Bacteria-mediated anti-tumor therapy has received widespread attention due to its natural tumor-targeting ability and specific immune-activation characteristics. It has made significant progress in breaking the limitations of monotherapy and effectively eradicating tumors, especially when combined with traditional therapy, such as radiotherapy. According to their different biological characteristics, bacteria and their derivatives can not only improve the sensitivity of tumor radiotherapy but also protect normal tissues. Moreover, genetically engineered bacteria and bacteria-based biomaterials have further expanded the scope of their applications in radiotherapy. In this review, we have summarized relevant researches on the application of bacteria and its derivatives in radiotherapy in recent years, expounding that the bacteria, bacterial derivatives and bacteria-based biomaterials can not only directly enhance radiotherapy but also improve the anti-tumor effect by improving the tumor microenvironment (TME) and immune effects. Furthermore, some probiotics can also protect normal tissues and organs such as intestines from radiation via anti-inflammatory, anti-oxidation and apoptosis inhibition. In conclusion, the prospect of bacteria in radiotherapy will be very extensive, but its biological safety and mechanism need to be further evaluated and studied.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane 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 explore the clinical efficacy of double traction-assisted reduction internal fixation and open reduction internal fixation in treating tibial plateau fractures.Methods:Data of patients with tibial plateau fracture admitted to West China Hospital of Sichuan University from January 2016 to December 2021 were retrospectively analyzed, and patients were divided into two groups according to treatment method: double traction-closed reduction internal fixation group (referred to as double traction group) and open reduction internal fixation group (referred to as open group). The double traction group included 21 patients, with 15 male and 6 female patients, with a mean age of 56.14±9.24 years (range, 45-72 years). Schatzker classification of fractures: 1 type I, 2 type II, 2 type III, 5 type IV, 6 type V, and 5 type VI. The open group included 29 patients, with 20 male and 9 female patients, with a mean age of 58.97±4.84 years (range, 47-70 years). Schatzker classification of fractures: 2 type I, 4 type II, 8 type III, 4 type IV, 5 type V, and 6 type VI. The surgical time, incision length, intraoperative blood loss, length of hospital stays, fracture healing time, postoperative time to full weight bearing, Rasmussen score, Hospital for Special Surgery (HSS) knee score, and complications were compared between the two groups of patients.Results:Both groups were followed up for 24 to 36 months, with an average of 30 months. There were significant differences in the operation time (92.61±6.22 min vs. 47.92±9.53 min), incision length (4.54±0.56 cm vs. 6.26±0.51 cm), and intraoperative blood loss (47.05±9.72 ml vs. 156.82±4.62 ml) between the group treated with closed reduction and double traction and the group treated with open reduction, with statistical significance ( t=18.83, 10.78, 53.24, P<0.001). There were also significant differences in the hospitalization time (5.35±0.41 d vs. 5.84±0.78 d), fracture healing time (3.72±0.74 months vs. 4.22±0.42 months), and time to full weight-bearing after surgery (11.29±1.10 weeks vs. 15.07±1.96 weeks) between the two groups, with statistical significance ( t=2.30, P=0.026; t=3.38, P<0.001; t=7.96, P<0.001). The HSS score at 6 months after surgery in the group treated with closed reduction and double traction was 81.61±2.32 points, which was higher than the score in the group treated with open reduction (77.66±4.01 points), with statistical significance ( t=4.07, P<0.001); at 12 months after surgery, the Rasmussen score in the group treated with closed reduction and double traction was 16.71±1.00 points, which was higher than the score in the group treated with open reduction (13.79±1.42 points), with statistical significance ( t=8.05, P<0.001). There was no fracture malunion or compartment syndrome occurred in both groups. The incidence of complications was 5% (1/21) in the group treated with closed reduction and double traction, and 10% (3/29) in the group treated with open reduction, with statistical significance (χ 2=0.52, P=0.473). Conclusion:The advantages of double traction-assisted reduction and internal fixation for tibial plateau fractures include minimal trauma, minimal bleeding, early mobilization, and shorter fracture healing time. It is a safe and reliable treatment method.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

An 85-year-old woman with gross hematuria for 10 days was presented to Wuxi No.2 People′s Hospital on Dec 10th, 2018.The images showed bladder mass. Pathological analysis of transurethrally resected tissue showed primary malignant melanoma with less pigmentations of urinary bladder. Without any following treatment, it grew again after 17 months. After the second surgery, she died of cachexia half a month later. Primary malignant melanoma with less pigmentations of urinary bladder is rare. It is vulnerable to misdiagnosis without immunohistochemical staining. The prognosis is poor.

OBJECTIVE To study the toxicity of the extract from Mi ao medicine Wikstroemia indica to zebrafish . METHODS Zebrafish embryo model was used as the object ，after exposure to W. indica extract （10，20，40 μg/mL），the number of spontaneous twitching within 1 min，heart rate within 10 s，the occurrence of malformation and death were detected and recorded . Zebrafish was used as the object ，after exposure to W. indica extract（10-100 μg/mL）for 24，48 and 72 h，and the median lethal concentration（LC50）of W. indica extract to zebrafish at different time points were calculated . After exposure to low ，medium and high concentration （27，37，51 μg/mL）of W. indica extract，the liver phenotype ，hepatocyte apoptosis and lipid deposition of zebrafish were observed ，and the activities of alanine aminotransferase （ALT），aspartate aminotransferase （AST）and lactate dehydrogenase（LDH）in liver tissue were detected . RESULTS Compared with blank group ，the number of spontaneous twitching ， malformation rate （except for 10 μg/mL group ）and mortality of embryos increased significantly in 10，20，40 μg/mL groups of W. indica extract，and the heart rate （except for 10，20 μg/mL group ）of embryos decreased significantly （P＜0.05）. LC50 of W. indica extract to zebrafish at 24，48 and 72 h were 39.850，28.300 and 21.490 μg/mL，respectively. After drug treatment ，the transparency of liver area of zebrafish in low ，medium and high concentration groups of W. indica extract reduced and their shape were enlarged；apoptosis and lipid deposition increased ；the activities of ALT ，AST and LDH in liver tissue were significantly increased （P＜0.05）. CONCLUSIONS Miao medicine W. indica extract had develop mental toxicity to zebrafish embryos and he patotoxicity to zebrafish .

Objective:To investigate the effect of TRIM52 antisense RNA 1 (TRIM52-AS1) on injury of brain cortex neurons induced by hypoxia/re-oxygenation (H/R) and its possible mechanism in rats.Methods:(1) The cortical neurons were cultured in vitro and divided into control group and model group. In the model group, H/R-induced cell injury models were prepared. Real-time quantitative PCR (RT-qPCR) was used to detect the expressions of TRIM52-AS1 and micro RNA (miR)-28-5p in neurons of the two groups. (2) The cortical neurons were divided into control group, model group, small interfering (si)-TRIM52-AS1 transfection group, and nonsense sequence transfection group. Cells in the model group were prepared for H/R-induced cell damage models. After cells in the latter two groups were transfected with si-TRIM52-AS1 or its nonsense control sequence for 6 h, they were prepared for H/R-induced cell damage models. RT-qPCR, CCK-8, and flow cytometry were used to detect the TRIM52-AS1 expression, and proliferation and apoptosis of neurons in the 4 groups; enzyme-linked immunosorbent assay (ELISA) and Western blotting were used to detect the lactate dehydrogenase (LDH), malondialdehyde (MDA) and superoxide dismutase (SOD) levels and protein expressions of Cyclin D1, Bcl-2 and Bax. (3) The cortical neurons were divided into miR-28-5p transfection group and nonsense sequence transfection group. After the cells were respectively transfected with miR-28-5p or its nonsense control sequence for 6 h, they were prepared for H/R-induced cell damage models. RT-qPCR, CCK-8, and flow cytometry were used to detect the TRIM52-AS1 expression, and proliferation and apoptosis of neurons in the two groups; ELISA and Western blotting were used to detect the LDH, MDA and SOD levels and protein expressions of Cyclin D1, Bcl-2 and Bax. (4) The cortical neurons were divided into wild-type TRIM52-AS1+miR-28-5p mimic transfection group, wild-type TRIM52-AS1+miR-28-5p nonsense control sequence transfection group, mutant TRIM52-AS1+miR-28-5p mimic transfection group, and mutant TRIM52-AS1+miR-28-5p nonsense control sequence transfection group. After the cells were co-transfected for 6 h, the culture medium was replaced with fresh medium and they were cultured for another 12 h, and then, the luciferase activity of cells in each group was detected by dual luciferase reporter gene experiment. (5) Cortical neurons were divided into nonsense sequence transfection group, miR-28-5p inhibitor transfection group, nonsense sequence+si-TRIM52-AS1 transfection group, and miR-28-5p inhibitor+si-TRIM52-AS1 transfection group, and these cells were transfected with miR-28-5p inhibitor nonsense control sequence, miR-28-5p inhibitor, miR-28-5p inhibitor nonsense control sequence+si-TRIM52-AS1, miR-28-5p inhibitor+si-TRIM52-AS1; 6 h after transfection, H/R-induced cell damage models were prepared. RT-qPCR, CCK-8, and flow cytometry were used to detect the miR-28-5p expression, proliferation and apoptosis of neurons in the two groups, respectively; ELISA and Western blotting were used to detect the LDH, MDA and SOD levels and protein expressions of Cyclin D1, Bcl-2 and Bax. Results:(1) As compared with those in the control group, the TRIM52-AS1 expression statistically increased, but the miR-28-5p expression significantly decreased in the model group ( P<0.05). (2) As compared with the control group, the model group and nonsense sequence transfection group had significantly increased LDH content in the culture supernatant, statistically decreased MDA and SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). As compared with the model group and nonsense sequence transfection group, si-TRIM52-AS1 transfection group had significantly decreased si-TRIM52-AS1 expression, statistically decreased LDH content in the culture supernatant and MDA content in the cells, significantly increased SOD content in the cells, significantly increased A value and protein expression of Cyclin D1 and Bcl-2, significantly decreased apoptosis rate and Bax protein expression ( P<0.05). (3) As compared with the nonsense sequence transfection group, the miR-28-5p transfection group had significantly increased miR-28-5p expression, significantly decreased LDH content in the culture supernatant and MDA content in the cells, and significantly increased SOD content in the cells, significantly increased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly decreased apoptotic rate and Bax protein expression ( P<0.05). (4) The luciferase activity of the wild-type TRIM52-AS1+miR-28-5p mimic transfection group was significantly lower than that of the wild-type TRIM52-AS1+miR-28-5p nonsense control sequence transfection group (0.43±0.04 vs. 1.00±0.09, P<0.05). (5) As compared with the nonsense sequence transfection group, the miR-28-5p inhibitor transfection group had significantly decreased miR-28-5p expression, significantly increased LDH content in the culture supernatant and MDA content in the cells, significantly decreased SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). As compared with the nonsense sequence+si-TRIM52-AS1 transfection group, the miR-28-5p inhibitor+si-TRIM52-AS1 transfection group had significantly decreased miR-28-5p expression, significantly increased LDH content in the culture supernatant and MDA content in the cells, significantly decreased SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). Conclusion:TRIM52-AS1 down-regulation may inhibit H/R-induced oxidative stress and apoptosis of rat brain cortical neurons by negatively regulating the miR-28-5p expression, which reduces neuronal cell damage.

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.

Objective:To investigate whether astragaloside (AST) IV can improve spatial learning and memory abilities by alleviating oxidative stress damage to the frontal cortex and hippocampus in vascular dementia (VD) rats induced by chronic cerebral ischemia.Methods:Totally, 72 adult male Wistar rats were randomly assigned to four groups: sham-operated group ( n=12), model group ( n=20), AST-IV 10 mg group ( n=20), and AST-IV 20 mg group ( n=20); chronic cerebral ischemia-induced VD models in the later three groups were established by permanent bilateral common carotid artery occlusion (BCCAO); 3 h after BCCAO, these rats were administered with saline, 10 mg/kg AST-IV, or 20 mg/kg AST-IV once daily for a consecutive 90 d. Ninety-four d after modeling, spatial learning and memory abilities were assessed by Morris water maze; the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), and malondialdehyde (MDA) levels were measured by enzyme linked immunosorbent assay (ELISA). The levels of lipid peroxidation and oxidative DNA damage were assessed by immunohistochemical staining for 4-hydroxynonenal (4-HNE) and 8-hydroxy20-deoxyguanosine (8-OhdG), respectively. Results:(1) On the 3 rd, 4 th and 5 th d of place navigation test, the escape latency in rats of the model group was significantly longer than that in the sham-operated group, and that in the AST-IV 20 mg group was significantly shorter than that in the model group ( P<0.05); spatial probe test showed that the time percentage of rats spending in platform region in the model group (20.3%±1.7%) was significantly smaller than that in the sham-oprated group (48.2%±3.6%), and that in the AST-IV 20 mg group (39.7%±3.2%) was significantly larger than that in the model group ( P<0.05). (2) As compared with those in the sham-operated group, the SOD, GSH-Px and CAT activities were statistically decreased while MDA level was significantly increased in the frontal cortex and hippocampal CA1 area of rats in the model group ( P<0.05); as compared with those in the model group, the SOD, GSH-Px and CAT activities were statistically increased while MDA level was significantly decreased in the frontal cortex and hippocampal CA1 area of rats in the AST-IV 20 mg group ( P<0.05). (3) As compared with those in the model group, the numbers of 4-HNE and 8-oHdG positive cells in the frontal cortex and hippocampal CA1 area of rats in the AST-IV 20 mg group were significantly smaller ( P<0.05). Conclusion:Intraperitoneal injection of high dose AST-IV can ameliorate oxidative damage in the frontal cortex and hippocampal CA1 area in chronic cerebral ischemia-induced VD models, and has the potential to reverse spatial learning damages and memory dysfunction.