OBJECTIVE: To explore clinical effects of bone setting manipulation combined with pry reduction and Kirschner needle internal fixation in treating SandersⅡ-Ⅲ calcaneal fracture. METHODS: Clinical data of 52 patients with types Sanders Ⅱand Ⅲ calcaneal fracture (foot) treated with bone-setting manipulation combined with pry reduction and Kirscher needle internal fixation from July 2017 to July 2019 were retrospectively analyzed, including 43 males and 9 females, aged from 31 to 72 years old with an average of (50.83±10.48) years old; 15 patients with Sanders typeⅡ and 37 patients with Sanders type Ⅲ. The changes of Bühler angle, Gissane angle, calcaneus width and calcaneus height before operation and 24 months after operation were compared, and Maryland foot function score was performed to evaluate clinical effects. RESULTS: All patients were followed up from 24 to 60 months with an average of (41.50±9.86)months. The fracture healed normally and the healing time was (11.00±0.95) weeks. Bühler angle, Gissane angle, calcaneal bone width and calcaneal bone height were increased from (16.37±8.36)°, (96.27±9.62)°, (46.82±4.67) mm, (38.41±3.58) mm before operation to (31.48±8.24)°, (111.62±8.69)°, (42.06±4.83) mm, (44.21±3.82) mm at 24 months after operation, and the difference were statistically significant (P<0.01). Postoperative Maryland score at 24 months was (93.04±8.83), 40 patients got excellent result, 7 good and 5 fair. CONCLUSION Orthopedic manipulation combined with percutaneous reduction and Kirschner wire internal fixation could significantly improve Bühler angle, Gissane angle, width, and height of Sanders typeⅡ and Ⅲ calcaneal fractures, and the curative effect is satisfactory.
Humans ; Male ; Female ; Calcaneus/surgery* ; Middle Aged ; Fracture Fixation, Internal/methods* ; Adult ; Aged ; Fractures, Bone/therapy* ; Retrospective Studies ; Bone Wires ; Manipulation, Orthopedic/methods*

Compounds isolated from Epimedium include the total flavonoids of Epimedium , icariin, and its metabolites (icaritin, icariside I, and icariside II), which have similar molecular structures. Modern pharmacological research and clinical practice have proved that Epimedium and its active components have a wide range of pharmacological effects, especially in improving sexual function, hormone regulation, anti-osteoporosis, immune function regulation, anti-oxidation, and anti-tumor activity. To date, we still need a comprehensive source of knowledge about the pharmacological effects of Epimedium and its bioactive compounds on the male reproductive system. However, their actions in other tissues have been reviewed in recent years. This review critically focuses on the Epimedium , its bioactive compounds, and the biochemical and molecular mechanisms that modulate vital pathways associated with the male reproductive system. Such intrinsic knowledge will significantly further studies on the Epimedium and its bioactive compounds that protect the male reproductive system and provide some guidances for clinical treatment of related male reproductive disorders.
Male ; Epimedium/chemistry* ; Humans ; Genitalia, Male/drug effects* ; Flavonoids/therapeutic use* ; Animals

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.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective To observe the effects of electroacupuncture(EA)on morphine-induced microglia activation and analgesic tolerance,and explore the potential mechanism of EA in the treatment of morphine analgesic tolerance.Methods A total of 60 clean-grade SD rats were randomly assigned to control group,morphine group,morphine+EA group,and morphine+EA+colony-stimulating factor 1(CSF1)group,with 15 rats in each group.Morphine analgesic tolerance model was established by continuous 7-d intrathecal injection of morphine in the morphine,morphine+EA and morphine+EA+CSF1 groups.EA was given in the rats of morphine+EA and morphine+EA+CSF1 groups at"Zusanli"and"Sanyinjiao"acupoints,with dilatational wave,frequency of 2/100 Hz,stimulation intensities of 0.5,1.0,and 1.5 mA(10 min per intensity),once a day,for 7 consecutive days.Rats in morphine+EA+CSF1 group were given intrathecal injection with recombinant CSF1 protein for 7 consecutive days.The effect of EA on morphine analgesic tolerance in rats was observed by mechanical withdrawal threshold(MWT).After 7 d,the rats were sacrificed,and the L4-6 spinal dorsal horn and dorsal root ganglion tissues were isolated.The expression of CSF1 protein and mRNA in the dorsal root ganglia and spinal dorsal horn was detected by Western blotting and quantitative polymerase chain reaction.The expression of ionized calcium-binding adapter molecule 1(IBA-1),a marker of microglia in the spinal dorsal horn,was detected by immunofluorescence method,and the expression of interleukin(IL)-1β,IL-6 and tumor necrosis factor(TNF)-α in the spinal cord was detected by enzyme-linked immunosorbent assay(ELISA).Results After intrathecal injection of morphine,the percentage of maximal possible potential effect(%MPE)in the morphine group was decreased progressively,indicating that the morphine analgesic tolerance model was successfully constructed.Compared with the morphine group,the%MPE in the morphine+EA group was increased after intrathecal injection at 3,5 and 7 d(all P＜0.05).Compared with the morphine+EA group,the%MPE in the morphine+EA+CSF1 group was all decreased after intrathecal injection at 3,5 and 7 d(all P＜0.05).Compared with the control group,the expression of CSF1 protein and mRNA in dorsal root ganglion and the expression of CSF1 protein in spinal dorsal horn in the morphine group were increased(all P＜0.05).Compared with the morphine group,the expression levels of CSF1 protein and mRNA in dorsal root ganglion and CSF1 protein in spinal dorsal horn in the morphine+EA group were decreased(all P＜0.05).There was no significant difference in the expression of CSF1 mRNA in the spinal dorsal horn among those groups(all P＞0.05).Compared with the control group,the expression of IBA-1 in the spinal dorsal horn of the morphine group was increased(P＜0.05).Compared with the morphine group,the expression of IBA-1 in the spinal dorsal horn of the morphine+EA group was decreased(P＜0.05).Compared with the morphine+EA group,the expression of IBA-1 in the spinal dorsal horn of the morphine+EA+CSF1 group was increased(P＜0.05).Conclusion EA can inhibit the activation of microglia in the spinal dorsal horn of rats and improve morphine analgesic tolerance in rats.The mechanism may be related to the reduction of CSF1 protein expression in the spinal dorsal horn.

Objective:To understand the current status of knowledge, attitude, and practice (KAP) of nurses in palliative care under the model of palliative co-care in hospitals of different levels in Zhejiang Province, and to analyze the influencing factors.Methods:This study was a cross-sectional study. Convenience sampling was used to select 541 clinical registered nurses from 3 Class Ⅲ hospitals, 3 Class Ⅱ hospitals, and 2 ClassⅠ hospitals in Hangzhou, Huzhou, and Lishui, Zhejiang Province, from March to April 2023. A general information questionnaire and the KAP Survey Scale of Palliative Care Under the Palliative Co-care Model were used to investigate the subjects. Multiple linear regression analysis was conducted to analyze the influencing factors of nurses' KAP of palliative care under palliative co-care. A total of 541 questionnaires were distributed, and 535 valid questionnaires were recovered, with an effective response rate of 98.89%.Results:The scores of 535 nurses for palliative care knowledge, attitude, and practice were (16.29±1.99), (71.10±9.00), and (32.21±5.89), respectively. Multiple linear regression analysis revealed that hospital level, gender, and whether nurses have participated in on-the-job training on palliative care are influencing factors of nurses' knowledge of palliative care ( P<0.05) ; ethnicity and the duration of palliative care training courses attended within two years are influencing factors of nurses' attitude toward palliative care ( P<0.05) ; department is an influencing factor of nurses' practice of palliative care ( P<0.05) . Conclusions:Under the palliative co-care model in Zhejiang Province, nurses demonstrate a good attitude toward palliative care, while their knowledge and practice levels of palliative care still have room for improvement, with distinct influencing factors for each dimension-hospital level, gender, and on-the-job training participation affect knowledge; ethnicity and training duration within two years affect attitude; and department affects practice.

Objective:To understand the current status of knowledge, attitude, and practice (KAP) of nurses in palliative care under the model of palliative co-care in hospitals of different levels in Zhejiang Province, and to analyze the influencing factors.Methods:This study was a cross-sectional study. Convenience sampling was used to select 541 clinical registered nurses from 3 Class Ⅲ hospitals, 3 Class Ⅱ hospitals, and 2 ClassⅠ hospitals in Hangzhou, Huzhou, and Lishui, Zhejiang Province, from March to April 2023. A general information questionnaire and the KAP Survey Scale of Palliative Care Under the Palliative Co-care Model were used to investigate the subjects. Multiple linear regression analysis was conducted to analyze the influencing factors of nurses' KAP of palliative care under palliative co-care. A total of 541 questionnaires were distributed, and 535 valid questionnaires were recovered, with an effective response rate of 98.89%.Results:The scores of 535 nurses for palliative care knowledge, attitude, and practice were (16.29±1.99), (71.10±9.00), and (32.21±5.89), respectively. Multiple linear regression analysis revealed that hospital level, gender, and whether nurses have participated in on-the-job training on palliative care are influencing factors of nurses' knowledge of palliative care ( P<0.05) ; ethnicity and the duration of palliative care training courses attended within two years are influencing factors of nurses' attitude toward palliative care ( P<0.05) ; department is an influencing factor of nurses' practice of palliative care ( P<0.05) . Conclusions:Under the palliative co-care model in Zhejiang Province, nurses demonstrate a good attitude toward palliative care, while their knowledge and practice levels of palliative care still have room for improvement, with distinct influencing factors for each dimension-hospital level, gender, and on-the-job training participation affect knowledge; ethnicity and training duration within two years affect attitude; and department affects practice.

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.