As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

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.

A 56-year-old female was admitted to the Department of Rheumatology,Peking Union Medical College Hospital with complaint of recurrent fever and acute lumbar pain.Fever was complicated with malaise,cough and occasional blood-streaked sputum.Lab tests showed elevated white blood cell count,increased serum creatinine,erythrocyte sedimentation rate and C-reactive protein.Other lab findings included severe anemia,hematuria,and proteinuria.Immunological examinations were positive for antinuclear antibodies,antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibody.Ultrasonography and CT scan detected a huge spontaneous perirenal hematoma at right side.Angiography revealed multiple microaneurysms on bilateral renal arteries and branches.A diagnosis of systemic vasculitis was suggested.Under the combination therapy of corticosteroids and cyclophosphamide,the patient presented sustained remission for one year.This case indicates that prompt and sufficient treatment of primary disease is essential to a promising outcome.

Objective To explore the brain function changes in cirrhotic patients with normal blood ammonia and high in direct bilirubin with regional homogeneity (ReHo) of resting-state functional MRI (rs-fMRI).Methods Fifty-three cirrhotic patients with normal blood ammonia and high indirect bilirubin (cirrhosis group) and 60 healthy volunteers (control group) performed rs-fMRI scans.ReHo values in different brain areas of the two groups were acquired and compared.The correlation between the ReHo values of different brain regions in both groups and the indirect bilirubin concentrations was analyzed.Results Compared with control group,cirrhosis group showed that ReHo values increased in left dorsal-lateral frontal gyrus,left orbital superior frontal gyrus,left top edge of angular gyrus,left precentral gyrus,right caudate,right putamen,right insula,right olfactory cortex (all P＜0.001),and decreased in left superior occipital gyrus,left middle occipital gyrus,left cuneus,left orbital inferior frontal gyrus,right paracentral lobule,right precuneus,right middle occipital gyrus,bilateral lingual gyrus and bilateral cerebellum (all P＜0.001).ReHo values in right insula and right putamen in cirrhotic patients positively correlated with indirect bilirubin (r=0.32,P=0.021).Conclusion The resting state brain function increases and decreases in some brain regions of cirrhotic patients with normal blood ammonia and high indirect bilirubin.Indirect bilirubin level correlates with function of some brain regions,which has certain effect on brain function of adult.

[Summary] A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia . During hospitalization she developed multiorgan dysfunction , infected pancreatic necrosis , abdominal compartment syndrome and intrauterine fetal death . She was successfully treated by multidisciplinary team including department of emergency medicine , ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.

PURPOSE: This study is intended to investigate the effects of plants or plant-derived antioxidants on prevention of osteoporosis through the maintenance of reactive oxygen species (ROS) at a favorable level. MATERIALS AND METHODS: In this study, a novel antioxidant, namely 3,4,5-Trihydroxy-N-[4-(5-hydroxy-6-methoxy-pyrimidin-4-ylsulfamoyl)-phenyl]-benzamide (ZXHA-TC) was synthesized from gallic acid and sulfadimoxine. Its effect on osteoblast metabolism was investigated via the detection of cell proliferation, cell viability, production of ROS, and expression of osteogenic-specific genes including runt-related transcription factor 2 (RUNX2), bone sialoprotein (BSP), osteocalcin (OCN), alpha-1 type I collagen (COL1A1), and osteogenic-related proteins after treatment for 2, 4, and 6 days respectively. RESULTS: The results showed that ZXHA-TC has a stimulating effect on the proliferation and osteogenic differentiation of primary osteoblasts by promoting cell proliferation, cell viability, and the expression of genes BSP and OCN. Productions of bone matrix and mineralization were also increased by ZXHA-TC treatment as a result of up-regulation of COL1A1 and alkaline phosphatase (ALP) at the early stage and down-regulation of both genes subsequently. A range of 6.25x10(-3) microg/mL to 6.25x10(-1) microg/mL is the recommended dose for ZXHA-TC, within which 6.25x10(-2) microg/mL showed the best performance. CONCLUSION: This study may hold promise for the development of a novel agent for the treatment of osteoporosis.
Alkaline Phosphatase/metabolism ; Bone Morphogenetic Proteins/pharmacology ; Cell Differentiation/*drug effects ; Cell Proliferation/*drug effects ; Collagen Type I/genetics ; Core Binding Factor Alpha 1 Subunit ; Down-Regulation ; Gallic Acid ; Osteoblasts/*drug effects ; Osteocalcin/metabolism ; Osteogenesis/drug effects ; Osteoporosis/*prevention & control ; Reactive Oxygen Species ; Up-Regulation

Objective To explore properties of emotion memory circuits in late-life depression,and differences in functional connectivity of emotional memory network between late-life depression and healthy controls who were investigated by resting-state fMRI.Methods Eighteen late life depression patients and twenty four healthy controls were involved in our study.Resting-state functional MRI data were acquired via 3.0T MRI scanner.Functional MRI data were analyzed.Behavioral data were acquired during retrieval.The independent samples t-test of functional MRI data and ANOVA of behavioral performance were performed with AFNI and SPSS 13.0 statistical software,respectively.Results Decreased connectivities had been shown in depression,including amygdala-thalamus,amygdala-left inferior frontal gyrus,supramarginal gyrus-dorsomedial prefrontal cortex/anterior cingulate cortex (ACC),middle temporal gyrus-middle frontal gyrus and thalamus-inferior frontal gyros/left frontal eye fields (FEF) connectivity;while increased connectivities included hippocampus-middle temporal gyrus,hippocampusventromedial prefrontal cortex/middle temporal gyrus/ACC/FEF,middle temporal gyrus-fusiform gyrus/FEF,insula-middle temporal gyrus/FEF and thalamus-caudate connectivity (P＜0.05).For depression,global hubs included left amygdale,right hippocampus,right middle frontal gyrus,and right insula.For healthy group,global hubs included bilateral amygdale and middle frontal gyrus,right anterior inferior parietal lobe and right insula.Conclusion There are common and different characters in functional connectivity of emotional memory network between depression and healthy control.Global hub function decreases in the right amygdale and left inferior frontal gyrus,while right hippocampus shows compensatory increase.

Objective The brain volume and behavioral performance of emotional memory were measured by combining voxel-hased morphometry (VBM) and behavior to explore the morphological characters of brain regions related to the emotional enhancement effect of memory.Methods A total of 32 healthy young subjects participated in the study.The experimental processes included MR scan and behavioral performance of emotional memory the latter of which involved two phases-encoding and retrieval.Behavioral performance was recorded and the whole-brain 3D MRI data were acquired via 3.0T MR.3D MRI data were segmented by VBM5,and the wholebrain volumes of gray matter,white matter and CSF were produced.SPM5 and SPSS13.0 were used for statistical analysis of the 3D MRI data and behavioral data,respectively.Results Retrieval accuracy of the emotional pictures was higher than that of the neutral pictures ( t =5.08,P＜0.001 ),the emotional enhancement effect was significant ( Δ Pr =0.12 ± 0.01 ).Brain regions related to emotional enhancement effect included bilateral amygdala,dorsolateral prefrontal cortex,middle frontal gyrus,dorsomedial prefrontal cortex,fusiform gyms,right parahippocampus,left orbitofrontal cortex and middle cingulate gyms.Volume ratio of bilateral amygdala were related to emotion enhancement effect evidently (left:r=0.564,P＜0.01 ; right:r=0.541,P＜0.01 ).Conclusion This study morphologically confirms that brain regions,such as amygdale and prefrontal cortex,are critical structures for the enhancement of emotional memory,and further extends the findings of previous functional imaging studies.

Objective To evaluate the accuracy of five blood glucose measurements commonly used in ICU and to determine the potential factors interfering the accuracy. Method This prospective study carried out in consecutively enrolled 49 patients stayed more than 48 hours in the medical ICU of Peking Union Medical College Hospital from November 2007 to January 2008. A total of 130 blood samples were measured to determine blood glucose with five different methods, and the biochemistry analyzer in central laboratory was regarded as reference method for comparison with other four methods, ( 1 ) capillary blood/glucometer;(2) arterial blood/glucometer; (3) arterial blood/blood gas analyzer; and (4) arterial blood/biochemistry analyzer. The accuracy of a method tested was judged by the difference in level of blood glucose between it and reference method, correlation coefficient, bias correction factor and discrepancy. The independent factors for the discrepancies were identified by multivariate logistic regression. Results The values of differences in level of blood glucose between above four methods and the reference were ( 1.7 ± 1.4) mmol/L,( 1.6 ± 1.4 ) mmol/L, ( 1.1 ± 1.2) mmol/L, and (0.5 ± 1.2 ) mmol/L, respectively. The rates of discrepancy were 66.9%, 63.8%, 40.0% and 23.8%. The correlation coefficients were 0. 844, 0. 845, 0. 895and 0. 896. The bias correction factors were 0. 821,0.831,0.914 and 0. 979. Decrease in hematocrit was statistically associated with the discrepancy between glucometer analysis methods and the reference, with OR of 0.923 for capillary blood ( P = 0.03 ) and 0. 912 for arterial blood( P = 0.014), respectively. Conclusions Glucometer analysis poorly correlated with reference method and blood gas analysis in ICU patients. Decrease in hematocrit significantly increased the degree of discrepancy in glucose measurements between glucometer analysis and the reference.

BACKGROUND:Fluoride treatment of osteoporosis has been controversial.Literatures addressing the effect of fluoride on bone bio-mechanical parameters of femur in young rats are few.OBJECTIVE:To study the effects of fluoride on bone biomechanical parameters of femur in young rats.METHODS:Ninety 2-month-old SPF Sprague Dawley rats,half male and female,were randomly divided into 9 groups:control group(young,adult and long-time)and drug-administered group(young high-fluoride,young low-fluoride,adult high-fluoride,adut low-fluoride,long-term high-fluoride and long-term low-fluoride).Rats in the control group were orally administered with physiological saline,while in the drug-administered group were given orally with different dose fluoride at the corresponding times.After experiment,rats were sacrificed under anaesthesia.Three-point bending test was performed at the left femur.The effects of fluoride on maximum load and rigidity of femur were measured.RESULTS AND CONCLUSION:Compared with young control group,the maximum load and the rigidity of femur in the young high-fluoride group were decreased by 13.18%and 13.61%,respectively(P＜0.05),which had no dramatically difference in the young low-fluoride group.Compared with long-term high-fluoride group,the maximum load and the rigidity offemur in the young high-fluoride were decreased by 17.22%and 17.17%(P＜0.05),which were obvious increased in the long.term low-fluoride grou by 18.33%and 19.15%,respectively(P＜0.05).The maximum load and the rigidity of femur were strengthened in the adult high-fluoride and adult low-fluoride groups(P＜0.05).The results suggested that young rats are more sensitive to high-dose fluoride,which can reduce bone quality in rats.The negative effects on bone quailty of rats were gradually displayed as the prolongation of the period of fluoride.