Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective To evaluate the clinical efficacy of Targeted Ⅱ Formula(composed of Astragali Radix,Pseudostellariae Radix,Ophiopogonis Radix,Asparagi Radix,Glehniae Radix,Rehmanniae Radix,Ligustri Lucidi Fructus,Ecliptae Herba,Polygonati Rhizoma,Polygonati Odorati Rhizoma,etc.)in delaying epidermal growth factor receptor(EGFR)tyrosine kinase inhibitors(TKIs)resistance in EGFR mutation-positive non-small cell lung cancer(NSCLC)patients with.Methods Between January 1,2019 and June 30,2023,64 NSCLC patients with qi-yin deficiency syndrome treated at Shanghai Pulmonary Hospital(affiliated to Tongji University)were stratified based on their 1-month post-targeted therapy response and then were randomized into a treatment group(receiving Icotinib plus Targeted Ⅱ Formula decoction)or a control group(receiving Icotinib alone).Patients were followed-up until disease progression.Progression-free survival(PFS),adverse events,quality of life,and immune function were assessed.Results(1)In terms of PFS,the mean PFS in the treatment group was(18.78±7.17)months,while that in the control group was(11.76±4.26)months.The PFS in the treatment group was significantly longer than that in the control group,with a statistically significant difference(P＜0.001);the 1-year PFS rate in the treatment group was 87.50％(28/32),significantly higher than the 38.71％(12/31)in the control group,with a statistically significant difference(P＜0.001).(2)In terms of adverse reactions,the incidence of targeted drug-related rash in the treatment group was 68.75％(22/32),lower than that of the control group(80.65％,25/31),but the difference between the two groups was not statistically significant(P＞0.05).In terms of rash grading,both groups primarily had Grade 1 rashes,and the treatment group had fewer Grade 2 and 3 rashes than the control group,indicating that the severity of rashes was more pronounced in the control group.(3)In terms of quality of life,after treatment,the Karnofsky Performance Status(KPS)score in the treatment group significantly increased compared to before treatment(P＜0.05),while the control group showed no significant increase compared to before treatment(P＞0.05).The intergroup comparison revealed that the increase of KPS scores in the treatment group was significantly greater than that in the control group,with a statistically significant difference(P＜0.05).(4)In terms of immune function,after treatment,the levels of CD8+T lymphocytes and interferon-γ(IFN-γ)in peripheral blood were significantly higher in the treatment group than before treatment(P＜0.05),while those in the control group were significantly lower than before treatment(P＜0.05);Intergroup comparisons revealed that the treatment group exhibited a significantly greater reduction in peripheral blood CD8+T lymphocyte and IFN-γ expression levels compared to the control group,with statistically significant differences(P＜0.05).Conclusion This study employed an innovative stratified randomization design to eliminate bias in Icotinib efficacy.The results demonstrate that Targeted Ⅱ Formula effectively delays EGFR-TKI resistance,mitigates adverse events,and improves quality of life in EGFR mutation-positive NSCLC patients with qi-yin deficiency syndrome,supporting its role as an adjuvant therapy in targeted lung cancer treatment.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective:To establish a clinical laboratory diagnostic pathway for hepatitis C covering diagnosis, differential diagnosis, drug toxicity monitoring, and therapeutic and prognostic evaluation, and to explore a new teaching model for laboratory diagnostics based on the clinical laboratory diagnostic pathway.Methods:According to the clinical diagnosis and treatment guidelines for hepatitis C, laboratory testing strategies for different stages of diagnosis and treatment of the disease were formulated to establish a clinical laboratory diagnostic pathway for hepatitis C. The pathway was applied in the teaching for undergraduate medical students of the seven-year program of grade 2019 of The First Clinical College of Wuhan University, with those of grade 2018 as the control to receive traditional teaching. The teaching effect was compared through questionnaires and quizzes in class. The data were analyzed through the t test with the use of SPSS 19.0. Results:A clinical laboratory diagnostic pathway for hepatitis C recognized by clinicians was established, covering the entire process of clinical diagnosis, differential diagnosis, monitoring of drug side effects, and therapeutic and prognostic evaluation. The students of grade 2019 receiving the pathway-based teaching model had significant improvements in teaching quality evaluation indicators ( P<0.05), with the most marked improvement in "having mastered the key and difficult points of this lesson", with a score of (60.90±2.15) points for grade 2018 and (84.80±3.44) points for grade 2019. The total score for teaching evaluation was significantly higher in students of grade 2019 than in those of grade 2018 [(94.02±4.29) vs. (79.21±3.68)] points, P<0.05). Grade 2019 also had a significantly higher classroom quiz score than grade 2018 (94.60±5.63) vs. (78.10±4.92), P<0.01]. Conclusions:We established and applied a clinical laboratory diagnostic pathway of hepatitis C in the teaching model of laboratory diagnostics, which organically integrates laboratory diagnostics and clinical medicine, and significantly improves the quality of teaching.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

OBJECTIVE: To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. METHODS: A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone ( n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups ( P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. RESULTS: No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection ( P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group ( P>0.05), the above scores showed significant differences between different time points ( P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased ( P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group ( P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups ( P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group ( P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group ( P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. CONCLUSION Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.
Humans ; Platelet-Rich Plasma ; Rotator Cuff Injuries/therapy* ; Female ; Male ; Treatment Outcome ; Pain Measurement ; Leukocytes ; Tendon Injuries/therapy* ; Middle Aged ; Ultrasonography ; Ultrasonography, Interventional ; Range of Motion, Articular ; Adult

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Non-small cell lung cancer (NSCLC) ranks the first among malignant tumors in China and even in the whole world. In recent years, the developement of genetic testing technology, particularly tumor gene sequencing, has provided a solid basis for the clinical molecular diagnosis of NSCLC, which has greatly increased the chances of patients benefiting from targeted therapy or immunotherapy, and ultimately extending their survival. Standardizing the use of tumor gene sequencing is crucial for the precision medicine in NSCLC. This paper discusses the normalization of tumor gene sequencing technology in the clinical molecular diagnostic pathway of NSCLC, which may promote the standardized use of tumor gene sequencing technology in targeted therapy or immunotherapy drug selection, toxicity and side effect prediction, efficacy monitoring, recurrence and prognosis evaluation of NSCLC patients. This article discusses the standardization of the application of tumor gene sequencing technology in the clinical molecular diagnosis pathway of NSCLC. Additionally, it offers a foundation for the uniform use of tumor gene sequencing technology in other solid tumors.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Radiation-induced pulmonary fibrosis (RIPF) is one of the most serious late complications after nuclear radiation accident, bone marrow transplantation pretreatment and thoracic tumor radiotherapy. The formation process of RIPF is complicated and the pathogenesis has not been fully elucidated. Recent studies have shown that radiation-induced epithelial-mesenchymal transition (EMT) of lung epithelial cells is an indispensable segment of RIPF. This article reviews the role of radiation-induced lung EMT in the occurrence and development of RIPF and related drugs with EMT as a potential therapeutic target, providing ideas for the development of therapeutic drugs for RIPF in the future.