ObjectiveTo characterize the features of etomidate-related criminal cases in Guangxi after its formal scheduling as a controlled substance in China. MethodsWe collected judicial documents of etomidate-related criminal cases in Guangxi， published on China Judgments Online from October 2023 to July 2025. Demographic， criminological， and forensic toxicological characteristics were extracted. We analyzed the differences in demographic characteristics between the offenders and the baseline of the general population in Guangxi， and examined the associations of age， educational attainment， prior criminal conviction， and employment status with offense types. ResultsA total of 51 adjudicated cases were included， involving 174 individuals. The offenders were predominantly male， young adults， with low educational attainment， prior criminal convictions， and unemployed status. Statistically significant differences were observed between the offenders and the baseline of the general population in Guangxi across four dimensions： gender， age， educational attainment， and employment status （all P values＜0.01）. The primary offense types were the crime of providing shelter for others to use drugs and drug trafficking offenses. The majority of cases involved joint offenses committed by multiple perpetrators， with e-cigarettes and related products as the main drug delivery vehicles. Forensic toxicological testing confirmed concurrent polydrug use of etomidate and ketamine among the involved individuals. Prior criminal conviction status was statistically associated with the choice of offense type （Fisher's P = 0.006）. Offenders with prior convictions predominantly committed single-type offenses， while those without prior convictions accounted for a significantly higher proportion of multiple concurrent offenses relative to the former group. ConclusionAfter the scheduling of etomidate， the offender population in etomidate-related criminal cases in Guangxi is characterized by low educational attainment， low employment rate， and high prevalence of prior criminal convictions. The offenses exhibited covert modus operandi， group-based offending patterns， and a growing trend of polydrug use. We recommend strengthening the monitoring of high-risk populations and upgrading the technical system of forensic toxicological testing to address the challenges posed by emerging illicit drugs.

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 evaluate the efficacy of dexmedetomidine-scalp nerve block (SNB) combined with general anesthesia in the patients with acute traumatic brain injury (TBI) undergoing craniotomy.Methods:In this randomized controlled trial, 74 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex with acute TBI, aged 30-78 yr, with body mass index of 18-30 kg/m 2, underwent craniotomy for hematoma evacuation combined with decompressive craniectomy at the Traditional Chinese Medicine Hospital of Kunshan from January to December 2024, of the Glasgow Coma Scale score 8-12, were selected and divided into 2 groups ( n=37 each) using a random number table method: dexmedetomidine combined with ultrasound-guided SNB group (DS group) and ultrasound-guided SNB group (S group). Before anesthesia, dexmedetomidine was infused as a loading dose of 1 μg/kg over 10 min followed by an infusion of 0.3 μg·kg -1·h -1 until the end of operation. Ultrasound-guided SNB was performed after completion of intubation in both groups. The consumption of intraoperative fentanyl, propofol and remifentanil and the usage of vasoactive drugs were recorded. Before surgery (T 0), at 1 h after the start of surgery (T 1) and at the end of surgery (T 2), blood samples from the jugular bulbar and radial artery were collected, the jugular venous oxygen saturation was recorded, the arteriovenous oxygen content and cerebral oxygen uptake rate were calculated, and the occurrence of postoperative complications was also recorded. Results:Compared with group S, the consumption of fentanyl, propofol and remifentanil was significantly reduced, the usage rate of vasoactive drugs was decreased, the arteriovenous oxygen content and cerebral oxygen uptake rate were decreased at T 1 and T 2, the jugular venous oxygen saturation was increased, and the incidence of postoperative agitation was decreased in group DS ( P<0.05). Conclusions:Dexmedetomidine-SNB combined with general anesthesia can optimize the analgesic effect, improve cerebral oxygen supply and demand, reduce the occurrence of postoperative agitation when used in patients with acute TBI undergoing craniotomy.

Objective:To investigate the effect of ultrasound-guided scalp nerve block (SNB) combined with dexmedetomidine on cerebral blood flow after craniotomy in patients with acute traumatic brain injury (TBI).Methods:A randomized controlled design was conducted. Patients aged 25-65 years, with ASA physical status I–III and Glasgow Coma Scale scores of 9-12, who underwent craniotomy for acute TBI at Kunshan Traditional Chinese Medicine Hospital between January 2024 and February 2025 were selected. Patients with unstable vital signs, cranial tumors, cardiovascular diseases, local anesthetic allergies, or infections at the puncture site were excluded. Using a random number table, patients were divided into two groups: the ultrasound-guided SNB combined with dexmedetomidine group (SD group) and the dexmedetomidine-alone group (D group). General clinical data, peak systolic velocity (PSV), mean blood flow velocity (MBFV), intracranial pressure (ICP), S100 calcium-binding protein beta (S-100β protein), neuron-specific enolase (NSE) levels, and postoperative complications were compared. Dynamic changes in PSV and MBFV were analyzed using repeated measures analysis of variance, while inter-group comparisons used independent sample t-tests. Results:A total of 79 patients were included, with 40 in the SD group and 39 in the D group. There were no significant differences in general clinical data between the two groups (all P>0.05). In the D group, PSV and MBFV at T 1 and T 2 were significantly higher than at T0 [(125.04±20.43) cm/s vs. (126.83±21.76) cm/s vs. (110.63±18.49) cm/s, P=0.001; (61.75±8.34) cm/s vs. (62.81±8.54) cm/s vs. (57.82±6.93) cm/s, P=0.017], whereas no significant differences were observed in the SD group (all P>0.05). PSV, MBFV, ICP, S-100β protein, and NSE levels at T1 and T2 in the SD group were lower than those in the D group (all P<0.05). The incidence of postoperative hypertension, agitation, and the use rate of vasoactive drugs were also lower in the SD group compared to the D group (all P<0.05). Conclusion:The application of ultrasound-guided SNB combined with dexmedetomidine in TBI patients after craniotomy can help stabilize cerebral blood flow and ICP, mitigate neuronal injury, and reduce the incidence of postoperative complications.

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 evaluate the efficacy of dexmedetomidine-scalp nerve block (SNB) combined with general anesthesia in the patients with acute traumatic brain injury (TBI) undergoing craniotomy.Methods:In this randomized controlled trial, 74 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex with acute TBI, aged 30-78 yr, with body mass index of 18-30 kg/m 2, underwent craniotomy for hematoma evacuation combined with decompressive craniectomy at the Traditional Chinese Medicine Hospital of Kunshan from January to December 2024, of the Glasgow Coma Scale score 8-12, were selected and divided into 2 groups ( n=37 each) using a random number table method: dexmedetomidine combined with ultrasound-guided SNB group (DS group) and ultrasound-guided SNB group (S group). Before anesthesia, dexmedetomidine was infused as a loading dose of 1 μg/kg over 10 min followed by an infusion of 0.3 μg·kg -1·h -1 until the end of operation. Ultrasound-guided SNB was performed after completion of intubation in both groups. The consumption of intraoperative fentanyl, propofol and remifentanil and the usage of vasoactive drugs were recorded. Before surgery (T 0), at 1 h after the start of surgery (T 1) and at the end of surgery (T 2), blood samples from the jugular bulbar and radial artery were collected, the jugular venous oxygen saturation was recorded, the arteriovenous oxygen content and cerebral oxygen uptake rate were calculated, and the occurrence of postoperative complications was also recorded. Results:Compared with group S, the consumption of fentanyl, propofol and remifentanil was significantly reduced, the usage rate of vasoactive drugs was decreased, the arteriovenous oxygen content and cerebral oxygen uptake rate were decreased at T 1 and T 2, the jugular venous oxygen saturation was increased, and the incidence of postoperative agitation was decreased in group DS ( P<0.05). Conclusions:Dexmedetomidine-SNB combined with general anesthesia can optimize the analgesic effect, improve cerebral oxygen supply and demand, reduce the occurrence of postoperative agitation when used in patients with acute TBI undergoing craniotomy.

Objective To determine the levels of arsenic in food in Chongqing city,and to assess the levels of dietary arsenic exposure and the associated potential health risks in residents of Chongqing city.Methods By using the monitoring data on arsenic levels in food in Chongqing between 2018 and 2023 in combination with the local dietary survey data for Chongqing from the 2018 China Nutrition and Health Survey Program,and adopting the 2-dimensional Monte Carlo simulation,we made an estimate of the dietary arsenic exposure levels of Chongqing residents.The margin of exposure(MOE)method was applied to assess both non-carcinogenic risks(skin damage)and carcinogenic risks(lung cancer and urinary system cancers)associated with dietary intake of arsenic.Results Out of 4900 food samples,the detection rate of arsenic was 36.40％,with the average levels ranging from the median bound(MB)of 0.020 7 to the upper bound(UB)of 0.023 4 mg/kg.The highest average levels were found in rice and its products,with an MB of 0.0981 and a UB of 0.098 5 mg/kg.The daily average exposure to inorganic arsenic for residents of different ages,sexes,and places of residence was highest in individuals aged 3 to 6,with an MB of 1.046 μg/(kg·d)and a UB of 1.116 μg/(kg·d),and lowest among individuals aged 60 and older.Arsenic exposure was higher in males than that in females and higher in people living in rural areas compared to those in urban areas.In terms of non-carcinogenic risks,the MOE values for inorganic arsenic were always higher than 1 in various populations.As for carcinogenic risks,the MOE values were all less than 100 in various populations.Rice and its products were the main source of dietary arsenic exposure in Chongqing,accounting for 69.97％to 74.37％of the total exposure.Conclusion The non-carcinogenic risk caused by dietary arsenic exposure in Chongqing is relatively low,but there may be a certain level of carcinogenic risk.Continued attentions should be given to dietary arsenic exposure levels in young children.

Objective To examine the value of bronchoscopy in the diagnosis of sputum-negative pulmonary tuberculosis in a general hospital.Methods A retrospective study was conducted for the 459 patients treated in a general hospital from June 2010 to May 2015.All the patients had symptoms and radiographic changes suggestive of pulmonary tuberculosis but smearnegative.All patients were subjected to bronchoscopy,including brushing,bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB).The bronchoscopic specimens were submitted for direct smear and acid-fast stain,Mycobacterium tuberculosis culture or histopathological assay,respectively.Results The diagnosis was confirmed by bronchoscopy in 378 (82.4％) of the 459 patients.Of the 378 patients whose diagnosis was confirmed,pulmonary tuberculosis was identified in 238 patients (63.0％).Other diagnoses included bronchogenic carcinoma,non-specific inflammation,organizing pneumonia,pulmonary fungal infection,interstitial pneumonia,sarcoidosis,nontuberculous mycobacterial infection.Of the patients with confirmed diagnosis by bronchoscopy,the sensitivity for diagnosis was 57.95％ by direct smear and acid-fast stain of brushing or BALF,79.78％ by culture of BALF,and 56.93％ by histopathological assay of TBB specimens.The integrated method by combining smear and stain,culture and histopathological assay of TBB specimens could improve the sensitivity,specificity,positive predictive value,and negative predictive value to 91.01％,97.46％,97.98％ and 88.89％.Conclusions For the patients whose clinical manifestations and imaging changes are suggestive of pulmonary tuberculosis but smear-negative,bronchoscopy is a valuable method for the diagnosis,which should be adopted as a routine test in clinical practice.

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR₁, 72 cases in CR₂) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34⁺ cell number and transfused CD3⁺ cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR₂ compared to that in CR₁ (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR₁ and CR₂ patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

Objective: To investigate the effect of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) pre-conditioning on prognosis of acute myeloid leukemia in first complete remission (CR₁-AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) , and to explore the value of MRD monitoring by MFC in the prognosis evaluation on allo-HSCT in CR₁-AML. Methods: Between April 2012 and March 2015, consecutive 186 patients with CR₁-AML who underwent allo-HSCT were analyzed retrospectively. MRD in BM before conditioning was detected by eight-color MFC. Any level of residual disease was considered to be MRD positive. Results: ①Of 186 patients, MRD was negative in 151 patients, positive in 35 patients (<1% in 25 patients and 1% to 3% in 10 patients) . ② With the median follow up of 18 (5-41) months, two-year DFS was 80.0% (95%CI 68.5%-92.3%) . Univariate analysis showed that MRD positive patients had lower DFS[62.9% (95%CI 50.6%-75.2%) vs 88.9% (95%CI 76.6%-100.0%) , P<0.001], higher relapse[11.4% (95%CI 4.1%-29.0%) vs 3.3% (95% CI 0.6%-20.9%) , P=0.003] and higher NRM [25.7% (95% CI 8.1%-43.3%) vs 7.9% (95% CI 1.3%-26.5%) , P=0.001] after HSCT compared with that of MRD negative patients. Secondary AML showed lower DFS than primary AML [60.0% (95% CI 42.4%-76.6%) vs 86.0% (95% CI 68.4%-100.0%) , P=0.004]. ③Multivariate analysis indicated that MRD positive pre-HSCT was the independent risk factor on DFS [HR=4.565 (95%CI 2.918-9.482) , P<0.001], relapse [HR=5.854 (95%CI 1.538-22.288) , P=0.010] and NRM [HR=3.379 (95%CI 1.361-8.391) , P=0.009] after allo-HSCT in CR₁-AML. Conclusion MRD positive pre-conditioning was the only negative impact factor for patients with CR₁-AML after allo-HSCT. MRD by MFC can be used to assess the prognosis of CR₁-AML after allo-HSCT.