[This corrects the article DOI: 10.1016/j.apsb.2022.05.019.].

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 investigate the effects of the culture supernatant of Faecalibacterium prausnitzii(F.prausnitzii)on intestinal barrier function and liver fibrosis progression in mice.Methods A total of 24 male C57BL/6 mice were randomly assigned to three groups:normal control group(Control),liver fibrosis model group(Model),and model mice+F.prausnitzii supernatant group(Model+S).Hepatic fibrosis was induced by intraperitoneal injection of carbon tetrachloride in both the Model group and the Model+S group over a period of 10 weeks.Following a 2-week modeling period,the mice in the Model+S group were subjected to an 8-week treatment with bacterial supernatant.The colon and liver were analyzed for pathological morphology using HE staining.Additionally,impairment of intestinal barrier function was assessed by periodic acid schiff staining,ELISA,and fluorescein isothiocyanate-dextran(FITC-Dextran)fluorescent probe.Changes in the gut microbiota structure were analyzed with 16S rDNA sequencing.The degree of liver fibrosis was assessed using sirius red staining,and the expression levels of markers associated with intestinal barrier function,liver fibrosis,and inflammation were measured using qPCR and ELISA.Results Compared with the Model group,the severity of intestinal damage and the expressions of pro-inflammatory factors in the Model+S group were decreased.Additionally,there was a significant increase in the expressions of multiple genes related to intestinal barrier function,as well as a decrease in the concentration of FITC-Dextran in peripheral blood and lipopolysaccharide in the liver(all P＜0.05),and there was an improvement in the composition of the gut microbiota.Furthermore,while the liver function and extent of liver fibrosis in the Model+S group did not show any significant differences compared to the Model group,there was a noticeable decrease in the infiltration of inflammatory cells within the liver.Additionally,the expressions of pro-inflammatory factors such as Tlr4,Il-6 and Tnf-α,and the concentration of IL-6 in the liver was significantly decreased(all P＜0.05).Conclusion The F.prausnitzii supernatant exhibits the potential to enhance intestinal barrier function and rectify gut microbiota imbalance in mice with liver fibrosis,thus reducing hepatic inflammation.However,it does not exert any significant effect on the progression of liver fibrosis.

OBJECTIVE To observe the impact of Bifidobacterium quadruple viable organisms combined with inter-ferons on serum amyloid A(SAA),transforming growth factor-β(TGF-β),25-hydroxyvitamin D3[25(OH)D3]and intestinal function of the children with rotavirus-induced viral diarrhea.METHODS A total of 88 children with rotavirus-induced viral diarrhea who were treated in Affiliated Hospital of Jiangnan University from Mar.2020 to Dec.2023 were recruited as the research subjects and were randomly divided into the conventional group with 44 cases(conventional symptomatic therapy plus interferons)and the combination group with 44 cases(the conven-tional symptomatic therapy plus Bifidobacterium quadruple viable organisms),and both groups were continuously treated for 5 days.The clinical curative effect and improvement of clinical symptoms were observed and compared between the two groups.The changes of peripheral blood immune function indexes,inflammatory factors,intesti-nal function indexes,SAA,TGF-β and 25(OH)D3 were analyzed.RESULTS There was no significant difference in the effective rate of treatment between the combination group and the conventional group after the treatment for 5 days(Z=1.375,P=0.169).The duration of stool property back to normal,fever abatement,number of defeca-tion times back to normal,cessation of diarrhea,virus turning to be negative and disappearance of abdominal pain was shorter in the combination group than in the conventional group(P＜0.05).The immune function,inflamma-tory factors and intestinal function indexes were improved more remarkably in the combination group than in the conventional group after the treatment for 5 days(P＜0.05).The levels of SAA,TGF-β and 25(OH)D3 of the combination group were respectively(3.84±0.35)pg/ml,(4.87±0.28)pg/ml and(50.63±7.14)pg/ml after the treatment for 5 days,higher than those of the conventional group.CONCLUSION Bifidobacterium quadruple viable organisms combined with interferons can effectively shorten the recovery time of clinical symptoms of the children with rotavirus-induced viral diarrhea,relieve the inflammatory reactions,improve the intestinal function and immune function,and stabilize the levels of serum SAA,TGF-β and 25(OH)D3.

Objective To investigate the effects of the culture supernatant of Faecalibacterium prausnitzii(F.prausnitzii)on intestinal barrier function and liver fibrosis progression in mice.Methods A total of 24 male C57BL/6 mice were randomly assigned to three groups:normal control group(Control),liver fibrosis model group(Model),and model mice+F.prausnitzii supernatant group(Model+S).Hepatic fibrosis was induced by intraperitoneal injection of carbon tetrachloride in both the Model group and the Model+S group over a period of 10 weeks.Following a 2-week modeling period,the mice in the Model+S group were subjected to an 8-week treatment with bacterial supernatant.The colon and liver were analyzed for pathological morphology using HE staining.Additionally,impairment of intestinal barrier function was assessed by periodic acid schiff staining,ELISA,and fluorescein isothiocyanate-dextran(FITC-Dextran)fluorescent probe.Changes in the gut microbiota structure were analyzed with 16S rDNA sequencing.The degree of liver fibrosis was assessed using sirius red staining,and the expression levels of markers associated with intestinal barrier function,liver fibrosis,and inflammation were measured using qPCR and ELISA.Results Compared with the Model group,the severity of intestinal damage and the expressions of pro-inflammatory factors in the Model+S group were decreased.Additionally,there was a significant increase in the expressions of multiple genes related to intestinal barrier function,as well as a decrease in the concentration of FITC-Dextran in peripheral blood and lipopolysaccharide in the liver(all P＜0.05),and there was an improvement in the composition of the gut microbiota.Furthermore,while the liver function and extent of liver fibrosis in the Model+S group did not show any significant differences compared to the Model group,there was a noticeable decrease in the infiltration of inflammatory cells within the liver.Additionally,the expressions of pro-inflammatory factors such as Tlr4,Il-6 and Tnf-α,and the concentration of IL-6 in the liver was significantly decreased(all P＜0.05).Conclusion The F.prausnitzii supernatant exhibits the potential to enhance intestinal barrier function and rectify gut microbiota imbalance in mice with liver fibrosis,thus reducing hepatic inflammation.However,it does not exert any significant effect on the progression of liver fibrosis.

OBJECTIVE To observe the impact of Bifidobacterium quadruple viable organisms combined with inter-ferons on serum amyloid A(SAA),transforming growth factor-β(TGF-β),25-hydroxyvitamin D3[25(OH)D3]and intestinal function of the children with rotavirus-induced viral diarrhea.METHODS A total of 88 children with rotavirus-induced viral diarrhea who were treated in Affiliated Hospital of Jiangnan University from Mar.2020 to Dec.2023 were recruited as the research subjects and were randomly divided into the conventional group with 44 cases(conventional symptomatic therapy plus interferons)and the combination group with 44 cases(the conven-tional symptomatic therapy plus Bifidobacterium quadruple viable organisms),and both groups were continuously treated for 5 days.The clinical curative effect and improvement of clinical symptoms were observed and compared between the two groups.The changes of peripheral blood immune function indexes,inflammatory factors,intesti-nal function indexes,SAA,TGF-β and 25(OH)D3 were analyzed.RESULTS There was no significant difference in the effective rate of treatment between the combination group and the conventional group after the treatment for 5 days(Z=1.375,P=0.169).The duration of stool property back to normal,fever abatement,number of defeca-tion times back to normal,cessation of diarrhea,virus turning to be negative and disappearance of abdominal pain was shorter in the combination group than in the conventional group(P＜0.05).The immune function,inflamma-tory factors and intestinal function indexes were improved more remarkably in the combination group than in the conventional group after the treatment for 5 days(P＜0.05).The levels of SAA,TGF-β and 25(OH)D3 of the combination group were respectively(3.84±0.35)pg/ml,(4.87±0.28)pg/ml and(50.63±7.14)pg/ml after the treatment for 5 days,higher than those of the conventional group.CONCLUSION Bifidobacterium quadruple viable organisms combined with interferons can effectively shorten the recovery time of clinical symptoms of the children with rotavirus-induced viral diarrhea,relieve the inflammatory reactions,improve the intestinal function and immune function,and stabilize the levels of serum SAA,TGF-β and 25(OH)D3.

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 investigate the value of an MRI and digital pathology images based omics nomogram for the prediction of recurrence risk in soft tissue sarcoma (STS).Methods:This was a retrospective cohort study. From January 2016 to March 2021, 192 patients with STS confirmed by pathology in the Affiliated Hospital of Qingdao University were enrolled, among which 112 patients in the Laoshan campus were enrolled as training set, and 80 patients in the Shinan campus were enrolled as validation set. The patients were divided into recurrence group ( n=87) and no recurrence group ( n=105) during follow-up. The clinical and MRI features of patients were collected. The radiomics features based on fat saturated T 2WI images and pathomics features based on digital pathology images of the lesions were extracted respectively. The clinical model, radiomics model, pathomics model, radiomics-pathomics combined model, and omics nomogram which combined the optimal prediction model and the clinical model were established by multivariate Cox regression analysis. The concordance index (C index) and time-dependent area under the receiver operating characteristic curve (t-AUC) were used to evaluate the performance of each model in predicting STS postoperative recurrence. The DeLong test was used for comparison of t-AUC between every two models. The X-tile software was used to determine the cut-off value of the omics nomogram, then the patients were divided into low risk ( n=106), medium risk ( n=64), and high risk ( n=22) groups. Three groups′ cumulative recurrence-free survival (RFS) rates were calculated and compared by the Kaplan-Meier survival curve and log-rank test. Results:The performance of the radiomics-pathomics combined model was superior to the radiomics model and pathomics model, with C index of 0.727 (95% CI 0.632-0.823) and medium t-AUC value of 0.737 (95% CI0.584-0.891) in the validation set. The omics nomogram was established by combining the clinical model and the radiomics-pathomics combined model, with C index of 0.763 (95% CI 0.685-0.842) and medium t-AUC value of 0.783 (95% CI0.639-0.927) in the validation set. The t-AUC value of omics nomogram was significantly higher than that of clinical model, TNM model, radiomics model, and pathomics model in the validation set ( Z=3.33, 2.18, 2.08, 2.72, P=0.001, 0.029, 0.037, 0.007). There was no statistical difference in t-AUC between the omics nomogram and radiomics-pathomics combined model ( Z=0.70, P=0.487). In the validation set, the 1-year RFS rates of STS patients in the low, medium, and high recurrence risk groups were 92.0% (95% CI 81.5%-100%), 55.9% (95% CI 40.8%-76.6%), and 37.5% (95% CI 15.3%-91.7%). In the training and validation sets, there were statistically significant in cumulative RFS rates among the low, medium, and high groups of STS patients (training set χ2=73.90, P<0.001; validation set χ2=18.70, P<0.001). Conclusion:The omics nomogram based on MRI and digital pathology images has favorable performance for the prediction of STS recurrence risk.

Diffusion weighted imaging is an important imaging technique for diagnosing and evaluating the effectiveness of disease treatment,mainly focusing on the overall diffusion behavior of water molecules but ignoring the microscopic movement of water molecules and the details of tissue microstructures.Combining oscillatory gradient spin-echo and pulsed gradient spin echo sequences,time-dependent diffusion MRI(td-dMRI)captured diffusion MRI signals at varying time,in order to obtain information of different microstructures,which had recently emerged into clinical application with the advancements of hardware.The principles of td-dMRI technology and its application progresses in tumors were reviewed in this article.

Advanced radiotherapy technology enables the dose to more accurately conform to the tumor target area of the patient, providing accurate treatment for the patient, but the gradient of the patient's radiation dose at the tumor edge is getting larger, which putting forward higher requirements for radiotherapy dose verification. The dose verification system software KylinRay-Dose4D can verify the patient's pre-treatment plan and the in vivo/on-line dose during the patient's treatment, providing important reference for the physicist to modify the radiotherapy plan and ensuring that the patient receives accurate treatment. This study introduces the overall design and key technologies of KylinRay-Dose4D, and tests the pre-treatment plan dose checking calculation and 2D/3D dose verification through clinical cases. The test results showed that the 2D/3D gamma pass rate (3 mm/3%) of KylinRay-Dose4D reconstructed dose compared with TPS plan dose and measured dose is larger than 95%, which indicating that the reconstructed dose of KylinRay-Dose4D meets the requirement of clinical application.
Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy, Intensity-Modulated/methods* ; Software ; Neoplasms ; Phantoms, Imaging ; Radiometry/methods*