Poly(lactic-co-glycolide)(PLGA)is a key excipient in long-acting sustained-release preparations,and its degradation properties directly affect the drug release behavior.In this study,PLGA microspheres were prepared by microfluidic techniques,and the morphology changes of the microspheres were observed by scanning electron microscopy(SEM).In alkaline environment,due to the accelerated hydrolysis of ester bonds,the surface of the microspheres was rapidly dissolved and eroded,and the degradation rate was significantly higher than that in acidic environment.High temperature accelerated the degradation of PLGA microspheres.Under neutral and alkaline conditions,the microspheres showed aggregation and adhesion.Under acidic conditions,the microspheres gradually decomposed into irregular fragments.The high ionic strength further promoted the surface corrosion of the microspheres,especially under extreme pH conditions.Simultaneously,PLGA microspheres encapsulating coumarin were prepared to simulate the microsphere formulation.The release rate of coumarin after degradation of the microspheres under different conditions was observed by measuring the absorbance with ultraviolet-visible spectrophotometry.The results were consistent with those of the blank microspheres.This study revealed that the degradation of PLGA microspheres was significantly pH-dependent,temperature sensitive and ion strength responsive.These findings not only helped to understand and optimize the long-term stability and controlled release performance of drug-carrying microspheres,but also provided a theoretical basis for further improvement of PLGA-based drug carrier design.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

In recent years,the incidence and mortality of heatstroke have been increasing annually alongside global warming,with a marked rise in cases exhibiting atypical symptoms.To address the increasingly complex challenges in heatstroke prevention and treatment,Heatstroke Prevention and Treatment Research Center of Chinese PLA,Expert Group of Heatstroke Prevention and Treatment of Chinese PLA,and Chinese PLA Professional Committee of Critical Care Medicine have jointly developed this guideline(2025 edition).Utilizing the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system,Appraisal of Guidelines for Research and Evaluation(AGREE)criteria,and Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards,and based on the 2015 draft"Expert Consensus on the Standardized Diagnosis and Treatment of Heatstroke"and the 2019"Chinese Expert Consensus on the Diagnosis and Treatment of Heatstroke",this guideline has been crafted.This guideline provides 25 evidence-based recommendations to guide the prevention,treatment and research of heatstroke,which thoroughly covers 8 critical domains:clinical classification,pathophysiological mechanisms,clinical manifestations,diagnostic criteria,differential diagnosis,treatment protocols,rehabilitation and return to work,and prevention.

Objective To explore influencing factors of subsequent fracture among elderly osteoporotic patients and provide a basis for improving the management and early intervention after osteoporotic fracture.Methods A total of 14 349 elderly patients with osteoporotic fracture in 594 hospitals across 31 provinces(autonomous regions and municipalities)were selected by convenience sampling method from September to December 2023.A general information questionnaire and a clinical characteristics of fracture questionnaire were used.The univariate analysis and logistic regression were used to clarify the influencing factors and gender differences.Results A total of 11364 valid questionnaires were collected,with a valid questionnaire recovery rate of 79.20％.Gender,age,occupation,education,marital status,family history of osteoporosis,comorbid osteoarthropathies/rheumatism/ophthalmopathies,bone mineral density,risk of fall,risk of fracture grade,reasons and site for first fracture,whether to use walking aid and receive home rehabilitation guidance were associated with the occurrence of subsequent fracture.Gender comparisons found that widowhood,family history of osteoporosis,comorbid rheumatism,vertebral fracture,alcohol consumption,fall or no causative factor triggering the fracture,and educational level,home rehabilitation instruction were associated with the risk of subsequent fracture only in women(P＜0.05).Smoking was associated with the risk of subsequent fracture only in men(P＜0.05).Conclusion Osteoporotic subsequent fracture in the elderly is affected by multidimensional factors,with significant gender differences.The surveillance of key populations should be strengthened in prevention,control and intervention.

In recent years,the incidence and mortality of heatstroke have been increasing annually alongside global warming,with a marked rise in cases exhibiting atypical symptoms.To address the increasingly complex challenges in heatstroke prevention and treatment,Heatstroke Prevention and Treatment Research Center of Chinese PLA,Expert Group of Heatstroke Prevention and Treatment of Chinese PLA,and Chinese PLA Professional Committee of Critical Care Medicine have jointly developed this guideline(2025 edition).Utilizing the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system,Appraisal of Guidelines for Research and Evaluation(AGREE)criteria,and Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards,and based on the 2015 draft"Expert Consensus on the Standardized Diagnosis and Treatment of Heatstroke"and the 2019"Chinese Expert Consensus on the Diagnosis and Treatment of Heatstroke",this guideline has been crafted.This guideline provides 25 evidence-based recommendations to guide the prevention,treatment and research of heatstroke,which thoroughly covers 8 critical domains:clinical classification,pathophysiological mechanisms,clinical manifestations,diagnostic criteria,differential diagnosis,treatment protocols,rehabilitation and return to work,and prevention.

Objective:To systematically evaluate the current status and methodological quality of guideline and consensus in ovarian stimulation for in vitro fertilization (IVF), and to provide reference for the development of future guidelines and research. Methods:A systematic search was conducted in databases including PubMed, Embase, CNKI, Wanfang, Sinomed and relevant guideline websites from inceptions to October 2024. Data were extracted from the literature that met the inclusion criteria, and methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) tool. Descriptive analysis was performed with results presented in visual data charts.Results:A total of 23 studies were included, with 8 guidelines and 15 consensus. Totally 21 (91.3%) studies focused on the selection of ovarian stimulation protocols, with the majority concentrating on protocols for patients undergoing IVF treatment for the first cycle, and 12 (52.2%) studies focused on the selection of gonadotropin starting dosage. In terms of methodology, the average standardized scores in the 6 assessment domains of the AGREE Ⅱ tool were as follows: scope and purpose (85.1%), stakeholder involvement (66.6%), rigour of development (36.5%), clarity of presentation (70.1%), applicability (36.4%), and editorial independence (46.2%).Conclusion:Current recommendations in ovarian stimulation for IVF exhibit inconsistencies, and the methodological quality varies, which partially hinders the translation of evidence into clinical practice. Future research should further focus on the selection of ovarian stimulation protocols and gonadotropin starting dosage, promoting the update and refinement of guidelines and consensus to guide the precise treatment of ovarian stimulation.

Background and Aims:Sleeve gastrectomy(SG)has become the most widely performed bariatric procedure worldwide,but postoperative gastroesophageal reflux disease(GERD)remains a major concern.This multicenter study aimed to identify independent risk factors associated with GERD after SG to guide preoperative assessment and intraoperative management.Methods:Clinical data of 672 patients who underwent SG between January 2020 and December 2022 in six bariatric centers and completed a 12-month follow-up were retrospectively analyzed.Demographic characteristics,esophagogastric junction(EGJ)integrity graded by the AFS system,operative parameters,and postoperative outcomes were compared between patients with and without GERD.Multivariate logistic regression was used to identify predictors of postoperative GERD.Results:The overall incidence of GERD after SG was 24.7%(166/672).Multivariate analysis revealed that a preoperative BMI>35 kg/m2(OR=1.68,P=0.033),EGJ integrity AFS grade>2(OR=2.90,P=0.006),and preoperative reflux symptoms(OR=2.44,P=0.030)were independent risk factors for GERD.A staple line more than 1 cm from the angle of His(OR=0.45,P<0.001)and a bougie size>36 Fr(OR=0.08,P=0.001)were protective factors.Conclusion:High BMI,impaired EGJ integrity,and preoperative reflux symptoms significantly increase the risk of GERD after SG,whereas adequate preservation of the His angle and appropriate bougie calibration may reduce it.Comprehensive preoperative EGJ assessment and standardized surgical techniques are essential for minimizing postoperative reflux.

Objective:To evaluate the short-term safety and efficacy of total laparoscopic, laparoscopy-assisted, and open total gastrectomy in patients with gastric cancer who have undergone neoadjuvant therapy.Methods:In this retrospective cohort study, relevant clinical data on 243 patients who had undergone radical total gastrectomy after receiving neoadjuvant therapy were collected. These patients had been admitted to the First Affiliated Hospital of Air Force Medical University, Yuncheng Central Hospital of Shanxi Province, and Heji Hospital Affiliated to Changzhi Medical College between January 2020 and April 2024. Among them, 202 were male (83.1%) and 41 were female (16.9%), and their average age was 61.3±8.1 years. The patients were allocated to three groups according to surgical procedure: total laparoscopic (68 cases), laparoscopic- assisted (79 cases), and open surgery (96 cases). We compared relevant baseline characteristics, neoadjuvant treatment, intraoperative and postoperative conditions, postoperative histopathological findings, and related complications between these three groups.Results:There were no statistically significant differences in baseline characteristics or neoadjuvant treatment between the three groups (all P>0.05). The operative time was longer in the total laparoscopic group than in the laparoscopic-assisted and open surgery groups (267.7±37.9 minutes vs. 243.9±38.3 minutes vs. 219.7±41.2 minutes, respectively; F=7,112.278; P<0.001). However, more lymph nodes were harvested in the total laparoscopic group than in the laparoscopic-assisted and open surgery groups (27.8±4.8 vs. 27.4±6.3 vs. 27.2±5.1, respectively; F=6.042; P=0.002). Additionally, the total laparoscopic group had shorter times to first postoperative flatus (2.3±0.7 days vs. 2.4±0.7 days vs. 2.6±0.6 days, respectively; F=5.094; P=0.006] and first postoperative bowel movement (2.9±0.5 days vs. 3.0±0.6 days vs. 3.0±0.6 days, respectively; F=3.929; P=0.020). There were no statistically significant differences in intraoperative blood loss, intraoperative transfusion rates, postoperative intensive care unit admission rates, maximum tumor diameter, number of positive lymph nodes dissected, TNM stage, time to first postoperative oral intake, time to drain removal, or length of hospital stay between the three groups (all P>0.05). Among the 243 patients, 22 developed postoperative complications, making the overall complication rate 9.1%. Six patients (8.8%) in the total laparoscopic group developed complications, comprising two (2.9%) Grade IIIa Clavien-Dindo complications. One of these patients (1.5%) was readmitted within 30 days due to complications. Seven patients (8.9%) in the laparoscopic-assisted group developed complications, comprising two (2.5%) Grade IIIa Clavien-Dindo complications. One of these patients was readmitted within 30 days and another was within 90 days due to complications. Nine patients (9.4%) in the open surgery group developed complications, comprising four (4.2%) Grade IIIa Clavien-Dindo complications. Two patients (2.1%) were readmitted within 30 days and another (1.0%) within 90 days due to complications. There were no statistically significant differences among the three surgical approaches in overall postoperative complication rates, Clavien-Dindo grades, or readmission rates 30 and 90 days postoperatively (all P>0.05). Conclusions:In patients with gastric cancer who have undergone neoadjuvant therapy, there are no significant differences in the overall safety and short-term effectiveness of the three surgical procedures. Although the operative time is longer for total laparoscopic total gastrectomy, this procedure offers the advantages of faster postoperative recovery and earlier resumption of feeding.

To establish a TaqMan-based multiplex RT-qPCR method for the identification of Japa-nese encephalitis virus(JEV),Porcine reproductive and respiratory syndrome virus(PRRSV),and Classical swine fever virus(CSFV),this study designed and synthesized three pairs of specific primers and probes based on the conserved sequences of JEV E,PRRSV ORF6,and CSFV E2 a-vailable in the NCBI GenBank.By optimizing the reaction system and protocol,a multiplex RT-qPCR method for detecting these three viruses was developed and applied to the detection of clini-cal samples.The results showed that the established TaqMan multiplex RT-qPCR specifically am-plified the gene fragments of JEV,PRRSV,and CSFV,and did not amplify other non-target genes,indicating good specificity of the method.Intra-assay and inter-assay repeatability tests showed that the coefficient of variation(Cv)values were all below 3％,demonstrating that the method has ex-cellent repeatability.Sensitivity tests revealed that the minimum detectable amount for the recom-binant plasmids of the three viruses was 100 copies/pL.Using the established method,a total of 969 samples,including blood,aborted fetuses,semen,and deceased pigs,from 26 pig farms in Guizhou Province were tested.The detection rates were 34.3％(332/969)for JEV,28.3％(274/969)for PRRSV,and 19.8％(192/969)for CSFV.The co-infection rates were 10.1％(98/969)for JEV and PRRSV,12.1％(117/969)for JEV and CSFV,and 14.6％(141/969)for CSFV and PRRSV.Additionally,the triple co-infection rate of JEV,PRRSV,and CSFV was 7.9％(77/969).These results indicate that the TaqMan multiplex RT-qPCR method developed in this study is ef-fective for detecting these three viruses in pig farms,providing technical support for identifying vi-ral causes of reproductive disorders.