Objective:To compare the effect of two hemostatic drugs, tranexamic acid and hemocoagulase, on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted to select 80 adult patients with Kashin-Beck disease who underwent unilateral primary total knee arthroplasty at Linyou County Hospital from January 2021 to March 2023. According to the inclusion and exclusion criteria, 19 cases with chronic anemia, long-term oral anticoagulants implanted with cardiac stents, and hematological diseases were excluded. Among the remaining 61 adult patients, 24 cases with preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity were selected as the experimental group, and 37 cases with preoperative intravenous application combined with intraoperative local application of hemocoagulase in articular cavity were selected as the control group. The preoperative general condition, postoperative drainage volume, total perioperative blood loss, occult blood loss, and hemoglobin levels at different time points before and after surgery were compared between the two groups of patients.Results:There was no statistically significant difference in age, gender distribution, body mass index, preoperative hemoglobin level, preoperative prothrombin time, and preoperative activated partial thromboplastin time between the two groups of patients ( P > 0.05). The total perioperative blood loss [(1 027.78 ± 472.71) ml], drainage volume 48 h after surgery [(336.67 ± 112.74) ml] in the experimental group were all lower than those in the control group [(1 390.39 ± 454.01), (498.65 ± 187.57) ml], and the differences were statistically significant ( P < 0.05). The hemoglobin levels on the second and fifth day after surgery were significantly higher than those in the control group, and the differences were statistically significant ( P < 0.05). Conclusion:For total knee arthroplasty for adult patients with Kashin-Beck disease, preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity is superior to hemocoagulase, which can effectively reduce total perioperative blood loss and postoperative drainage volume, and is worthy of clinical promotion.

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 effects of 20%mannitol injection on the proliferation and apoptosis of hu-man lung squamous carcinoma cell line NCI-H292 and its possible mechanisms.Methods NCI-H292 cells were incubated with 20%and lower concentrations of mannitol.Cell proliferation and viability were detected by CCK-8 assay.Cell apoptosis was detected by flow cytometry and the expression of mitochondrial apoptosis pathway-related proteins Bcl-2 and Bax was detected by Western blot.Results Compared with the control group,mannitol inhibited cell proliferation in a dose-and time-dependent manner(P＜0.05),20%mannitol could induce cell ap-optosis(P＜0.05).The expression level of Bcl-2 was significantly reduced,while that expression level of Bax was significantly increased in cells incubated with 20%mannitol(P＜0.05).Conclusions Clinically used 20%man-nitol injection can induce apoptosis of lung squamous carcinoma cell line NCI-H292.Its mechanism is related to mi-tochondrial pathway-related proteins Bcl-2 and Bax.

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 compare the effect of two hemostatic drugs, tranexamic acid and hemocoagulase, on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted to select 80 adult patients with Kashin-Beck disease who underwent unilateral primary total knee arthroplasty at Linyou County Hospital from January 2021 to March 2023. According to the inclusion and exclusion criteria, 19 cases with chronic anemia, long-term oral anticoagulants implanted with cardiac stents, and hematological diseases were excluded. Among the remaining 61 adult patients, 24 cases with preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity were selected as the experimental group, and 37 cases with preoperative intravenous application combined with intraoperative local application of hemocoagulase in articular cavity were selected as the control group. The preoperative general condition, postoperative drainage volume, total perioperative blood loss, occult blood loss, and hemoglobin levels at different time points before and after surgery were compared between the two groups of patients.Results:There was no statistically significant difference in age, gender distribution, body mass index, preoperative hemoglobin level, preoperative prothrombin time, and preoperative activated partial thromboplastin time between the two groups of patients ( P > 0.05). The total perioperative blood loss [(1 027.78 ± 472.71) ml], drainage volume 48 h after surgery [(336.67 ± 112.74) ml] in the experimental group were all lower than those in the control group [(1 390.39 ± 454.01), (498.65 ± 187.57) ml], and the differences were statistically significant ( P < 0.05). The hemoglobin levels on the second and fifth day after surgery were significantly higher than those in the control group, and the differences were statistically significant ( P < 0.05). Conclusion:For total knee arthroplasty for adult patients with Kashin-Beck disease, preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity is superior to hemocoagulase, which can effectively reduce total perioperative blood loss and postoperative drainage volume, and is worthy of clinical promotion.

Objective To measure the abdominal muscle composition of maintenance dialysis patients using quantitative computed tomography(QCT)and to analyze its relationship with abdominal aortic calcification(AAC).Methods The abdominal CT data of 193 maintenance dialysis patients were analyzed retrospectively and their clinical data were collected.The abdominal muscle composi-tion,including muscle area and muscle fat area,was measured at the middle level of L3 vertebral by QCT.The abdominal aortic calcifica-tion scores(AACs)were calculated using the Agatston method.The groups were grouped according to the quartiles of AACs,and differences in muscle area,muscle fat area and their associated variables were compared between the four groups.The relationship between abdominal muscle composition and AAC was assessed using Spearman rank correlation analysis and partial correlation analysis.Results AACs were positively correlated with age,male,dialysis age,diabetes,hypertension,and abdominal muscle fat area(r=0.555,0.172,0.192,0.348,0.335,0.358,all P<0.05),while no significant correlation was found with abdominal muscle area.A partial correlation analysis controlling for age,sex,dialysis age,hypertension and diabetes showed that AACs were still positively correlated with abdominal muscle fat area(r=0.183,P=0.012).Conclusion Abdominal muscle fat area in maintenance dialysis patients is positively associ-ated with the degree of AAC,and high abdominal muscle fat area is a risk factor for AAC.Enhanced muscle exercise may prevent the risk of vascular calcification in dialysis patients.

OBJECTIVE To analyze the effect of Huanglian Jiedu Decoction(HLJDD)on the intestinal flora and metabolites of Parkinson's disease(PD)model mice,and explore the mechanism of HLJDD in intervening in PD based on 16S rRNA technology and non-targeted metabolomics technology.METHODS The PD model of mice was induced by subcutaneous injection of MPTP 20 mg·kg-1·d-1 and peritoneal injection of probenecid 200 mg·kg-1·d-1,and the weight and behavior indexes of mice were measured after drug intervention.HPLC-QTRAP-MS/MS technique was used to detect the levels of neurotransmitters in the striatum of mice.The levels of striatal inflammatory factors were detected by ELISA.The changes of intestinal flora in mice were analyzed by 16S rRNA technology.UHPLC-Q-TOF-MS was used to detect endogenous metabolites in mouse striatum,Orthogonal partial least squares discriminant analysis(OPLS-DA)was adopted to screen potential differential metabolites,and MetaboAnalyst 5.0 was introduced to predict metabolic pathways associated with PD.RESULTS HLJDD significantly improved the motor symptoms and neuroinflammation of PD mice(P<0.01),regulated the level of neurotransmitters,and corrected the intestinal microbiota disorder of PD mice,manifes-ted by the increase of intestinal microbial diversity and the restoration of microbiota profile.After treatment with HLJDD,the abun-dance of Prevotella and Akkermansia in PD mice was significantly increased,and the abundance of Clostridium was decreased(P<0.01).The abnormal metabolite levels were restored mainly by regulating the tryptophan metabolic pathway in the feces and striatum of PD model mice.CONCLUSION HLJDD can significantly improve the pathological damage of PD model mice,and the regulation of disordered intestinal flora and tryptophan metabolism pathway may be the potential mechanism of HLJDD to intervene in PD.

The 13th World Congress of the International Hepato-Pancreato-Biliary Association was held from 4th to 7th September 2018 in Geneva,Switzerland.Thousands of wellknown specialists and scholars from 96 countries around the world were invited for the great event.The congress aimed to explore the latest achievements of diagnosis and treatment of hepatobiliary and pancreatic diseases from both the clinical and basic perspective.In this article,authors reviewed and analyzed the up-to-date research information and combined clinical researches of the author team,in order to share the experience and achievements in the field of hepato-pancreato-biliary surgery with colleagues and provide new information and inference for optimization of diagnosis and treatment in this field.

BACKGROUND: Irradiation therapy in the cancer patients after surgery may have negative effects on implant fixation. OBJECTIVE: To observe the effects of 60Co irradiation and trace element zinc on fixation strengths of titanium implant. METHODS: Thirty-six adult male rabbits were involved. One piece of titanium implant was separately placed into the bilateral proximal tibial heads in rabbits to set up animal models of titanium implants. The animals were randomly divided into control group, zinc supplement group, 60Co irradiation group and 60Co irradiation and zinc supplement group. Zinc sulfate of 10 g/L was administered intramuscularly to animals in the zinc supplement group at the dose of 4 mg/kg once per day, and those in the control group were treated with saline at the same dose. The animals in the 60Co irradiation group received 60Co irradiation at the dose of 45 Gy and saline by intramuscular injection. Those in the 60Co irradiation and zinc supplement group received 60Co irradiation and zinc sulfate. The animals were killed at 1, 4 and 12 weeks after treatment. The fixation strengths were measured and compared among groups. RESULTS AND CONCLUSION: (1) Zinc supplement made the titanium implants have higher fixation strengths, and reach a high level at 4 weeks after surgery. (2) 60Co irradiation significantly inhibited the fixation strengths of the implants. After 60Co radiation, zinc supplement stil could promote fixation strengths of titanium implants. (3) It is indicated that amount of zinc supplement after irradiation therapy can al eviate the negative effects of irradiation on implant fixation.

Objective To observe the expression of the unfolded protein response especially the inositol-requiring enzyme-1 (IREl)-Xbp1 signaling pathway, and the change trend of osteogenic markers after inhibition of IREl expression through siRNA interference in osteoblasts exposed to fluoride. Methods Proliferation activity of MC3T3-E1 cells was detected by CCK-8 assay, and 0.0, 0.1, 1.0, 2.0, 8.0, 16.0, 20.0, 32.0, 64.0 mg/L groups were set up. Then representative doses of low, medium and high fluoride (2.0, 8.0, 20.0 mg/L) were selected to treat MC3T3-E1 cells and the expression of the unfolded protein response related genes and osteogenic markers [alkaline phosphatase (ALP), osteocalcin (OCN), Runx2, osterix, binding immunoglobulin protein (Bip), protein kinase-like endoplasmin reticulum kinase ( PERK ) , activated transcription factor 6 (ATF6), Xbp1] was detected by Real-time PCR. MC3T3-E1 cells were transfected with IRE1 siRNA and then exposed to fluoride, and the expression of IRE1 signaling pathway and osteogenic markers was detected by Western blotting and real-time PCR. Results CCK-8 results showed the bidirectional effect of fluoride on the activity of osteoblasts. Compared with the 0.0 mg/L group [1.00 ± 0.01 (d 1), 1.00 ± 0.02 (d 3), 1.00 ± 0.08 (d 7)], the osteoblast activity was significantly enhanced at 2.0 mg/L [1.11 ± 0.02 (d 1), 1.29 ± 0.02 (d 3)], 8.0 mg/L [1.16 ± 0.02 (d 1), 1.44 ± 0.03 (d 3), all P<0.05], while 20.0 mg/L inhibited cell activity [0.83 ± 0.01 (d 1), 0.81 ± 0.01 (d 3), 0.96 ± 0.04 (d 7), all P< 0.05]. Compared with the 0.0 mg/L group [6.86 ± 2.13 (ALP), 4.58 ± 1.52 (OCN), 2.65 ± 0.38 (Runx2), 12.48 ± 3.96 (osterix)], 2.0 mg/L significantly induced the expression of intracellular ALP (12.80 ± 3.62), Runx2 (6.61 ± 0.48) and osterix (21.42 ± 1.56), and the differences were statistically significant (all P< 0.05), while 20.0 mg/L inhibited the expression of ALP (0.88 ± 0.17), OCN (0.16 ± 0.05) and osterix (1.35 ± 0.51), and the differences were statistically significant (all P<0.05). Compared with the 0.0 mg/L group [1.36 ± 0.58 (IRE1), 0.96 ± 0.45 (Xbp1)], the expression of endoplasmic reticulum stress related genes IRE1 [14.84 ± 2.57 (2.0 mg/L), 4.10 ± 0.52 (8.0 mg/L), 5.30 ± 0.63 (20.0 mg/L)] and Xbp1 [2.62 ± 0.66 (2.0 mg/L), 1.97 ± 0.47 (20.0 mg/L)] were significantly increased in the corresponding fluoride groups (all P<0.05). After IRE1 gene knockout, compared with the control group [gene:3.25 ± 0.48 (OCN), 5.62 ± 1.86 (Runx2), 2.67 ± 0.35 (ALP); protein: 0.16 ± 0.03 (OCN), 0.34 ± 0.27 (ALP)], the gene expression of OCN [0.63 ± 0.46 (2.0 mg/L), 0.81 ± 0.36 (8.0 mg/L), 0.62 ± 0.31 (20.0 mg/L)], Runx2 [0.18 ± 0.03 (2.0 mg/L), 0.12 ± 0.01 (8.0 mg/L), 1.09 ± 0.33 (20.0 mg/L)] and ALP [1.01 ± 0.12 (8.0 mg/L), 0.38 ± 0.09 (20.0 mg/L)] in the corresponding fluoride groups were significantly decreased (all P < 0.05), protein expression of OCN [0.06 ± 0.02 (2.0 mg/L), 0.06 ± 0.02 (8.0 mg/L), 0.07 ± 0.03 (20.0 mg/L)], and ALP [0.02 ± 0.01 (8.0 mg/L), 0 (20.0 mg/L)] were significantly decreased (all P< 0.05). Conclusion Unfolded protein response is observed under different doses of fluoride in osteoblasts, and IRE1 gene knockout has inhibited the expression of ALP, OCN, osterix and Runx2 in osteoblasts induced by fluoride, which suggests that IRE1 signaling pathway may play a key role in the differentiation of osteoblasts exposed to fluoride.