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.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the effect of ursolic acid on the inflammatory response and oxidative stress induced by hydrogen peroxide(H2O2)in nerve cells PC12 and its related mechanisms.Methods Nerve cells PC12 were treated with H2O2 to establish a cell injury model,and then treated with various concentrations of ursolic acid(2.5,5,10,and 20 μmol/L).MTT experiment was used to detect cell viability.PC12 cells were divided into control group(Con),hydrogen peroxide group(H2O2),hydrogen peroxide+ursolic acid group(H2O2+ursolic acid).Flow cytometry was used to detect cell apoptosis;Western blot was used to detect the expression of Cleaved cas3,Bax,Bcl-2,NF-κB,iNOS,NO,mTOR pathway proteins;DCFH-DA method was used to detect the relative level of ROS,while ELISA was used to detect oxidative stress and inflammatory response indicators.Results Compared with the Con group,the cell viability of the H2O2 group was significantly reduced;compared with the H2O2 group,the cell viability of the H2O2+2.5,5,10,20 μmol/L ursolic acid groups increased.Compared with the Con group,the apoptosis rate,LDH content,relative level of ROS,TNF-α,IL-1β in H2O2 group were significantly increased,CAT activity and SOD activity were significantly decreased,Cleaved cas3,Bax,NF-κB,iNOS,NO,P-mTOR,p-p70S6K protein expression increased,Bcl-2 protein expression decreased.Compared with the H2O2 group,the apoptosis rate,LDH content,relative level of ROS,TNF-α,IL-1β in the H2O2+ursolic acid groups were significantly decreased,CAT activity and SOD activity were significantly increased,Cleaved cas3,Bax,NF-κB,the expression of iNOS,NO,p-mTOR,and p-p70S6K protein decreased,and the expression of Bcl-2 protein increased.Conclusion Ursolic acid may reduce the apoptosis,inflammation and oxidative stress induced by hydrogen peroxide in neuronal PC12 cells by regulating the mTOR signaling pathway.

Objective To investigate the effect of ursolic acid on the inflammatory response and oxidative stress induced by hydrogen peroxide(H2O2)in nerve cells PC12 and its related mechanisms.Methods Nerve cells PC12 were treated with H2O2 to establish a cell injury model,and then treated with various concentrations of ursolic acid(2.5,5,10,and 20 μmol/L).MTT experiment was used to detect cell viability.PC12 cells were divided into control group(Con),hydrogen peroxide group(H2O2),hydrogen peroxide+ursolic acid group(H2O2+ursolic acid).Flow cytometry was used to detect cell apoptosis;Western blot was used to detect the expression of Cleaved cas3,Bax,Bcl-2,NF-κB,iNOS,NO,mTOR pathway proteins;DCFH-DA method was used to detect the relative level of ROS,while ELISA was used to detect oxidative stress and inflammatory response indicators.Results Compared with the Con group,the cell viability of the H2O2 group was significantly reduced;compared with the H2O2 group,the cell viability of the H2O2+2.5,5,10,20 μmol/L ursolic acid groups increased.Compared with the Con group,the apoptosis rate,LDH content,relative level of ROS,TNF-α,IL-1β in H2O2 group were significantly increased,CAT activity and SOD activity were significantly decreased,Cleaved cas3,Bax,NF-κB,iNOS,NO,P-mTOR,p-p70S6K protein expression increased,Bcl-2 protein expression decreased.Compared with the H2O2 group,the apoptosis rate,LDH content,relative level of ROS,TNF-α,IL-1β in the H2O2+ursolic acid groups were significantly decreased,CAT activity and SOD activity were significantly increased,Cleaved cas3,Bax,NF-κB,the expression of iNOS,NO,p-mTOR,and p-p70S6K protein decreased,and the expression of Bcl-2 protein increased.Conclusion Ursolic acid may reduce the apoptosis,inflammation and oxidative stress induced by hydrogen peroxide in neuronal PC12 cells by regulating the mTOR signaling pathway.

Nowadays potential preclinical drugs for the treatment of nonalcoholic steatohepatitis (NASH) have failed to achieve expected therapeutic efficacy because the pathogenic mechanisms are underestimated. Inactive rhomboid protein 2 (IRHOM2), a promising target for treatment of inflammation-related diseases, contributes to deregulated hepatocyte metabolism-associated nonalcoholic steatohepatitis (NASH) progression. However, the molecular mechanism underlying Irhom2 regulation is still not completely understood. In this work, we identify the ubiquitin-specific protease 13 (USP13) as a critical and novel endogenous blocker of IRHOM2, and we also indicate that USP13 is an IRHOM2-interacting protein that catalyzes deubiquitination of Irhom2 in hepatocytes. Hepatocyte-specific loss of the Usp13 disrupts liver metabolic homeostasis, followed by glycometabolic disorder, lipid deposition, increased inflammation, and markedly promotes NASH development. Conversely, transgenic mice with Usp13 overexpression, lentivirus (LV)- or adeno-associated virus (AAV)-driven Usp13 gene therapeutics mitigates NASH in 3 models of rodent. Mechanistically, in response to metabolic stresses, USP13 directly interacts with IRHOM2 and removes its K63-linked ubiquitination induced by ubiquitin-conjugating enzyme E2N (UBC13), a ubiquitin E2 conjugating enzyme, and thus prevents its activation of downstream cascade pathway. USP13 is a potential treatment target for NASH therapy by targeting the Irhom2 signaling pathway.

Objective: To examine the safety and effectiveness of a new stent graft system for endovascular repair of abdominal aortic aneurysm(AAA). Methods: This is a prospective,multi-center,single-arm clinical trial. The patients with AAA treated with a new stent graft system were enrolled at 21 centers from September 2018 to September 2019 in China. Follow-up was performed before discharge, and at 30, 180, 360 days after operation, respectively. The primary safety endpoint was the incidence of major adverse events(MAE) within 30 days. The primary efficacy endpoint was the success rate of AAA treatment at 360 days. Secondary safety endpoints were the incidence of perioperative access complications and acute lower limb ischemia,all-cause mortality, AAA related mortality and incidence of serious adverse events (SAE) at 180 and 360 days. Secondary efficacy endpoints were the incidence of type Ⅰ or Ⅲ endoleak,stent displacement,and conversion to open surgery or re-intervention at 180 and 360 days. Results: One hundred and fifty-six patients were enrolled,including 137 males and 19 females. The age was (68.9±6.9) years (range:48.2 to 84.6 years).Maximum aneurysm diameter was (50.8±11.2) mm (range:25.0 to 85.0 mm),diameter of proximal landing zone was (21.2±2.5) mm (range:17.0 to 29.5 mm),and length of proximal landing zone was (31.4±13.0) mm (range:11.0 to 75.0 mm).The incidence of MAE was 1.3% (2/156) at 30 days,both were all-cause death cases. The success rate of AAA treatment was 88.5% (138/156) at 360 days. No perioperative access complication and acute lower limb ischemia occurred. All-cause mortality was 2.0% (3/154) at 180 days and 2.6% (4/153) at 360 days,and there was no AAA related death. The incidence of SAE was 23.0%(35/152) at 180 days and 30.5%(46/151) at 360 days, and no device-related SAE occurred. The incidence of type Ⅰor Ⅲ endoleak was 3.4% (5/147) at 180 days and 3.5% (5/144) at 360 days. Conclusion: The new stent graft system is easy to operate,and early-term safety and effectiveness results are expected.
Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Prospective Studies ; China ; Ischemia ; Aortic Aneurysm, Abdominal/surgery*

Objective: To analyze the clinical characteristics of children with Burkitt lymphoma (BL) and to summarize the mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) regimen. Methods: Clinical features of 436 BL patients who were ≤18 years old and treated with the CNCL-B-NHL-2017 regimen from May 2017 to April 2021 were analyzed retrospectively. Clinical characteristics of patients at disease onset were analyzed and the therapeutic effects of patients with different clinical stages and risk groups were compared. Survival analysis was performed by Kaplan-Meier method, and Cox regression was used to identify the prognostic factors. Results: Among 436 patients, there were 368 (84.4%) males and 68 (15.6%) females, the age of disease onset was 6.0 (4.0, 9.0) years old. According to the St. Jude staging system, there were 4 patients (0.9%) with stage Ⅰ, 30 patients (6.9%) with stage Ⅱ, 217 patients (49.8%) with stage Ⅲ, and 185 patients (42.4%) with stage Ⅳ. All patients were stratified into following risk groups: group A (n=1, 0.2%), group B1 (n=46, 10.6%), group B2 (n=19, 4.4%), group C1 (n=285, 65.4%), group C2 (n=85, 19.5%). Sixty-three patients (14.4%) were treated with chemotherapy only and 373 patients (85.6%) were treated with chemotherapy combined with rituximab. Twenty-one patients (4.8%) suffered from progressive disease, 3 patients (0.7%) relapsed, and 13 patients (3.0%) died of treatment-related complications. The follow-up time of all patients was 24.0 (13.0, 35.0) months, the 2-year event free survival (EFS) rate of all patients was (90.9±1.4) %. The 2-year EFS rates of group A, B1, B2, C1 and C2 were 100.0%, 100.0%, (94.7±5.1) %, (90.7±1.7) % and (85.9±4.0) %, respectively. The 2-year EFS rates was higher in group A, B1, and B2 than those in group C1 (χ²=4.16, P=0.041) and group C2 (χ²=7.21, P=0.007). The 2-year EFS rates of the patients treated with chemotherapy alone and those treated with chemotherapy combined with rituximab were (79.3±5.1)% and (92.9±1.4)% (χ²=14.23, P<0.001) respectively. Multivariate analysis showed that stage Ⅳ (including leukemia stage), serum lactate dehydrogenase (LDH)>4-fold normal value, and with residual tumor in the mid-term evaluation were risk factors for poor prognosis (HR=1.38,1.23,8.52,95%CI 1.05-1.82,1.05-1.43,3.96-18.30). Conclusions: The CNCL-B-NHL-2017 regimen show significant effect in the treatment of pediatric BL. The combination of rituximab improve the efficacy further.
Adolescent ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Burkitt Lymphoma/drug therapy* ; Child ; Disease-Free Survival ; Female ; Humans ; Lactate Dehydrogenases ; Lymphoma, B-Cell/drug therapy* ; Male ; Prognosis ; Retrospective Studies ; Rituximab/therapeutic use* ; Treatment Outcome

Objective:To investigate the effect of multicomponent training on nutritional status and muscle function in older adults with frailty syndrome.Methods:A total of 120 elderly patients with frailty syndrome of Elderly Diagnosis and Treatment and Physical Examination Center,Jiangsu Provincial People′s Hospital from June 2018 to December 2019 were randomly divided into observation group and control group, each contained 60 cases. The control group received routine nursing care. On the basis of these, the observation group was given multicomponent training. The nutritional status, frailty status and muscle function were compared between two groups before and after 12 weeks of intervention.Results:Before intervention, there was no significant difference in the nutritional status, degree of frailty and muscle function between the two groups ( P>0.05). After intervention, the protein, skeletal muscle and total plasma protein, serum albumin, serum prealbumin and transferrin were (7.55 ± 1.34) kg, (21.37 ± 2.41) kg, (61.97 ± 5.69) g/L, (229.05 ± 17.67)mg/L, (42.14 ± 4.83) g/L, (2 364.29 ± 296.31) mg/L in the observation group, significantly higher than those in the control group (6.92 ± 0.97) kg, (20.31 ± 2.04) kg, (57.96 ± 5.22) g/L, (210.15 ± 27.99) mg/L, (37.66 ± 5.75) g/L, (2 247.42 ± 267.39) mg/L, the differences were statistically significant ( t values were 2.19-4.47, P<0.05). After intervention, the scores of physical, psychological and total frailty were 6.03 ± 0.71, 2.46 ± 0.73, 9.63 ± 0.99 in the observation group, significantly higher than in the control group (6.45 ± 0.95) pionts, (2.71 ± 0.52) pionts, (10.34 ± 1.20) pionts, the differences were statistically significant ( t=2.67, 2.02, 3.39, P<0.05). After intervention, the side-by-side, full-tandem, 4-m walk, repeated chair stands scores and total Short Physical Performance Battery (SPPB) scores were (0.87 ± 0.28) pionts, (1.65 ± 0.29) pionts, (2.09 ± 0.47) pionts, (1.93 ± 0.49) pionts, (7.36 ± 0.75) pionts, those socres were (0.72 ± 0.31) pionts, (1.50 ± 0.31) pionts, (1.87 ± 0.61) pionts, (1.70 ± 0.62) pionts, (6.55 ± 0.89) pionts in the control group, the differences were statistically significant ( t values were 2.16-5.18, P<0.05). Conclusions:Multicomponent training can improve the nutritional status and muscle function and delay the progress of frailty in elderly in elderly patients.

Objective: To understand pneumonia mortality in children aged 0-14 years in China in recent 15 years, and to provide reference for child pneumonia prevention and treatment. Methods: Based on the death data from China Statistical Yearbook 2005-2019, pneumonia mortality in urban and rural children aged 0-14 was extracted and the standardized mortality was calculated, and the trend of mortality was fitted by Joinpoint regression model. Results: The crude mortality rate of child pneumonia in urban and rural areas showed an increasing trend, while the standardized mortality rate showed a fluctuating downward trend. Joinpoint regression showed that the mortality rate of pneumonia in urban and rural children showed a monotonous downward trend, and there was no turning point. The overall APC of pneumonia mortality of urban children was -3.4, that of boys and girls were both -3.5. Trend for annual changes in urban areas were found significant among total sample and boys (both P <0.05). The overall APC of pneumonia mortality in rural children was -7.8, that of boys and girls were -7.1 and -7.8, respectively. Trend for annual changes in rural areas were found significant among total sample and boys(both P <0.05). There was no significant differences in the trend of mortality between urban and rural groups. Conclusion During 2005 to 2019, child pneumonia mortality in urban and rural areas in China shows a downward trend, which is relatively balanced in urban and rural areas. Further strengthened pediatric pneumonia treatment and management are expected to reduce the pneumonia mortality.