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.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.

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 analyze characteristics and prophylaxis of pulmonary embolism (PE) after greater saphenous vein ligation and stripping.Methods We retrospectively analyzed the clinical characteristics and treatment of 11 inpatients with postoperative PE in Anhui Provincial Hospital and other hospitals from January 2008 to June 2013.Results In this group 6 patients died after failed cardiopulmonary resuscitation (CPR) and other treatments,the mortality was 54.5％.5 patients recovered after anticoagulation,thrombolysis and other treatments.During the process of thrombolysis,floating thrombus was found within the femoral vein in 2 patients and inferior vena cava filter was implanted.After 8-25 months follow-up,all 5 patients were free of difficulty of breathing,chest tightness,chest pain and other symptoms.Among many clinical manifestations,dyspnea (90.9％) was the most common,other clinical manifestations included chest pain (27.3％),syncope (18.2％),sudden death (18.2％).There was no typical triad of dyspnea,chest pain and hemoptysis in these patients.Conclusions Early diagnosis and early treatment of PE are most important to decrease mortality and to improve the prognosis of patients suffering from postoperative PE.

Objective To explore the effect of stromal cell-derived factor-1 ( SDF-1 ) in combination with transplantation of peripheral blood endothelial progenitor cells (EPCs) for the treatment of nude mice hindlimb ischemia. Methods Hindlimb ischemia model was established in nude mice, mice were then divided into five groups randomly: ischemic control group, peripheral blood EPCs transplantation group, SDF-1 local application group, SDF-1 combined with EPCs group, SDF-1 combined with AMD3100 treated EPCs group. Local CD34+VEGFR+ cells in the hind gastrocnemius were detected at day 3,7 after transplantation. The intensity of neovasculorization were evaluated at day 28. Results The double-positive cells number of control group, EPCs group, SDF-1 group, SDF-1 + EPCs group, SDF-1 + AMD3100 EPCs group were 0.00 ±0.00,5. 30 ±0.65,0.00 ±0.00,10. 31 ±0. 63,1. 86 ±0. 17 at day 3 and 0. 00 ±0. 00, 7.05 ±0. 18,0. 00 ±0. 00,11. 81 ±0. 53,2. 83 ±0. 48 at day 7. The number of new capillaries were 3. 00 ± 0.13,6.15 ± 0. 04,6. 20 ± 0. 10,10. 65 ± 0.08,6. 21 ±0. 08 at day 28. SDF-1 increased the CD34 + VEGFR+ cells (P ＜0. 05) and the number of new vessels (P ＜0.05). SDF-1 combined EPCs further increased the number of new vessels (P ＜ 0. 05 ). Conclusions SDF-1 enhances blood vessel formation and promotes angiogenesis by promoting EPCs homing, which could be blocked by AMD3100.

With the population aging, diet changing and incveasing risk factors on vascular disease, the lower extremity ischemic disease has become a frequently occurring disease of older person, and it is the main reason for amputation disability. In the 21st century the stem cells transplantation is one of the most advanced technologies and has been applied quickly to clinical therapy, regarded as a radical treatment of lower extremity ischemic disease. Endothelial progenitor cells have gradually become a new direction and a new research focus because of its unique biological characteristics in the treatment of this disease. This article focuses on endothelial progenitor cells in treating extremity ischemia lesions on the theoretical basis and research developments.

Objective:Glutamine is the main oxidative fuel of the enterocyte which enters the enterocyte primarily via amino acid transporters.The aim of the test was to study the distributions and functions of glutamine transporters in IEC-6 cell line.Methods:The rat intestinal epithelial cell line(IEC-6) was incubated in vitro.The mRNA expression of different glutamine transporters,protein expression of system ASCT2,and the [3H]-L-glutamine uptake were measured.Results:The mRNA of system ASCT2,SN1,ATA1,LAT1,LAT2 was expressed and the protein expression of ASCT2 was also validated in IEC-6.In Na+-containing buffer,the velocity of Na+-dependent glutamine uptake was(164.07?37.94) fmol/(mg protein?10min).In Na+-free buffer,the velocity of glutamine uptake was(58.71?10.51)fmol/(mg protein?10min).With the saturate dosage of MeAIB,the velocity of glutamine uptake was(81.02 ?19.59) fmol/(mg protein?10min).Conclusion:There may be five kinds of glutamine transporters(ASCT2,SN1,ATA1,LAT1,and LAT2) in IEC-6 cell.The Na+-dependent transporter was the major contributor(64.22%) to glutamine total uptake in IEC-6.The contributions of system A and the remainder were 50.62% and 13.60%,respectively.The Na+-independent transporter was the lesser contributor(35.78%).

Objective: It is difficult to repair large-area Ⅲ?burn wound in children.Here we introduce the advantages of the back skin donor site in repairing Ⅲ?burn wound in children.Methods: This clinical study included 15 children with Ⅲ?burn,ranging in age from 18 months to 11 years(mean 7.6 years),with the Ⅲ?burn wound area averaging at 12.6% of the total body surface.The back skin donor site was used to repair the wound.The functional site,such as the joint,was preferentially considered if the skin graft was not enough for all the wounds.Results: Most of the skin grafts survived and the donor sites on the back healed very well.The patients were followed up for six months to three years,which revealed that the skin grafts remained soft without dysfunction and the scar hyperplasia was mild on the donor site.Conclusion: The back donor site supplies larger-area skin with good quality.The donor site heals fast.After healing,patients could sleep on back and compress the scar so as to prevent scar hyperplasia,and the scar does not affect the patient's appearance.With all these advantages,the back donor site is a good choice for repairing Ⅲ?burn wound in children.