Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To analyze the epidemiological features of geriatric humeral surgical neck fractures from 2010 through 2019 in The Third Hospital of Hebei Medical University.Methods:A retrospective study was conducted of the data of the inpatients aged ≥60 years who had been treated for humeral surgical neck fractures in The Third Hospital of Hebei Medical University from 2010 through 2019. The patients were divided into 2 groups by the year of admission: the former five-year group (group A from January 1, 2010 to December 31, 2014) and latter five-year group (group B from January 1, 2015 to December 31, 2019). The data of the patients were compared between the 2 groups to find the epidemiological characteristics and trends of the humeral surgical neck fractures in the 10-year period.Results:A total of 312 geriatric humeral surgical neck fractures were included, accounting for 1.2%(312/25, 764) of the upper limb fractures and 0.4% (312/88, 886) of all the fractures in the same period. There were 64 males and 248 females, giving a male/female ratio of 0.26∶1. Their ages ranged from 60 to 93 years. The peak age of the fractures was from 60 to 69 years for both males and females. Falls and indoor activity injuries accounted for the largest proportion (71.2%, 222/312). The common fracture types were 11-A2 and 11-A3. The proportion of overweight and obese patients by the body mass index (BMI) was the largest (58.7%, 183/312). There were no statistically significant differences between groups A and B in male/female ratio (0.37:1 versus 0.22:1) or in proportion of peak age patients [42.7% (38/89) versus 55.2% (123/223)] ( P>0.05). There were statistically significant differences between the 2 groups in injury causes, fracture types and BMI distribution ( P<0.05). Conclusions:The geriatric humeral surgical neck fractures accounted for 1.2% of the upper limb fractures and 0.4% of all the fractures in the same period. There were more female patients than male ones. Falls and indoor activity injuries were the most common causes. The proportions of complex fractures and overweight and obese patients increased.

Objective:To analyze the epidemiological characteristics of all the patients with intertrochanteric fracture admitted to the Third Hospital of Heibei Medical University in the past 10 years.Methods:Data of patients with intertrochanteric fracture admitted to our hospital from January 1, 2010 to December 31, 2019 were retrospectively analyzed. According to the year of admission, all the patients were divided into two groups: the first five years (group A) and the last five years (group B). Gender, age, injury cause, Evans classification, complicated diseases, length of hospital stay and whether surgical treatment or not were compared.Results:A total of 6,125 patients with intertrochanteric fracture were included in the study, including 2,664 males and 3,461 females with a male to female ratio of 0.77∶1. The peak age was 70-79 for males and 80-89 for females. There were 2,314 cases in group A (male to female ratio was 0.91∶1) and 3,811 cases in group B (0.70∶1), showing significant differences between the 2 groups in the male to female ratio ( χ2=25.265, P< 0.05). The peak age ranged from 70 to 80 years (31.9%,739/2,314) in group A and from 80 to 90 years (34.5%, 1,313/3,811) in group B. There were significant differences between the 2 groups in the sex ratios of age groups from 70 to 79 years ( χ2=0.024, P< 0.05). In all the 6,152 patients with a definite injury cause, the fall and indoor activity accounted for the highest proportion (83.9%, 5,140/6,125), and the proportion of group A was 75.4% (1,745/2,314) while the proportion of group B was 89.1%(3,395/3,811) showing a significant differences between the 2 groups in injury cause ( χ2=14.363, P< 0.05). Based on X-ray films or computer tomography (CT) of 3,560 patients, the Evans type II and III were the most common types. Type II accounted for the highest proportion in group A (38.1%, 239/628) while type III did in group B (39.5%, 1,159/2,932) . There were significant differences between the 2 groups in the proportion of Evans classification ( χ2=183.569, P< 0.05). Of all the 6,125 fracture cases, 4,846 fracture patients (79.1%) were complicated with medical diseases. There was a statistically significant difference between the 2 group of the patients who were complicated with medical diseases ( χ2=8.916, P< 0.05). A total of 5,148 patients were treated by operation and 1,925 patients were in group A while the other 3,259 cases were in group B. In group A, the median hospitalization was 14 days and the quartile interval was 8 days. In group B, the median hospitalization and the quartile interval was 12 days and 8 days respectively. There were significant differences between the 2 groups in length of hospital stay for patients treated by surgery ( Z=-9.909, P<0.001). Conclusion:The intertrochanteric fractures admitted to the Third Hospital of Heibei Medical University in the past 10 years were more common in females than in males. Fall and indoor activity was the most common injury cause. Evans types II and III prevailed. The fractures showed an aging trend by comparing the former 5 years and latter 5 years. The number of intertrochanteric fracture patients complicated with medical diseases increased significantly, but the total days of hospitalization was on the decline.

Purpose: Fibroblast growth factor receptor 4 (FGFR4) plays a critical role in cancer progression involving in tumor proliferation, invasion, and metastasis. This study clarified the role of FGFR4-Arg388 variant in gastric cancer (GC), and more importantly highlighted the possibility of this single nucleotide polymorphism (SNP) as potential therapeutic targets. Materials and Methods: FGFR4 polymorphism was characterized in advanced GC patients to perform statistical analysis. FGFR4-dependent signal pathways involving cell proliferation, invasion, migration, and resistance to oxaliplatin (OXA) in accordance with the SNP were also assessed in transfected GC cell lines. Results: Among 102 GC patients, the FGFR4-Arg388 patients showed significantly higher tumor stage (p=0.047) and worse overall survival (p=0.033) than the Gly388 patients. Immunohistochemical results showed that FGFR4-Arg388 patients were more likely to have higher vimentin (p=0.025) and p-STAT3 (p=0.009) expression compared with FGFR4-Gly388 patients. In transfected GC cells, the overexpression of FGFR4-Arg388 variant increased proliferation and invasion of GC cells, increasing resistance of GC cells to OXA compared with cells overexpressing the Gly388 allele. Conclusion The exploration mechanism may be through FGFR4-Arg388/STAT3/epithelial to mesenchymal transition axis regulating pivotal oncogenic properties of GC cells. The FGFR4-Arg388 variant may be a biomarker and a candidate target for adjuvant treatment of GC.

Objective To investigate the changes of brain edma and expression of blood high mobil-ity group box 1(HMGB1) and calcium binding protein S100B after traumatic brain injury (TBI) in IL-4 knockout (IL-4 KO) mice,and to explore the effects of IL-4 on traumatic brain injury. Methods Twenty male wild type ( WT) or twenty male IL-4 KO BALB/cJ mice were randomly divided into WT sham TBI group,WT TBI group,IL-4 KO sham TBI group and IL-4 KO TBI group(n=10 in each group).The model of traumatic brain injury was established by the free falling body epidural impact method,then the brain water content was measured. The expression of aquaporin-4 ( APQ4) and HMGB1 in injured brain of each group was detected by Western blot,and the concentration of HMGB1 and S100B in serum was detected by ELISA assay. Results ( 1 ) The brain water content of injured lateral brain of BALB/cJ mice with IL-4 gene knockout was significantly higher than that of wild type mice with brain injury model (WT group: (80.03± 0.35)％;IL-4 KO group:(81.93±0.41)％;P<0.05).(2) The Western blot showed that the expression of AQP4 and HMGB1 in brain tissue of BALB/cJ mice with IL-4 gene knockout was significantly higher than those in wild type mice after traumatic brain injury. ( 3) The results of ELISA showed that the levels of HMGB1 and S100B in the serum of IL-4 knockout BALB/cJ mice were significantly higher than those of wild type mice (HMGB1:WT group:(9.21±0.74)ng/ml;IL-4 gene knock-out group:(13.39±1.33)ng/ml,P<0.05;S100B protein:WT group:(11.11±0.84)pg/ml;IL-4 KO group: (18.11±2.02)pg/ml,P<0.05 ). Conclusion The brain tissue water content and the expression of APQ4 are increased in IL-4 KO TBI mice.The expression of HMGB1 in brain issue and serum and S100B in serum are also up-regulated.

Objective To compare and analyze the epidemiological features of adult patients with scapular fracture between eastern and western areas in China from 2010 to 2011. Methods The data of adult patients with scapular fracture who had been treated from January 2010 to December 2011 in 63 hospitals in the eastern and western areas in China were collected through the PACS system and case reports checking system. The data from the eastern 35 hospitals were classified as group A and those from the 28 western hospitals as group B. The analytic items included gender, age and AO classification. Results A total of 2, 063 cases were collected. The median age was 44 years ( interquartile range, from 33 to 56 years ) and gender ratio 3. 50:1 in Group A of 1, 376 cases; the median age was 41 years ( interquartile range, from 31 to 51 years ) and gender ratio 3. 09:1 in Group B of 687 cases. There was a significant difference between the 2 groups in median age ( Z= -3. 798, P=0. 000 ) . There was no significant difference between the 2 groups in gender ratio or constituent ratio of fracture peak age ( P > 0. 05 ) . The proportions of patients from 16 to 20 and from 31 to 40 years old in group A were significantly lower than in group B ( P <0. 05 ) . The proportion of middle-aged patients was significantly higher and that of young patients significantly lower in group A than in group B. The proportion of AO type 14-A fractures in group A ( 66. 49％) was significantly higher than in group B ( 55. 60％) while the proportion of AO type 14-C fractures was significantly lower ( 21. 37％) in group A than in group B ( 29. 55％) . Conclusions Most scapular fractures occurred in male patients. The proportion of young patients in the eastern area was lower than in the western area, but the proportion of middle-aged patients was higher in the eastern area than in the western area. The proportion of AO type 14-A fractures in the eastern area was significantly higher than in the western area while the proportion of AO type 14-C fractures in the eastern area significantly lower than in the western area.

Objective To compare the epidemiological characteristics of adult single fractures of the cuneiform between the east and west areas in China from 2010 through 2011.Methods Thirty-five hospitals in the east coast area (group A) and 28 hospitals in the west inland area (group B) were selected for this investigation. The data of adult single fracture of the cuneiform treated between January 2010 and De-cember 2011 at the 63 hospitals were collected through the PACS system and medical records inquiry system. The epidemiological characteristics concerning age, gender and fracture classification were compared between the 2 groups. Results A total of 457 adult single fractures of the cuneiform were collected, involving 384 cases in group A and 73 cases in group B. They accounted respectively for 4.38% (384/8,772) and 3.53% (73/2, 068) of the adult tarsal bone fractures in the same period, showing no significant difference (P >0.05), accounted respectively for 1.71% (384/22, 455) and 1.15% (73/6, 354) of the adult foot frac-tures, showing a significant difference (P <0.05), and accounted respectively for 0.20% (384/192,991) and 0.09% (73/81, 143) of all the adult fractures, showing a significant difference (P <0.05). The median age was 39 years in group A (29, 50) and 36 years in group B (25, 45), showing a significant difference (P <0.05). The male to female ratio was 1.61:1 (237/147) for group A and 1.52:1 (44/29) for group B. The peak age range of the fracture for males was from 21 to 30 years old in both groups, and its proportion was 28.69% (68/237) in group A and 38.64% (17/44) in group B. The peak age range of the fracture for females was from 41 to 50 years old in both groups, and its proportion was 26.53% (39/147)in group A and 27.59% (8/29) in group B. All the above comparisons were statistically insignificant (P> 0.05). The proportion of the age group of≥61 years was significantly larger in group A than in group B (P <0.05). The high risk type of the fracture was type 85-A1 in both groups, and its proportion was 61.98% (238/384) in group A and 52.05% (38/73) in group B. The proportion of type 85-B1 was significantly larger in group B than in group A (P <0.05). Conclusions Adult single fractures of the cuneiform were more common in young and male patients. The proportion of elderly patients (≥61 years old) was significantly larger in the east area. The high risk type of the fracture was simple fracture involving the medial cuneiform bone (type 85-A) in both areas. The proportion of the comminuted fracture of the medial cuneiform (type 85-B1) was significantly larger in the west area.

Objective To compare and analyze the epidemiological features of adult pelvic fractures between West China and East China from 2010 to 2011.Methods The data of adult pelvic fractures treated from January 2010 to December 2011 in 63 hospitals in West China and East China were collected through the PACS system and case reports checking system.The data from the 35 hospitals in East China were assigned into group A and those from the 28 hospitals in West China into group B.The analytic items included gender,age,age distribution and type of AO classification.Results A total of 7,896 cases were collected.In group A of 5,683 cases,there were 2,829 males and 2,854 females,with a male to female ratio of 0.99∶1 and a median age of 42 years (interquartile range,from 30 to 55 years).In group B of 2,213 cases,there were 1,123 males and 1,090 females,with a male to female ratio of 1.03∶1 and a median age of 41 years (interquartile range,from 31 to 54 years).There was no significant difference in the male to female ratio between the 2 groups (x2 =0.594,P =0.441) but there was a significant difference in the median age (Z =-4.344,P =0.000).The age distribution showed that the peak range was from 31 to 40 years in group A (with a proportion of 21.50％) and from 41 to 50 years in group B (with a proportion of 23.41％),showing no significant difference between the 2 groups (P ＞ 0.05).In both groups,type 61-A was the high risk type of fracture (82.23％ in group A and 86.08％ in group B),and type 61-A2 the high risk subtype of fracture (41.47％ in group A and 54.36％ in group B),showing significant differences (P ＜ 0.05).Conclusions East China and West China had similar male to female ratios in pelvic fractures.Generally,the patients in West China were younger,for the most patients in East China were aged from 31 to 40 years and those in West China from 41 to 50 years.In both East China and West China,type 61-A2 and subtype 61-A2 were the most common,but the proportions of type 61-A2 and subtype 61-A2 were higher in West China than in East China.

Objective To analyze and compare epidemiological characteristics of adult single metatarsal fractures between the east and west areas in China from 2010 through 2011.Methods Thirty-five hospitals in the east area (group A) and 28 hospitals in the west area (group B) participated in this epidemiological investigation of adult single metatarsal fractures treated from January 2010 through December 2011.Data concerning gender,age and fracture location and type were documented and compared between groups A and group B.Results There were 4,779 fractures in group A and 1,708 in group B,accounting for 21.28％ (4,779/22,455) and 26.88％ (1,708/6,354) of the adult foot fractures,and 2.48％ (4,779/192,991) and 2.10％ (1,708/81,143) of all the adult fractures,respectively,showing significant differences between the 2 groups (P ＜ 0.05).The ratio of male to female was 1.21:1 in group A and 1.48:1 in group B,showing a significant difference (x2 =11.768,P =0.001).The median age of group A (43 years) was significantly older than that of group B (40 years) (Z =-6.275,P ＜ 0.001).The proportions of the patients aged from 21 to 30 years (19.02％) and of those aged from 31 to 40 years (18.62％) in group A were significantly lower than those in group B (22.66％ and 21.60％),but the proportion of the patients aged from 51 to 60 years in group A (21.09％) was significantly higher than that in group B (14.64 ％) (P ＜ 0.05).The proportions of type 87-A (40.18％) and type 87-C (5.52％) in group A were significantly lower than those in group B (44.38％ and 8.20％),but the proportion of type 87-B in group A (54.30％) was significantly higher than that in group B (47.42％) (P ＜ 0.05).There was no significant difference between the 2 groups in the distribution of fracture locations (P ＞ 0.05).Conclusions The most common single metatarsal fracture was that of the fifth metatarsal bone and the fractures of proximal metatarsal bone accounted for the largest proportion in both the cast and west areas.The west area had higher proportions of male patients and single metatarsal fracture than the east area.