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.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

This article reviews the high-risk factors, risk assessment tools, information identification systems, and nursing management strategies of incontinence-associated dermatitis, in order to provide evidence for medical and nursing staff to choose appropriate identification tools and early identify high-risk patients with incontinence-associated dermatitis.

Objective: Intraoperative localization of the ureter can contribute to accurate dissection and minimize ureteral injury in colorectal surgery. We aim to summarize a single center's experience of fluorescence ureteral visualization using methylene blue (MB) and explore its visualization efficiency. Methods: This is a descriptive case-series-study. Clinical data of patients who had undergone laparoscopic colorectal surgery and fluorescence visualization of the ureter in the Gastrointestinal Surgery Department of Guangdong Provincial People's Hospital from March 2022 to May 2022 were retrospectively collected. Patients with incomplete surgery videos, renal insufficiency, or allergic reactions were excluded. MB was infused with 0.9% NaCl at 1.0 mg/kg in 100 mL of normal saline for 5 to 15 minutes during laparoscopic exploration. Imaging was performed using a device developed in-house by OptoMedic (Guangdong, China) that operates at 660nm to achieve excitation of MB. Clinical information, MB dosage, rate of successful fluorescence, time to fluorescence, operation time, blood loss, intraoperative blood oxygen levels, pathological staging, changes in renal function, and post-operative complications were retrospectively analyzed. Results: The study cohort comprised 27 patients (24 men and 3 women) with an average age of (60.25±16.95) years and an average body mass index of (21.72±3.42) kg/m². The dosage of MB was 0.3-1.0 mg/kg and the infusion time was 5-15 minutes. Fluorescence signals were detected in all patients. The median time to signal detection was 20 (range, 10 to 40) minutes after MB infusion. The range of intraoperative blood oxygen fluctuation averaged 2.5% (range, 0 to 7.0%). The median change in creatine concentration was -1.3 (range, -17.2 to 29.2) µmol/L. No patients had complications associated with use of MB. Fluorescence visualization of the ureter was very valuable clinically in two patients (thick mesentery, stage T4). Conclusion: MB is a safe and effective means of visualizing the ureter by fluorescence during laparoscopic colorectal surgery, especially when the procedure is difficult. MB in a dosage of less than 1 mg/kg can slowly infused for more than 5 minutes during laparoscopic exploration. During the infusion, attention must be paid to blood oxygen fluctuations.
Male ; Humans ; Female ; Adult ; Middle Aged ; Aged ; Ureter/surgery* ; Methylene Blue ; Retrospective Studies ; Infusions, Intravenous ; Colorectal Surgery ; Laparoscopy/methods* ; Digestive System Surgical Procedures

Objective:To evaluate and summarize evidence related to structured skin care for incontinence-associated dermatitis (IAD) in adult inpatients, so as to provide a reference for clinical nursing decision-making.Methods:Clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus related to structured skin care for IAD in adult inpatients were retrieved by computer in British Medical Journal Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, Canadian Registered Nurses Association of Ontario, Guidelines International Network, National Guideline Centre, National Institute for Health and Care Excellence, Medlive, the Cochrane Library, PubMed, Web of Science, CINAHL, Embase, WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Literature Database. The retrieval time limit was from the establishment of the database to April 30, 2021. Two investigators independently assessed the quality of the included evidence and the level of recommendation.Results:A total of 14 articles were included, involving 2 clinical decisions, 1 practice guideline, 6 evidence summaries, 2 systematic reviews, and 3 expert consensus. A total of 29 best evidence was compiled from 4 aspects of structured skin care assessment, cleansing, moisturizing and isolation.Conclusions:Medical and nursing staff should integrate evidence with clinical scenarios and patient preferences to make optimal clinical decisions on structured skin care and improve the quality of care for adult inpatients with IAD.

OBJECTIVE：To provi de reference for standardizing pediatric clinical trials and promoting the development and application of pediatric medication in China. METHODS ：Chinese Clinical Trial Registry （Chi CTR ）database were searched to collect all clinical trials related to pediatric population under 18 years old from the inception to Oct. 1st，2019. Those clinical trials were analyzed statistically in respect of name of registered project ，involved disease/system ，research stage ，registration time ， registration status ，regional distribution of research institutions ，source of funds ，research type ，whether data management committee was set up ，situation of recruited research objects ，ethics committee approval status ，whether blind method was adopted ， whether to collect human specimens and whereabouts of human specimens. RESULTS ：A total of 231 pediatric drug clinical trials were included. The clinical trials involved 21 kinds of diseases/systems ，mainly were tumors and tumor-like lesions ，ophthalmic diseases and allergic disease. The research stage has the most items （85 trials，36.80％）in post-marketing drug clinical trials ；there were 77 items of phase Ⅰ-Ⅳ clinical trials （33.33％）. The number of pediatric drug clinical trials was increased year by year ，and among which 179 trials were pre-registered （77.49％），52 trials were supplementary registration （22.51％）. Beijing ，Shanghai， Guangdong，Chongqing and Zhejiang were the major regions where pediatric drug clinical trials were carried out ，and the clinical trial projects of which accounted for 66.23％（153/231）of the total number of included projects. The funding sources were mainly self-financing（57.85％），hospital finance （20.18％），and local government finance （10.31％）. The main type of research was intervention study and observational study ，accounting for 88.31％ in total. Totally 145 trials（62.77％）had not yet determined whether to set up a data management committee ；201 trials（87.01％）had passed the review of the ethics committee of the relevant institution；168 trials（72.73％）did not clarify whether the blind method was used ；133 trials（57.58％）had collected 001-001） human specimens ，and the collected human specimens were 3360875。E-mail：794446155@qq.com mainly destroyed after use. CONCLUSIONS ：The number of pediatric drug clinical trials registered in Chi CTR is increasing but there i s regional imbalance. Researchers have gradually established the concept of pediatric clinical trial registration ，and have realized the importance of data management to research quality ，and the management of collected trial specimens is relatively standardized. It is suggested that relevant departments increase the publicity of clinical trial registration and improve the clinical trial registration management system ； relevant researchers should increase the awareness of clinical trial registration ，standardize registration application and trial project management.

OBJECTIVE: To investigate the effects of different stimultors (PHA, PMA and IL-2) and culture systems (PBMC and whole blood) on the proliferation of human peripheral blood lymphocyte subsets, so as to provide the experimental basis for selecting the appropriate system according to the experimental purposes. METHODS: A total of 10 ml serum samples were collected from healthy volunteers (n=6). The 300 μl whole blood was directly used to detect lymphocyte subsets by flow cytometry. The 400 μl whole blood were inoculated respectively with 3 different stimulators at 37℃ and 5% CO2 for 60 h; Three different stimulators were also added to the PBMC which were isolated from 2 ml whole blood. Then the proliferation ability of lymphocyte subsets was analyzed by flow cytometry. RESULTS: After the PBMC were stimulated with PHA, CD4CD8CD3 lymphocytes were the most subset; The proportion of CD3CD4 T lymphocytes and CD3CD19 B lymphocytes decreased after being stimulated by PMA (P<0.01, P<0.05); the lymphocyte subset ratio had no significant change after being stimulated by IL-2. After the whole blood system was stimulated with PHA, the CD4/CD8 T lymphoblasts were main subsets, the counts of B lymphocytes and NK cells were reduced; after being stimulated with PMA, the number of CD8CD3 T lymphoblast and CD4CD8T lymphocytes increased, the B/NK cells were not distinguished with the surface markers; after the whole blood system was stimulated with IL-2, the proportion of NK cells significantly increased (P<0.05). CONCLUSION Lymphocyte proliferation stimulated by PMA is the fastest, while the effect of IL-2 on the lymphocyte subset proportion stimulated by IL-2 is the minimal. After being stimulated by PHA the division cycles of lymphocyte are the most.
Cell Proliferation ; Flow Cytometry ; Humans ; Killer Cells, Natural ; Lymphocyte Activation ; Lymphocyte Count ; Lymphocyte Subsets

OBJECTIVETo investigate relation between displaced inferior ramus fractures and posterior pelvic ring injury.

METHODSFrom August 2012 to August 2015, 51 patients of pubic ramus fractures with complete record were retrospective reviewed including 27 males and 24 females with an average age of(49.1±19.0) years old ranging from 9 to 90 years old. The time from injury to treatment ranged from 0.3 to 48 hours with an average of 10.1 hours. According to Tile classification of pelvic fractures, 28 cases were type A, 17 cases were type B, 6 cases were type C. Pelvic radiographs and computed tomography scans were detailed and evaluated for whether there were posterior pelvic ring injury, meanwhile pubic rami fractures were divided into 4 groups as follow: displaced inferior ramus fractures group, undisplaced inferior ramus fractures group, displaced superior ramus fractures group, undisplaced superior ramus fractures group;the incidence rate of association of posterior pelvic ring injury was determined and compared.

RESULTSTwenty-six patients had displaced inferior ramus fractures, all of them (100%) were combined with posterior pelvic ring injury. Twenty patients had undisplaced inferior ramus fractures, 6 of them(30%)were combined with posterior pelvic ring injury. Twenty-eight patients had displaced superior ramus fractures, 22 of them(78.5%) were combined with posterior pelvic ring injury. Twelve patients had displaced superior ramus fractures, 5 of them(41.6%) were combined with posterior pelvic ring injury. Compared with undisplaced inferior ramus fractures group, there was statistic difference(=0.028 8<0.05) on the incidence rate of posterior pelvic ring injury, there were no statistic difference(=0.055 8>0.05;=0.168 3>0.05) while compared with other undisplaced superior ramus fractures group and displaced superior ramus fractures group, but the incidence rate of association with posterior pelvic ring injury much higher than both of two groups (100% vs 41.6%, 78.5%).

CONCLUSIONSDisplaced inferior pubic ramus fractures have the highest incidence rate of association with posterior pelvic ring injury, frequently prompted injury to the posterior pelvis. Displaced inferior ramus fractures were an indirect evidence of posterior pelvic injury.

OBJECTIVE:To promote the safe use of Heparin sodium injection for children. METHODS:According to litera-ture retrieve,questionnaire survey and field investigation,Health care failure mode and effect analysis method(HFMEA)was ad-opted to search for the failure modes of Heparin sodium injection for children,and preventive strategies were established and imple-mented based on these failure modes. Its effects were evaluated by comparing the error rate and risk priority number rating (RPN value)before and after the implementation. RESULTS:Totally 5 risk points of Heparin sodium injection requiring immediate inter-vention were obtained from RPN value,including wrong dose of Heparin sodium injection in prescribing,pharmacists'unclearness for the calculation method of the dose of Heparin sodium injection in dispensing,and nurses'no performing of double check sys-tem before infusion in administration,etc. After implementing related countermeasures,related error of Heparin sodium injection was decreased from 8 cases to 1 case,and error rate was declined from 3.76% to 0.51%(P<0.01). The RPN values of 5 failure modes were decreased from 112.08,91.56,115.78,94.52,99.23 to 28.02,23.91,27.71,23.63,20.55,respectively. CONCLU-SIONS:HFMEA can prospectively conduct systematical analysis for Heparin sodium injection for children. Implementing related countermeasures based on the current situation of our hospital can reduce the related error of Heparin sodium injection and promote the medication safety of children.