Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To identify core contents of health education for patients with pemphigus by using the Delphi method.Methods:On the basis of literature review and group discussions, two rounds of questionnaire survey were performed in 17 experts to evaluate the importance of health education items for patients with pemphigus by using the Delphi method. Indices including importance score, coefficient of variation, authority coefficient and Kendall coefficient of concordance were calculated to identify core contents of health education for patients with pemphigus.Results:In the two rounds of questionnaire survey, all experts complete the questionnaires, the coefficients of variation were all less than 0.35, the authority coefficient was 0.893, and the Kendall coefficients of concordance were 0.283 and 0.288 respectively ( χ2= 168.17, 181.25, respectively, both P < 0.001) . After the two rounds of expert consultation, the core contents of health education for patients with pemphigus were finally confirmed, which consisted of 6 primary items and 32 secondary items, and the primary items included "disease knowledge", "medication guidance", " dietary guidance", "skin care", "rest, activities and psychological guidance" and " follow-up and medical guidance". Conclusion:By using the Delphi method, the core contents of health education have been successfully identified for patients with pemphigus, which provide a basis for systematization and scientization of health education contents for patients with pemphigus.

BACKGROUND:How to control the orderly formation of colage in skin repair and scarring process is worthy of attention. OBJECTIVE: To investigate the effect of basic fibroblast growth factor (bFGF) combined with insulin-like growth factor 1 (IGF-1) on the proliferation and colagen synthesis of rat bone marrow mesenchymal stem celsin vitro. METHODS:Rat bone marrow mesenchymal stem cels were isolated and cultured to induce adipogenic differentiation assessed by oil red O staining and osteogenic differentiation identified by alizarin red stainingin vitro. Passage 3 cels were cultured in the medium containing bFGF, IGF-1, combination of them or the control fluid, respectively. MTT assay was used to detect cel proliferation at 12, 24, 48, 72 and 96 hours of culture. The expression of type I colagen and type III colagen were detected by RT-PCR and western blot after 10 days of incubation. RESULTS AND CONCLUSION:Compared with the control group, bFGF or IGF-1 alone significantly promoted the proliferation of bone marrow mesenchymal stem cels, and inhibited the expression of type I colagen and type III colagen. After combined use of bFGF and IGF-1, the proliferation of bone marrow mesenchymal stem cels was improved more significantly, and the expression of type I colagen and type III colagen returned to normal levels. These findings indicate that the combination of IGF-1 and bFGF can promote proliferation of bone marrow mesenchymal stem cels and restrain the expression of type I colagen and type III colagen, which may be helpful for control and repair of scar formation during wound healing.