OBJECTIVE: To summarize research progress on enhanced recovery after posterior cruciate ligament (PCL) reconstruction, clarify the core contradictions, effective intervention methods, and evaluation shortcomings in current clinical practice, and provide theoretical support for optimizing clinical rehabilitation strategies. METHODS: Relevant domestic and international literature in recent years was systematically searched. The key technologies and challenges for enhanced recovery after PCL reconstruction were analyzed from three aspects: the core issues of enhanced recovery after PCL reconstruction, treatment strategies, and the post-reconstruction effectiveness evaluation system. RESULTS: Enhanced recovery after PCL reconstruction mainly faces two core problems. First, there is a balance dilemma between graft tendon protection and knee joint function recovery: the tensile capacity of the graft tendon is weak in the early postoperative period, so excessive weight-bearing easily leads to relaxation, while overly conservative immobilization causes muscle atrophy and joint adhesion. Second, the return-to-sport rate is significantly affected by injury type and treatment method: patients with combined multiple ligament or meniscus injuries have a much lower return-to-sport rate than those with isolated PCL injury, and the risk of return-to-sport failure is higher. Current research mainly promotes rehabilitation from two aspects: physical therapy and surgical technology. Physical therapy runs through the perioperative period: preoperatively, muscle strength training, swelling control, and maintenance of joint range of motion are used to optimize surgical conditions; postoperatively, phased intervention is implemented. Surgical technology focuses on minimally invasive and anatomical approaches: arthroscopic surgery reduces injury, double-bundle reconstruction and internal tension-relief technology improve stability, and modified tunnel positioning and special surgical methods avoid the risk of "Killer Turn". Postoperative functional evaluation adopts multi-dimensional indicators: subjective evaluation relies on scales such as Lysholm and International Knee Documentation Committee (IKDC); objective evaluation assesses stability through Telos stress test and posterior drawer test; imaging evaluation takes MRI as the core; psychological evaluation is assisted by the Tampa scale of kinesiophobia-11 (TSK-11). However, there are obvious shortcomings, such as the lack of PCL-specific evaluation tools. CONCLUSION Enhanced recovery after PCL reconstruction requires the integration of precise surgery, individualized rehabilitation, and comprehensive subjective and objective evaluation. In the future, biomaterials and digital technologies should be integrated to optimize the full-cycle management of PCL reconstruction, thereby improving functional recovery and the effect of return to sports.
Humans ; Posterior Cruciate Ligament Reconstruction/rehabilitation* ; Posterior Cruciate Ligament/injuries* ; Recovery of Function ; Knee Joint/physiopathology* ; Knee Injuries/rehabilitation* ; Return to Sport ; Enhanced Recovery After Surgery ; Tendons/transplantation* ; Arthroscopy

OBJECTIVE: To investigate the effectiveness of hip arthroscopy in the treatment of patients with femoroacetabular impingement (FAI) syndrome combined with ligamentum teres injury. METHODS: A retrospective analysis was conducted on 23 patients (23 hips) with Cam-type FAI syndrome combined with ligamentum teres injury who met the selection criteria between April 2022 and May 2024. The cohort included 12 males and 11 females, with a mean age of 29.16 years (range, 16-57 years). According to Tönnis classification, there were 5 cases of grade 0, 10 cases of grade Ⅰ, and 8 cases of grade Ⅱ in hip osteoarthritis. The disease duration ranged from 6 to 24 months, with an average of 12 months. Under hip arthroscopy, hypertrophic synovium and the damaged ligamentum teres were debrided, while the torn labrum and cartilage were repaired, and femoral head-neck osteoplasty was performed to eliminate impingement, restore the normal morphology of the acetabulum and femoral head-neck, and suture the joint capsule. Acetabular lateral center-edge angle (LCEA) and α angle (reflecting the degree of non-sphericity at the femoral head-neck junction) were measured before and after operation, and the modified Harris hip score (mHHS), the International Hip Outcome Tool-12 (IHOT-12), and the visual analogue scale (VAS) score for pain were evaluated. RESULTS: The operation was successfully completed in all patients. The incisions healed by first intention after operation, and there was no perioperative complications such as iatrogenic cartilage injury, fracture, infection, neurovascular traction injury, or lower extremity venous thrombosis. All the 23 patients were followed up 12-24 months, with an average of 14.6 months. The pain of hip joint significantly relieved, and the function of hip joint improved; no complication such as joint stiffness, joint instability, and osteonecrosis of the femoral head occurred. The α angle, VAS score, mHHS score, and IHOT-12 score at last follow-up were significantly better than those before operation ( P<0.05); there was no significant difference in LCEA compared to preoperative value ( P>0.05). CONCLUSION Hip arthroscopy is a safe and effective treatment for patients with FAI syndrome combined with ligamentum teres injury, which can achieve satisfactory effectiveness.
Humans ; Femoracetabular Impingement/complications* ; Arthroscopy/methods* ; Adult ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adolescent ; Treatment Outcome ; Young Adult ; Hip Joint/surgery* ; Acetabulum/surgery* ; Round Ligaments/surgery* ; Range of Motion, Articular

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective:This study aimed to explore neurobiomarkers for schizophrenia relapse by comparing brain functional activity between first-diagnosed drug-na?ve schizophrenia (FDS) patients and relapsed schizophrenia (RS) patients.Methods:In this cross-sectional study, a total of 85 RS patients, 75 FDS patients, and 82 controls were recruited from the outpatient and inpatient departments of the Affiliated Brain Hospital of Nanjing Medical University between September 2018 and June 2020. All participants underwent magnetic resonance imaging scans. The fractional amplitude of low-frequency fluctuation (fALFF) was calculated to assess individual′s brain activity. The severity of psychiatric symptoms among patients with schizophrenia was evaluated using the Positive and Negative Syndrome Scale (PANSS). Voxel-based analysis of covariance (ANCOVA) with post-hoc two-sample t-tests was used to compare fALFF values among groups, and partial correlation analysis was employed to examine relationships between aberrant fALFF values and psychiatric symptoms. Results:The RS group demonstrated significantly higher negative symptom scores (21.5±9.1) compared to the FDS group (18.4±8.3; t=-2.28, P<0.05). Relative to the control group, the FDS group showed increased fALFF values in the cerebellum vermis 4/5 and the right putamen( t=4.45, 4.55, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05), while fALFF values were decreased in the right precentral gyrus/postcentral gyrus, bilateral precuneus, and right paracentral lobule ( t=-4.77--4.20, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05). The RS group exhibited increased fALFF values in the left cerebellum 9/10, bilateral cerebellum 6/8/Crus Ⅰ, right inferior temporal gyrus, right middle temporal gyrus, right inferior frontal gyrus (orbital part), and right putamen( t=4.78-5.44, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05), while decreased fALFF values were observed in the bilateral calcarine/cuneus, left superior medial frontal gyrus, right precuneus/cuneus, bilateral precuneus, and right precentral gyrus/postcentral gyrus ( t=-4.97--4.38, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05). Compared with the FDS group, the RS group showed increased fALFF values in the right cerebellum Crus Ⅰ (GRF-corrected, t=3.83, voxel-level P<0.001, cluster-level P<0.05). In the FDS group, correlation analysis revealed that fALFF values in the bilateral precuneus were negatively correlated with negative symptom scores, general psychopathology scores, and the PANSS total score ( r=-0.32, -0.26, -0.26,all P<0.05), while no such correlation was found in the RS group. Conclusions:RS patients exhibit more severe negative symptoms and more diffuse brain functional abnormalities compared to FDS patients, particularly affecting the default mode network and cerebellar regions. Functional alterations in the right cerebellum Crus Ⅰ and bilateral precuneus may serve as potential neuroimaging markers for identifying relapse in schizophrenia.

Objective:To develop and validate a Self-care Ability Scale for Arteriovenous Fistula (AVF) in Maintenance Hemodialysis (MHD) patients.Methods:Guided by Orem's self-care theory, the initial item pool of the scale was developed through a literature review, semi-structured interviews, and group discussions. The initial scale was finalized after two rounds of expert consultation using the Delphi method. A convenience sampling method was used to recruit 418 MHD patients using AVF in January 2024 for item analysis, exploratory factor analysis and reliability testing. Another 293 MHD patients using AVF were recruited in March 2024 for confirmatory factor analysis.Results:The self-care ability scale for AVF in MHD patients included four dimensions: knowledge and skills of AVF self-care, willingness and attitude toward AVF self-care, recognition and prevention of AVF complications, and patient self-adjustment and adaptation, comprising 38 items. The content validity index at the scale level was 0.98. Exploratory factor analysis extracted four common factors with a cumulative variance contribution rate of 84.706%. Confirmatory factor analysis indicated good model fit, strong convergent validity, and ideal discriminant validity. The total Cronbach's α coefficient of the scale was 0.987; the split-half reliability coefficient was 0.902, and the test-retest reliability coefficient was 0.979.Conclusions:The Self-care Ability Scale for AVF in MHD patients demonstrates excellent reliability and validity, making it a suitable tool for assessing patients' ability to self-care for their AVF.

Objective:This study aimed to explore neurobiomarkers for schizophrenia relapse by comparing brain functional activity between first-diagnosed drug-na?ve schizophrenia (FDS) patients and relapsed schizophrenia (RS) patients.Methods:In this cross-sectional study, a total of 85 RS patients, 75 FDS patients, and 82 controls were recruited from the outpatient and inpatient departments of the Affiliated Brain Hospital of Nanjing Medical University between September 2018 and June 2020. All participants underwent magnetic resonance imaging scans. The fractional amplitude of low-frequency fluctuation (fALFF) was calculated to assess individual′s brain activity. The severity of psychiatric symptoms among patients with schizophrenia was evaluated using the Positive and Negative Syndrome Scale (PANSS). Voxel-based analysis of covariance (ANCOVA) with post-hoc two-sample t-tests was used to compare fALFF values among groups, and partial correlation analysis was employed to examine relationships between aberrant fALFF values and psychiatric symptoms. Results:The RS group demonstrated significantly higher negative symptom scores (21.5±9.1) compared to the FDS group (18.4±8.3; t=-2.28, P<0.05). Relative to the control group, the FDS group showed increased fALFF values in the cerebellum vermis 4/5 and the right putamen( t=4.45, 4.55, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05), while fALFF values were decreased in the right precentral gyrus/postcentral gyrus, bilateral precuneus, and right paracentral lobule ( t=-4.77--4.20, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05). The RS group exhibited increased fALFF values in the left cerebellum 9/10, bilateral cerebellum 6/8/Crus Ⅰ, right inferior temporal gyrus, right middle temporal gyrus, right inferior frontal gyrus (orbital part), and right putamen( t=4.78-5.44, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05), while decreased fALFF values were observed in the bilateral calcarine/cuneus, left superior medial frontal gyrus, right precuneus/cuneus, bilateral precuneus, and right precentral gyrus/postcentral gyrus ( t=-4.97--4.38, GRF-corrected, voxel-level P<0.001, cluster-level P<0.05). Compared with the FDS group, the RS group showed increased fALFF values in the right cerebellum Crus Ⅰ (GRF-corrected, t=3.83, voxel-level P<0.001, cluster-level P<0.05). In the FDS group, correlation analysis revealed that fALFF values in the bilateral precuneus were negatively correlated with negative symptom scores, general psychopathology scores, and the PANSS total score ( r=-0.32, -0.26, -0.26,all P<0.05), while no such correlation was found in the RS group. Conclusions:RS patients exhibit more severe negative symptoms and more diffuse brain functional abnormalities compared to FDS patients, particularly affecting the default mode network and cerebellar regions. Functional alterations in the right cerebellum Crus Ⅰ and bilateral precuneus may serve as potential neuroimaging markers for identifying relapse in schizophrenia.

Objective:To develop and validate a Self-care Ability Scale for Arteriovenous Fistula (AVF) in Maintenance Hemodialysis (MHD) patients.Methods:Guided by Orem's self-care theory, the initial item pool of the scale was developed through a literature review, semi-structured interviews, and group discussions. The initial scale was finalized after two rounds of expert consultation using the Delphi method. A convenience sampling method was used to recruit 418 MHD patients using AVF in January 2024 for item analysis, exploratory factor analysis and reliability testing. Another 293 MHD patients using AVF were recruited in March 2024 for confirmatory factor analysis.Results:The self-care ability scale for AVF in MHD patients included four dimensions: knowledge and skills of AVF self-care, willingness and attitude toward AVF self-care, recognition and prevention of AVF complications, and patient self-adjustment and adaptation, comprising 38 items. The content validity index at the scale level was 0.98. Exploratory factor analysis extracted four common factors with a cumulative variance contribution rate of 84.706%. Confirmatory factor analysis indicated good model fit, strong convergent validity, and ideal discriminant validity. The total Cronbach's α coefficient of the scale was 0.987; the split-half reliability coefficient was 0.902, and the test-retest reliability coefficient was 0.979.Conclusions:The Self-care Ability Scale for AVF in MHD patients demonstrates excellent reliability and validity, making it a suitable tool for assessing patients' ability to self-care for their AVF.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective:To evaluate and screen the regimens of tigecycline intraventricular injection in extensively drug resistant Acinetobacter baumannii (XDRAB) intracranial infection based on Monte Carlo simulation and pharmacokinetic/pharmacodynamic (PK/PD) model.Methods:Nine patients with XDRAB intracranial infection confirmed as having susceptibility to tigecycline or polymyxin antimicrobials from January 1, 2018 to December 31, 2023 were screened from electronic medical record system in Second Affiliated Hospital of Shandong First Medical University. WHONET software was used to extract pathogen susceptibility data isolated from cerebrospinal fluid samples. Minimum inhibitory concentration (MIC) of tigecycline against XDRAB was analyzed by drug susceptibility test; different regimens for intraventricular tigecycline injection were designed based on MIC: 2 mg/12 h, 3 mg/12 h, 4 mg/12 h, 5 mg/12 h, 6 mg/12 h, and 10 mg/12 h, with drug concentration of 0.5 mg/mL or 1.0 mg/mL once a day. Target value of PK/PD index was set as ?C max/MIC≥8; Monte Carlo was used to simulate the compliance of PK/PD index of tigecycline with different MIC against XDRAB for different dosed regimens (probability of target attainment [PTA] and cumulative fraction of response [CFR]); the best regiment was selected (screening basis: PTA≥90% or CFR≥90%). Results:(1) A total of 27 strains of pathogenic bacteria from 9 patients were extracted from drug susceptibility test, in which MIC of tigecycline against XDRAB was 55.56% for 2 mg/L, 25.93% for 4 mg/L, and 18.52% for 8 mg/L. (2) When the drug concentration was 0.5 mg/mL or 1.0 mg/mL, respectively, all 6 regimens had PTA>90% at 2 mg/L MIC; 5 regimens, except for 2 mg/12 h, had PTA>90% at 4 mg/L MIC; regimens of 5 mg/12 h, 6 mg/12 h, and 10 mg/12 h could achieve PTA>90% at 8 mg/L MIC. (3) When the drug concentration was 0.5 mg/mL, regimens of 4 mg/12 h, 5 mg/12 h, 6 mg/12 h, and 10 mg/12 h could achieve CFR>90%; when the drug concentration was 1 mg/mL, regimens of 4 mg/12 h, 5 mg/12 h, 6 mg/12 h, and 10 mg/12 h could achieve CFR>92%.Conclusion:In intraventricular tigecycline injection for XDRAB intracranial infection, 2 mg/12 h regimen is available in 2 mg/L MIC, 3 mg/12 h regimen is available in 4 mg/L MIC, and 5 mg/12 h regimen is available in 8 mg/L MIC, with either 0.5 mg/mL or 1 mg/mL concentration.

Objective We aimed to investigate the relationship between microscopic pattern of blood stasis and renal pathological grade and related physical and chemical indexes in children with Henoch-Sch?nlein purpura nephritis(HSPN).Methods We conducted a retrospective analysis of 800 HSPN children from the medical records of the First Affiliated Hospital of Henan University of Chinese Medicine.Laboratory indicators(blood routine test,urine routine test,coagulation test,liver function)and renal pathological indicators of them were collected.According to the severity of renal pathological microscopic lesions,the microscopic pattern of blood stasis was divided into three types,including choroidal discord,dead blood coagulation and intracarenal disease accumulation.The classification of renal microscopic pattern of blood stasis and the correlation between laboratory indexes and renal pathological index were analyzed by Spearman grade correlation and binary Logistic regression analysis.Results(ⅰ)There was no statistical difference of the distribution of the renal microscopic pattern of blood stasis in the different traditional Chinese medicine patterns.(ⅱ)There were significant differences in the contents or the grade of albumin and fibrinogen in the HSPN children with different microscopic pattern of blood stasis(all P＜0.05).(ⅲ)The maximum area under the receiver operating characteristic(ROC)curve between fibrinogen and intracarenal disease accumulation was 0.594(95％CI from 0.540 to 0.633,P＜0.001);sensitivity was 0.447,specificity was 0.725;the best threshold on the ROC curve of 0.172 was 3.755 g/L.(ⅳ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the scores of intracarenal disease accumulation type(r=0.176,r=0.315,r=0.656;all P＜0.001).(ⅴ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the renal microscopic pattern of blood stasis(r=0.157,r=0.377,r=0.429;all P＜0.001).Conclusion The microscopic renal pattern of blood stasis can not only reflect the severity of renal blood stasis,but also reflect the severity and long-term prognosis of renal diseases.Albumin and urinary protein grade can reflect the early stage of the microscopic renal pattern of the blood stasis(choroidal discord).The content of fibrinogen increases with the aggravation of renal microscopic pattern of blood stasis,reflecting the end-stage of HSPN,which has the correlation with the formation and severity of related indexes.Fibrinogen can be used as a laboratory indicator to assist in the diagnosis of irreversible lesionsin the renal pathology of HSPN children.