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.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective:To utilize usculoskeletal ultrasound technology for real-time assessment of related muscle characteris-tics in patients with chronic nonspecific low back pain(NLBP)and to analyze the correlation with visual ana-logue scale(VAS)and Oswestry disability index questionnaire(ODI).Method:A total of 180 patients diagnosed with chronic NLBP in the department of rehabilitation of the Sec-ond Hospital in Fuzhou from December 2022 to June 2023 were selected as NLBP group,and 120 healthy subjects who underwent physical examination at the same time period were selected as the control group.VAS and ODI questionnaires were used to assess the two groups of subjects.Based on musculoskeletal ultrasound technology,the muscle thickness and elastic modulus of transverse abdominal muscle and multifidus muscle in resting and contraction positions were detected in real time.Finally,the correlation analysis was performed be-tween the real-time muscle characteristics monitoring indexes of musculoskeletal ultrasound and the VAS and ODI scores in NLBP patients.Result:The VAS score showed that the healthy group was 0.58±0.73 and the NLBP group was 3.29±0.42.There was a significant difference in VAS score between the two groups(t=40.729,P＜0.001).The ODI score showed that the healthy group was 4.25±0.36 and the NLBP group was 14.41±1.63.The difference of ODI score between the two groups was statistically significant(t=-67.162,P＜0.001).The transverse abdominal muscle test showed that the thickness of the healthy group was 3.89±0.31 mm,and the thickness of the NLBP group was 2.85±0.26 mm.At the contraction position,the thickness of the healthy group was 5.18±0.35 mm,and the thickness of the NLBP group was 3.64±0.29 mm.The multifidus muscle test showed that the thickness of the healthy group was 2.19±0.14 cm,and the thickness of the NLBP group was 1.82±0.16 cm.At the contraction position,the thickness of the healthy group was 3.15±0.22 cm,and the thickness of the NLBP group was 2.41±0.21 cm.Compared with the healthy group,the muscle thickness of the transverse abdominis of the NLBP group(t=-31.401,-48.751;P＜0.001)and multifidus muscle thickness were significantly reduced(t=-20.610,-29.335;P＜0.001).The correlation analysis showed that there was a significant negative correlation between VAS score and transverse abdominal muscle thickness(r=-0.69,P＜0.001)and multifidus muscle thickness(r--0.45,P＜0.001)at rest.There was a significant negative correlation between the VAS score and the thickness of the transverse abdominal muscle(r=-0.59,P＜0.001)and the thickness of the multifidus muscle(r=-0.31,P＜0.001).At rest,there was a significant negative correlation between ODI score and transverse abdominal muscle thickness(r=-0.58,P＜0.001)and multifidus muscle thickness(r=-0.36,P＜0.001).In the contractile position,there was a significant negative correlation between the VAS score and the thickness of the transverse abdominal muscle(r=-0.54,P＜0.001)and the thickness of the multifidus muscle(r=-0.22,P=0.0029).Conclusion:Musculoskeletal ultrasonography can be used as a real-time detection method to evaluate the rele-vant characteristic indexes of NLBP in subjects.

Objective:To utilize usculoskeletal ultrasound technology for real-time assessment of related muscle characteris-tics in patients with chronic nonspecific low back pain(NLBP)and to analyze the correlation with visual ana-logue scale(VAS)and Oswestry disability index questionnaire(ODI).Method:A total of 180 patients diagnosed with chronic NLBP in the department of rehabilitation of the Sec-ond Hospital in Fuzhou from December 2022 to June 2023 were selected as NLBP group,and 120 healthy subjects who underwent physical examination at the same time period were selected as the control group.VAS and ODI questionnaires were used to assess the two groups of subjects.Based on musculoskeletal ultrasound technology,the muscle thickness and elastic modulus of transverse abdominal muscle and multifidus muscle in resting and contraction positions were detected in real time.Finally,the correlation analysis was performed be-tween the real-time muscle characteristics monitoring indexes of musculoskeletal ultrasound and the VAS and ODI scores in NLBP patients.Result:The VAS score showed that the healthy group was 0.58±0.73 and the NLBP group was 3.29±0.42.There was a significant difference in VAS score between the two groups(t=40.729,P＜0.001).The ODI score showed that the healthy group was 4.25±0.36 and the NLBP group was 14.41±1.63.The difference of ODI score between the two groups was statistically significant(t=-67.162,P＜0.001).The transverse abdominal muscle test showed that the thickness of the healthy group was 3.89±0.31 mm,and the thickness of the NLBP group was 2.85±0.26 mm.At the contraction position,the thickness of the healthy group was 5.18±0.35 mm,and the thickness of the NLBP group was 3.64±0.29 mm.The multifidus muscle test showed that the thickness of the healthy group was 2.19±0.14 cm,and the thickness of the NLBP group was 1.82±0.16 cm.At the contraction position,the thickness of the healthy group was 3.15±0.22 cm,and the thickness of the NLBP group was 2.41±0.21 cm.Compared with the healthy group,the muscle thickness of the transverse abdominis of the NLBP group(t=-31.401,-48.751;P＜0.001)and multifidus muscle thickness were significantly reduced(t=-20.610,-29.335;P＜0.001).The correlation analysis showed that there was a significant negative correlation between VAS score and transverse abdominal muscle thickness(r=-0.69,P＜0.001)and multifidus muscle thickness(r--0.45,P＜0.001)at rest.There was a significant negative correlation between the VAS score and the thickness of the transverse abdominal muscle(r=-0.59,P＜0.001)and the thickness of the multifidus muscle(r=-0.31,P＜0.001).At rest,there was a significant negative correlation between ODI score and transverse abdominal muscle thickness(r=-0.58,P＜0.001)and multifidus muscle thickness(r=-0.36,P＜0.001).In the contractile position,there was a significant negative correlation between the VAS score and the thickness of the transverse abdominal muscle(r=-0.54,P＜0.001)and the thickness of the multifidus muscle(r=-0.22,P=0.0029).Conclusion:Musculoskeletal ultrasonography can be used as a real-time detection method to evaluate the rele-vant characteristic indexes of NLBP in subjects.

Objective:To investigate the anatomical basis for the preparation of the profunda artery perforator flap (PAPF) in the posteromedial femoral region and its application in the reconstruction of oral and maxillofacial defects.Methods:Six lower limbs of Chinese adult cadavers were micro-surgically dissected. CT angiography (CTA) data of bilateral lower limbs of 6 patients was also collected retrospectively. The number, external diameter, pedicle length, and distribution of perforators in the posteromedial femoral region were recorded from the specimens and CTA data. Meanwhile, 10 patients with oral squamous cell carcinoma in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University from August 2018 to June 2021 were treated with the PAPF. At each follow-up, contour and function of recipient and donor site, as well as swallowing and speech function were evaluated.Results:A total of 19 profunda artery perforator were identified in 6 lower limb specimens. The outer diameter at the beginning of the source artery was (2.34±0.25) mm and the total length of the pedicle was (11.12±1.06) cm. CTA data analysis of 12 legs identified 15 perforators of profunda artery in the posteromedial region. Eleven perforators were septocutaneous, including 2 perforators with a common trunk, while the remaining 4 perforators were musculocutaneous. As for different patterns of perforators (septocutaneous perforators, musculocutaneous perforators and perforators with a common trunk), the longitudinal distance to the pubic tubercle was (19.95±2.43), (21.84±2.54) and (19.48±0.55) cm respectively. The horizontal distance to the posterior edge of gracilis was (3.54±1.10), (3.72±0.30) and (3.85±1.48) cm, respectively. The initial diameters of perforators was (2.4±0.4), (2.6±0.6) and 1.9 mm respectively. Ten cases of the profunda artery perforator flaps survived successfully after operation. The flap sizes ranged from 8 cm×6 cm to 12 cm×7 cm. The patients were evaluated at 1, 3 and 6 months, and with 6 months interval ever since. During the follow-up, the shape of the recipient site was ideal, and the swallowing and language functions were not significantly affected. There was only linear scar in the donor area, and the function of the thigh was basically normal.Conclusions:PAPF possessed a good anatomic stability, suitable vascular pedicle length and diameter, minor influence to the donor area, sufficient amount tissue with good quality. It is an ideal choice for head and neck reconstruction.

Objective:To assess the applying value of Chinese shorter version of the Visual Function Index questionnaire (VF-11R-CN) for presenting low-vision cataract pre-operation and post-operation by using minimal clinically important difference (MCID) determined by combination of distribution-based with anchor-based methods, and to compare the improvement rate of vision-related quality of life (VRQol).Methods:A cross-sectional study was performed in this study.Ninety-eight patients with presenting low vision cataract were enrolled at Eye Hospital of Wenzhou Medical University from May 2018 to June 2019.All the patients received a phacoemulsification with intraocular lens implantation.A questionnaire survey was carried out with VF-11R-CN Scale before surgery and 1 month-3 months after surgery, and a complement anchor item was added during the questionnaire after surgery.The applicability of the scale was assessed by floor or ceiling effects, and score difference of the VF-11R-CN over time and effective size was determined.Distribution-based MCID was calculated using 0.5 standard deviation (SD) of score difference and 1.96 standard error of measurement (SEM). Anchor-based MCID was calculated using the slope of the linear regression analysis.In responder analysis, sensitivity and specificity of MCID was reported.The differences of postoperative VRQol improvement rate based-on MCID were compared between male and female, single eye disease and multiple eye diseases, pre-operative and post-operative scores.This study protocol was approved by the Ethics Committee of Eye Hospital of Wenzhou Medical University, and followed the Declaration of Helsinki.Written informed consent was obtained from each patient prior to any medical examination.Results:A total of 85 patients completed the following up.The mean score difference was 399.51±234.92, and that of the presenting visual acuity (PVA) was 0.65±0.36.Both the minor floor and ceiling effects were 1.18% before surgery, and the ceiling effects were 22.35% after surgery.The score before surgery was significantly higher than that after surgery ( t=15.68, P<0.001). The effective size for the surgery was 1.63.The MCID was 122.23 and 123.10 according to 0.5 SD and 1.96 SEM.The linearity regression analysis showed that score difference reduced 106.17 if anchor item option increased 1.The average MCID estimate was 117.17.A total of 76 patients (89.41%) reported an improvement of VRQol.The sensitivity of MCID for the assessment of VRQol was 96.67% and specificity was 46.67%.No significant differences were found in VRQol improvement rate between gender, single cataract and multiple eye diseases or PVA (LogMAR 1.3 as cutoff value) ( P=0.73, 0.88, 0.27). Conclusions:VF-11R-CN scale is available for Chinese presenting low vision cataract patients undergoing surgery.The MCID value for the cataract surgery is 117.17 scores, with a high sensitivity and a relatively low specificity.

Chemerin is a cytokine that attracts much attention in the reproductive process. This study aimed to explore the effects of chemerin and its receptor chemokine-like receptor 1 (CMKLR1) on the maintenance of early pregnancy. The expression levels of chemerin and CMKLR1 in the decidua tissues of 20 early normal pregnant women and 20 early spontaneous abortion women were examined by Western blot and real-time polymerase chain reaction analyses. CMKLR1 receptor antagonist (α-NETA) was then intrauterinely injected into normal pregnant mice model to assess its effect on the outcome of pregnancy and the phosphorylation rate of ERK1/2 in decidua tissues.We found that the expression level of chemerin in women who had experienced early spontaneous abortion was lower than in those who had experienced normal early pregnancy (P < 0.01); conversely, CMKLR1 expression was higher in the former than in the latter (P < 0.01). In a pregnant-mouse model, the embryo resorption rate of α-NETA group was higher than that in the negative control group (61.5% vs. 10.8%) (P < 0.001). Compared with the control group, ERK1/2 phosphorylation in decidua tissues decreased in the α-NETA-treated group (P < 0.01). These results suggested that the inhibition of the chemerin/CMKLR1 signaling pathway can lead to the abortion of mouse embryos, and that chemerin/CMKLR1 may play an important role in the maintenance of early pregnancy possibly by regulating ERK1/2 phosphorylation.
Adult ; Animals ; Chemokines ; analysis ; metabolism ; Female ; Humans ; Intercellular Signaling Peptides and Proteins ; analysis ; metabolism ; Mice ; Pregnancy ; metabolism ; Pregnancy Rate ; Pregnancy, Animal ; Receptors, Chemokine ; metabolism ; Receptors, G-Protein-Coupled ; metabolism ; Signal Transduction ; Young Adult

This study was aimed to evaluate the clinical effect and safety of Chinese medicine treatment of lumbar disc herniation with qi-tonifying, stasis-resolving and kidney-tonifying method. The randomized con-trolled trial (RCT) was applied in the study to evaluate the clinical effect of qi-tonifying, stasis-resolving and kidney-tonifying method in the treatment of lumbar disc herniation . A total of 122 lumbar disc herniation pa-tients were randomly divided into the treatment group ( n = 61 ) and the control group ( n = 61 ) . Chinese medicine treatment with the qi-tonifying, stasis-resolving and kidney-tonifying method was applied in the treatment group . And Celecoxib and Methycobal were orally administered in the control group . Then , the VAS scores, JOA scores, Oswestry disability index (ODI) were recorded and analyzed pre-treatment, four weeks af-ter treatment and the twelfth week of follow-up in order to evaluate the clinical effect . Adverse reactions were also observed and recorded at the same time to give a comprehensive evaluation on its safety . The results showed that there were no significant differences between the treatment group and control group in the baseline data before treatment . Hence , data from two groups were comparable . Compared with pre-treatment , the VAS scores and ODI scores were obviously reduced in both groups after four-week treatment . The JOA scores were increased obviously ( P < 0 . 05 ) . There were no statistical differences on ODI scores and JOA scores between two groups . The VAS scores of the treatment group were obviously higher than the control group ( P < 0 . 05 ) . In the twelfth week of follow-up , the VAS scores , ODI scores and JOA scores had increasing tendency in
both groups . There were no statistical differences between two groups . There were no statistical differences on the total effective rate between two groups . In the treatment group , four patients received surgery , four cases lost to follow-up , and four cases with mild adverse event . In the control group , six patients received surgery , three cases lost to follow-up , and two cases with mild adverse event . It was concluded that the RCT of Chi-nese medicine treatment of lumbar disc herniation with q i-tonifying , stasis-resolving and kidney-tonifying method received same clinical effect as the combination of Celecoxib and Methycobal . The Chinese medicine treatment can effectively relieve pain degree of lumbar disc herniation , improve function of the lumbar vertebrae and improve the daily life and social activity ability of patients. The short-term follow-up effects were con-firmed . However , the long-term efficacy still requires further study .

Objective To sensitize the T-cell in the peripheral blood of the active tuberculosis pa-tients by rCFP-10/ESAT-6 fusion protein, phytohaemaggiutinin(PHA) and physiologic saline, and to detect the IFN-γ to approach the significance of the tuberculosis infection. Methods One hundred and eleven pa-tients were diagnosed by clinical definite, 292 undergraduate students were chosen by X-ray and PPD-selec-fion as volunteers. 3.0 ml of blood was taken from each volunteer, rCFP-IO/ESAT-6, PHA and physiologic saline were added into each 1.0 ml, respectively. The A valule and antibody of IFN-γ were assayed by ELISA. Results Treated with rCFP-10/ESAT-6 group: the A value average of patients group was 1. 3885±0.6236, students group was 0.2944±0.0917. Intergroup t'=16.4259, P<0.05, set>0.42 as cut-off, the positive rate of patients group was 93.58%, students group was 13.07%. Treated with PHA group: the A value average of patients group was 1.2463±0.5541, of which the other was 0.5613±0.064, t'=19.1797,P<0.05. Treated with physiologic saline group:the A value average of patients group was 0.0772±0.0444,of which the other was 0.0290±0.0235,t'=13.9487,P<0.05. All had significant deviation. The antibody positive rate of the patients group was 66.36%, the students group was 7.19%. Conclusion rCFP-10/ESAT-6 as specific antigen, the sensitivity of IFN-γ release assay by ELISA is above 90%. No matter specific or non-specific disposal, the active tuberculosis patients have higher IFN-γ, release level and antibody than the control group.