Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Objective:To compare the clinical effects on new bone formation and foot-ankle function between proximal tibial bone transport and distal tibial bone transport in the treatment of massive bone defects after tibial osteomyelitis debridement.Methods:From July 2012 to July 2017, 42 patients with chronic tibial osteomyelitis received bone transport surgery at Department of Orthopaedics, Nanfang Hospital.According to the Cierny-Mader classification for chronic osteomyelitis, all of them belonged to diffusive tibial osteomyelitis (type IV).Of them, 32 were treated by proximal tibial bone transport after tibial osteomyelitis debridement.In the proximal group, there were 27 males and 5 females, aged from 17 to 65 years and involving 20 left and 12 right sides. The other 10 cases received distal tibial bone transport. In the distal group, all of them were male, aged from 25 to 63 years and involving 6 left and 4 right sides. The 2 groups were compared in terms of external fixation index (EFI) and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle and Hindfoot Scale.Results:There were no significant differences between the 2 groups in the preoperative general data such as gender, age or osteomyelitis site, indicating the 2 groups were comparable ( P>0.05). Both groups obtained complete follow-up. The proximal group was followed up for 590.1 d ± 287.3 d and the distal group for 615.6 d ± 130.6 d, showing no significant difference between groups ( P>0.05). In the proximal group 2 cases developed talipes equinovalgus after bone transport while in the distal group 3 cases did, and surgical intervention was needed for them. Surgical intervention was also carried out for16 cases of non-union at the docking site in the proximal group and for 2 ones in the distal group. The EFI was 76.2 d/cm±50.0 d/cm for the proximal group and 84.3 d/cm ± 59.9 d/cm for the distal group, showing no significant difference between groups ( P>0.05). The AOFAS scores were 81.4±10.1 for the proximal group and 60.0±5.9 for the distal group, showing a significant difference ( P<0.05). Conclusion:In the treatment of massive bone defects after tibial osteomyelitis debridement, no significant difference has been observed in the effect on bone formation between proximal tibial bone transport and distal tibial bone transport, but the former transport may have a less adverse effect on foot-ankle function.

Acute hematogenous osteomyelitis (AHO) is the type of its kind diagnosed most frequently in pediatric patients. In the past decade, the incidence of methicillin-resistant Staphylococcus aureus infections has increased in children. The more complex situation of infections may lead additionally to deep vein thrombosis (DVT), septic pulmonary embolism, pneumonia, empyema, endocarditis, bacteremia and septic shock. Hence, hospital stays are often lengthy and patients often critically ill. Since delayed appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development, early accurate diagnosis and prompt initiation of appropriate treatment remain central principles in the evaluation and treatment of AHO. Therefore, care of children with AHO inevitably requires an organized and interdisciplinary approach to reach timely, comprehensive and accurate diagnoses so that effective treatment may be carefully planned and enacted with subsequent monitoring of the child until clinical resolution is achieved. This review is devoted exclusively to the management of AHO in children, providing an update on the current understanding of existing evidence and future directions to improve care for pediatric AHO.

Diabetic foot ulcer is a major complication of diabetes which is the most expensive and the most difficult to deal with and leads to a high rate of non-traumatic amputation.Diabetic foot osteomyelitis results from aggravation of diabetic foot ulcer.Unfortunately,the current therapeutic outcomes of diabetic foot osteomyelitis are still unsatisfactory because of its difficult diagnosis and special treatment protocols which are entirely different from those for conventional soft tissue infections.This paper summarizes the latest advances achieved in diagnosis and treatment of diabetic foot osteomyelitis.

Objective: To investigate the feasibility of long noncoding RNA (lncRNA)_AK096792 as a clinical predictor of bronchopulmonary dysplasia (BPD) in preterm infants. Methods: All the cord blood(2-5 mL) of very low birth weight (VLBW) preterm infants born in Huai′an First Hospital Affiliated to Nanjing Medical University were collected from December 1, 2015 to December 1, 2017.Moreover, the peripheral blood(2 mL) of those VLBW infants diagnosed with BPD was also collected.A total of 36 infants with BPD were collected.Another 36 cases of premature children with VLBW were chosen as control group according to random number table.The relative content of lncRNA_AK096792 in cord blood and peripheral blood was detected by using real-time quantitative PCR (qPCR). Additionally, the correlation of lncRNA_AK096792 levels between cord and peripheral blood of BPD infants was analyzed.The sensitivity and specificity of lncRNA_AK096792 for BPD were analyzed by using receiver operating curve test. Results: (1)LncRNA_AK096792 was a common, evolutionarily conserved, non-coding RNA present in both mouse and human.(2) The expression level of lncRNA_AK096792 in peripheral blood was significantly higher than that in cord blood in BPD group[(463.3±352.0)% vs.(50.0±37.5)%], and the difference was significant(P<0.001), and they were highly correlated (r=0.825, P<0.001). (3) The level of lncRNA_AK096792 in cord blood in BPD group was signi-ficantly higher than that in non-BPD group [(484.3±280.5)% vs.(101.2±28.6)%], and the difference was significant(P<0.001). (4)When lncRNA_AK096792 served as a clinical predictor for BPD, the specificity was 83.3%, the sensitivity was 75.6%, and an area under the receiver operating characteristic curve was 0.88(P<0.001). Conclusions LncRNA_AK096792 is highly correlated with the development of BPD.The level of lncRNA_AK096792 in umbilical cord blood of premature infants can be used as an early predictive marker for BPD, it calls for further study.

Objective To observe the effects of warm water bath active rewarming and passive rewarming on lung pathological injury and arterial blood gas of SD rats with hypothermia induced by prolonged seawater immersion.Methods One hundred male Sprague-Dawley rats were randomly divided into the normal control group (without any treatment) and the hypothermia group (seawater immersion at 20 ℃ for 24 h),The animals in the passive rewarming groups 1,2,3 and 4,each consisting of 10,had seawater immersion at 20 ℃for 24 h and received passive rewarming,and then they were respectively executed at 0,3,6 and 12 hours after rewarming,The animals in the active rewarming groups 1,2,3 and 4,each consisting of 10,underwent seawater immersion at 20 ℃ for 24 h and received active rewarming,and then they were sacrificed at 0,3,6and 12 hours after rewarming,Changes in lung pathology,arterial blood gas and other indicators were detected in all the animal groups.Results Both warm water bath active rewarming and passive rewarming all could help to restore lung injury and blood gas abnormality in rats with hypothermia induced by prolonged seawater immersion.Compared with that of the passive rewarming group [6 h:(7.6 ± 2.2) scores,12 h:(5.3 _± 1.3)scores],the recovery of lung pathological injury in warm water bath rewarming group was obviously better at 6 h(5.8 ± 1.2) scores and 12 h(3.8 ± 1.4) scores after rewarming,with statistical significance (P ＜ 0.05),and actual bicarbonate recovery was even better at 6 h after rewarming,also with statistical significance (P ＜0.05).Conclusions Compared with passive rewarming,warm water bath rewarming could significantly alleviate lung injury and arterial blood gas abnormality in hypothermic rats induced by prolonged seawater immersion,and it might produce even better effect on the prevention of rewarming-related acute respiratory distress syndrome.

Objective To study the effects of active rewarming and passive rewarming on pulmonary oxidative stress and inflammatory response in rats with hypothermia induced by acute severe seawater immersion.Methods Sixty-four male healthy SD rats were randomly divided into the normal control group , the low temperature immersion group , the active rewarming group and the passive rewarming group . In accordance with rewarming time points , the two rewarming groups were further subdivided into the 2 h, 6 h and 12 h rewarming groups , each consisting of 8 animals.Effects of 2 different rewarming methods on lung oxygen free radicals ( MDA, SOD, GSH-PX) and serum inflammatory factors ( IL-6, IL-1β, TNF-a) were compared between the groups.Results (1) The MDA level [(2.84 ±0.46) nmol/mg pro] of the lungs in the 2 h active rewarming group was significantly higher than that of the 2 h passive rewarming group (P<0.05), and the MDA levels [(1.98 ±0.35) nmol/mg pro, (1.84 ±0.38) nmol/mg pro] of the 6 h and 12 h passive rewarming groups were slightly higher than those [(1.68 ±0.19) nmol/mg pro,(1.54 ±0.17) nmol/mg pro] of the 6 h and 12 h passive rewarming groups (P<0.05).(2) The SOD activity in the lungs of the 2 h and 6 h active rewarming groups was slightly higher than that of the 2 h and 6 h passive rewarming groups(P>0.05). The SOD activity in the lungs of the 12 h active rewarming group was higher than that of the 12 h passive rewarming group(P>0.05).(3) The GSH-PX activity in the lungs of the 2 h active rewarming group was slightly higher than that of the 2 h passive rewarming group(P>0.05).The GSH-PX activity in the lungs of the 6 h and 12 h active rewarming group was significantly higher than that of the 6 h and 12 h passive rewarming group(P<0.05).(4) The serum IL-1βand IL-6 levels of the 2 h passive rewarming group were obviously higher that those of the 2 h active rewarming group(P<0.05).The serum IL-1βand IL-6 levels in the 6 h and 12 h passive rewarming groups were slightly higher than those of the 6 h and 12 h active rewarming groups ( P<0.05).(5) The serum TNF-a levels of the 2 h, 6 h and 12 h passive rewarming groups were slightly higher that those of the 2 h, 6 h and 12 h active rewarming groups (P<0.05).Conclusion As compared with the active rewarming group , the activation of oxidative stress and inflammatory response in the passive rewarming group might worsen pulmonary lesion of the rats with hypothermia induced by acute severe seawater immersion .

Objective To observe the effects of warm water bath active rewarming and passive rewarming on lung pathological injury and arterial blood gas of SD rats with hypothermia induced by prolonged seawater immersion.Methods One hundred male Sprague-Dawley rats were randomly divided into the normal control group (without any treatment) and the hypothermia group (seawater immersion at 20 ℃ for 24 h),The animals in the passive rewarming groups 1,2,3 and 4,each consisting of 10,had seawater immersion at 20 ℃for 24 h and received passive rewarming,and then they were respectively executed at 0,3,6 and 12 hours after rewarming,The animals in the active rewarming groups 1,2,3 and 4,each consisting of 10,underwent seawater immersion at 20 ℃ for 24 h and received active rewarming,and then they were sacrificed at 0,3,6and 12 hours after rewarming,Changes in lung pathology,arterial blood gas and other indicators were detected in all the animal groups.Results Both warm water bath active rewarming and passive rewarming all could help to restore lung injury and blood gas abnormality in rats with hypothermia induced by prolonged seawater immersion.Compared with that of the passive rewarming group [6 h:(7.6 ± 2.2) scores,12 h:(5.3 _± 1.3)scores],the recovery of lung pathological injury in warm water bath rewarming group was obviously better at 6 h(5.8 ± 1.2) scores and 12 h(3.8 ± 1.4) scores after rewarming,with statistical significance (P ＜ 0.05),and actual bicarbonate recovery was even better at 6 h after rewarming,also with statistical significance (P ＜0.05).Conclusions Compared with passive rewarming,warm water bath rewarming could significantly alleviate lung injury and arterial blood gas abnormality in hypothermic rats induced by prolonged seawater immersion,and it might produce even better effect on the prevention of rewarming-related acute respiratory distress syndrome.

Objective To study the effects of active rewarming and passive rewarming on pulmonary oxidative stress and inflammatory response in rats with hypothermia induced by acute severe seawater immersion.Methods Sixty-four male healthy SD rats were randomly divided into the normal control group , the low temperature immersion group , the active rewarming group and the passive rewarming group . In accordance with rewarming time points , the two rewarming groups were further subdivided into the 2 h, 6 h and 12 h rewarming groups , each consisting of 8 animals.Effects of 2 different rewarming methods on lung oxygen free radicals ( MDA, SOD, GSH-PX) and serum inflammatory factors ( IL-6, IL-1β, TNF-a) were compared between the groups.Results (1) The MDA level [(2.84 ±0.46) nmol/mg pro] of the lungs in the 2 h active rewarming group was significantly higher than that of the 2 h passive rewarming group (P<0.05), and the MDA levels [(1.98 ±0.35) nmol/mg pro, (1.84 ±0.38) nmol/mg pro] of the 6 h and 12 h passive rewarming groups were slightly higher than those [(1.68 ±0.19) nmol/mg pro,(1.54 ±0.17) nmol/mg pro] of the 6 h and 12 h passive rewarming groups (P<0.05).(2) The SOD activity in the lungs of the 2 h and 6 h active rewarming groups was slightly higher than that of the 2 h and 6 h passive rewarming groups(P>0.05). The SOD activity in the lungs of the 12 h active rewarming group was higher than that of the 12 h passive rewarming group(P>0.05).(3) The GSH-PX activity in the lungs of the 2 h active rewarming group was slightly higher than that of the 2 h passive rewarming group(P>0.05).The GSH-PX activity in the lungs of the 6 h and 12 h active rewarming group was significantly higher than that of the 6 h and 12 h passive rewarming group(P<0.05).(4) The serum IL-1βand IL-6 levels of the 2 h passive rewarming group were obviously higher that those of the 2 h active rewarming group(P<0.05).The serum IL-1βand IL-6 levels in the 6 h and 12 h passive rewarming groups were slightly higher than those of the 6 h and 12 h active rewarming groups ( P<0.05).(5) The serum TNF-a levels of the 2 h, 6 h and 12 h passive rewarming groups were slightly higher that those of the 2 h, 6 h and 12 h active rewarming groups (P<0.05).Conclusion As compared with the active rewarming group , the activation of oxidative stress and inflammatory response in the passive rewarming group might worsen pulmonary lesion of the rats with hypothermia induced by acute severe seawater immersion .

Objective To observe the effects of seawater immersion at different temperatures on survival time and mortality and physiological state of non-anesthetized rats.Methods Totally 100 SD male rats(The abdominal cavity was implanted with a temperature sensor in advance)were randomly divided into five groups which were immersed in 20 ℃,17 ℃,15 ℃,13 ℃ and 10 ℃ seawater,respectively.Each group contains 20 rats.The changes of respiration,heart rate and muscle fibrillation within 2 hours were observed and the survival time and mortality of each group were counted in 24 hours.The decrease trend of intraperitoneal temperature in rats was analyzed retrospectively within 2 hours.Results Soaking for 10 minutes,the respiratory and heart rate of each group were significantly increased,but there was no significant difference among groups(P>0.05).The respiratory and heart rate decreased rapidly between 10 and 40 minutes,and the decline was slower relatively between 40 and 80 minutes.Soaking for 80 minutes,the respiration rate of rats among groups had significant difference(P<0.05).Immersing for 100 minutes,the heart rates of rats in each group were significantly different(P<0.05).Soaking for 20 minutes,the muscle fibrillation of 15 ℃,13 ℃ and 10 ℃ group reached the peak,and there were significant differences among groups(P<0.05),then disappeared.However the rats in 20 ℃ and 17 ℃ group reached the peak at 30 minutes,but there was no significant difference between two groups(P>0.05),hereafter the muscle fibrillation was maintained at a certain level.The mean survival time of 20 ℃ group,17 ℃ group,15 ℃ group,13 ℃ group and 10 ℃ group in 24 hours were(23.6±1.23)hours,(15.0±4.16)hours,(7.7±3.21)hours,(2.4±0.91)hours and (1.1±0.39)hours,respectively,and the survival curve of each group was statistically significant(P<0.05).The intraperitoneal temperature of rats showed a decline in the cliff,the lower the water temperature,the faster the descending.Soaking for 40 minutes,the difference of intraperitoneal temperature of each group was statistically significant(P<0.05).Conclusion The effects of seawater immersion at different temperatures on the physiological state and survival time and mortality of rats are significantly different.With the decrease of water temperature,the physiological state changes more obviously,the survival time is shorter and the mortality rate is higher.