1.An Attention-weighted Tri-modal Ultrasound Network (TUS-Net) for Screening of Atypical Hepatocellular Carcinoma From LR-M Liver Nodules
He-Chong ZHANG ; Liang-Hui HUANG ; Xue-Hua WANG ; Shang-Lin JIANG ; Ying-Ying CHEN ; Ya-Guang ZENG ; Wei ZHENG
Progress in Biochemistry and Biophysics 2026;53(5):1485-1498
ObjectiveDiscriminating atypical hepatocellular carcinoma (HCC) from other malignancies in liver nodules classified as Liver Imaging Reporting and Data System category M (LR-M) remains a significant diagnostic challenge on conventional ultrasound examination. The LR-M category, originally intended to capture non-HCC malignancies, paradoxically contains up to 63% of atypical HCCs that deviate from classic enhancement patterns, leading to potential misdiagnosis and suboptimal treatment planning. While deep learning has shown promise in HCC diagnosis, most existing models rely exclusively on single-modality ultrasound, overlooking the diagnostic benefits of integrating complementary information from multiple imaging sources. To address this gap, we propose a novel attention-weighted tri-modal ultrasound network (TUS-Net) that integrates contrast-enhanced ultrasound (CEUS), B-mode ultrasound (BUS), and time-intensity curves (TICs) to improve diagnostic accuracy for these clinically challenging lesions. MethodsOur framework incorporates a three-dimensional convolutional neural network (C3D) backbone to extract spatiotemporal features from CEUS videos, capturing dynamic vascular patterns critical for lesion characterization. To effectively fuse complementary modalities, we introduce a dual-channel feature fusion module (DCFFM) that adaptively combines features from CEUS and BUS through channel-wise attention mechanisms, allowing the model to dynamically weigh the contribution of each modality based on diagnostic relevance. Additionally, we propose a temporal intensity feature fusion module (TIFFM) that leverages quantitative hemodynamic information from TICs to guide the model’s attention toward diagnostically critical temporal phases, such as arterial wash-in and portal venous washout. The model is further enhanced by automated lesion localization using YOLOX and class activation mapping for interpretability, ensuring that predictions align with clinically meaningful imaging features. ResultsEvaluated on a tri-modal ultrasound dataset comprising 161 patients with pathologically confirmed LR-M nodules (131 atypical HCC and 30 non-HCC malignancies), our model achieved an accuracy of 86.83%, a sensitivity of 92.50%, a specificity of 75.50%, and an AUC of 89.32% in screening atypical HCC. Compared to single-modality baselines, TUS-Net demonstrated superior specificity, a clinically critical metric given the higher risk associated with misclassifying non-HCC malignancies. Ablation studies confirmed the contribution of each module, with the full model outperforming both standard C3D and 3D ResNet backbones integrated with attention mechanisms. A reader study involving junior and senior radiologists further validated the clinical utility of AI assistance, showing consistent improvements in specificity and inter-reader consistency, particularly for less experienced clinicians. ConclusionThese results surpass existing benchmark models and demonstrate the potential of our approach to enhance diagnostic precision in clinically specific cases. By intelligently fusing multi-modal ultrasound data with attention-guided mechanisms, TUS-Net offers a reliable and interpretable tool that holds promise for improving the non-invasive diagnosis of atypical HCC in challenging LR-M liver nodules.
2.An Attention-weighted Tri-modal Ultrasound Network (TUS-Net) for Screening of Atypical Hepatocellular Carcinoma From LR-M Liver Nodules
He-Chong ZHANG ; Liang-Hui HUANG ; Xue-Hua WANG ; Shang-Lin JIANG ; Ying-Ying CHEN ; Ya-Guang ZENG ; Wei ZHENG
Progress in Biochemistry and Biophysics 2026;53(5):1485-1498
ObjectiveDiscriminating atypical hepatocellular carcinoma (HCC) from other malignancies in liver nodules classified as Liver Imaging Reporting and Data System category M (LR-M) remains a significant diagnostic challenge on conventional ultrasound examination. The LR-M category, originally intended to capture non-HCC malignancies, paradoxically contains up to 63% of atypical HCCs that deviate from classic enhancement patterns, leading to potential misdiagnosis and suboptimal treatment planning. While deep learning has shown promise in HCC diagnosis, most existing models rely exclusively on single-modality ultrasound, overlooking the diagnostic benefits of integrating complementary information from multiple imaging sources. To address this gap, we propose a novel attention-weighted tri-modal ultrasound network (TUS-Net) that integrates contrast-enhanced ultrasound (CEUS), B-mode ultrasound (BUS), and time-intensity curves (TICs) to improve diagnostic accuracy for these clinically challenging lesions. MethodsOur framework incorporates a three-dimensional convolutional neural network (C3D) backbone to extract spatiotemporal features from CEUS videos, capturing dynamic vascular patterns critical for lesion characterization. To effectively fuse complementary modalities, we introduce a dual-channel feature fusion module (DCFFM) that adaptively combines features from CEUS and BUS through channel-wise attention mechanisms, allowing the model to dynamically weigh the contribution of each modality based on diagnostic relevance. Additionally, we propose a temporal intensity feature fusion module (TIFFM) that leverages quantitative hemodynamic information from TICs to guide the model’s attention toward diagnostically critical temporal phases, such as arterial wash-in and portal venous washout. The model is further enhanced by automated lesion localization using YOLOX and class activation mapping for interpretability, ensuring that predictions align with clinically meaningful imaging features. ResultsEvaluated on a tri-modal ultrasound dataset comprising 161 patients with pathologically confirmed LR-M nodules (131 atypical HCC and 30 non-HCC malignancies), our model achieved an accuracy of 86.83%, a sensitivity of 92.50%, a specificity of 75.50%, and an AUC of 89.32% in screening atypical HCC. Compared to single-modality baselines, TUS-Net demonstrated superior specificity, a clinically critical metric given the higher risk associated with misclassifying non-HCC malignancies. Ablation studies confirmed the contribution of each module, with the full model outperforming both standard C3D and 3D ResNet backbones integrated with attention mechanisms. A reader study involving junior and senior radiologists further validated the clinical utility of AI assistance, showing consistent improvements in specificity and inter-reader consistency, particularly for less experienced clinicians. ConclusionThese results surpass existing benchmark models and demonstrate the potential of our approach to enhance diagnostic precision in clinically specific cases. By intelligently fusing multi-modal ultrasound data with attention-guided mechanisms, TUS-Net offers a reliable and interpretable tool that holds promise for improving the non-invasive diagnosis of atypical HCC in challenging LR-M liver nodules.
3.Construction of Mouse Models of Psoriasis-like Lesions Induced by Cold Exposure Combined with Imiquimod and Evaluation of Therapeutic Efficacy of Kaixuan Jiedu Core Prescription
Meiqi SUN ; Xue XIAO ; Jiarong WU ; Jiaqi LI ; Ningxin ZHANG ; Mengyao JIANG ; Huan LIU ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(19):69-78
ObjectiveTo establish the mouse models of psoriasis-like lesions induced by continuous cold exposure or intermittent cold exposure combined with imiquimod (IMQ), and to evaluate the interventional effects of Kaixuan Jiedu core prescription (KXJD) on the two models. MethodsMale C57BL/6J mice were selected and classified into two experimental batches. The first batch of 36 mice was randomized into a room temperature group, a continuous cold exposure (10 ℃/24 h) group, and an intermittent cold exposure (10 ℃/6 h) group. Each group was further divided into a normal subgroup and a model subgroup (topical application of IMQ to induce skin lesions), with 6 mice in each subgroup, for modeling and evaluation. The second batch of 54 mice, with 6 in each group, were subjected to the same temperature grouping with an additional KXJD (30.42 g·kg-1, continuous gavage for 5 days) group. Comprehensive evaluation of model characteristics and KXJD efficacy was conducted through Psoriasis Area and Severity Index (PASI) scoring, skin temperature measurement by infrared thermography, histopathological observation by hematoxylin-eosin (HE) staining, detection of vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule 1 (CD31) by immunohistochemistry, detection of Claudin-1 and Occludin by immunofluorescence assay, determination of serum levels of tumor necrosis factor-α (TNF-α) and interleukin (IL)-10 by enzyme-linked immunosorbent assay (ELISA), and quantification of mRNA levels of IL-17A, IL-23, IL-6, and chemokine ligand 20 (CCL20) in skin lesions by quantitative Real-time polymerase chain reaction (Real-time PCR). ResultsModel mice in all temperature groups exhibited typical psoriasis-like skin lesions. Compared with the normal groups, the model groups showed increased PASI scores, decreased skin temperatures (P<0.05), obvious epidermal thickening, parakeratosis, and dermal inflammatory cell infiltration, as well as elevated mRNA levels of IL-17A, IL-23, IL-6, and CCL20 (P<0.05). Cold exposure further aggravated psoriasis. The total PASI score of the intermittent cold exposure model group was higher than that of the room temperature model group (P<0.05). The serum IL-10 did not show a compensatory elevation, and the blood vessels presented a characteristic of elevated CD31 expression (P<0.05) without a synchronous increase in VEGF. The continuous cold exposure model group exhibited more significant dermal capillary tortuosity and dilation, with the highest mRNA levels of IL-17A, IL-23, IL-6, and CCL20 among all groups. Compared with the respective model groups, KXJD intervention alleviated skin lesions, reduced epidermal thickness and inflammatory cell infiltration, and increased skin temperature, with the temperature increase being particularly significant in the intermittent cold exposure+KXJD group (P<0.05). Furthermore, KXJD down-regulated the expression of VEGF and CD31, restored the expression of Claudin-1 and Occludin, decreased the mRNA levels of IL-17A and IL-23 (P<0.05), and reduced the serum TNF-α level. ConclusionThis study successfully established compound psoriasis-like mouse models induced by cold exposure combined with IMQ. It confirms that cold aggravates the severity of psoriasis by exacerbating the closure of Xuanfu (sweat pores), microcirculation disorders, and immune imbalance. Moreover, different cold exposure patterns have distinct mechanism differences. Continuous cold exposure focuses on enhancing the inflammatory response via the IL-23/IL-17 axis and angiogenesis, simulating chronic aggravation under a long-term cold environment. Intermittent cold exposure tends to impair immune regulation and induce microvascular endothelial stress, corresponding to acute exacerbations caused by sudden temperature drops. KXJD can effectively alleviate psoriasis-like skin lesions under cold conditions by unblocking Xuanfu, regulating vasomotor function, and correcting abnormal immune-inflammatory responses.
4.Kaixuan Jiedu Core Prescription Alleviates Psoriatic Skin Lesions in Mice by Modulating Cold-sensitive TRPM8 Neuron-derived Signaling
Xue XIAO ; Bin YANG ; Meiqi SUN ; Haoruo YANG ; Ningxin ZHANG ; Jiaqi LI ; Huan LIU ; Mengyao JIANG ; Yuanyao SHE ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(19):89-101
ObjectiveTo investigate the ameliorative effects of Kaixuan Jiedu core prescription (KXJD) on skin lesions in psoriasis-like mouse models under cold environment exposure, and to analyze its influences on transient receptor potential (TRP) channels and related neuroimmune regulatory factors. MethodsThirty-six C57BL/6J mice were randomized into 6 groups, with 6 mice in each group. Two feeding conditions were set: Normal temperature and cold [simulating a cold environment at (10±0.5) ℃, for 6 h daily]. Mice were induced to develop psoriasis-like lesions by applying imiquimod externally. The model mice were allocated into model groups and KXJD (30.42 g·kg-1, continuous gavage for 5 days) groups. Normal mice were used as the control group. Specifically, mice were allocated into normal temperature, normal temperature model, normal temperature+KXJD, cold exposure control, cold exposure model, and cold exposure+KXJD groups. The pathological changes in skin lesions were observed by hematoxylin-eosin (HE) staining. The expression of cluster of differentiation (CD) 3+ T lymphocytes, CD11c+ dendritic cells (DCs), phosphorylated extracellular signal-regulated kinase (p-ERK), and substance P (SP) were detected by immunofluorescence assay. The protein level of transient receptor potential cation channel subfamily M member 8 (TRPM8) in the skin tissue was determined by Western blot. The expression of TRPM8, transient receptor potential cation channel subfamily V member 1 (TRPV1), transient receptor potential cation channel subfamily A member 1 (TRPA1), and transient receptor potential cation channel subfamily V member 2 (TRPV2) at the protein and mRNA levels was determined by immunohistochemistry and Real-time PCR, respectively. The levels of calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) in the serum were analyzed by enzyme-linked immunosorbent assay (ELISA). The enrichment analysis of differentially expressed genes (DEGs) and TRP pathway network construction were conducted based on the GEO database. The co-expression of TRPM8 and CGRP in the skin lesions was verified by immunofluorescence double labeling. ResultsBoth the normal temperature and cold exposure model groups showed typical psoriasis-like skin lesions. Compared with the normal temperature and cold exposure control groups, the model groups had excessive epidermal keratinization, thickened spinous layer, and inflammatory infiltration in the dermis, with increased pathological scores (P<0.05), increased infiltration of CD3+ and CD11c+ cells and expression of p-ERK and SP, upregulated mRNA levels of TRPM8, TRPA1, and TRPV2, downregulated mRNA level of TRPV1 (P<0.05), and reduced content of CGRP and increased content of NPY in the serum. Compared with the normal temperature and cold exposure model groups, KXJD reduced the pathological manifestations and pathological scores of psoriasis-like skin lesions (P<0.05), and inhibited the infiltration of CD3+ and CD11c+ cells and the expression of p-ERK and SP. Gene enrichment analysis suggested that the DEGs of psoriasis were significantly enriched in the interleukin (IL)-17 signaling pathway and TRP channel inflammatory regulation. Compared with the normal temperature and cold exposure model groups, KXJD reversed the abnormal mRNA levels of genes related to the TRP channel subfamilies (P<0.05), increased the CGRP level, and decreased the NPY level. Immunofluorescence double labeling further confirmed that compared with the model groups, KXJD down-regulated the co-expression of TRPM8 and CGRP in the skin lesions. ConclusionKXJD may ameliorate psoriasis-like skin lesions by downregulating the overexpressed cold-sensitive receptor TRPM8 in skin lesions and correcting the disorder of neuropeptide (such as SP and CGRP) release mediated by it, thereby inhibiting the IL-23/helper T cell 17 (Th17) core inflammatory pathway, suppressing the infiltration of inflammatory cells and the activation of the ERK signaling pathway, and regulating the Xuanfu (sweat pore)-TRPM8-neuroimmune response axis.
5.Mechanism of Kaixuan Jiedu Core Prescription in Ameliorating Psoriasis-like Inflammation via TrkA Receptor-mediated Regulation of CGRP Expression and Dendritic Cell Activation
Huan LIU ; Mengyao JIANG ; Jiaqi LI ; Meiqi SUN ; Xue XIAO ; Ningxin ZHANG ; Bin YANG ; Ping SONG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(19):102-110
ObjectiveTo investigate the ameliorative effects and mechanisms of Kaixuan Jiedu core prescription (KXJD) on neuroimmunological inflammation in imiquimod (IMQ)-induced psoriasis-like mice. MethodsA total of 24 C57BL/6J mice were randomly divided into four groups (n=6): Normal, model, KXJD, and tropomyosin receptor kinase A (TrkA) inhibitor GW441756 groups. The mice in the model, KXJD, and GW441756 groups were topically treated with 5% IMQ cream (62.5 mg·d-1) on the back to induce psoriasis-like inflammation. The KXJD group received KXJD by gavage (30.42 g·kg-1), the GW441756 group received intraperitoneal injection of GW441756 (10 mg·kg-1), and the normal and model groups received an equal volume of normal saline by gavage, with continuous intervention for 5 days. The severity of skin lesions was evaluated using the psoriasis area and severity index (PASI). Hematoxylin-eosin (HE) staining was used to measure epidermal thickness and observe pathological changes in the lesioned skin. Immunohistochemistry was employed to detect the expression of proliferating cell nuclear antigen (Ki67) and interleukin-17A (IL-17A) in the lesioned skin. Enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of interleukin-23 (IL-23) and calcitonin gene-related peptide (CGRP) in the lesioned tissues. Western blot was used to detect the expression of TrkA and phosphorylated TrkA (p-TrkA). Immunofluorescence assay was performed to detect the expression of TrkA receptor, protein gene product 9.5 (PGP9.5), cluster of differentiation 11c (CD11c), and CGRP in the lesions. Flow cytometry was used to detect the activation of splenic dendritic cells (DCs). ResultsCompared with the normal group, the model group exhibited typical psoriasis-like inflammation, characterized by erythema, infiltration and scaling, with histopathological findings of epidermal hyperkeratosis and acanthosis. The model group showed significantly increased expression of Ki67, IL-17A, IL-23 and p-TrkA (P<0.05, P<0.01), increased fluorescence intensity of CD11c, and significantly decreased CGRP expression (P<0.05). The splenic DC activation was significantly enhanced, as indicated by the increased mean fluorescence intensity (MFI) of CD86 (P<0.05). Compared with the model group, both the KXJD and GW441756 groups showed amelioration of the psoriasis-like skin inflammation, with significantly down-regulated expression of IL-17A, IL-23 and p-TrkA (P<0.05, P<0.01), significantly up-regulated expression of CGRP (P<0.01), reduced CD11c+ DC infiltration, and restored splenic DC activation balance (down-regulated CD86 MFI and up-regulated CD80 and CD40 MFI). Furthermore, the inhibitory effect of KXJD on Ki67 was significantly superior to that of the GW441756 group (P<0.01). ConclusionKXJD may alleviate IMQ-induced psoriasis-like inflammation in mice by targeting and inhibiting TrkA receptor phosphorylation, regulating CGRP expression in the lesions, and ameliorating aberrant activation of dendritic cells, while also significantly inhibiting keratinocyte proliferation.
6.Comparison of the Risk Stratification Systems of CHIC and New CCCG in the Prognostic Evaluation of Hepatoblastoma
Zhen LI ; Hong JIANG ; Wenqing WANG ; Yuanqi WANG ; Libin HUANG ; Juncheng LIU ; Hongman XUE
Journal of Sun Yat-sen University(Medical Sciences) 2026;47(2):346-353
ObjectiveTo compare the Children's Hepatic tumors International Collaboration (CHIC) and the new Chinese Children's Cancer Group (CCCG) hepatoblastoma (HB) risk stratification systems in terms of their prognostic prediction efficacy and chemotherapy guidance value for Chinese children with HB, aiming to identify the risk stratification system more suitable for Chinese HB patients. MethodsThis retrospective study analyzed the clinical data of 403 pediatric patients with HB aged < 18 years who were initially diagnosed at The First Affiliated Hospital of Sun Yat-sen University between February 2010 and September 2023. The prognostic predictive efficacy and chemotherapy-guided value of the CHIC and CCCG risk stratification systems was compared. Statistical analysis was performed using SPSS 27.0. Results①Using the new CCCG risk stratification, the 5-year event-free survival (EFS) rates for children who received versus did not receive risk-stratified chemotherapy according to the CCCG-HB-2016 protocol were 82.5% and 67.7% (P=0.002), respectively, and the 5-year overall survival (OS) rates were 91.5% and 85.1% (P=0.038). Using CHIC risk stratification, the corresponding 5-year EFS rates for children who received versus did not receive risk-stratified chemotherapy according to the CCCG-HB-2016 protocol were 80.3% and 68.5% (P=0.030), and the 5-year OS rates were 90.9% and 85.8% (P=0.151). ②Among children treated with the CCCG-HB-2016 protocol stratified by the new CCCG system, the 5-year EFS rates for the very low-risk (6 cases), low-risk (20 cases), intermediate-risk (61 cases), and high-risk (69 cases) groups were 100%, 94.1%, 94.7%, and 66.2% (P<0.001), respectively, and the 5-year OS rates were 100%, 100%, 96.5%, and 82.0% (P=0.017). Among children treated with the CCCG-HB-2016 protocol stratified by the CHIC system, the 5-year EFS rates for the very low-risk (32 cases), low-risk (22 cases), intermediate-risk (37 cases), and high-risk (54 cases) groups were 93.8%, 95.2%, 76.1%, and 66.8% (P=0.003), respectively, and the 5-year OS rates were 93.1%, 100%, 89.5%, and 85.6% (P=0.190). ③For patients receiving CCCG-HB-2016 risk-stratified chemotherapy, the P-values for EFS comparisons between the CHIC and new CCCG systems within the very low-risk, low-risk, intermediate-risk, and high-risk groups were 0.537, 0.879, 0.023, and 0.934, respectively. Among patients who received stratified chemotherapy according to the CCCG-HB-2016 regimen, the intermediate-risk group in the new CCCG risk stratification system exhibited a significant advantage in 5-year event-free survival (EFS) compared with the intermediate-risk group in the CHIC risk stratification system (94.7% vs. 76.1%). ConclusionCompared to the CHIC risk stratification, the new CCCG stratification may offer better prognostic prediction and guidance value for chemotherapy in Chinese HB patients, with the intermediate-risk group showing superior outcomes.
7.Chemical constituents from Euphorbia humifusa and their in vitro anti-hepatoma activity
Si-fan YAO ; Wu-hui SUN ; Yi ZHANG ; Wen AI ; Xue-jing LI ; Bi-qing ZHAO ; Xiao-jiang ZHOU
Chinese Traditional Patent Medicine 2025;47(7):2243-2249
AIM To study the chemical constituents from Euphorbia humifusa Willd.and their in vitro anti-hepatoma activity.METHODS Silica gel,D101 macroporous adsorption resin and semi-preparative RP-HPLC were used for isolated and purified,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The anti-hepatocellular carcinoma activity was determined by MTT mothod.RESULTS Eighteen compounds were isolated and identified as 22-O-angeloyl-R1-barrigenol(1),dimethyl 3,3'-[oxybis(4,1-phenylene)](2E,2'E)-diacrylate(2),N-(3-methoxy-1,3-dioxopropyl)-D-tryptophan methyl ester(3),N-acetyltryptophan methyl ester(4),N-(methoxycarbonyl)-tryptophan methyl ester(5),(3β,5α,17β)-4,4,8,14-tetramethyl-18-norandrostane-3,17-diol(6),3β,18,19β-trihydroxylupane(7),pregnenolone(8),3-hydroxy-5,6-epoxy-7-megastigmen-9-one(9),dehydrovomifoliol(10),loliolide(11),2,2'-oxybis(1,4-di-tert-butylbenzene)(12),dibutyl phthalate(13),4-methoxycinnamic acid(14),3,4-dimethoxycinnamic acid(15),methyl 4-hydroxybenzoate(16),kaempferol(17),quercetin(18).The IC50 values of compounds 1,7 and 8 on HepG2 cells were(17.27±0.92),(19.11±2.14)and(7.53±1.09)μmol/L,respectively.CONCLUSION Compounds 1-16 are first isolated from this plant.Compounds 1,7 and 8 have anti-hepatoma activity.
8.Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults (version 2025)
Bobin MI ; Faqi CAO ; Weixian HU ; Wu ZHOU ; Chenchen YAN ; Hui LI ; Yun SUN ; Yuan XIONG ; Jinmi ZHAO ; Qikai HUA ; Xinbao WU ; Xieyuan JIANG ; Dianying ZHANG ; Zhongguo FU ; Dankai WU ; Guangyao LIU ; Guodong LIU ; Tengbo YU ; Jinhai TAN ; Xi CHEN ; Fengfei LIN ; Zhangyuan LIN ; Dongfa LIAO ; Aiguo WANG ; Shiwu DONG ; Gaoxing LUO ; Zhao XIE ; Dong SUN ; Dehao FU ; Yunfeng CHEN ; Changqing ZHANG ; Kun LIU ; Deye SONG ; Yongjun RUI ; Fei WU ; Ximing LIU ; Junwen WANG ; Meng ZHAO ; Biao CHE ; Bing HU ; Chengjian HE ; Guanglin WANG ; Xiao CHEN ; Guandong DAI ; Shiyuan FANG ; Wenchao SONG ; Ming CHEN ; Guanghua GUO ; Yongqing XU ; Lei YANG ; Wenqian ZHANG ; Kun ZHANG ; Xin TANG ; Hua CHEN ; Weiguo XU ; Shuquan GUO ; Yong LIU ; Xiaodong GUO ; Zhewei YE ; Liming XIONG ; Tian XIA ; Hongbin WU ; Qisheng ZHOU ; Mengfei LIU ; Yiqiang HU ; Yanjiu HAN ; Hang XUE ; Kangkang ZHA ; Wei CHEN ; Zhiyong HOU ; Bin YU ; Jiacan SU ; Peifu TANG ; Baoguo JIANG ; Guohui LIU
Chinese Journal of Trauma 2025;41(5):421-432
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.
9.Expert consensus on intraoperative repositioning for patients with spine fracture and dislocation (version 2025)
Dongmei BIAN ; Ke SUN ; Ningbo CHEN ; Caixia BAI ; Miao WANG ; Yafeng QIAO ; Fei WANG ; Hong WANG ; Feng TIAN ; Mei YAN ; Meng BAI ; Linjuan ZHANG ; Liyan ZHAO ; Yaqing CUI ; Xue JIANG ; Leling FENG ; Ning NING ; Junqin DING ; Lan WEI ; Yonghua ZHAI ; Yu ZENG ; Zengmei ZHANG ; Jiqun HE ; Fenggui BIE ; Hong CHEN ; Zengyan WANG ; Li LI ; Li ZHANG ; Yaying ZHOU ; Bing SHAO ; Ying WANG ; Caixia XIE ; Yanfeng YAO ; Jingjing AN ; Wen SHI ; Xiongtao LIU ; Xiaoyan AN ; Ning NAN ; Lan LI ; Xiaohui GOU ; Qiaomei LI ; Xiuting WU ; Yuqin ZHANG ; Jing LIU ; Fusen XIANG ; Xu XU ; Na MEI ; Jiao ZHOU ; Shan FAN ; Qian WANG ; Shuixia LI
Chinese Journal of Trauma 2025;41(2):138-147
Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.
10.Epidemiological characteristics and influencing factors of diabetes and pre-diabetes among adult residents in Hainan Province
Juan JIANG ; Changfu XIONG ; Dingwei SUN ; Ying LIU ; Hongying WU ; Xingren WANG ; Xiaohuan WANG ; Tingting OU ; Xue ZHOU ; Shizhu MENG ; Saiku CHEN ; Kanglin WANG ; Lu ZHONG ; Bin HE
Chinese Journal of Epidemiology 2025;46(4):700-708
Objective:To describe epidemiological characteristics and their influencing factors of diabetes and pre-diabetes among adult residents in Hainan Province and provide a theoretical basis to develop epidemic prevention and control strategies for diabetes.Methods:This study used a two-stage unequal proportion cluster sampling method, and 32 857 subjects (≥18 years old) were collected from 24 cities/counties/districts in Hainan Province. All the subjects were investigated with questionnaires, physical examination, and laboratory tests from January to June 2023. The χ2 and Mantel-Haenszel trend χ2 tests were used to analyze the data. Multivariate logistic regression was used to analyze the factors influencing diabetes and pre-diabetes. SPSS 23.0 software was used to analyze the data. Results:The crude prevalence of diabetes and pre-diabetes in adult residents of Hainan Province were 18.1% and 22.8%, while the weighted rates were 13.7% and 20.7%, respectively. The results of multivariate logistic regression analysis showed that: aging (30-39 years old: OR=2.65, 95% CI: 2.06-3.41; 40-49 years old: OR=5.64, 95% CI: 4.40-7.24; 50- 59 years old: OR=9.88, 95% CI: 7.71-12.67; 60-69 years old: OR=18.34, 95% CI: 14.28-23.55; 70-79 years old: OR=21.30, 95% CI: 16.41-27.65; 80 years old and above: OR=24.13, 95% CI: 17.94-32.46), nationality (Li minority group: OR=1.50, 95% CI: 1.38-1.63; other ethnic groups: OR=1.53, 95% CI: 1.20-1.94), urban ( OR=1.12, 95% CI: 1.04-1.21), central obesity ( OR=2.14, 95% CI: 2.01-2.29), higher frequency of alcohol consumption (5-7 day/week: OR=1.24, 95% CI: 1.11-1.38), physical inactivity ( OR=1.09, 95% CI: 1.02-1.17) were risk factors for diabetes, while aging (30-39 years old: OR=1.53, 95% CI: 1.31-1.79; 40-49 years old: OR=2.36, 95% CI: 2.01-2.76; 50-59 years old: OR=3.03, 95% CI: 2.58-3.55; 60-69 years old: OR=4.22, 95% CI: 3.58-4.97; 70-79 years old: OR=5.05, 95% CI: 4.23-6.04; 80 years old and above: OR=6.08, 95% CI: 4.86-7.61), nationality: (Li minority group: OR=1.18, 95% CI: 1.10-1.28; other ethnic groups: OR=1.40, 95% CI: 1.14-1.71), urban ( OR=1.12, 95% CI: 1.04-1.19), central obesity ( OR=1.72, 95% CI: 1.62-1.83), higher frequency of alcohol consumption (1-4 day/week: OR=1.12, 95% CI: 1.01-1.23; 5-7 day/week: OR=1.35, 95% CI: 1.22-1.49) were risk factors for pre-diabetes. Conclusions:The epidemic situation of diabetes and pre-diabetes among adult residents in Hainan Province was not optimistic. In order to control the development of abnormal blood glucose, measures and targeted health education should be carried out to strengthen the screening, treatment, and management of people with abnormal blood glucose among different populations.

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