Objective:To investigate the impacts of different surgical fixation sequences on the post-operative functional outcomes in patients with ankle fracture combined with Lisfranc injury.Methods:A retrospective study was conducted to analyze the 20 patients with ankle fracture and concomitant Lisfranc injury who had been treated between January 2014 and December 2023 at Department of Orthopedics, The 82nd Group Army Hospital of PLA. The cohort included 16 males and 4 females, with an age of (41.3±12.3) years. Patients were divided into 2 groups based on their surgical sequence: an ankle-first group ( n=12) treated first by open reduction and internal fixation of the ankle fracture and then by additional incision reduction and fixation of the Lisfranc injury, and a foot-first group ( n=8) treated first by open reduction and fixation of the Lisfranc injury and then by another incision for open reduction and internal fixation of the ankle fracture. The surgical time, intraoperative fluoroscopy frequency, postoperative Lisfranc articular step-off, postoperative arch height index (AHI), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and incidence of traumatic arthritis at 1 year after surgery were compared between the 2 groups. Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (18.3±3.2) months after surgery. There was no statistically significant difference in surgical time or incidence of traumatic arthritis between the 2 groups ( P>0.05). In the ankle-first group, the intra-operative fluoroscopy frequency [(16.6±2.6) times] was significantly higher than that in the foot-first group [(13.6±2.5) times], and the postoperative Lisfranc articular step-off [0.0 (0.0, 0.8) mm], postoperative AHI [0.31 (0.29, 0.32)], and AOFAS ankle-hindfoot score at 1 year after surgery [(85.2±2.2) points] were all significantly better than those in the foot-first group [(1.3±1.3) mm, 0.29±0.01, and (81.0±4.1) points] (all P<0.05). Conclusion:In the treatment of ankle fracture combined with Lisfranc injury, prioritizing ankle fixation provides a stable biomechanical foundation for subsequent midfoot reduction, leading to improved functional recovery and radiographic outcomes, but requires increased intraoperative fluoroscopy.

Ileocecal duplication is a rare congenital gastrointestinal abnormality,with lesions predominantly localized near the ileocecal valve and manifesting as cystic structures.Clinically,it presents with diverse symptoms,including abdominal pain,vomiting,abdominal mass,etc.However,symptoms such as intussusception and appendicitis are easily confused with it.Furthermore,the imaging features of ileocecal duplication are nonspecific,which further increases the risk of misdiagnosis.Treatment options include laparoscopic surgery and laparotomy.Notably,laparoscopic surgery is highly feasible,especially for infants and young children,and achieves a prognosis comparable to that of laparotomy.In the case report presented in this study,a 1-year-old male patient was admitted to the hospital due to abdominal pain.Definitive diagnosis could not be established through comprehensive imaging examinations,and the diagnosis of ileocecal duplication cyst was ultimately confirmed surgically.Additionally,the diagnosis,imaging features,treatment,and prognosis of ileocecal duplication are systematically collated and summarized.

Ileocecal duplication is a rare congenital gastrointestinal abnormality,with lesions predominantly localized near the ileocecal valve and manifesting as cystic structures.Clinically,it presents with diverse symptoms,including abdominal pain,vomiting,abdominal mass,etc.However,symptoms such as intussusception and appendicitis are easily confused with it.Furthermore,the imaging features of ileocecal duplication are nonspecific,which further increases the risk of misdiagnosis.Treatment options include laparoscopic surgery and laparotomy.Notably,laparoscopic surgery is highly feasible,especially for infants and young children,and achieves a prognosis comparable to that of laparotomy.In the case report presented in this study,a 1-year-old male patient was admitted to the hospital due to abdominal pain.Definitive diagnosis could not be established through comprehensive imaging examinations,and the diagnosis of ileocecal duplication cyst was ultimately confirmed surgically.Additionally,the diagnosis,imaging features,treatment,and prognosis of ileocecal duplication are systematically collated and summarized.

Objective To construct and validate a predictive model for gastric precancerous le-sions based on urea breath test,serum pepsinogen(PG)and gastrin-17(G-17).Methods Partici-pants who underwent endoscopic screening for upper gastrointestinal tumors were retrospectively en-rolled as study subjects.Using random function,all participants were divided into training cohort of 2,788 cases(comprising 1,290 cases in precancerous lesion group and 1,498 cases in control group)and validation cohort of 1,194 cases(comprising 581 cases in precancerous lesion group and 613 cases in control group)at a ratio of 7 to 3.A simple model was established based on urea breath test,PG and G-17.Clinical data between the precancerous lesion group and the control group in the training cohort were compared.A predictive model for gastric precancerous lesions was constructed u-sing multifactorial Logistic regression analysis,and a scoring model for gastric precancerous lesions(the complete model)was developed based on this predictive model.The complete model,the simple model,the new ABC method,and the Li's score were all included in the validation cohort to compare the predictive performance of the four models.Results Multifactorial Logistic regression analysis indicated that male,smoking,positive Helicobacter pylori(Hp)infection,PG Ⅱ ≥10.19 μg/L,the ratio of PG Ⅰ to PG Ⅱ(PGR)≤11.87,and G-17 ≥3.82 pmol/L were independent risk factors for gastric precancerous lesions(P＜0.05).A predictive model for gastric precancerous lesions was constructed based on these risk factors,and the complete model was established based on the predic-tive model.The total score ranged from 0 to 12(with 6 to 12 indicating a high-risk population for gastric precancerous lesions and 0 to 5 indicating a low-risk population).When the complete model,the simple model,the new ABC method,and the Li's score were included in the validation cohort for comparison,the predictive values of the complete model and the simple model were similar.Both models demonstrated higher sensitivity,specificity,positive predictive value,negative predictive value,and accuracy compared to the new ABC method and the Li's score.Furthermore,the diag-nostic value of the simple model in the high-sensitivity region was slightly superior to that of the com-plete model.Conclusion The simple model constructed based on the urea breath test,PG and G-17 exhibits favorable predictive efficacy,calibration,and clinical utility,and is of positive signifi-cance for the early identification of patients with gastric precancerous lesions.

Ubiquitination is a crucial post-translational modification that is extensively involved in the regulation of protein activity,signal transduction,and the maintenance of genomic stability.As an important member of the deubiquitinating enzyme(DUB)family,ubiquitin-specific protease 11(USP11)dynamically regulates the stability and function of key tumor proteins by targeting specific substrates for deubiquitination.This,in turn,influences various biological behaviors of tumor cells,including proliferation,apoptosis,migration,invasion,metastasis,and drug resistance,ultimately exhibiting a dual role in either promoting or inhibiting cancer.This article systematically reviewed the relevant research progress on the role of USP11 in tumorigenesis and development and provided an in-depth analysis of the specific mechanisms by which USP11 participates in cellular biological behav-iors,aiming to offer a theoretical basis for the future development of small-molecule inhibitors targeting USP11,the formulation of combination drug strategies,and the identification of effective biomarkers.

Objective:To investigate the impacts of different surgical fixation sequences on the post-operative functional outcomes in patients with ankle fracture combined with Lisfranc injury.Methods:A retrospective study was conducted to analyze the 20 patients with ankle fracture and concomitant Lisfranc injury who had been treated between January 2014 and December 2023 at Department of Orthopedics, The 82nd Group Army Hospital of PLA. The cohort included 16 males and 4 females, with an age of (41.3±12.3) years. Patients were divided into 2 groups based on their surgical sequence: an ankle-first group ( n=12) treated first by open reduction and internal fixation of the ankle fracture and then by additional incision reduction and fixation of the Lisfranc injury, and a foot-first group ( n=8) treated first by open reduction and fixation of the Lisfranc injury and then by another incision for open reduction and internal fixation of the ankle fracture. The surgical time, intraoperative fluoroscopy frequency, postoperative Lisfranc articular step-off, postoperative arch height index (AHI), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and incidence of traumatic arthritis at 1 year after surgery were compared between the 2 groups. Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (18.3±3.2) months after surgery. There was no statistically significant difference in surgical time or incidence of traumatic arthritis between the 2 groups ( P>0.05). In the ankle-first group, the intra-operative fluoroscopy frequency [(16.6±2.6) times] was significantly higher than that in the foot-first group [(13.6±2.5) times], and the postoperative Lisfranc articular step-off [0.0 (0.0, 0.8) mm], postoperative AHI [0.31 (0.29, 0.32)], and AOFAS ankle-hindfoot score at 1 year after surgery [(85.2±2.2) points] were all significantly better than those in the foot-first group [(1.3±1.3) mm, 0.29±0.01, and (81.0±4.1) points] (all P<0.05). Conclusion:In the treatment of ankle fracture combined with Lisfranc injury, prioritizing ankle fixation provides a stable biomechanical foundation for subsequent midfoot reduction, leading to improved functional recovery and radiographic outcomes, but requires increased intraoperative fluoroscopy.

Objective:To investigate the effect of sinusoidal alternating electromagnetic field(SEMF)on fracture healing and its mechanism.Methods:Femoral fracture model was established using specific pathogen free male Wistar rats.Thirty rats were randomly divided into the control and SEMF groups with 15 rats in each group.The SEMF group was given 50 Hz 1.8 mT for 90 min every day,while the control group was not treated.X-ray examinations were performed every two weeks to determine the formation of bone scabs.Three rats from both groups were sacrificed after 2 and 4 weeks of treatment.Protein was extracted from the fractured femurs,and the expression of type Ⅰ collagen(COL-1),osterix(OSX),Runt-related transcription factor 2(RUNX2),and vascular endothelial growth factor(VEGF)was detected by Western blotting.After 8 weeks,the femur on the operated side was taken for micro-CT scanning to observe fracture healing,angiography to observe blood vessel growth,and organs such as hearts,livers,spleens,lungs,and kidneys were taken for safety evaluation by hematoxylin-eosin staining(HE staining).Results:The bone scab scores of the SEMF group were significantly higher than those of the control group after 2,4,6,and 8 weeks of treatment(all P<0.01).The fracture healing of the SEMF group was better than that of the control group after 8 weeks,and the bone volume scores of the two groups were 0.243±0.012 and 0.186±0.008,respectively(P<0.01);the number of blood vessels in the SEMF group was also more than that of the control group after 8 weeks.Western blotting results showed that the expressions of COL-1,OSX,RUNX2,and VEGF were higher in the SEMF group than those in the control group after 2 and 4 weeks of treatment(all P<0.05).HE staining showed that histopathological results of the examined organs were normal in both groups.Conclusion:SEMF can accelerate fracture healing by promoting the expression of osteogenic factors and vascular proliferation without significant adverse effects.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

As a prescription for tonifying kidney yang， Youguiwan accords with the pathogenesis of osteoarthritis. Professor LIU Yuan-lu from the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine found that modified Youguiwan had a significant effect on the clinical conservative treatment of osteoarthritis pain with Chinese medicine. There are teams studying the mechanism of Youguiwan in the treatment of osteoarthritis in China， but the profound study of the compound needs the mechanism of each component as support. Youguiwan contains 10 kinds of Chinese medicine， including Rehmanniae Radix Praeparata， Aconiti Lateralis Radix Praeparata， Cinnamomi Cortex， Dioscoreae Rhizoma， Corni Fructus， Cuscutae Semen， Angelicae Sinensis Radix， Eucommiae Cortex， Cervi Cornus Colla， and Lycii Fructus. With more and more attention to the study of Chinese medicine monomer， the amount of related research in this field is increasing. Therefore， it is of great significance to summarize the mechanism of Youguiwan in the treatment of osteoarthritis. Based on the sovereign， minister， assistant， and guide of Chinese medicine in Youguiwan， this paper used China National Knowledge Infrastructure （CNKI）， Pharmacopoeia of the People's Republic of China （2020 edition Vol. 1）， and ChemicalBook platform to understand the active components of each kind of Chinese medicine， and used PubMed to search. The latest research progress of effective monomers that had an intersection with the mechanism of osteoarthritis was summarized， and there were five pharmacological effects including anti-inflammation， pain inhibition， chondrocyte apoptosis， oxidative stress， and extracellular matrix degradation， involving several signaling pathways. The theory of sovereign， minister， assistant， and guide and the molecular mechanism were integrated and discussed， respectively， and finally， they were combined with traditional Chinese medicine theory， providing theoretical references for further study in this direction.