Pelvic fractures represent severe clinical trauma, accounting for 3.0%-8.0% of all fractures. They are predominantly caused by high-energy violence, with over half of cases involving concomitant injuries or polytrauma. Based on the mechanism of injury (low-energy vs high-energy violence), pelvic fractures can be classified into stable and unstable types. The disability rate caused by pelvic fractures ranges from 50.0% to 60.0%, with the most severe complications including traumatic hemorrhagic shock and pelvic organ injuries. Improper management can lead to a mortality rate of 13.0%-22.6%. Therefore, early intervention must strictly adhere to the principles of Advanced Trauma Life Support (ATLS), prioritizing lifesaving measures and stabilizing vital signs before proceeding with pelvic fracture related examinations and interventions. If it is confirmed that the shock is caused by pelvic fracture-related hemorrhage, standardized resuscitation procedures must be implemented. The content of this consensus is based on current evidence-based medical literature; in the absence of clear evidence, recommendations are provided by the consensus development group.

Onychophagia, also known as chronic habitual nail-biting behavior, is a behavioral disorder characterized by repeatedly biting nails. It can not only cause damage to nails and cuticles, but also lead to oral diseases such as malocclusion, gingivitis, periodontitis, and temporomandibular joint dysfunction. The disease also exerts negative effects on patients′ psychological and social functioning, leading to feelings of shame and a decline in quality of life.Its diagnosis mainly relies on detailed medical history collection, observation of the patient′s nail-biting behavior and comprehensive examination of the fingernails (toenails) along with general skin examination. Differential diagnosis should include onychodystrophy, onychotillomania, onychomycosis (fungal infection), nail psoriasis, nail lichen planus, immune-mediated vasculitis and subungual melanoma. The treatment for onychophagia includes psychological behavior therapy, drug therapy, and traditional Chinese medicine therapy. Evidence for the treatment of onychophagia primarily comes from case reports. Multi-center, randomized controlled trials are needed to further validate the efficacy of these treatments, thereby providing a scientific basis for optimizing the treatment of onychophagia. This paper systematically reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatment of onychophagia, providing reference for clinical diagnosis and treatment.

To examine cerebellar morphological differences between individuals with autism spectrum disorder (ASD) and typically developing (TD) controls using multicenter structural MRI data and validate the cross-site robustness of the results.

This study included 2 147 participants (aged 6-35 years; 1 030 cases of ASD, 1 117 cases of TD) from 28 sites. Intracranial volume effects were regressed out to obtain residual cerebellar volumes. A linear mixed-effects (LME) model was applied with group, sex, and age as fixed effects and scanning sites as random effects. Estimated marginal means (EMMeans) were derived from the LME model for group comparisons. Cross-site consistency was further evaluated using random-effects meta-analysis of effect sizes (Hedges′g).

After controlling for age, sex, and site, the LME model revealed that the residual volume of the left cerebellum in the TD group was significantly larger than that in the ASD group (β=0.515, P=0.0345), while no significant intergroup difference was observed in the right cerebellum (β=0.368, P=0.1280). Age was negatively associated with bilateral cerebellar volumes (β=-0.094, -0.091, P<0.01), and females exhibited smaller volumes than males (β=-0.959, -0.925, P<0.01). The estimated marginal mean comparison further confirmed that the volume of the left cerebellum was significantly reduced in the ASD group compared to the TD group (EMMeans=-0.515, 95%CI: -0.992 to -0.037, P=0.0346), whereas no significant difference in the right cerebellum (EMMeans=-0.368, 95%CI: -0.842 to 0.106, P=0.1277). Meta-analysis demonstrated minimal cross-site heterogeneity (I²=0%) for both hemispheres, with pooled effect sizes of -0.06 (95%CI: -0.14 to 0.03) for the left cerebellum and -0.03 (95%CI: -0.12 to 0.05) for the right cerebellum, indicating the left cerebellar differences have good consistency.

Individuals with ASD exhibit specific reductions in the structure of the left cerebellum, a finding that is robust across multi-center data. These morphdogical changes in the left cerebellum may provide imaging evidence contributing to the understanding of neuropathological mechanisms in ASD.

To explore the impact of blood pressure control strategies on fetal growth restriction (FGR) in preeclampsia (PE) patients with different proteinuria levels.

The data of 199 PE patients admitted to Shanxi Provincial Nuclear Industry 215 Hospital from March 2023 to February 2025 were retrospectively analyzed. According to the level of proteinuria, they were divided into a mild proteinuria group (n=112) and a massive proteinuria group (n=87). Among them, 103 patients had an average blood pressure controlled at 130-139/80-89 mmHg (strict control subgroup) (1 mmHg=0.133 kPa), while 96 cases had an average blood pressure controlled at 140-155/90-105 mmHg (conventional control subgroup). The study aimed to compare the baseline data of patients with different proteinuria levels, compare the incidence of FGR as the primary outcome in each group, analyze influencing factors related to FGR, investigate the interaction between proteinuria and blood pressure control target on FGR, and compare the maternal safety and fetal/neonatal outcomes among groups.

The systolic blood pressure (151.32±5.08)mmHg, diastolic blood pressure (99.65±4.21)mmHg and 24 h urine protein quantification (5.43±1.10)g in the massive proteinuria group were significantly higher than those in the mild proteinuria group [(145.89±4.67)mmHg, (94.56±3.89)mmHg, (1.12±0.26)g] (t=7.829, 8.832, 40.077, all P<0.05). The incidence of FGR in the massive proteinuria group[27.59(24/87)], was significantly higher than that in the mild proteinuria group[12.50%(14/112)] (χ²=7.213, P<0.01). Within the massive proteinuria group, the incidence of FGR in the strictly controlled subgroup [39.02%(16/41)] was higher than that in the conventionally controlled subgroup [17.39%(8/46)] (χ²=5.079, P<0.05). There were statistically significant differences in 24 h urinary protein quantification, systolic blood pressure, diastolic blood pressure and proteinuria stratification between the non-FGR group and the FGR group (t=6.926, 5.804, 6.076, χ²=7.213, all P<0.05). In all PE patients, after adjusting for systolic blood pressure and diastolic blood pressure, 24 h urinary protein quantification (OR=1.603, 95%CI: 1.214-2.117) was a significant influencing factor of FGR (P<0.01). Within the massive proteinuria group, the blood pressure control target (OR=2.079, 95%CI: 1.522-2.839) was a influencing factor of FGR (P<0.01). The interaction analysis showed for proteinuria and blood pressure control target in PE patients, RERI=1.882 (95%CI: 1.054-2.710), S=6.937 (95%CI: 3.258-7.004), AP=0.588 (95%CI: 0.396-0.712). Among FGR cases in patients with both massive proteinuria and strict blood pressure control, 58.8% of the risk was caused by the synergistic effect of these 2 factors. Severe hypertension was observed in 16 patients (18.39%) in the high proteinuria group, significantly higher than the 10 cases (8.93%) in the mild proteinuria group (P<0.05). The birth weight of newborns in the massive proteinuria group [(2 195.03±495.65)g] was lower than that in the mild proteinuria group [(2 569.23±483.26)g] (P<0.01).

The proteinuria level and blood pressure control target of PE patients affect the risk of FGR together. Massive proteinuria is an independent risk factor for FGR, and the use of strict blood pressure control targets in related patients will increase the incidence of FGR.

To explore the evolution of research hotspots and cutting-edge trends in magnetic resonance imaging (MRI) for lung cancer diagnosis in China over the past 35 years.

Literature was retrieved from three major Chinese databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP, published from January 1, 1991, to December 31, 2025. The retrieved literature was screened and deduplicated using NoteExpress. Bibliometric and visual analyses, including annual publication volume, institutional and author collaboration networks, as well as keyword co-occurrence and burst analysis, were conducted using CiteSpace and VOSviewer.

A total of 1 588 articles were eventually included. The annual publication volume showed an overall upward trend, peaking in 2019 with 111 articles. Among them, the second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) was the institution with the highest domestic publication output (34 articles). High-yield authors demonstrated collaborative relationships and formed their own stable research teams, yet cross-team collaborations remained limited. In terms of institutional collaboration, both intra-institutional and cross-institutional cooperation existed, but collaborations among top-tier institutions were relatively scarce. Keyword analysis indicated that in recent years, the research focus of MRI in lung cancer had gradually evolved from functional imaging such as diffusion-weighted imaging to pathological types and radiomics.

Over the past 35 years, research hotspots on MRI in lung cancer have gradually shifted from functional imaging to cutting-edge fields such as radiomics, quantitative imaging, precise detection of pulmonary nodules, and artificial intelligence.

To investigate the clinical utility of echocardiography in guiding the transcatheter aortic valve replacement (TAVR) procedure with the J-VALVE TF system for patients suffering from severe aortic insufficiency (AI), alongside a comprehensive summary of the diagnostic and therapeutic journey.

The diagnosis and treatment data of one patient with severe AI admitted to the Air Force Medical Center on October 29, 2025, were retrospectively analyzed. Preoperative echocardiography was used to accurately assess valve structure (including number, morphology, echogenicity, etc.), the cause of regurgitation (including valve calcification, prolapse, perforation, annular dilatation, etc.) and its severity (including the ratio of regurgitant jet width to left ventricular outflow tract width, regurgitant area and length, Doppler spectra, etc.). Key aortic root dimensions were measured (including valve orifice area, aortic annulus, sinus of Valsalva, sinotubular junction, and ascending aortic diameters) to provide a basis for selecting the appropriate J-VALVE TF prosthesis size. Intraoperative ultrasound served as a real-time " navigation" system, guiding the entire process of device delivery and deployment, and providing immediate assessment of prosthesis position, function, and the presence of paravalvular leakage. Postoperative ultrasound served as the primary follow-up tool to evaluate prosthetic valve function and cardiac chamber reverse remodeling.

The patient experienced chest tightness and shortness of breath one year prior while lying flat at night. Symptoms could be induced by exertion or insomnia, lasted approximately one minute, and could be relieved by taking a deep breath. Echocardiography indicated: aortic developmental anomaly, aortic valve insufficiency with massive regurgitation, dilatation of the aortic sinus, and widening of the ascending aorta. Based on clinical presentation and echocardiographic findings, the patient underwent TAVR using the J-VALVE TF valve system. Intraoperative ultrasound provided real-time guidance during the delivery and deployment of the J-VALVE TF valve, monitoring the deployment process and the relative position of the delivery system. It was used to assess potential impacts on the mitral valve and coronary ostia before deployment and to evaluate prosthetic valve function after deployment. Postoperative assessment focused on the presence of paravalvular leakage, cardiac function, and the recovery of cardiac chamber geometry.

Echocardiography provides critical diagnostic support and is indispensable for the successful implementation of J-VALVE TF valve implantation in patients with severe aortic regurgitation and complex anatomical features.

To explore the clinical characteristics, echocardiographic findings, and diagnostic challenges of low-flow/low-gradient aortic stenosis (LF/LGAS).

A retrospective analysis was conducted on the clinical data and imaging examinations of a LF/LGAS patient presenting with severe mitral regurgitation (MR) admitted to the Department of Cardiology of Northern Jiangsu People′s Hospital on February 26, 2024. Combined with literature review, the causes of misdiagnosis at the initial diagnosis were explored and relevant experiences were summarized.

The patient was a 78-year-old female who was admitted to the hospital due to chest tightness and shortness of breath for 2 years, which worsened with coughing and expectoration for more than 2 months. Transthoracic echocardiography upon admission showed a left ventricular ejection fraction (LVEF) of 33.0%, accompanied by severe functional MR. The EuroSCORE Ⅱ score was 11.2%, indicating a high-risk surgical condition. The mitral valve leaflet was > 10 mm and had good mobility. The initial plan was to perform transcatheter mitral valve edge-to-edge repair. Intraoperative transesophageal echocardiography (TEE) and low-dose dobutamine stress echocardiography (LDDSE) indicated that the aortic valve orifice area was 0.9 cm². Eventually, the main cause was determined as LF/LGAS, and transcatheter aortic valve replacement was performed instead. The valve was in good position after the operation, and no obvious perivalvular leakage or regurgitation was observed. One year later, a re-examination by echocardiography showed mild to moderate MR and the LVEF was 45.0%.

The possibility of LF/LGAS should be considered for patients with aortic stenosis whose clinical manifestations are inconsistent with conventional echocardiographic parameters. Intraoperative TEE combined with LDDSE facilitates definitive diagnosis, guides targeted interventional therapy, and improves patient prognosis.

To explore the clinical characteristics and management strategies of Graves disease (GD) complicated with concurrent Hashimoto′s thyroiditis, and the occurrence of agranulocytosis, thyroid storm, and drug-induced lupus erythematosus (DILE) during the course of treatment with methimazole.

A retrospective analysis was conducted on a 33-year-old woman admitted to the Department of Endocrinology, the Fifth Affiliated Hospital of Zhengzhou University with a thyroid storm complicated by severe granulocytopenia and DILE. Her comprehensive clinical presentation, laboratory evaluations, and therapeutic management were reviewed.

The patient, a 33-year-old woman, presented with significant hyperthyroidism at initial diagnosis, characterized by elevated levels of free triiodothyronine (FT3) (16.23 pmol/L) and free thyroxine (FT4) (45.38 pmol/L), decreased thyroid-stimulating hormone (TSH) levels (0.006 U/L), positive thyrotropin receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb), and increased thyroid iodine uptake (2 h 49.40%, 6 h 80.90%, 24 h 94.10%). Ultrasonography revealed a mildly enlarged thyroid with diffuse heterogeneous hypoechogenicity and slightly increased vascularity, consistent with the clinical presentation of GD complicated by HT, accompanied by granulocytopenia. Methimazole therapy induced myelosuppression (characterized by agranulocytosis, anemia, and thrombocytopenia), leading to secondary acute suppurative tonsillitis and triggering a thyroid storm (BWPS score 45). A bone marrow biopsy revealed hypoplasia of hematopoietic tissue. Key immunological tests were positive for antinuclear antibodies (≥1∶160) and anti-Sm antibodies, suggesting hematologic damage caused by DILE. After discontinuation of methimazole, aggressive antimicrobial therapy, administration of recombinant human granulocyte colony-stimulating factor (G-CSF), glucocorticoids, immunosuppressants, and subsequent I¹³¹ therapy, the patient′s infection was controlled. Complete blood count parameters gradually normalized. Thyroid function converted to subclinical hypothyroidism after I¹³¹ therapy and normalized with levothyroxine supplementation. DILE-related markers (antinuclear antibody titers) decreased, allowing for a reduction in glucocorticoid and immunosuppressive doses, and the patient′s condition remained stable.

Antithyroid drugs (e.g., methimazole) may trigger autoimmune responses, including DILE. In clinical practice, secondary immune abnormalities should be promptly screened during the diagnosis and treatment of hyperthyroidism with hematologic abnormalities to achieve early identification and intervention.

Cerebral ischemia-reperfusion injury (CIRI) is a complex pathophysiological process characterized by exacerbated brain tissue damage and related functional impairments following the restoration of blood flow after transient cerebral ischemia. Studies indicate that safflower alleviates ischemia-reperfusion injury through multiple mechanisms, including regulating hemodynamics, dilating blood vessels, improving hypoxia, counteracting free radical damage, exerting anti-inflammatory effects, and modulating neuronal autophagy. However, the precise molecular mechanisms underlying its therapeutic effects remain unclear. This review focuses on the neuroprotective roles of safflower in CIRI and its molecular mechanisms. By comprehensively analyzing the recent research advances, we find that bioactive components of safflower can mitigate CIRI through multiple pathways. This work aims to provide theoretical foundations for investigating the molecular mechanisms of traditional Chinese medicine in CIRI management and guide clinical rational drug utilization.

At present, the prevalence of type 2 diabetes mellitus (T2DM) continues to rise, and the prevention and treatment of its multi-system complications have become a major public health challenge. In addition to traditional risk factors such as abnormal glucose and lipid metabolism, abnormal cortisol secretion levels and rhythm disorders caused by hypothalamic-pituitary-adrenal axis dysfunction have increasingly attracted attention in the onset and progression of T2DM and its complications. The authors systematically review the clinical evidence on the impact of abnormal cortisol levels and rhythm disorders on the risk of T2DM, summarize the typical changes in cortisol levels and rhythms in T2DM patients, and focus on elaborating the associations between the two and the cerebrovascular diseases, microvascular diseases, and musculoskeletal system diseases related to T2DM, with the aim of providing a theoretical basis for deeply revealing its mechanism and exploring prevention and treatment strategies that take cortisol levels and rhythms as dual assessment targets.