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.

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.

Background::Early detection of esophageal squamous cell carcinoma (ESCC) can considerably improve the prognosis of patients. Aberrant cell-free DNA (cfDNA) methylation signatures are a promising tool for detecting ESCC. However, available markers based on cell-free DNA methylation are still inadequate. This study aimed to identify ESCC-specific cfDNA methylation markers and evaluate the diagnostic performance in the early detection of ESCC.Methods::We performed whole-genome bisulfite sequencing (WGBS) for 24 ESCC tissues and their normal adjacent tissues. Based on the WGBS data, we identified 21,469,837 eligible CpG sites (CpGs). By integrating several methylation datasets, we identified several promising ESCC-specific cell-free DNA methylation markers. Finally, we developed a dual-marker panel based on methylated KCNA3 and OTOP2, and then, we evaluated its performance in our training and validation cohorts. Results::The ESCC diagnostic model constructed based on KCNA3 and OTOP2 had an AUC of 0.91 [95% CI: 0.85–0.95], and an optimal sensitivity and specificity of 84.91% and 94.32%, respectively, in the training cohort. In the independent validation cohort, the AUC was 0.88 [95% CI: 0.83–0.92], along with an optimal sensitivity of 81.5% and specificity of 92.9%. The model sensitivity for stage I–II ESCC was 78.4%, which was slightly lower than the sensitivity of the model (85.7%) for stage III–IV ESCC. Conclusion::The dual-target panel based on cfDNA showed excellent performance for detecting ESCC and might be an alternative strategy for screening ESCC.

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.

Objective:To explore the current situation of attitudes toward seeking professional psychological help among parents of premature infants, and to analyze its influencing factors.Methods:From January to September 2019, this study selected 121 parents of premature infants at two ClassⅢ Grade A hospitals of Zhejiang Province as subjects by convenience sampling. Those parents were investigated with the General Information Questionnaire, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) , Simplified Coping Style Questionnaire (SCSQ) and the General Self-Efficacy Scale (GSES) . A total of 121 questionnaires were sent out and 112 valid questionnaires were collected with 92.6% for the valid recovery rate.Results:Among 112 parents of premature infants, the total score of ATSPPH-SF was (18.11±3.76) . There were statistical differences in the total score of ATSPPH-SF among parents with different body weight of premature infants, parents' genders, places of residence and family monthly income ( P<0.05) . Among parents of premature infants, the total score of ATSPPH-SF had a positive correlation with positive coping style ( r=0.337, P<0.05) , and had negative correlations with scores of negative coping style and self-efficacy ( r=-0.319, -0.296, P<0.05) . Multiple linear regression analysis showed that the influencing factors of attitudes toward seeking professional psychological help among parents of premature infants included the body weight of premature infants, family monthly income, positive coping style and self-efficacy with statistical differences ( P<0.05) . Conclusions:Nursing managers should pay attention to the attitudes toward seeking professional psychological help among parents of premature infants, especially in those with low levels of body weight of premature infants, family monthly income and self-efficacy. Nursing managers also should help them to establish the positive coping style so as to improve parents' acceptance of seeking professional psychological help.

The major immunogenic protein capsid (Cap) of porcine circovirus type 2 (PCV2) is critical to induce neutralizing antibodies and protective immune response against PCV2 infection. This study was conducted to investigate the immune response of recombinant adenovirus expressing PCV2b Cap and C-terminal domain of Yersinia pseudotuberculosis invasin (Cap-InvC) fusion protein in pigs. The recombinant adenovirus rAd-Cap-InvC, rAd-Cap and rAd were generated and used to immunize pigs. The phosphate-buffered saline was used as negative control. The specific antibodies levels in rAd-Cap-InvC and ZJ/C-strain vaccine groups were higher than that of rAd-Cap group (p < 0.05), and the neutralization antibody titer in rAd-Cap-InvC group was significantly higher than those of other groups during 21–42 days post-immunization (DPI). Moreover, lymphocyte proliferative level, interferon-γ and interleukin-13 levels in rAd-Cap-InvC group were increased compared to rAd-Cap group (p < 0.05). After virulent challenge, viruses were not detected from the blood samples in rAd-Cap-InvC and ZJ/C-strain vaccine groups after 49 DPI. And the respiratory symptom, rectal temperature, lung lesion and lymph node lesion were minimal and similar in the ZJ/C-strain and rAd-Cap-InVC groups. In conclusion, our results demonstrated that rAd-Cap-InvC was more efficiently to stimulate the production of antibody and protect pigs from PCV2 infection. We inferred that InvC is a good candidate gene for further development and application of PCV2 genetic engineering vaccine.
Adenoviridae ; Adenovirus Vaccines ; Antibodies ; Antibodies, Neutralizing ; Capsid ; Capsid Proteins ; Circovirus ; Genetic Engineering ; Immunization ; Interleukin-13 ; Lung ; Lymph Nodes ; Lymphocytes ; Swine ; Yersinia pseudotuberculosis

OBJECTIVE： To investigate the pratice of pharmaceutical care provided by clinical pharmacists in orthopedics department. METHODS： Based on the characteristics of orthopedic diseases and clinical drug use， combined with case analysis， the content， work focus and working methods of pharmaceutical care provided by clinical pharmacists were summarized in orthopedics department of our hospital. RESULTS： Clinical pharmacists of our hospital provided basal pharmaceutical care， such as pharmacy consultation， drug reforming， medication education. Focusing on the application standardization of antibiotics in perioperative period， pain evaluation， analgesic regimen optimization， hemostasis and anticoagulation medication safety monitoring of patients undergoing orthopaedic surgery， clinical pharmacists went deep into ward work to assist physicians in formulating treatment plans. Results of case analysis showed that the work of clinical pharmacists was recognized by doctors and promoted rational drug use in clinic. CONCLUSIONS： Clinical pharmacists should combine different specialty characteristics to carry out pharmacy services for specific groups， continuously improve the professional level and their ability to work， and improve the level of pharmaceutical care.

Objective To determine if preventive antibiotics is effective in stroke associated pneumonia in patients with acute stroke.Methods Medline (January 1950 to January 2017),EMBASE (January 1974 to January 2017),Cochrane Library (January 2009 to January 2017),CNKI (January 1979 to January 2017)and Wanfang data (January 1998 to January 2017) were searched for randomized controlled trial comparing preventive antibiotics with placebo/blank controls for stroke associated pneumonia in patients with acute stroke.The included studies were screened out strictly based on the criterion of inclusion and exclusion.The quality of included studies was evaluated and the data were extracted by two researchers independently.RevMan 5.1 was used for Meta analysis.Results A total of 4 studies involving 3894 patients were included.The results of Meta-analysis indicated that there was no significant difference in the incidence of stroke associated pneumonia between preventive antibiotics and control groups (OR=0.96,95％CI:0.72-1.29,P=0.810);and there were no statistically significant differences in mortality (OR=1.05,95％CI:0.88-1.25,P=0.570) and good outcome (modified Rankin scale ≤ 2,OR=1.02,95％CI:0.89-1.17,P=0.780).There were no serious adverse reactions related to the studied drugs in 4 studies.Conclusion Preventive antibiotics could neither reduce the incidence of stroke associated pneumonia nor decrease the mortality or improve the proportion of good outcome.

OBJECTIVE: To provide scientific evidence for the further improvement of hospital antibacterial management, the formulation of related management decisions and long-acting mechanism. METHODS: Technique for order preference by similarity to ideal solution (TOPSIS) was used to select 8 evaluation indexes as utilization rate of antibiotics in the inpatients to synthetically evaluate the effect of antibacterial management in 10 third grade general hospitals of Xi'an from 2012 to 2016. RESULTS: Results of synthesis evaluation by TOPSIS method showed that the least effect was in 2012 [coefficient of proximity from the object of evaluation to the optimal value (Ci) =0]; the effect of antibacterials management was improved gradually during 2013-2015, and there was the best effect in 2015 (Ci=0. 918 3); but declined in 2016 (Ci=0. 838 5). Only one evaluation index (the rate of microbial examination in the inpatient receiving special use of antibacterials) was improved significantly in the 5 years(P＜0. 01), but there was no statistical significance in the data of other 7 indexes (P＞0. 01). CONCLUSIONS: The effect of antibacterials management in 10 third grade general hospitals of Xi'an was on the rise from 2012 to 2015, but was declined in 2016. It might be slack. A long-acting management mechanism of antibacterial management is needed to be established, in order to consolidate the achievements from "special rectification for clinical antibacterial use" and further improve the normal and dynamic operation of antibacterial management measure. TOPSIS method is objective and comprehensive method for synthesis evaluation of the effect of antibacterial management, and is of significance to antibacterial supervision and use.

Objective To analyze the correlation between mutation in JAK2-V617F gene in peripheral blood mononuclear cells and thrombotic events in patients with myeloproliferative.Methods Investigation of thrombosis in 391 patients with MPN,using QRT-PCR to detect JAK2-V617F gene mutation in peripheral blood of patients.Result 105 cases of thrombotic events in 391 MPN patients (26.9％),84 cases of thrombotic events in 273 JAK2-V617F gene mutation positive patients (30.8 ％),however,21 cases of thrombotic events in 118 J AK2-V617F gene mutation negative panents (17.8 ％).The difference between the two groups was statistically significant (x2 =32.30,P＜0.01).In the PV group,45 cases of thrombosis events in JAK2-V617F positive patients (29.2 ％),6 cases of thrombosis events in JAK2-V617F negativepatients (42.9％),there was significant difference between the two groups (x2 =2.13,P＞0.05).In the ET group,18 cases of thrombosis events in JAK2-V617F positive patients (32.2％),9 cases of thrombosis events in JAK2-V617F negative patients (15.8％),there was significant difference between the two groups (x2 =12.32,P＜0.01).In the PMF group,21 cases of thrombosis events in JAK2-V617F posinve patients (33.3 ％),6 cases of thrombosis events in JAK2-V617F negativepatients (12.8 ％),there was significant difference between the two groups (x2 =14.32,P＜0.01).Conclusion JAK2-V617F positive MPN patients were more susceptible to thrombotic events especially in patients with ET and PMF.