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.

Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Objective: To investigate the current status of job burnout in in-service sailors, and to provide a basis for the development of intervention measures for job burnout in sailors. Methods: From September 2015 to May 2016, stratified cluster random sampling was used to select 6 172 in-service sailors from 13 provinces and cities as research subjects. General demographic data including age, education background, and household registration and occupational characteristics such as job position, navigating zone, and nature of employment were collected. The Maslach Burnout Inventory-General Survey (MBI-GS) was used to measure the levels of emotional exhaustion, depersonalization, low occupational efficiency, and job burnout, and the influencing factors for job burnout were also analyzed. Results: Of all 6 172 in-service sailors, 112 (1.8%) had a positive result in emotional exhaustion, 870 (14.1%) had a positive result in depersonalization, and 3 517 (57.0%) had a positive result in low occupational efficiency. Of all sailors, 63.3% had job burnout, among whom 54.1% had mild burnout, 8.7% had moderate burnout, and 0.5% had severe burnout. There was a significant difference in the score of job burnout between the sailors with different ages, education backgrounds, types of household registration, job positions, navigating zones, ornature of employment (P<0.05). Age, education background, household registration, job position, navigating zone, and nature of employment were major influencing factors for job burnout in in-service sailors (P<0.05) , and there was a higher level of job burnout in the sailors with an age of 30-39 years, education background of junior college or above, urban registration, a job position of second mate/third engineer, a navigating zone of coastal lines, orthe nature of employment of freelance sailor. Conclusion There is a high incidence rate of job burnout among in-service sailors, and the sailors with a young age, urban registration, a navigating zone of coastal lines, or thenature of employment of freelance sailor tend to have low occupational efficiency. Related measures should be adopted for active intervention.

OBJECTIVE: To develop a mental health self-assessment scale for Chinese seafarers. METHODS: The detail dimensions and clauses of Mental health scale for Chinese seafarers( MHSCS) was composed through literature reviews,interviews and expert evaluation. A total of 1309 seafarers were randomly recruited as test subjects by convenience sampling method, and the preliminary scale was constructed to predict their mental health. The formal scale was established after data analysis by analyzing means of differentiation,correlation,exploratory factor and frequency,then its reliability and validity were tested. RESULTS: The MHSCS contains 109 entries in 11 dimensions. Its Cronbach 's αcoefficient of the total scale and each dimension was 0. 638-0. 982,and the retest reliability was 0. 806-0. 922. The scores in each dimension of the scale were positively correlated with the scores of each dimension of Symptom Checklist 90 scores( correlation coefficient = 0. 486-0. 860,P < 0. 01). The confirmatory factor analysis showed that the model fitted well(x~2/df = 2. 93,the normed fit index was 0. 950,the non-normed fit index was 0. 970,the incremental fit index was 0. 970,the relative fit index was 0. 950,the comparative fit index was 0. 970,the root mean square error of approximation was 0. 067). CONCLUSION: The MHSCS has good reliability and validity,meets the requirements of psychometrics standard,and can be used as a mental health evaluation tool for the Chinese seafarers.

We wished to undertake molecular characterization of the reverse transcriptase (RT) gene and overlapping surface (S) gene in lamivudine-treated patients with chronic infection with the hepatitis B virus (HBV). Sequencing analyses of the HBV RT/S gene of isolates from 25 chronic hepatitis B (CHB) patients with the YMDD mutation and 30 treatment-naïve CHB patients were undertaken. In patients with the YMDD mutation, rtM2041 was the major type of mutation (20/25, 80%). rtL80I was present in most of the patients with rtM204I (14/20, 70%). rtL180M coexisted with rtM204V (5/5, 100%). Patients with the YMDD mutation had a significantly higher prevalence of mutation of the RT gene than treatment-naïve CHB patients (P < 0.05). Classical primary resistance and secondary/compensatory mutations were detected at only five sites (rtL80, rtV173, rtL180, rtM204, rtM250) in CHB patients with the YMDD mutation. The frequency of nucleos(t)ide analog resistance (NAr) mutation within the RT gene in patients with the YMDD mutation was significantly higher than that in treatment-naïve patients (P < 0.05). Amino-acid mutations within the RT gene were also associated with other types of NAr in patients with the YMDD mutation. The rate of amino-acid variants within the S gene region was significantly higher in patients with the YMDD mutation than that in treatment-naïve patients (P < 0.05). sM133L and sG145R variants were also present in patients with the YMDD mutation. These observations suggest that CHB patients with the YMDD mutation also have NAr mutations related to other NA drugs, which might lead to cross-resistance in CHB patients. Variants present in the S gene region could cause changes in the antigenicity of HBsAg, which could result in a false-negative diagnosis of HBsAg and immune in escape of the HBV.
Adolescent ; Adult ; Antigens, Surface ; genetics ; Antigens, Viral ; genetics ; DNA Mutational Analysis ; Female ; Genetic Variation ; Hepatitis B, Chronic ; drug therapy ; genetics ; Humans ; Lamivudine ; pharmacology ; therapeutic use ; Male ; Middle Aged ; RNA-Directed DNA Polymerase ; genetics ; Young Adult

Objective To analyze the variations of surface(S) region,basic core promoter (BCP) and precore (preC) regions in genomes of hepatitis B virus (HBV) from patients with coexistence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs).Methods S region,BCP and preC regions in genomes of HBV were amplified and sequenced in 62 HBV-infected patients including 27 HBsAg-positive/anti-HBs-positive patients (double positive group) and 35 HBsAg-positive/ anti-HBs-negative patients (single positive group).The sequencing results and amino acid variants in these regions were analyzed.Difference of means between groups was compared by t test.Sample rate and variation rate were compared by chi-square test.Results One hundred and fifty-six amino acids mutations within the S region were detected in 27 patients of double positive group and 100 mutations in 35 patients of single positive group.The mutation rate in double positive group was significantly higher than those in single positive (2.56％ vs 1.26％,x2 =32.07,P＜0.05).The amino acid variants in double positive group were much higher than those in single positive group within major hydrophilic region (MHR),especially in the first loop area of a-determinant in S region (4.76 ％ vs 1.02 ％,x2 =11.58,P＜0.05).The mutation rate of A1762T/G1764A in BCP in double positive group was significantly higher than those in single positive group (59.3％ vs 28.6％,x2 =5.895,P＜0.05).The mutation rate of A1846T in preC region was higher in double positive group than those in single positive group (40.7％ vs 17.1％,x2-4.265,P＜0.05).The mutation rate of A1762T/G1764A+G1896A in double positive group was also higher than that in single positive group (37.0％ vs 14.3％,x2 =4.302,P＜0.05).Conclusions The mutation rates of S region,especially in the first loop area within a-determinant,BCP and preC regions which are related with hepatocellular carcinoma development in HBsAg and anti-HBs double positive group are higher than those in HBsAg single positive group in chronic HBV infected patients.

Objective The aim of this study was to analysis the variability of reverse transcriptase (RT) in chronic hepatitis B (CHB) patients treated with nucleos(t) ide analogue (NA) drugs.Methods Polymerase chain reaction (PCR) and direct-sequencing were performed to analysis the entire hepatitis B virus (HBV) RT gene of HBV isolates from 55 consecutive CHB patients treated with NA.Results Mutations were found at the 7 classical NA resistance (NAr) positions (rtL80,rtV173,rtL180,rtA181,rtM204,rtN236,rtM250),but not at other 4 classical NAr positions (rtI169,rtT184,rtA194,rtS202).Among the 55 HBV isolates,31 (56.4％) harboured classical NAr mutations,the rtM204V/I was the major mutation type (27/31,87.1％) in the patients treated with NA rtL80I was occurred in most of the patients with rtM204I (14/22,63.6％).The rtL180 mol/L was often coexisted with the rtM204V (5/5,100％).Non-classical mutations related to NAr were also found at other positions,including rtA222T,rtL229 F/S/ W,rtS256C/G,rtQ267H.The rtA222T mutation had a highest percentage (40％,22/55) in these nonclassical mutation positions.Conclusions The patterns of mutation within RT gene are complex in CHB patients treated with NA drugs.In the RT gene of patients treated with NA drugs,there were also had other mutation positions,which might be associate with NA resistance.Monitoring HBV drug resistance mutation markers and patterns in patients treated with NA drugs is benefit to adjust the regimens timely in clinical therapy.

ObjectiveTo explore the expression and clinical significance ofaquaporin (AQP) 1 and AQP 4 in human pulmonary adenocarcinoma H1299 cell line.MethodsH1299 cell line in human pulmonary adenocarcinoma(pulmonary adenocarcinoma group) were obtained,the expressions of AQP1 and AQP4 in mRNA level and their locations were determined in H1299 cell line respectively by semiquantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot analysis.The migration of tumor cells were observed by Matrigel invasion assay.Then normal tissues adjacent of pulmonary adenocarcinoma (above cancer line 3 cm,no tumor cell with pathological proven) were as control group.ResultsThe results of RT-PCR showed that AQP1,AQP4 mRNA was 1.030 ± 0.070 and 1.140 ± 0.190 in conlrol group,which were lower than those in pulmonary adenocarcinoma group (2.021 ± 0.250 and 2.180 ±0.180)(P＜0.05 ).The results of Western blot showed AQP1,AQP4 located on the membrane of H1299 cell.Both AQPI and AQP4 mRNA expressed very high in pulmonary adenocarcinoma group,while expressed very low in control group (P＜0.05).Matrigel invasion assay showed that the invasion was positively related to AQP1,AQP4(r =0.351,P ＜ 0.05 ).ConclusionAQP1,AQP4 significantly over express in H1299 cell line,both of them phy important roles in the growth of tumor tissue and cell migration.

Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.