[Objective]To explore the efficacy of warm acupuncture combined with Guizhi Shaoyao Zhimu Decoction in the treatment of knee osteoarthritis and its effect on synovial hyperplasia.[Methods]A total of 106 patients with knee osteoarthritis treated at the Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to January 2024 were selected and randomly divided into two groups by using a computer-generated random number method,53 patients in observation group and 53 patients in control group.The control group was treated with Guizhi Shaoyao Zhimu Decoction,while the observation group received Guizhi Shaoyao Zhimu Decoction combined with warm acupuncture.After one month of treatment,the traditional Chinese Medicine(TCM)syndromes,knee joint function,inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),matrix metalloproteinase-3(MMP-3),synovial hyperplasia indicators such as cartilage oligomeric matrix protein(COMP),osteoprotegerin(OPG)and fibroblast growth factor-2(FGF-2)were compared between the two groups.The therapeutic efficacy and adverse reactions were also evaluated.[Results]After treatment,the joint pain,difficulty in extension and flexion,exacerbation in cold weather and heaviness of the limbs in both groups decreased,with observation group showing significantly lower scores than control group(P<0.05).After treatment,the Lysholm knee function score,knee flexion angle,OPG and FGF-2 levels in observation group were higher than those in control group(P<0.05),while COMP was lower(P<0.05).The levels of TNF-α,IL-1 and MMP-3 decreased in both groups,with observation group showing lower levels than control group(P

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Objective:To explore the effect of exercise on the memory of rats modeling vascular cognitive impairment (VCI) and also its effects on the hippocampal Sema3G/neuropilin-2 (Nrp2)/PlexinA4 signaling pathway.Methods:Eighteen male Sprague-Dawley rats were randomly divided into a sham-operated group, a model group, and an exercise group, each of 6. The model and exercise groups underwent VCI modeling via bilateral common carotid artery occlusion, while the sham-operated group received the same surgical procedure without vessel ligation or transection. Beginning forty-eight hours after the surgery, the exercise group carried out daily 30-minute treadmill training sessions, 5 days a week, for a total of 4 weeks, while the other two groups were placed on the same treadmill with it not in operation. After the intervention, cognitive functioning was assessed using the novel object recognition (NOR) test and a Y-maze test. Western blotting was employed to evaluate the expression of Sema3G, Nrp2, PlexinA4, and Rac1 in the hippocampus. Immunofluorescence staining was used to observe the distribution of Nrp2 and PlexinA4 in the hippocampus.Results:Compared with the model group, the exercise group exhibited significantly higher NOR indices during both the short-term and long-term memory testing phases after the intervention. Those rats also tended to have significantly longer total exploration times in the novel arm of the Y-maze test. The western blotting revealed that the expression levels of Sema3G, PlexinA4, and Rac1 in the hippocampus were significantly higher in the exercise group compared to the model group, on average. Immunofluorescence showed significantly increased PlexinA4 fluorescence intensity in the CA1, CA3, and dentate gyrus (DG) regions of the hippocampus, and significantly elevated Nrp2 fluorescence intensity in the CA3 region in the exercise group compared to the model group. The Pearson correlation coefficients for Nrp2/PlexinA4 co-localization in the CA1, CA3 and DG regions were significantly higher in the exercise group than in the model group.Conclusions:Exercise training significantly improves memory function in rats with VCI, and this effect may be associated with activation of the hippocampal Sema3G/Nrp2/PlexinA4 signaling pathway.

[Objective]To explore the efficacy of warm acupuncture combined with Guizhi Shaoyao Zhimu Decoction in the treatment of knee osteoarthritis and its effect on synovial hyperplasia.[Methods]A total of 106 patients with knee osteoarthritis treated at the Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to January 2024 were selected and randomly divided into two groups by using a computer-generated random number method,53 patients in observation group and 53 patients in control group.The control group was treated with Guizhi Shaoyao Zhimu Decoction,while the observation group received Guizhi Shaoyao Zhimu Decoction combined with warm acupuncture.After one month of treatment,the traditional Chinese Medicine(TCM)syndromes,knee joint function,inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),matrix metalloproteinase-3(MMP-3),synovial hyperplasia indicators such as cartilage oligomeric matrix protein(COMP),osteoprotegerin(OPG)and fibroblast growth factor-2(FGF-2)were compared between the two groups.The therapeutic efficacy and adverse reactions were also evaluated.[Results]After treatment,the joint pain,difficulty in extension and flexion,exacerbation in cold weather and heaviness of the limbs in both groups decreased,with observation group showing significantly lower scores than control group(P<0.05).After treatment,the Lysholm knee function score,knee flexion angle,OPG and FGF-2 levels in observation group were higher than those in control group(P<0.05),while COMP was lower(P<0.05).The levels of TNF-α,IL-1 and MMP-3 decreased in both groups,with observation group showing lower levels than control group(P

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.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Objective:To explore the effect of exercise on the memory of rats modeling vascular cognitive impairment (VCI) and also its effects on the hippocampal Sema3G/neuropilin-2 (Nrp2)/PlexinA4 signaling pathway.Methods:Eighteen male Sprague-Dawley rats were randomly divided into a sham-operated group, a model group, and an exercise group, each of 6. The model and exercise groups underwent VCI modeling via bilateral common carotid artery occlusion, while the sham-operated group received the same surgical procedure without vessel ligation or transection. Beginning forty-eight hours after the surgery, the exercise group carried out daily 30-minute treadmill training sessions, 5 days a week, for a total of 4 weeks, while the other two groups were placed on the same treadmill with it not in operation. After the intervention, cognitive functioning was assessed using the novel object recognition (NOR) test and a Y-maze test. Western blotting was employed to evaluate the expression of Sema3G, Nrp2, PlexinA4, and Rac1 in the hippocampus. Immunofluorescence staining was used to observe the distribution of Nrp2 and PlexinA4 in the hippocampus.Results:Compared with the model group, the exercise group exhibited significantly higher NOR indices during both the short-term and long-term memory testing phases after the intervention. Those rats also tended to have significantly longer total exploration times in the novel arm of the Y-maze test. The western blotting revealed that the expression levels of Sema3G, PlexinA4, and Rac1 in the hippocampus were significantly higher in the exercise group compared to the model group, on average. Immunofluorescence showed significantly increased PlexinA4 fluorescence intensity in the CA1, CA3, and dentate gyrus (DG) regions of the hippocampus, and significantly elevated Nrp2 fluorescence intensity in the CA3 region in the exercise group compared to the model group. The Pearson correlation coefficients for Nrp2/PlexinA4 co-localization in the CA1, CA3 and DG regions were significantly higher in the exercise group than in the model group.Conclusions:Exercise training significantly improves memory function in rats with VCI, and this effect may be associated with activation of the hippocampal Sema3G/Nrp2/PlexinA4 signaling pathway.

Approximately 60% of colorectal cancer (CRC) patients exhibit TP53 mutations, which are strongly associated with tumor progression, chemotherapy resistance, and an unfavorable prognosis. However, targeting p53 has historically been challenging, and currently, there are no approved p53-based therapeutics for clinical use worldwide. In this study, we discovered that ubiquitin carboxyl terminal hydrolase L3 (UCHL3) plays a crucial role in high-level glycolysis, enhanced stem-like properties, and 5-fluorouracil (5-FU) chemoresistance in TP53-mutant CRC by exerting its deubiquitinating enzyme activity to stabilize α-enolase (ENO1) protein. Notably, we identified a newly Food and Drug Administration (FDA)-approved drug, pacritinib, that potently suppresses UCHL3 expression by blocking the janus kinase 2 (JAK2)-signal transducer and activator of transcription 3 (STAT3) pathway in TP53-mutant CRC. Furthermore, Pacritinib was demonstrated to effectively inhibit glycolysis and improve the sensitivity to 5-FU chemotherapy in TP53-mutant CRC. Our findings suggest that targeting the JAK2-STAT3-UCHL3-ENO1 axis is a promising strategy to suppress glycolysis and enhance the efficacy of 5-FU chemotherapy in TP53-mutant CRC. Pacritinib shows potential for clinical application in the treatment of TP53-mutant CRC.

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 evaluate the surgical methods for treating distal urethral stricture.Methods:The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital,Captial Medical University between January 2018 and December 2022 were retrospectively collected.Including male geni-tal lichen sclerosus(MGLS)33 cases,iatrogenic injury 25 cases,postoperative hypospadias 12 cases,and other causes such as trauma 10 cases.Among these cases,strictures involved the urethral meatus in 54 instances,of which 38 were treated with meatotomy(MO),7 with penile skin flap urethroplasty(PSFU),and 9 with oral mucosa graft urethroplasty(OMGU).There were also 26 instances where stric-tures involved both the navicular fossa and meatus;one case underwent PSFU while 25 underwent OMGU.Based on different surgical methods used for treatment purposes we divided the patients into MO group,PSFU group and OMGU group.The age of the three groups was(48.8±20.0)years,(53.3±21.8)years and(44.5±16.4)years.The mean±SD body mass index(BMI)was(28.6±3.9)kg/m2,(29.6±3.2)kg/m2 and(29.2±4.8)kg/m2.The preoperative maximum flow rate was(5.8±2.3)mL/s,(6.8±2.4)mL/s and(5.7±3.1)mL/s.Results:All the operations were suc-cessfully completed without Clavien Ⅲ or Ⅳ complications.The median length of strictures(measured intraoperatively)in the three groups were 1.1(1.0,1.6),1.5(1.1,2.0)and 4.0(2.5,5.0)cm.The median operation time was 60.0(60.0,75.0),85.0(75.0,112.5)and 180.0(75.0,330.0)min.The median estimated blood loss was 5.0(2.0,10.0),15.0(5.0,42.5)and 180.0(135.0,216.3)mL.The median postoperative hospital stay was 3.5(2.0,5.0),6.5(3.5,7.0)and 7.5(7.0,11.3)days.The median follow-up duration was 40.0(26.3,57.3),55.0(18.8,62.8)and 52.5(30.5,64.0)months.The median postoperative maximum flow rate was 18.3(15.5,19.8),19.2(16.1,20.1)and 17.2(14.2,19.6)mL/s.Among the 38 patients with MO,33 cases had nor-mal urination without reintervention,and 5 cases experienced recurrent strictures and required regular urethral dilation.Among the 8 patients with PSFU,7 cases had normal urination without reintervention,and one case developed a urinary fistula,for which intervention was recommended but the patient opted to maintain the status quo.Among the 34 patients with OMGU,28 cases had normal urination without re-intervention.There were 6 instances of stenosis recurrence,with 5 cases requiring regular urethral dila-tions and one case requiring reconstructive surgery.The overall success rate of operation was 85.0％,and the reintervention rate was 15.0％.Statistical analysis revealed significant differences in etiologies among the three groups(P=0.002),as well as in stricture locations(P＜0.001),length of strictures(P＜0.001),operation time(P＜0.001),estimated blood loss(P＜0.001)and postoperative hospital stays(P＜0.001).However,no significant differences were observed in terms of age,BMI,history of previous urethral stricture surgeries,preoperative maximum flow rate,follow-up duration,postoperative maximum flow rate and reintervention rate.Univariate and multivariate Logistic regression analyses indi-cated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention(P=0.026).Conclusion:MO and PSFU are primarily suitable for treating short-segment(≤1.5 cm)distal penile urethral strictures,whereas OMGU is more appropriate for longer segment strictures.MO and OMGU can both be utilized in managing MGLS cases.PSFU and OMGU are more conducive to im-proving the appearance of the urethral meatus.The success rate of surgical management of distal penile urethral stricture is 85.0％,15.0％of the patients still require surgical intervention after surgery,and having history of previous urethral stricture surgeries is a risk factor for postoperative reintervention.