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 explore the effectiveness and safety of guiding painless gastroscopic entry with plica aryepiglottica movement as the mark.Methods A total of 200 patients with elective painless gas-troscopic examination from January 2022 to August 2022 were selected,92 males and 108 female,aged 18-60 years old,BMI 18-30 kg/m2 and ASA grade Ⅰ-Ⅲ.The patients were divided into the two groups:the con-trol group (group C) and observation group (group O) by adopting the random number table method,100 ca-ses in each group.The disappearance of eyelash reflex in the group C served as the entry timing of gastrosco-py,while the plica aryepiglottica non-movement under the gastroscopic view in the group O served as the en-try timing of gastroscopy.The bispectral index (BIS) value during gastroscopic operation persistently main-tained 40-60.The main observation indicators were the adverse reactions caused by gastroscopic operation (body movement reactions,bucking,hiccup,laryngeal spasm,etc.),and the secondary observation indicators were:general data of the two groups,SpO2,HR,SBP and DBP values after entering the room (T0),at the en-try time of gastroscopy (T1),3 min after gastroscopic entry (T2),6 min after gastroscopic entry (T3) and at the time of gastroscopic retraction (T4),and the time of medication to gastroscopy,gastroscopic operation time and intraoperative medication supplementation.Results A total of 192 cases were ultimately included,99 cases in the group C and 93 cases in the group O.There was no statistically significant difference in general da-ta between the two groups (P>0.05);compared with the group C,the use amount of cyclophosphamide dur-ing anesthesia induction in the group O was increased (P<0.05).Compared with the group C,the incidence rates of body movement reaction,bucking,hiccup and total adverse reactions in the group O were decreased (P<0.05);SpO2,HR,SBP and DBP at different time points had no statistically significant differences be-tween the two groups (P>0.05).Conclusion Using the glottic movement as the marker to guide the pain-less gastroscopy entry is effective and safe,and could reduce the adverse reactions such as body movement re-action,bucking and hiccup caused by gastroscopic entry.Observing the plica aryepiglottica movement in the gastrocopic entry operation is simple and easy to perform,which could serve an objective gastroscopic entry timing mark and is worth promoting and using in clinic.

Background and Aims:Stenting and plain old balloon angioplasty (POBA) remain the primary treatments for femoropopliteal in-stent restenosis (ISR). These approaches demonstrate good short-term patency;however,ISR frequently recurs due to continuous stimulation of the vascular intima by the stent. With advancements in endovascular technology,excimer laser ablation (ELA) combined with drug-coated balloons (DCB) offers a novel strategy for treating ISR. This study investigated the safety and efficacy of ELA combined with DCB for complex femoropopliteal ISR.Methods:The clinical data of 69 patients with femoropopliteal ISR treated with interventional procedures between June 2020 and June 2022 were retrospectively analyzed. Among them,27 patients underwent ELA combined with DCB treatment (ELA+DCB group),and 42 patients underwent POBA combined with DCB treatment (POBA+DCB group). Relevant clinical variables were compared between the two groups.Results:No significant differences were observed in baseline characteristics between the two groups (all P>0.05). True lumen re-entry was achieved in all 69 patients. The procedural success rates for the ELA+DCB and POBA+DCB groups were 92.6％ (25/27) and 90.5％ (38/42),respectively,with no statistically significant difference (P>0.05). Intraoperative adverse events were comparable between groups (all P>0.05). Logistic regression analysis indicated that thrombus in the target lesion was an independent risk factor for distal embolization during ELA+DCB (HR=24.695,95％ CI=1.061-574.904,P=0.046). Ankle-brachial index (ABI) values immediately after the procedure and at 1 and 6 months postoperatively showed no significant differences between the two groups (all P>0.05). However,the ELA+DCB group demonstrated superior ABI outcomes at 12,18,and 24 months postoperatively (all P<0.05). There were no significant differences in all-cause mortality or amputation rates postoperatively (both P>0.05). Kaplan-Meier analysis showed that the ELA+DCB group had higher 2-year freedom from target lesion revascularization (81.5％ vs. 57.1％,P=0.044) and 2-year patency rates (77.8％ vs. 52.4％,P=0.031) compared to the POBA+DCB group. ROC curve analysis identified a laser tube diameter/reference vessel diameter (TD/RVD) ratio cutoff value of 0.47 (AUC=0.825,95％ CI=0.619-1.000) for predicting 2-year patency after ELA plus DCB treatment,with a specificity of 66.7％. Cox regression analysis revealed that postoperative antithrombotic therapy (HR=0.033,95％ CI=0.002-0.661,P=0.026),≥2 tibial arteries recanalized (HR=0.022,95％ CI=0.001-0.808,P=0.038),and TD/RVD ≥ 0.47 (HR=0.002,95％ CI=0.000-0.403,P=0.022) were independent factors associated with improved 2-year patency after ELA plus DCB treatment.Conclusion:For complex femoropopliteal ISR,ELA combined with DCB does not show significant advantages in safety compared to POBA combined with DCB,but it provides superior long-term efficacy. Intraoperative management and postoperative antithrombotic therapy may influence the mid-to long-term outcomes of ELA combined with DCB for treating complex femoropopliteal ISR.

Background and Aims:Stenting and plain old balloon angioplasty (POBA) remain the primary treatments for femoropopliteal in-stent restenosis (ISR). These approaches demonstrate good short-term patency;however,ISR frequently recurs due to continuous stimulation of the vascular intima by the stent. With advancements in endovascular technology,excimer laser ablation (ELA) combined with drug-coated balloons (DCB) offers a novel strategy for treating ISR. This study investigated the safety and efficacy of ELA combined with DCB for complex femoropopliteal ISR.Methods:The clinical data of 69 patients with femoropopliteal ISR treated with interventional procedures between June 2020 and June 2022 were retrospectively analyzed. Among them,27 patients underwent ELA combined with DCB treatment (ELA+DCB group),and 42 patients underwent POBA combined with DCB treatment (POBA+DCB group). Relevant clinical variables were compared between the two groups.Results:No significant differences were observed in baseline characteristics between the two groups (all P>0.05). True lumen re-entry was achieved in all 69 patients. The procedural success rates for the ELA+DCB and POBA+DCB groups were 92.6％ (25/27) and 90.5％ (38/42),respectively,with no statistically significant difference (P>0.05). Intraoperative adverse events were comparable between groups (all P>0.05). Logistic regression analysis indicated that thrombus in the target lesion was an independent risk factor for distal embolization during ELA+DCB (HR=24.695,95％ CI=1.061-574.904,P=0.046). Ankle-brachial index (ABI) values immediately after the procedure and at 1 and 6 months postoperatively showed no significant differences between the two groups (all P>0.05). However,the ELA+DCB group demonstrated superior ABI outcomes at 12,18,and 24 months postoperatively (all P<0.05). There were no significant differences in all-cause mortality or amputation rates postoperatively (both P>0.05). Kaplan-Meier analysis showed that the ELA+DCB group had higher 2-year freedom from target lesion revascularization (81.5％ vs. 57.1％,P=0.044) and 2-year patency rates (77.8％ vs. 52.4％,P=0.031) compared to the POBA+DCB group. ROC curve analysis identified a laser tube diameter/reference vessel diameter (TD/RVD) ratio cutoff value of 0.47 (AUC=0.825,95％ CI=0.619-1.000) for predicting 2-year patency after ELA plus DCB treatment,with a specificity of 66.7％. Cox regression analysis revealed that postoperative antithrombotic therapy (HR=0.033,95％ CI=0.002-0.661,P=0.026),≥2 tibial arteries recanalized (HR=0.022,95％ CI=0.001-0.808,P=0.038),and TD/RVD ≥ 0.47 (HR=0.002,95％ CI=0.000-0.403,P=0.022) were independent factors associated with improved 2-year patency after ELA plus DCB treatment.Conclusion:For complex femoropopliteal ISR,ELA combined with DCB does not show significant advantages in safety compared to POBA combined with DCB,but it provides superior long-term efficacy. Intraoperative management and postoperative antithrombotic therapy may influence the mid-to long-term outcomes of ELA combined with DCB for treating complex femoropopliteal ISR.

Existing traditional Chinese medicine (TCM)-related databases are still insufficient in data standardization, integrity and precision, and need to be updated urgently. Herein, an Encyclopedia of Traditional Chinese Medicine version 2.0 (ETCM v2.0, http://www.tcmip.cn/ETCM2/front/#/) was constructed as the latest curated database hosting 48,442 TCM formulas recorded by ancient Chinese medical books, 9872 Chinese patent drugs, 2079 Chinese medicinal materials and 38,298 ingredients. To facilitate the mechanistic research and new drug discovery, we improved the target identification method based on a two-dimensional ligand similarity search module, which provides the confirmed and/or potential targets of each ingredient, as well as their binding activities. Importantly, five TCM formulas/Chinese patent drugs/herbs/ingredients with the highest Jaccard similarity scores to the submitted drugs are offered in ETCM v2.0, which may be of significance to identify prescriptions/herbs/ingredients with similar clinical efficacy, to summarize the rules of prescription use, and to find alternative drugs for endangered Chinese medicinal materials. Moreover, ETCM v2.0 provides an enhanced JavaScript-based network visualization tool for creating, modifying and exploring multi-scale biological networks. ETCM v2.0 may be a major data warehouse for the quality marker identification of TCMs, the TCM-derived drug discovery and repurposing, and the pharmacological mechanism investigation of TCMs against various human diseases.

With the escalation of plastic bans and restrictions, bio-based plastics, represented by polylactic acid (PLA), have become a major alternative to traditional plastics in the current market and are unanimously regarded as having potential for development. However, there are still several misconceptions about bio-based plastics, whose complete degradation requires specific composting conditions. Bio-based plastics might be slow to degrade when it is released into the natural environment. They might also be harmful to humans, biodiversity and ecosystem function as traditional petroleum-based plastics do. In recent years, with the increasing production capacity and market size of PLA plastics in China, there is an urgent need to investigate and further strengthen the management of the life cycle of PLA and other bio-based plastics. In particular, the in-situ biodegradability and recycling of hard-to-recycle bio-based plastics in the ecological environment should be focused. This review introduces the characteristics, synthesis and commercialization of PLA plastics, summarizes the current research progress of microbial and enzymatic degradation of PLA plastics, and discusses their biodegradation mechanisms. Moreover, two bio-disposal methods against PLA plastic waste, including microbial in-situ treatment and enzymatic closed-loop recycling, are proposed. At last, the prospects and trends for the development of PLA plastics are presented.
Humans ; Ecosystem ; Biodegradable Plastics ; Polyesters ; Biodegradation, Environmental

Polyurethane (PUR) plastics is widely used because of its unique physical and chemical properties. However, unreasonable disposal of the vast amount of used PUR plastics has caused serious environmental pollution. The efficient degradation and utilization of used PUR plastics by means of microorganisms has become one of the current research hotspots, and efficient PUR degrading microbes are the key to the biological treatment of PUR plastics. In this study, an Impranil DLN-degrading bacteria G-11 was isolated from used PUR plastic samples collected from landfill, and its PUR-degrading characteristics were studied. Strain G-11 was identified as Amycolatopsis sp. through 16S rRNA gene sequence alignment. PUR degradation experiment showed that the weight loss rate of the commercial PUR plastics upon treatment of strain G-11 was 4.67%. Scanning electron microscope (SEM) showed that the surface structure of G-11-treated PUR plastics was destroyed with an eroded morphology. Contact angle and thermogravimetry analysis (TGA) showed that the hydrophilicity of PUR plastics increased along with decreased thermal stability upon treatment by strain G-11, which were consistent with the weight loss and morphological observation. These results indicated that strain G-11 isolated from landfill has potential application in biodegradation of waste PUR plastics.
Plastics/metabolism* ; Polyurethanes/chemistry* ; RNA, Ribosomal, 16S ; Bacteria/genetics* ; Biodegradation, Environmental

Objective:To examine the expression of core clock genes in the peripheral blood mononuclear cells (PBMCs) and the level of circadian disturbance-related proteins in the serum of chronic pancreatitis (CP) patients with pancreatic exocrine insufficiency (PEI), and explore their potential diagnostic value in clinical practice.Methods:The peripheral blood samples and related clinical data from 68 patients diagnosed with CP in Shanghai General Hospital from Jan 2015 to Jan 2022 were collected. Peripheral blood samples from 30 healthy individuals were used for control. The M-ANNHEIM classification system was used to stratify the clinical stages of patients with CP. The mRNA expression of the core clock genes, including Clock, Bmal1, Per1/2/3 and Cry1/2 in PBMCs was analyzed using realtime qPCR, and the expression of circadian disturbance-related proteins like TrkB, CD 36 and Rbp in serum was measured with ELISA. The receiver operating characteristic curve(ROC) and the area under curve (AUC) was used to test the efficiency for diagnozing PEI. Results:The mRNA expression of Per1 in CP patients was significantly decreased (0.76 vs 1, P<0.05), and the AUC for diagnozing PEI was 0.744 (95% CI 0.628-0.860), with a cut-off value of 0.72; and the sensitivity and specificity was 84.8% and 57.1%, respectively. The protein abundance of serum CD 36 was significantly increased in CP patients (33.85±19.74ng/ml vs 24.71±11.53 ng/ml, P<0.05); the AUC for diagnozing PEI was 0.834 (95% CI 0.735-0.932), with a cut-off value of 29.75 pg/ml; and the sensitivity and specificity was 74.3% and 84.8%, respectively. The expression of CD 36 was increased with the increase of CP clinical stage, and there were statistically significant differences between either two stages (all P value <0.05). The mRNA expression of Per1 in patients with CP in Stage Ⅰ was significantly higher than that in patients with CP in Stage Ⅱ or Ⅲ, and the differences were statistically significant ( P<0.05), but no statistical difference was found between Stage Ⅱ and Stage Ⅲ. Conclusions:The decreased expression of Per1 mRNA in PBMCs and increased level of CD 36 in serum are significantly related to the occurrence of PEI in CP, suggesting that they may have potential value for diagnozing PEI and guiding the clinical practice.

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.
China/epidemiology* ; Diabetes Mellitus/etiology* ; Humans ; Liver Transplantation/adverse effects* ; Risk Factors ; Tacrolimus/adverse effects* ; Triglycerides