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 analyze the infection status and epidemiological characteristics of respiratory pathogens in children with acute respiratory infections (ARI) at Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University from 2023 to 2024.Methods:This study enrolled the patients (aged 0-17 years) who visited the outpatient or emergency department or were hospitalized at Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University due to ARI from March 2023 to March 2024. Throat swab specimens of the patients were collected, and fluorescence quantitative PCR was used to detect influenza A virus (FluA), influenza B virus (FluB), respiratory syncytial virus (RSV), human rhinovirus (HRV), human adenovirus (HAdV), and Myocoplasima pneumonia ( Mp). These patients were divided into five groups by gender: <1, 1-2, 3-5, 6-11, 12-17 years. Chi-square test was used to perform statistical analysis on the detection rates of respiratory pathogens among patients of different genders and ages, and across distinct seasons. Results:A total of 46 379 children were enrolled and among them, 27 418 children tested positive for respiratory pathogens, with a positive rate of 59.12%. Among the positive cases, 5 177 (18.88%) were infected with more than one respiratory pathogen, with the co-infection of Mp and HRV being the most common type, followed by Mp and HAdV co-infection. The pathogens, ranked from the highest to the lowest detection rates, were Mp (20.74%, 9 620/46 379), RSV (12.76%, 5 920/46 379), HAdV (11.64%, 5 399/46 379), HRV (11.24%, 5 213/46 379), FluB (8.23%, 3 815/46 379), and FluA (6.80%, 3 154/46 379). There were statistically significant differences in the detection rates of RSV, HRV and Mp among children of different genders (χ 2=11.85, 15.23, 16.36; all P<0.001). The differences in the detection rates of the six pathogens among different age groups were statistically significant (all P<0.001), and the detection rates of FluA, FluB, HRV, HAdV and Mp in children aged 0-5 years showed an upward trend with age (all P<0.001). The highest detection rates of FluA, FluB, HRV and HAdV were in the 3-5 years group, while the highest detection rate of Mp was in the 6-11 years group, which was 40.15% (4 615/11 495). The detection rate of RSV showed a decreasing trend with age ( P<0.001), with the highest detection rate observed in the <1 year group (25.02%, 2 208/8 826). There were statistically significant differences in the detection rates of the six pathogens in different seasons (all P<0.001). Conclusions:The overall detection rate of respiratory pathogens in children with ARI in Xuzhou from 2023 to 2024 is high. Single-pathogen infection is the predominant pattern, and the most prevalent pathogen is Mp. There are gender differences in the detection rates of RSV, HRV, and Mp. The detection rate of RSV decreases with age, while the detection rates of FluA, FluB, HRV, HAdV, and Mp increase with age among children aged 0-5 years. The prevalence of FluA, FluB, RSV, HRV, HAdV, and Mp all exhibit seasonal patterns.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

Objective The purpose of the study is to breed homozygous interferon-γ knockout(IFN-γ-/-)mice and optimize the breeding strategies to achieve continuous and stable reproduction of IFN-γ-/-mice,which could be used as an ideal animal model for fundamental research.Methods Initially,heterozygous IFN-γ knockout(IFN-γ+/-)C57BL/6J mice were used as the parental generation for breeding.Subsequently,3 breeding strategies were employed using the offspring:(1)female heterozygotes mated with male heterozygotes;(2)male homozygotes mated with female heterozygotes;(3)female homozygotes mated with male homozygotes.The number and survival rate of IFN-γ-/-mice were compared across the three breeding strategies to determine the optimal breeding strategy.Under the optimal strategy,the effects of female mating age and diet type on the reproductive performance of IFN-γ-/-mice were further evaluated.Data from the first three litters of 60 IFN-γ-/-female mice,including litter size,number of weaning survivors,and weaning survival rate,were recorded and analyzed.In addition,the effects of dietary supplementation of pregnant mice and environmental optimization measures,such as the provision of shelters,were evaluated.Results Under conditions where the nutritional needs of pregnant mice were adequately met by supplementation with egg yolk and sunflower seeds,mating of female and male IFN-γ-/-mice result ed in a litter size of five to eight IFN-γ-/-mice,demonstrating higher efficiency compared to other breeding strategies.In addition,diet type and mating age significantly influenced female reproductive performance.When 7～9 weeks old female IFN-γ-/-mice were mated to male IFN-γ-/-mice and fed a high-protein breeding diet,litter size(6.9±1.7),weaning survival number(6.5％±2.0％)and weaning survival rate(93.2％±17.8％)were higher than those under other conditions.In addition,providing shelters to prevent fighting between breeding pairs further improved reproductive outcomes.Conclusions By adopting an optimized breeding strategy,combined with a high-protein diet,nutritional supplementation,and standardized mating age management,the breeding efficiency and stability of IFN-γ-/-mice can be significantly improved.This provides a reliable animal model for related research.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

Objective The purpose of the study is to breed homozygous interferon-γ knockout(IFN-γ-/-)mice and optimize the breeding strategies to achieve continuous and stable reproduction of IFN-γ-/-mice,which could be used as an ideal animal model for fundamental research.Methods Initially,heterozygous IFN-γ knockout(IFN-γ+/-)C57BL/6J mice were used as the parental generation for breeding.Subsequently,3 breeding strategies were employed using the offspring:(1)female heterozygotes mated with male heterozygotes;(2)male homozygotes mated with female heterozygotes;(3)female homozygotes mated with male homozygotes.The number and survival rate of IFN-γ-/-mice were compared across the three breeding strategies to determine the optimal breeding strategy.Under the optimal strategy,the effects of female mating age and diet type on the reproductive performance of IFN-γ-/-mice were further evaluated.Data from the first three litters of 60 IFN-γ-/-female mice,including litter size,number of weaning survivors,and weaning survival rate,were recorded and analyzed.In addition,the effects of dietary supplementation of pregnant mice and environmental optimization measures,such as the provision of shelters,were evaluated.Results Under conditions where the nutritional needs of pregnant mice were adequately met by supplementation with egg yolk and sunflower seeds,mating of female and male IFN-γ-/-mice result ed in a litter size of five to eight IFN-γ-/-mice,demonstrating higher efficiency compared to other breeding strategies.In addition,diet type and mating age significantly influenced female reproductive performance.When 7～9 weeks old female IFN-γ-/-mice were mated to male IFN-γ-/-mice and fed a high-protein breeding diet,litter size(6.9±1.7),weaning survival number(6.5％±2.0％)and weaning survival rate(93.2％±17.8％)were higher than those under other conditions.In addition,providing shelters to prevent fighting between breeding pairs further improved reproductive outcomes.Conclusions By adopting an optimized breeding strategy,combined with a high-protein diet,nutritional supplementation,and standardized mating age management,the breeding efficiency and stability of IFN-γ-/-mice can be significantly improved.This provides a reliable animal model for related research.

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 analyze the infection status and epidemiological characteristics of respiratory pathogens in children with acute respiratory infections (ARI) at Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University from 2023 to 2024.Methods:This study enrolled the patients (aged 0-17 years) who visited the outpatient or emergency department or were hospitalized at Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University due to ARI from March 2023 to March 2024. Throat swab specimens of the patients were collected, and fluorescence quantitative PCR was used to detect influenza A virus (FluA), influenza B virus (FluB), respiratory syncytial virus (RSV), human rhinovirus (HRV), human adenovirus (HAdV), and Myocoplasima pneumonia ( Mp). These patients were divided into five groups by gender: <1, 1-2, 3-5, 6-11, 12-17 years. Chi-square test was used to perform statistical analysis on the detection rates of respiratory pathogens among patients of different genders and ages, and across distinct seasons. Results:A total of 46 379 children were enrolled and among them, 27 418 children tested positive for respiratory pathogens, with a positive rate of 59.12%. Among the positive cases, 5 177 (18.88%) were infected with more than one respiratory pathogen, with the co-infection of Mp and HRV being the most common type, followed by Mp and HAdV co-infection. The pathogens, ranked from the highest to the lowest detection rates, were Mp (20.74%, 9 620/46 379), RSV (12.76%, 5 920/46 379), HAdV (11.64%, 5 399/46 379), HRV (11.24%, 5 213/46 379), FluB (8.23%, 3 815/46 379), and FluA (6.80%, 3 154/46 379). There were statistically significant differences in the detection rates of RSV, HRV and Mp among children of different genders (χ 2=11.85, 15.23, 16.36; all P<0.001). The differences in the detection rates of the six pathogens among different age groups were statistically significant (all P<0.001), and the detection rates of FluA, FluB, HRV, HAdV and Mp in children aged 0-5 years showed an upward trend with age (all P<0.001). The highest detection rates of FluA, FluB, HRV and HAdV were in the 3-5 years group, while the highest detection rate of Mp was in the 6-11 years group, which was 40.15% (4 615/11 495). The detection rate of RSV showed a decreasing trend with age ( P<0.001), with the highest detection rate observed in the <1 year group (25.02%, 2 208/8 826). There were statistically significant differences in the detection rates of the six pathogens in different seasons (all P<0.001). Conclusions:The overall detection rate of respiratory pathogens in children with ARI in Xuzhou from 2023 to 2024 is high. Single-pathogen infection is the predominant pattern, and the most prevalent pathogen is Mp. There are gender differences in the detection rates of RSV, HRV, and Mp. The detection rate of RSV decreases with age, while the detection rates of FluA, FluB, HRV, HAdV, and Mp increase with age among children aged 0-5 years. The prevalence of FluA, FluB, RSV, HRV, HAdV, and Mp all exhibit seasonal patterns.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective Mobile artificial lumbar complex(MALC)which suitable for reconstruction after subtotal lumbar resection in goats was developed,and to test stability of the complex and postoperative lumbar segmental motor function.Methods Eighteen male boer goats aged from 1 to 2 years old(weighted from 35 to 45 kg)were selected and divided into con-trol group,fusion group and non-fusion group,with 6 goats in each group.According to preoperative CT scans and MRI exami-nations of lumbar,the goat MALC was designed and performed by 3D printed for non-fusion group.Operation was performed on three groups respectively,and only vertebral body and disc were exposed in control group.In fusion group,L4 part of vertebral body and the upper and lower complete disc tissues were removed,and the lumbar spine bone plate fixation was performed with titanium mesh bone grafting.In non-fusion group,vertebral body and disc were removed in the same way,and MALC was im-planted.AP and lateral X-rays of lumbar vertebrae in goat were taken at 6 months after surgery,in order to understand whether the plant was dislocated,displaced and fractured.Biomechanical tests were performed on the specimens by mechanical instru-ment to measure range of motion(ROM)of L2,3,L,4,L4,5intervertebral space and the overall ROM of L2-5 lumbar vertebrae.Results MALC of lumbar vertebra was designed by 3D printing,and its component artificial vertebrae and upper and lower ar-tificial end plates were manufactured.The semi-spherical structure was fabricated by precision lathe using high-crosslinked polyethylene material,and the prosthesis was assembled.Postoperative AP and lateral X-rays of lumbar vertebra at 6 months showed the implant position of implant and MALC were good without displacement and dislocation.In vitro biomechanical test of lumbar vertebrae specimens:(1)There were no statistical significance in ROM of lumbar intervertebral space flexion and extension,lateral flexion and rotation on L.4 and L4,5,between non-fusion group and control group(P＞0.05),while ROM of fu-sion group was significantly reduced compared with the other two groups(P＜0.05).There were no significant difference in ROM of L2.3 intervertebral flexion and extension,lateral flexion and rotation between non-fusion group and control group(P＞0.05),while fusion group was significantly increased compared with the other two groups(P＜0.001).(2)There was no signifi-cant difference in overall lumbar ROM of L2-5(P＞0.05).Conclusion The individual MALC could restore intervertebral height of lumbar vertebra while maintaining the stability of lumbar vertebra and re-establishing motor function of lumbar space.