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.

Post-stroke depression (PSD) is an important mental complication of stroke, affecting nearly 1/3 of stroke patients, seriously affecting patients' functional recovery and quality of life, and is associated with increased mortality of stroke patients. Traditional antidepressant treatments include medication and psychotherapy, but there may be problems with adverse reactions, tolerance, or limited effectiveness. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuroregulatory technique, offers a new treatment option for patients with PSD. This article reviews the application of rTMS in the treatment of PSD and its possible mechanism.

Objective:This study focuses on the use of narrative medical records in palliative care teams and analyzes text from cases.The goal is to establish a foundation for standardizing and structuring narrative content, providing guidance for incorporating future narratives into medical record writing.Methods:Three cases of narrative medical records from the palliative care team at Peking Union Medical College Hospital were chosen for text analysis to demonstrate the clinical significance of narrative medical records within palliative care teams.These records included medical consultation records, social work service records, and disease progress records, authored by nurses, social workers, and doctors, respectively.Results:Our study discovered that narrative medical records demonstrate traits such as structured writing, cooperative writing, and comprehensive documentation.Furthermore, the narrative information contained in these records can be efficiently organized and condensed.Conclusions:By examining the cases and utilization of narrative medical records in the healthcare community, we emphasize the potential benefits of incorporating narrative elements into existing medical documentation.These results offer valuable insights for enhancing medical education in the future.

Objective To investigate the effect of SMAD family member 3(SMAD3) silenced by small interfering RNA (siRNA) on macrophage polarization and transforming growth factor β1 (TGF-β1)/ SMAD family signaling pathway in rheumatoid arthritis (RA). Methods RA macrophages co-cultured with rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) were used as a cell model. TGF-β1 was used to stimulate macrophages, and SMAD3-specific siRNA (si-SMAD3) and negative control siRNA (si-NC) were transfected into human RA macrophages co-cultured in Transwell^TM chamber. The expression of SMAD3 mRNA was detected by real-time fluorescence quantitative PCR, and the expression of TGF-β1, SMAD3 and SMAD7 protein was detected by Western blot analysis. The contents of TGF-β1 and IL-23 in cell culture supernatant were determined by ELISA. Cell proliferation was detected by CCK-8 assay. Transwell^TM chamber was used to measure cell migration. Results Compared with the model group and the si-NC group, the expression of TGF-β1, SMAD3 mRNA and protein in RA macrophages decreased significantly after silencing SMAD3. In addition, the secretion of IL-23 decreased significantly, and the cell proliferation activity and cell migration were inhibited, with high expression of SMAD7. Conclusion Knockdown of SMAD3 can promote M2 polarization and SMAD7 expression in RA macrophages.
Humans ; Arthritis, Rheumatoid/genetics* ; Interleukin-23 ; Macrophages ; RNA, Messenger ; RNA, Small Interfering/genetics* ; Smad7 Protein/genetics* ; Transforming Growth Factor beta1/genetics* ; Smad3 Protein/genetics* ; Gene Silencing

The cross regional loose medical alliance is an important carrier in the current integrated development process of medical services in the Yangtze River Delta region. Smith policy implementation process model was used to analyze the development difficulties of cross regional loose medical alliances from idealized policies, policy implementation institutions, policy target groups, and policy implementation environment. Such medical alliances were formed under the background of integrated development in the Yangtze River Delta, with Shanghai′s tertiary public hospitals as leading units and medical institutions in Jiangsu, Zhejiang, and Anhui provinces as member units. Analysis showed that the policies for such medical alliances development had not yet clearly defined the organizational management mode, operational mechanism, and implementation path, and the corporate governance structure of medical alliance was immature; The policy implementation agencies were relatively lagging behind in the support of special funds and the formulation of related supporting policies; Participation of policy target groups was insufficient and their incentive mechanisms was imperfect; There were problems in the policy implementation environment, namely inconsistent medical and health service regulations and systems in different regions, different health financing capabilities of local governments, insufficient coordination of medical institution management concepts, and a lack of unified standards in information systems. Based on the above difficulties, this study proposed to strengthen the development planning and layout of cross regional loose medical alliances, and improve the corporate governance structure; To strengthen the government′s main responsibility and improving policy implementation capabilities; To improve the internal cooperation and operation mechanism of cross regional loose medical alliances, and enhance the sense of identity of the target group; To optimize the policy implementation environment and implement various support measures, so as to provide references for further promoting the coordinated development of high-quality medical resources in the Yangtze River Delta region.

Apoptosis ; Cardiopulmonary Resuscitation ; Humans ; Out-of-Hospital Cardiac Arrest ; Programmed Cell Death 1 Receptor/biosynthesis* ; Return of Spontaneous Circulation ; Th1 Cells ; Th2 Cells

Objective:To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol, the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist (GnRH-A) protocol in poor ovarian responders classified by Poseidon criteria, and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods:The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study. The patients were further divided into lower age group (<35 years) and high age group (≥35 years). The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared. Results:Totally 1249 eligible subjects were recruited in the study, including 410 patients in lower age group and 839 patients in high age group. In lower age group, early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (5.6±3.6 vs. 4.6±3.2 vs. 2.4±1.7, P<0.001) and No. of transferable embryos (2.2±1.6 vs. 1.6±1.6 vs. 1.1±1.1, P<0.001), lower cancellation rate of embryo transfer [20.8% (33/159) vs. 39.5% (49/124) vs. 69.3% (88/127), P<0.001], higher pregnancy rate per transfer [40.9% (65/159) vs. 29.0% (36/124) vs. 15.7% (20/127), P<0.001], and higher live birth rate [31.4% (50/159) vs. 23.4% (29/124) vs. 12.6% (16/127), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no significant difference in implantation rate and abortion rate among three protocols ( P>0.05). In high age group, the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (3.9±2.8 vs. 3.1±2.3 vs. 2.5±1.8, P<0.001) and No. of transferable embryos (2.8±2.0 vs. 2.4±2.0 vs. 2.1±1.7, P<0.001), lower cancellation rate of embryo transfer [19.5% (60/307) vs. 28.7% (102/355) vs. 53.3% (56/105), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no statistical significance in implantation rate, pregnancy rate, abortion rate and live birth rate among the three protocols ( P>0.05). Conclusion:It seems that the early-follicular phase long-acting GnRH-a long protocol was more effective in clinical outcomes than the mid-luteal phase short-acting GnRH-a long protocol and the GnRH-A protocol for young patients with POR. It is worth emphasizing that the older the patient is, the lower the live birth rate will be. The characteristics and prognosis of patients should be used to develop clinical management strategies especially for the POR crowd.

Objective:To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol, the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist (GnRH-A) protocol in poor ovarian responders classified by Poseidon criteria, and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods:The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study. The patients were further divided into lower age group (<35 years) and high age group (≥35 years). The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared. Results:Totally 1249 eligible subjects were recruited in the study, including 410 patients in lower age group and 839 patients in high age group. In lower age group, early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (5.6±3.6 vs. 4.6±3.2 vs. 2.4±1.7, P<0.001) and No. of transferable embryos (2.2±1.6 vs. 1.6±1.6 vs. 1.1±1.1, P<0.001), lower cancellation rate of embryo transfer [20.8% (33/159) vs. 39.5% (49/124) vs. 69.3% (88/127), P<0.001], higher pregnancy rate per transfer [40.9% (65/159) vs. 29.0% (36/124) vs. 15.7% (20/127), P<0.001], and higher live birth rate [31.4% (50/159) vs. 23.4% (29/124) vs. 12.6% (16/127), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no significant difference in implantation rate and abortion rate among three protocols ( P>0.05). In high age group, the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (3.9±2.8 vs. 3.1±2.3 vs. 2.5±1.8, P<0.001) and No. of transferable embryos (2.8±2.0 vs. 2.4±2.0 vs. 2.1±1.7, P<0.001), lower cancellation rate of embryo transfer [19.5% (60/307) vs. 28.7% (102/355) vs. 53.3% (56/105), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no statistical significance in implantation rate, pregnancy rate, abortion rate and live birth rate among the three protocols ( P>0.05). Conclusion:It seems that the early-follicular phase long-acting GnRH-a long protocol was more effective in clinical outcomes than the mid-luteal phase short-acting GnRH-a long protocol and the GnRH-A protocol for young patients with POR. It is worth emphasizing that the older the patient is, the lower the live birth rate will be. The characteristics and prognosis of patients should be used to develop clinical management strategies especially for the POR crowd.

Objective To evaluate the effectiveness of a chronic disease self-management program (CDSMP) in the Nanjing community. Methods From April to June 2016, the volunteer patients with chronic diseases from National Basic Public Health Services Plan were recruited and agreed to enter the CDSMP. A total of 42 self-management groups were established. The Nanjing CDSMP was based on the model of the Shanghai CDSMP developed by Stanford University. Questionnaire surveys, anthropometric measurements, and laboratory examinations were collected at 3 measurement moments (baseline, after 6 months, and after 12 months). Qualitative data were obtained from 1-2 participants in each self-management group. Paired t-tests, paired Chi-square tests, generalized estimating equation, and content analysis were used to evaluate the effectiveness of the CDSMP. Results Among 562 eligible patients, 548 completed 3 questionnaire surveys, physical measurements, and laboratory examinations. Sixty-six interviewees completed qualitative evaluations. Compared with baseline, the time of stretching or strengthening exercise and aerobic exercise; the scores on communication with the medical doctor; self-efficacy to manage symptoms and manage disease in general; quality of life in physical component summary and mental component summary; and rate of glucose control were all higher after 6 months and after 12 months interventions, whereas the score of fatigue; pain, health distress; social/role activities limitation; and the value of body weight, systolic blood pressure, and triglyceride were all decreased (all P values<0.01). The satisfaction rate of CDSMP in general, and content were 87.9%, 90.9%, and 83.3%, respectively. Conclusion Overall, the Nanjing CDSMP was successful in improving knowledge and self-management skills, increasing self-management behaviors, self-efficacy, health status, and quality of life, and decreasing body weight, blood pressures, and lipids. It is suggested that CDSMP may be widely used in Nanjing communities.