Perfluorooctane sulfonate （PFOS） has significant biotoxicity and can disrupt the structure and function of the blood-brain barrier. PFOS exposure can lead to the degradation of tight junction proteins in the blood-brain barrier and damage to astrocytes， resulting in increased permeability of the blood-brain barrier， as well as the activation of multiple signaling pathways， including PI3K/AKT， p38 MAPK， oxidative stress， and calcium signaling pathways. Damage to the blood-brain barrier may trigger various neurological diseases， and PFOS affects the function of the blood-brain barrier through multiple mechanisms， thereby interfering with the normal operation of the central nervous system. This article aims to review the research progress on the signaling pathways related to PFOS-induced blood-brain barrier damage and suggests that future studies could focus on developing more precise in vivo models， utilizing advanced molecular biology techniques to reveal more detailed molecular mechanisms， and exploring the synergistic effects of PFOS with other environmental toxins， in order to provide scientific evidence for the clinical prevention and treatment of PFOS-induced neurological diseases.

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 investigate the influencing factors of the course of perioperative prophylactic antibiotics in patients undergoing total hip arthroplasty,and explore management strategies for enhancing perioperative prophylactic medication administration.Methods The clinical data for patients undergoing total hip arthroplasty at Affiliated Hospital of Chengdu University from January,2020 to September,2024 were retrospectively collected.Patients were divided into a 24 h group and a 48-72 h group based on the duration of prophylactic antibacterial therapy.The general characteristics,surgical-related indicators,preoperative and postoperative laboratory test results,and surgical outcome measures between the two groups of patients were compared.Multivariate Logistic regression analysis was performed to identify influencing factors associated with prolonged duration of prophylactic antibacterial therapy.Results A total of 126 patients who underwent total hip arthroplasty were enrolled,including 74 cases in the 24 h group and 52 cases in the 48-72 h group.Univariate analysis results showed that there were statistically significant differences in the following indicators between the two groups:surgical cause,surgical duration,intraoperative blood loss,drainage duration of plasma drainage tubes,preoperative white blood cell count,and preoperative neutrophil count(P<0.05).The results of multivariate Logistic regression analysis showed that the reason for surgery and the duration of plasma drain tube drainage were the influencing factors of antimicrobial treatment course for total hip arthroplasty(P<0.05).The results of receiver operating characteristic curve analysis showed that the prediction model(constructed based on the drainage time of plasma drainage tube)for prophylactic antimicrobial treatment course to 48-72 h was 0.721.When the drainage time of plasma drainage tubes was≥40.56 h,the risk of requiring prophylactic antimicrobial therapy for an extended course of 48-72 h increased significantly.Conclusion The patient's surgical reason and the duration of plasma drain drainage may be related to the prophylactic antimicrobial course of more than 24 hours.Clinical pharmacists may utilize this parameter as a patient-specific characteristic,with the support of information systems,the hierarchical patient management can be implemented,thereby enhancing the effectiveness of medication surveillance and progressively elevating the 24 h discontinuation rate of perioperative prophylactic antibiotics.

OBJECTIVE To investigate the regulatory effect of Rasfonin on SOS1(Son of Seven-less,one of the major guanylate exchange factors)expressions and the underlying mechanism.METHODS① Human cancer cells MCF-7(breast cancer cells,KRASWT wild-type),Calu-1(non-small cell lung cancer,KRASG12C mutation),and UM-UC-3(bladder metastatic cell carcinoma,KRASG12C mutation)were divided into the control group and Rasfonin(1,5,10 and 15 μmol·L-1)treated groups.CCK-8 assay was used to observe the effects of Rasfonin on the proliferation of MCF-7,Calu-1,and UM-UC-3 cells after 24 h of Rasfonin treatment.In addition,these cells were divided into the control group,EGF stimulation group(EGF 50 μg·L-1,stimulated for 5 min),and Rasfonin treated groups(pretreated with 5 and 10 μmol·L-1 Rasfonin before 5 min EGF stimulation).Quantitative real-time PCR(real-time fluores-cence PCR)and Western blotting were employed to identify the expression levels of SOS1 mRNA and protein in MCF-7,Calu-1 and UM-UC-3 cells.② The co-expression systems of KRAS and SOS1 were established by transfecting plasmids(KRAS-NC,KRASWT,KRASG12C and SOS1)into 293T cells that were divided into the control group and Rasfonin(1,5 and 10 μmol·L-1)treated group.The dual luciferase reporter gene assay was used to evaluate the effects of Rasfonin on activities of the SOS1 promoter.Moreover,293T cells were divided into the EGF stimulation group(EGF 50 μg·L-1,stimulated for 5 min)and Rasfonin treated groups(12 h of treatment with 10 μmol·L-1 Rasfonin before 5 min EGF stimula-tion).Western blotting was performed to determine the role of KRASG12C protein in the inhibition of Rasfonin on SOS1 expression.RESULTS ① Compared with the control group,Rasfonin inhibited the prolifera-tion of Calu-1 and UM-UC-3 cells at concentrations of 5,10 and 15 μmol·L-1(IC50 was 8.22 and 4.94 μmol·L-1).But for MCF-7 cells,only 15 μmol·L-1 Rasfonin could decrease their viability(IC50 was 45.15 μmol·L-1).Compared with the EGF stimulation group,mRNA expressions of SOS1 were increased after Rasfonin treatment of 1 h.mRNA expressions of SOS1 were decreased in Calu-1 cells after 3 h of Rasfonin treatment.These changes also occurred after Rasfonin treatment of 3 h and 6 h in UM-UC-3 cells.Further-more,Rasfonin treatment did not influence SOS1 protein expressions in MCF-7 cells,but can signifi-cantly inhibit SOS1 expression of in UM-UC-3 and Calu-1 cells.② Rasfonin had no significant effects on the activity of SOS1 promoter and its protein level in 293T cells when only SOS1 was expressed,but significantly inhibited its activity and its protein level when SOS1 was co-expressed with KRAS protein.CONCLUSION One of the anti-tumor mechanisms of Rasfonin is to inhibit the activity of SOS1 promoter to decrease mRNA and protein expressions of SOS1 through KRASG12C protein.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To investigate the influencing factors of the course of perioperative prophylactic antibiotics in patients undergoing total hip arthroplasty,and explore management strategies for enhancing perioperative prophylactic medication administration.Methods The clinical data for patients undergoing total hip arthroplasty at Affiliated Hospital of Chengdu University from January,2020 to September,2024 were retrospectively collected.Patients were divided into a 24 h group and a 48-72 h group based on the duration of prophylactic antibacterial therapy.The general characteristics,surgical-related indicators,preoperative and postoperative laboratory test results,and surgical outcome measures between the two groups of patients were compared.Multivariate Logistic regression analysis was performed to identify influencing factors associated with prolonged duration of prophylactic antibacterial therapy.Results A total of 126 patients who underwent total hip arthroplasty were enrolled,including 74 cases in the 24 h group and 52 cases in the 48-72 h group.Univariate analysis results showed that there were statistically significant differences in the following indicators between the two groups:surgical cause,surgical duration,intraoperative blood loss,drainage duration of plasma drainage tubes,preoperative white blood cell count,and preoperative neutrophil count(P<0.05).The results of multivariate Logistic regression analysis showed that the reason for surgery and the duration of plasma drain tube drainage were the influencing factors of antimicrobial treatment course for total hip arthroplasty(P<0.05).The results of receiver operating characteristic curve analysis showed that the prediction model(constructed based on the drainage time of plasma drainage tube)for prophylactic antimicrobial treatment course to 48-72 h was 0.721.When the drainage time of plasma drainage tubes was≥40.56 h,the risk of requiring prophylactic antimicrobial therapy for an extended course of 48-72 h increased significantly.Conclusion The patient's surgical reason and the duration of plasma drain drainage may be related to the prophylactic antimicrobial course of more than 24 hours.Clinical pharmacists may utilize this parameter as a patient-specific characteristic,with the support of information systems,the hierarchical patient management can be implemented,thereby enhancing the effectiveness of medication surveillance and progressively elevating the 24 h discontinuation rate of perioperative prophylactic antibiotics.

OBJECTIVE To investigate the regulatory effect of Rasfonin on SOS1(Son of Seven-less,one of the major guanylate exchange factors)expressions and the underlying mechanism.METHODS① Human cancer cells MCF-7(breast cancer cells,KRASWT wild-type),Calu-1(non-small cell lung cancer,KRASG12C mutation),and UM-UC-3(bladder metastatic cell carcinoma,KRASG12C mutation)were divided into the control group and Rasfonin(1,5,10 and 15 μmol·L-1)treated groups.CCK-8 assay was used to observe the effects of Rasfonin on the proliferation of MCF-7,Calu-1,and UM-UC-3 cells after 24 h of Rasfonin treatment.In addition,these cells were divided into the control group,EGF stimulation group(EGF 50 μg·L-1,stimulated for 5 min),and Rasfonin treated groups(pretreated with 5 and 10 μmol·L-1 Rasfonin before 5 min EGF stimulation).Quantitative real-time PCR(real-time fluores-cence PCR)and Western blotting were employed to identify the expression levels of SOS1 mRNA and protein in MCF-7,Calu-1 and UM-UC-3 cells.② The co-expression systems of KRAS and SOS1 were established by transfecting plasmids(KRAS-NC,KRASWT,KRASG12C and SOS1)into 293T cells that were divided into the control group and Rasfonin(1,5 and 10 μmol·L-1)treated group.The dual luciferase reporter gene assay was used to evaluate the effects of Rasfonin on activities of the SOS1 promoter.Moreover,293T cells were divided into the EGF stimulation group(EGF 50 μg·L-1,stimulated for 5 min)and Rasfonin treated groups(12 h of treatment with 10 μmol·L-1 Rasfonin before 5 min EGF stimula-tion).Western blotting was performed to determine the role of KRASG12C protein in the inhibition of Rasfonin on SOS1 expression.RESULTS ① Compared with the control group,Rasfonin inhibited the prolifera-tion of Calu-1 and UM-UC-3 cells at concentrations of 5,10 and 15 μmol·L-1(IC50 was 8.22 and 4.94 μmol·L-1).But for MCF-7 cells,only 15 μmol·L-1 Rasfonin could decrease their viability(IC50 was 45.15 μmol·L-1).Compared with the EGF stimulation group,mRNA expressions of SOS1 were increased after Rasfonin treatment of 1 h.mRNA expressions of SOS1 were decreased in Calu-1 cells after 3 h of Rasfonin treatment.These changes also occurred after Rasfonin treatment of 3 h and 6 h in UM-UC-3 cells.Further-more,Rasfonin treatment did not influence SOS1 protein expressions in MCF-7 cells,but can signifi-cantly inhibit SOS1 expression of in UM-UC-3 and Calu-1 cells.② Rasfonin had no significant effects on the activity of SOS1 promoter and its protein level in 293T cells when only SOS1 was expressed,but significantly inhibited its activity and its protein level when SOS1 was co-expressed with KRAS protein.CONCLUSION One of the anti-tumor mechanisms of Rasfonin is to inhibit the activity of SOS1 promoter to decrease mRNA and protein expressions of SOS1 through KRASG12C protein.

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 explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.