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.

Objective To establish an electrical field(EF)stimulation model for Schwann cells(SCs),and to provide a basis for exploring the mechanisms of EF stimulation in promoting proliferation,migration and epithelial-to-mesenchymal transition of SCs.Methods A YC-3 bipolar programmable electrical stimulator and an electrotaxis chamber were used to construct an EF stimulation system to stimulate SCs.In the study,SCs were divided into control group(Ctrl)receiving no EF stimulation and EF group stimulated by continuous constant-voltage EF(100 mV/mm,3 h).The effects of EF stimulation on the proliferation and migration of SCs were analyzed using CCK-8 assay,and wound healing assay+Transwell assay,separately;and its effect on SCs adhesion was observed by analyzing the expressions of E-cadherin and N-cadherin using Western Blot.Results The CCK-8 assay results suggested that the absorbance at 450 nm was significantly higher in EF group than in Ctrl group(P<0.05).The results of wound healing assay+Transwell assay revealed that EF group had higher cell migration efficiency than Ctrl group(P<0.05).Western Blot results showed decreased E-cadherin expression and increased N-cadherin expression in EF group as compared with Ctrl group(P<0.05).Conclusion The improved EF stimulation system for SCs is operable.EF stimulation can promote the proliferation and migration of SCs.The decreased E-cadherin expression and increased N-cadherin expression may be related to the occurrence of epithelial-to-mesenchymal transition in SCs after EF stimulation.

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.

Objective To establish an electrical field(EF)stimulation model for Schwann cells(SCs),and to provide a basis for exploring the mechanisms of EF stimulation in promoting proliferation,migration and epithelial-to-mesenchymal transition of SCs.Methods A YC-3 bipolar programmable electrical stimulator and an electrotaxis chamber were used to construct an EF stimulation system to stimulate SCs.In the study,SCs were divided into control group(Ctrl)receiving no EF stimulation and EF group stimulated by continuous constant-voltage EF(100 mV/mm,3 h).The effects of EF stimulation on the proliferation and migration of SCs were analyzed using CCK-8 assay,and wound healing assay+Transwell assay,separately;and its effect on SCs adhesion was observed by analyzing the expressions of E-cadherin and N-cadherin using Western Blot.Results The CCK-8 assay results suggested that the absorbance at 450 nm was significantly higher in EF group than in Ctrl group(P<0.05).The results of wound healing assay+Transwell assay revealed that EF group had higher cell migration efficiency than Ctrl group(P<0.05).Western Blot results showed decreased E-cadherin expression and increased N-cadherin expression in EF group as compared with Ctrl group(P<0.05).Conclusion The improved EF stimulation system for SCs is operable.EF stimulation can promote the proliferation and migration of SCs.The decreased E-cadherin expression and increased N-cadherin expression may be related to the occurrence of epithelial-to-mesenchymal transition in SCs after EF stimulation.

Objective:To analyze the effect of the over-the-scope-clip system (OTSC) system in the treatment of iatrogenic gastrointestinal perforation.Methods:Retrospective selection of clinical data from 21 patients with gastrointestinal perforation during endoscopic examination and treatment from May 2016 to December 2023 in the Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University. By analyzing the patient's basic information, perforation cause, perforation diameter, length of hospital stay, post-treatment outcome, complications, and treatment success rate, the effectiveness of using the OTSC system to treat iatrogenic gastrointestinal perforation is comprehensively evaluated, and the influencing factors that may be related to the failure of OTSC system closure are analyzed. Independent sample t-test is used for inter group comparison of metric data that conforms to normal distribution. Fisher's exact probability test was used for inter group comparison of count data.Results:There were 21 cases of acute iatrogenic gastrointestinal perforation, including 12 males and 9 females, aged (61.95±15.47) years, 4 cases of duodenal perforation, 10 cases of gastric perforation, and 7 cases of colon perforation. The diameter of the perforation was (1.18±0.56)cm, and the perforation sealing time was (8.29±4.42) min. Among the 21 patients, 5 cases of occlusion failed, of which 2 cases of sigmoid colon perforation were transferred to surgery in time due to OTSC insufficiency, 3 cases were perforated in duodenal colon and colonic splenic area, 3 cases of delayed abdominal infection after OTSC system occlusion, 16 cases of OTSC system closure and perforation without complications such as delayed perforation, and the average length of hospital stay of patients in the OTSC system wound closure group was (11.56±6.53) d, which was shorter than that in the OTSC system closure failure group ((38.00±21.34) d), The proportion of passive perforation in the failure group (100%, 5/5) > the success group (31%, 5/16).The occlusion success rate of passive perforation in the OTSC system (50%, 5/10) < active perforation (100%, 11/11), the diameter of perforation of the failure group ((1.72±0.80)cm) was significantly > that of the successful group ((1.06±0.49)cm), the diameter of perforation ≥2.0 cm in the failure group (80.0%, 4/5) was significantly > that of the successful group (12.5%, 2/16), the proportion of duodeno-colonic perforation in the failure group (100.0%, 5/5) > the success group (37.5%, 6/16), the difference was statistically significant ( P values were 0.049, 0.012, 0.012, 0.037, 0.011, and 0.035, respectively). Conclusion:The closure of acute iatrogenic gastrointestinal perforation by the OTSC system has significant therapeutic effects and can reduce the probability of surgical conversion due to perforation to a certain extent. It is worth promoting and applying. The diameter of the perforation (≥2 cm), the perforation method (passive perforation), and the perforation site (the difficult part of duodenum-colon operation) may be the relevant influencing factors for the failure of the occlusion of the OTSC system.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Endoscopic submucosal dissection (ESD) is the common method for treatment of early gastric cancer. Compared with endoscopic mucosal resection (EMR), ESD can completely remove large lesions while ensuring negative margins as much as possible, which enables a more accurate pathological staging of tissue and reduces the risk of postoperative cancer recurrence. On the other hand, ESD generally results in larger ulcerations than EMR, which increases the likelihood of complications such as bleeding and perforation. Delayed bleeding is one of the main complications after gastric ESD. Delayed bleeding after ESD can cause hemorrhagic shock and even death, so we should take effective management strategies to prevent the occurrence of delayed bleeding after gastric ESD, such as the use of acid suppressive drugs, enough intraoperative hemostasis, lesion closure, and the use of lesion covering materials.

Objective:To analyze the prognostic value of nomogram model for cervical cancer based on the imaging features of diffusion kurtosis imaging (DKI) histogram.Methods:The DKI and clinical data of 272 patients with cervical cancer who were admitted to Affiliated Hospital of Guangdong Medical University from March 2015 to February 2022 were collected and retrospectively analyzed. All patients were randomly divided into the training group ( n=190) and validation group ( n=82) at a ratio of 7 vs. 3. The parameters of DKI histogram were obtained by GE AW 4.2 MRI software. The best prognostic imaging features were screened by LASSO regression. The DKI radiomics score was calculated by linear combination. The independent risk factors of prognosis were identified by univariate and multivariate regression analyses, and a nomogram model was constructed. The model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The internal consistency of the model was evaluated by the calibration map. Results:Adenocarcinoma ( HR=2.496, 95% CI=1.312-4.749, P=0.005), DKI score ( HR=24.087, 95% CI=6.062-95.711, P<0.001), depth of invasion ≥ 1/2 muscular layer ( HR=2.277, 95% CI=1.156-4.487, P=0.017) and neutrophil to lymphocyte ratio (NLR) ( HR=1.800, 95% CI=1.313-2.468, P<0.001) were the independent risk factors for prognosis of cervical cancer. The AUC of the nomogram model in the training and validation groups were 0.860 and 0.757, respectively. The calibration curve was well fitted with the 45° diagonal. The prediction results of long-term prognosis of this model were in good agreement with the actual situation. Conclusions:Adenocarcinoma, NLR, DKI score and depth of invasion ≥ 1/2 muscular layer are the independent risk factors for the prognosis of patients with cervical cancer. The constructed nomogram model could reliably predict the 3-year survival rate of patients with cervical cancer.

Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.

Objective The pathogenesis of acute mountain sickness(AMS)is still unclear.This study intends to continuously record the changes of physiological parameters of the Han population in the plain after high altitude exposure,and screen out the difference between AMS and high altitude acclimatization.Methods A total of 46 healthy Han people in the plain were recruited to establish a study cohort.The basic physiological and hematological parameters were measured at the time of in the plain(500 m above sea level,CQ),on the second day(LS1),the 23rd day(LS2),the 44th day(LS3)and the 65th day(LS4)after reaching the plateau.According to the 2018 version of the Louise Lake Acute Mountain Sickness Scoring System(LLS)scale score at LS2,they were divided into the AMS group and the non-AMS group,and the differences and continuous changes of parameters between groups were analyzed.Results At any time point,there was no significant difference in basic physiological and hematological parameters such as oxygen saturation,heart rate(HR),blood pressure(BP),red blood cell count(BRC),hemoglobin(Hb),and hematocrit(HCT)between the two groups(P＞0.05).Among the blood biochemical parameters,only albumin(ALB)was statistically significant at the time of LS2 and LS3 between the AMS group and the non-AMS group(P＜0.05),and the in-crease of ALB was significantly correlated with the decrease of AMS incidence(OR=0.676,95％CI:0.511-0.894,P=0.006).Conclusion Blood oxygen saturation,BRC,hemoglobin level Hb,Hb may have no predictive value for AMS,while ALB may be a good predictor for AMS,and its changes may play an important role in a-voiding AMS and promoting high altitude acclimatization.