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.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P＜0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P＜0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.

Objective To compare the trichloroethylene (TCE)-induced alteration in cell proliferation,cell apoptosis,histone deacetylase activity and expression levels in human hepatic L-02 cells (L-02 cells) and SET deficient cells,and reveal the TCE-induced effect in histone modification and the role of SET on epigenetic pathway.Methods The L-02 cells and preestablished SET deficient cells were treated with different TCE concentrations.For the changes of cell proliferation level and apoptosis rate,The L-02 cells and SET deficiency cells without TCE treatment were served as the control group,the TCE treatment was in the concentration of 2.0 and 8.0 mmol/L for 24 h.For histone deacetylase activity and expression levels,the TCE treatment was in the concentration of 0.25,0.50,1.0,2.0,4.0,and 8.0 mmol/L for 24 h.Results After treatment with TCE for 24 h,the cell proliferation level was significantly decreased and the apoptotic rate was significantly increased in both cell lines.When concentration of TCE were reached to 8.0 mmol/L,the difference of cell proliferation level and apoptotic rate between two groups was statistically significant (t=-4.362 for proliferation level and t =23.950 for apoptotic rate,both P＜0.05).After treatment with TCE for 24 h in various concentration (0,0.25,0.50,1.00,2.00,4.00 and 8.00 mmol/L),the activity of histone deacetylases was significantly increased in both cell lines.When the TCE concentration were high than 0.50 mmol/L,compared with control group of L-02 cells,the enzymes activity were significantly increased (F=403.26,P＜ 0.001).When TCE concentration was reached 1.00 mmol/L,the enzyme activity is highest.Compared with control group of SET deficiency cells,the enzyme activity was significantly increased when TCE concentration was reached 1.00 mmol/L (F=44.01,P＜0.001).When concentration of TCE reached 0.50 mmol/L,the difference of enzyme activity between two groups was statistically significant.For the protein expression,compared with control group of L-02 cells,TCE exposure can induced a significant increased expression level of HDAC2 in TCE-treated L-02 cells (Fvalues were 79.99,P＜0.001).But the alteration in SET deficiency cells was not significant.Conclusion TCE exposure can induce a significant alteration on cell proliferation,apoptotic rate and,the activity and expression on histone deacetylases.SET deficiency can attenuate the TCE-induced alteration in histone modification in L-02 cells.Our results indicated that SET is involved in the mechanism of TCE-induced cytotoxicity and epigenetic regulation in L-02 cells.

Objective To compare the trichloroethylene (TCE)-induced alteration in cell proliferation,cell apoptosis,histone deacetylase activity and expression levels in human hepatic L-02 cells (L-02 cells) and SET deficient cells,and reveal the TCE-induced effect in histone modification and the role of SET on epigenetic pathway.Methods The L-02 cells and preestablished SET deficient cells were treated with different TCE concentrations.For the changes of cell proliferation level and apoptosis rate,The L-02 cells and SET deficiency cells without TCE treatment were served as the control group,the TCE treatment was in the concentration of 2.0 and 8.0 mmol/L for 24 h.For histone deacetylase activity and expression levels,the TCE treatment was in the concentration of 0.25,0.50,1.0,2.0,4.0,and 8.0 mmol/L for 24 h.Results After treatment with TCE for 24 h,the cell proliferation level was significantly decreased and the apoptotic rate was significantly increased in both cell lines.When concentration of TCE were reached to 8.0 mmol/L,the difference of cell proliferation level and apoptotic rate between two groups was statistically significant (t=-4.362 for proliferation level and t =23.950 for apoptotic rate,both P＜0.05).After treatment with TCE for 24 h in various concentration (0,0.25,0.50,1.00,2.00,4.00 and 8.00 mmol/L),the activity of histone deacetylases was significantly increased in both cell lines.When the TCE concentration were high than 0.50 mmol/L,compared with control group of L-02 cells,the enzymes activity were significantly increased (F=403.26,P＜ 0.001).When TCE concentration was reached 1.00 mmol/L,the enzyme activity is highest.Compared with control group of SET deficiency cells,the enzyme activity was significantly increased when TCE concentration was reached 1.00 mmol/L (F=44.01,P＜0.001).When concentration of TCE reached 0.50 mmol/L,the difference of enzyme activity between two groups was statistically significant.For the protein expression,compared with control group of L-02 cells,TCE exposure can induced a significant increased expression level of HDAC2 in TCE-treated L-02 cells (Fvalues were 79.99,P＜0.001).But the alteration in SET deficiency cells was not significant.Conclusion TCE exposure can induce a significant alteration on cell proliferation,apoptotic rate and,the activity and expression on histone deacetylases.SET deficiency can attenuate the TCE-induced alteration in histone modification in L-02 cells.Our results indicated that SET is involved in the mechanism of TCE-induced cytotoxicity and epigenetic regulation in L-02 cells.

BACKGROUND:Although the renal transplantation technology has been quite mature, vascular complications during and after transplantation inevitably occur.
OBJECTIVE: To investigate the diagnosis and management of vascular complications during and after renal transplantation.
METHODS: A retrospective analysis was performed in 11 patients suffering from vascular complications during and after renal transplantation. During the transplantation, there were two cases of arterial anastomotic stenosis, one case of renal vain transverse, three cases of atherosclerosis plaque of the external iliac artery blocking the transplant renal artery, one case of twisted renal vein. After transplantation, there were two cases of extra renal pseudoaneurysm, one case of arterial anastomotic stenosis, and one case of renal artery obstruction.
RESULTS AND CONCLUSION: Two cases of arterial anastomotic stenosis during operation had good recovery, and renal alograft dysfunction occurred after 6 and 11 years, respectively. In the case of renal vain transverse, the renal alograft functioned for 12 years. Among the three cases of atherosclerosis plaque of external iliac artery blocking the transplant renal artery, 1 case presented with renal alograft dysfunction immediately, the other two patients,renal function recovered wel during the folow-up of 6 and 2 years respectively. In the case of twisted renal vein, delayed graft function occurred, and the patient died of severe pulmonary infection 1 month later. The renal alograft dysfunction occurred in the two cases of post-transplantation extra renal pseudoaneurysm. The case of post-transplantation arterial anastomotic stenosis was treated by baloon angioplasty and metalic stent placement via femoralartery, and the renal function became normal during 18 months of folow-up. The case of post-transplantation renal artery obstruction appeared to have delayed graft function, and died of severe pulmonary infection 3 weeks later. These findings indicate that patients with vascular complications during and after renal transplantation can obtain satisfactory outcomes if receiving accurate diagnosis and timely treatment.

Purpose To investigate the imaging characteristics and accuracy of diagnosing pilocytic astrocytoma (PA) with perfusion weighted imaging (PWI), diffusion weighted imaging (DWI), magnetic resonance sprectroscopy, susceptibility weighted imaging (SWI) and diffusion tensor imaging. Material and Methods MRI imaging of 11 patients with PA was retrospectively analyzed for functional imaging features. Results In 11 patients with PA, there were 9 mixed cystic and solid lesions, 1 case of cystic lesion and 1 case with solid lesion. Ten lesions showed mixed hypointensity on T1WI, and mixed hyperintensity on T2WI and FLAIR. One case was hypointense on T1WI, and hyperintense on T2WI and FLAIR. Prominent contrast enhancement was seen in the solid portion, capsular wall and mural nodules. On SWI 3 cases showed patchy low signal, 2 cases of dot-like low signal and 2 cases without low signal, with average intratumoral susceptibility signal intensity classification of 1.57. PWI findings were characterized by high perfusion with relative cerebral blood volume averaging 2.64±1.22. There was elevated choline component in the solid portion with significantly decreased NAA with average Cho/NAA ratio of 5.13±4.72 (1.46-15.26). Lactate peak was increased in 5 cases. On DWI there was limited diffusion in 1 case. 7 cases did not demonstrate limited diffusion with average relative apparent diffusion coefficient of 1.60±0.58. Conclusion Most MRI features of pilocystic astrocytoma are consistent with low grade glioma. There are characteristic functional imaging findings with higher perfusion than other gliomas. Functional MRI can evaluate tumor metabolism and prognosis.

Objective To investigate the clinical features and outcome of retroperitoneal fibrosis (RPF).Methods Thirty-three cases of RPF treated in the Department of Rheumatology and Immunology were analyzed retrospectively,including the clinical characteristics and laboratory data.Results RPF occurred predominantly in elderly men with untypical clinical manifestations such as back pain,abdominal pain and lower limb edema.In laboratory tests,the inflammatory parameters such as erythrocyte sedimentation rate and C-reactive protein increased significantly,and renal function failure was frequent finding in patients with urethral obstruction.All patients had retroperitoneal soft tissue image or urethral obstruction on computed tomography or magnetic resonance imaging,four of which had histological diagnosis of idiopathic RPF.Twenty-three patients received surgical interventions.Eighteen patients received medical treatment alone including corticosteroids,immunosuppressants,and tamoxifen.Nine patients received corticosteroids after surgical intervention.Surgery and medical treatments are effective for idiopathic RPF.Conclusion Image examination is valuable in diagnosis and differential diagnosis of PRF.Pathological diagnosis is the golden standard.Long-term low dose corticosteroids and immunosuppressants may prevent relapse of idiopathic RPF.

Objective To compare clinical effect of gonadotropin releasing hormone agonist(GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD)in treatment of endometriosis.Methods Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups.35 patients in GnRH-a group were treated by goserelin (3.6 mg)for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg)combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily.Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index(KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E_2) and bone gla-protein (BGP) .The first menstruation and VAS were also followed up after treatment.Results Every 3 cases in two groups lost follow-up.(1)Reproductive hormone: the level of E_2 in add-back group [(94 ± 71) pmol/L]was significantly higher than (54±52) pmol/L in GnRH-a group(P <0.01).The level of FSH in add-back group [(3.0 ± 1.9) U/L]was significantly lower than (5.7 ± 2.9) U/L in GnRH-a group (P < 0.05).(2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment(P < 0.05), and remained until menstruated.(3) KMI: KMI in add back-group (10 ± 8) was significantly lower than (14 ± 6) in GnRH-a group (P < 0.05).(4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P < 0.05), no remarkable difference of BMD was observed before and after treatment in add-back group.Before treatment, serum BGP in both groups did not show statistical difference.After treatment, the level of BGP in GnRH-a group [(7932±5206) ng/L]was significantly higher than (5419±2917) ng/L in add-back group (P <0.05).Conclusions GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss.Therefore,it is a safe and effective treatment.