Background Climate change poses a significant threat to public health. In China, relevant health intervention research is still in its early stages, and evidence for evaluating the effectiveness of regional climate change health adaptation strategies and measures is scarce. Objective To investigate the level of climate change-related health literacy among residents in Shenzhen, implement targeted health interventions, and assess the intervention effects as well as their influencing factors. Methods From July 2023 to January 2024, 4 communities were randomly selected in Shenzhen, and a total of 896 community residents were enrolled and divided into an intervention group (444 participants) and a control group (452 participants). Baseline and follow-up surveys on climate change-related health literacy were conducted among residents for both groups. During the period between the two surveys, the intervention group received targeted health interventions. Health literacy—comprising 3 dimensions: basic health knowledge and concepts, basic health skills, and healthy lifestyles—was defined as achieving ≥80% of the total score. A differences-in-differences model was adopted to analyze the impact of the intervention, and multiple linear regression was used to explore the factors influencing the intervention effect. Results The baseline survey showed that 240 out of the 896 surveyed residents (26.79%) possessed climate change health literacy. For the 3 dimensions, the number of residents and the proportions with corresponding literacy in descending order were: basic health skills (521, 58.15%), healthy lifestyles (345, 38.50%), and basic health knowledge and concepts (44, 4.91%). After the intervention, the intervention group showed a 3.19% increase in the total health literacy score, a 3.55% increase in basic health knowledge and concepts, and a 4.24% increase in basic health skills (t=2.79, 2.77, and 2.47 respectively) (P<0.05). No significant change was observed in healthy lifestyle scores (t=0.70, P>0.05). Further analysis showed that awareness of the “dual carbon goals” and occupation were significantly associated with the intervention effect on overall health literacy (P<0.05). For basic health knowledge and concepts, occupation, history of chronic diseases, and awareness of the “dual carbon goals” had statistically significant effects on the intervention outcomes (P<0.05). Regarding basic health skills, awareness of the “dual carbon goals” significantly influenced the intervention effect (P<0.001). In terms of healthy lifestyles, gender, educational level, occupation, and awareness of climate change were significantly associated with the intervention effect (P<0.05). Conclusion The climate change-related health literacy among community residents in Shenzhen is in urgent need of improvement. Health interventions can effectively enhance residents' basic health knowledge and concepts, basic health skills, and overall literacy level. In the future, it is necessary to strengthen the popularization of climate change health knowledge based on different population characteristics and further optimize intervention strategies, to comprehensively improve residents' health adaptation capacity to climate change.

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.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective To explore the clinical efficacy of modified anteromedia approach with superior extensor retinaculars and traditional anteromedia combined with posterolateral approach in the treatment of Rüedi-Allg?wer type Ⅲ Pilon fractures.Methods In this study selected 56 patients with Rüedi-Allg?wer type Ⅲ Pilon fractures treated in our hospital from January 2020 to January 2022,all of whom met the inclusion and exclusion criteria,27 in the experimental group and 29 in the control group.Both groups underwent open reduction and internal fixation of Pilon fractures.The experimental group used a modified anteromedial approach to preserve the supraspinatus,while the control group used a traditional anteromedial combined with posterolateral approach to cut off the supraspinatus.The general clinical data,operation time,intraoperative blood loss,postoperative drainage volume,fracture reduction quality,early pain VAS score,complications and ankle function evaluation of the experimental group and the control group were compared in detail,and the early clinical efficacy of the two surgical methods was analyzed and compared.Results There were no significant differences in age,gender,body mass index(BMI),complications,injury mechanism and the time from admission to operation between the experimental group and the control group(P>0.05).Experimental group:operation time(115.92±12.23)min,intraoperative blood loss(129.25±16.15)mL,postoperative drainage volume(82.44±25.57)mL,fracture healing time(17.89±2.39)w;Control group:operation time(172.75±15.09)min,intraoperative blood loss(177.24±14.36)mL,postoperative drainage volume(115.06±21.95)mL,fracture healing time(19.93±3.75)w.The operative time and fracture healing time of the experimental group were less than those of the control group(P<0.05),and the intraoperative blood loss and postoperative drainage volume of the experimental group were less than those of the control group,the difference was statistically significant(P<0.05).The Buewell-Charnley fracture reduction radio-logical evaluation criteria were used to evaluate the fracture reduction,and the rate of good reduction was 96.29%in the experimental group and 93.10%in the control group.There was no statistical significance in the anatomical reduction between the two groups(P>0.05).Visual analog scale(VAS)was used to evaluate postoperative pain,and pain VAS scores of the experimental group were lower than those of the control group at 3 days,1 week and 4 weeks after surgery(P<0.05).Both groups were followed up for at least 12 months after surgery,and the incidence of postoperative complications in the experimental group was lower than that in the control group(P<0.05).The AOFAS score of the experimental group was higher than that of the control group at 3 months,6 months and 12 months after surgery(P<0.05).Conclusion Improvement on the medial approach retains the superior extensor retinaculum,relative to the combined surgical approach to cut off the superior extensor retinacu-lum treatment Rüedi-Allg?wer Ⅲ Pilon fractures,with shorter operation time,less intraoperative blood loss,less postoperative complications and other advantages.The functional recovery of the ankle joint in the modified antero-medial approach preserving the superior extensor retinaculum was better than that in the combined approach cutting the superior extensor retinaculum.

Objective To explore the clinical efficacy of modified anteromedia approach with superior extensor retinaculars and traditional anteromedia combined with posterolateral approach in the treatment of Rüedi-Allg?wer type Ⅲ Pilon fractures.Methods In this study selected 56 patients with Rüedi-Allg?wer type Ⅲ Pilon fractures treated in our hospital from January 2020 to January 2022,all of whom met the inclusion and exclusion criteria,27 in the experimental group and 29 in the control group.Both groups underwent open reduction and internal fixation of Pilon fractures.The experimental group used a modified anteromedial approach to preserve the supraspinatus,while the control group used a traditional anteromedial combined with posterolateral approach to cut off the supraspinatus.The general clinical data,operation time,intraoperative blood loss,postoperative drainage volume,fracture reduction quality,early pain VAS score,complications and ankle function evaluation of the experimental group and the control group were compared in detail,and the early clinical efficacy of the two surgical methods was analyzed and compared.Results There were no significant differences in age,gender,body mass index(BMI),complications,injury mechanism and the time from admission to operation between the experimental group and the control group(P>0.05).Experimental group:operation time(115.92±12.23)min,intraoperative blood loss(129.25±16.15)mL,postoperative drainage volume(82.44±25.57)mL,fracture healing time(17.89±2.39)w;Control group:operation time(172.75±15.09)min,intraoperative blood loss(177.24±14.36)mL,postoperative drainage volume(115.06±21.95)mL,fracture healing time(19.93±3.75)w.The operative time and fracture healing time of the experimental group were less than those of the control group(P<0.05),and the intraoperative blood loss and postoperative drainage volume of the experimental group were less than those of the control group,the difference was statistically significant(P<0.05).The Buewell-Charnley fracture reduction radio-logical evaluation criteria were used to evaluate the fracture reduction,and the rate of good reduction was 96.29%in the experimental group and 93.10%in the control group.There was no statistical significance in the anatomical reduction between the two groups(P>0.05).Visual analog scale(VAS)was used to evaluate postoperative pain,and pain VAS scores of the experimental group were lower than those of the control group at 3 days,1 week and 4 weeks after surgery(P<0.05).Both groups were followed up for at least 12 months after surgery,and the incidence of postoperative complications in the experimental group was lower than that in the control group(P<0.05).The AOFAS score of the experimental group was higher than that of the control group at 3 months,6 months and 12 months after surgery(P<0.05).Conclusion Improvement on the medial approach retains the superior extensor retinaculum,relative to the combined surgical approach to cut off the superior extensor retinacu-lum treatment Rüedi-Allg?wer Ⅲ Pilon fractures,with shorter operation time,less intraoperative blood loss,less postoperative complications and other advantages.The functional recovery of the ankle joint in the modified antero-medial approach preserving the superior extensor retinaculum was better than that in the combined approach cutting the superior extensor retinaculum.

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.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective:To evaluate the clinical efficacy of Professor Ding Zhiguo's internal and external combined treatment of Hashimoto's disease, and to explore its mechanism.Methods:Prospective cohort study. A total of 85 patients of professor Ding Zhiguo from Sun Simmiao Hospital of Beijing University of Chinese Medicine and Dongzhimen Hospital of Beijing University of Chinese Medicine from August 2022 to March 2023 were selected and divided into control group (43 cases) and drug group (42 cases) by random number table method. Another 20 healthy volunteers were recruited for health control observation. The control group was given iodine restricted diet, the drug group was treated with Qinggan Sanjie Xiaoying Prescription combined with Liqi Sanjie Xiaoying Ointment, and the healthy control group was not treated with any intervention. Both drug group and control group were observed continuously for 4 weeks. TCM syndrome scores were performed before and after treatment. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess the degree of anxiety and depression, Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and fatigue severity Scale (FSS) was used to assess the degree of fatigue. Lower limb lymphedema self-sensory symptoms assessment questionnaire was used to evaluate the symptoms of lower limb lymphedema. The serum levels of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were measured by automatic electrochemiluminescence immunoassay, and the reduction rate was calculated. The levels of serum Akt, ERK and protein kinase C (PKC) were detected by ELISA. The thyroid volume was calculated and the anterior and posterior diameter of the isthmus was recorded. The clinical efficacy and safety were evaluated.Results:The total effective rate was 71.43% (30/42) in the drug group and 27.91% (12/43) in the control group, with statistical significance ( χ2=16.10, P<0.01). The serum TPOAb [137.95 (141.44) IU/ml vs. 153.40 (154.93) IU/ml, Z=-4.37] and TGAb [182.00 (238.52) IU/ml vs. 190.50 (257.55) IU/ml, Z=-2.13] levels in the drug group were lower after treatment ( P<0.01 or P<0.05), and the decrease rate of TPOAb [15.62 (21.90)% vs. -6.42 (32.89)%, Z=-4.12] and TGAb [5.25 (20.49)% vs. -0.72 (17.67)%, Z=-2.67] were higher than that in the control group ( P<0.01). The thyroid volume [11.37 (6.48) cm 3vs. 12.89 (6.63) cm 3, Z=-2.95] and isthmus thickness [0.27 (0.14) cm vs. 0.28 (0.15) cm, Z=-2.18] in the drug group were reduced after treatment compared with that before treatment ( P<0.05). TCM syndrome scores (6.10±1.38 vs. 14.42±7.35, t=-7.29), HAMA (5.21±1.32 vs. 9.28±2.25, Z=-7.02), HAMD (8.28±3.17 vs. 10.42±5.28, t=-2.26), PSQI (6.00±2.16 vs. 9.47±3.08, t=-6.01), FSS (34.71±5.51 vs. 38.23±8.35, t=-2.30), lower limb lymphedema self-induced symptom evaluation questionnaire scores (4.95±2.56 vs. 7.86±3.07, t=-4.74) after treatment were lower than before treatment and lower than control group ( P<0.001 or P<0.05).The serum levels of Akt [52.28 (17.72) μmol/L vs. 44.38 (2.75) μmol/L],ERK [2 843.43 (607.90) ng/L vs. 2 648.25 (290.74) ng/L],PKC [8.87 (3.10) pmol/L vs. 7.88 (1.25) pmol/L] in drug group were higher than those in the healthy control group before treatment ( P<0.05), the levels of Akt [37.37 (7.90) μmol/L vs. 44.38 (2.75) μmol/L], ERK [2 432.74 (402.56) ng/L vs. 2 648.25 (290.74) ng/L] in drug group were lower than those in the healthy group after treatment ( P<0.05). After treatment, the levels of Akt [37.37 (7.90) μmol/L vs. 52.28 (17.72) μmol/L, 49.56 (9.12) μmol/L], ERK [2 432.74 (402.56) ng/L vs. 2 843.43 (607.90) ng/L, 3 021.76 (360.22) ng/L], PKC [7.37 (1.84) pmol/L vs. 8.87 (3.10) pmol/L, 10.00 (2.42) pmol/L] in drug group were lower than before treatment and lower than control group ( P<0.01). There were no adverse events during treatment in both groups. Conclusion:The internal and external treatment of Hashimoto's disease by Professor Ding Zhiguo can effectively reduce the level of thyroid antibody titer, reduce the thyroid swelling and isthmus thickness, improve the clinical symptoms of patients with Hashimoto's disease, and may play a therapeutic role by interfering with MAPK signaling pathway.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Objective To explore the clinical efficacy and mechanism of Qinggan Sanjie Xiaoying Decoction in the treatment of Hashimoto's thyroiditis with syndrome of stagnation heat of liver meridian and stagnation of spleen deficiency and phlegm.Methods Totally 70 patients were divided into control group and medicine group according to their wishes,with 35 patients in each group.Both groups were restricted to an iodine diet.The medicine group was given Qinggan Sanjie Xiaoying Granules,1 sachet at a time,twice a day,orally.The treatment for both groups lasted for 4 weeks.20 healthy people were chosen as the healthy group.The clinical efficacy of both groups was observed.TCM symptom score,thyroid antibody titer levels(TPOAb,TGAb),changes in thyroid volume and isthmus of both groups before and after treatment were compared.Levels of serum IKKα,IKBα and TNF-α of the three groups were compared.Adverse reactions of patients daring the treatment period were monitored.Results The total effective rate of the medicine group was 85.71%(30/35),while the control group was 20.00%(7/35).The medicine group was superior to the control group(P<0.05).Compared with before treatment,the medication group showed significant improvement in TCM symptom scores,TPOAb and TGAb titer levels,thyroid volume,and thyroid isthmus thickness after treatment(P<0.05).After treatment,TCM symptom score,thyroid volume in the medicine group were lower than those in the control group(P<0.05),and the decrease rate of TPOAb titer was higher than that in the group(P<0.05).The levels of IKKα and TNF-α before treatment of medicine group and control group were higher than that in the healthy control group,and the level of IKBα was lower than that of the healthy control group(P<0.05);compared with before treatment,the levels of IKKα and TNF-α in the medicine group decreased,and the level of IKBα increased(P<0.05);after treatment,the levels of IKKα and TNF-α in the medicine group were lower than that in the control group,and IKBα was higher than the control group(P<0.05).No adverse events were observed during the treatment period in both groups of patients.Conclusion Qinggan Sanjie Xiaoying Decoction can reduce the antibody titer level,thyroid enlargement,isthmus thickness,and TCM syndrome score in the treatment of Hashimoto's thyroiditis.It is safe and effective in clinical practice.Qinggan Sanjie Xiaoying Decoction may play a therapeutic role by interfering with NF-κB signaling pathway.