Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Objective To retrospectively analyze the effects of nerve block anesthesia versus general anesthesia on intertrochanteric fracture in the elderly. Methods The 104 elderly inpatients undergoing closed reduction and intramedullary nailing for the treatment of femoral intertrochanteric fractures were recruited into this study at Department of Orthopedics ,Xiangya Hospital ,Central South University from January 2015 to June 2017.Medical records were collected and analyzed by SPSS 16.0 or GraphPad Prism 6.0 software. Results A total of 104 patients were divided into general anesthesia group(n= 48 )and nerve block anesthesia group (n= 56 ). There was no statistical difference in the demographic characteristics between the two groups. The changes in heart rate ,maximum changes of systolic/diastolic blood pressures ,and infusion volume during surgery were lower in the nerve block anesthesia group than in the general anesthesia group [(12.7 ± 7.3)vs. (18.1 ± 7.8)beats/min ,(22.5 ± 8.8/12.2 ± 7.5)mmHg vs. (34.3 ± 7.9/21.6 ± 6.6)mmHg ,(792.9 ± 387.0)ml vs. (1 083.0 ± 445.5)ml ,respectively ,t=3.64 ,7.14 ,6.73 ,5.16 ,all P＜0.01]. There was no statistically significant difference between two groups in other perioperative data and the number of deaths at three months and one year after surgery. Conclusions As compared with the general anesthesia ,the nerve block anesthesia has less effects on the heart rate ,less maximum changes of systolic and diastolic blood pressures ,and less infusion volume during surgery ,and has no significant increase in postoperative mortality ,which is safe and worthy of further promotion.

OBJECTIVE: To investigate whether the level of homocysteine in patients with postpartum depression is associated with depression index. METHODS: A total of 43 women with postpartum depression or with potential postpartum depression, who visited the psychological clinic of Maternal and Child Health Hospital of Hunan Province from June, 2012 to April, 2014, were enrolled in this study. They were evaluated by the Edinburgh Postnatal Depression Scale and Hamilton Depression Scale. Chinese Classification of Mental Disorder (the third edition) was used for their diagnosis. The depressive index was calculated by Edinburgh Postnatal Depression Scale, Hamilton Depression Scale, and clinical symptom scores, which was used to assess the level of depressive symptoms. The level of homocysteine in serum was detected by chemoluminescent method. Meanwhile, another 31 women, who visited the hospital without postpartum depression, were used as controls to compare with the 43 patients. RESULTS: The homocysteine level in the women with postpartum depression was significantly higher than that in the control group [(10.09 ± 3.59) μmol/L vs (8.57 ± 1.59) μmol/L, t=12.392, P=0.001]. The depression index was positively correlated with the level of homocysteine (r=0.231, P<0.05). CONCLUSION The level of serum homocysteine is associated with postpartum depression, suggesting that the level of serum homocysteine might be a risk biomarker for postpartum depression.
Asian Continental Ancestry Group ; Case-Control Studies ; Depression, Postpartum ; blood ; Female ; Homocysteine ; blood ; Humans ; Psychiatric Status Rating Scales

Objective To identify the effective results of ultrasound in degradation of polymeric nanoparticles released DNA .Polymeric nanoparticles was made by dehydration of polyacetylglutamicacid (PLGA, polylactic-co-glycolic acid)solution. Method Green Fluorescent Protein (GFP) was enclosed by PLGA. Different kinds of ultrasound mode and different duct cycle and power ones were used to radiate PLGA solution for 90 s, 9 min, 20 min separately after the solution prepared for 2 hrs,then putted the solution on centrifugal machine at 13000 r/m. Using Choloroform to get rid of fat-soluble impurity,then applied nanodrop to survey the releasing rate of DNA. Finally the effect of cell expression were observed by fluorescent microscope. Results The amount of DNA released from PLGA in groups which were exposed to ultrasound were significantly different from the groups which were not exposed to ultrosound. The releasing amount of former groups had upper limitation. The releasing rate was increased with the increment of the irradiation time,frequency of ultrasound;The effect of the DNA releasing and PLGA degradation by continuous-wave irradiation was stronger than pulsed-wave ultrasound. Conclusion Ultrasound can promote the degradation of PLGA, and do help in DNA releasing and expression in vitro.

Objective To investigate the feasibility and the efficacy of ultrasound in promoting PLGA nanoparticle-mediated gene transfection in vivo.Methods Prostate cancer cell line PC-3 was used to generate xenografts in nude mice for gene transfection experiment in vivo.GFP plasmid was encapsulated in PLGA-based nanoparticles.Nanoparticles were injected into tumors locally.Two hours later,xenografts were exposed to ultrasound.Xenograft tissues were harvested in different time points to assess the efficiency of gene expression with regard to different parameters of ultrasound. Results PLGA nanoparticle-encapsulated GFP plasmids were readily transfected to PC-3 cells in vivo.A large number of GFP expressing cells were observed after exposed to ultrasound with 1.0 MHz 50% duty factor continuous wave.In comparison,ultrasound exposure with 40% duty factor pulse wave in vivo had low efficacy in terms of GFP expression.No animal death was noticed due to ultrasound exposure.Conclusions Ultrasound exposure can enhance the release of plasmid DNA content delivered by PLGA nanoparticles in vivo,local exposure to ultrasound wave would be used in conjunction with PLGA nanoparticle-mediated targeted delivery to the tissue or organ of interest.

Objective To explore the optimum flow shear stress and mass transport for the construction of tissue-engineered bone.Methods The β-tricalcium phosphate (β-TCP) scaffolds seeded with human bone marrow-derived mesenchymal stem cells (HBMMSCs) were cultured in perfusion bioreactor.When the same flow rate was applied,the flow shear stress was separately 1×,2× and 3×.When the same flow shear stress was applied,the flow rates were separately 3 ml/min,6 ml/min and 9 ml/min.Cell proliferation was measured by MTT method.The construction of tissue-engineered bone was evaluated by measuring alkaline phosphatase (AKP) activity,secretion of osteopontin (OP) and osteocalcin (OC),and the mineralization of extracellular matrix (ECM).The flow shear stress and the mass transport were obtained using computational fluid dynamics.Results When the flow rate was same,the most cell proliferation was found in 2× group.The AKP activity and secretion of OC was higher in 2× and 3× groups than in those in 1× group.After 28days,the highest amount of mineralization of ECM was found in 3× group.When the flow shear stress was same,the AKP activity was highest in 6 ml/min group.After 28 days,secretion of OC and formation of mineralized ECM was highest in 3 ml/min group.When the flow rate was same,the flow shear stress was separately 0.004-0.007 Pa,0.009-0.013 Pa and 0.013-0.018 Pa.When the flow shear stress was same,the flow rate was separately 0.267-0.384 mm/s,0.521-0.765 mm/s and 0.765-1.177 mm/s.Conclusion When the tissue-engineered bone was constructed,0.013-0.018 Pa flow shear stress and 0.267-0.384 mm/s mass transport velocity could improve the construction of the tissue-engineered bone in vitro.