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.

Objective:To explore the influencing factors of survival in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy and construct the nomogram prediction model.Methods:A retrospective case series study was conducted. The data of 130 patients with newly diagnosed esophageal squamous cell carcinoma who received intensity-modulated radiotherapy at Shanxi Province Cancer Hospital from February 2016 to June 2018 were collected. Cox regression analysis was used to screen the independent influencing factors for overall survival (OS) and progression-free survival (PFS). The nomogram models for predicting the 1-year and 2-year OS rates and PFS rates of esophageal squamous cell carcinoma patients after intensity-modulated radiotherapy were constructed based on the screened independent influencing factors. The calibration curves and receiver operating characteristic (ROC) curves were drawn to evaluate the consistency and efficacy of the nomogram prediction model. Bootstrap method (B = 500 times) was used for internal validation.Results:The median age of 130 patients was 59 years old, including 90 males and 40 females; esophageal lesions of 10 cases were located in the neck, 34 cases were in the upper chest, 55 cases were in the middle chest, and 31 cases were in the lower chest; clinical staging: 3 cases were stage Ⅰ, 37 cases were stage Ⅱ, 79 cases were stage Ⅲ, and 11 cases were stage Ⅳ. Multivariate Cox regression analysis showed that the clinical staging and gross tumor volume (GTV) were independent factors affecting OS and PFS in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy (both P < 0.01). The nomogram models for predicting the 1-year and 2-year PFS rates and OS rates of patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy were construct based on the clinical staging and GTV. The calibration curves showed good consistency between the predicted results of the model and the actual observed results. The Bootstrap method and ROC curves internal validation results showed that the area under the curve (AUC) of the model was 0.832 for predicting 1-year OS rate, 0.838 for predicting 2-year OS rate, 0.829 for predicting 1-year PFS rate, and 0.900 for predicting 2-year PFS rate. Conclusions:Clinical staging and GTV are independent influencing factors of OS and PFS in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy. The nomogram models constructed based on these two factors can be used to predict the survival prognosis of patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy.

Anticipatory anxiety is a negative emotion that arises when individuals encounter potential threats or uncertainties in the future. It is the core symptom of a variety of anxiety disorders, and is closely associated with the occurrence, severity, treatment outcome, and prognosis of anxiety disorders, which has garnered a growing amount of focus in clinical practice. Nevertheless, scientific research on anticipatory anxiety continues to face obstacles such as unclear pathological mechanisms, the absence of simple and consistent self-assessment tools, and effective interventions. To improve understanding of the role of anticipatory anxiety in the diagnosis and treatment of anxiety disorders, this study reviews pertinent domestic and international literature, and briefly introduces the concept, assessment and measurement, activation paradigm, pathological mechanisms, and interventions of anticipatory anxiety.

Objective:To construct an indicator system for entrustable professional activities (EPAs) in the general practice enhancement stage of pediatric specialist physician training.Methods:A draft indicator system for EPAs in the general practice enhancement stage of pediatric physician training was developed through core EPAs working group discussion, literature review, nominal group discussion, and expert consultation. Subsequently, the indicator system was preliminarily implemented and revised.Results:The core EPAs working group consisted of nine specialist physician trainers. In the initial brainstorming stage, a "potential list" of 30 activities was established. After literature review and collation, the draft indicator system included eight EPAs. Through nominal group discussion, the connotation of the draft was enriched, and the importance of the EPAs was ranked and modified. Finally, through expert consultation, the EPAs for the general practice enhancement stage of pediatric specialist physician training were determined. These included basic operations for the treatment of critically ill children, identification and management of critical illnesses, referral of critically ill children, perioperative management, in-hospital consultation, medical and teaching management and system improvement, doctor-patient communication and dispute handling, and response to public health events. During the preliminary implementation stage, a total of nine specialist physicians who participated in the training were evaluated. Based on the problems found in the pre-evaluation, the indicators of EPAs were revised, and a corresponding curriculum training system was developed.Conclusions:Through multiple rounds of nominal group discussion and expert consultation, the indicator system for EPAs in the general practice enhancement stage of pediatric specialist physician training was formulated. The system was preliminarily implemented and revised, and a curriculum system was constructed.

Objective:To construct an indicator system for entrustable professional activities (EPAs) in the general practice enhancement stage of pediatric specialist physician training.Methods:A draft indicator system for EPAs in the general practice enhancement stage of pediatric physician training was developed through core EPAs working group discussion, literature review, nominal group discussion, and expert consultation. Subsequently, the indicator system was preliminarily implemented and revised.Results:The core EPAs working group consisted of nine specialist physician trainers. In the initial brainstorming stage, a "potential list" of 30 activities was established. After literature review and collation, the draft indicator system included eight EPAs. Through nominal group discussion, the connotation of the draft was enriched, and the importance of the EPAs was ranked and modified. Finally, through expert consultation, the EPAs for the general practice enhancement stage of pediatric specialist physician training were determined. These included basic operations for the treatment of critically ill children, identification and management of critical illnesses, referral of critically ill children, perioperative management, in-hospital consultation, medical and teaching management and system improvement, doctor-patient communication and dispute handling, and response to public health events. During the preliminary implementation stage, a total of nine specialist physicians who participated in the training were evaluated. Based on the problems found in the pre-evaluation, the indicators of EPAs were revised, and a corresponding curriculum training system was developed.Conclusions:Through multiple rounds of nominal group discussion and expert consultation, the indicator system for EPAs in the general practice enhancement stage of pediatric specialist physician training was formulated. The system was preliminarily implemented and revised, and a curriculum system was constructed.

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.

Objective:To explore the influencing factors of survival in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy and construct the nomogram prediction model.Methods:A retrospective case series study was conducted. The data of 130 patients with newly diagnosed esophageal squamous cell carcinoma who received intensity-modulated radiotherapy at Shanxi Province Cancer Hospital from February 2016 to June 2018 were collected. Cox regression analysis was used to screen the independent influencing factors for overall survival (OS) and progression-free survival (PFS). The nomogram models for predicting the 1-year and 2-year OS rates and PFS rates of esophageal squamous cell carcinoma patients after intensity-modulated radiotherapy were constructed based on the screened independent influencing factors. The calibration curves and receiver operating characteristic (ROC) curves were drawn to evaluate the consistency and efficacy of the nomogram prediction model. Bootstrap method (B = 500 times) was used for internal validation.Results:The median age of 130 patients was 59 years old, including 90 males and 40 females; esophageal lesions of 10 cases were located in the neck, 34 cases were in the upper chest, 55 cases were in the middle chest, and 31 cases were in the lower chest; clinical staging: 3 cases were stage Ⅰ, 37 cases were stage Ⅱ, 79 cases were stage Ⅲ, and 11 cases were stage Ⅳ. Multivariate Cox regression analysis showed that the clinical staging and gross tumor volume (GTV) were independent factors affecting OS and PFS in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy (both P < 0.01). The nomogram models for predicting the 1-year and 2-year PFS rates and OS rates of patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy were construct based on the clinical staging and GTV. The calibration curves showed good consistency between the predicted results of the model and the actual observed results. The Bootstrap method and ROC curves internal validation results showed that the area under the curve (AUC) of the model was 0.832 for predicting 1-year OS rate, 0.838 for predicting 2-year OS rate, 0.829 for predicting 1-year PFS rate, and 0.900 for predicting 2-year PFS rate. Conclusions:Clinical staging and GTV are independent influencing factors of OS and PFS in patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy. The nomogram models constructed based on these two factors can be used to predict the survival prognosis of patients with esophageal squamous cell carcinoma after intensity-modulated radiotherapy.

Anticipatory anxiety is a negative emotion that arises when individuals encounter potential threats or uncertainties in the future. It is the core symptom of a variety of anxiety disorders, and is closely associated with the occurrence, severity, treatment outcome, and prognosis of anxiety disorders, which has garnered a growing amount of focus in clinical practice. Nevertheless, scientific research on anticipatory anxiety continues to face obstacles such as unclear pathological mechanisms, the absence of simple and consistent self-assessment tools, and effective interventions. To improve understanding of the role of anticipatory anxiety in the diagnosis and treatment of anxiety disorders, this study reviews pertinent domestic and international literature, and briefly introduces the concept, assessment and measurement, activation paradigm, pathological mechanisms, and interventions of anticipatory anxiety.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.