ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Next generation sequencing (NGS) technology is playing an increasingly important role in the diagnosis of genetic diseases. Whole exome sequencing (WES), which targets the coding regions of the genome, has been widely used in the diagnosis of genetic diseases for its low cost and high efficiency. However, compared to conventional methods, the Next Generation Sequencing (NGS) process is intricate, and there is variability in the expertise of data analysts and variant interpreters, which may lead to inconsistencies in the outcomes. To ensure the quality of testing and enhance the diagnostic rate of diseases, this consensus has provided recommendations regarding the laboratory setup, operational procedures, data analysis, result interpretation, and quality control for WES, with an aim to standardize its application in the detection of genetic disorders.

Objective:To investigate the risk factors and their predictive efficacy for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 216 pediatric patients with distal tibial epiphyseal fractures admitted to Zhengzhou Orthopedics Hospital from January 2018 to December 2023, including 136 males and 80 females, aged 2-16 years [11.8(9.8, 13.3)years]. Among them, 112 patients were affected on the left side and 104 on the right. According to the Salter-Harris fracture classification, the fracture was classified as type I in 14 patients, type II in 97, type III in 38, type IV in 64 and type VI in 3. According to the presence of premature epiphyseal closure after surgery, the patients were divided into premature epiphyseal closure group ( n=38) and normal epiphyseal group ( n=178). Age, gender, body mass index (BMI), injury mechanism, side of injury, Salter-Harris classification of fracture, initial displacement distance of the fracture end, medial malleolar involvement by the fracture line surgical fixation method, operation duration, reduction method, and reduction quality were recorded in the two groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for postoperative premature physeal closure in pediatric patients with distal tibial epiphyseal fracture. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of premature physeal closure in pediatric patients with distal tibial epiphyseal fractures. Results:Univariate analysis showed the occurrence of postoperative premature epiphyseal closure of the distal tibia was associated with age, Salter-Harris fracture classification, medial malleolar involvement by the fracture line, surgical fixation method, reduction method, and reduction quality ( P<0.05), while it was not correlated with gender, BMI, injury mechanism, side of injury, initial displacement distance of the fracture end, and operation duration ( P>0.05). Multivariate binary Logistic regression analysis showed that medial malleolar involvement by the fracture line ( OR=0.18, 95% CI 0.04, 0.76, P<0.05) and reduction quality ( OR=43.18,95% CI 10.71, 174.05, P<0.01) were significantly correlated with the occurrence of postoperative premature epiphyseal closure of the distal tibia. The results of ROC curve analysis showed that medial malleolar involvement by the fracture line had limited predictive efficiency (AUC=0.53, 95% CI 0.43, 0.63), reduction quality had moderate predictive efficacy (AUC=0.81, 95% CI 0.72, 0.91), while their combination demonstrated even higher predictive efficacy (AUC=0.83, 95% CI 0.74, 0.91). Conclusions:Medial malleolar involvement by the fracture line and reduction quality are independent risk factors for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures. Reduction quality demonstrates good predictive efficacy, while medial malleolar involvement by the fracture line shows limited predictive value. The combination of both factors achieves even better predictive performance.

Objective:To address the critical issue of missing dynamic border molding information in edentulous direct digital impression technology, this study explores innovative digital solutions and conducts preliminary application validation.Methods:Based on the myostatic line theory, a methodology was established: intraoral scanner (IOS) high-frequency video was utilized to dynamically capture functional molding data of soft tissues, integrated with a self-developed mobility gradient recognition algorithm to achieve dynamic threshold segmentation between the muscle dynamic zone and myostatic zone, termed "optical digital molding technology". Ten edentulous patients with well-fitting complete dentures, treated at the Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2024 to December 2024, were enrolled. The standard deviation between the muscle static line (generated by mobility gradient algorithm with thresholds of 0.3-0.7 mm) and the denture border curve was analyzed to optimize the dynamic threshold, followed by single-case clinical validation.Results:Among the mobility thresholds of 0.3-0.7 mm, the 0.5 mm threshold yielded the smallest standard deviation between the myostatic line and denture border. Clinical validation demonstrated that dentures designed with this threshold exhibited no displacement during dynamic functional tests, with marginal sealing meeting clinical standards.Conclusions:The optical digital border molding technique for edentulous soft tissue boundaries translates the myostatic line theory into quantifiable parameters for the first time. Based on data from 10 cases, a mobility threshold of 0.5 mm is recommended for clinical application.

Objective:To investigate the imaging characteristics of clear cell acanthoma (CCA) by dermoscopy and reflectance confocal microscopy (RCM) .Methods:A retrospective analysis was conducted on 12 patients diagnosed with CCA through histopathological examination at the Department of Dermatology, Wuhan No.1 Hospital, from 2020 to 2024. Dermoscopic and RCM features of these cases were summarized.Results:Among the 12 CCA patients, 3 were males and 9 were females, and they were aged 50.08 ± 10.43 years. Clinically, CCA lesions were typically presented as red or brown papules or nodules with well-defined borders, ranging in diameter from 3 mm to 2 cm. Histopathological examination showed that the tumor manifested as psoriasiform or papillary hyperplasia with a thickened spinous layer and a distinct boundary surrounded by the normal skin; proliferating cells were larger with lightly stained cytoplasm; neutrophil infiltration was observed in the epidermis, and vascular dilation was observed in the dermal papillae and superficial dermis; periodic acid-Schiff staining revealed abundant glycogen in the cells. In 10 patients examined by dermoscopy, dotted, globular, or glomerular vessels were arranged in a beaded pattern in all the 10 patients, and collar-like scales were seen at the edges of the lesions in 6 patients. In 6 patients examined by RCM, RCM images all revealed epidermal hyperplasia, thickened spinous layers, large keratinocytes with enlarged nuclei and abundant cytoplasm that blended in with the intercellular demarcations, disordered honeycomb structure of the epidermis, and dilation and up-thrust of blood vessels in the dermal papillae and superficial dermis; segmented cell infiltration was observed in the epidermis of 4 patients. As measured, the longest diameters of cells in the upper part of the CCA spinous layer ranged from 30.25 μm to 35.13 μm; the longest diameters of spinous layer cells at the CCA follicles (19.39 ± 2.93 μm) were significantly lower than those of the surrounding spinous layer cells (30.95 ± 5.66 μm, t = 5.73, P < 0.001) . Conclusions:CCA presents a distinctive vascular pattern on dermoscopy, and the majority of histological features can be visualized by RCM. Dermoscopy and RCM can be relatively reliable auxiliary diagnostic methods for CCA.

Objective:To investigate the efficacy of hybrid fixation with tibial prosthesis in primary total knee arthroplasty (TKA) in patients with osteoporosis or osteopenia.Methods:A total of 39 patients (42 knees) with knee osteoarthritis who underwent primary TKA with hybrid fixation with tibial prosthesis in the First Affiliated Hospital of Zhejiang University from November 2022 to June 2024 were retrospectively analyzed. There were 12 males and 27 females with an average age of 68.23±7.02 years (range, 58-89 years). The mean body mass index was 26.15±4.63 kg/m 2 (range, 19.48-39.03 kg/m 2), and the mean bone mineral density T score was -2.38±0.78 (from -4.2 to -1.2). The left knee was 19, and the right knee was 23. The visual analogue scale (VAS) and Knee Society score (KSS) were used to evaluate the knee joint pain and function, and the knee flexion range of motion was measured. Radiographic evaluation included hip-knee-ankle angle, lateral distal femoral angle, and posterior slope of tibial plateau. Results:All patients successfully completed the operation and were followed up for 19.8±5.1 months (range, 4.9-23.6 months). All patients were treated with hybrid fixation with tibial prosthesis assisted by 3D printed porous titanium alloy sleeve. The operation time was 73.8±10.8 min (range, 54-98 min). Thirty-four of 39 patients received standard anti-osteoporosis therapy before operation. The VAS score at the last follow-up was 0(0, 1), which was lower than that before operation 7(6,8), and the difference was statistically significant ( U<0.001, Ρ<0.001). The KSS clinical score at the last follow-up was 76.67±10.04, which was higher than that before operation (50.95±7.35), and the difference was statistically significant ( t=12.030, Ρ<0.001). The knee flexion range of motion at last follow-up was 97.26°±12.94°, showing no significant difference when compared with preoperative 94.52°±16.52° ( t=0.846, Ρ=0.400). The hip-knee-ankle angle at last follow-up was 176.2°±2.54°, which was significantly higher than that before operation 173.5°±5.25° ( t=3.328, Ρ=0.002). The distal lateral femoral and posterior tibial inclination angles at the final follow-up were 89.58°±1.62° and 2.85°±0.91°, respectively, compared with 90.71°±4.01° and 3.05°±1.25° preoperatively, with no statistically significant differences ( t=1.556, Ρ=0.127; t=0.923, Ρ=0.359). No prosthesis loosening, dislocation, periprosthetic infection, deep vein thrombosis and other complications occurred. Conclusion:Hybrid fixation with tibial prosthesis in primary TKA for patients with osteoporosis or osteopenia has a satisfactory clinical effect, which can relieve knee pain and improve joint function.

Genetic factors are often involved in the pathogenesis of young adult stroke, and its subtype, atherosclerotic type of large arteries, may be caused by a combination of genetic and environmental factors, but little is known about its underlying pathogenesis. To provide clues for better understanding of identifying relevant stroke etiological genetic factors and adopting effective preventive strategies, the role of genetic factors in atherosclerosis and related risk factors was described, and the possible genetic mechanisms of large-artery atherosclerotic stroke in young people were explored, which may be further investigated in future research in the following areas: etiological typing of stroke in young people and the related genetic mechanisms; modifiable vascular risk factors and the development of secondary prevention strategies; high-resolution vascular imaging magnetic resonance imaging in the etiological typing of stroke in young people and the pathogenesis of premature atherosclerosis and vulnerable plaques.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.