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 analyze the characteristics of anonymous online dating and related factors of not being tested for HIV among men who have sex with men and to provide the basis for developing targeted HIV prevention strategies and intervention measures.Methods:Using a cross-sectional study design, respondents were recruited with the assistance of MSM social organizations from April to July 2023 in eight cities in Shandong Province. Snowball sampling, activity venues, and networks were employed, targeting a sample size of 400 people per city. A face-to-face questionnaire survey collected data on sociodemographic characteristics, drug use, sexual intercourse, and online informed dating. Blood samples were also collected for HIV and syphilis antibody testing.Results:In the past six months, 2 787 MSM sought homosexual partners through the Internet, and 78.26% (2 181/2 787) chose to make anonymous online dating. Before having homosexual sex with online sexual partners, 10.41% (290/2 787) of them did not ask each other about HIV infection status and 33.37% (930/2 787) of them not being tested for HIV. There were statistically significant differences in the distribution of age, marital status, household registration, education level, sexual orientation, ways to find male sexual partners, not asking online sexual partners about their HIV status before sexual intercourse, no mutual HIV testing with online sexual partners before sexual intercourse, and syphilis antibody between anonymous and non-anonymous online dating persons (all P<0.05). The results of multivariate logistic regression analysis showed that <25 years old (a OR=1.43, 95% CI: 1.15-1.77) and ≥35 years old age group (a OR=1.61, 95% CI: 1.29-2.01), people with no AIDS knowledge (a OR=2.37, 95% CI: 1.25-4.49), drug users (a OR=1.38, 95% CI: 1.17-1.63), online dating anonymous (a OR=2.19, 95% CI: 1.76-2.73), HIV antibody positive (a OR=3.61, 95% CI: 2.22-5.88) and no intervention services in the last 1 year (a OR=1.58, 95% CI: 1.05-2.38) were the related factors of MSM not being tested for HIV before having sexual intercourse through online dating. Conclusions:The phenomenon of anonymous online dating was common among MSM in Shandong Province, and the proportion of MSM not being tested for HIV before having sexual intercourse through anonymous online dating was relatively high. It is necessary to strengthen health publicity and promote informed dating in MSM.

Infection Prevention and Control(IPC)programs are crucial for prevention of hospital-associated infec-tions(HAIs),health and safety of patients and health care workers.The major task confronting the health care is to effectively carry out the IPC programs so as to raise the efficiency and quality of management of HAIs.In recent years,the rapid development of artificial intelligence(AI)technology has provided new ideas for the management of HAIs.The application and progress of research on application of AI technologies such as machine learning,nat-ural language processing and computer vision in surveillance,early warning,diagnosis,prevention and control,smart medical equipment and management of antibiotics were reviewed in the article.Meanwhile,the problems and challenges confronting the AI application,such as technical breakthroughs,data privacy and health care work-ers' acceptance,were also expounded.In the future,it is necessary to push forward the technology research and development,establish the safe and reliable data management system,increase the experience of health care work-ers and energize the interdisciplinary cooperation on IPC.

BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

Objective:To analyze the characteristics of anonymous online dating and related factors of not being tested for HIV among men who have sex with men and to provide the basis for developing targeted HIV prevention strategies and intervention measures.Methods:Using a cross-sectional study design, respondents were recruited with the assistance of MSM social organizations from April to July 2023 in eight cities in Shandong Province. Snowball sampling, activity venues, and networks were employed, targeting a sample size of 400 people per city. A face-to-face questionnaire survey collected data on sociodemographic characteristics, drug use, sexual intercourse, and online informed dating. Blood samples were also collected for HIV and syphilis antibody testing.Results:In the past six months, 2 787 MSM sought homosexual partners through the Internet, and 78.26% (2 181/2 787) chose to make anonymous online dating. Before having homosexual sex with online sexual partners, 10.41% (290/2 787) of them did not ask each other about HIV infection status and 33.37% (930/2 787) of them not being tested for HIV. There were statistically significant differences in the distribution of age, marital status, household registration, education level, sexual orientation, ways to find male sexual partners, not asking online sexual partners about their HIV status before sexual intercourse, no mutual HIV testing with online sexual partners before sexual intercourse, and syphilis antibody between anonymous and non-anonymous online dating persons (all P<0.05). The results of multivariate logistic regression analysis showed that <25 years old (a OR=1.43, 95% CI: 1.15-1.77) and ≥35 years old age group (a OR=1.61, 95% CI: 1.29-2.01), people with no AIDS knowledge (a OR=2.37, 95% CI: 1.25-4.49), drug users (a OR=1.38, 95% CI: 1.17-1.63), online dating anonymous (a OR=2.19, 95% CI: 1.76-2.73), HIV antibody positive (a OR=3.61, 95% CI: 2.22-5.88) and no intervention services in the last 1 year (a OR=1.58, 95% CI: 1.05-2.38) were the related factors of MSM not being tested for HIV before having sexual intercourse through online dating. Conclusions:The phenomenon of anonymous online dating was common among MSM in Shandong Province, and the proportion of MSM not being tested for HIV before having sexual intercourse through anonymous online dating was relatively high. It is necessary to strengthen health publicity and promote informed dating in MSM.

Infection Prevention and Control(IPC)programs are crucial for prevention of hospital-associated infec-tions(HAIs),health and safety of patients and health care workers.The major task confronting the health care is to effectively carry out the IPC programs so as to raise the efficiency and quality of management of HAIs.In recent years,the rapid development of artificial intelligence(AI)technology has provided new ideas for the management of HAIs.The application and progress of research on application of AI technologies such as machine learning,nat-ural language processing and computer vision in surveillance,early warning,diagnosis,prevention and control,smart medical equipment and management of antibiotics were reviewed in the article.Meanwhile,the problems and challenges confronting the AI application,such as technical breakthroughs,data privacy and health care work-ers' acceptance,were also expounded.In the future,it is necessary to push forward the technology research and development,establish the safe and reliable data management system,increase the experience of health care work-ers and energize the interdisciplinary cooperation on IPC.

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 expression characteristics of mucin 5B (MUC5B) protein and programmed cell death factor 4 (PDCD4) protein in patients with intrahepatic cholangiocarcinoma (ICC), and to construct a nomogram model for prognosis prediction.Methods:Clinical data of 100 patients who underwent radical surgical resection and were diagnosed as ICC by postoperative pathology from September 2009 to September 2020 in the Third Affiliated Hospital of Wenzhou Medical University were retrospectively selected, including 46 males and 54 females, aged (56.9±12.2) years old. Immunohistochemistry was used to detect the expression of MUC5B and PDCD4 protein in 100 cases of ICC and corresponding adjacent tissues respectively, and the relationship between them and clinicopathological factors of ICC patients was analyzed. Univariate and multivariate Cox regression analysis were performed to analyze the influencing factors on postoperative prognosis of ICC patients. The nomogram model was constructed using rms package and performed internal verification.Results:The positive expression rate of MUC5B protein in ICC was 76.0% (76/100), which was higher than that in para-cancer tissues 27.0%(27/100), and the difference was statistically significant ( χ2=11.33, P=0.015). While the positive expression rate of PDCD4 protein in ICC was 21.0%(21/100), which was lower than that in normal tissues 73.0% (73/100), and the difference was statistically significant ( χ2=15.57, P=0.007). Multivariate Cox regression analysis showed that ICC patients with carbohydrate antigen 19-9>37 kU/L, tumor length>5 cm, tumor TNM stage Ⅱ/Ⅲ, tumor medium/low differentiation, MUC5B positive expression, and PDCD4 negative expression had a high risk of short survival after resection (all P<0.05). The nomogram model was constructed based on the above indicators, and the C-index was 0.801. The postoperative survival calibration curve showed that the high predictive survival fit of the nomogram model, and the area under the receiver operating characteristic curve was 0.862. Conclusions:Positive expression of MUC5B protein and negative expression of PDCD4 protein in ICC tissue suggest poor prognosis of ICC patients. The nomogram model constructed on the basis of MUC5B and PDCD4 protein is well distinguished and has ideal predictive efficacy.

Objective To investigate the curative effect of early hemoperfusion(HP)in treating patients with sepsis.Methods Early stage sepsis patients admitted to the First People's Hospital of Nanyang City Affiliated to Henan University from January 2020 to December 2022 were selected as the research subjects.These patients were randomly divided into experimental group(62 patients)and control group(31 patients).Early bundle therapy combined with continuous renal replacement therapy(CRRT)were used in both groups as the standard treatment,but only the standard treatment was used in control group.Based on the treatment of control group,the patients in experimental group were treated with HP,the"2-2-1"plan(on the first and second days,connecting resin HP device HA380 in series every 12 hours,and connecting one perfusion device in series on the third day)was applied.The white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukins(IL-6,IL-10),the hemodynamic indicators(systolic blood pressure,diastolic blood pressure),lactic acid(Lac),sequential organ failure assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ),and the difference in intensive care unit(ICU)hospitalization time of the patients before admission and after 3 day treatment were compared between the two groups.The Kaplan-Meier method was used to draw survival curves and the difference in 28-day survival rates was compared between the two groups.Results After 3 days of treatment,the inflammatory indexes TNF-α,IL-6,IL-10,PCT,CRP,WBC and SOFA score,APACHEⅡscore,Lac in the experimental group all decreased significantly(all P<0.05).In the control group,only the PCT and CRP indexes significantly decreased compared with those before treatment(both P<0.05).Compared with the control group,the difference before and after the change of PCT,CRP,IL-6,IL-10 and SOFA score,APACHEⅡscore,Lac in the experimental group were significant[PCT(μg/L):12.31(6.95,42.69)vs.3.84(1.06,14.47),CRP(mg/L):78.69±64.60 vs.31.49±81.14,IL-6(ng/L):1 357.20(243.96,7 205.50)vs.110.00(-1 749.00,1 377.00),IL-10(ng/L):36.87(5.43,1 218.80)vs.2.67(-11.00,22.79),SOFA score:5(3,7)vs.1(-3,6),APACHEⅡscore:8(5,11)vs.5(-2,7),Lac(mmol/L):3.93±2.89 vs.2.42±2.89,all P<0.05].The clearance rate of inflammatory cytokines IL-6 and IL-10 in the experimental group was higher than that in the control group(IL-6:F=17.93,P<0.001,IL-10:F=6.62,P=0.012).The Kaplan-Meier curve showed the 28-day survival rate of the experimental group was higher than that of the control group(79.03%vs.58.06%),the differences were statistically significant(Log-Rank test:χ2=4.706,P=0.030).Multivariate Cox regression analysis showed that no HP treatment,Lac level before treatment and high APACHEⅡ score were risk factors for death Conclusion HP in the early interventional treatment of sepsis can reduce the levels of inflammatory cytokines and control the inflammatory storm.The HP"2-2-1"treatment frequency can effectively improve the prognosis of septic patients and increase their survival rate.

Acromioclavicular joint dislocation is a common clinical condition in shoulder injuries, causing shoulder pain, swelling, and tenderness, and leading to limitations in abduction, elevation, forward flexion, and extension of the upper limb, which severely affects the patient′s daily life. Rockwood type ⅢB to type Ⅵ acromioclavicular joint dislocations, involving coracoclavicular ligament rupture, often require surgical treatment. Coracoclavicular fixation or ligament reconstruction, by reconstructing the coracoclavicular ligament, restores the vertical stability of the acromioclavicular joint and is more in line with the anatomical structure of the joint, which has been widely accepted by clinical physicians and patients. However, in recent years, there have been reports questioning its adequacy in horizontal stability. This article aims to review the treatment of acromioclavicular joint dislocations with coracoclavicular fixation and coracoclavicular ligament reconstruction and to discuss the future prospects of this approach.