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.

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.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To analyze the current status and influencing factors of balance ability in elderly inpatients, and to explore the correlation between balance function and the tendency to suffer from geriatric syndromes.Methods:A total of 262 elderly patients hospitalized from April to August 2023 were selected as the research objects by convenience sampling method.A systematic health assessment was performed by professional evaluators using the "Edge Intelligent Geriatric Assessment System" software of the Jiangsu Province Hospital within one week after admission.According to the results of Performance Oriented Mobility Assessment(POMA), the subjects were divided into normal balance group(n=188), POMA score 19 to 24 group(n=36)and less than 19 score group(n=38), the differences in the tendency of the three groups of patients to develop geriatric syndromes were compared.Logistic regression analysis was used to screen the related factors and construct the regression equation.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of regression equation.Results:A total of 262 patients, of which 156(59.54%)were males, with an age range of 60 to 100 years(mean age 74.11±8.77 years)were included in the study.The total POMA score of 262 patients was 23.69±6.00, of which 74 cases(28.24%)had balance dysfunction.Univariate analysis showed that there were significant differences in age( t=20.356, P<0.001), serum albumin( t=3.999, P=0.019), proportions of people suffering from depression, frailty, sarcopenia, sleep disorders, nutrition risk and high fall risk between patients with different balance ability( χ2=10.250, 76.763, 101.728, 37.805, 22.472, 75.095, all P<0.05).Binary logistic regression model showed that age, sarcopenia, suspected insomnia, insomnia, and nutritional risk were independent predictors of balance ability in elderly patients(OR=1.071, 12.424, 6.719, 8.321, 3.440, all P<0.05).The above related variables were included in the regression equation: Logit(P)=-8.792+ 0.069×age+ 2.520×sarcopenia+ 1.905×suspected insomnia+ 2.119×insomnia+ 1.236×nutritional risk.ROC curve analysis showed that the area under the curve(AUC)was 0.902(95% CI: 0.857-0.946, P<0.001), the predictive specificity was 86.17% and the sensitivity was 85.14%. Conclusions:Age≥75.5 years, sarcopenia, sleep disorders, and nutritional risk could be used as predictors of balance disorders in elderly inpatients.The regression model constructed based on these indicators has a good predictive value.The establishment of the edge intelligent geriatric assessment system promotes the improvement of medical information level.

Objective:To explore the association between oral health status, the lower respiratory tract microbiome, and the frequent acute exacerbation phenotype in chronic obstructive pulmonary disease (COPD).Methods:This cross-sectional study enrolled 39 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalized in the Department of Respiratory Medicine, Henan Provincial People′s Hospital between March 2021 and December 2022. Based on the number of hospitalization episodes for acute exacerbation in the past year, patients were divided into a frequent exacerbator group (≥2 times, n=28) and a non-frequent exacerbator group (<2 times, n=11). Bronchoalveolar lavage fluid (BALF) samples were collected from all subjects for metagenomic next-generation sequencing (mNGS). Oral health indicators and clinical data were also collected. Statistical analyses were performed using Spearman correlation analysis and multivariable Firth logistic regression analysis. Results:The frequent exacerbation group showed a significantly higher percentage of individuals with≥8 tooth loss compared to the non-frequent exacerbation group (96.4% vs 18.2%, P<0.001), a significantly younger age at first tooth loss in adulthood (53.96±7.30 years vs 62.10±5.80 years, P=0.003), and a significantly higher proportion of individuals who hardly brushed their teeth (50.00% vs 9.09%, P=0.038). The alpha-diversity indices of the lower respiratory tract microbiota were significantly lower in the frequent exacerbation group than in the non-frequent exacerbation group (all P<0.01). The relative abundances of Bacillota, Bacteroidota, Fusobacteriota, Streptococcus, Prevotella, Veillonella, Neisseria, Rothia, Prevotellamelaninogenica, Prevotellajejuni, Rothia mucilaginosa, Veillonella parvula, and Neisseria subflava were lower in the frequent exacerbation group (all P<0.05). In patients with AECOPD, the exacerbation frequency and the presence of ≥8 tooth loss were both negatively correlated with the Shannon index ( r=-0.854, P<0.001; r=-0.642, P<0.001, respectively). Further analysis revealed that Bacillota ( r=-0.862, P<0.001) and Streptococcus ( r=-0.814, P<0.001) were significantly negatively correlated with exacerbation frequency, while Pseudomonas was positively correlated with exacerbation frequency (all P<0.05). Bacillota ( r=0.369, P=0.021), Fusobacteriota ( r=0.368, P=0.021), and Veillonella ( r=0.379, P=0.017) were positively correlated with FEV 1% predicted. Multivariable Firth logistic regression analysis revealed that the first principal component of the microbial community ( OR=2.29, 95% CI: 1.20-11.07) and the loss of≥8 teeth ( OR=14.37, 95% CI: 1.42-482.51) were independent factors associated with frequent acute exacerbations. Conclusion:Frequent acute exacerbations of COPD are significant association with deteriorated oral health and dysbiosis of the lower respiratory tract microbiome, characterized by reduced alpha-diversity and depletion of commensal bacteria.

AIM: To compare the refractive prediction accuracy of 7 intraocular lens(IOL)calculation formulas in the cataract eyes with short axial length(AL)at different corneal curvatures and anterior chamber depth(ACD), and analyze relevant influencing factors contributing to prediction errors.METHODS: A retrospective analysis was performed for 125 patients(125 eyes)with a short AL, who received cataract phacoemulsification at Shenyang He Eye Specialist Hospital from November 2020 to December 2021. According to the keratometry(Km), they were divided into low flat Km group(≤45.5 D), medium and high Km group(45.5 D

Objective To investigate alterations in interhemispheric functional connectivity(FC)in the cerebral cortices connected via the corpus callosum in patients with Alzheimer's disease(AD),and to explore their relationships with cognitive function and activities of daily living.Methods Resting-state functional magnetic resonance imaging data were collected from 28 patients with Alzheimer's dementia(d-AD),47 patients with mild cognitive impairment(MCI),and 37 healthy controls(HC).Using a trancallosal tract template,32 pairs of homologous cortical brain regions directly connected to 32 subregions of the corpus callosum were selected as regions of interest for interhemispheric FC analysis.Further correlation analyses were performed between FC values in patient groups and their scores on the Montreal Cognitive Assessment-Basic(MoCA-B)Scale and the Activities of Daily Living(ADL)Scale.Results Compared with HC group,both MCI and d-AD groups exhibited hyperconnectivity(significantly increased FC)in interhemispheric non-homologous brain regions.Specifically,hyperconnectivity in the MCI group was scattered across the frontal,parietal,temporal,and occipital lobes,while in the d-AD group,it was concentrated within the precentral and postcentral gyri.Notably,hyperconnectivity involving the prefrontal and occipital lobes in the MCI group showed significant declines in the d-AD group.The interhemispheric homologous FC in the d-AD group reduced more significantly than the MCI group.Additionally,in the d-AD group,2 interhemispheric FC within the prefrontal lobe(between the bilateral orbital parts of the inferior frontal gyrus,and between the left medial frontal gyrus and the right middle frontal gyrus)were correlated with MoCA-B scores,and 2 FC(between the bilateral middle occipital gyri,and between the left inferior parietal lobule and the right middle frontal gyrus)were correlated with ADL scores.Conclusion MCI and d-AD exhibit distinct patterns of interhemispheric FC alterations,and the interhemispheric FC changes in AD patients are non-progressive.The close relationships between interhemispheric homologous/non-homologous FC and MoCA-B/ADL scores in d-AD patients provide an objective basis and reference for clinical neuromodulation.

Objective To explore function-structure covariant patterns in Alzheimer's disease(AD)and mild cognitive impairment(MCI),and to investigate their associations with cognitive function and activities of daily living.Methods three-way parallel group independent component analysis(three-way pGICA),was used to identify the covariant patterns of resting-state functional MRI temporal data,gray matter density maps,and fractional anisotropy(FA)maps,and the differences between different groups were compared.Furthermore,the associations of covariant patterns with the Montreal Cognitive Assessment-Basic(MoCA_B)Scale scores and Activities of Daily Living Scale scores were analyzed.Results The function-structure covariant patterns in AD and MCI were characterized by the enhanced negative functional connectivity between the left posterior salience network and the right default mode network,the decreased gray matter density in the bilateral dorsolateral prefrontal cortex,and the reduced FA values in the left superior corona radiata(correlations:P<0.001,FDR corrected).Compared with HC group,AD group showed significant abnormalities in all identified covariant patterns(P<0.01,FDR corrected),but MCI group only exhibited a significant decrease in gray matter density in the bilateral dorsolateral prefrontal cortex(P<0.05,FDR corrected).Additionally,AD group had significantly lower FA value in the left superior corona radiata than MCI group(P<0.05,FDR corrected).The loadings reflecting the degree of covariation were significantly correlated with the Activities of Daily Living Scale scores(P<0.05,FDR corrected)but not with MoCA_B Scale scores.Conclusion The function-structure covariant patterns in AD and MCI are consistent with the declines in activities of daily living.The multimodal fusion analysis(three-way pGICA)provides a novel approach to understand the brain damage mechanisms underlying the covariant evolution of MCI and AD.

Objective To explore function-structure covariant patterns in Alzheimer's disease(AD)and mild cognitive impairment(MCI),and to investigate their associations with cognitive function and activities of daily living.Methods three-way parallel group independent component analysis(three-way pGICA),was used to identify the covariant patterns of resting-state functional MRI temporal data,gray matter density maps,and fractional anisotropy(FA)maps,and the differences between different groups were compared.Furthermore,the associations of covariant patterns with the Montreal Cognitive Assessment-Basic(MoCA_B)Scale scores and Activities of Daily Living Scale scores were analyzed.Results The function-structure covariant patterns in AD and MCI were characterized by the enhanced negative functional connectivity between the left posterior salience network and the right default mode network,the decreased gray matter density in the bilateral dorsolateral prefrontal cortex,and the reduced FA values in the left superior corona radiata(correlations:P<0.001,FDR corrected).Compared with HC group,AD group showed significant abnormalities in all identified covariant patterns(P<0.01,FDR corrected),but MCI group only exhibited a significant decrease in gray matter density in the bilateral dorsolateral prefrontal cortex(P<0.05,FDR corrected).Additionally,AD group had significantly lower FA value in the left superior corona radiata than MCI group(P<0.05,FDR corrected).The loadings reflecting the degree of covariation were significantly correlated with the Activities of Daily Living Scale scores(P<0.05,FDR corrected)but not with MoCA_B Scale scores.Conclusion The function-structure covariant patterns in AD and MCI are consistent with the declines in activities of daily living.The multimodal fusion analysis(three-way pGICA)provides a novel approach to understand the brain damage mechanisms underlying the covariant evolution of MCI and AD.

Objective To investigate alterations in interhemispheric functional connectivity(FC)in the cerebral cortices connected via the corpus callosum in patients with Alzheimer's disease(AD),and to explore their relationships with cognitive function and activities of daily living.Methods Resting-state functional magnetic resonance imaging data were collected from 28 patients with Alzheimer's dementia(d-AD),47 patients with mild cognitive impairment(MCI),and 37 healthy controls(HC).Using a trancallosal tract template,32 pairs of homologous cortical brain regions directly connected to 32 subregions of the corpus callosum were selected as regions of interest for interhemispheric FC analysis.Further correlation analyses were performed between FC values in patient groups and their scores on the Montreal Cognitive Assessment-Basic(MoCA-B)Scale and the Activities of Daily Living(ADL)Scale.Results Compared with HC group,both MCI and d-AD groups exhibited hyperconnectivity(significantly increased FC)in interhemispheric non-homologous brain regions.Specifically,hyperconnectivity in the MCI group was scattered across the frontal,parietal,temporal,and occipital lobes,while in the d-AD group,it was concentrated within the precentral and postcentral gyri.Notably,hyperconnectivity involving the prefrontal and occipital lobes in the MCI group showed significant declines in the d-AD group.The interhemispheric homologous FC in the d-AD group reduced more significantly than the MCI group.Additionally,in the d-AD group,2 interhemispheric FC within the prefrontal lobe(between the bilateral orbital parts of the inferior frontal gyrus,and between the left medial frontal gyrus and the right middle frontal gyrus)were correlated with MoCA-B scores,and 2 FC(between the bilateral middle occipital gyri,and between the left inferior parietal lobule and the right middle frontal gyrus)were correlated with ADL scores.Conclusion MCI and d-AD exhibit distinct patterns of interhemispheric FC alterations,and the interhemispheric FC changes in AD patients are non-progressive.The close relationships between interhemispheric homologous/non-homologous FC and MoCA-B/ADL scores in d-AD patients provide an objective basis and reference for clinical neuromodulation.