The importance of consensus research in medical decision-making has become increasinglyprominent. However, this field has long lacked unified terminology definitions and reporting standards, leading to significant heterogeneity in study design, implementation, and result presentation that affects the credibility and reproducibility of outcomes. The ACCurate COnsensus Reporting Document (ACCORD) in the field of biomedical research provides a structured writing framework for various consensus methods such as the Delphi method and nominal group technique, aiming to enhance the completeness and transparency of study reports. Combined with specific cases, this article interprets the core items of ACCORD, offering references for the design, implementation, and reporting of high-quality consensus research in China.

OBJECTIVE: To explore the effectiveness of primary interventional revascularization combined with secondary perforator composite flap in the treatment of peripheral arterial disease (PAD) accompanied by soft tissue defects around the ankle. METHODS: Between January 2022 and January 2025, 12 patients with PAD and soft tissue defects around the ankle were admitted. Among them, there were 9 males and 3 females; their ages ranged from 52 to 82 years, with an average of 68.9 years. The causes of injury included 4 cases of traffic accident, 5 cases of falls, 1 case of falling from height, 1 case of foreign body puncture injury, and 1 case of electric shock injury. The infection duration ranged from 1 month to 35 years, with a median duration of 3.5 months. The wound size ranged from 5.5 cm×3.0 cm to 15.0 cm×9.0 cm. The ankle-brachial index (ABI) was 0.32±0.12. The visual analogue scale (VAS) score for pain was 3.3±0.5. Preoperative vascular stenosis assessment was performed in all patients, with primary intervention to dredge large and medium-sized arteries, followed by secondary repair of the wound using a perforator composite flap. The flap size ranged from 6.5 cm×4.0 cm to 16.0 cm×10.0 cm. The donor sites were sutured directly or repaired with skin grafts. After two stages of treatment, the effectiveness was evaluated by measuring ABI, observing flap survival and wound healing, assessing VAS scores, and American Orthopedic Foot and Ankle Society (AOFAS) scores. RESULTS: All 12 cases completed two stages of treatment; all patients were followed up after the second-stage treatment, with a follow-up period ranging from 7 to 28 months, with an average of 16.8 months. After the first-stage treatment, the skin temperature around the ankle was significantly higher than that before treatment, and the ABI increased to 0.71±0.07, with a significant difference ( t=9.918, P<0.001). After the second-stage treatment, the blisters on the distal end of the skin flap occurred in 3 cases. The flaps survived and the wounds healed, with a healing time ranging from 10 to 14 days (mean, 11.8 days). The incisions at the donor site healed by first intention, and the skin grafts survived. The VAS score was 0.5±0.5 at 3 weeks, which was significantly lower than that before treatment ( t=13.675, P<0.001). No infection recurrence occurred during follow-up. At 6 months after the second-stage treatment, the AOFAS score of the ankle joint ranged from 92 to 97, with an average of 94.7, all reaching excellent. CONCLUSION Interventional revascularization combined with perforator composite flap for staged treatment of PAD with ankle soft tissue defects can obtain good effectiveness, by unclogging the main blood vessels, improving lower limb blood supply, and improving the survival rate of the skin flap.
Humans ; Male ; Female ; Middle Aged ; Aged ; Peripheral Arterial Disease/surgery* ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Aged, 80 and over ; Ankle/blood supply* ; Treatment Outcome ; Ankle Brachial Index ; Skin Transplantation/methods*

  Objective  To promote the development of high-quality health standards in China and summarize the characteristics of global health standards management systems and development processes.  Methods  We conducted a systematic search of relevant databases and the websites of standardization institutions. A descriptive method was used to analyze the basic characteristics of the standard management systems and development processes.  Results  The majority of the investigated countries and organizations primarily implement voluntary standards, with the exception of Chinese and the European Committee for Standardization that enforce compulsory standards. All countries and organizations have health standards at the national, group, and enterprise levels. In China and Japan, standards authorities are subordinate to the government, while in other countries or organizations, they operate as independent civil societies. The development process for health standards generally involves five stages: "Project/Proposal → Draft → Enquiry → Review → Publication". However, the specific steps in the development of health standards vary across different countries and organizations. Furthermore, China ranks high in the number of both standards and health standards issued, but the proportion of health standards is only 2.06%.  Conclusions  There are significant differences between China and other countries in terms of the management system and development process of health standards. To promote the management and development of high-quality health standards in China, we recommend promoting the coordination mechanism for standard development, increasing efforts to publicize standards and evaluate the implementation effect, strengthening the construction of personnel for the development of health standards, optimizing the efficiency of standard development and improving the internationalization level of health standards.

The robot surgery system has developed rapidly in recent years. The application of robot surgery systems in plastic and reconstructive surgery is also increasingly wide, but it is still in the initial stage compared to other specialties. This article focuses on the development status of the robot surgery system in the field of plastic and reconstructive surgery, and makes an outlook on the future development of the technology, to promote the application of the robot surgery system in the plastic and reconstructive surgery.

The robot surgery system has developed rapidly in recent years. The application of robot surgery systems in plastic and reconstructive surgery is also increasingly wide, but it is still in the initial stage compared to other specialties. This article focuses on the development status of the robot surgery system in the field of plastic and reconstructive surgery, and makes an outlook on the future development of the technology, to promote the application of the robot surgery system in the plastic and reconstructive surgery.

Objective To investigate the clinical characteristics of elderly patients with acute myo-cardial infarction(AMI)complicated with ischemic stroke and provide reference for the formula-tion of more precise prevention and treatment strategies.Methods A retrospective study was con-ducted on 439 consecutive AMI patients admitted to our department from January 2018 to Decem-ber 2019.They were divided into ischemic stroke group(n=55)and non-ischemic stroke group(n=384)based on having concomitant ischemic stroke or not.For the 114 patients who completed head CT angiography,they were assigned into ischemic stroke patients(n=27)and non-ischemic stroke patients(n=87).The clinical characteristics and intracranial arterial lesions were analyzed in the patients.Total score of intracranial artery calcification was used to evaluate the level of in-tracranial artery calcification and the degree of atherosclerosis.Results The ischemic stroke group had significantly larger proportions of concomitant hypertension,diabetes and renal dysfunction,pre-admission usage of aspirin/clopidogrel and statin,higher levels of glycosylated hemoglobin(HbA1c)and B-type brain natriuretic peptide,more 3-vessel lesions and elevated Gensini score,but decreased hemoglobin level,platelet count and estimated glomerular filtration rate when com-pared with the non-ischemic stroke patients(P＜0.05,P＜0.01).The proportions of intracranial artery calcification,severe calcification,intracranial artery carotid calcification,and intracranial artery stenosis ≥50％were obviously higher in the ischemic stroke patients than the non-ische-mic stroke patients(92.6％vs 78.2％,P=0.041;40.7％vs 21.8％,P=0.037;81.5％vs 62.1％,P=0.039;55.6％vs 35.6％,P=0.042).Binary logistic regression analysis showed that diabetes was an independent risk factor for ischemic stroke in the elderly AMI patients(OR=2.187,95％CI:1.205-3.970,P=0.010).Conclusion The elderly AMI patients complicated with ischemic stroke have more comorbidities,and severer disease condition,coronary artery disease and in-tracranial artery disease.In addition,coexistence of diabetes significantly increases the risk of is-chemic stroke in elderly AMI patients.

Objectives: . The necessity to develop a method for prognostication and to identify novel biomarkers for personalized medicine in patients with head and neck squamous cell carcinoma (HNSCC) cannot be overstated. Recently, pathomics, which relies on quantitative analysis of medical imaging, has come to the forefront. CXCL8, an essential inflammatory cytokine, has been shown to correlate with overall survival (OS). This study examined the relationship between CXCL8 mRNA expression and pathomics features and aimed to explore the biological underpinnings of CXCL8. Methods: . Clinical information and transcripts per million mRNA sequencing data were obtained from The Cancer Genome Atlas (TCGA)-HNSCC dataset. We identified correlations between CXCL8 mRNA expression and patient survival rates using a Kaplan-Meier survival curve. A retrospective analysis of 313 samples diagnosed with HNSCC in the TCGA database was conducted. Pathomics features were extracted from hematoxylin and eosin–stained images, and then the minimum redundancy maximum relevance, with recursive feature elimination (mRMR-RFE) method was applied, followed by screening with the logistic regression algorithm. Results: . Kaplan-Meier curves indicated that high expression of CXCL8 was significantly associated with decreased OS. The logistic regression pathomics model incorporated 16 radiomics features identified by the mRMR-RFE method in the training set and demonstrated strong performance in the testing set. Calibration plots showed that the probability of high gene expression predicted by the pathomics model was in good agreement with actual observations, suggesting the model’s high clinical applicability. Conclusion . The pathomics model of CXCL8 mRNA expression serves as an effective tool for predicting prognosis in patients with HNSCC and can aid in clinical decision-making. Elevated levels of CXCL8 expression may lead to reduced DNA damage and are associated with a pro-inflammatory tumor microenvironment, offering a potential therapeutic target.

Humans ; Hypertension/therapy* ; Publications ; Research Design

Objective : To investigate the cross⁃sectional associations of serum interleukin( IL) Ⅳ18 with cartilage volume , cartilage defects , bone marrow lesions ( BML) and biomarkers of cartilage degradation in patients with knee osteoarthritis (OA) , and to provide new ideas and new methods for clinical diagnosis and treatment. Methods: The study included 151 patients with knee OA , a general questionnaire survey was conducted , and the knee strucral was photographed by magnetic resonance imaging (MRI) . The cartilage volume was measured by OsiriX software in 3D⁃FLASH sequence , and cartilage defect and BML were determined in T2⁃weighted sequence. Serum IL-18 and matrix metalloproteinase ( MMP) Ⅳ3 , 13 levels were measured by enzyme⁃linked immunosorbent assay(ELISA) . SPSS software was used for statistical analysis. Results : In multivariable analyses , serum IL⁃18 level was consistent at divided part of joint (femorotibial joint and the patella femoral joint , all P < 0. 05) . Serum IL⁃18 level was positively associated with cartilage defect and BML at media femorotibial area (all P < 0. 01) . Serum IL⁃18 level was positively associated with MMP⁃3 (β = 0. 31 , 95% CI:0. 001 - 0. 010) and MMP⁃13 (β = 0. 86 , 95% CI:0. 08 - 0. 10 , all P < 0. 01) . CI:0. 08 - 0. 10 , all P < 0. 01) . Conclusion Serum IL⁃18 level is negatively associated with cartilage volume and Serum IL⁃18 level is negatively associated with cartilage volume and positively associated with cartilage defect , BML , MMP⁃3 and MMP⁃13 , suggesting IL⁃18 may play a significant role duce the injury of article cartilage in patients with knee OA and delay the progression of disease.

[Abstract] Objective: To construct a circRNA profile of esophageal squamous cell carcinoma (ESCC) and analyze differentially expressed circRNAs. Methods: Samples were taken from 3 patients with esophageal squamous cell carcinoma who were hospitalized in the Department of Thoracic Surgery, Jintan Hospital, Jiangsu University from June 2018 to February 2019. The circRNA expression profile was constructed by high-throughput sequencing technique, and the circRNA differentially expressed in 3 pairs of esophageal squamous cell carcinoma tissues and adjacent tissues was detected. The biological functions and related signal pathways of these circRNA were analyzed by GO and KEGG techniques. Results: By comparing the expression levels of circRNA between esophageal squamous cell carcinoma and adjacent tissues, 905 differentially expressed circRNA were found, of which 404 were up-regulated and 501 were down-regulated. hsa_circ_0004390 was the CIRC RNA with the highest up-regulation factor (FC=7.9712), and novel_circ_0012687 was the one with the highest down-regulation factor. GO and KEGG analysis showed that these circRNA may be involved in biological processes such as cell cycle, cell components and protein binding of cancer cells, and signal pathways such as Hippo and cGMP-PKG. Conclusion: The expression profile analysis of circRNA in esophageal squamous cell carcinoma showed that the significantly differentially expressed circRNA could be used as a potential biomarker of esophageal squamous cell carcinoma.