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.

Prolonged disorders of consciousness (pDoC) represent severe complications following severe traumatic brain injury, imposing substantial burden on both families and the society. Currently, the diagnosis and treatment of pDoC still face challenges, including insufficient assessment accuracy and limited efficacy of arousal therapies. On one hand, innovative approaches such as neuroimaging, electrophysiological techniques, and neuromodulation have provided new directions for the diagnosis and treatment of pDoC, yet standardized diagnostic and therapeutic protocols as well as large-scale clinical evidence remain lacking. On the other hand, standardized management of pDoC requires multidisciplinary collaboration, yet the limited number of specialized arousal centers in China hinders the provision of systematic therapy. The Department of Neurosurgery at West China Hospital, Sichuan University has established a comprehensive pDoC care system through a multidisciplinary team approach. To this end, the authors systematically summarized the clinical exploration and advancements in pDOC arousal therapy by West China Hospital′s neurosurgical team, aiming to provide valuable insights for domestic peers and jointly advance the optimization and advancement of pDoC diagnosis and treatment.

Prolonged disorders of consciousness (pDoC) represent severe complications following severe traumatic brain injury, imposing substantial burden on both families and the society. Currently, the diagnosis and treatment of pDoC still face challenges, including insufficient assessment accuracy and limited efficacy of arousal therapies. On one hand, innovative approaches such as neuroimaging, electrophysiological techniques, and neuromodulation have provided new directions for the diagnosis and treatment of pDoC, yet standardized diagnostic and therapeutic protocols as well as large-scale clinical evidence remain lacking. On the other hand, standardized management of pDoC requires multidisciplinary collaboration, yet the limited number of specialized arousal centers in China hinders the provision of systematic therapy. The Department of Neurosurgery at West China Hospital, Sichuan University has established a comprehensive pDoC care system through a multidisciplinary team approach. To this end, the authors systematically summarized the clinical exploration and advancements in pDOC arousal therapy by West China Hospital′s neurosurgical team, aiming to provide valuable insights for domestic peers and jointly advance the optimization and advancement of pDoC diagnosis and treatment.

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 evaluate the effects of intermittent hypoxia-reoxygenation(IHR)on body weight,diet and water intake,circulating metabolites,and responses to central leptin injection in a rat model of diet-induced obesity(DIO).Methods Rat models of DIO established by 12-week high-fat diet(HFD)feeding were randomized into normoxia group(n=15),intermittent hypoxia group(6％O2,30 cycles/h,8 h/day for 4 weeks;n=15),and IHR group(2 weeks of intermittent hypoxia followed by 2 weeks of reoxygenation;n=15).Body weight,diet and water intake of the rats were recorded,and circulating leptin,IL-6,and Ang-Ⅱ levels were detected.After IHR treatment,the rats received intracerebroventricular injection of 4 μg leptin,and the hypothalamus and liver were taken 1 h later for detecting POMC,FRA-1 and FRA-2 expressions in the hypothalamus using immunohistochemistry,POMC,pSTAT3 and LepR expressions in the hypothalamus using Western blotting,and LepR mRNA expression in the hypothalamus and liver using RT-PCR.Results The rats in intermittent hypoxia group showed significantly increased weight gain,food intake and elevated systemic inflammatory cytokine levels.Intermittent hypoxia obviously inhibited the expression of POMC,lowered the expressions of FRA-1 and pSTAT3,reduced the responsiveness of the rats to exogenous leptin,and downregulated the mRNA and protein expression of LepR.Two weeks of reoxygenation treatment obviously reduced intermittent hypoxia-induced weight gain and metabolic disorder and improved leptin sensitivity of the rats.Conclusion Prolonged intermittent hypoxia impairs hypothalamic leptin signaling by downregulating LepR expression to promote weight gain in obese rats,which can be improved by reoxygenation treatment.

Objective To evaluate the effects of intermittent hypoxia-reoxygenation(IHR)on body weight,diet and water intake,circulating metabolites,and responses to central leptin injection in a rat model of diet-induced obesity(DIO).Methods Rat models of DIO established by 12-week high-fat diet(HFD)feeding were randomized into normoxia group(n=15),intermittent hypoxia group(6％O2,30 cycles/h,8 h/day for 4 weeks;n=15),and IHR group(2 weeks of intermittent hypoxia followed by 2 weeks of reoxygenation;n=15).Body weight,diet and water intake of the rats were recorded,and circulating leptin,IL-6,and Ang-Ⅱ levels were detected.After IHR treatment,the rats received intracerebroventricular injection of 4 μg leptin,and the hypothalamus and liver were taken 1 h later for detecting POMC,FRA-1 and FRA-2 expressions in the hypothalamus using immunohistochemistry,POMC,pSTAT3 and LepR expressions in the hypothalamus using Western blotting,and LepR mRNA expression in the hypothalamus and liver using RT-PCR.Results The rats in intermittent hypoxia group showed significantly increased weight gain,food intake and elevated systemic inflammatory cytokine levels.Intermittent hypoxia obviously inhibited the expression of POMC,lowered the expressions of FRA-1 and pSTAT3,reduced the responsiveness of the rats to exogenous leptin,and downregulated the mRNA and protein expression of LepR.Two weeks of reoxygenation treatment obviously reduced intermittent hypoxia-induced weight gain and metabolic disorder and improved leptin sensitivity of the rats.Conclusion Prolonged intermittent hypoxia impairs hypothalamic leptin signaling by downregulating LepR expression to promote weight gain in obese rats,which can be improved by reoxygenation treatment.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Objective:To investigate the clinical characteristics and related factors of patients with chronic obstructive pulmonary disease (COPD) complicated by obstructive sleep apnea (OSA).Methods:The clinical data of 153 patients with COPD who received treatment in Xiangyang First People's Hospital from July 2018 to December 2019 were retrospectively analyzed. A total of 101 patients with complete data regarding pulmonary function and polysomnography who met inclusion criteria were selected. They were divided into simple COPD (COPD group, n = 33) and COPD + OSA (OS group, n = 68) groups according to whether they developed OSA. General clinical data, pulmonary function indexes and polysomnography indexes were compared between the COPD and OS groups. Logistic regression analysis was performed to analyze the degree of airflow limitation and the related factors of COPD combined with OSA. Results:There were more males than females in each group. In the OS group, the proportion of males, body mass index, forced expiratory volume in one second (FEV 1), forced expiratory volume in 1 second percent predicted (FEV 1%pred), the ratio of FEV 1 to forced vital capacity (FVC), apnea-hypopnea index and oxygen desaturation index in the OS group were 92.6%, 24.0 (23.4, 24.8) kg/m 2, 1.2 (1.2, 1.5) L, 50.0 (49.6, 59.4)%, 49.1 (46.9, 53.0)%, 15.4 (16.4, 25.3) times/h, 14.8 (17.3, 25.6) times/h, respectively, which were significantly higher than those in the COPD group [75.8%, 23.0 (21.6, 23.7) kg/m 2, 0.9 (0.9, 1.1) L, 41.0 (38.3, 49.1) %, 41.9 (39.5, 49.24)%, 1.9 (1.6, 2.4) times/h, 4.0 (3.7, 9.7) times/h, t or U = 4.246, 1 399.000, 1 544.500, 1 483.000, 1 407.000, 2 244.000, 1 915.000, all P < 0.05]. The lowest oxygen saturation at night in the OS group was significantly lower than that in the COPD group [81.5 (79.4, 82.6) % vs. 87.0 (80.2, 86.6) %, U = 758.500, P < 0.05]. There were no significant differences in age, smoking index and forced vital capacity between COPD and OS groups ( t = - 0.963, 1 150.000, - 1.954, all P > 0.05). Correlation and Logistic regression analysis revealed that the risk of severe or very severe airflow limitation was lower in the OS group than in the COPD group ( OR = 0.392, P < 0.05). BMI, FEV 1, FEV 1%pred were the risk factors of COPD combined with OSA ( OR = 1.185, 5.554, 1.034, all P < 0.05). BMI and FEV 1 were the independent risk factors of COPD combined with OSA ( OR = 1.168, 5.248, both P < 0.05). Conclusion:COPD and OSA are more common in males and in patients with higher BMI. OSA patients tend to develop lower degree of airflow limitation and more severe hypoxemia and apnea-hypopnea at night than COPD patients. Apnea-hypopnea index is the protective factor against airflow limitation in COPD. BMI, FEV 1 and FEV 1%pred are the risk factors of COPD combined with OSA. BMI and FEV 1 are the independent risk factors of COPD combined with OSA.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.