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.

BACKGROUND:Micro-robots have the characteristics of small size,flexibility,and strong targeting,and can complete complex tasks in a single or clustered manner in a narrow environment.With the continuous optimization of materials,preparation processes,and driving approaches,they have shown increasingly important application value in the field of biomedicine. OBJECTIVE:To analyze the application of field-driven micro-robots in medical field and to look forward to their application prospect. METHODS:Using"microrobots,nanorobots,drivers,biomedical,medical"as Chinese keywords and"microrobots,micro-robots,nanorobots,micromachine,microswimmer,medical"as English keywords,WanFang Data and PubMed databases were searched,respectively.The search time range was from January 2010 to January 2024,and a small number of long-term articles were included.Through reading the titles and preliminarily screening the abstracts,the repetitive studies,low-quality journals,and irrelevant literature were excluded.After reading the entire text,66 papers were finally included for review. RESULTS AND CONCLUSION:Field-driven medical micro-robots mainly include magnetic,optical,thermal,ultrasonic,and multi-mixed factor-driven robots.Field-driven robots have been used in intestinal diagnosis,drug targeting therapy,and stem cell therapy.Medical micro-robots are currently only used in a small number of clinical applications,but most of which are still in the theoretical and experimental stages.Medical micro-robots will face many challenges in future,such as large-scale preparation,precise control of micro-robots,recycling or degradation in vivo,whether the materials used will cause adverse reactions to the human body,and the related minimally invasive medical procedures.

Hepatic encephalopathy(HE)is a common complication of severe liver disease in the end stage,and it is urgently needed to improve the rate of effective treatment and clarify the pathogenesis of HE.The liver is a crucial hub for immune regulation,and disruption of immune homeostasis is a key factor in the pathological mechanisms of HE.As the main metabolites of intestinal flora,short-chain fatty acids(SCFAs)play a vital role in the biological processes of both innate and adaptive immunity and can regulate the proliferation and differentiation of immune cells maintain the homeostasis of intestinal microenvironment and the integrity of barrier function.Studies have shown that SCFAs participate in bidirectional and dynamic interactions with the liver-gut-brain axis through immunomodulatory pathways,thereby playing an important role in the diagnosis,treatment,and prognostic evaluation of HE.Starting from the immunoregulatory effect of SCFAs,this article summarizes and analyzes the crosstalk relationship between SCFAs and the liver-gut-brain axis and the significance of SCFAs in the diagnosis and treatment of HE,in order to provide new ideas for optimizing clinical prevention and treatment strategies.

Hepatic encephalopathy （HE） is a common complication of severe liver disease in the end stage， and it is urgently needed to improve the rate of effective treatment and clarify the pathogenesis of HE. The liver is a crucial hub for immune regulation， and disruption of immune homeostasis is a key factor in the pathological mechanisms of HE. As the main metabolites of intestinal flora， short-chain fatty acids （SCFAs） play a vital role in the biological processes of both innate and adaptive immunity and can regulate the proliferation and differentiation of immune cells maintain the homeostasis of intestinal microenvironment and the integrity of barrier function. Studies have shown that SCFAs participate in bidirectional and dynamic interactions with the liver-gut-brain axis through immunomodulatory pathways， thereby playing an important role in the diagnosis， treatment， and prognostic evaluation of HE. Starting from the immunoregulatory effect of SCFAs， this article summarizes and analyzes the crosstalk relationship between SCFAs and the liver-gut-brain axis and the significance of SCFAs in the diagnosis and treatment of HE， in order to provide new ideas for optimizing clinical prevention and treatment strategies.

In recent years, with the rapid advancement of digital technologies, the application of intelligent medicine in the field of endocrine and metabolic diseases has been continuously expanding. This review focuses on the latest progress in intelligent medicine within this domain, aiming to provide valuable insights and references for promoting the integration of intelligent medicine with the diagnosis and treatment of endocrine and metabolic diseases.

Objective:To compare the value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of American Society of Anesthesiologists Physical Status classification Ⅲ-Ⅳ patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective OPCABG, were retrospectively collected at Tianjin Chest Hospital from September 2021 to October 2023. Intraoperative hypotension was quantified using the methods such as the number of occurrence, average decrease in magnitude, duration, and the area under the threshold (mean arterial pressure <65 mmHg, 1 mmHg = 0.133 kPa). Patients were divided into AKI group and non-AKI group based on the occurrence of AKI within 7 days postoperatively. The extended logistic regression model was used to adjust for confounding factors, and the receiver operating characteristic curves were plotted to compare the accuracy of different methods for intraoperative hypotension in predicting postoperative AKI. Results:The results of multivariate logistic regression analysis showed that the frequency of hypotension ( OR=1.03, 95% confidence interval [ CI] 1.01-1.05, P=0.010), duration of hypotension ( OR=1.04, 95% CI 1.01-1.08, P=0.007), and area under the threshold ( OR=1.03, 95% CI 1.01-1.06, P=0.023) were risk factors for postoperative AKI. The areas under the curve for the quantification methods predicting the occurrence of postoperative AKI within 7 days, including the duration of hypotension, area under the threshold, frequency of hypotension, and mean decrease in blood pressure, were 0.751, 0.652, 0.647 and 0.513, respectively. Conclusions:The duration of hypotension, area under the threshold and frequency of hypotension are independent risk factors for postoperative AKI in patients undergoing OPCABG. The duration of hypotension has a higher accuracy in predicting the occurrence of postoperative AKI.

Hepatic encephalopathy is a neuropsychiatric syndrome secondary to severe liver disease.Recent studies have shown that the development of hepatic encephalopathy is closely associated with bile acid/short-chain fatty acid metabolic disorder.As the core theory of traditional Chinese medicine,the theory of Yin and Yang provides a unique perspective for analyzing the association between bile acids/short-chain fatty acids and hepatic encephalopathy.Bile acids function like Yang,governing the free flow of Qi and assisting in metabolic processes,while short-chain fatty acids belong to Yin,maintaining internal stability and conservation,preserving the intestinal barrier,and combating inflammation and toxins.Bile acids and short-chain fatty acids constrain each other and are interdependent to regulate the dynamic equilibrium of the gut-liver-brain axis.On this basis,by regulating the metabolic imbalance of bile acids and short-chain fatty acids,it is expected to restore the dynamic balance of Yin and Yang in patients with hepatic encephalopathy under the synergistic intervention of traditional Chinese medicine and Western medicine.

Hepatic encephalopathy is a neuropsychiatric syndrome secondary to severe liver disease.Recent studies have shown that the development of hepatic encephalopathy is closely associated with bile acid/short-chain fatty acid metabolic disorder.As the core theory of traditional Chinese medicine,the theory of Yin and Yang provides a unique perspective for analyzing the association between bile acids/short-chain fatty acids and hepatic encephalopathy.Bile acids function like Yang,governing the free flow of Qi and assisting in metabolic processes,while short-chain fatty acids belong to Yin,maintaining internal stability and conservation,preserving the intestinal barrier,and combating inflammation and toxins.Bile acids and short-chain fatty acids constrain each other and are interdependent to regulate the dynamic equilibrium of the gut-liver-brain axis.On this basis,by regulating the metabolic imbalance of bile acids and short-chain fatty acids,it is expected to restore the dynamic balance of Yin and Yang in patients with hepatic encephalopathy under the synergistic intervention of traditional Chinese medicine and Western medicine.

Objective:To compare the value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of American Society of Anesthesiologists Physical Status classification Ⅲ-Ⅳ patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective OPCABG, were retrospectively collected at Tianjin Chest Hospital from September 2021 to October 2023. Intraoperative hypotension was quantified using the methods such as the number of occurrence, average decrease in magnitude, duration, and the area under the threshold (mean arterial pressure <65 mmHg, 1 mmHg = 0.133 kPa). Patients were divided into AKI group and non-AKI group based on the occurrence of AKI within 7 days postoperatively. The extended logistic regression model was used to adjust for confounding factors, and the receiver operating characteristic curves were plotted to compare the accuracy of different methods for intraoperative hypotension in predicting postoperative AKI. Results:The results of multivariate logistic regression analysis showed that the frequency of hypotension ( OR=1.03, 95% confidence interval [ CI] 1.01-1.05, P=0.010), duration of hypotension ( OR=1.04, 95% CI 1.01-1.08, P=0.007), and area under the threshold ( OR=1.03, 95% CI 1.01-1.06, P=0.023) were risk factors for postoperative AKI. The areas under the curve for the quantification methods predicting the occurrence of postoperative AKI within 7 days, including the duration of hypotension, area under the threshold, frequency of hypotension, and mean decrease in blood pressure, were 0.751, 0.652, 0.647 and 0.513, respectively. Conclusions:The duration of hypotension, area under the threshold and frequency of hypotension are independent risk factors for postoperative AKI in patients undergoing OPCABG. The duration of hypotension has a higher accuracy in predicting the occurrence of postoperative AKI.

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.