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 identify the potential differently expressed genes and microRNAs(mi-RNAs)in sepsis survivors and non-survivors through bioinformatics-based research based on gene expression omnibus(GEO).Methods Two gene expression profile microarray datasets of human blood samples(GSE48080 and GSE54514)were downloaded from the GEO database.The differential expression genes(DEGs)between sepsis survivors and non-survivors at two time points(diagnosis of sepsis,course of sep-sis)were screened with the GEO2R online tool.The gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were used to study the pathophysiological processes and potential signaling pathways involved in sepsis related death DEGs.STRING online tool was used to construct the DEGs protein-protein interaction(PPI).Cytoscape with CytoHubba was used to investigate the potential hub genes.NetworkAnalyst was used to construct targeted miRNAs of the hub genes.Real-time quantitative PCR(RT-qPCR)was established to evaluate the expression of potential hub genes in our sepsis survivors and non-survivors.Results During the course of sepsis,there was heterogeneity in gene expre-ssion between sepsis survivors and non-survivors.Fifteen DEGs were found to be remarkably differentially expressed between sepsis survivors and non-survivors during the course of sepsis.Four KEGG pathways,in-cluding staphylococcus aureus infection,NOD-like receptor signaling pathway,sulfur metabolism and col-lecting duct acid secretion,were significantly enriched.In combination with the results of the PPI network and CytoHubba,ten hub genes(SLC4A1,EPB42,LTF,LCN2,DEFA4,HBM,HBG1,GMPR,CAMP,OLFM4)were selected as potential biomarkers for sepsis-associated mortality.With NetworkAnalyst analysis,ten miRNAs were predicted as potential key miRNAs.RT-qPCR confirmed that the expressions of five of these genes(SLC4A1,EPB42,LCN2,DEFA4,OLFM4)were in accordance with the microarray results.Conclusion Bioinformatics analysis based on GEO database showed DEGs between sepsis suvivors and non-survivors in the course of sepsis,which contributed to identification of potential biomarkers and risk factors for sepsis-associated mortality.

Objective:To explore the diagnostic value of CT pulmonary vascular quantitative parameters in patients with chronic obstructive pulmonary disease (COPD) and high-risk groups.Methods:A retrospective study of 1 126 patients who underwent chest CT examination and pulmonary function test in Shanghai Tongji Hospital from January 2015 to August 2020. According to lung function, they were divided into COPD group (471 cases), high-risk group (454 cases), and normal control group (201 cases). Pulmonary vascular parameters on chest CT, including the total number of vessels (N total), the number cross-sectional area of vessels under 5 mm 2 (N CSA<5), lung surface area (LSA), number of pulmonary blood vessels per unit lung surface area (N total/LSA) and the total area of vessels (VA total) at a 9, 15, 21 mm depth from the pleural surface, and the total blood vessel volume (TBV), blood vessel volume under 5 mm 2 and 10 mm 2(BV5 and BV10) were measured quantitatively. Kruskal-Wallis H test was used to compare the differences of quantitative parameters of pulmonary vascular in the three groups; Spearman rank test was used to analyze the correlation between CT pulmonary vascular parameters and pulmonary function. Results:There were significant differences in N total/LSA at a 9, 15, 21 mm depth from the pleural surface among three groups ( P<0.05). There were significant differences in N CSA<5, N total at a 9 mm depth from the pleural surface among three groups ( P<0.05). There were significant differences in LSA at a 9 mm depth from the pleural surface, N CSA<5, N total, LSA, VA total at a 15, 21 mm depth from the pleural surface and TBV, BV5 and BV10 among three groups ( P<0.05). In high-risk group, there were positive correlation between N total/LSA, VA total at a 9 mm depth from the pleural surface and some pulmonary function parameters ( r=0.095-0.139, P<0.05). N CSA<5, N total, LSA, N total/LSA, TBV, BV5 and BV10 at different depth from pleural surface were negatively correlated with some pulmonary function parameters ( r=-0.110--0.215, P<0.05). In COPD group, number of vessels at a 9 mm depth from the pleural surface was positively correlated with the diffusion capacity for carbon monoxide of the lung single breath ( r=0.105, 0.103, P<0.05). In addition to N total/LSA were positively correlated with lung function parameters ( r=0.181-0.324, P<0.05), the remaining pulmonary vascular parameters were negatively correlated with some pulmonary function parameters ( r=-0.092--0.431, P<0.05). Conclusion:Quantitative chest CT imaging are able to effectively evaluate pulmonary vascular changes in COPD patients and high-risk groups, and the quantitative parameters of pulmonary vascular CT may distinguish COPD from high-risk groups, providing a novel means for early diagnosis of COPD and prediction of high-risk groups.

OBJECTIVES: This study aimed to investigate how naringenin (Nar) affected the anti-inflammatory, vascula-rization, and osteogenesis differentiation of human periodontal ligament stem cells (hPDLSCs) stimulated by lipopolysaccharide (LPS) and to preliminarily explore the underlying mechanism. METHODS: Cell-counting kit-8 (CCK8), cell scratch test, and Transwell assay were used to investigate the proliferation and migratory capabilities of hPDLSCs. Alkaline phosphatase (ALP) staining, alizarin red staining, lumen-formation assay, enzyme-linked immunosorbent assay, quantitative timed polymerase chain reaction, and Western blot were used to measure the expression of osteopontin (OPN), Runt-related transcription factor 2 (RUNX2), vascular endothlial growth factor (VEGF), basic fibroblast growth factor (bFGF), von Willebrand factor (vWF), tumor necrosis factor-α (TNF-α), and interleukin (IL)-6. RESULTS: We observed that 10 μmol/L Nar could attenuate the inflammatory response of hPDLSCs stimulated by 10 μg/mL LPS and promoted their proliferation, migration, and vascularization differentiation. Furthermore, 0.1 μmol/L Nar could effectively restore the osteogenic differentiation of inflammatory hPDLSCs. The effects of Nar's anti-inflammatory and promotion of osteogenic differentiation significantly decreased and inflammatory vascularization differentiation increased after adding AMD3100 (a specific CXCR4 inhibitor). CONCLUSIONS Nar demonstrated the ability to promote the anti-inflammatory, vascularization, and osteogenic effects of hPDLSCs stimulated by LPS, and the ability was associated with the stromal cell-derived factor/C-X-C motif chemokine receptor 4 signaling axis.
Humans ; Anti-Inflammatory Agents/pharmacology* ; Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Chemokine CXCL12 ; Lipopolysaccharides/pharmacology* ; Osteogenesis ; Periodontal Ligament/metabolism* ; Receptors, Chemokine/metabolism* ; Stem Cells ; Interleukin-8/metabolism*

Objective: To observe the growth and metastasis of lung cancer promoted by bone marrow derived mesenchymal stem cells (BMSCs) in tumor microenvironment and investigate the underlined mechanisms. Methods: Specific chemotaxis of BMSCs towards lung cancer was observed, and the tumor growth and metastasis were assessed in vivo. Furthermore, CD34 expression determined by immunohistochemistry was used to assess the microvessel density (MVD), and the expressions of GFP and α-SMA determined by immunofluorescence were used to detect the BMSCs derived mesenchymal cells. We investigated the effect of BMSCs on migration, invasion of lung cancer cells including A549 and H446 cells by using scratch assays and Transwell Assay in vitro. We also explored the effect of BMSCs on epithelial mesenchymal transition of A549 and H446 cells by observing the phenotype transition and E-Cadherin protein expression detected by Western blot. At last, we screened the potentially key soluble factors by enzyme linked immunosorbent assay (ELISA). Results: In NOD mice, labeled BMSCs injected via tail vein were special chemotaxis to tumor cells, and promoted the tumor growth [the time of tumor formation in A549+ BMSCs and A549 alone was (5.0±1.5) days and (10.0±3.6) days, respectively, P<0.05; the time of tumor formation in H446+ BMSCs and H446 alone was (5.2±1.5) days and (12.0±2.0) days, respectively, P<0.05]. The tumor incidence of A549+ BMSCs was 100%, significantly higher than 66.7% of A549 alone (P<0.05), while the tumor incidence of H446+ BMSCs was 83.0%, significantly higher than 50.0% of H446 alone (P<0.05). The BMSCs also increased the tumor volume [the tumor volume of A549+ BMSCs and A549 alone was (193.0±42.3) mm³ and (97.8±42.9) mm^3, respectively, P<0.05; the tumor volume of H446+ BMSCs and H446 alone was (78.6±34.8) mm³ and (25.3±12.7) mm^3, respectively, P<0.05] and facilitated the tumor metastasis (the tumor metastatic incidence of A549+ BMSCs and A549 alone was 100.0% and 16.7%, respectively, P<0.05; the tumor metastatic incidence of H446+ BMSCs and H446 alone was 100.0% and 0.0%, respectively, P<0.05). Furthermore, BMSCs increased tumor vessel formation (the MVD of A549+ BMSCs and A549 alone was 53.2±11.4 and 25.3±11.5, respectively, P<0.05; the MVD of H446+ BMSCs and H446 alone was 56.8±12.5 and 24.8±10.0, respectively, P<0.05). BMSCs were able to differentiate to fibroblasts in the lung squamous cell carcinoma and promoted the migration and invasion of lung cancer cells (the A of cells in the migrated lower chambers of A549+ BMSCs and A549 alone was 1.9±0.2 and 1.1±0.1, respectively, P<0.05; the A of cells in the migrated lower chambers of H446+ BMSCs and H446 alone was 1.9±0.3 and 0.9±0.2, respectively, P<0.05). The cell shape was longer and sharper, the intercellular junctions were reduced and the relative expression level of E-Cadherin protein in A549 co-cultured with BMDCs was 0.36, significantly down-regulated when compared to 0.55 of A549 alone (P<0.05), and the relative expression level of E-Cadherin protein in H446 co-cultured with BMDCs was 0.28, significantly down-regulated when compared to 0.46 of H446 cells alone (P<0.05). The concentration of IL-6 in the conditional medium of BMSCs, A549 co-cultured with BMSCs and H446 co-cultured with BMSCs was 910.5, 957.2, and 963.8, respectively, significantly up-regulated when compared to 18.8 of control group (P<0.05). The expression level of PGE2 in A549 co-cultured with BMSCs and H446 co-cultured with BMSCs was 130.5 and 87.2, significantly up-regulated when compared to 13.8 of control group and 23.8 of BMSCs group (P<0.05). Conclusions Our results suggest that BMSCs contribute to the tumor growth through facilitating angiogenesis, and promote tumor metastasis through paracrine manner and down-regulation of E-Cadherin protein. IL-6 and PGE2 produced by BMDCs might be the potentially important cytokines.

Objective To evaluate the effect of preoperative anxiety on the dosage of opioid drugs in perioperative period.Methods Fourty female patients who aged 18-65 years,ASA Ⅰ or Ⅱ, undergoing laparoscopic hysterectomy were enrolled during November 2014 to August 2015.Demo-graphic characteristics of the patients were recorded.The patients were separated into two groups ac-cording to their state anxiety inventory (SAI).The patients with SAI>37 score were included in the high-anxious patients group (group H,n=22)while the other patients with SAI≤37 were enrolled in the low-anxious patients group (group L,n=18).All patients received the SAI test at the day be-fore surgery.The anesthesia time,intraoperative remifentanil consumption,duration of the first time giving analgesia after surgery,consumption of sufentanil at 1(T1 ),2(T2 ),4(T3 ),6(T4 ),24(T5 ) and 48 hours(T6 )after operation were recorded.Visual analogue scale (VAS)scores,the times of pressing PCIA and the side effects of opioid 48 h after the surgery were recorded.Results In group H, the time for first dose of opioid after surgery was significantly shorter than group L (P <0.05).The con-sumption of sufentanil in group H was significantly more than group L at T1-T6 (P <0.05).The times of pressing PCIA at the T5 time point after operation in group H was more than group L (P<0.05).No sta-tistically difference was found in the incidence of nausea or vomit between the two groups.There were no re-spiratory depression, pruritus or urinary retention in all patients.Conclusion Patients with high preoperative anxiety level perceive needed more opioids in postoperative pain control.

Objective To study the present situation and influence factors of pulmonary rehabilitation among COPD patients in community.Methods The present situation of pulmonary rehabilitation was investigated using questionnaire in 201 COPD patients,including one community in Guangzhou and three communities in Qingyuan,and the influencing factors were analyzed by Logistic regression.Results Total of 201 COPD patients,20.4％ COPD patients could insist on oxygen therapy,just one patient's oxygen time more than 15 hours;40.8％ COPD patients would increase the oxygen flow if exacerbation;17.9％ COPD patients could insist on respiratory exercising,and 75.5％ COPD patients took exercise in wrong way.50.7％ COPD patients took exercise in their life.3-4 times in hospital with a high rate of home oxygen therapy.Farmers and the course more than ten years with a high rate of exercising.Conclusions The cognition of COPD patients about pulmonary rehabilitation is poor,and also the compliance of pulmonary rehabilitation exercise is bad.The medical staff should strengthen the education of pulmonary rehabilitation of COPI patients in community,and pay attention to patients' hospitalization,occupation,and course of disease.

Objective According to radiation therapy (6WV-X line) on experimental gerbils which were successfully infected by echinococcus granulosus,the outcomes of bone hydatid disease after radiation therapy were studied.Methods Totally 240 gerbil models that were infected bone hydatid disease,were randomly divided into three groups (each group was further divided into three-month and six-month groups,40 gerbils per group),one group as a control group,the 40 Gy/5 times and 50 Gy/5 times groups were given 6WV-X line radiation therapy.After 5 consecutive radiation therapies,stopped for two days and then repeated for five times.At the end of three and six months after radiotherapy,the rate of death and the ulceration or infection of the lesions was compared.Fifteen gerbils from each group were randomly selected to observe the deaths of scolex,protein and calcium concentration changes,the maximum diameter changes of the lesions,the changes of hydatid cyst wet weight and the rate of suppressing capsule,the bone destruction,and rebuilding situation of lesions under a microscope.Results At the end of three and six months after radiation therapy,with increasing dosage,the deaths decreased significantly (x2 =10.4,17.4,all P ＜ 0.05);the ulceration or infection of the lesions decreased significantly (x2 =6.0,10.1,all P ＜ 0.05);the mortality rate of scolex increased [3 month:(22.4 ± 3.1),(95.0 ± 5.2),(136.0 ± 5.4);6 month:(23.2 ± 2.2),(98.2 ± 4.6),(169.3 ± 7.0);F =2 252.5,3 220.3,all P ＜ 0.05];the concentration of protein and the calcium ion were changed significantly [3 month:(1.059 ± 0.056),(0.733 ± 0.051),(0.571 ± 0.043)g/L and (2.802 ± 0.157),(3.056 ± 0.060),(3.546 ± 0.135)mmol/L;6 month:(1.088 ± 0.043),(0.753 ± 0.034),(0.340 ± 0.032)g/L and (2.804 ± 0.019),(3.068 ± 0.052),(3.886 ± 0.046)mmol/L;F =366.0,138.9 and 1 550.5,2 727.3,all P ＜ 0.05];the maximum diameters of the lesions reduced significantly [3 month:(2.38 ± 0.14),(1.69 ± 0.05),(1.40 ± 0.09)cm;6 month:(2.65 ± 0.05),(1.69 ± 0.03),(1.03 ± 0.06)cm;F =372.5,3 846.1,all P ＜ 0.05];the hydatid cyst wet weight decreased significantly [3 month:(3.47 ± 0.11),(2.54 ± 0.12),(1.46 ± 0.07)g;6 month:(3.75 ± 0.31),(2.55 ± 0.08),(1.02 ± 0.20)g;F =1 475.6,608.0,all P ＜ 0.05].In the same group with time went on,in the control and 40 Gy/5 times group,the deaths gradually increased (x2 =4.3,4.6,all P ＜ 0.05),but in the 50 Gy/5 times group,the deaths was not significantly increased (x2 =1.1,P ＞ 0.05);in the control and 40 Gy/5 times group,the ulceration or infection of the lesions gradually increased (x2 =5.5,4.3,all P ＜ 0.05),but in the 50 Gy/5 times group,the ulceration or infection of the lesions did not change significantly (x2 =0.3,P ＞ 0.05);in the 50 Gy/5 times group,the mortality rate of scolex was significantly increased (F =212.6,P ＜ 0.05);in 50 Gy/5 times group,the protein (calcium) concentration decreased (increased) significantly (F =271.8,84.7,all P ＜ 0.05);the maximum diameters of the lesions increased gradually in the control group (F =47.1,P ＜ 0.05),in 50 Gy/5 times group,the maximum diameters of the lesions decreased gradually (F =188.3,P ＜ 0.05);in the control group,hydatid cyst wet weight increased significantly (F =10.7,P ＜ 0.05),in the 50 Gy/5 times group,hydatid cyst wet weight was significantly reduced (F =68.5,P ＜ 0.05);with increasing dosage,the damage of the bone matrix and the cells in lacunae of the lesions gradually increased,in the same group with time went on,in the control group,a few amount of bone cells in lacuna died,and in 40 Gy/5 times and 50 Gy/5 times groups,the bone matrix and bone cells were partially repaired.Conclusion The long-term effects of appropriate dosage (50 Gy/5 times) radiation on experiments hydatid diseased gerbils are affirmed,but it is still need a clinical validation.