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 identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

Objective To identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

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.

This article reviews the high-risk factors, risk assessment tools, information identification systems, and nursing management strategies of incontinence-associated dermatitis, in order to provide evidence for medical and nursing staff to choose appropriate identification tools and early identify high-risk patients with incontinence-associated dermatitis.

Objective:To evaluate and summarize evidence related to structured skin care for incontinence-associated dermatitis (IAD) in adult inpatients, so as to provide a reference for clinical nursing decision-making.Methods:Clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus related to structured skin care for IAD in adult inpatients were retrieved by computer in British Medical Journal Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, Canadian Registered Nurses Association of Ontario, Guidelines International Network, National Guideline Centre, National Institute for Health and Care Excellence, Medlive, the Cochrane Library, PubMed, Web of Science, CINAHL, Embase, WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Literature Database. The retrieval time limit was from the establishment of the database to April 30, 2021. Two investigators independently assessed the quality of the included evidence and the level of recommendation.Results:A total of 14 articles were included, involving 2 clinical decisions, 1 practice guideline, 6 evidence summaries, 2 systematic reviews, and 3 expert consensus. A total of 29 best evidence was compiled from 4 aspects of structured skin care assessment, cleansing, moisturizing and isolation.Conclusions:Medical and nursing staff should integrate evidence with clinical scenarios and patient preferences to make optimal clinical decisions on structured skin care and improve the quality of care for adult inpatients with IAD.

Objective: Intraoperative localization of the ureter can contribute to accurate dissection and minimize ureteral injury in colorectal surgery. We aim to summarize a single center's experience of fluorescence ureteral visualization using methylene blue (MB) and explore its visualization efficiency. Methods: This is a descriptive case-series-study. Clinical data of patients who had undergone laparoscopic colorectal surgery and fluorescence visualization of the ureter in the Gastrointestinal Surgery Department of Guangdong Provincial People's Hospital from March 2022 to May 2022 were retrospectively collected. Patients with incomplete surgery videos, renal insufficiency, or allergic reactions were excluded. MB was infused with 0.9% NaCl at 1.0 mg/kg in 100 mL of normal saline for 5 to 15 minutes during laparoscopic exploration. Imaging was performed using a device developed in-house by OptoMedic (Guangdong, China) that operates at 660nm to achieve excitation of MB. Clinical information, MB dosage, rate of successful fluorescence, time to fluorescence, operation time, blood loss, intraoperative blood oxygen levels, pathological staging, changes in renal function, and post-operative complications were retrospectively analyzed. Results: The study cohort comprised 27 patients (24 men and 3 women) with an average age of (60.25±16.95) years and an average body mass index of (21.72±3.42) kg/m². The dosage of MB was 0.3-1.0 mg/kg and the infusion time was 5-15 minutes. Fluorescence signals were detected in all patients. The median time to signal detection was 20 (range, 10 to 40) minutes after MB infusion. The range of intraoperative blood oxygen fluctuation averaged 2.5% (range, 0 to 7.0%). The median change in creatine concentration was -1.3 (range, -17.2 to 29.2) µmol/L. No patients had complications associated with use of MB. Fluorescence visualization of the ureter was very valuable clinically in two patients (thick mesentery, stage T4). Conclusion: MB is a safe and effective means of visualizing the ureter by fluorescence during laparoscopic colorectal surgery, especially when the procedure is difficult. MB in a dosage of less than 1 mg/kg can slowly infused for more than 5 minutes during laparoscopic exploration. During the infusion, attention must be paid to blood oxygen fluctuations.
Male ; Humans ; Female ; Adult ; Middle Aged ; Aged ; Ureter/surgery* ; Methylene Blue ; Retrospective Studies ; Infusions, Intravenous ; Colorectal Surgery ; Laparoscopy/methods* ; Digestive System Surgical Procedures

Objective:To evaluate the effects of pulmonary rehabilitation on anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) .Methods:The RCTs on application effects of pulmonary rehabilitation in COPD patients were searched in Cochrane Library, Medline, PsycINFO, PubMed, Web of Science, Embase, China Biology Medicine disc, CNKI, Wanfang Database and VIP Database from the establishment of those databases to August 1, 2020. Quality assessment and data extraction were performed for the included articles, and Meta-analysis was performed using Stata 14.0 and RevMan 5.3 software.Results:A total of 14 articles were included, including 1 106 patients. Meta-analysis results showed that pulmonary rehabilitation therapy was helpful to improve the symptoms of depression [ SMD= -0.79, 95% CI (-0.94--0.64) , P<0.01]and anxiety [ SMD=-0.61, 95% CI (-0.82--0.41) , P<0.01]in COPD patients. The results of subgroup analysis showed that the relief degree of depression and anxiety of patients in the intervention group was statistically significantly different from those of the control group ( P<0.01) when the intervention was longer than 3 months or less than or equal to 3 months. Conclusions:Pulmonary rehabilitation can improve the depression and anxiety of COPD patients, and the results of intervention for more than 3 months and less than or equal to 3 months are consistent. Combining the actual clinical situation, the shortest intervention time of 3 months can be used for intervention in order to obtain more ideal intervention effect.

Objective To investigate the relationships between serum osteocalcin (OC) levels and glycometabolism markers in nondiabetic post-traumatic male patients.Methods Populaitons were selected at the Department of Emergency Medicine of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from October 2017 to February 2019.The age,injury severity score (ISS),and characteristic indicators were recorded.The inclusion criteria were age ≥ 18 years and blood collection time ＜ 24 h after the injury.The exclusion criteria were emergency surgery,acute brain trauma,and hemoglobin A1c (HbA1c) ≥ 6.0％.The patients were divided into two groups by fasting plasma glucose (FPG):stress hyperglycemia (SH) (FPG＞7.8 mmol/L) and nonstress hyperglycemia (NO-SH) (FPG ≤ 7.8 mmol/L) groups.The fasting venous blood samples were collected and examined.The characteristics and biochemical indicators in the two groups were compared statistically by LSD-t test,rank sum test and ANOVA,and the relationships between serum OC levels and glycometabolism markers were analyzed by partial correlation analysis.Results A total of 395 traumatic patients were enrolled and divided into the SH group (n=182) and NO-SH group (n=213).There were no differences in ISS,fasting insulin (FINS),and C-peptide (C-P) levels between groups.Age,HbAlc and FPG were higher (P=0.041,P=0.037,P＜0.01),while the OC level was lower (P=0.023),in the SH group than those in the NO-SH group.The serum OC level did not correlate with HbAlc,FPG,and FINS,but negatively correlated with C-P by partial correlation analysis (r=-0.262,P=0.008).The multivariate linear regression analysis showed that C-P was an independent factor affecting serum OC levels after trauma (β=-0.655,P=0.043).Conclusion A correlation existed between the serum OC level and glycometabolism markers in nondiabetic post-traumatic male patients.

OBJECTIVE: To investigate the effects of different stimultors (PHA, PMA and IL-2) and culture systems (PBMC and whole blood) on the proliferation of human peripheral blood lymphocyte subsets, so as to provide the experimental basis for selecting the appropriate system according to the experimental purposes. METHODS: A total of 10 ml serum samples were collected from healthy volunteers (n=6). The 300 μl whole blood was directly used to detect lymphocyte subsets by flow cytometry. The 400 μl whole blood were inoculated respectively with 3 different stimulators at 37℃ and 5% CO2 for 60 h; Three different stimulators were also added to the PBMC which were isolated from 2 ml whole blood. Then the proliferation ability of lymphocyte subsets was analyzed by flow cytometry. RESULTS: After the PBMC were stimulated with PHA, CD4CD8CD3 lymphocytes were the most subset; The proportion of CD3CD4 T lymphocytes and CD3CD19 B lymphocytes decreased after being stimulated by PMA (P<0.01, P<0.05); the lymphocyte subset ratio had no significant change after being stimulated by IL-2. After the whole blood system was stimulated with PHA, the CD4/CD8 T lymphoblasts were main subsets, the counts of B lymphocytes and NK cells were reduced; after being stimulated with PMA, the number of CD8CD3 T lymphoblast and CD4CD8T lymphocytes increased, the B/NK cells were not distinguished with the surface markers; after the whole blood system was stimulated with IL-2, the proportion of NK cells significantly increased (P<0.05). CONCLUSION Lymphocyte proliferation stimulated by PMA is the fastest, while the effect of IL-2 on the lymphocyte subset proportion stimulated by IL-2 is the minimal. After being stimulated by PHA the division cycles of lymphocyte are the most.
Cell Proliferation ; Flow Cytometry ; Humans ; Killer Cells, Natural ; Lymphocyte Activation ; Lymphocyte Count ; Lymphocyte Subsets