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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.
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Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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Edible bird's nest (EBN) is a kind of natural invigorant with a long history of consumption in Asia, especially in China. EBN is formed by mixing the saliva of swiftlets (Aerodramus) with feathers and other components during the breeding season. Proteins are the most important nutrient in EBN. By studying proteins in EBN, we can not only elucidate their components at the molecular level, but also study their bioactivities. Therefore, it is of great significance to study the proteins in EBN. Previous research on the proteins in EBN was preliminary and cursory, and no one has summarized and analyzed the proteins in EBN and correlated the bioactivities of these proteins with the biological functions of EBN. This article focused on the proteins in EBN, listed the proteins identified in different proteomic studies, and introduced the sources, structures and bioactivities of the most frequently identified proteins, including acidic mammalian chitinase, lysyl oxidase homolog 3, mucin-5AC, ovoinhibitor, nucleobindin-2, calcium-binding protein (MW: 4.5 × 104) and glucose-regulated protein (MW: 7.8 × 104). The properties of these proteins are closely related to the bioactivities of EBN. Therefore, this article can provide inspiration for further research on the efficacy of EBN.
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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.
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Ischemic cerebrovascular disease (ICVD) is the most common type of nervous system disease in clinical practice in China at present. It is the important leading cause of death after heart disease and tumors. Ischemic cerebrovascular disease has a high rate of occurrence and mortality. It is easy to cause problems such as limb dysfunction, language disorders, nerve dysfunction, etc. It has a great negative effect on the quality of life of patients, and seriously affects the quality of their lives. Although the current research on the treatment of the disease has achieved certain results, single therapies can only treat some key parts of the disease and cannot completely reverse the whole process. At present, thrombolysis, antiplatelet aggregation, degradation of plasma fibrin, anticoagulation, and hemodilution are mainly used in clinical treatment. It is critical to select appropriate treatment methods based on the pathological characteristics of patients to improve efficacy and prognosis. In this review, the research progress in therapies for ischemic cerebrovascular disease was reviewed, both at home and abroad.
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The global pandemic of coronavirus disease 2019 (COVID-19) has killed almost two million people worldwide and over 400 thousand in the United States (US). As the pandemic evolves, informed policy-making and strategic resource allocation relies on accurate forecasts. To predict the spread of the virus within US counties, we curated an array of county-level demographic and COVID-19-relevant health risk factors. In combination with the county-level case and death numbers curated by John Hopkins university, we developed a forecasting model using deep learning (DL). We implemented an autoencoder-based Seq2Seq model with gated recurrent units (GRUs) in the deep recurrent layers. We trained the model to predict future incident cases, deaths and the reproductive number, R. For most counties, it makes accurate predictions of new incident cases, deaths and R values, up to 30 days in the future. Our framework can also be used to predict other targets that are useful indices for policymaking, for example hospitalization or the occupancy of intensive care units. Our DL framework is publicly available on GitHub and can be adapted for other indices of the COVID-19 spread. We hope that our forecasts and model can help local governments in the continued fight against COVID-19.
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Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multi-model ensemble forecast that combined predictions from dozens of different research groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naive baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-week horizon 3-5 times larger than when predicting at a 1-week horizon. This project underscores the role that collaboration and active coordination between governmental public health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks. Significance StatementThis paper compares the probabilistic accuracy of short-term forecasts of reported deaths due to COVID-19 during the first year and a half of the pandemic in the US. Results show high variation in accuracy between and within stand-alone models, and more consistent accuracy from an ensemble model that combined forecasts from all eligible models. This demonstrates that an ensemble model provided a reliable and comparatively accurate means of forecasting deaths during the COVID-19 pandemic that exceeded the performance of all of the models that contributed to it. This work strengthens the evidence base for synthesizing multiple models to support public health action.
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The rotator cuff of the elderly always is significantly degenerated and often accompanied by osteoarthritis, muscle weakness and muscle atrophy. Rotator cuff tear is the most common cause of shoulder pain. The incidence of massive rotator cuff tear is high in the elderly. Damaged rotator cuff tissue is difficult to repair with a high retear rate after surgical repair, which seriously reduces the quality of life of patients. Therefore, the authors focus on a brief overview of the characteristics, treatment choices, and rehabilitation exercises of the aged patients with massive rotator cuff tear so as to provide references for treating massive rotator cuff tear in the elderly.
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Objective:To investigate the effect of passive motion and immobilization on shoulder function early after arthroscopic repair of rotator cuff tears.Methods:A retrospective case-control study was conducted to analyze the clinical data of 78 patients with rotator cuff tear admitted to Xinhua Hospital, Shanghai Jiaotong University School of Medicine from January 2016 to December 2017. There were 36 males and 42 females, aged 35-78 years [(62.7±3.2)years]. There were 36 patients with medium-sized tears (1-3 cm), 31 with small tears (<1 cm), and 11 with partial articular supraspinatus tendon avulsion (PASTA). All patients underwent arthroscopic rotator cuff repair. Forty-three patients started rehabilitation exercise immediately after operation (motion group). Thirty-five patients were immobilized with shoulder abduction brace for 6 weeks, and started rehabilitation exercise at week 7 (immobilization group). The range of motion, visual analogue pain score (VAS), simplified shoulder joint function test (SST) and Constant shoulder joint score were compared between the two groups before surgery, 6 weeks, 3 months and 12 months after surgery. The healing results were assessed by ultrasound 12 months after surgery. Complications were observed.Results:All the patients were followed up for 12-16 months [(13.7±1.3)months]. There were 7 patients with shoulder joint stiffness in each group (motion group: 16%, immobilization group: 20%) ( P<0.05). There were no significant differences between the two groups in VAS, SST or Constant score at postoperative 6 weeks, 3 months and 12 months ( P>0.05). The forward flexion and external rotation with the arm at the side in immobilization group was (124.9±12.9)° and 25(20, 30)° at postoperative 6 weeks, significantly improved in motion group [(136.6±16.7)°, 30(25, 40)°] ( P<0.05). There were no significant differences between the two groups in forward flexion and external rotation with the arm at the side at postoperative 3 and 12 months ( P>0.05). There were no significant differences between the two groups in internal rotation at postoperative 6 weeks, 3 months, and 12 months ( P>0.05). All rotator cuffs were healed verified by ultrasound at postoperative 12 months. No infection or implant displacement occurred after operation. Conclusions:For arthroscopic repair of medium-sized tears, small tears and PASTA, early postoperative rehabilitation exercises have advantage in improving range of motion only at early stage when compared to immobilization, which disappears with time. Moreover, the two methods have no significant differences in improving postoperative pain and shoulder function.
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Objective:To investigate the influences of anxiety on postoperative efficacy in elderly patients with complex proximal humerus fractures.Methods:A retrospective case control study was conducted to analyze the clinical data of 297 elderly patients with complex proximal humerus fractures admitted to 5 tertiary hospitals in Shanghai from January 2017 to December 2018. There were 121 males and 176 females, aged 65-85 years [(74.2±8.5)years]. The fracture types included Neer type III in 176 patients and Neer type IV in 121 patients. Two days after admission, patients were analyzed by self-rating anxiety scale (SAS) and anxiety factors questionnaire (participated by Shanghai Mental Health Center) and they were divided into anxiety group (SAS>35) and nonanxiety group (SAS≤35). Anxiety group included 68 patients, among which 7 had conservative treatments. Nonanxiety group contained 229 patients, among which 7 had conservative treatments. Both groups underwent with proximal reduction of humerus fractures accepted the operations. Operative patient in both groups underwent open reduction and plate fixation. The surgery rate and length of hospital stay were compared between groups. After 1 year of follow-up, Constant-Murley score was used to evaluate the effect of shoulder joint and dual-energy X-ray absorptiometry (DXA) was taken to observe the wrist joint bone mineral density. Postoperative complications were recorded.Results:All operative patients were followed up for 10-28 months, with an average of 13.6 months. The surgery rate was 89.7% (61/68) in anxiety group and 96.9% (222/229) in nonanxiety group ( P<0.05). The hospital stay was (6.8±3.4)days for non-surgery patients and (10.2±2.8)days for surgery patients in anxiety group and (4.2±1.6)days for non-surgery patients and (7.4±2.2)days for surgery patients in nonanxiety group ( P<0.05). In anxiety group and nonanxiety group, the excellent and good rate of Constant-Murley score was respective 75.4% (46/61) and 88.3% (196/222) and the wrist joint bone mineral density was respective (-3.1±0.5)SD and (-2.9±0.6)SD (both P<0.05). The incidence of complications was 8.2% (5/61) in anxiety group and 4.5% (10/222) in nonanxiety group ( P>0.05). Conclusions:Anxiety has a significant negative influence on the surgery rate, length of hospital stay, shoulder joint function, wrist joint bone mineral density. Intervention on anxiety in elderly patients with complex proximal humerus fractures should be valued attention by clinical orthopedic surgeons.
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Objective:To identify potential risk factors of varus collapse after unstable proximal humerus fracture treated with locking plates.Methods:A retrospective case series study was conducted on data of 146 patients with unstable proximal humerus fracture stabilized by locking plates at Xinhua Hospital, Shanghai Jiaotong University School of Medicine from January 2008 through December 2014. These patients were classified into varus collapse group ( n=39) and non-varus collapse group ( n=107) according to the occurrence of varus collapse. The gender, age, bone mineral density, cause of injury, fracture Neer classification, fracture type (varus or valgus), surgical timing, surgical techniques (medial support, cancellous bone graft, suture augmentation), number of humeral head screws and reduction quality were recorded. Potential risk factors were evaluated using univariate analysis and multivariate Logistic regression. The subjective reliability analysis was performed for Neer classification and medial fracture assessments. Results:Varus collapse group had higher ratio of osteoporosis, varus fracture, lack of medial column support, absence of suture augmentation and varus malreductin compared to non-varus collapse group ( P<0.05). While the two groups had no significant differences in gender, age, fracture classification, allogeneic cancellous bone transplantation and number of humeral head screws ( P>0.05). Moreover, the Logistic regression analysis indicated that osteoporosis, varus fracture, lack of medial column support, absence of suture augmentation and varus malreduction were major independent risk factors for varus collapse in proximal humerus fractures ( P<0.05). Among these risk variables, the lack of medial column support showed the strongest correlation of varus collapse after proximal humerus fractures treated with locking plates ( OR=9.62), and varus malreduction was another remarkable risk factor ( OR=8.39). The reliability of Neer classification and medial fracture assessments between interobservers and intraobservers was good. Conclusion:The risk factors for varus collapse after unstable proximal humerus fracture treated with locking plate are osteoporosis, varus fracture, lack of medial column support, absence of suture augmentation and varus malreduction.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Since December 2019, corona virus disease 2019 (COVID-19) 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 COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 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 COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With aim to reasonably cope with the elderly patients with hip fracture during epidemic of corona virus disease 2019 (COVID-19), Professor Su Jiacan and Academician Zhang Yingze organized the "expert consensus on diagnosis and treatment of elderly patients with hip fracture under epidemic of corona virus disease 2019" that for the first time formulated the management strategies for the elderly patients with hip fracture including selection of surgical methods and protective measures for medical staff from perspective of orthopedic surgeons. The authors interpret the clinical guiding value and key points of diagnosis and treatment of the consensus to help clinicians better understand the consensus and strengthen its practical application.
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With the spread of corona virus disease 2019 (COVID-19) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus to make better decision against this epidemic and protect patients and medical staff. This consensus elaborates not only epidemic condition of COVID-19, but also general principles of medical admission, treatment and protection for both medical staff and patients, so as to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of COVID-19.
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Objective:To understand the current situation of research in the field of sepsis caused by Gram positive bacteria (G + bacteria) in China, to clarify the research content and analyze its general research direction, so as to find the hot topics of research in recent years. Methods:The literatures in SinoMed related to sepsis caused by G + bacteria and published in Chinese from building database to October 2019 were screened. The distribution and trend of the published year, journals, research institutions and researchers of relevant literature were analyzed, and Ucinet 6.0 software was used to draw the social network graph of the researchers and to analyze their internal relations. The subject words of related literatures were extracted. The relationship among the subject words in related literatures was arranged according to the centrality by NetDraw in Ucinet 6.0 software, the bibliographic information co-occurrence analysis system software (BICOMS2 software) was used to classify the subject words and the visualization matrix was generated. The graph clustering tool software (gCLUTO software) was used to cluster the subject words, and the visualization surface graph was generated to analyze the current research hot spot, research trend and research direction of G + bacteria-induced sepsis. Results:A total of 1 976 literatures about sepsis caused by G + bacteria were retrieved, and 26 literatures in conference summaries, news reports, research information, missing content, or inconsistent with the theme were excluded. Finally, a total of 1 950 literatures were enrolled in final analysis. The number of published literatures analysis showed that from 1979 to 1992, there were few studies about sepsis caused by G + bacteria, which increased geometrically from 2008, and the number of literatures published from 2008 to 2018 was 1 144, accounting for 58.67% (1 144/1 950). From 1979 to 2019, 23 high-yield institutions published more than 5 literatures, of which 6 were institutions with 10 or more literatures, and only one institution with more than 20 literatures. There were only 5 journals with more than 100 articles, 5 381 authors involved in the literatures, but few authors with more than 10 literatures published, and no inter-provincial or inter-municipal cooperation was found. A social network analysis of 103 high-frequency subject words that appeared more than 5 times showed that the study of sepsis caused by G + bacteria mainly focused on "sepsis", including the incidence of sepsis caused by drug resistant Staphylococcus aureus was on the rise, especially in newborns and children with weakened immune systems, the selection of therapeutic drugs gradually developed to glycopeptides with strong anti-drug resistance and synthetic oxazolidinones. The research and development of drugs for the treatment of sepsis caused by G + bacteria might become a new research direction or field in the future. Cluster analysis of 103 high-frequency subject words showed that the research hot spots of G + bacteria-induced sepsis mainly focused on five topics, namely early diagnosis of sepsis; bacterial infection pathway of sepsis, nosocomial infection and bacterial drug resistance; the basis of epidemiological prevention and treatment of sepsis; venous catheter infection-related sepsis; the treatment, nursing and prognosis of patients with sepsis. Conclusion:The studies of sepsis caused by G + bacteria are winning more and more attention, but the resources sharing and academic exchanges among hospitals need to be further improved.
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With aim to reasonably cope with the elderly patients with hip fracture during epidemic of corona virus disease 2019 (COVID-19), Professor Su Jiacan and Academician Zhang Yingze organized the "expert consensus on elderly patients with hip fractures under epidemic of novel coronavirus pneumonia" that for the first time formulated the management strategies for the elderly patients with hip fracture including selection of surgical methods and protective measures for medical staff from perspective of orthopedic surgeons. The authors interpret the clinical guiding value and key points of diagnosis and treatment of the consensus to help clinicians better understand the consensus and strengthen its practical application.
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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.
ABSTRACT
With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.
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Objective@#To evaluate the effects of the classical prescriptions Dahuang-Huanglian-Xiexin decoction combined with conventional western medicine on the lipid metabolism disorder and changes of intestinal microflora in patients with type 2 diabetes mellitus (T2DM).@*Methods@#A total of 120 patients who met the inclusion criteria were divided into the two group according to the treatment order, with 60 patients in each group. Both groups were given conventional hypoglycemic therapy, the control group was given bifidobacteria lactobacillus triple viable tablets, and the treatment group was given Dahuang-Huanglian-Xiexin decoction on the basis of the control group. Both groups were treated with 14 days for one course and 4 courses in total. The number of gram-positive coccus (G+c), gram-negative coccus (G-c), gram-positive bacillus (G+b) and gram-negative bacillus (G-b) in each 500 bacteria were observed under oil microscope, and the cocci/bacillus ratio were calculated. The TC and TG were detected by oxidase method, and HDL and LDL were detected by automatic biochemical analyzer. The FPG, 2 hPG and HbA1c were detected by automatic biochemical analyzer. TCM symptom scores were calculated.@*Results@#After treatment, the abdominal distension, congestion discomfort, and constipation score were significantly lower than the control group (t values were 3.685, 3.551 and 3.708, respectively, all Ps<0.05); Serum TG, TC and LDL-c levels were significantly lower than the control group (t values were 3.602, 3.581 and 3.421, respectively, all Ps<0.05); HDL-c level was significantly higher than that of the control group (t=3.358, P=0.046); Serum FPG, 2 hPG and HbA1c levels were significantly lower than the control group (t values were 3.502, 3.271 and 3.708, respectively, all Ps<0.05). After treatment, the G-c (271.47/500 ± 22.63/500 vs. 266.81/500 ± 22.36/500, t=3.792), G+b (81.26/500 ± 6.52/500 vs. 73.19/500 ± 6.94/500, t=3.511), G-b (183.76/500 ± 16.19/500 vs. 164.37/500 ± 15.83/500, t=3.306) levels in the treatment group significantly higher than those in the control group (P<0.05). After treatment, both c/b levels was (0.65 ± 0.13 vs. 0.87 ± 0.21, t=3.325) decreased significantly (P<0.05).@*Conclusions@#Dahuang-Huanglian-Xiexin decoction combined with conventional western medicine can improve the clinical symptoms of T2DM patients, reduce blood glucose and lipid levels, and inhibit the body mass and improve insulin resistance by adjusting the structure of intestinal flora, increasing probiotics and reducing pathogenic bacteria.
