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.

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 explore the speech features of female patients with anhedonic depression and their recognition of pleasure deficient symptoms.Methods:A total of 102 female depression patients who were hospitalized at Nanjing Brain Hospital from September 2020 to October 2021 were selected, including 62 anhedonic depression patients (anhedonic group) and 40 non-anhedonic depression patients (non-anhedonic group). A total of 50 female healthy controls were recruited during the same period.All participants were evaluated by the 17-item Hamilton depression scale (HAMD-17), Snaith-Hamilton pleasure scale (SHAPS), and the temporal experience of pleasure scale (TEPS), as well as voice acquisition.SPSS 23.0 software was used for data processing.Statistical analysis was conducted using one-way ANOVA, non-parametric tests, Logistic regression, and receiver operating characteristic curve.Results:Compared with the non-anhedonic group, the anhedonic group showed significant changes in 15 voice features(all P<0.05), including Mel-frequency cepstral coefficients, formant frequencies, intensity, and energy features.Among these features, Mel-frequency cepstral coefficients exhibited the highest accuracy in identifying anhedonic depression, with sensitivity of 47.5%, specificity of 91.9%, area under curve (AUC) of 0.751, 95% CI=0.686-0.866.Formant frequencies could identify female anhedonic depression, with a sensitivity of 90.0%, a specificity of 40.3%, an AUC of 0.647, and 95% CI=0.605-0.824.Energy features could identify anhedonic deficient depression, with a sensitivity of 60.0%, a specificity of 74.2%, an AUC of 0.679, and 95% CI=0.587-0.804.Intensity features could identify female anhedonic depression, with a sensitivity of 70.0%, a specificity of 58.1%, an AUC of 0.640, and 95% CI=0.554-0.769. Conclusion:Mel-frequency cepstral coefficients, formant frequencies, intensity features, and energy features may have specific changes in female patients with anhedonic depression.The Mel-frequency cepstral coefficients has the highest recognition accuracy for anhedonic symptoms in female depression patients, and is expected to become an objective evaluation index for female anhedonic depression.

Objective:To explore the curative effects of Nice knot fixation on tuberosity healing in hemiarthroplasty for complex proximal humeral fractures.Methods:A retrospective analysis was conducted of the eligible 32 complex proximal humeral fractures which had been treated at Department of Trauma and Orthopedics, Peking University People's Hospital between May 1, 2016 and May 1, 2019. Nice knot fixation was used to repair greater and lesser tuberosities in hemiarthroplasty for all the patients. There were 6 males and 26 females, aged from 60 to 90 years (mean, 74.9 years). By the Neer classification, there were 4 three-part fractures combined with dislocation, 20 four-part fractures, and 8 four-part fractures combined with dislocation. Shoulder joint X-rays were taken at postoperative 1, 2, 3, 6, and 12 months at the outpatient clinic to evaluate the patients' shoulder joint mobility, visual analog scale (VAS) pain score and Constant-Murley shoulder score. Tuberosity healing was assessed based on the X-rays and related complications were recorded.Results:The 32 patients received complete follow-up for 12 to 25 months (average, 17.82 months). At the 12-month follow-up, their shoulder flexion averaged 131.3° (from 80° to 155°), abduction 126.9° (from 80° to 155°), external rotation 48.4° (from 30° to 60°), internal rotation the L2 level, VAS pain score 0.9 (from 0 to 5), and Constant-Murley score 83.4 (from 58 to 96). The rate of patient satisfaction was 87.5%(28/32). Tuberosity-related complications were observed in 6 cases with an incidence of 18.8%. Complications like infection and prosthetic loosening were found in none of the patients.Conclusion:In hemiarthroplasty for complex proximal humeral fractures, application of Nice knot to fixate greater and lesser tuberosities can lead to rigid fixation, definite curative effects and a low incidence of tuberosity-related complications.

Objective:To establish a new classification of lateral clavicle fractures and to evaluate its clinical value.Methods:The data of 67 patients with lateral clavicle fractures admitted from January 2016 to December 2020 were included. Thirty-seven cases were from Shanghai First People's Hospital, including 22 males and 15 females, with an average age of 49.1 years (22-78 years). Thirty cases were from the Second Upper Limb Ward of Tianjin Hospital of Tianjin, including 20 males and 10 females, with an average age of 47.6 years (19-76 years). The ligament injury was determined by measuring the coracoclavicular space on Zanca view X-ray and the distance between the fracture fragment on the inferior surface of the 3D-CT and the distal end of the clavicle. All patients were classified according to the new classification (based on the measurement on Zanca view X-ray and 3D-CT reconstruction, the relationship between the fracture and the coracoclavicular ligament footprint, coracoclavicular ligament injury, the injury of the acromioclavicular joint and the stability of the fracture), conservative treatment is preferable for stable fractures, and surgical treatment for unstable fractures. Three experienced orthopaedic surgeons and three radiologists independently observed the imaging data of 67 patients with distal clavicle fractures, determined the fracture type according to the new classification, and randomly reclassified after 4 weeks interval. Finally, 15 cases were randomly selected for internal control (2 junior orthopedic physicians), and the ICC value was used to assess the reliability. Results:The lateral clavicle fractures were divided into 5 types according to the Gongji classification. Type 1: isolated conical tubercle avulsion fracture, and the fracture line is located medial to the coracoid process; Type 2: complete involvement of the trapezoid & conical ligament at the clavicle insertion, and the fracture line extends to the middle of the clavicle, mean while the acromioclavicular joint is intact; Type 3: fracture fragments on the inferior surface involving the trapezoidal/conical ligament, respectively; Type 4: rupture of the conical ligament, and avulsion fracture of the trapezoid ligament; Type 5: conical ligament intact, and avulsion fracture of clavicle insertion of the trapezoid ligament. There were 18 cases of type 1, 4 cases of type 2, 8 cases of type 3, 32 cases of type 4, and 5 cases of type 5. The inter-observer and intra-observer agreement of all included cases was good (inter-group: first ICC=0.764, second ICC=0.778; intra-group: shoulder specialist ICC=0.782, radiologist ICC=0.750, internal control ICC=0.793). Types 1 and 2 fractures were fixed with anatomical plate and coracoid anchor. Type 3 and 4 fractures were fixed with clavicle hook plate and coracoid anchor. And type 5 underwent conservative treatment. At the last follow-up, all patients had no obvious shoulder joint instability and pain, and no internal fixation failure or fixation breakage was found. Conclusion:The Gongji classification has moderate reliability between observers and intra-observers, and the Gongji distal clavicle fracture classification has a good significance for evaluating the stability of the fracture and guiding the selection of the treatment.

OBJECTIVE：To explo re the potential molecular mechanism of ursolic acid in the treatment of osteoporosis （OP）. METHODS：TCMSP，PubMed database and UniProt database were used to screen potential targets of monomer compound ursolic acid. OP related target genes were searched with GeneCards database. The common target genes of component-disease were obtained by Venny 2.1 online mapping tool. The protein-protein interaction （PPI）network of component-disease common target genes was constructed by using STRING database ，and topological analysis was carried out ；the core target genes ，whose degree value was greater than the average degree value ，were screened. GO functional annotation and KEGG pathway enrichment analysis of component-disease common target genes were carried out by DAVID database. AutoDock Vina 1.1.2 software was used for molecular docking ，using protein encoded by the core target gene as receptor and ursolic acid as ligand. RESULTS ：A total of 55 ursolic acid related target genes and 4 273 OP related target genes were excavated ，with a total of 44 common target genes. PPI network with above common target genes included 44 nodes and 513 edges，with an average node degree of 23.3. There were 24 core target genes ，including VEGFA，TP53，IL6，CASP3. There were 340 GO functional items were enriched （corrected P＜ 0.05），including 263 biological processes （negative regulation of apoptosis ，etc.），25 molecular functions （protein binding ，etc.） and 52 cell components （cytosol，etc.）. There were 90 KEGG signaling pathways （corrected P＜0.05），such as tumor pathway ， hepatitis B pathway ，TNF signaling pathway ，viral carcinogenesis and phosphatidylinositol 3 kinase/protein kinase B （PI3K-Akt） signaling pathway. The binding energy between ursolic acid and 6 proteins encoded by core target genes such as TP53 was lower than －5 kcal/mol，which had strong binding activity. CONCLUSIONS ：The therapeutic effect of ursolic acid on OP may be achieved by regulating VEGFA，TP53，IL6，CASP3，JUN and other core target genes and acting on multiple key pathways such as cancer pathway ， hepatitis B and TNF signaling

Currently, the definition, classification and Chinese nomenclature of intra-hepatic cholangiocarcinoma (ICC) are controversial. Whether ICC belongs to liver cancer or carcinoma of bile duct is debatable, and the two terms"intrahepatic cholangiocarcinoma"and"cholangiocellular carcinoma"are simultaneously used without distinction, bringing great confusions to clinical practice. Based on authoritative literatures at home and abroad, the authors give suggestions on the definition, classification and Chinese nomenclature of ICC, as well as the classification of carcinoma of bile duct, which recommend that the Chinese translation of "cholangiocarcinoma" should be "epithelial carcinoma of bile duct (cholangiocellular carcinoma)", the mass-forming type ICC should be classified as primary liver cancer, naming as"intrahepatic cholangiocarcinoma"and the periductal-infiltrating type and intraductal-growing type ICCs still be classified as carcinoma of bile duct, naming as"perihilar cholangiocarcinoma". The authors recommend to classify carcinoma of bile duct into: perihilar cholangiocarcinoma, hilar cholangiocarcinoma, and distal cholangiocarcinoma.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Hepatocellular carcinoma (HCC) accounts for approximately 75%-85% of primary liver cancer cases and is one of the most frequently diagnosed malignancies worldwide. Immunotherapy is currently considered to be the most promising treatment to prevent the progression and postoperative recurrence of HCC. At present, the treatment strategies of immunotherapy for HCC are classified as active immunotherapy and passive immunotherapy, including tumor vaccine therapy, immune checkpoint inhibitors, and adoptive cell therapy. Here we review the current clinical progression and discuss the future perspective on immune therapy for HCC.

Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture.Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1,2014 to February 1,2016 to Department of Trauma and Orthopedics,Peking University People's Hospital.They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture:0 to 10 points,11 to 20 points,21 to 30 points,31 to 40 points and above 41 points.Postoperative complications and deaths were recorded.The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture.Results The 286 patients scored 24.9 ± 11.0 (from 0 to 69) preoperatively.The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8.The incidence of medical complications was 4.00％ (1/25) in the 0 to 10 points group,4.17％ (3/72) in the 11 to 20 points group,14.66％ (17/116) in the 21 to 30 points group,23.53％ (12/51) in the 31 to 40 points group and 50.00％ (11/22) in the above 41 pints group.Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture,the preoperative risk scoring system can provide an effective prediction of surgical risks.