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.

Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.

Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.

Objective: Understanding mental health status of students with learning disabilities in Beijing to provide a basis for mental health promotion of students with learning disabilities. Methods: By means of random cluster sampling, 5 787 enrolled students in grade one and grade two of 11 public junior middle schools in Beijing were selected as the survey subjects. A self designed questionnaire was used to investigate the students’ learning disabilities and mental health status through anonymous self filling. Results: About 11.6% students self reported learning disabilities. The proportions of students with learning difficulty in mathematical reasoning and calculation were higher, 44.1% and 40.7% respectively. The reported rate of mental health problems was 38.3%. The top four of the 10 symptoms were obsessive compulsive symptoms, learning pressure, emotional instability and anxiety(2.19±0.77)(2.17±0.99)(2.09±0.90)(2.07±1.08). Compared with students without learning disabilities, students with self reported learning disabilities had poorer mental health status(OR=1.47), and learning disabilities were related to most factors of mental health. Different types of learning disabilities were associated with different mental health factors. Conclusion Mental health problems of students with learning disabilities are higher than that of students without learning disabilities. It is necessary to strengthen the mental health support for students with learning disabilities and improve their mental health.

Objective To investigate the diagnostic value of IL-27, ADA and TB-Ab in TB pleurisy. Methods The data of 74 TB pleurisy cases and 45 non-TB pleurisy cases were screened randomly from June 2017 to July 2018 in Dalian Tuberculosis Hospital. Value of IL-27, ADA and TB-Ab in blood and pleural fluid of the two groups of cases was detected, and diagnostic value of these biomarkers in TB pleurisy was compared. Results The value of IL-27, ADA and TB-Ab in blood and pleural effusion of patients with TB pleurisy were higher than those of control group (P < 0.05). ROC curve analysis showed that areas under the blood IL-27, ADA and TB-Ab curves were 0.820, 0.744 and 0.589 (P<0.05) respectively, while those under the pleural effusion curves were 0.921, 0.876 and 0.708 (P<0.05) respectively. The area under the curve of IL-27 and ADA ROC curve was 0.921 (P<0.05), but 95% CI was higher than that of pleural effusion ADA (0.804-0.930) and IL-27(0.857-0.962). Conclusions Detection of IL-27 and ADA in pleural effusion is of great value in the diagnosis of TB pleurisy. The combined detection of IL-27 and ADA in pleural effusion would improve the diagnostic value.

Objective To explore the long-term effectiveness of using extracorporeal shock waves in the treatment of plantar fasciitis. Methods Extracorporeal shock wave therapy was applied to 23 plantar fasciitis suffer-ers once a week for three weeks. MRI examinations were performed before and 4 hours after the first treatment. Before the treatment and one month after it was complete, all of the patients rated their pain using a visual analogue scale ( VAS) , and their infirmity was quantified using a heel tenderness index ( HTI) and the ankle-hind foot scale of the American Orthopaedic Foot and Ankle Society ( AOFAS) . The longest walking time was also recorded. Paired t-tests compared the T2 values of the fascia, muscles and fat pads, the longest walking time and the VAS scores before and after the treatment. Pearson correlation coefficients were evaluated to test the significance of any correlation between the T2 changes and the changes in the VAS scores. Results After the shock wave therapy, the average VAS, HIT and AOFAS scores had significantly decreased, while the longest walking time had increased significantly. The mag-netic resonance imaging showed increased edema in the fascia and their surrounding soft tissues. And the extent and degree of the T2 weighted high signal increased four hours after the treatment. The changes in the T2 values correlated positively and significantly with the changes in the VAS scores. Conclusion Extracorporeal shock waves have an excellent therapeutic effect on plantar fasciitis. They can significantly relieve heel pain and improve foot movement.

Objective To analyze the monitoring results of plague in Qianxi'nan Prefecture in Guizhou Province from 2006 to 2015,and to provide a reference for prevention and control of plague.Methods Using a retrospective analysis method,plague epidemic reports,epidemic source investigations,and animal plague surveillance data from 3 monitoring sites in Xingyi City,Anlong County,and Yilong Experimental Area in Qianxi'nan Prefecture from 2006-2015 were collected and analyzed.Results In 2006-2015,no rat plague and human plague occurred in Qianxi'nan Prefecture.There was no Yersinia pestis,and a total of 1 plague antigen F1 positive rat was detected in Xingyi City in 2006.The density of indoor rat was 2.28％ (3 580/157 192),the density of indoor Rattus flavipectus was 1.31％ (2 052/157 192),ranging from 0.90％ to 1.82％,the differences were statistically significant between different years (x2 =91.110,P ＜ 0.05);and the density of outdoor rat was 1.52％ (2 358/154 732),the density of outdoor Rattus flavipectus was 0.58％ (905/154 732),ranging from 0.39％ to 0.90％,the differences were statistically significant between different years (x2 =63.428,P ＜ 0.05).In the composition of rodents,Rattus flavipectus was the dominant species,Rattus norvegicus and Mus musculus were common species.The musk deer index was 1.19.In the composition of flea species,the Xenopsylla cheopis was the dominant species with an index of 0.64,Leptopsylla segnis and Monopsyllus anisus were common species.Conclusions Rattus flavipectus and Xenopsylla cheopis was the dominant rodent and flea species in Qianxi'nan Prefecture.The density of indoor Rattus flavipectus and the index of flea are higher than those of the national standard of plague control (1.0％,0.5).In the future,densities of Rattus flavipectus should be closely monitored,and the rodent and flea killing activities should be carried out in time.

Objective To investigate the expressions of miR-21 in clinical lung tissues,serum of lung cancer patients and X-ray irradiated A549 cells in vitro and in vivo.Methods A549 cells were irradiated with 2 and 4 Gy X-rays,and pulmonary metastasis model of lung cancer in nude mice was established to detect the expression of miR-21 in vitro and in vivo,as well as in clinical lung tissues of different pathological types serum sample of lung cancer patients and NSCLC patients whether or not received radiotherapy.The survival rate was further analyzed in the above mention NSCLC patients.Results The miR-21 expressions was up-regulated in 60.0％ of tissue samples of NSCLC patients,and it was up-regulated in 50.5％ serum samples of lung cancer patients (52 out of 103).The miR-21 expressions in lung adenocarcinoma and squamous cell carcinoma had significant difference (x2 =5.766,P ＜ 0.05).In the serum samples of 87 NSCLC patients,miR-21 was detected in 66.7％ samples from the patients of radiotherapy but only 39.6％ of patients without radiotherapy (x2 =6.321,P ＜ 0.05).Kaplan-Meier curves showed that the survival rate of patients with low miR-21 expression was higher than that with high miR-21 expression (P ＜ 0.05).Multivariate Cox regression analysis demonstrated that the miR-21 expression,regional lymph node metastasis and radiotherapy were independent prognostic factors for NSCLC patients.The expression of miR-21 was up-regulated significantly in X-ray irradiated A549 cells at different time-points after irradiation (t =-7.552--1.206,P ＜ 0.05).Furthermore,the expression of miR-21was up-regulated in the serum and lung of nude mice (t =-47.845--2.356,P ＜ 0.05).Conclusions The X-ray irradiation could up-regulate the expression of miR-21 in A549 cells in vitro and in vivo,which might be correlated with the enhanced metastasis of A549 cells.

Objective To investigate the expression of miR-520d-3p in 2 and 4 Gy X-ray irradiated A549 cells, serum samples of non-small cell lung cancer (NSCLC) patients and its significance. Methods Real time quantitative PCR (RT-qPCR) was employed to detect the expression miR-520d-3p in 2 and 4 Gy X-ray irradiated A549 cells in vitro. Besides, 0, 2 and 4 Gy X-ray irradiated A549 cells were used to prepare animal model of nude mice lung metastasis through mainline. The expressions of miR-520d-3p and lung tissue of nude mice were detected, and the serum samples of NSCLC patients were collected to test the expression of miR-520d-3p . Results Compared with the control group ( 0 Gy ) , the expression of miR-520d-3p was up-regulated significantly in 2 and 4 Gy X-ray irradiated A549 cells after 48 hours (1.00±0.03, 1.47±0.10, 1.84 ±0.09 respectively), and there was a significant difference (F= 94.350, P= 0.000). Furthermore, compared the control group with injection after 10 weeks, the expressions of miR-520d-3p in nude mice lung tissue in 0, 2 and 4 Gy X-ray irradiated groups were increased (2.33 ±0.13, 8.24 ±0.25, 3.46 ±0.14, respectively) (F=1.787, P= 0.227), and the expressions in serum were increased (11.43±2.30, 10.22±4.62, 8.99 ±3.67, respectively) (F= 1.547, P= 0.246). Out of 20 serum samples of NSCLC patients (including 10 cases of adenocarcinoma, 10 cases of squamous carcinoma ), 11 cases (55%) were detected with up-regulated miR-520d-3p expression. Conclusions 2 and 4 Gy X-ray could increase the expression of miR-520d-3p of A549 cells in vitro and in vivo, which might be correlated with the enhanced invasion and metastasis of A549 cells induced by X-ray in vitro and in vivo. Furthermore, the expressions of miR-520d-3p were increased significantly in over 50%serum samples of NSCLC patients, which might be a new marker for the diagnosis of NSCLC.