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.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

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.

In order to strengthen standardized residency training process management, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology combines informatization with teaching case library and establishes and improves the process of teaching case filling from the three aspects of the module for residency teaching case filling, the module for instructor feedback, and the module for functional department management, thereby establishing a teaching case system centered on residents and based on the standardized residency training process management and supporting the innovation of standardized residency training pattern with an integrated teaching platform, which provides new methods for the connotation construction of standardized residency training.

Objective To investigate the application effect of levosimendan combined with nicorandil in the treatment of elderly patients with ischemic cardiomyopathy(ICM).Methods Elderly patients with ICM were divided into the control group and the treatment group by cohort method.The control group was treated with levosimendan at 12 μg·kg-1.7 d later,and the treatment was carried out once again.On this basis,the treatment group was given oral administration of nicorandil,5 mg per dose,tid.Patients in two groups were treated for 3 months.The two groups were compared in terms of clinical efficacy,ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),posterior wall end systolic thickness(PWS),interventricular septum thickness in systole(IVSS)and left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)],myocardial injury markers[cardiac troponin Ⅰ(cTn Ⅰ)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],and endocrine hormones[angiotensin Ⅱ(Ang Ⅱ)and aldosterone(ALD)].Safety was evaluated.Results There were 52 cases and 46 cases in the treatment group and the control group,respectively.After 3 months of treatment,the effective rates in the treatment group and the control group were 92.31％(48 cases/52 cases)and 78.26％(36 cases/46 cases),the difference was statistically significant(P＜0.05).After 3 months of treatment,LVPWT in the treatment group and the control group were(8.17±2.25)and(9.33±2.84)mm;PWS were(10.14±2.29)and(11.32±2.90)mm;IVSS were(11.19±1.74)and(12.04±1.85)mm;LVMI were(1.93±0.21)and(2.06±0.28)mg·g-1;LVEF were(52.74±8.67)％and(49.30±7.59)％;LVESD were(43.87±5.74)and(46.66±6.48)mm;LVEDD were(51.40±8.61)and(55.25±9.58)mm;cTn Ⅰlevels were(0.25±0.03)and(0.36±0.08)μg·L-1;NT-proBNP levels were(384.58±36.06)and(401.25±42.83)ng·L-1;Ang Ⅱ levels were(56.37±10.03)and(63.25±12.46)ng·L-1;ALD levels were(50.87±13.08)and(58.36±16.54)ng·L-1.The differences were statistically significant(all P＜0.05).The total incidence rates of adverse drug reactions in the treatment group and the control group were 7.69％(4 cases/52 cases)and 4.35％(2 cases/46 cases),without statistically significant difference(P＞0.05).Conclusion Levosimendan injection combined with nicorandil tablet can effectively inhibit ventricular remodeling and myocardial injury in elderly patients with ICM.Meanwhile,it can help to improve cardiac function and endocrine hormones in the patients,with good safety.

Objective To investigate the application effect of levosimendan combined with nicorandil in the treatment of elderly patients with ischemic cardiomyopathy(ICM).Methods Elderly patients with ICM were divided into the control group and the treatment group by cohort method.The control group was treated with levosimendan at 12 μg·kg-1.7 d later,and the treatment was carried out once again.On this basis,the treatment group was given oral administration of nicorandil,5 mg per dose,tid.Patients in two groups were treated for 3 months.The two groups were compared in terms of clinical efficacy,ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),posterior wall end systolic thickness(PWS),interventricular septum thickness in systole(IVSS)and left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)],myocardial injury markers[cardiac troponin Ⅰ(cTn Ⅰ)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],and endocrine hormones[angiotensin Ⅱ(Ang Ⅱ)and aldosterone(ALD)].Safety was evaluated.Results There were 52 cases and 46 cases in the treatment group and the control group,respectively.After 3 months of treatment,the effective rates in the treatment group and the control group were 92.31％(48 cases/52 cases)and 78.26％(36 cases/46 cases),the difference was statistically significant(P＜0.05).After 3 months of treatment,LVPWT in the treatment group and the control group were(8.17±2.25)and(9.33±2.84)mm;PWS were(10.14±2.29)and(11.32±2.90)mm;IVSS were(11.19±1.74)and(12.04±1.85)mm;LVMI were(1.93±0.21)and(2.06±0.28)mg·g-1;LVEF were(52.74±8.67)％and(49.30±7.59)％;LVESD were(43.87±5.74)and(46.66±6.48)mm;LVEDD were(51.40±8.61)and(55.25±9.58)mm;cTn Ⅰlevels were(0.25±0.03)and(0.36±0.08)μg·L-1;NT-proBNP levels were(384.58±36.06)and(401.25±42.83)ng·L-1;Ang Ⅱ levels were(56.37±10.03)and(63.25±12.46)ng·L-1;ALD levels were(50.87±13.08)and(58.36±16.54)ng·L-1.The differences were statistically significant(all P＜0.05).The total incidence rates of adverse drug reactions in the treatment group and the control group were 7.69％(4 cases/52 cases)and 4.35％(2 cases/46 cases),without statistically significant difference(P＞0.05).Conclusion Levosimendan injection combined with nicorandil tablet can effectively inhibit ventricular remodeling and myocardial injury in elderly patients with ICM.Meanwhile,it can help to improve cardiac function and endocrine hormones in the patients,with good safety.

OBJECTIVE: To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults. METHODS: This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results. RESULTS: The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m². During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m³, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m³, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m³ increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m³. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter. CONCLUSION Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.
Humans ; Female ; Adult ; Young Adult ; Air Pollutants/analysis* ; Heart Rate/physiology* ; Volatile Organic Compounds/analysis* ; Carbon Dioxide ; Particulate Matter/adverse effects* ; Environmental Pollutants

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

ObjectiveTo summarize the clinical features and prognosis of pulmonary mucormycosis （PM） in southern China， and to explore the diagnostic value of metagenomic next generation sequencing （mNGS） in PM. MethodsThe clinical manifestations， diagnosis， treatment and prognosis of patients diagnosed with PM in The First Affiliated Hospital of Sun Yat-sen University from January 1， 2019 to January 31， 2022 who had undergone mNGS detection in lung tissue or alveolar lavage fluid were collected retrospectively. A total of 14 patients with PM were included， including 4 patients with confirmed diagnosis and 10 patients with clinical diagnosis. ResultsAll patients had underlying medical conditions， with hematological malignancies and diabetes being the most common. The most common symptoms were fever （n = 10）， cough （n = 9） and shortness of breath （n = 9）. Consolidation was the most common sign of chest CT， followed by mass， mostly with cavity. On laboratory tests， decreased CD4+T lymphocytes， elevated CD8+T lymphocytes， and decreased CD4+/CD8+ ratio， and presentation with pleural effusion indicate poor prognosis. The positive rate of mNGS diagnosis was 78.5%， which was significantly higher than that of histopathology （50%）， fungus rapid fluorescence staining （61.5%） and fungal culture （23.1%） of bronchoalveolar lavage fluid. ConclusionsPulmonary mucormycosis is more likely to occur in patients with underlying diseases or who are immunocompromised. The clinical manifestations lack specificity. The low CD4/CD8 ratio and presentation of pleural effusion on CT imaging indicate poor prognosis of patients. mNGS is a rapid， convenient and sensitive method for the diagnosis of PM， which has advantages in the diagnosis of pulmonary mucormycosis.