Objective To investigate the clinical effect of hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of mixed hemorrhoids with annular prolapse.Methods A retrospective analysis was conducted to select 80 patients with annular prolapse mixed hemorrhoids admitted to the anorectal Department of our hospital from January 2022 to April 2023.According to different treatment plans,they were divided into control group(n=40 cases)who received external stripping and internal ligation combined with tape ligation,and study group(n=40 cases)who received hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligation and suspension.The operative effect,operative status,postoperative anal pain,anal edema,stool blood score and quality of life were evaluated.Results The effective rate of the study group was 97.50％,which was higher than that of the control group(77.50％)(P＜0.05).The operation time,intraoperative blood loss,hospital stay and wound healing time of the research group were(25.03±10.00)minutes,(10.00±5.32)ml,(7.25±1.54)days and(12.21±2.00)days respectively.[is better than that of control group(29.85±14.00)minutes,ml(17.85±10.25),(11.87±2.35),(18.89±4.85)days],two groups of comparison,the difference was statistically significant(P＜0.05).The VAS scores of anal pain in the study group on 1 day,3 days and 7 days after the operation were(4.25±0.85)points,(2.89±0.54)points and(2.00±0.30)points,respectively.The scores of perianal edema were(1.87±0.36)points,(1.41±0.30)points,and(1.00±0.20)points,respectively.The hematochezia scores were(1.85±0.21)points,(1.34±0.18)points,and(0.85±0.13)points,respectively.Which were better than that of control group[(7.56±1.10),(6.54±1.03),(4.87±1.00)][(2.40±0.58),(2.03±0.49),(1.87±0.45)][(2.45±0.55),(2.03±0.47),(1.88±0.25)],and the differences were statistically significant(P＜0.05).The recurrence rate was 2.50％in the study group and 17.50％in the control group(P＜0.05).The scores of SF,MH,PF and GH of the Modified Health Survey Summary Form(SF-36)in the study group were(88.54±10.22,87.87±10.58,88.97±10.00,89.95±10.05)higher than those of the control group(67.52±10.00,70.10±11.25,71.10±9.85,70.00±10.00)(P＜0.05).Conclusion Hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of patients with annular prolapse mixed hemorrhoids has ideal surgical effect and little trauma,which is beneficial to promoting postoperative rehabilitation,alleviating anal pain,improving anal edema and hematostoecium,and improving quality of life.

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 investigate the clinical effect of hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of mixed hemorrhoids with annular prolapse.Methods A retrospective analysis was conducted to select 80 patients with annular prolapse mixed hemorrhoids admitted to the anorectal Department of our hospital from January 2022 to April 2023.According to different treatment plans,they were divided into control group(n=40 cases)who received external stripping and internal ligation combined with tape ligation,and study group(n=40 cases)who received hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligation and suspension.The operative effect,operative status,postoperative anal pain,anal edema,stool blood score and quality of life were evaluated.Results The effective rate of the study group was 97.50％,which was higher than that of the control group(77.50％)(P＜0.05).The operation time,intraoperative blood loss,hospital stay and wound healing time of the research group were(25.03±10.00)minutes,(10.00±5.32)ml,(7.25±1.54)days and(12.21±2.00)days respectively.[is better than that of control group(29.85±14.00)minutes,ml(17.85±10.25),(11.87±2.35),(18.89±4.85)days],two groups of comparison,the difference was statistically significant(P＜0.05).The VAS scores of anal pain in the study group on 1 day,3 days and 7 days after the operation were(4.25±0.85)points,(2.89±0.54)points and(2.00±0.30)points,respectively.The scores of perianal edema were(1.87±0.36)points,(1.41±0.30)points,and(1.00±0.20)points,respectively.The hematochezia scores were(1.85±0.21)points,(1.34±0.18)points,and(0.85±0.13)points,respectively.Which were better than that of control group[(7.56±1.10),(6.54±1.03),(4.87±1.00)][(2.40±0.58),(2.03±0.49),(1.87±0.45)][(2.45±0.55),(2.03±0.47),(1.88±0.25)],and the differences were statistically significant(P＜0.05).The recurrence rate was 2.50％in the study group and 17.50％in the control group(P＜0.05).The scores of SF,MH,PF and GH of the Modified Health Survey Summary Form(SF-36)in the study group were(88.54±10.22,87.87±10.58,88.97±10.00,89.95±10.05)higher than those of the control group(67.52±10.00,70.10±11.25,71.10±9.85,70.00±10.00)(P＜0.05).Conclusion Hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of patients with annular prolapse mixed hemorrhoids has ideal surgical effect and little trauma,which is beneficial to promoting postoperative rehabilitation,alleviating anal pain,improving anal edema and hematostoecium,and improving quality of life.

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 study the efficacy of ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine in postoperative analgesia after cesarean section.Methods:98 cases of women who underwent cesarean section in our hospital from Jan. 2021 to Jan. 2024 were selected, and all patients were divided into control group and study group with 49 cases each using random number table method. Both groups received routine cesarean section, the control group was given quadrate fascia plane block, and the study group was given quadrate fascia plane block combined with dexmedetomidine. The postoperative recovery, pain score, sufentanil dosage, sleep quality and incidence of adverse reactions were compared between the two groups.Results:There was no significant difference in age, gestational age or BMI between the two groups ( P>0.05). The first standing time of the study group was (5.52±1.09) h, the walking time of getting out of bed was (7.45±1.79) h, and the colostrum time was (27.61±2.92) h. The three indexes of the control group were (6.94±1.48) h, the walking time of getting out of bed was (9.52±2.03) h, and the colostrum time was (32.08±3.45) h, respectively. The study group was lower than the control group ( P<0.05). The NRS score at rest 12h and 24h after surgery was (2.58±0.53; 1.57±0.68) score, 12h, 24h resting NRS score of control group was 3.54±0.75, 3.12±1.01; The score was lower in the study group than that in the control group ( P<0.05). The NRS scores of 12h and 24h postoperative activities in the study group were (3.61±0.72; The NRS score of 12h and 24h activities in the control group was 4.12±0.79, 3.73±1.08; The score in the study group was lower than that in the control group ( P<0.05). The dosage of sufentanil for 12h, 24h and 48h in the study group was (15.17±3.24; 23.28±4.02; 41.61±4.82) μg, 48h analgesic pump compression times were (2.94±1.22) times, the number of relief analgesia cases were 3 times, the dosage of sufentanil at 12h, 24h, 48h in the control group was (20.08±4.03; 36.14±4.57; 59.33±6.25) μg, 48h analgesic pump compression times were (6.15±1.71) times, the number of relief analgesia cases was 10 times, the study group was lower than the control group ( P<0.05). The PSQI scores at 1d, 2d and 3d were 15.14±1.15; 16.31±1.21; 17.34±1.31 in the control group, while they were 13.25±1.08; 15.28±1.16; 16.45±1.25 in the study group, lower than that in the control group ( P<0.05). The incidence of adverse reactions was 10.20% in the study group and 26.53% in the control group, lower than that in the control group ( P<0.05) . Conclusion:Ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine can improve the recovery after cesarean section, reduce the pain after delivery and sufentanil dosage, improve the quality of sleep and reduce adverse reactions, and have a good analgesic effect.

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.

AIM:To explore the therapeutic effect of Buyang-Huanwu decoction (BYHWD) on experimental au-toimmune encephalomyelitis ( EAE) and its immunoregulatory effect on monocyte-macrophages .METHODS: Chronic EAE was induced by myelin oligodendrocyte glycoprotein peptide fragment 35-55 ( MOG35-55 ) in the female C57BL/6 mice, which were randomly divided into saline group and BYHWD group .On day 3 after immunization , the mice in BYHWD group were orally administrated with BYHWD , while normal saline was given to the control mice .The clinical score and body mass were recorded every other day .At day 17 after immunization , the mice were sacrificed and spinal cords were obtained for HE staining and myelin staining .The M1 and M2 macrophage phenotypes of splenic cells were detected by flow cytometry and immunofluorescence staining .The protein expression of iNOS , TNF-α, arginase and IL-10 in the spinal cord macro-phages was determined by Western blotting .RESULTS:BYHWD delayed the onset of EAE , reduced the clinical scores of EAE, inhibited the inflammatory cell infiltration and demyelination in the spinal cord , and promoted the conversion of M 1 macrophages into M2 phenotype in the spinal cord and spleen .CONCLUSION:BYHWD intervention attenuates the be-havioral and pathological changes in the EAE mice , and its mechanism may be related to the macrophage conversion .

OBJECTIVE: To explore the therapeutic effect of Fasudil-modified splenic mononuclear cells (MNCs) in experimental autoimmune encephalomyelitis (EAE) and the possible mechanisms.
 METHODS: C57BL/6 female mice were immunized with myelin oligodendrocyte glycoprotein peptide 35-55 to establish active immunity EAE model. Splenic MNCs were isolated on the 9th day after immunization and treated with or without Fasudil for 72 h in vitro. These cells were collected for analysis of the variance of T cell subtypes, the level of cytokines and the activity of Rho kinase (ROCK). MNCs (5×107 cells) were resuspended in 500 µL of phosphate buffer solution (PBS) and transferred into EAE model (intraperitoneal injection), which was divided into a PBS-MNCs group and a Fasudil-MNCs group. Changes of body weight and clinical symptom scores were observed.
 RESULTS: Splenic encephalitogenic MNCs from EAE mice on the 9th day after immunization could establish passive transfer EAE model. But Fasudil-treated MNCs did not trigger EAE development. Compared with the PBS-MNCs group, the loss of body weight was less in the Fasudil-MNCs group. The in vitro experiment indicated that Fasudil could suppress the activity of ROCK on MNCs (P<0.01), decrease the percentage of CD4+ T cells with the expression of interferon-γ (IFN-γ) and interleukin-17 (IL-17) (IFN-γ: P<0.01; IL-17: P<0.05), while increase the secretion of CD4+ T cells with the expression of transforming growth factor-β (TGF-β) and IL-10 (all P<0.001) . Furthermore, Fasudil could inhibit the release of IL-17 (P<0.001) and enhance the level of IL-10 (P<0.05).
 CONCLUSION Fasudil-modified cell therapy affects the occurrence and development of EAE by inhibiting the inflammatory reaction of helper T cell 1 (Th1) and Th17 while enhancing the immunoregulative effect of Th2.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine ; analogs & derivatives ; Animals ; Encephalomyelitis, Autoimmune, Experimental ; Female ; Interferon-gamma ; Interleukin-10 ; Interleukin-17 ; Mice ; Mice, Inbred C57BL ; Myelin-Oligodendrocyte Glycoprotein ; Spleen ; T-Lymphocytes ; Transforming Growth Factor beta ; rho-Associated Kinases

The occurence and progress of hepatocellular carcinoma(HCC)is a complex network inter-action process connected by multiple signaling pathways involving genes,cells and various active molecules. The effects and functions of biological molecular markers also vary among different pathways. Moreover,wheth-er the molecular markers have prediction effects for the prognosis of HCC remains unclear,and studies investing this issue are still insufficient. The current studies reveal that molecular markers involves in multiple pathways including gene expression,gene regulation,cell cycle regulation,cancer stem cell proliferation and differentia-tion. These processes are intimately associated with the occurrence and prognosis of HCC. The relevant gene or molecular that may indicate the prognosis of HCC includes p53 gene,long non-coding RNA,cell cycle regula-tors,liver cancer stem cell surface-associated molecules,etc.

Objective To investigate the immunoregulatory effect of Fasudil-modified macrophages on cell transferred experimental autoimmune encephalomyelitis ( EAE) in a mouse model.Methods Fe-male C57BL/6 mice were immunized with MOG35-55 to establish the model of EAE.The encephalomyelitic mononuclear cells ( MNCs) were isolated from spleen of mice with EAE on day 9 after immunization and treated with or without Fasudil for 72 h in vitro.Several assays including the flow cytometry analysis, Griess reaction and ELISA were performed to analyze the M1 and M2 phenotypes of macrophages, the production of NO and the levels of cytokines, respectively.The cultured MNCs (5×107 cells) were resuspended in 500μl of PBS and transferred into na?ve C57BL/6 recipients via intraperitoneal injection.Two groups including the PBS-MNCs group and the Fasudil-MNCs group were set up.The body weights and clinical scores of the mice in each group were recorded in every other days after the induction of EAE in the recipients.Results The Fasudil treated MNCs affected the induction of EAE in adoptive cell transferred mice.The expression of CD16/32, iNOS and IL-12 on F4/80-macrophages were decreased, while the expression of CD206, CD23 and IL-10 on F4/80-macrophages were increased upon the treatment of Fasudil, indicating that Fasudil im-proved the differentiation of macrophages from M1 to M2 phenotypes.Moreover, Fasudil inhibited the pro-duction of NO and enhanced the expression of Arginase-1.Conclusion Fasudil ameliorated the clinical se-verity of EAE in mice by promoting the transformation of macrophages from M1 to M2 phenotype.