AIM:To explore the effects of Jianpi Huatan formula on regulating T cells and helper T cells 17(Th17)cells in patients with polycystic ova-ry syndrome(PCOS)due to spleen deficiency and phlegm dampness syndrome,and conduct a model evaluation.METHODS:Ninety-two patients with spleen deficiency phlegm dampness syndrome(PCOS)admitted to our hospital from January 2023 to October 2024 were selected as the research sub-jects.Propensity score matching(PSM)method was used to match them in a 1:1 ratio,with 46 pa-tients in each group.The control group received conventional treatment,while the observation group received treatment with Jianpi Huatan for-mula on the basis of the control group.Compared and analyze the differences in clinical data and lab-oratory indicators between two groups;Compared the changes of sex hormone,glucose metabolism and TCM syndrome score before and after treat-ment in the two groups,and focused on the chang-es of regulatory T cells(Treg)and Th17 cells in the two groups before and after treatment;And used the Generalized Estimation Equation(GEE)model to analyze its improvement.Multiple linear regres-sion analysis was used to examine its correlation with the score of traditional Chinese medicine syn-drome.A time effect model of Jianpi Huatan formu-la for treating PCOS with spleen deficiency and phlegm dampness syndrome was established using a nonlinear mixed effects model.The fitting effect of the final model was evaluated through the good-ness of fit.Bootstrap was used to test and evaluate the stability of model parameters.Visual prediction testing was used to evaluate the predictive perfor-mance of the model.Typical time effect curves of traditional Chinese medicine symptom scores was simulated based on the final model for each base-line.RESULTS:After treatment,the total effective rate of the observation group was significantly high-er than that of the control group(χ2=4.842,P=0.028);Compared with before treatment,after 1months and 3 months of treatment,TC,TG,LDL-C,T,LH,FSH,AMH,FPG,FINS,HOMA-IR,the score of traditional Chinese medicine syndrome were sig-nificantly reduced,while E2 and HDL-C were signifi-cantly increased,and the improvement in the ob-servation group was significantly greater than that in the control group(P<0.05);The results of repeat-ed measures ANOVA showed significant difference-sin the time effects,inter group effects,and interac-tion effects of Treg,Th17,and Treg/Th17 between the two groups of patients(P<0.05).The GEE anal-ysis results showed that the improvement of Treg,Th17,and Treg/Th17 in the observation group were better than that in the control group(P<0.05);The results of multiple linear regression analysis showed that the levels of TC,TG,LDL-C,T,LH,FSH,AMH,FPG,FINS,HOMA-IR,Th17 were significantly positively correlated with TCM syndrome score,while the levels of E2,HDL-C,Treg,and Treg/Th17 were significantly negatively correlated with TCM syndrome score(P<0.05);The decrease in tradition-al Chinese medicine symptom score compared to baseline gradually increases over time,eventually reaching the pharmacological platform,which was consistent with the classic Emax model.After gradu-ally screening covariates,it was found that the baseline value of traditional Chinese medicine symptom score had a significant impact on the effi-cacy parameter Emax.The final model was Emax,i=15.42+1.21×(Baselinei-24.41).The goodness of fit results showed that the final model had a good fit-ting effect on the measured data.The model pa-rameters obtained from Bootstrap testing were very consistent with the original model,indicated that the model parameter estimation was robust.The visual prediction test results showed that the model had good predictive performance.The typi-cal efficacy time curve showed that the higher the baseline value of TCM symptom score,the greater the decrease in score.At 3 months of treatment,the TCM symptom score at each baseline basically decreased to below 10 points.CONCLUSION:The formula for strengthening the spleen and resolving phlegm can effectively improve the levels of Treg and Th17 in PCOS patients with spleen deficiency and phlegm dampness syndrome,and has good therapeutic effects,which is worthy of clinical appli-cation.

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

Objective:To compare the clinical efficacy of autologous bone grafting or bioceramic bone grafting combined with locking compression plate (LCP) internal fixation in the treatment of Schatzker type II and III tibial plateau fractures.Methods:A retrospective analysis was conducted on 104 patients with Schatzker type II and III tibial plateau fractures who underwent surgical treatment at the Department of Orthopedics, PLA Central Theater Command General Hospital from January 2010 to December 2021. The cohort comprised 55 males and 49 females, with an average age of 49.13±13.80 years (range 18-73 years). All fractures were unilateral: 55 on the left and 49 on the right. According to the Schatzker classification, 59 were Type II and 45 were Type III. Causes of injury included traffic accidents (48 cases), falls from height (3 cases), sprains or falls (45 cases), and other causes (8 cases). During surgery, bioceramic material or allograft bone tissue was implanted into the collapsed tibial plateau region to restore articular surface flatness. Based on graft type, patients were divided into the allograft bone group (63 cases) and the bioceramic group (41 cases). All cases underwent proximal lateral tibial LCP internal fixation. The two groups were compared in terms of operative time, intraoperative blood loss, bone graft volume, length of hospital stay, fracture healing time, and postoperative complications. The Rasmussen radiographic collapse score was used to evaluate fracture reduction, and the Hospital for Special Surgery (HSS) score system was used to assess knee joint function.Results:All patients were followed up for 12(12, 13) months (range 12-16 months). The fracture healing time in the allograft bone group was 13.70±1.36 weeks (range 11-16 weeks), which was significantly shorter than that in the bioceramic group: 14.59±1.73 weeks (range 11-19 weeks) ( t=2.911, P=0.004). The time to full weight-bearing in the allograft group was 15.0(14.0, 17.0) weeks (range 13-23 weeks), which was shorter than the 16.0 (15.5, 18.5) weeks (range 12-24 weeks) in the bioceramic group, showing a statistically significant difference ( Z=-3.019, P=0.002). At 12 months postoperatively, the Rasmussen radiographic collapse score was 1(0, 1) in the bioceramic group, significantly lower than the 1(1, 2) score in the allograft group ( Z=-2.083, P=0.037). No statistically significant differences were observed between the two groups in bone graft volume, surgical duration, intraoperative blood loss, hospitalization duration, or HSS scores at 6 and 12 months postoperatively ( P>0.05). The complication rate was 6.3% (4/63) in the allograft group and 2.4% (1/41) in the bioceramic group, with no statistically significant difference (χ 2=0.830, P=0.362). Conclusions:For Schatzker type II and III tibial plateau fractures, the use of allograft bone or bioceramic combined with LCP internal fixation can achieve good results. Allograft bone has advantages in terms of fracture healing speed and early weight-bearing recovery, while bioceramic is more effective in maintaining joint surface stability.

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI radiomics and signal intensity in hepatobiliary phase(HBP)in predicting the pathological differentiation degree of hep-atocellular carcinoma(HCC).Methods The clinical and imaging data of 224 patients pathologically confirmed with HCC were col-lected.All patients were randomly divided into test group(68 cases)and training group(156 cases)at a ratio of 7︰3.The ITK-SNAP software was used to delineate region of interest(ROI)on arterial phase(AP),portal venous phase(PVP)and HBP,the radiomics features of the tumor tissues were extracted and the radiomics models were established using the FAE software.Logistic regression analysis was used to determine the clinical independent predictors associated with the pathological differentiation degree of HCC and to construct clinical model and clinical-radiomics model.Receiver operating characteristic(ROC)curve was plotted for each model and the area under the curve(AUC)was calculated to compare the diagnostic efficacy of the models.Results Age,alpha-fetoprotein(AFP),and r-glutamyltransferase(r-GT)were independent risk factors for predicting the degree of pathological differentiation of HCC.The AUC of the clinical-radiomics model in the training group and test group were 0.825 and 0.779,respectively,which were higher than those of the radiomics model(0.812 and 0.771)and the clinical model(0.687 and 0.666).Conclusion Gd-EOB-DTPA enhanced MRI radiomics have certain value in predicting the degree of pathological differentiation of HCC,while the predictive value of the signal intensity on HBP and the signal intensity ratio(SIR)on HBP is limited.

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 investigate the application value of D-dimer (D-D) as the primary indicator, combined with NT-proBNP and neutrophil percentage in the differential diagnosis of acute aortic dissection (AAD), pulmonary embolism (PE), and acute myocardial infarction (AMI).Methods:A retrospective case-control study was conducted, including 764 patients with acute chest pain who presented to the Emergency Department of Beijing Fuwai Hospital from March 1st, 2024, to February 28th, 2025. Patients were clinically diagnosed with AAD (299 cases) and other acute chest pain conditions (AMI 425 cases, PE 40 cases). The AAD group had the age of 56.00 (45.00, 64.00) years old with 226 males (75.59%); the AMI group had a median the age of 65.00 (55.00, 70.00) years with 339 males (79.76%); and the PE group had the age of 70.00 (59.75, 74.00) years with 15 males (37.50%). Baseline clinical data were collected and compared among the three groups, including general parameters such as heart rate, systolic blood pressure, and diastolic blood pressure. Laboratory parameters included N-terminal pro-brain natriuretic peptide (NT-proBNP), prothrombin time (PT), activated partial thromboplastin time (APTT), D-D, cardiac troponin I (cTnI), myoglobin, creatine kinase-MB (CK-MB), white blood cell count, neutrophil percentage, lymphocyte percentage, platelet count, and mean platelet volume (MPV). Comparisons between groups were performed using the Kruskal-Wallis rank-sum test and χ2 test. Independent discriminatory factors were identified through multivariate logistic regression analysis, and the diagnostic performance of individual indicators and combined models were analyzed using receiver operating characteristic (ROC) curves.Results:The D-D level in the AAD group [3.93 (1.48, 19.59) μg/ml] was significantly higher than that in the AMI group [0.26 (0.14, 0.56) μg/ml] and PE group [2.13 (0.84, 6.13) μg/ml] ( F=200.12, P<0.001). Multivariate analysis showed that D-D, NT-proBNP, neutrophil percentage, and lymphocyte percentage were all independent factors for differentiating AAD from AMI. NT-proBNP, total white blood cell count, neutrophil percentage, and lymphocyte percentage were independent predictors for differentiating AAD from PE. ROC analysis showed that D-D had an area under the curve (AUC) of 0.93 (95% CI 0.91-0.95) for differentiating AAD from AMI, with a sensitivity of 81.6% and specificity of 92.9%. In the differential diagnosis between AAD and PE, the model combining D-dimer, NT-proBNP, and neutrophil percentage had an AUC of 0.86 (95% CI 0.80-0.91), with a sensitivity of 85.0% and a specificity of 72.5%. Conclusion:D-D has significant value in the differential diagnosis of AAD from AMI and PE, with particularly good individual diagnostic performance for differentiating AAD from AMI. Combining NT-proBNP and neutrophil percentage can significantly improve differential diagnostic performance.

Objective:To compare the clinical efficacy of autologous bone grafting or bioceramic bone grafting combined with locking compression plate (LCP) internal fixation in the treatment of Schatzker type II and III tibial plateau fractures.Methods:A retrospective analysis was conducted on 104 patients with Schatzker type II and III tibial plateau fractures who underwent surgical treatment at the Department of Orthopedics, PLA Central Theater Command General Hospital from January 2010 to December 2021. The cohort comprised 55 males and 49 females, with an average age of 49.13±13.80 years (range 18-73 years). All fractures were unilateral: 55 on the left and 49 on the right. According to the Schatzker classification, 59 were Type II and 45 were Type III. Causes of injury included traffic accidents (48 cases), falls from height (3 cases), sprains or falls (45 cases), and other causes (8 cases). During surgery, bioceramic material or allograft bone tissue was implanted into the collapsed tibial plateau region to restore articular surface flatness. Based on graft type, patients were divided into the allograft bone group (63 cases) and the bioceramic group (41 cases). All cases underwent proximal lateral tibial LCP internal fixation. The two groups were compared in terms of operative time, intraoperative blood loss, bone graft volume, length of hospital stay, fracture healing time, and postoperative complications. The Rasmussen radiographic collapse score was used to evaluate fracture reduction, and the Hospital for Special Surgery (HSS) score system was used to assess knee joint function.Results:All patients were followed up for 12(12, 13) months (range 12-16 months). The fracture healing time in the allograft bone group was 13.70±1.36 weeks (range 11-16 weeks), which was significantly shorter than that in the bioceramic group: 14.59±1.73 weeks (range 11-19 weeks) ( t=2.911, P=0.004). The time to full weight-bearing in the allograft group was 15.0(14.0, 17.0) weeks (range 13-23 weeks), which was shorter than the 16.0 (15.5, 18.5) weeks (range 12-24 weeks) in the bioceramic group, showing a statistically significant difference ( Z=-3.019, P=0.002). At 12 months postoperatively, the Rasmussen radiographic collapse score was 1(0, 1) in the bioceramic group, significantly lower than the 1(1, 2) score in the allograft group ( Z=-2.083, P=0.037). No statistically significant differences were observed between the two groups in bone graft volume, surgical duration, intraoperative blood loss, hospitalization duration, or HSS scores at 6 and 12 months postoperatively ( P>0.05). The complication rate was 6.3% (4/63) in the allograft group and 2.4% (1/41) in the bioceramic group, with no statistically significant difference (χ 2=0.830, P=0.362). Conclusions:For Schatzker type II and III tibial plateau fractures, the use of allograft bone or bioceramic combined with LCP internal fixation can achieve good results. Allograft bone has advantages in terms of fracture healing speed and early weight-bearing recovery, while bioceramic is more effective in maintaining joint surface stability.

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI radiomics and signal intensity in hepatobiliary phase(HBP)in predicting the pathological differentiation degree of hep-atocellular carcinoma(HCC).Methods The clinical and imaging data of 224 patients pathologically confirmed with HCC were col-lected.All patients were randomly divided into test group(68 cases)and training group(156 cases)at a ratio of 7︰3.The ITK-SNAP software was used to delineate region of interest(ROI)on arterial phase(AP),portal venous phase(PVP)and HBP,the radiomics features of the tumor tissues were extracted and the radiomics models were established using the FAE software.Logistic regression analysis was used to determine the clinical independent predictors associated with the pathological differentiation degree of HCC and to construct clinical model and clinical-radiomics model.Receiver operating characteristic(ROC)curve was plotted for each model and the area under the curve(AUC)was calculated to compare the diagnostic efficacy of the models.Results Age,alpha-fetoprotein(AFP),and r-glutamyltransferase(r-GT)were independent risk factors for predicting the degree of pathological differentiation of HCC.The AUC of the clinical-radiomics model in the training group and test group were 0.825 and 0.779,respectively,which were higher than those of the radiomics model(0.812 and 0.771)and the clinical model(0.687 and 0.666).Conclusion Gd-EOB-DTPA enhanced MRI radiomics have certain value in predicting the degree of pathological differentiation of HCC,while the predictive value of the signal intensity on HBP and the signal intensity ratio(SIR)on HBP is limited.

Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.