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 rapid division of left Glisson pedicle and Arantius tube plane in laparoscopic anatomical left hemihepatectomy (LALH).Methods:Clinical data of 25 patients (15 with intrahepatic bile duct calculus and 10 with liver tumor) undergoing LALH in the Department of Hepatobiliary and Pancreatic Surgery, Jiangyin Hospital Affiliated to Nantong University from June 2020 to November 2024 were retrospectively analyzed, including 14 males and 11 females, aged (66.6±11.9) years. Among the patients, 15 received LALH with rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion, and the others received LALH after traditional dissection of left Glisson pedicle. Age, sex, body mass index, time of left Glisson pedicle dissection, whether the MHV exposure, the time of liver transection, whether MHV and its important branches or bile duct injury occurred, intraoperative blood loss, the incidence of postoperative biliary leakage, the time of abdominal drainage remove, the hospital stay, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, albumin 3 days after postoperative were compared between the groups.Results:The times of left Glisson pedicle dissection in the new-fasion and traditional group were (6.1±1.6) min and (13.8±3.0) min, and the time of liver transection was (24.9±3.5) min and (33.4±3.3) min, respectively ( t=-8.34, 6.08, P<0.001 for both). After division of left Glisson pedicle, the MHV was well exposed in 14 cases of new-fashion group and none of traditional group ( P<0.001). All the patients successfully completed the operation without conversion to laparotomy. Intraoperative blood loss, incidence of postoperative bile leakage, time of peritoneal drainage tube removal, postoperative hospital stay, AST, ALT, total bilirubin and albumin 3 days after surgery between the two groups were no significant differences (all P>0.05). Conclusion:LALH using the rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion could be safe and feasible, the time of left Glisson pedicle and liver transection was short.

Glucose-6-phosphate dehydrogenase(G6PD)deficiency is one of the most common monogenic genetic diseases in the world.China is the high incidence area of this disease.G6PD heterozygote is the main form of G6PD deficiency in females,which belongs to X-linked incomplete dominant inheritance.Therefore,the enzyme activities of female heterozygotes vary widely,showing normal to mild to moderate enzyme activi-ties.There is no unified calibrators for G6PD enzymatic detection reagents commonly used in clinical practice,and the results of the same sample detected by different kits from different manufacturers are different,so there is a phenomenon of missed detection in clinical screening of female G6PD heterozygotes.Although G6PD gene detection can effectively improve the detection rate of female heterozygotes,its clinical application is lim-ited due to cost and other reasons.Therefore,the development of detection methods that can improve the de-tection rate of female heterozygotes and are suitable for large-scale screening and clinical application will be an urgent need to be solved in clinical practice.This article reviews the epidemiology of G6PD deficiency,genetic characteristics of female G6PD gene,clinical manifestations and detection methods of G6PD female heterozy-gotes.

Objective:To investigate the effect of circulating plasma cell(CPC)on the prognosis of multiple myeloma(MM),and to es-tablish and validate a modified CPC-RISS staging system based on CPC and RISS.Methods:A retrospective analysis was performed for the clinical data of 639 treatment-na?ve patients with MM who were treated in Department of Hematology,Xijing Hospital,from January 2006 to June 2023.Peripheral blood smear was used to calculate the percentage of CPC in patients,and the impact of CPC and other related factors on the prognosis of MM patients was analyzed.A CPC-RISS staging system was established based on RISS stage and the percentage of CPC,and the differences in survival and prognosis were analyzed between patients with different stages.Results:Compared with the patients without CPC,detectable CPC was significantly associated with various high-risk factors for MM,and the MM patients with CPC had a lower complete remission rate and shorter overall survival time and progression-free survival time.The modified CPC-RISS staging system was used to classify the patients with MM into four stages,and there were significant differences in median survival time and progression-free survival time between the patients with different stages of MM.Conclusion:The MM pa-tients with the presence of CPC exhibit more aggressive features,worse response to treatment,and a reduction in long-term survival rate.The modified CPC-RISS staging system can effectively predict the prognosis of treatment-na?ve MM patients.

Objective:To study the etiological relationship between Yunnan sudden unexplained death (hereinafter referred to as YNSUD) and the desmosomal protein gene mutation of arrhythmogenic right ventricular cardiomyopathy (ARVC).Methods:From September 2019 to August 2020, a cross-sectional survey method was used to select 9 key counties (cities) of YNSUD in Yunnan Province as survey sites. Autopsy cardiac blood samples of YNSUD cases ( n = 11) were collected, and peripheral venous blood samples of co-occurring case ( n = 1), case relatives ( n = 128), and control population ( n = 60) were collected. Genomic DNA from blood was extracted. After PCR amplification, 97 exons of 5 ARVC desmosomal protein genes, including plakophilin-2 (PKP2), desmoglein-2 (DSG2), desmocollin-2 (DSC2), desmoplakin (DSP), and junction plakoglobin (JUP) were sequenced by Sanger method, and the gene mutation was analyzed. Results:Compared with the control population, YNSUD cases, co-occurring case and case relatives carried 52 gene mutation sites in 36 exons of the ARVC desmosomal protein gene, with a total mutation rate of 37.11% (36/97). Among them, there were 21 in DSP gene, 10 in DSG2 gene, 8 in PKP2 gene, 8 in DSC2 gene, and 5 in JUP gene. YNSUD cases, co-occurring case and case relatives carried two same gene mutation sites: DSG2 gene exon 15 c.3321 T>C synonymous mutation and JUP gene exon 3 c.213 T>C synonymous mutation.Conclusions:The mutation rate of ARVC desmosomal protein gene is relatively high in the population of YNSUD. The two same gene mutation sites (DSG2 gene c.3321 T>C and JUP gene c.213 T>C) carried by YNSUD cases, co-occurring case and case relatives may be associated with the pathogenesis of YNSUD.

Objective:To observe the effect of modified autologous skull defect repair in patients with traumatic brain injury and its influence on neurological function and living ability.Methods:104 patients with traumatic brain injury who were admitted to our hospital from March 2022 to August 2024 were included,they were divided into Group A[37 cases,poly ether ether ketone(PEEK)skull defect repair],Group B(35 cases,traditional titanium mesh skull defect repair),and Group C(32 cases,modified autologous skull defect repair).Perioperative indicators,neurological function,activity of daily living,quality of life,satisfaction,and incidence of postoperative complications were compared among three groups.Results:There were no differences in the operation time,operation blood loss and postoperative hospital stay among the three groups(P＞0.05).The hospitalization costs of Group A,Group B and Group C decreased successively(P＜0.05).Activity of Daily Living(ADL)scores at 3 and 6 months after surgery increased among three groups,while National Institutes of Health Stroke Scale(NIHSS)scores decreased(P＜0.05).There was no significant difference in physiological function,social function,psychological function,and material life among the three groups at 6 months after surgery(P＞0.05).The overall satisfaction rate in Group C was higher than that of Group A and Group B(P＜0.05).The overall incidence of complications in Group C was lower than that in Group A and Group B(P＜0.05).Conclusion:PEEK,traditional titanium mesh,and modified autologous skull are used in skull defect repair,operation time,operation blood loss and postoperative hospital stay are comparable,they can also reduce neurological function damage,improve living ability,and enhance the quality of life of patients,however,PEEK is relatively expensive,the satisfaction of traditional titanium mesh is low,andincidence of postoperative complications are relatively high.

Objective:To observe the effect of modified autologous skull defect repair in patients with traumatic brain injury and its influence on neurological function and living ability.Methods:104 patients with traumatic brain injury who were admitted to our hospital from March 2022 to August 2024 were included,they were divided into Group A[37 cases,poly ether ether ketone(PEEK)skull defect repair],Group B(35 cases,traditional titanium mesh skull defect repair),and Group C(32 cases,modified autologous skull defect repair).Perioperative indicators,neurological function,activity of daily living,quality of life,satisfaction,and incidence of postoperative complications were compared among three groups.Results:There were no differences in the operation time,operation blood loss and postoperative hospital stay among the three groups(P＞0.05).The hospitalization costs of Group A,Group B and Group C decreased successively(P＜0.05).Activity of Daily Living(ADL)scores at 3 and 6 months after surgery increased among three groups,while National Institutes of Health Stroke Scale(NIHSS)scores decreased(P＜0.05).There was no significant difference in physiological function,social function,psychological function,and material life among the three groups at 6 months after surgery(P＞0.05).The overall satisfaction rate in Group C was higher than that of Group A and Group B(P＜0.05).The overall incidence of complications in Group C was lower than that in Group A and Group B(P＜0.05).Conclusion:PEEK,traditional titanium mesh,and modified autologous skull are used in skull defect repair,operation time,operation blood loss and postoperative hospital stay are comparable,they can also reduce neurological function damage,improve living ability,and enhance the quality of life of patients,however,PEEK is relatively expensive,the satisfaction of traditional titanium mesh is low,andincidence of postoperative complications are relatively high.