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.

In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective:To evaluate the clinical efficacy of a replay propeller distal perforator flap of the lateral circumflex femoral artery in reconstruction of the donor site defect left by the harvest of a free anterolateral thigh perforator flap (ALTPF).Methods:From June 2023 to June 2024, retrospective analysis of 11 patients with foot and ankle soft tissue defects were treated in the Department of Microsurgery, Sichuan Modern Hospital. The patients were 7 males and 4 females, aged 9-57 (average 28.6) years. Causes of injury were car accident (5 patients), machine crush (5 patients) and skin necrosis following a fall (1 patient). The size of soft tissue defects was 8.0 cm ×11.0 cm - 9.0 cm×14.5 cm. A reversed perforator island flap of distal descending branch of the lateral circumflex femoral artery was prepared to reconstruct the defect left at the donor site after the harvest of a free ALTPF. The ALTPFs were 8.5 cm × 11.5 cm to 9.5 cm × 15.5 cm in size, and the sizes of the perforator flap of descending branch of lateral circumflex femoral artery designed to reconstruct the donor site defects were at 5.0 cm × 9.0 cm to 6.0 cm × 12.0 cm. After the surgery, scheduled follow-ups were carried out at outpatient clinic and via telephone and WeChat reviews. Wound healing at recipient and donor sites, flap survival and functional recovery were observed.Results:All flaps survived smoothly after surgery, and the wounds in the donor and recipient sites healed primarily. No vascular compromise, wound dehiscence or significant swelling occurred. A total of 9 patients completed the 6-18 months postoperative follow-up, with an average of 11 months. Two patients lost in the follow-up. Only linear scars left in the donor sites, without significant impact on the thigh function. The colour and appearance of the flaps were natural.Conclusion:It is effective to use a distal replay flap of the descending branch of lateral circumflex femoral artery for reconstruction of the donor site defect left by the harvest of a free ALTPF.

Objective:To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA).Methods:This was a retrospective cohort study. A total of 55 ASA patients who underwent vERAT at the Pediatric Department of the Tangdu Hospital of Air Force Medical University between November 2023 and January 2025 were selected and divided into groups based on the presence or absence of fecaliths: fecalith group and non-fecalith group. The baseline characteristics, initial treatment success rates, treatment costs, hospital stay duration, procedure time, and recurrence rates between two groups were compared. Mann-Whitney U test and χ2 test were used to evaluate group differences. Results:A total of 55 ASA patients were enrolled, including 38 males and 17 females, with the age of 11.2 (9.2, 13.1) years. Based on the presence of fecaliths, patients were divided into two groups: fecalith group (32 cases) and non-fecalith group (23 cases). No statistically significant differences were observed between the two groups in terms of age, gender, duration of abdominal pain, white blood cell count, neutrophil percentage, diameter of appendix, thickness of appendix clinical symptoms or signs (all P>0.05). The initial treatment success rates were 91% (29/32) in fecalith group and 96% (22/23) in non-fecalith group, with no statistically significant difference ( P=0.632). However, significant differences were noted in stent placement ( χ2=5.85, P=0.026) and procedure time ( Z=4.75, P<0.001). The follow-up duration time was 6.0 (2.0, 12.0) and 7.0 (2.0, 8.5) months for the fecalith and non-fecalith groups, respectively, with no significant difference ( Z=0.05, P=0.962). The recurrence rates were 14% (4/29) in fecalith group and 5% (1/22) in non-fecalith group, with no statistically significant difference ( P=0.375). Conclusions:vERAT can safely and effectively treat pediatric ASA, regardless of the presence or absence of fecaliths. It can provide a new treatment option for ASA.

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.

Objective:To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA).Methods:This was a retrospective cohort study. A total of 55 ASA patients who underwent vERAT at the Pediatric Department of the Tangdu Hospital of Air Force Medical University between November 2023 and January 2025 were selected and divided into groups based on the presence or absence of fecaliths: fecalith group and non-fecalith group. The baseline characteristics, initial treatment success rates, treatment costs, hospital stay duration, procedure time, and recurrence rates between two groups were compared. Mann-Whitney U test and χ2 test were used to evaluate group differences. Results:A total of 55 ASA patients were enrolled, including 38 males and 17 females, with the age of 11.2 (9.2, 13.1) years. Based on the presence of fecaliths, patients were divided into two groups: fecalith group (32 cases) and non-fecalith group (23 cases). No statistically significant differences were observed between the two groups in terms of age, gender, duration of abdominal pain, white blood cell count, neutrophil percentage, diameter of appendix, thickness of appendix clinical symptoms or signs (all P>0.05). The initial treatment success rates were 91% (29/32) in fecalith group and 96% (22/23) in non-fecalith group, with no statistically significant difference ( P=0.632). However, significant differences were noted in stent placement ( χ2=5.85, P=0.026) and procedure time ( Z=4.75, P<0.001). The follow-up duration time was 6.0 (2.0, 12.0) and 7.0 (2.0, 8.5) months for the fecalith and non-fecalith groups, respectively, with no significant difference ( Z=0.05, P=0.962). The recurrence rates were 14% (4/29) in fecalith group and 5% (1/22) in non-fecalith group, with no statistically significant difference ( P=0.375). Conclusions:vERAT can safely and effectively treat pediatric ASA, regardless of the presence or absence of fecaliths. It can provide a new treatment option for ASA.

In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective:To evaluate the clinical efficacy of a replay propeller distal perforator flap of the lateral circumflex femoral artery in reconstruction of the donor site defect left by the harvest of a free anterolateral thigh perforator flap (ALTPF).Methods:From June 2023 to June 2024, retrospective analysis of 11 patients with foot and ankle soft tissue defects were treated in the Department of Microsurgery, Sichuan Modern Hospital. The patients were 7 males and 4 females, aged 9-57 (average 28.6) years. Causes of injury were car accident (5 patients), machine crush (5 patients) and skin necrosis following a fall (1 patient). The size of soft tissue defects was 8.0 cm ×11.0 cm - 9.0 cm×14.5 cm. A reversed perforator island flap of distal descending branch of the lateral circumflex femoral artery was prepared to reconstruct the defect left at the donor site after the harvest of a free ALTPF. The ALTPFs were 8.5 cm × 11.5 cm to 9.5 cm × 15.5 cm in size, and the sizes of the perforator flap of descending branch of lateral circumflex femoral artery designed to reconstruct the donor site defects were at 5.0 cm × 9.0 cm to 6.0 cm × 12.0 cm. After the surgery, scheduled follow-ups were carried out at outpatient clinic and via telephone and WeChat reviews. Wound healing at recipient and donor sites, flap survival and functional recovery were observed.Results:All flaps survived smoothly after surgery, and the wounds in the donor and recipient sites healed primarily. No vascular compromise, wound dehiscence or significant swelling occurred. A total of 9 patients completed the 6-18 months postoperative follow-up, with an average of 11 months. Two patients lost in the follow-up. Only linear scars left in the donor sites, without significant impact on the thigh function. The colour and appearance of the flaps were natural.Conclusion:It is effective to use a distal replay flap of the descending branch of lateral circumflex femoral artery for reconstruction of the donor site defect left by the harvest of a free ALTPF.

Objective:To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis.Methods:This study was a case-control study. A total of 586 children with acute appendicitis, who were admitted to the Pediatric Department of Second Affiliated Hospital of Air Force Medical University between January 2019 and November 2023, were selected as the research subjects. According to the severity of the disease, the patients were divided into simple appendicitis group, suppurative appendicitis group and perforated appendicitis group. The baseline data, hospitalization treatment and costs, outcomes, and recurrence in each group were analyzed, and the difference in the effectiveness of mERAT between the groups were compared by Kruskal-Wallis H test and χ2 test. Results:Among 586 children, there were 338 males and 248 females. The age at onset was 7.0 (4.6, 9.4) years. There were 475 cases of simple appendicitis, 78 cases of suppurative appendicitis, and 33 cases of perforated appendicitis. There were no significant differences in age and gender among the three groups ( F=0.59, χ2=3.31, both P>0.05). However, there were statistically significant differences in body temperature, white blood cell counts, neutrophil percentage, lymphocyte percentage, nausea or vomiting, right lower abdominal pain, umbilical pain, right lower abdominal tenderness, and right lower abdominal rebound pain ( H=7.56, 161.52, 169.11, and 169.61, χ2=12.05, 13.82, 12.05, 7.74, 20.35, and 94.61, all P<0.05). Also, the treatment time, postoperative hospital stay, total hospital stay, and cost showed statistically significant differences ( H=4.70, 33.66, 34.99, 30.37, all P<0.05). There was no significant difference in the initial treatment success rate (98.1% (466/475) vs. 98.7% (77/78) vs. 90.9% (30/33), P=0.057). During the 30 (23, 36) months of follow-up, the recurrence rate was 7.9% (35/433) in the simple appendicitis group, 20.8% (15/72) in the suppurative appendicitis group, and 30.0% (9/30) in the perforated appendicitis group, with a statistically significant difference ( χ2=23.56, P<0.001). Among the children with recurrent appendicitis, 15 cases still chose mERAT, of them 11 cases (31.2%) had simple appendicitis, 2 cases (2/15) had suppurative appendicitis, and 2 cases (2/9) had perforated appendicitis.The latest time to recurrence in the 3 groups was 32, 35 and 10 months, respectively. Conclusion:Treatment with mERAT has a good effect in pediatric simple appendicitis, but has a higher recurrence rate despite a better initial treatment success rate in suppurative appendicitis and perforated appendicitis.

Objective:To summarize the best evidence of rehabilitation exercise in patients with lumbar spinal stenosis surgery.Methods:The evidence-based questions were established based on PIPOST's principles, and Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, UpToDate, PubMed, Embase, Web of Science, American Medical Association, Orthopedic Branch of Chinese Medical Doctor Association and other databases and websites were searched by computer. The search period was from the establishment of the databases to October 31, 2022. Two researchers conducted quality evaluation, evidence extraction, and summarization of the included literature.Results:A total of 10 articles were included, including six expert consensus articles, three systematic review articles, and one meta-analysis article. A total of 16 pieces of evidence were summarized from nine aspects of rehabilitation exercise evaluation, principles, timing, methods, health education, psychotherapy, pain management, evaluation and post discharge follow-up.Conclusions:This study summarizes the best evidence for rehabilitation exercise in patients with lumbar spinal stenosis after surgery, and it suggests that healthcare professionals apply evidence based on clinical context and patient willingness.