Objective To establish an electrical field(EF)stimulation model for Schwann cells(SCs),and to provide a basis for exploring the mechanisms of EF stimulation in promoting proliferation,migration and epithelial-to-mesenchymal transition of SCs.Methods A YC-3 bipolar programmable electrical stimulator and an electrotaxis chamber were used to construct an EF stimulation system to stimulate SCs.In the study,SCs were divided into control group(Ctrl)receiving no EF stimulation and EF group stimulated by continuous constant-voltage EF(100 mV/mm,3 h).The effects of EF stimulation on the proliferation and migration of SCs were analyzed using CCK-8 assay,and wound healing assay+Transwell assay,separately;and its effect on SCs adhesion was observed by analyzing the expressions of E-cadherin and N-cadherin using Western Blot.Results The CCK-8 assay results suggested that the absorbance at 450 nm was significantly higher in EF group than in Ctrl group(P<0.05).The results of wound healing assay+Transwell assay revealed that EF group had higher cell migration efficiency than Ctrl group(P<0.05).Western Blot results showed decreased E-cadherin expression and increased N-cadherin expression in EF group as compared with Ctrl group(P<0.05).Conclusion The improved EF stimulation system for SCs is operable.EF stimulation can promote the proliferation and migration of SCs.The decreased E-cadherin expression and increased N-cadherin expression may be related to the occurrence of epithelial-to-mesenchymal transition in SCs after EF stimulation.

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 establish an electrical field(EF)stimulation model for Schwann cells(SCs),and to provide a basis for exploring the mechanisms of EF stimulation in promoting proliferation,migration and epithelial-to-mesenchymal transition of SCs.Methods A YC-3 bipolar programmable electrical stimulator and an electrotaxis chamber were used to construct an EF stimulation system to stimulate SCs.In the study,SCs were divided into control group(Ctrl)receiving no EF stimulation and EF group stimulated by continuous constant-voltage EF(100 mV/mm,3 h).The effects of EF stimulation on the proliferation and migration of SCs were analyzed using CCK-8 assay,and wound healing assay+Transwell assay,separately;and its effect on SCs adhesion was observed by analyzing the expressions of E-cadherin and N-cadherin using Western Blot.Results The CCK-8 assay results suggested that the absorbance at 450 nm was significantly higher in EF group than in Ctrl group(P<0.05).The results of wound healing assay+Transwell assay revealed that EF group had higher cell migration efficiency than Ctrl group(P<0.05).Western Blot results showed decreased E-cadherin expression and increased N-cadherin expression in EF group as compared with Ctrl group(P<0.05).Conclusion The improved EF stimulation system for SCs is operable.EF stimulation can promote the proliferation and migration of SCs.The decreased E-cadherin expression and increased N-cadherin expression may be related to the occurrence of epithelial-to-mesenchymal transition in SCs after EF stimulation.

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 analyze the effect of the over-the-scope-clip system (OTSC) system in the treatment of iatrogenic gastrointestinal perforation.Methods:Retrospective selection of clinical data from 21 patients with gastrointestinal perforation during endoscopic examination and treatment from May 2016 to December 2023 in the Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University. By analyzing the patient's basic information, perforation cause, perforation diameter, length of hospital stay, post-treatment outcome, complications, and treatment success rate, the effectiveness of using the OTSC system to treat iatrogenic gastrointestinal perforation is comprehensively evaluated, and the influencing factors that may be related to the failure of OTSC system closure are analyzed. Independent sample t-test is used for inter group comparison of metric data that conforms to normal distribution. Fisher's exact probability test was used for inter group comparison of count data.Results:There were 21 cases of acute iatrogenic gastrointestinal perforation, including 12 males and 9 females, aged (61.95±15.47) years, 4 cases of duodenal perforation, 10 cases of gastric perforation, and 7 cases of colon perforation. The diameter of the perforation was (1.18±0.56)cm, and the perforation sealing time was (8.29±4.42) min. Among the 21 patients, 5 cases of occlusion failed, of which 2 cases of sigmoid colon perforation were transferred to surgery in time due to OTSC insufficiency, 3 cases were perforated in duodenal colon and colonic splenic area, 3 cases of delayed abdominal infection after OTSC system occlusion, 16 cases of OTSC system closure and perforation without complications such as delayed perforation, and the average length of hospital stay of patients in the OTSC system wound closure group was (11.56±6.53) d, which was shorter than that in the OTSC system closure failure group ((38.00±21.34) d), The proportion of passive perforation in the failure group (100%, 5/5) > the success group (31%, 5/16).The occlusion success rate of passive perforation in the OTSC system (50%, 5/10) < active perforation (100%, 11/11), the diameter of perforation of the failure group ((1.72±0.80)cm) was significantly > that of the successful group ((1.06±0.49)cm), the diameter of perforation ≥2.0 cm in the failure group (80.0%, 4/5) was significantly > that of the successful group (12.5%, 2/16), the proportion of duodeno-colonic perforation in the failure group (100.0%, 5/5) > the success group (37.5%, 6/16), the difference was statistically significant ( P values were 0.049, 0.012, 0.012, 0.037, 0.011, and 0.035, respectively). Conclusion:The closure of acute iatrogenic gastrointestinal perforation by the OTSC system has significant therapeutic effects and can reduce the probability of surgical conversion due to perforation to a certain extent. It is worth promoting and applying. The diameter of the perforation (≥2 cm), the perforation method (passive perforation), and the perforation site (the difficult part of duodenum-colon operation) may be the relevant influencing factors for the failure of the occlusion of the OTSC system.

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.

With the growing influence of slow population growth and population aging, China has established the birth policy and issued a series of documents to promote maternal and fetal health and improve the birth rate. With the increase in prevalence of birth defects, timely diagnosis and intervention in utero provide possibilities to reduce unnecessary abortions and offer better prognosis. Congenital heart disease (CHD), as one of the most common congenital birth defects, is the leading cause of mortality in patients aged <5 years, and brings a heavy burden to both the affected families and society. Fetuses with CHD are associated with an increased risk of pregnancy-related complications and premature birth, and children with CHD typically face growth and developmental problems even after the correction of malformation. Therefore, management including diagnosis, treatment, and rehabilitation throughout the fetal period into childhood and even adulthood is essential for children with CHD. Based on the rapid advances in intrauterine and perinatal medicine and an in-depth collaboration among obstetrics and pediatrics, a novel diagnosis and treatment system has been established for the management of CHD in the past 2 decades in Shanghai Xinhua Hospital. This Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease model provides prenatal diagnosis, intrauterine intervention, delivery room service and neonatal therapies, and postintrauterine rehabilitation for children with CHD. We have developed a four-dimensional spatiotemporal image correlation echocardiography and a three-dimensional cardiac virtual endoscopy system for the intrauterine diagnosis of CHD, dramatically raising the diagnostic utility. Our innovative and independent newborn-intervention technique has effectively reduced the re-intervention rate in patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. In 2018, Xinhua Hospital independently performed the case of fetal aortic valvuloplasty in Asia through a multidepartment collaborative effort. All children treated in this system achieved biventricular circulation and a better long-term postoperative outcome. We also have conducted postoperative rehabilitation therapy to promote the development and health of children with CHD. The practice of Xinhua model has reduced unnecessary abortion of CHD fetuses, reduced the mortality rate associated with critical CHD, and improved the mid- and long-term prognosis in CHD, which is essential to promote the fertility level and children’s health. Furthermore, translational medicine platform and the birth cohort Early Life Plan was constructed to explore the origins of major developmental diseases and establish an early intervention model in CHD. This practice of assessment of the intrauterine system has been expanded to other congenital defects in Xinhua Hospital, and sequential treatment of more than 2,000 cases has been completed to date. Based on practice in intrauterine management of CHD and other diseases, the concept of Intrauterine Pediatrics was proposed as a first to emphasize early prevention and intervention of childhood diseases and promote a comprehensive lifecycle service for children. The development and evolution of this system requires further attention not only from researchers but also from the government and global medical communities.

[Objective]To explore the pathogenesis of lung cancer from the perspective of Xuanfu,and to analyze the theoretical basis and clinical significance of YE Tianshi's acrid theory in the treatment of lung cancer.[Methods]According to the theory of Xuanfu,this paper discussed its influence on the occurrence,development and metastasis of lung cancer from three aspects:the loss of opening and closing of Xuanfu,the loss of"Xuanfu-collaterals"and the loss of"Xuanfu Qi-liquid".By reading YE Tianshi's A Guide to Clinical Practice with Medical Records,YE Tianshi's"acrid"theory and its differentiation and treatment experiences for cancer were summarized,and demonstrated it with a medical record.[Results]Xuanfu opening and closing loss,collaterals loss,Qi and liquid loss,the body's healthy Qi deficiency,Qi stagnation,blood stasis,phlegm and toxin interaction,led to the occurrence and development of lung cancer;YE Tianshi was good at using acrid drugs in the treatment of cancer,and advocated that acrid drugs could dispel wind,move Qi,dissolve phlegm,break concretions and tonify deficiency.In the elderly patients mentioned in the medical records,lung cancer recurred due to deficiency of Qi and stagnation of Xuanfu,phlegm and blood stasis.Therefore,the treatment of acridity was given,and lung cancer was alleviated.[Conclusion]YE Tianshi's"acrid"theory is suitable for different stages of lung cancer treatment by regulating the opening and closing of Xuanfu,which is worthy of clinical promotion.

Objective The pathogenesis of acute mountain sickness(AMS)is still unclear.This study intends to continuously record the changes of physiological parameters of the Han population in the plain after high altitude exposure,and screen out the difference between AMS and high altitude acclimatization.Methods A total of 46 healthy Han people in the plain were recruited to establish a study cohort.The basic physiological and hematological parameters were measured at the time of in the plain(500 m above sea level,CQ),on the second day(LS1),the 23rd day(LS2),the 44th day(LS3)and the 65th day(LS4)after reaching the plateau.According to the 2018 version of the Louise Lake Acute Mountain Sickness Scoring System(LLS)scale score at LS2,they were divided into the AMS group and the non-AMS group,and the differences and continuous changes of parameters between groups were analyzed.Results At any time point,there was no significant difference in basic physiological and hematological parameters such as oxygen saturation,heart rate(HR),blood pressure(BP),red blood cell count(BRC),hemoglobin(Hb),and hematocrit(HCT)between the two groups(P＞0.05).Among the blood biochemical parameters,only albumin(ALB)was statistically significant at the time of LS2 and LS3 between the AMS group and the non-AMS group(P＜0.05),and the in-crease of ALB was significantly correlated with the decrease of AMS incidence(OR=0.676,95％CI:0.511-0.894,P=0.006).Conclusion Blood oxygen saturation,BRC,hemoglobin level Hb,Hb may have no predictive value for AMS,while ALB may be a good predictor for AMS,and its changes may play an important role in a-voiding AMS and promoting high altitude acclimatization.

Objective To develop a nomogram based on pulmonary nodules preoperative CT signs and 3D quantitative parameters for predicting mediastinal lymph node metastases in patients with clinical stage ⅠA lung adenocarcinoma.Methods The imaging data of 164 patients who underwent preoperative CT scan and systematic lymph node dissection were analyzed retrospectively.Commercially available AI software was used to extract 3D quantitative parameters of pulmonary nodules automatically,and CT signs of pulmonary nodules were analyzed.Logistic regression was used to explore the role of these parameters in predicting pathological nodal involvement.A nomogram prediction model was established,then discrimination and calibration of the model were evaluated.Results Among 164 enrolled patients,19(11.6％)were tested positive for mediastinal lymph node metastases at pathology review.The nomogram incorporated spiculation,lobulation,the largest cross-sectional area,and carcinoembryonic antigen(CEA).The model showed great discrimination and calibration,with a C-index of 0.942[95％confidence interval(CI)0.923-0.961].The predicted value of the model fitted well with the actual observed value on the calibration curve.Conclusion The nomogram prediction model based on preoperative CT signs,3D quantitative parameters,and CEA can estimate the probability of mediastinal lymph node metastases in clinical stage ⅠA lung adenocarcinoma.This model may help with clinical decision-making and individualized evaluation.