Fungal infection is an increasingly serious clinical problem,especially in immunocompromised patients.Fungi,such as Candida albicans,Aspergillus,and Cryptococcus,can form biofilm,which enhance their drug re-sistance and immune evasion ability,thus become major obstacles to the treatment of infection.Biofilm formation is not limited to human body,it can also form on the surface of medical devices,leading to chronic and recurrent infec-tion.This article elaborates the biofilm formation mechanisms and hazards caused by different fungi such as Candi-da albicans and Aspergillus,emphasizes immune suppression,chronic diseases,and medical devices as high-risk factors for biofilm formation.Fungi can form biofilm through multiple stages such as adhesion,proliferation,extra-cellular matrix(ECM)construction,and cell dispersion,and enhance drug resistance based on physical barriers and gene regulation.Although existing antifungal agents are effective in infection caused by planktonic fungi,their treatment efficacy on fungal biofilm is limited.Therefore,the article explores new treatment strategies,including non-pharmacological therapies such as photodynamic therapy and electric field therapy,as well as targeted gene edi-ting and the application of new biomaterials.It is necessary to strengthen the combination of basic research and clini-cal applications,develop efficient and low toxicity treatment scheme to improve the successful treatment rate for patients.

Fungal infection is an increasingly serious clinical problem,especially in immunocompromised patients.Fungi,such as Candida albicans,Aspergillus,and Cryptococcus,can form biofilm,which enhance their drug re-sistance and immune evasion ability,thus become major obstacles to the treatment of infection.Biofilm formation is not limited to human body,it can also form on the surface of medical devices,leading to chronic and recurrent infec-tion.This article elaborates the biofilm formation mechanisms and hazards caused by different fungi such as Candi-da albicans and Aspergillus,emphasizes immune suppression,chronic diseases,and medical devices as high-risk factors for biofilm formation.Fungi can form biofilm through multiple stages such as adhesion,proliferation,extra-cellular matrix(ECM)construction,and cell dispersion,and enhance drug resistance based on physical barriers and gene regulation.Although existing antifungal agents are effective in infection caused by planktonic fungi,their treatment efficacy on fungal biofilm is limited.Therefore,the article explores new treatment strategies,including non-pharmacological therapies such as photodynamic therapy and electric field therapy,as well as targeted gene edi-ting and the application of new biomaterials.It is necessary to strengthen the combination of basic research and clini-cal applications,develop efficient and low toxicity treatment scheme to improve the successful treatment rate for patients.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective To investigate the changes in the serum MMP-9 (matrix metalloproteinase-9) and the expressions of MMP-9 in lung, kidney and intestine in rats with multiple organ dysfunction syndrome (MODS) and confirm extracellular matrix injuries being the mechanism in MODS in order to propose a novel theoretical basis for cfinical treatment of MODS. Method Forty wister rats were randomly divided into two groups: control group (n=8) and MODS model group (n=32). The rats of model group were further divided into four subgroups ac-cordingto the time elapsed after modelling: 12 h (n=8), 24 h(n=8) ,48 h(n=8) and 72 h (n=8), and were modelled by celiac injection of mixed liquid of zymosan-paraffin (4 mL/100 g) after blood loss (1mL/100 g) by extirpating their left eyes. Blood,lung, kidney and intestine were sampled 12,24,48 and 72 hours after models were established. The histological changes in the lung, kidney and intestine of the rats were observed by light mi-croscope. The serum MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA). The immunohisto-chemistry was used to observe the expression of MMP-9 in lung,kidney and intestine during different phases of MODS. The data were processed by one-way ANOVA and Bivariate analysis. Results Compared with control group, the organs were injured by congestion, edema and inflammatory cells infiltration to a certain extent in model groups. The serum MMP-9 increased markedly 12 hours after modelling (P<0.01 ) and peaked 48 hours later. The expressions of MMP-9 in lung, kidney and small intestine significantly increased from 12 h to 72 h after mod-elling (P<0.01 or 0.05). Conclusions The MMP-9 increased both in serum and tissue are closely associated with the pathological process of MODS. The mechanism of organ damage probably attributes to the damage of extra-celluar matrix and tissue construction.

Objective To investigate the changes of thrombomodulin and matrix metalloproteinase-9 in sepsis and determine their significance in the early diagnosis and prognosis of multiple organ dysfunction syndrome. Methods The plasma levels of thrombomodulin and matrix metalloproteinase-9 in 32 ICU patients with sepsis were measured by immunofluorescence. Results Compared with control group,the levels of TM and MMP-9 were significantly higher on the day of the diagnosis of sepsis(P