Transarterial radioembolization (TARE) is a widely utilized therapeutic approach for hepatocellular carcinoma (HCC), however, the clinical implementation is constrained by the stringent preparation conditions of radioembolization agents. Herein, we incorporated the superstable homogeneous iodinated formulation technology (SHIFT), simultaneously utilizing an enhanced solvent form in a carbon dioxide supercritical fluid environment, to encapsulate radionuclides (such as ¹³¹I,¹⁷⁷Lu, or ¹⁸F) with lipiodol for the preparation of radiolipiodol. The resulting radiolipiodol exhibited exceptional stability and ultra-high labeling efficiency (≥99%) and displayed notable intratumoral radionuclide retention and in vivo stability more than 2 weeks following locoregional injection in subcutaneous tumors in mice and orthotopic liver tumors in rats and rabbits. Given these encouraging findings, ¹⁸F was authorized as a radiotracer in radiolipiodol for clinical trials in HCC patients, and showed a favorable tumor accumulation, with a tumor-to-liver uptake ratio of ≥50 and minimal radionuclide leakage, confirming the feasibility of SHIFT for TARE applications. In the context of transforming from preclinical to clinical screening, the preparation of radiolipiodol by SHIFT represents an innovative physical strategy for radionuclide encapsulation. Hence, this work offers a reliable and efficient approach for TARE in HCC, showing considerable promise for clinical application (ChiCTR2400087731).

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.

Objective To investigate the utility of dual-energy computed tomography(DECT)virtual non-contrast(VNC)images instead of true non-contrast(TNC)images in the quantitative analysis of emphysema.Methods A retrospective selection was con-ducted on 59 patients who underwent chest CT plain scan plus dual-phase enhanced scan on APEX-CT.VNC images of arterial phase(VNCart)and venous phase(VNCven)were generated on AW4.7 workstation.Volume CT dose index(CTDIvol)and dose length product(DLP)were recorded respectively.In a double-blind manner,two physicians graded the severity of each patient's emphysema according to the Fleischner Society's emphysema visual classification system.The"digital lung"detection and analysis platform was used to quantitatively measure emphysema at three thresholds(-950 HU,-930 HU and-910 HU),and the difference in meas-urement results between VNC images and TNC images was compared.Quantitative differences in low attenuation volume(LAV),percentage of low attenuation area(LAA%)and mean lung density(MLD)at the-950 HU threshold were compared using Bland-Altman plots.Results Using TNC images as the standard,there was no significant difference in the results of the visual classifica-tion evaluation of emphysema between TNC and VNC images(χ2=2.80,P=0.247).In quantitative measurement,there was no significant difference in total lung volume(TLV)(χ2=3.26,P=0.196)between the three groups images.Compared to TNC ima-ges,there were no statistically significant differences in LAV,LAA%and MLD of VNCven images at 15th percentile lung density(Perc 15%)and different thresholds(P>0.05).Compared to the TNC mode,the VNC mode could reduce the effective dose(ED)by approximately 32.6%.Conclusion The use of DECT VNCven images on chest has the potential to replace TNC for the quantitative analysis of emphysema,thereby streamlining scans and reducing radiation dose.

Objective To explore the value of deep learning image reconstruction(DLIR)algorithm to improve the quality of low keV monochromatic portal vein images of energy spectrum CT.Methods Fifty patients who underwent enhanced upper abdominal energy spectrum CT scan were selected.Mixed-model adaptive statistical iterative reconstruction-Veo(50%ASIR-V)algorithm and high-deep learning image reconstruction(DLIR-H)algorithm were used to obtain monochromatic images at 40-70 keV(with intervals of 10 keV).The CT and standard deviation(SD)values of the portal vein trunk,left and right branches,and erector spinae muscle were measured in the transverse position,and the signal-to-noise ratio(SNR)and portal vein contrast-to-noise ratio(CNR)were calculated for objective evaluation.The portal vein image quality between the two algorithms and different energy was subjectively scored by two physicians.Results In terms of objective evaluation:compared with 50%ASIR-V,the CNR and SNR of portal vein in monochromatic DLIR-H images at the same keV between 40-70 keV energy levels were increased while the SD value was decreased(P＜0.05),and the CT value was unchanged;there was no statistical difference in the magnitude of change in CNR between the two algorithms at different energy levels(P＞0.05);there was a statistically significant difference in the magnitude of change in SNR and SD value(P＜0.05)and the magnitude of change was the largest at 40 keV;comparison between different energy levels of DLIR-H,the CNR and SD value of 40 keV DLIR-H were the highest(P＜0.05),and there was no significant difference in the SNR(P＞0.05).In terms of subjective evaluation:there was no significant difference between the subjective scores of the two algorithms at the same keV from 40-70 keV(P＞0.05),and the two reconstruction algorithms at 40 keV and 50 keV had the highest subjective scores between different keV.Conclusion The DLIR algorithm can reduce the noise of low keV monochromatic images,improve the image quality of portal vein.

Objective To investigate the utility of dual-energy computed tomography(DECT)virtual non-contrast(VNC)images instead of true non-contrast(TNC)images in the quantitative analysis of emphysema.Methods A retrospective selection was con-ducted on 59 patients who underwent chest CT plain scan plus dual-phase enhanced scan on APEX-CT.VNC images of arterial phase(VNCart)and venous phase(VNCven)were generated on AW4.7 workstation.Volume CT dose index(CTDIvol)and dose length product(DLP)were recorded respectively.In a double-blind manner,two physicians graded the severity of each patient's emphysema according to the Fleischner Society's emphysema visual classification system.The"digital lung"detection and analysis platform was used to quantitatively measure emphysema at three thresholds(-950 HU,-930 HU and-910 HU),and the difference in meas-urement results between VNC images and TNC images was compared.Quantitative differences in low attenuation volume(LAV),percentage of low attenuation area(LAA%)and mean lung density(MLD)at the-950 HU threshold were compared using Bland-Altman plots.Results Using TNC images as the standard,there was no significant difference in the results of the visual classifica-tion evaluation of emphysema between TNC and VNC images(χ2=2.80,P=0.247).In quantitative measurement,there was no significant difference in total lung volume(TLV)(χ2=3.26,P=0.196)between the three groups images.Compared to TNC ima-ges,there were no statistically significant differences in LAV,LAA%and MLD of VNCven images at 15th percentile lung density(Perc 15%)and different thresholds(P>0.05).Compared to the TNC mode,the VNC mode could reduce the effective dose(ED)by approximately 32.6%.Conclusion The use of DECT VNCven images on chest has the potential to replace TNC for the quantitative analysis of emphysema,thereby streamlining scans and reducing radiation dose.

Objective To explore the value of deep learning image reconstruction(DLIR)algorithm to improve the quality of low keV monochromatic portal vein images of energy spectrum CT.Methods Fifty patients who underwent enhanced upper abdominal energy spectrum CT scan were selected.Mixed-model adaptive statistical iterative reconstruction-Veo(50%ASIR-V)algorithm and high-deep learning image reconstruction(DLIR-H)algorithm were used to obtain monochromatic images at 40-70 keV(with intervals of 10 keV).The CT and standard deviation(SD)values of the portal vein trunk,left and right branches,and erector spinae muscle were measured in the transverse position,and the signal-to-noise ratio(SNR)and portal vein contrast-to-noise ratio(CNR)were calculated for objective evaluation.The portal vein image quality between the two algorithms and different energy was subjectively scored by two physicians.Results In terms of objective evaluation:compared with 50%ASIR-V,the CNR and SNR of portal vein in monochromatic DLIR-H images at the same keV between 40-70 keV energy levels were increased while the SD value was decreased(P＜0.05),and the CT value was unchanged;there was no statistical difference in the magnitude of change in CNR between the two algorithms at different energy levels(P＞0.05);there was a statistically significant difference in the magnitude of change in SNR and SD value(P＜0.05)and the magnitude of change was the largest at 40 keV;comparison between different energy levels of DLIR-H,the CNR and SD value of 40 keV DLIR-H were the highest(P＜0.05),and there was no significant difference in the SNR(P＞0.05).In terms of subjective evaluation:there was no significant difference between the subjective scores of the two algorithms at the same keV from 40-70 keV(P＞0.05),and the two reconstruction algorithms at 40 keV and 50 keV had the highest subjective scores between different keV.Conclusion The DLIR algorithm can reduce the noise of low keV monochromatic images,improve the image quality of portal vein.

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.

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.

Objective To explore the effect of deep learning image reconstruction(DLIR)algorithm combined with"double low"[low voltage(kV)and low contrast agent dosage]technique on the image quality of coronary computed tomography angiography(CCTA)in overweight patients compared with adaptive statistical iterative reconstruction(ASIR-V)and filtered back projection(FBP).Methods Fifty-two patients with body mass index(BMI)between 25.1 kg/m2and 28 kg/m2 who underwent CCTA scanning were prospectively selected,all of whom scanned on a GE Revolution APEX-CT with a tube voltage of 80 kV,a smart mA(500-1 300 mA),a noise index of 30,and a contrast dosage of 0.5 mL/kg;four groups of images were reconstructed for each patient,FBP,50％ASIR-V,DLIR-M,and DLIR-H.The CT and SD values of the aorta(AO)root,the proximal segment of the right coronary artery(RCA),the left circumflex(LCX),the left anterior descending branch(LAD)and the pericardial fat were measured,and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.Two doctors experienced in the diagnosis of cardiovascular disease were selected to subjectively score the reconstructed images using a double-blind method.The SD value,SNR value,CNR value and subjective scores of images in the four groups were compared.Results In the objective image quality evaluation,there were statistically significant differences in SD value,SNR value and CNR value of reconstructed images in the four groups(P＜0.05).As the four groups of reconstruction algorithms FBP,50％ASIR-V,DLIR-M,and DLIR-H were changed sequentially,the image SD value gradually decreased,the SNR value and CNR value gradually increased,and the DLIR-H group had the lowest SD value and the highest SNR and CNR values.In the subjective image quality evaluation,the subjective scores of the two doctors had good consistency(Kappa value=0.900),and the difference between them was statistically significant(P＜0.001).The subjective scores of DLIR-M and DLIR-H groups were higher.Conclusion DLIR algorithm combined with"double-low"technique can significantly improve the CCTA image quality of overweight patients,which is better than 50％ASIR-V and FBP.

Modulating Tankyrases (TNKS), interactions with USP25 to promote TNKS degradation, rather than inhibiting their enzymatic activities, is emerging as an alternative/specific approach to inhibit the Wnt/β-catenin pathway. Here, we identified UAT-B, a novel neoantimycin analog isolated from Streptomyces conglobatus, as a small-molecule inhibitor of TNKS-USP25 protein-protein interaction (PPI) to overcome multi-drug resistance in colorectal cancer (CRC). The disruption of TNKS-USP25 complex formation by UAT-B led to a significant decrease in TNKS levels, triggering cell apoptosis through modulation of the Wnt/β-catenin pathway. Importantly, UAT-B successfully inhibited the CRC cells growth that harbored high TNKS levels, as demonstrated in various in vitro and in vivo studies utilizing cell line-based and patient-derived xenografts, as well as APC^min/+ spontaneous CRC models. Collectively, these findings suggest that targeting the TNKS-USP25 PPI using a small-molecule inhibitor represents a compelling therapeutic strategy for CRC treatment, and UAT-B emerges as a promising candidate for further preclinical and clinical investigations.