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.

Objective:To prepare heparin (Hep)-modified gelatin methacryloyl (GelMA) microspheres and to investigate their application in liver-targeted delivery of adipose-derived mesenchymal stem cells (ADSCs).Methods:GelMA microspheres were modified with Hep to obtain GelMA-Hep microspheres. The surface morphology of the GelMA-Hep microspheres was observed by scanning electron microscopy. The changes of carbon atoms, nitrogen atoms and sulfur atoms on the surface of the GelMA-Hep microspheres were detected by X-ray photoelectron spectroscopy. The surface chemical group composition of the GelMA-Hep microspheres was analyzed by Fourier transform infrared spectrometer. The swelling properties of the GelMA-Hep microspheres were detected by water absorption swelling experiment. Human liver HL-7702 cells transfected with lentivirus were co-cultured with GelMA, GelMA-dopamine (GelMA-dop) and GelMA-Hep microspheres. The effects of microspheres on cell proliferation activity were evaluated by cell counting kit-8 method and live/dead cell staining experiment. The adhesion of microspheres to cells was observed by confocal microscopy. The GelMA-Hep microspheres loaded with ADSCs were injected into C57BL/6 mice through the tail vein, and its efficiency of liver-targeted delivery of ADSCs was observed by a small animal in vivo imaging system. The data were compared by independent sample t test or one-way analysis of variance. Results:The GelMA-Hep microspheres were prepared by modifying the GelMA microspheres with Hep. Compared with the GelMA microspheres, the size of the GelMA-Hep microspheres did not change significantly, and the surface did not collapse and showed some crystalline particles. The binding energy of sulfur atoms on the surface of the GelMA-Hep microspheres increased from 166 eV to 168 eV. On the surface of the GelMA-Hep microspheres, the characteristic peaks of sulfonic acid and sulfate groups of Hep were detected at 1 490 cm ?1 and from 1 135 cm ?1 to 1 050 cm ?1, respectively. The swelling rate of the GelMA-dop microspheres was uniform, while the swelling rate of the GelMA microspheres and the GelMA-Hep microsphere was quite different, but the final swelling mass of the three microspheres tended to be consistent at 5 min. After 12, 24, 36 and 48 h of culture, the relative proliferation of cells in the GelMA-Hep group (1.61±0.29, 1.78±0.05, 2.27±0.08, 2.26±0.33) were higher than those in the negative control group (1.00±0.00, 1.28±0.06, 1.39±0.02, 1.41±0.04) (all P<0.05). After 36 h of culture, the relative proliferation of cells in the GelMA-Hep group was higher than that in the GelMA-dop group (1.63±0.21), with significant difference ( P<0.05). Live/dead cell staining experiment showed that after 12 h of cell culture in the GelMA-Hep group, only a few microspheres had cell adhesion; at 24 h, the cells were densely distributed on the surface of the microspheres. After 36 h, the number of cells increased further. At 48 h, live cells were distributed throughout the microspheres. Confocal microscopy showed that after 24 h of culture, cells adhered to the surface of the microspheres in the GelMA-Hep group and showed a stretched morphology. The liver of the GelMA-Hep+ADSCs group showed strong fluorescence at 0.5 h, and the fluorescence brightness continued to 48.0 h. The number of ADSCs reaching the liver was more than that of ADSCs group and GelMA+ADSCs group. Conclusions:GelMA-Hep microspheres were successfully prepared, which can improve the efficiency of liver-targeted delivery of ADSCs.

Objective To explore the influencing factors of cognitive impairment in non-dialysis patients with chronic kidney disease(CKD).Methods A total of 60 hospitalized non-dialysis patients with CKD in the Department of Nephrology of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from September 2022 to September 2023 were enrolled as research objects.According to the estimated glomerular filtration rate(eGFR),they were divided into stage 1 to 2 of CKD group[eGFR ≥60 mL/(min·1.73 m2)]with 23 cases,the stage 3 of CKD group[eGFR 30～＜60 mL/(min·1.73 m2)]with 20 cases,and stage 4 to 5 of CKD group[eGFR＜30 mL/(min·1.73 m2)]with 17 cases.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the cognitive function of the patients.Basic data and common clinical laboratory in-dicators on hospital admission were collected to analyze the differences in cognitive function levels under different renal function statuses and to explore the influencing factors of cognitive impairment.Results The incidence rates of cognitive impairment in the stage 1 to 2 of CKD group,stage 3 of CKD group,and stage 4 to 5 of CKD group were 47.8％,85.0％,and 94.1％respectively,the median MoCA scored 26,24 and 20 respectively,with statistically significant between-group differ-ences(P＜0.05).Cognitive function was significantly negatively correlated with age(r=-0.634,P＜0.001),blood urea nitrogen(BUN)(r=-0.574,P＜0.001),serum creatinine(Cr)(r=-0.417,P＜0.001),cystatin C(Cys-C)(r=-0.327,P=0.011),serum β2-microglobulin(β2-MG)(r=-0.259,P=0.046),and N-terminal pro-brain natriuretic peptide(NT-proBNP)(r=-0.474,P＜0.001),and was significantly positively correlated with hemoglobin(HB)(r=0.401,P=0.001)and eGFR(r=0.485,P＜0.001).Multivariate Logistic regression analysis showed that age(P=0.006)and NT-proBNP(P=0.041)were influencing factors of cognitive im-pairment in non-dialysis patients with CKD.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of age for prediction were 0.860,0.864 and 0.812 respectively,the AUC,sensitivity,and specificity of NT-proBNP for pre-diction were 0.808,0.795 and 0.875 respectively,and the combined prediction of age and NT-proBNP had an AUC,sensitivity,and specificity of 0.893,0.955,and 0.750,respectively.Conclusion As renal function deteriorates,the incidence rate and severity of cognitive impairment in non-dialysis patients with CKD tend to increase.Advanced age,renal function deterioration,high NT-proBNP level,and anemia are associated with the occurrence of cognitive impairment in non-di-alysis patients with CKD,among which age and NT-proBNP are influencing factors for cognitive im-pairment.

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.

Objective:To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn.Methods:The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm 2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm 2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm 2 in the hard and thin scar area, and 30-40 FUs /cm 2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M ( Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results:A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm 2, with an average of 63.3 cm 2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) ( W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm 2/33.3 FUs/cm 2) to 89.7% (26.1 FUs/cm 2/29.1 FUs/cm 2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion:The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

Objective:To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn.Methods:The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm 2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm 2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm 2 in the hard and thin scar area, and 30-40 FUs /cm 2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M ( Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results:A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm 2, with an average of 63.3 cm 2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) ( W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm 2/33.3 FUs/cm 2) to 89.7% (26.1 FUs/cm 2/29.1 FUs/cm 2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion:The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

OBJECTIVE：To investigate the effe cts of Buyang huanwu decoction on hemorheology and platelet related biological indexes of hyperlipidemia model rats. METHODS ：Male Wistar rats were randomly divided into blank control group （10 rats）and model group （40 rats）. Blank control group was given normal diet ，and model group was given high-lipid diet for 6 weeks at least to induce hypelipidemia model. After modeling ，rats were randomly divided into model control group ，positive control group （simvastatin，0.004 g/kg），Buyang huanwu decoction low-dose and medium-dose groups （3.5，14.0 g/kg，by crude drug），with 10 rats in each group. Blank control group and model control group were given normal saline intragastrically ， administration groups were given relevant drug intragastrically ，0.01 mL/g，once a day ，for consecutive 4 weeks. Thirty min after last medication ，hemorheological indexes （whole blood viscosity ，plasma viscosity ），platelet adhesion related indexes [adhesion rate，von Willebrand factor （vWF），fibronectin（FN）]，platelet release related indexes [ β-thromboglobulin（β-TG），platelet factor 4 （PF4）] and platelet fibrinolytic system related indexes [tissue plasminogen activator （t-PA），plasminogen activator inhibitor （PAI-1）]，platelet parameters （PLT，PDW，MPV，PCT，PLCR），4 kinds of coagulation parameters （APTT，TT，PT，FIB）were detected. RESULTS ：Compared with blank control group ，the whole blood viscosity （low，medium and high shear rate ），plasma viscosity，platelet adhesion rate ，the contents or levels of vWF ，FN，β-TG，PAI-1，PLT，MPV，PCT，PLCR and FIB in model control group were increased significantly （P＜0.05 or P＜0.01），and t-PA content was significantly decreased （P＜0.05）. Compared with model control group ，the whole blood viscosity （except for whole blood viscosity of high shear rate in Buyang huanwu decoction high-dose group ），plasma viscosity ，platelet adhesion rate ，the contents or levels of vWF ，FN，β-TG，PAI-1， PLT，PDW（except for Buyang huanwu decoction low-dose and high-dose groups ），MPV，PCT，PLCR（except for Byang huanwu decoction low-dose group ）and FIB were decreased significantly （P＜0.05 or P＜0.01），while t-PA content （except for positive control group ） was increased significantly （P＜0.05）. CONCLUSIONS ：Buyang huanwu decoction can significantly improve the pathological state in hyperlipidemia model rats by reducing blood viscosity and FN content ，improving platelet adhesion，enhancing fibrinolytic activity ，improving platelet aggregation ，inhibiting hypercoagulability and hyperplatelet release.

Objective:Dorsocervical fat pad is common in middle-aged women. Current treatments include surgical excision and liposuction. We evaluated the therapeutic effect of tumescent liposuction on dorsocervical fat pad. Anatomical study was also carried out to explore the anatomical structure and significance of dorsocervical fat pad.Methods:From Jan. 2009 to Dec. 2018, twenty-seven patients with dorsocervical fat pad were treated with tumescent liposuction in Peking University Third Hospital. Small incisions were made in bilateral scapular region and 4 mm suction cannula was applied. A female cadaver fixed with formaldehyde was dissected to investigate the structure of posterior cervical and dorsal region. The specimens were stained with HE and Masson staining.Results:14 patients were followed up for no less than 6 months, with an average follow-up time of 27 months. Patients＇ dorsocervical area were flat and smooth after the surgery. Patient satisfaction rate was 100% and no severe complication was reported except bruise and pain. The symptoms of dorsocervical pain in two patients were significantly improved after operation. Anatomical study showed that the dorsocervical fat pad was composed of superficial and deep layer of adipose tissue, with clear boundary between the two layers and no obvious capsule. The collagen fibers in deep layer were more and denser than those in superficial layer.Conclusions:Tumescent liposuction can effectively treat dorsocervical fat pad. The surgery outcome is ideal with little complication.Through the study of the anatomical structure of the dorsocervical fat pad, the operation method and principle of liposuction can be improved and the operation efficiency can be enhanced.

Objective:To investigate the technical route and clinical application effects of correcting abnormal hairline position after rhytidectomy with hair transplantation.Methods:A total of 61 patients in this group were female. The age distribution was 28 to 65 years. Among them, 45 cases underwent forehead (with endoscopy) and mid-face rhytidectomy, 11 cases underwent forehead rhytidectomy (with endoscopy). 5 cases underwent mid-face rhytidectomy. The interval between rhytidectomy and hair transplantation ranged 6 to 79 months, with an average of 18.4 months. The hairline position and morphology of the frontal, temporal and sideburns were redesigned according to aesthetic theory. Hair transplantation was performed to correct the abnormal hairline. When the patients were followed up, the hair survival rate was calculated.The patient’s hairline satisfaction and the degree of concealment of the infratemporal hairline scar were evaluated by patient and a third party attending plastic surgeon, respectively.Results:25 cases underwent hair transplantation of frontotemporal hairline and infratemporal hairline, 23 cases underwent hair transplantation of frontotemporal hairline and 13 cases underwent hair transplantation of infratemporal hairline. All patients were followed up for 12 to 24 months. The hair survival rate of frontotemporal hairline was 94.3%[90.8%(51.1/56.3) to 98.9%(52.5/53.1)]on average.The hair survival rate of the infratemporal hairline, whose incision was inside the temporal, was 93.2%[89.1%(31.1/34.9) to 98.6%(34.4/34.9)]on average. The hair survival rate of the infratemporal hairline, whose incision was on the edge of the temporal hairline, was 81.2%[60.4%(17.2/28.5) to 87.6%(26.8/30.6)]on average. The average satisfaction score of the frontal-temporal hairline for the patients and doctors was 4.5 points and 4.7 points, respectively. The evaluation of the satisfaction of the infratemporal hairline was divided into two parts. The average satisfaction score of the patients with incisions in the hairline was 4.4 points from patients and 4.7 points from doctors. The average satisfaction score of the patients with hairline incisions was 4.0 points for patientsand 4.2 points for doctors. The scar concealment degree of infratemporal hairline scar was 3.7 points for patients and 3.9 points for doctors in average.Conclusions:Correcting abnormal hairline position after rhytidectomy with hair transplantation can achieve satisfactory result. Since the position of the infratemporal hairline and the low hair survival rate on the scar, the effect of scar concealing is average. Replanting hair grafts and improving the design of the rhytidectomy incision are the method to solve this issue.

Objective:To investigate the technical route and clinical application effects of correcting abnormal hairline position after rhytidectomy with hair transplantation.Methods:A total of 61 patients in this group were female. The age distribution was 28 to 65 years. Among them, 45 cases underwent forehead (with endoscopy) and mid-face rhytidectomy, 11 cases underwent forehead rhytidectomy (with endoscopy). 5 cases underwent mid-face rhytidectomy. The interval between rhytidectomy and hair transplantation ranged 6 to 79 months, with an average of 18.4 months. The hairline position and morphology of the frontal, temporal and sideburns were redesigned according to aesthetic theory. Hair transplantation was performed to correct the abnormal hairline. When the patients were followed up, the hair survival rate was calculated.The patient’s hairline satisfaction and the degree of concealment of the infratemporal hairline scar were evaluated by patient and a third party attending plastic surgeon, respectively.Results:25 cases underwent hair transplantation of frontotemporal hairline and infratemporal hairline, 23 cases underwent hair transplantation of frontotemporal hairline and 13 cases underwent hair transplantation of infratemporal hairline. All patients were followed up for 12 to 24 months. The hair survival rate of frontotemporal hairline was 94.3%[90.8%(51.1/56.3) to 98.9%(52.5/53.1)]on average.The hair survival rate of the infratemporal hairline, whose incision was inside the temporal, was 93.2%[89.1%(31.1/34.9) to 98.6%(34.4/34.9)]on average. The hair survival rate of the infratemporal hairline, whose incision was on the edge of the temporal hairline, was 81.2%[60.4%(17.2/28.5) to 87.6%(26.8/30.6)]on average. The average satisfaction score of the frontal-temporal hairline for the patients and doctors was 4.5 points and 4.7 points, respectively. The evaluation of the satisfaction of the infratemporal hairline was divided into two parts. The average satisfaction score of the patients with incisions in the hairline was 4.4 points from patients and 4.7 points from doctors. The average satisfaction score of the patients with hairline incisions was 4.0 points for patientsand 4.2 points for doctors. The scar concealment degree of infratemporal hairline scar was 3.7 points for patients and 3.9 points for doctors in average.Conclusions:Correcting abnormal hairline position after rhytidectomy with hair transplantation can achieve satisfactory result. Since the position of the infratemporal hairline and the low hair survival rate on the scar, the effect of scar concealing is average. Replanting hair grafts and improving the design of the rhytidectomy incision are the method to solve this issue.