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.

Exhaled ammonia(NH3)is an essential noninvasive biomarker for disease diagnosis.In this study,an acetone-modifier positive photoionization ion mobility spectrometry(AM-PIMS)method was developed for accurate qualitative and quantitative analysis of exhaled NH3 with high selectivity and sensitivity.Acetone was introduced into the drift tube along with the drift gas as a modifier,and the characteristic NH3 product ion peak of(C3H6O)4NH4+(K0=1.45 cm2/V·s)was obtained through the ion-molecule reaction with acetone reactant ions(C3H6O)2H+(K0=1.87 cm2/V·s),which significantly increased the peak-to-peak resolution and improved the accuracy of exhaled NH3 qualitative identification.Moreover,the interference of high humidity and the memory effect of NH3 molecules were significantly reduced via online dilution and purging sampling,thus realizing breath-by-breath measurement.As a result,a wide quantitative range of 5.87-140.92 μmol/L with a response time of 40 ms was achieved,and the exhaled NH3 profile could be synchronized with the concentration curve of exhaled CO2.Finally,the analytical capacity of AM-PIMS was demonstrated by measuring the exhaled NH3 of healthy subjects,demon-strating its great potential for clinical disease diagnosis.

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in the patients after neoadjuvant treatment. Methods From January 2019 to February 2021, the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Comprehensive Breast Health Center, Department of General Surgery, Ruijin Hospital were collected. Comparison of clinicopathological features was done between neoadjuvant treatment group and control group. Univariate analysis was used to compare the rate of surgical complications between two groups. Results A total of 110 patients were enrolled with 23 cases (20.9%) in neoadjuvant treatment group and 87 cases (79.1%) in control group. None of carcinoma in situ (0 vs. 19.5%, P=0.003) and higher pTNM stage (P<0.001) was present in neoadjuvant treatment group compared with those in control group. However, there were no significant differences in the number of flap perforator of DIEP (P=0.472), the proportion of bipedicled flaps (P=0.489), operative time (P=0.651) and hospital length of stay (P=0.275) between two groups. No significant difference was found in the incidence of postoperative complications between two groups. Breast seroma was the most common recipient complication (13.0%, 3 cases) without donor complication in neoadjuvant treatment group. The most common complication was fat necrosis (12.6%, 11 cases) in recipient site and abdominal seroma (3.4%, 3 cases) in donor site of control group. Reoperation was done in one case (4.3%) of neoadjuvant treatment group and 4 cases (4.6%) of control group. DIEP flap necrosis with total flap loss occurred in 2 cases (2.3%) in control group, but none in neoadjuvant treatment group. Conclusions The imme-diate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.

Objective To explore the clinical effect of whole body vibration training on stroke patients with hemiplegia and its effect on patients'balance function.Methods Eighty-six stroke patients with hemiplegia admitted to the Second Hospital of Jiaxing from June 2017 to December 2018 were divided into control group (43 cases)and observation group (43 cases) by random number table method.The control group received routine training,while the observation group received whole body vibration training on the basis of the control group.Both two groups were treated for 12 weeks.The changes of upper limb motor function,daily living ability and Berg balance scale (BBS)scores before and after intervention were compared between the two groups.Results After intervention,the FMA scores of the control group and the observation group were (37.89 ± 5.34)points and (49.61 ± 5.47)points,respectively,which were higher than before intervention (observation group:t =21.706,control group:t =10.272,all P ＜0.05).The FMA score of the observation group was higher than that of the control group (t =10.054,P ＜0.05).The improved Barthel index (MBI) scores of the observation group and the control group were (68.98 ± 7.91)points and(52.15 ± 6.87) points,respectively,which were higher than those before intervention (observation group:t =22.170,control group:t =10.119,all P ＜ 0.05).The MBI score in the observation group was higher than that in the control group (t =10.534,P ＜ 0.05).The BBS scores of the observation group and the control group were (59.98 ±6.47) points and (48.98 ± 3.71) points,respectively,which were higher than those before intervention (observation group:t =20.820,control group:t =13.877,all P ＜0.05).The BBS score in the observation group was higher than that in the control group (t =9.672,P ＜ 0.05).Conclusion Whole body vibration training has good clinical effect on stroke patients with hemiplegia,and it can improve upper limb motor function,daily living ability and balance function.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective:To investigate the prevalence and clinical characteristics of mild cognitive impairment (MCI) and its related risk factors in patients with prodromal Parkinson's disease (pPD).Methods:Forty-seven pPD patients from Nanjing community and 37 healthy controls (HCs) were recruited in the present study. The pPD patients were divided into pPD-MCI group and normal cognition (pPD-NC) group according to Beijing version of Montreal Cognitive Assessment (BJ-MoCA). The general clinical data, Hamilton Depression Scale (HAMD) scores, Hamilton Anxiety Scale (HAMA) scores, number of patients with rapid eye movement-sleep behavior disorder (RBD), overall cognitive function and cognitive domain impairment of members from pPD group and HCs, pPD-MCI group and pPD-NC group were respectively compared. Risk factors for pPD-MCI were analyzed by multivariate Logistic regression analysis.Results:The prevalence of pPD-MCI in the 47 pPD patients was 57.45% (27/47). As compared with the HCs, pPD patients had significantly higher HAMD scores and HAMA scores, statistically larger number of patients with RBD, while significantly lower overall Montreal Cognitive Assessment (MoCA) scores and statistically lower scores in cognition domains of visuospatial and executive function, attention, abstraction, delayed memory and orientation ( P<0.05). Patients in pPD-MCI group had significantly higher HAMA scores, Unified Parkinson's Disease Rating Scale-Motor Examination scores, statistically lower education level, significantly lower MoCA scores, and statistically lower scores in cognition domains of visuospatial and executive function, abstraction, and delayed memory as compared with patients in pPD-NC group ( P<0.05). Multivariate Logistic regression analysis showed that low education level was an independent risk factor for pPD-MCI ( OR=0.800, 95%CI: 0.650-0.985, P=0.035). Conclusions:The prevalence of MCI in pPD patients is high, and multiple cognitive domains can be impaired in early stage. Patients with pPD-MCI are more vulnerable to depression and mild motor symptoms, so attention should be paid to emotional intervention and sport life guidance for patients at early stage. Education level is crucial for pPD-MCI, and cognitive training may contribute to slow down the process of MCI.

Gut Microbial species have different physiologic functions, such as digestion, nutrition, immunity, etc. Studies have shown that gut microbiota plays an important role in intestinal function. Gut microbiota is a complex ecosystem that participates in the physiological and pathological processes of the human body and forms a dynamic equilibrium with the human body. If this balance is broken, it may lead to or aggravate the occurrence and development of diseases. In recent years, researches have confirmed that the biological composition of gut microbiota in patients with diseases is significantly different from that of healthy people. The detection and transformation of gut microbiota has certain value and therapeutic effect on the diagnosis of diseases. Systematic biological methods can be used to study the relationship between gut microbiota and immunity and metabolism. In this paper, the related researches on the interactions between gut microbiota and human diseases were reviewed, including immunodeficiency-related diseases, autoimmune diseases, celiac diseases, intestinal microbial-related metabolic diseases and neurological diseases, and the related pathogenesis was summarized as well.

Objective To explore the clinical and genetic features of McLeod syndrome caused by XK gene mutation.Methods The clinical data of a patient who came from the Affiliated Brain Hospital of Nanjing Medical University in May 2017 and diagnosed as McLeod syndrome by gene detection were analyzed.Gene analysis was also carried out in his family to confirm the result.Results Acanthocytes in peripheral blood,systemic chorea symptom,and increased serum levels of creatine kinase were observed in this patient and his brother.The proband and his brother showed half mutations.One of the proband's sister was homozygous normal.The proband's mother,one of the proband's sister and the proband's daughter showed heterozygous mutations.The family analysis accorded with X-linked recessive inheritance trait.Genetic testing for mutations in the XK gene revealed a previously unreported hemizygous single base-pair frame shift deletion at exon 3 (c.1004G＞A).Conclusions A rare phenotype of a patient with McLeod syndrome is first described in mainland of China which was discovered coincidentally during routine blood group testing and consecutively genetically con fi rmed.One novel mutation in XK gene was found in the patient.For old male patient with multiple system disorders including dyskinetic movement disorders,cardiopathy,acanthocytes and elevated serum creatine kinase,a genetic test for XK gene mutation is highly suggested to confirm the McLeod syndrome.

OBJECTIVE: To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. METHODS: The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. RESULTS: No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, <0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, <0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, <0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, <0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (>0.05). CONCLUSIONS The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.
Carotid Arteries ; surgery ; Carotid Body Tumor ; pathology ; surgery ; Humans ; Neurilemmoma ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome