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.

Public health emergencies have occurred frequently in recent years, with the characteristics of difficult rescue and a complex environment. Helicopter emergency medical service is an effective way to deal with catastrophic events. The service can effectively shorten the transfer time taken for patient transfer between hospitals, directly send patients to the hospitals that meet requirements for clinical treatment, and avoid the possible delayed treatment caused by a secondary transfer. Helicopter emergency medical service in China is still in its infancy, and there are various problems in the actual operation. Strict whole process quality management is needed to achieve the expected outcome. The paper reviews the current situation of helicopter rescue for critically ill patients in China and suggests a set of quality management schemes (including base construction, rescue equipment allocation, rescue personnel selection, rescue system construction, and on-site rescue procedure standardization). Findings from this paper hope to provide evidence for the development of aviation rescue in China. This study is innovative and scientific.

Objective:To evaluate the clinical efficacy of the modified biplane Chevron osteotomy and autogenous osteochondral transplantation for the treatment of talar cartilage injury with bone cyst.Methods:From February 2016 to February 2019, 26 patients with talar cartilage injury and bone cyst were treated at Department of Orthopaedics, The First Affiliated Hospital to Guangxi Medical University. They were 16 males and 10 females, aged from 22 to 50 years (average, 36.2 years). According to the Hepple classification, there were 5 cases of type Ⅳ and 21 cases of type Ⅴ. The extent and range of talar cartilage injury were evaluated by arthroscopy, the modified biplane Chevron osteotomy of medial malleolus was performed to expose cartilage defects medial to the talus, unstable cartilage was removed thoroughly, sclerotic wall of the bone cyst was freshly treated, and an osteochondral column taken from the non-weight-bearing area of the ipsilateral femoral medial condyle was implanted into the injured area of talar cartilage. The clinical efficacy was evaluated by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society (AOFAS), Karlsson ankle scores, visual analogue scale (VAS) and Lysholm ankle scores between preoperation and one year post-operation.Results:All the 26 patients were followed up for an average of 20.6 months (from 12 to 30 months). Follow-up did not observe any postoperative complications like incision infection, cyst recurrence or malunion, or any obvious pain or movement limitation at the donor knee joint. The AOFAS ankle-hindfoot scores were significantly increased from preoperative 64.3±3.9 to 89.5±5.1 one year postoperation, the Karlsson scores were significantly increased from preoperative 60.5±5.5 to 85.2±6.9 one year postoperation, and the VAS scores were significantly decreased from preoperative 6.2±1.1 to 1.8±0.9 one year post-operation (all P<0.05). The Lysholm ankle scores before and after operation were 94.7±1.9 and 94.1±1.8, respectively, showing no significant difference ( P>0.05). Conclusion:In the treatment of talar osteochondral injury and bone cyst, the modified biplane Chevron osteotomy of medial malleolus and autogenous transplantation of osteochondral column can effectively relieve ankle pain and improve ankle function, leading to satisfactory clinical efficacy.

[Summary] A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia . During hospitalization she developed multiorgan dysfunction , infected pancreatic necrosis , abdominal compartment syndrome and intrauterine fetal death . She was successfully treated by multidisciplinary team including department of emergency medicine , ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.

Objective To explore the brain function changes in cirrhotic patients with normal blood ammonia and high in direct bilirubin with regional homogeneity (ReHo) of resting-state functional MRI (rs-fMRI).Methods Fifty-three cirrhotic patients with normal blood ammonia and high indirect bilirubin (cirrhosis group) and 60 healthy volunteers (control group) performed rs-fMRI scans.ReHo values in different brain areas of the two groups were acquired and compared.The correlation between the ReHo values of different brain regions in both groups and the indirect bilirubin concentrations was analyzed.Results Compared with control group,cirrhosis group showed that ReHo values increased in left dorsal-lateral frontal gyrus,left orbital superior frontal gyrus,left top edge of angular gyrus,left precentral gyrus,right caudate,right putamen,right insula,right olfactory cortex (all P＜0.001),and decreased in left superior occipital gyrus,left middle occipital gyrus,left cuneus,left orbital inferior frontal gyrus,right paracentral lobule,right precuneus,right middle occipital gyrus,bilateral lingual gyrus and bilateral cerebellum (all P＜0.001).ReHo values in right insula and right putamen in cirrhotic patients positively correlated with indirect bilirubin (r=0.32,P=0.021).Conclusion The resting state brain function increases and decreases in some brain regions of cirrhotic patients with normal blood ammonia and high indirect bilirubin.Indirect bilirubin level correlates with function of some brain regions,which has certain effect on brain function of adult.

Objective To investigate the diagnostic efficacy of fecal calprotectin(FC) on assessing endoscopic disease activity in colonic or ileo-colonic Crohn disease (CD) and CD-related surgery patients .Methods Totally 56 colonic or ileo-colonic CD pa-tients ,25 CD-related surgery patients and 25 irritable bowel syndrome (IBS) patients with previously confirmed diagnosis of CD and IBS were enrolled into this study .Fecal samples were collected from 1 to 3 day before bowel preparation and FC was measured by ELISA .Endoscopic activity was determined for colonic or ileo-colonic CD with Simple Endoscopic Score for Crohn′s Disease (SES-CD) and CD-related surgery patients with the Rutgeerts′ score .Results Among colonic or ileo-colonic CD patients ,the levels of FC in endoscopic active patients had significantly higher than that of endoscopic remission patients and IBS patients(P < 0 .01) ,there was significant correlation between levels of FC and the SES-CD (r= 0 .802 ,P< 0 .01) .FC threshold of 250 μg/g was tested to in-dicated active endoscopic disease with 97 .1% sensitivity and 71 .4% specificity .Among CD-related surgery patients ,FC level in IBS patients were significantly lower than that of endoscopic remission patients and endoscopic active patients ,but the FC in endoscopic remission patients and endoscopic active patients had no statistic difference(P> 0 .05) ,FC cutoff level of 250 μg /g gave a sensitivity and specificity of 50 .0% ,66 .7% ,respectively .Conclusion FC is a surrogate marker for the evaluation of colonic or ileo-colonic CD endoscopic disease activity .The FC ,however ,can not distinct remission period and active period after CD surgery .

Objective To explore properties of emotion memory circuits in late-life depression,and differences in functional connectivity of emotional memory network between late-life depression and healthy controls who were investigated by resting-state fMRI.Methods Eighteen late life depression patients and twenty four healthy controls were involved in our study.Resting-state functional MRI data were acquired via 3.0T MRI scanner.Functional MRI data were analyzed.Behavioral data were acquired during retrieval.The independent samples t-test of functional MRI data and ANOVA of behavioral performance were performed with AFNI and SPSS 13.0 statistical software,respectively.Results Decreased connectivities had been shown in depression,including amygdala-thalamus,amygdala-left inferior frontal gyrus,supramarginal gyrus-dorsomedial prefrontal cortex/anterior cingulate cortex (ACC),middle temporal gyrus-middle frontal gyrus and thalamus-inferior frontal gyros/left frontal eye fields (FEF) connectivity;while increased connectivities included hippocampus-middle temporal gyrus,hippocampusventromedial prefrontal cortex/middle temporal gyrus/ACC/FEF,middle temporal gyrus-fusiform gyrus/FEF,insula-middle temporal gyrus/FEF and thalamus-caudate connectivity (P＜0.05).For depression,global hubs included left amygdale,right hippocampus,right middle frontal gyrus,and right insula.For healthy group,global hubs included bilateral amygdale and middle frontal gyrus,right anterior inferior parietal lobe and right insula.Conclusion There are common and different characters in functional connectivity of emotional memory network between depression and healthy control.Global hub function decreases in the right amygdale and left inferior frontal gyrus,while right hippocampus shows compensatory increase.

Objective To assess the performance of the methylation‐sensitive high‐resolution melting curve analysis (MS‐HRM analysis) on the detection of the methylation in stool DNA for colorectal cancer screening .Methods Eighty‐two qualified stool samples were collected from 27 patients with colorectal cancer patients (CRC group) ,25 patients with advanced adenomas (AA group) ,and 30 healthy people (control group) .The methylation status of vimentin gene in all of the stool samples was detected by the MS‐HRM analysis on the LightCycler 480 platform .The fecal occult blood test (FOBT) was also used for the same samples . Results The positive rates of the MS‐HRM assay in the CRC group ,AA group ,and control group were 81 .5% (22/27) ,80 .0%(20/25) ,and 6 .7% (2/30) respectively .The positive rates of FOBT in the three groups were 37 .0% (10/27) ,12 .0% (3/25) and 3 .3% (1/30) respectively .The diagnostic sensitivity of the MS‐HRM assay for colorectal cancer and advanced adenomas (80 .8% , 42/52) was significantly higher than that of FOBT (25 .0% ,13/52)(P<0 .05) .No significant difference was found in the diagnos‐tic specificity between the MS‐HRM assay (93 .3% ,28/30) and the FOBT (96 .7% ,29/30) (P>0 .05) .Conclusion MS‐HRM performs better than FOBT and has great application potential in the detection of stool DNA methylation for colorectal cancer screening .

Objective To detect the change of serum cystatine C ( cys C ) level in Parkinson ’ s disease ( PD ) patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and explore its influencing factors .Methods Fifty-six PD patients with polysomnography examination from July 2011 to December 2013 in the Department of Neurology , the Second Affiliated Hospital of Soochow University were collected.Eighteen healthy controls who took the polysomnography examination during the same period were included.According to the apnea-hypopnea index ( AHI) , PD patients were further divided into two groups:PD with OSAHS group ( n=26 ) , and PD group ( n=30 ).The general conditions , movement function , biochemistry parameters , and sleep parameters were assessed.Statistical analysis was performed using SPSS ver 17.0 software.Results The mean serum levels of cys C in PD with OSAHS group , PD group and control group were (1.05 ±0.17) mg/L, (0.96 ±0.12) mg/L and (0.84 ±0.20) mg/L, respectively.Statistical analysis showed that there was significant difference in the three groups (F=9.184,P<0.05), and the mean serum level of cys C in PD with OSAHS group was the highest.In PD with OSAHS group , Spearman correlation analysis showed a positive and significant correlation between cys C levels and creatinine levels (r=0.459,P =0.018), urea levels (r =0.405,P =0.040), AHI (r =0.482,P =0.013), the oxygen desaturation index (r=0.408,P=0.038), the arousal index (r=0.392,P=0.047) as well as Hoehn and Yahr (H-Y) stage (r=0.467,P=0.016).Correlation was not observed between cys C levels and other clinical parameters (P>0.05).Multivariate analysis showed that creatinine levels (B=0.007,P=0.005), AHI (B=0.004,P=0.013) , H-Y stage (B=0.102,P=0.026) may be influencing factors of cys C levels in PD patients (P<0.05).Conclusions Cys C level is elevated in PD patients, especially in PD patients with OSAHS.The degree of hypoxia and severity of PD is related to the level of cys C in PD patients with OSAHS .

After communication with professional course teachers, clinical experts and graduates by investigation, informal discussion and expert interviews, the course and teaching of rehabilitation therapy was reformed to make the students not only meet the skill requirement,but also acquire basic theory and sustainable develop in their career.