)model and traditional logistic regression analysis,so as to provide data support for clinical practice.Methods This study included patients who underwent needle biopsy of lung masses from January 2020 to December 2023 in the Department of Interventional Therapy,Cancer Hospital,Tianjin Medical University.There were 844 cases,including 387 males and 457 females,ranging in age from 39 to 82 years.Clinical data and puncture-related characteristics were collected,including tumor size,puncture depth,puncture angle,presence of emphysema,lesion loca-tion in the lung,body position during puncture,whether the puncture passed through the interlobar fissure,and the number of punctures.The RF model was used to rank the importance of all variables,identifying those with the highest predictive value.Subsequently,a multivariate logistic regression model was applied to the top-ranked important variables to further e-valuate their independent impact on postoperative pulmonary hemorrhage.Results The RF model results showed that tumor size and puncture depth had the highest importance in predicting the risk of postoperative pulmonary hemorrhage.Multivari-ate logistic regression analysis further confirmed that smaller tumor size(HR:0.980,95％CI:0.971-0.989,P＜0.05)was significantly associated with a lower risk of hemorrhage,while greater puncture depth(HR:1.146,95％CI:1.063-1.235,P＜0.05)was closely related to a higher risk of hemorrhage.Additionally,other factors such as puncture angle,age,lesion location in the lung and presence of emphysema showed some influence but did not reach statistical significance in the multi-variate analysis.Conclusion This study successfully identified tumor size and puncture depth as independent risk factors for postoperative pulmonary hemorrhage by combining the RF model with multivariate logistic regression analysis.The appli-cation of the RF model improved the accuracy of feature selection,allowing us to focus on the most contributory predictive variables.These findings provide important support for preoperative risk assessment,suggesting that clinicians should priori-tize these key factors in preoperative evaluations to develop safer and more effective surgical plans,thereby reducing the risk of postoperative hemorrhage and other complications.

Endothelial cells have important physiological functions and regulatory effects related to the occurrence and development of various diseases. Piezo1 is a mechanically sensitive ion channel protein, which is widely distributed in various tissues of the body and participates in the occurrence and development of various diseases. Piezo1 is highly expressed in endothelial cells and plays an important regulatory role in endothelial cell function. This article reviews the structure and function of Piezo1, the physiological function and pathological damage mechanism of endothelial cells, and the role of endothelial cell Piezo1 in various diseases, in order to understand the function and regulation mechanism of endothelial cell Piezo1, and provide new targets and strategies for the treatment of related diseases.