OBJECTIVE To investigate the use of common disposable and reusable supplies for prevention and con-trol of infections in Shanghai.METHODS A survey was conducted for the use and reuse of disposable high-value consumables,disposable bronchoscopes and environmental cleaning and disinfection tools in Shanghai by using structured questionnaire.RESULTS Totally 81 medical institutions were involved in the survey,44(54.32％)of which were tertiary hospitals,and the median number of beds was 500.The orthopedic implants(70.37％),ul-trasound knife(69.14％)and endoscopic puncture instrument(66.67％)were the high-value consumables rank-ing the top 3 utilization rates.There was reuse of 18 types of high-value consumables in total among the 12 medi-cal institutions.The major causes of reuse of high-value consumables included fee less tan cost of consumables(58.33％)or being unable to included in charge items(33.33％).27.78％of the recycle high-value consumables were not treated with a dedicated disinfection and sterilization system and procedures for the disposable high-value consumables,and 33.33％did not have the report systems for related adverse reactions.49.09％of the medi-cal institutions reported to use the disposable bronchoscopes,4 of which reused them.The majority of the medi-cal institutions could carry out centralized cleaning and disinfection for the recycled floor cloths(60.81％)and cloth towels(56.76％),and 32.43％of the medical institutions reused the cloth towels by manual cleaning.The utilization rate of antiseptic wipes was 75.41％in adult intensive care unit,62.50％in neonatal intensive care unit.CONCLUSION The study reveals that there are some problems in the use of disposal and reusable supplies for prevention and control of infections,which may provide baseline data for management of the related supplies and the surveillance of disinfection of the recycled supplies so as to enhance the quality of management of hospital-asso-ciated infections.

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.

With the development of precision medicine and molecular pathology, fluorescence in situ hybridization (FISH) technology has been widely promoted and applied in department of pathology. In FISH detection, the most commonly used probes are HER2 amplification probes and a variety of separation probes. When detecting pathological specimens using separation probes, some specimens may show atypical signals other than the typical red-green separation signals. The observation, understanding and interpretation of atypical signals may affect the results of FISH, which are related to molecular subtyping and drug treatment of the patient. Eight types of atypical signals of separation probes in FISH detection based on reading experience were summarized and analyzed. At the same time, this article provides evidence and analysis on whether the gene has been rearrangedthrough verification experiments, image analysis and experimental analysis in literature, aiming to enhance the understanding of readers to atypical signals of FISH separation probes.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Artificial intelligence (AI) technology is expected to assist physicians in improving the accuracy and efficiency of embryo assessment. However, embryo development is a continuous and dynamic process, when is meaningful or the whole development process need to be considered? Some research teams use static image analysis, which loses much important information, and others utilize algorithm-driven applications of "black-box" models to analyse embryo videos, which have limited their interpretability or explainability. Machine learning or deep learning is prone to abused due to its inherent complexity, and in order to apply AI more accurately, this paper discusses the clinical implications of algorithmic interpretations of AI in human embryo ploidy prediction.

BACKGROUND:Sarcopenia is a comprehensive condition of aging induced decline in skeletal muscle mass and strength and represents a major health challenge for the elderly.Accumulating evidence suggests that mitochondrial dysfunction plays a key role in the pathogenesis of sarcopenia.OBJECTIVE:To summarize the mechanisms by which dysregulation of mitochondrial quality control leads to sarcopenia and to explore whether mitochondrial transplantation may be a potential target for the treatment of sarcopenia.METHODS:We searched PubMed and CNKI databases for relevant articles published from 2009 to 2023 using the keywords "sarcopenia,mitochondrial dysfunction,mitochondrial quality control,mitochondrial transplantation,limitations."RESULTS AND CONCLUSION:Given the key role of mitochondrial dysfunction in the pathogenesis of sarcopenia,mitochondrial transplantation may serve as a possible strategy for the treatment of sarcopenia by improving mitochondrial bioenergetics and modulating mitochondria related signaling pathways.Although some preclinical and clinical studies have confirmed the potential of mitochondrial transplantation for the treatment of various diseases,there are still some urgent questions regarding the specific details of mitochondrial transfer.

Objective To analyze the changes in serum levels of Krüppel-like transcription factors(KLF11)and long non-coding RNA small nucleolar RNA host gene 12(lncRNA SNHG12)in patients with intracranial aneurysm(IA),and their predictive value for prognosis.Methods A retrospective analysis was performed on 132 IA patients(IA group)who underwent interventional embolization for IA rupture and bleeding from February 2019 to February 2023,and 60 healthy people who underwent outpatient physical examination during the same period were selected as the control group.Serum levels of KLF11 was detected by enzyme-linked immunosorbent assay(ELISA),the level of lncRNA SNHG12 was detected by real-time fluorescence quantitative PCR(qRT-PCR).According to the modified Rankin scale(MRS)score,IA patients were divided into a good prognosis group(n=98,MRS score 0～2)and poor prognosis group(n=34,MRS score 3～6).Pearson correlation analysis was used to analyze the correlation between serum KLF11,lncRNA SNHG12 and cerebral hemodynamic parameters.Logistic regression analysis was used to analyze the factors affecting the prognosis of IA patients.The receiver operating characteristic curve was used to analyze the prognostic value of serum KLF11 and lncRNA SNHG12 in IA patients.Results The serum KLF11(47.12±6.58ng/L)and lncRNA SNHG12(1.89±0.36)in the IA group were lower than those in the control group(113.89±19.35ng/L,3.24±0.58),and the differences were statistically significant(t=19.695,35.476,all P<0.05).The levels of serum KLF11 and lncRNA SNHG12 in IA group were positively correlated with cerebral blood flow,cerebral blood volume and mean transit time(rKLF11=0.722,0.627,0.752;rlncRNA SNHG12=0.630,0.714,0.766,all P<0.05),and negatively correlated with intracranial pressure(r=-0.658,-0.599,all P<0.05).The proportion of CT Fisher grade 3～4 in IA patients in the poor prognosis group was higher than that in the good prognosis group,and the postoperative complication rate was higher than that in the good prognosis group,the serum KLF11(35.98±6.11 ng/L)and lncRNA SNHG12(1.12±0.30)levels were lower than those in the good prognosis group(50.98±6.90ng/L,2.16±0.39),and the differences were statistically significant(t=4.630～14.151,all P<0.05).CT Fisher grade 3～4,postoperative complications were risk factors for poor prognosis of IA patients(Wald χ2=8.403,12.049,all P<0.001),serum KLF11,lncRNA SNHG12 were protective factors(Wald χ2=5.550,7.904,all P<0.001).The AUC(95%CI)for predicting the prognosis of IA patients with the combination of serum KLF11 and lncRNA SNHG12 was 0.921(0.889～0.942),which was higher than the single detection of serum KLF11 and lncRNA SNHG12 at 0.848(0.805～0.886)and 0.810(0.767～0.852),and the differences were statistically significant(Z=5.886,4.367,all P<0.001).Conclusion The levels of serum KLF11 and lncRNA SNHG12 in IA patients are decreased,which are related to cerebral hemodynamic parameters.The combined detection has a high evaluation value for the prognosis of IA patients.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective:To develop an evidence-based nursing practice program based on the Stetler model to extend the lifespan of arteriovenous fistulas (AVF) in maintenance hemodialysis (MHD) patients and evaluate its effectiveness.Methods:An evidence-based nursing practice program was constructed based on the best evidence for extending AVF lifespan in MHD patients. Expert group discussions were held to determine review indicators. A baseline survey was conducted among 100 MHD patients and 42 nurses using covenience sompling at the Blood Purification Center of Wuxi People's Hospital from January to December 2023, to identify barriers and facilitators. In the following year, from January to December 2024, the evidence-based practice was implemented at the same hospital, and the AVF surgical intervention rate and AVF self-management levels of MHD patients were compared before and after the practice.Results:No statistically significant difference was found in the AVF surgery rates before and after the evidence-based practice ( P>0.05) . However, after implementing the evidence-based practice, MHD patients' scores on the AVF self-management scale significantly improved, and the difference was statistically significant ( P<0.01) . Conclusions:The evidence-based practice based on the Stetler model is beneficial for standardizing the clinical management of AVF, reducing the need for surgical interventions, and improving MHD patients' ability to self-manage their AVF.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.