With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

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.

Objective:To observe any regulatory effect of a pulsed electromagnetic field (PEMF) on A2A adenosine receptors (A2ARs) in the nucleus pulposus of rats with intervertebral disc degeneration (IDD), and to explore any combination with the A2ARs′ agonist-mediating ROS/PI3K/Akt signaling pathway.Methods:Fifty Sprague-Dawley rats were randomly divided into a control group, an intervertebral disc degeneration group (the model group), an A2AR agonist CGS-21680 treatment group (the agonist group), a PEMF group and a PEMF combined with CGS-21680 treatment group (the observation group). IDD was modeled in all except the rats in the control group. 100μL of CGS-21680 (100μg/kg) was injected into the L 5-6 intervertebral discs of the agonist group, while the PEMF group was given 30 minutes of PEMF intervention daily for 14 days at 1.5mT and 75Hz with a pulse width of 150μs. The observation group was injected with CGS-21680 and then given the same PEMF intervention. Primary nucleus pulposus cells from each group (50ng/mL) were cultured and the expressions of 8-OHDG, SOD, MDA and ROS were detected by immunohistochemistry, immunofluorescence or with an ELISA kit. The A2AR, PI3K, AKT and p-AKT protein levels were detected using western blotting. Results:The nucleus pulposus cells and the annulus fibrosus were obviously wrinkled, necrotic and broken in the model group but the annulus fibrosus was intact and the nucleus pulposus was almost normal in the observation group. Compared with the model group, the levels of SOD and A2AR, PI3K, p-AKT and AKT protein were higher in the agonist, PEMF and observation groups, while the expressions of MDA, ROS and 8-OHDG were weaker. The ROS level in the observation group was significantly lower than that in the agonist and PEMF groups, and the phosphorylation level of p-AKT in the observation group was significantly higher than in the agonist and PEMF groups. The average levels of SOD, A2AR, PI3K, p-AKT and AKT protein in the nucleus pulposus cells of the agonist, PEMF and observation groups were significantly higher than the IL-1β group′s average, while the average levels of MDA, ROS and 8-OHDG were significantly lower. The ROS levels in the observation group were significantly lower than in the agonist and PEMF groups, while the A2AR protein content and p-AKT phosphorylation in the observation group were significantly greater. The average Bax levels in the nucleus pulposus cells of the agonist, PEMF and observation groups were significantly lower than that in the IL-1β group, and the expression of Bcl-2 was significantly increased. There was significantly less apoptosis observed in the observation group than in the agonist and PEMF groups, while the expression of Bcl-2 was significantly higher.Conclusions:PEMF plays an anti-oxidative stress role by up-regulating A2AR activity and reducing ROS generation. Treatment with PEMF and A2AR agonist could further activate the phosphorylation of PI3K/Akt, down-regulate Bax and up-regulate Bcl-2, thus inhibiting the apoptosis of nucleus pulposus cells and alleviating the malignant progression of IDD.

Objective:To investigate the incidence, clinical characteristics and risk factors of growth retardation in pediatric onset IBD patients.Methods:A cross-sectional study was conducted. IBD patients with the age at diagnosis younger than 18 years old were recruited and screened in the Wechat group of patients in 8 IBD medical centers across the country. Demographic, clinical and growth-related data were collected through questionnaire survey, and the incidences of growth retardation at the time of diagnosis and investigation were calculated. According to whether there was growth retardation at the time of investigation, the patients were divided into growth retardation group and non-growth retardation group. The influencing factors of growth retardation were analyzed by the univariate analysis and multivariate Logistic regression analysis.Results:A total of 97 patients were involved including 8 ulcerative colitis (UC) and 89 Crohn′s disease (CD). There was no growth retardation in UC patients. Among 89 patients with CD, there were 48 males and 41 females, and the age was 15.5 (1.0, 21.0) years old. At the time of investigation, 14 patients (15.7%) with growth retardation were set as the growth retardation group, and 75 without growth retardation were set as the non-growth retardation group. The incidence of growth retardation was 19.0% (16/84) at the time of diagnosis. Univariate analysis results showed that compared with non-growth retardation group, patients in growth retardation group had lower diagnostic age [5.0 (1.0, 13.8) years old vs. 14.0 (12.0, 16.0) years old, P = 0.003], severer disease activity ( P = 0.006), higher proportion of acute gastrointestinal perforation [28.6% (4/14) vs. 2.7% (2/75), P = 0.005], higher proportion of patients in using glucocorticoids [64.3% (9/14) vs. 33.3% (25/75), P = 0.029), and longer time of using glucocorticoids [1.5 (0, 6.5) months vs. 0 (0, 3.0) months, P = 0.040], while the proportion of patients using biological agents was lower [42.9% (6/14) vs. 80.0% (60/75), P = 0.010], and the time of using biological agents was shorter [0 (0, 6.3) months vs. 7.0 (1.0, 12.0) months, P = 0.006]. Logistic regression analysis revealed that the age at diagnosis of CD was still a risk factor for growth retardation after correcting other factors ( OR = 6.909, 95% CI: 1.250-38.195, P = 0.027) . Conclusion:The pediatric onset IBD patients with low diagnostic age are prone to growth retardation, which should be paid attention to.

Objective:To investigate the incidence, clinical characteristics and risk factors of growth retardation in pediatric onset IBD patients.Methods:A cross-sectional study was conducted. IBD patients with the age at diagnosis younger than 18 years old were recruited and screened in the Wechat group of patients in 8 IBD medical centers across the country. Demographic, clinical and growth-related data were collected through questionnaire survey, and the incidences of growth retardation at the time of diagnosis and investigation were calculated. According to whether there was growth retardation at the time of investigation, the patients were divided into growth retardation group and non-growth retardation group. The influencing factors of growth retardation were analyzed by the univariate analysis and multivariate Logistic regression analysis.Results:A total of 97 patients were involved including 8 ulcerative colitis (UC) and 89 Crohn′s disease (CD). There was no growth retardation in UC patients. Among 89 patients with CD, there were 48 males and 41 females, and the age was 15.5 (1.0, 21.0) years old. At the time of investigation, 14 patients (15.7%) with growth retardation were set as the growth retardation group, and 75 without growth retardation were set as the non-growth retardation group. The incidence of growth retardation was 19.0% (16/84) at the time of diagnosis. Univariate analysis results showed that compared with non-growth retardation group, patients in growth retardation group had lower diagnostic age [5.0 (1.0, 13.8) years old vs. 14.0 (12.0, 16.0) years old, P = 0.003], severer disease activity ( P = 0.006), higher proportion of acute gastrointestinal perforation [28.6% (4/14) vs. 2.7% (2/75), P = 0.005], higher proportion of patients in using glucocorticoids [64.3% (9/14) vs. 33.3% (25/75), P = 0.029), and longer time of using glucocorticoids [1.5 (0, 6.5) months vs. 0 (0, 3.0) months, P = 0.040], while the proportion of patients using biological agents was lower [42.9% (6/14) vs. 80.0% (60/75), P = 0.010], and the time of using biological agents was shorter [0 (0, 6.3) months vs. 7.0 (1.0, 12.0) months, P = 0.006]. Logistic regression analysis revealed that the age at diagnosis of CD was still a risk factor for growth retardation after correcting other factors ( OR = 6.909, 95% CI: 1.250-38.195, P = 0.027) . Conclusion:The pediatric onset IBD patients with low diagnostic age are prone to growth retardation, which should be paid attention to.

Based on the higher requirements of the complex maritime battlefield environment for medical support under the new circumstances, this article carried out the task analysis of medical service provided by the large warship as a maritime medical treatment platform. The article introduced the overall architecture of a China’s dock landing ship (LSD) and its current deployment scheme of medical resources, reviewed the current development in China and other countries of LSD fulfilling the mission of maritime medical support, and put forward the assumption of an LSD taking the mission of maritime medical support as a level-2 medical platform. Furthermore, the article discussed and demonstrated the ship’s capacity of medical service and the demand for medical support when it was used as a medical treatment platform from two aspects, i. e., the scope of medical treatment and the deployment of medical resources, with a view to providing scientific basis and theoretical support for carrying out "capacity-based" training with full complement of personnel and equipment in real combat conditions.

Based on the higher requirements of the complex maritime battlefield environment for medical support under the new circumstances, this article carried out the task analysis of medical service provided by the large warship as a maritime medical treatment platform. The article introduced the overall architecture of a China’s dock landing ship (LSD) and its current deployment scheme of medical resources, reviewed the current development in China and other countries of LSD fulfilling the mission of maritime medical support, and put forward the assumption of an LSD taking the mission of maritime medical support as a level-2 medical platform. Furthermore, the article discussed and demonstrated the ship’s capacity of medical service and the demand for medical support when it was used as a medical treatment platform from two aspects, i. e., the scope of medical treatment and the deployment of medical resources, with a view to providing scientific basis and theoretical support for carrying out "capacity-based" training with full complement of personnel and equipment in real combat conditions.

According to the related requirements of safety reevaluation of TCM injections,hospital centralized monitoring of the safety of TCM injection was consecutively pressed ahead.Centralized security monitoring was a large-scale real world research involving numerous data acquisition,transmission,verification and analysis.The quality of data acquisition and data verification directly affected the authenticity and reliability of research data and results.Therefore,data management played a significant role in the safety monitoring of TCM injections.Based on the analysis of previous researches,this paper discussed the implementation content,links and the frequent problems and corresponding solutions of data management during the safety monitoring of TCM injections,combining with the experience in the implementation of projects.

The implementation process management plays a important role for the quality of centralized safety monitoring study of post-marketing Chinese medical injections.One of the critical link is hospital.Currently,there is no principle or specification for hospital choosing,number of monitoring points,data collection responsible part and forms of data collection as well.These issues caused uneven quality,huge differences in results and questioned conclusion.Based on the previous research experience,this paper focused on discussing the link of hospital where research data may be influenced,and proposed some suggestions.