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 clinical efficacy of anterior versus posterior app-roach to posterior rectus sheath in laparoscopic totally extraperitoneal sublay (TES) for diastasis recti combined with umbilical hernia.Methods:The retrospective cohort study was conducted. The clinicopathological data of 45 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to The University of Hong Kong-Shenzhen Hospital and 24 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to Shenzhen People's Hospital from January 2019 to December 2024 were collected. There were 6 males and 63 females, aged (50±14)years. All 69 patients underwent laparoscopic TES. Among them, 36 patients under-going the anterior approach to the posterior rectus sheath were assigned to anterior approach group, and 33 patients undergoing the posterior approach were assigned to posterior approach group. Observation indicators: (1) surgical conditions; (2) follow-up conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. All patients in both groups successfully completed the surgery. The type of mesh placed was self-fixating mesh in all cases, with no conversion to open surgery, and routine drainage tube placement was performed postoperatively. For the anterior approach group and the posterior approach group, the operative time was (167±44)minutes and (214±53)minutes, the maximum separation width of the rectus abdominis was (3.57±0.79)cm and (4.08±0.99)cm, respectively, showing significant differences in the above indicators between the two groups ( t=-4.00, -2.36, P<0.05). For the anterior approach group and the posterior approach group, cases with peritoneal injury were 26 and 29, the umbilical hernia defect diameter was (2.15±0.46)cm and (2.24±0.52) cm, the postoperative drainage volume was (62±22)mL and (72±36)mL, respectively, showing no significant difference in the above indicators between the two groups ( χ2=2.61, t=-0.76, -1.50, P>0.05). (2) Follow-up conditions. Among the 69 patients, 61 were followed up, including 31 cases in the anterior approach group and 30 cases in the posterior approach group. The duration of follow-up was 31(range, 8-44)months for the anterior approach group and 35(range, 9-60)months for the posterior approach group, respectively. No recurrence (abdominal wall bulge), seroma, chronic pain, or infection occurred in either group, and all patients were able to complete the trunk flexion movement with hands behind the head. Conclusion:Both the anterior and posterior approaches to posterior rectus sheath are safe and effective in laparoscopic TES for diastasis recti abdominis combined with umbilical hernia, among which the anterior approach to posterior rectus sheath has a shorter operation time.

Objective To observe the correlation between cortical thickness and pathological deposition of β-amyloid(Aβ)in patients with Alzheimer disease(AD)induced mild cognitive impairment(MCI)or dementia.Methods Totally 22 AD patients were prospectively enrolled and divided into dementia group(n=12)and MCI group(n=10)based on the degree of cognitive impairment,while 17 healthy individuals without cognitive impairment were recruited as control group.MR examination and 18F-florbutaben(18F-FBB)PET imaging were performed,the cortical thickness and Aβ deposition value(Centiloid[CL]value)were calculated and compared among 3 groups and between each 2 groups,then the correlation between the above two indexes was analyzed.Results The cortical thickness in dementia group,MCI group and control group was(2.18±0.14),(2.35±0.08)and(2.36±0.09)mm,respectively,with significant difference among 3 groups(P＜0.05).The cortical thickness in dementia group was significantly thinner than that in MCI group and control group(both P＜0.05).CL value in dementia group,MCI group and control group was 77.97(63.07,95.55),65.51(54.54,90.50)and-1.17(-9.66,4.88),respectively,with significant difference among 3 groups(P＜0.05).CL value in dementia group and MCI group were significantly higher than in control group(both P＜0.05).The cortical thickness was moderately negatively correlated with CL value in MCI group(r=-0.580,P=0.048)but not in the other 2 groups(both P＞0.05).Conclusion The cortical thickness was moderately negatively correlated with abnormal deposition of Aβ in patients with AD induced MCI,but was not during dementia.

OBJECTIVE To establish the HPLC fingerprint of Xintong granules and the quantitative analysis of multi-components by single-marker method(QAMS)to determine the contents of 7 components,so as to provide a scientific basis for their quality control.METHODS HPLC method was used to establish the fingerprints for 10 batches of Xintong granules(No.S1-S10),and similarity evaluation,cluster analysis(CA)and partial least squares-discriminant analysis(PLS-DA)were performed.At the same time,the contents of seven components,including puerarin,daidzin,calycosin-7-O-β-D-glucoside,stilbene glycoside,naringin,icariin and tanshinone ⅡA,were determined by QAMS method,and were compared with the results of external standard method.RESULTS A total of 18 common peaks were marked and 7 peaks were identified in the HPLC fingerprints for 10 batches of Xintong granules,namely puerarin(peak 4),daidzin(peak 7),calycosin-7-O-β-D-glucoside(peak 9),stilbene glycoside(peak 10),naringin(peak 12),icariin(peak 17),and tanshinone ⅡA(peak 18);the similarities among them were more than 0.990,and CA and PLS-DA results showed that S4-S5,S8-S10,S1-S3 and S6-S7 were clustered into three categories,respectively.Using naringin as the internal standard,the contents of puerarin,daidzin,calycosin-7-O-β-D-glucoside,stilbene glycoside,icariin and tanshinone ⅡA were determined to be 7.868 1-10.181 2,1.709 2-2.374 1,0.285 2-0.326 3,1.024 1-1.523 9,0.140 2-0.290 4,and 0.077 1-0.219 4 mg/g,respectively,by the QAMS.These results showed no significant differences compared to those obtained by the external standard method.CONCLUSIONS Established HPLC fingerprint and QAMS method are convenient,stable and accurate,which can provide a basis for the quality evaluation of Xintong granules.

Objective:To explore the clinical characteristics and healthcare burden in patients with McCune-Albright syndrome (MAS).Methods:A cross-sectional study was conducted at the Children′s Hospital, Zhejiang University School of Medicine. Clinical and healthcare burden data were systematically collected through structured questionnaires in 164 children with MAS from February 2022 to May 2023. According to the clinical characteristics, patients were categorized into 3 groups: monosymptomatic, bisymptomatic and trisymptomatic groups. Patients were also divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Comparative analyses of clinical characteristics and healthcare burden were conducted across age, sex, and symptom categories.Results:The cohort comprised 59 males (36.0%) and 105 females (64.0%) with an age of 4.6 (2.0, 7.4) years. Age stratification revealed 117 cases (71.3%) aged 0-<7 years, 29 cases (17.7%) aged 7-<10 years, and 18 cases (11.0%) aged 10-<18 years. Among monosymptomatic (67 cases, 40.9%), the cohort comprised 32 females (47.8%) and 35 males (52.2%), predominantly presenting with fibrous dysplasia (57 cases, 85.1%). This subgroup showed peak prevalence in the 0-<7 years age range (29 cases (50.9%)). The bisymptomatic cohort (56 cases, 34.1%) consisted of 39 females (69.6%) and 17 males (30.4%), predominantly manifesting fibrous dysplasia with skin hyperpigmentation (25 cases, 44.6%). Peak prevalence occurred in the 0-<7 years subgroup(16 cases (64.0%)). The trisymptomatic cohort (41 cases, 25.0%) consisted of 34 females (82.9%) and 7 males (17.1%), with peak prevalence occurring in the 0-<7 years subgroup (36 cases (87.8%)). The diagnostic journey analysis revealed 94 cases (57.3%) required 1-3 referrals, and 34 cases (20.7%) necessitated >3 referrals from symptom onset to definitive diagnosis. Healthcare expenditure analysis revealed 69 families (42.1%) incurred direct medical costs of 10 000-100 000 CNY, with 11 families (6.7%) exceeding >100 000 CNY. Direct non-medical costs reached of 10 000-100 000 CNY for 62 families (37.8%) and >100 000 CNY for 4 families (2.4%). Productivity loss affected 58 families (35.4%) at 10 000-100 000 CNY and 8 families (4.9%) above 100 000 CNY during the study period.Conclusion:MAS requires increased attention to skeletal manifestations, especially in children aged 0-<7 years. Moreover, the significant financial burden on families necessitates a society-wide support system.

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 explore the clinical characteristics and healthcare burden in patients with McCune-Albright syndrome (MAS).Methods:A cross-sectional study was conducted at the Children′s Hospital, Zhejiang University School of Medicine. Clinical and healthcare burden data were systematically collected through structured questionnaires in 164 children with MAS from February 2022 to May 2023. According to the clinical characteristics, patients were categorized into 3 groups: monosymptomatic, bisymptomatic and trisymptomatic groups. Patients were also divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Comparative analyses of clinical characteristics and healthcare burden were conducted across age, sex, and symptom categories.Results:The cohort comprised 59 males (36.0%) and 105 females (64.0%) with an age of 4.6 (2.0, 7.4) years. Age stratification revealed 117 cases (71.3%) aged 0-<7 years, 29 cases (17.7%) aged 7-<10 years, and 18 cases (11.0%) aged 10-<18 years. Among monosymptomatic (67 cases, 40.9%), the cohort comprised 32 females (47.8%) and 35 males (52.2%), predominantly presenting with fibrous dysplasia (57 cases, 85.1%). This subgroup showed peak prevalence in the 0-<7 years age range (29 cases (50.9%)). The bisymptomatic cohort (56 cases, 34.1%) consisted of 39 females (69.6%) and 17 males (30.4%), predominantly manifesting fibrous dysplasia with skin hyperpigmentation (25 cases, 44.6%). Peak prevalence occurred in the 0-<7 years subgroup(16 cases (64.0%)). The trisymptomatic cohort (41 cases, 25.0%) consisted of 34 females (82.9%) and 7 males (17.1%), with peak prevalence occurring in the 0-<7 years subgroup (36 cases (87.8%)). The diagnostic journey analysis revealed 94 cases (57.3%) required 1-3 referrals, and 34 cases (20.7%) necessitated >3 referrals from symptom onset to definitive diagnosis. Healthcare expenditure analysis revealed 69 families (42.1%) incurred direct medical costs of 10 000-100 000 CNY, with 11 families (6.7%) exceeding >100 000 CNY. Direct non-medical costs reached of 10 000-100 000 CNY for 62 families (37.8%) and >100 000 CNY for 4 families (2.4%). Productivity loss affected 58 families (35.4%) at 10 000-100 000 CNY and 8 families (4.9%) above 100 000 CNY during the study period.Conclusion:MAS requires increased attention to skeletal manifestations, especially in children aged 0-<7 years. Moreover, the significant financial burden on families necessitates a society-wide support system.

Objective:To investigate the clinical efficacy of anterior versus posterior app-roach to posterior rectus sheath in laparoscopic totally extraperitoneal sublay (TES) for diastasis recti combined with umbilical hernia.Methods:The retrospective cohort study was conducted. The clinicopathological data of 45 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to The University of Hong Kong-Shenzhen Hospital and 24 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to Shenzhen People's Hospital from January 2019 to December 2024 were collected. There were 6 males and 63 females, aged (50±14)years. All 69 patients underwent laparoscopic TES. Among them, 36 patients under-going the anterior approach to the posterior rectus sheath were assigned to anterior approach group, and 33 patients undergoing the posterior approach were assigned to posterior approach group. Observation indicators: (1) surgical conditions; (2) follow-up conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. All patients in both groups successfully completed the surgery. The type of mesh placed was self-fixating mesh in all cases, with no conversion to open surgery, and routine drainage tube placement was performed postoperatively. For the anterior approach group and the posterior approach group, the operative time was (167±44)minutes and (214±53)minutes, the maximum separation width of the rectus abdominis was (3.57±0.79)cm and (4.08±0.99)cm, respectively, showing significant differences in the above indicators between the two groups ( t=-4.00, -2.36, P<0.05). For the anterior approach group and the posterior approach group, cases with peritoneal injury were 26 and 29, the umbilical hernia defect diameter was (2.15±0.46)cm and (2.24±0.52) cm, the postoperative drainage volume was (62±22)mL and (72±36)mL, respectively, showing no significant difference in the above indicators between the two groups ( χ2=2.61, t=-0.76, -1.50, P>0.05). (2) Follow-up conditions. Among the 69 patients, 61 were followed up, including 31 cases in the anterior approach group and 30 cases in the posterior approach group. The duration of follow-up was 31(range, 8-44)months for the anterior approach group and 35(range, 9-60)months for the posterior approach group, respectively. No recurrence (abdominal wall bulge), seroma, chronic pain, or infection occurred in either group, and all patients were able to complete the trunk flexion movement with hands behind the head. Conclusion:Both the anterior and posterior approaches to posterior rectus sheath are safe and effective in laparoscopic TES for diastasis recti abdominis combined with umbilical hernia, among which the anterior approach to posterior rectus sheath has a shorter operation time.

Objective To observe the correlation between cortical thickness and pathological deposition of β-amyloid(Aβ)in patients with Alzheimer disease(AD)induced mild cognitive impairment(MCI)or dementia.Methods Totally 22 AD patients were prospectively enrolled and divided into dementia group(n=12)and MCI group(n=10)based on the degree of cognitive impairment,while 17 healthy individuals without cognitive impairment were recruited as control group.MR examination and 18F-florbutaben(18F-FBB)PET imaging were performed,the cortical thickness and Aβ deposition value(Centiloid[CL]value)were calculated and compared among 3 groups and between each 2 groups,then the correlation between the above two indexes was analyzed.Results The cortical thickness in dementia group,MCI group and control group was(2.18±0.14),(2.35±0.08)and(2.36±0.09)mm,respectively,with significant difference among 3 groups(P＜0.05).The cortical thickness in dementia group was significantly thinner than that in MCI group and control group(both P＜0.05).CL value in dementia group,MCI group and control group was 77.97(63.07,95.55),65.51(54.54,90.50)and-1.17(-9.66,4.88),respectively,with significant difference among 3 groups(P＜0.05).CL value in dementia group and MCI group were significantly higher than in control group(both P＜0.05).The cortical thickness was moderately negatively correlated with CL value in MCI group(r=-0.580,P=0.048)but not in the other 2 groups(both P＞0.05).Conclusion The cortical thickness was moderately negatively correlated with abnormal deposition of Aβ in patients with AD induced MCI,but was not during dementia.

A total of 360 healthy 26 week old Huaixiang hens were randomly divided into 10 groups,of which,five groups were reared at normal temperature(NC,NT1,NT2,NT3,NT4)and other five groups were reared at high temperature(HC,HT1,HT2,HT3,HT4),all chickens were feed with 0,4,6,8,10 mg/kg canthaxanthin(CX)respectively.The pre-test period was 2 weeks and the main test period was 9 weeks.The results showed that high temperature reduced the egg pro-duction rate(P＜0.05),led to damage and hemorrhage in the ovaries,decreased the activity of su-peroxide dismutase(SOD),glutathione peroxidase(GSH-Px)in the serum and the ovaries(P＜0.05),decreased the levels of FSH,LH,P4,and E2(P＜0.05),decreased the expression of FSHR,LHR,ER,and PR(P＜0.05),and increased the levels of malonaldehyde(MDA)(P＜0.05)in the ovaries.Addition of CX increased the egg production rate(P＜0.05),increased the activity of serum and ovarian SOD and GSH-Px enzymes(P＜0.05),decreased the content of serum and ovarian MDA(P＜0.05)),increased the ovarian levels of FSH,LH,P4,E2(P＜0.05),and increased the o-varian expression of FSHR,LHR,ER,and PR(P＜0.05)in Huaixiang chickens at normal and high temperature environmental conditions,respectively.Among them,the highest egg production rate,the strongest antioxidant capacity of serum and ovarian tissues,the best integrity of ovarian tis-sues,ovarian reproductive hormone secretion and expression of reproductive hormone receptors were observed in Huaixiang chickens when 6 mg/kg of CX was added to the diet under normal temperature and when 8 mg/kg CX was added to the diet under high temperature conditions.The results showed that under normal and high temperature conditions,adding CX to the diet signifi-cantly increased the antioxidant capacity of serum and ovaries,alleviated the damage of ovary,pro-moted the secretion of reproductive hormone and the expression of reproductive hormone recep-tors,and increased egg production rate.Dietary supplemented with CX could not restore the dam-age and repair of ovarian tissue,the secretion of reproductive hormone and receptor to normal tem-perature level.The effects of CX on egg production rate,ovarian tissue structure,reproductive hor-mone and receptor expression in chickens were affected by the environmental temperature.When the egg production rate,antioxidant capacity of ovarian tissues,reproductive hormone levels and receptor expression of Huaixiang chickens were optimal,the amount of CX in high temperature en-vironment was more than that of the dose in normal temperature environment.