Infection Prevention and Control(IPC)programs are crucial for prevention of hospital-associated infec-tions(HAIs),health and safety of patients and health care workers.The major task confronting the health care is to effectively carry out the IPC programs so as to raise the efficiency and quality of management of HAIs.In recent years,the rapid development of artificial intelligence(AI)technology has provided new ideas for the management of HAIs.The application and progress of research on application of AI technologies such as machine learning,nat-ural language processing and computer vision in surveillance,early warning,diagnosis,prevention and control,smart medical equipment and management of antibiotics were reviewed in the article.Meanwhile,the problems and challenges confronting the AI application,such as technical breakthroughs,data privacy and health care work-ers' acceptance,were also expounded.In the future,it is necessary to push forward the technology research and development,establish the safe and reliable data management system,increase the experience of health care work-ers and energize the interdisciplinary cooperation on IPC.

Objective To investigate the impact of hepatopancreatic ampulla features on difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on 800 patients who underwent ERCP from June 2023 to April 2024.Hepatopancreatic ampullary features were categorized endoscopically into four types:1)Non-protruding(n=544);2)Protruding(n=120);3)Diverticula or mucosal folds(n=96);4)Tortuosity or tumor involvement(n=40).Standard biliary cannulation was initiated in all cases,with failure defined as difficult cannulation.Advanced cannulation techniques were employed for all difficult cannulation cases[double-guidewire technique(DGT)or precutsphincterotomy(PST)].Success rates and procedural complications were recorded.Results Standard biliary cannulation outcomes,success rates 79.96％(435/544)in non-protruding vs.69.17％(83/120)in protruding,72.92％(70/96)in diverticula or mucosal folds,and 65.00％(26/40)in tortuosity or tumor groups(x2=10.90,P=0.012);Difficult cannulation rates 18.01％(98/544)in non-protruding vs.27.50％(33/120)in protruding,27.08％(26/96)in diverticula or mucosal folds,and 30.00％(12/40)in tortuosity or tumor groups(x2=10.41,P=0.015).In the subgroups,the rates of DGT intubation in the four groups were 11.95％(65/544),15.83％(19/120),12.50％(12/96),and 20.00％(8/40),respectively.There was no statistically significant difference in the success rate of DGT intubation between the groups(x2=6.96,P=0.073).In the subgroups,the PST intubation rates were 6.07％(33/544),11.67％(14/120),14.58％(14/96),and 10.00％(4/40),respectively.There was no statistically significant difference in the success rate of PST intubation between the groups(x2=5.54,P=0.136).Advanced cannulation techniques were used in 169 patients,DGT success rates of 94.23％(98/104)vs.PST at 89.23％(58/65)(x2=19.50,P=0.021);PEP incidence 18.34％(31/169)in difficult cannulation vs.2.61％(16/614)in standard group(x2=58.64,P=0.000);No significant difference in PEP between DGT(21.25％)and PST(13.85％)groups(x2=1.17,P=0.279).Conclusion Hepatopancreatic ampulla features influences biliary cannulation success.Non-protruding ampullae demonstrate optimal outcomes with standard techniques.Notably,DGT and PST are associated with elevated PEP risks in difficult cannulation.

Objective To investigate the impact of hepatopancreatic ampulla features on difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on 800 patients who underwent ERCP from June 2023 to April 2024.Hepatopancreatic ampullary features were categorized endoscopically into four types:1)Non-protruding(n=544);2)Protruding(n=120);3)Diverticula or mucosal folds(n=96);4)Tortuosity or tumor involvement(n=40).Standard biliary cannulation was initiated in all cases,with failure defined as difficult cannulation.Advanced cannulation techniques were employed for all difficult cannulation cases[double-guidewire technique(DGT)or precutsphincterotomy(PST)].Success rates and procedural complications were recorded.Results Standard biliary cannulation outcomes,success rates 79.96％(435/544)in non-protruding vs.69.17％(83/120)in protruding,72.92％(70/96)in diverticula or mucosal folds,and 65.00％(26/40)in tortuosity or tumor groups(x2=10.90,P=0.012);Difficult cannulation rates 18.01％(98/544)in non-protruding vs.27.50％(33/120)in protruding,27.08％(26/96)in diverticula or mucosal folds,and 30.00％(12/40)in tortuosity or tumor groups(x2=10.41,P=0.015).In the subgroups,the rates of DGT intubation in the four groups were 11.95％(65/544),15.83％(19/120),12.50％(12/96),and 20.00％(8/40),respectively.There was no statistically significant difference in the success rate of DGT intubation between the groups(x2=6.96,P=0.073).In the subgroups,the PST intubation rates were 6.07％(33/544),11.67％(14/120),14.58％(14/96),and 10.00％(4/40),respectively.There was no statistically significant difference in the success rate of PST intubation between the groups(x2=5.54,P=0.136).Advanced cannulation techniques were used in 169 patients,DGT success rates of 94.23％(98/104)vs.PST at 89.23％(58/65)(x2=19.50,P=0.021);PEP incidence 18.34％(31/169)in difficult cannulation vs.2.61％(16/614)in standard group(x2=58.64,P=0.000);No significant difference in PEP between DGT(21.25％)and PST(13.85％)groups(x2=1.17,P=0.279).Conclusion Hepatopancreatic ampulla features influences biliary cannulation success.Non-protruding ampullae demonstrate optimal outcomes with standard techniques.Notably,DGT and PST are associated with elevated PEP risks in difficult cannulation.

Objective To explore a better surgical approach for the surgical treatment of avulsion fractures of the posterior cruciate ligament of the tibial plateau.Methods From July 2014 to May 2024,A total of 29 cases of avulsion fractures at the insertion point of the posterior cruciate ligament of the tibial platform were admitted to our department.They were divided into two groups according to different surgical approaches.There were 16 cases in group A,which adopted the modified posterior approach,and 13 cases in group B,which adopted the conventional posterior approach.The therapeutic effects of the two groups of patients were evaluated by using the Lysholm knee score scale after surgery and the KOOS knee injury and osteoarthritis outcome scoring system.Results All patients were followed up for 12 to 14 months,with an average of(12.6±0.3)months.No serious adverse complications such as non-healing of the surgical site occurred in group A.In group B,there was 1 case of delayed wound healing and 8 cases of knee joint pain during movement.The Lysholm knee joint score and KOOS knee joint outcome score of patients in group A at 12 months after the operation were(88.65±9.23)points and(90.48±6.84)points respectively,and those in group B were(63.98±10.77)points and(69.37±9.01)points respectively.Both groups in group A were more satisfied than those in group B,and the difference was statistically significant(P＜0.05).Conclusion For patients with avulsion fractures of the insertion point of the posterior cruciate ligament of the tibial platform,the modified minimally invasive penetrating muscle approach on the posterior side of the knee joint can reduce related complications such as excessive intraoperative bleeding,internal relaxation of the knee joint,and poor postoperative wound healing,enabling early functional exercise for patients and achieving a better prognosis.

Objective To explore a better surgical approach for the surgical treatment of avulsion fractures of the posterior cruciate ligament of the tibial plateau.Methods From July 2014 to May 2024,A total of 29 cases of avulsion fractures at the insertion point of the posterior cruciate ligament of the tibial platform were admitted to our department.They were divided into two groups according to different surgical approaches.There were 16 cases in group A,which adopted the modified posterior approach,and 13 cases in group B,which adopted the conventional posterior approach.The therapeutic effects of the two groups of patients were evaluated by using the Lysholm knee score scale after surgery and the KOOS knee injury and osteoarthritis outcome scoring system.Results All patients were followed up for 12 to 14 months,with an average of(12.6±0.3)months.No serious adverse complications such as non-healing of the surgical site occurred in group A.In group B,there was 1 case of delayed wound healing and 8 cases of knee joint pain during movement.The Lysholm knee joint score and KOOS knee joint outcome score of patients in group A at 12 months after the operation were(88.65±9.23)points and(90.48±6.84)points respectively,and those in group B were(63.98±10.77)points and(69.37±9.01)points respectively.Both groups in group A were more satisfied than those in group B,and the difference was statistically significant(P＜0.05).Conclusion For patients with avulsion fractures of the insertion point of the posterior cruciate ligament of the tibial platform,the modified minimally invasive penetrating muscle approach on the posterior side of the knee joint can reduce related complications such as excessive intraoperative bleeding,internal relaxation of the knee joint,and poor postoperative wound healing,enabling early functional exercise for patients and achieving a better prognosis.

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.

Infection Prevention and Control(IPC)programs are crucial for prevention of hospital-associated infec-tions(HAIs),health and safety of patients and health care workers.The major task confronting the health care is to effectively carry out the IPC programs so as to raise the efficiency and quality of management of HAIs.In recent years,the rapid development of artificial intelligence(AI)technology has provided new ideas for the management of HAIs.The application and progress of research on application of AI technologies such as machine learning,nat-ural language processing and computer vision in surveillance,early warning,diagnosis,prevention and control,smart medical equipment and management of antibiotics were reviewed in the article.Meanwhile,the problems and challenges confronting the AI application,such as technical breakthroughs,data privacy and health care work-ers' acceptance,were also expounded.In the future,it is necessary to push forward the technology research and development,establish the safe and reliable data management system,increase the experience of health care work-ers and energize the interdisciplinary cooperation on IPC.

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.

The development of medical research is completed by the cooperation of sponsors, investigators, subjects, and ethics committees. Clinically, it mainly includes clinical trials of medical devices, clinical medicine and new technology research. This paper analyzed the game and the relationship between rights, responsibilities and interests of relevant parties in medical research, combined with the relevant costs and sharing principles involved in medical research, and found that the use of the word "free" in the informed consent is easy to cause misunderstanding and the lack of relevant compensation costs in the informed consent, while the compensation and insurance costs had some problems, such as the imperfect subject compensation mechanism and the insufficient insurance purchase by the sponsor, which can not protect the basic rights and interests of the subjects. Therefore, in order to standardize the cost management of clinical medical research, it is necessary to standardize the process and content of informed consent, strengthen the supervision of medical research process, establish medical research damage compensation fund and research damage insurance system, so as to better protect the rights and interests of subjects.

Objective To explore the utility of different endoscopic retrograde cholangiopancreatography(ERCP)complexity scales in the training of endoscopists.Methods Clinical data of 237 patients treated by ERCP completed by trainee physicians at two hospitals in Eastern China from February 2022 to February 2023 were prospectively collected.All ERCP cases were classified using previously proposed complexity grading scales,including the American Society of Gastrointestinal Endoscopy(ASGE),Morriston and HOUSE grading scales,compared with the hepatopancreatic ampulla features classification.Successful intubation,successful surgical treatment and complication rates within 48 h were recorded.Results Within each grading,subgroups were divided according to severity,and the comparison of intubation success rates between subgroups in the 3 different grades showed statistically significant differences(P = 0.000).The treatment success rate and intubation success rate had similar findings(P = 0.000).There was no correlation between the complication rate and ASGE grading(P = 0.361),Morriston grading(P = 0.332),and HOUSE grading(P = 0.586).When only cases with primitive papillae were considered,the intubation success rate depended on the complexity grading after the newly added classification of hepatopancreatic ampulla features.In the ASGE group,the success rate of intubation was compared between different subgroups,and the difference was statistically significant(P = 0.004);in the Morriston group,the success rate of intubation was compared between different subgroups,and the success rate of intubation was statistically significant(P = 0.002);in the HOUSE group,the success rate of intubation was compared between different subgroups,and the difference was statistically significant(P = 0.000);In the hepatopancreatic ampulla characteristics group,the difference in intubation success rate was statistically significant when compared between different subgroups(P = 0.000).Similar findings were also found for treatment success rate and intubation success rate(P = 0.000).There was no correlation between the complication rate and ASGE group(P = 0.586),Morriston group(P = 0.443),HOUSE group(P = 0.306),and hepatopancreatic ampulla characteristics group(P = 0.350).Conclusion The use of hepatopancreatic ampulla features as a classification of biliary cannulation complexity is feasible and could be an alternative or additional means of predicting successful biliary cannulation and surgical treatment success and could be used in the future to assess endoscopist training and learning progress and technical standards.