BACKGROUND: The optimal antidepressant dosages remain controversial. This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive disorders (MDD). METHODS: We searched multiple databases, including the Embase, Cochrane Central Register of Controlled Trials, PubMed, and Web of Science, for the studies that were conducted between January 8, 2016, and April 30, 2023. The studies are double-blinded, randomized controlled trials (RCTs) involving the adults (≥18 years) with MDD. The primary outcomes were efficacy of antidepressant and the dose-response relationships. A frequentist network meta-analysis was conducted, treating participants with various dosages of the same antidepressant as a single therapy. We also implemented the model-based meta-analysis (MBMA) using a Bayesian method to explore the dose-response relationships. RESULTS: The network meta-analysis comprised 135,180 participants from 602 studies. All the antidepressants were more effective than the placebo; toludesvenlafaxine had the highest odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.65-7.72), and reboxetine had the lowest OR of 1.34 (95%CI: 1.14-1.57). Moreover, amitriptyline, clomipramine, and reboxetine showed a linear increase in effect size from low to high doses. The effect size of toludesvenlafaxine increased significantly up to 80 mg/day and subsequently maintained the maximal dose up to 160 mg/day while the predictive curves of nefazodone were fairly flat in different dosages. CONCLUSIONS: Although most antidepressants were more efficacious than placebo in treating MDD, no consistent dose-response relationship between any antidepressants was observed. For most antidepressants, the maximum efficacy was achieved at lower or middle prescribed doses, rather than at the upper limit. REGISTRATION No. CRD42023427480; https://www.crd.york.ac.uk/prospero/display_record.php?
Humans ; Antidepressive Agents/therapeutic use* ; Depressive Disorder, Major/drug therapy* ; Dose-Response Relationship, Drug ; Randomized Controlled Trials as Topic

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.

Objective:To investigate the clinical efficacy of anterior versus posterior app-roach to posterior rectus sheath in laparoscopic totally extraperitoneal sublay (TES) for diastasis recti combined with umbilical hernia.Methods:The retrospective cohort study was conducted. The clinicopathological data of 45 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to The University of Hong Kong-Shenzhen Hospital and 24 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to Shenzhen People's Hospital from January 2019 to December 2024 were collected. There were 6 males and 63 females, aged (50±14)years. All 69 patients underwent laparoscopic TES. Among them, 36 patients under-going the anterior approach to the posterior rectus sheath were assigned to anterior approach group, and 33 patients undergoing the posterior approach were assigned to posterior approach group. Observation indicators: (1) surgical conditions; (2) follow-up conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. All patients in both groups successfully completed the surgery. The type of mesh placed was self-fixating mesh in all cases, with no conversion to open surgery, and routine drainage tube placement was performed postoperatively. For the anterior approach group and the posterior approach group, the operative time was (167±44)minutes and (214±53)minutes, the maximum separation width of the rectus abdominis was (3.57±0.79)cm and (4.08±0.99)cm, respectively, showing significant differences in the above indicators between the two groups ( t=-4.00, -2.36, P<0.05). For the anterior approach group and the posterior approach group, cases with peritoneal injury were 26 and 29, the umbilical hernia defect diameter was (2.15±0.46)cm and (2.24±0.52) cm, the postoperative drainage volume was (62±22)mL and (72±36)mL, respectively, showing no significant difference in the above indicators between the two groups ( χ2=2.61, t=-0.76, -1.50, P>0.05). (2) Follow-up conditions. Among the 69 patients, 61 were followed up, including 31 cases in the anterior approach group and 30 cases in the posterior approach group. The duration of follow-up was 31(range, 8-44)months for the anterior approach group and 35(range, 9-60)months for the posterior approach group, respectively. No recurrence (abdominal wall bulge), seroma, chronic pain, or infection occurred in either group, and all patients were able to complete the trunk flexion movement with hands behind the head. Conclusion:Both the anterior and posterior approaches to posterior rectus sheath are safe and effective in laparoscopic TES for diastasis recti abdominis combined with umbilical hernia, among which the anterior approach to posterior rectus sheath has a shorter operation time.

Objective:To investigate the clinical efficacy of anterior versus posterior app-roach to posterior rectus sheath in laparoscopic totally extraperitoneal sublay (TES) for diastasis recti combined with umbilical hernia.Methods:The retrospective cohort study was conducted. The clinicopathological data of 45 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to The University of Hong Kong-Shenzhen Hospital and 24 patients with diastasis recti abdominis combined with umbilical hernia who were admitted to Shenzhen People's Hospital from January 2019 to December 2024 were collected. There were 6 males and 63 females, aged (50±14)years. All 69 patients underwent laparoscopic TES. Among them, 36 patients under-going the anterior approach to the posterior rectus sheath were assigned to anterior approach group, and 33 patients undergoing the posterior approach were assigned to posterior approach group. Observation indicators: (1) surgical conditions; (2) follow-up conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. All patients in both groups successfully completed the surgery. The type of mesh placed was self-fixating mesh in all cases, with no conversion to open surgery, and routine drainage tube placement was performed postoperatively. For the anterior approach group and the posterior approach group, the operative time was (167±44)minutes and (214±53)minutes, the maximum separation width of the rectus abdominis was (3.57±0.79)cm and (4.08±0.99)cm, respectively, showing significant differences in the above indicators between the two groups ( t=-4.00, -2.36, P<0.05). For the anterior approach group and the posterior approach group, cases with peritoneal injury were 26 and 29, the umbilical hernia defect diameter was (2.15±0.46)cm and (2.24±0.52) cm, the postoperative drainage volume was (62±22)mL and (72±36)mL, respectively, showing no significant difference in the above indicators between the two groups ( χ2=2.61, t=-0.76, -1.50, P>0.05). (2) Follow-up conditions. Among the 69 patients, 61 were followed up, including 31 cases in the anterior approach group and 30 cases in the posterior approach group. The duration of follow-up was 31(range, 8-44)months for the anterior approach group and 35(range, 9-60)months for the posterior approach group, respectively. No recurrence (abdominal wall bulge), seroma, chronic pain, or infection occurred in either group, and all patients were able to complete the trunk flexion movement with hands behind the head. Conclusion:Both the anterior and posterior approaches to posterior rectus sheath are safe and effective in laparoscopic TES for diastasis recti abdominis combined with umbilical hernia, among which the anterior approach to posterior rectus sheath has a shorter operation time.

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.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss. There are two primary forms of AMD: exudative age-related macular degeneration (WAMD) and atrophic AMD (DAMD). While numerous medications are currently available for the treatment of WAMD, yielding significant therapeutic outcomes, effective treatments for DAMD remain scarce. Various animal studies and clinical trials on DAMD treatment have been conducted, focusing primarily on antioxidants, complement pathway inhibitors, mitochondrial protectors, visual cycle inhibitors, neuroprotectants, amphiphilic polymer-based drug delivery systems, cell therapy, photobiomodulation therapy, gene therapy, surgical interventions, and traditional Chinese medicine. Among these, antioxidant supplementation with vitamins and complement pathway inhibitor APL-2 and ACP have received Food and Drug Administration approval for the treatment of DAMD. With the continuous development of the medical field, the future will explore the treatment methods with little trauma, good efficacy and good patient compliance, and successfully achieve clinical transformation.

Objective:To establish a foundation for the psychological selection of air combat personnel by studying the cognitive ability measurement methods for air combat personnel.Methods:The tests were done for 390 subjects including 142 radar operators, 117 radar academy students, 45 air combat personnel, and 86 radar trainees. Based on job analysis, 5 cognitive test tasks were developed, including graphic discrimination, working memory test, target tracking, voice anti-jamming, and comprehensive management. The discrimination was evaluated by the distribution graphs and coefficients of variation of the test results. The criterion-related validity was examined by correlating the cognitive test scores with the participants' work performance or academic grades, which served as the criteria. Content validity was determined by a 9-level scoring (1-9) of task necessity that collected from 30 air combat personnel and by the assessments of necessity of tested abilities that came from 30 experts. The parallel forms reliability, test-retest reliability and split-half reliability were tested respectively according to the results of each test.Results:The original scores of each test showed approximate normal distribution. The selected indicators' coefficients of variation were 14.4%-111.0%, reliabilities were 0.764-0.827, and criterion-related validities were 0.186-0.445, all of which were statistically significant (all P<0.05). In 30 air combat personnel, 53.3%-83.3% scored 7-9 to the necessity of test items, and 93.3% of 30 experts gave the required or basically required evaluations to the test items. Conclusions:The series tests show good content validity, and discrimination, reliability and the criterion-related validity meet the requirements of psychometrics. Especially the tests of graphic discrimination, working memory and target tracking expressed higher degree of discrimination, and can be used as cognitive ability assessment tool for the selection of air combat personnel.

Objective To analyze the influence of shaping on the bending strength of bone plates and the influence of different locking nail distributions on plate force to provide biomechanical references for shaping plates and selecting different locking nail distributions.Methods Finite element simulation analysis of the four-point bending strength of a plate was performed according to the YY/T 0342-2020 standard.Theoretical analysis and finite element simulation method were used to analyze the force on prosthesis models with different lock-nail distributions.Results At 30° bending,the 3.7 mm-thick plate had 28%higher equivalent plastic strain than the 2.7 mm-thick plate.The 3.7 and 2.7 mm-thick plates had ultimate bending angles of 55° and 67°,respectively.The crease had little impact on the plate stress.The four-point bending strength and equivalent bending stiffness of the unshapeed structure were 2.64 N·m and 1.12 N·m2,respectively.The four-point bending strength and equivalent bending stiffness with the crease were 2.63 N·m and 1.10 N·m2,respectively.After forward and backward bending,the four-point bending strength of the plate decreased from 2.64 to 2.45 N·m by approximately 7.72%,and the equivalent bending stiffness decreased from 1.12 to 0.98 N·m2 by approximately 12%.The impact was obvious.After implantation of tamponade screws,the four-point bending strength of the single-hole plate improved significantly from 2.64 to 3.15 N·m,by approximately 19.32%and the equivalent bending stiffness increased from 1.12 to 1.14 N·m2,by approximately 2.1%.At least two locking holes were reserved on both sides of the fracture line.Not inserting the locking screw reduced the stress by approximately 50%compared with the full insertion of the locking screw.During 15-week postoperative walking without bone callus formation,the material stress of TC4 reached 852.7 MPa and yielding occurred.Conclusions In a clinical scenario where larger shaping is required,it is not suitable for plates with larger thicknesses and plate fractures are more likely to occur after large-thickness shaping.This can guide the clinical selection of plates with appropriate thickness based on the shaping angle,and tamponade screws can be implanted in extreme cases.Fixing locking screws clinically is recommended;however,a method of fixing the locking screws with full screws is not recommended.The biomechanical effect is best when two locking holes at both ends of the fracture line are maintained without fixing the locking screws.

Objective:To explore the mechanism of Jianpi Qingchang Decoction in the treatment of UC by integrating network pharmacology, bioinformatics, molecular docking and experimental verification.Methods:The effective components and targets of Jianpi Qingchang Decoction were obtained from TCMSP database, and UC data sets GSE16879, GSE48958 and GSE75214 were obtained from GEO database, and differentially expressed genes were screened; intersection targets were obtained through Venn diagram, and GO function and KEGG pathway enrichment analysis was performed. An intersection target PPI network was constructed using STRING database and topology analysis was performed; hub genes were screened through lasso regression and the expression consistency of core targets in the dataset was verified through logistic regression. A UC mouse model was established and hub genes were validated.Results:A total of 213 drug targets of Jianpi Qingchang Decoction were obtained, and 499 common intersection targets of GSE16879, GSE48958 and GSE75214 were obtained by differential gene expression analysis. Thirty intersection targets of Jianpi Qingchang Decoction and UC were obtained, mainly acting on IL-17 signaling pathway, TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications, etc. PPI network topology analysis obtained 7 common intersection targets, including PTGS2, IL-1B, IL-6, MMP9, CXCL8, CCL2 and MMP2. IL-6 and MMP2 were selected as hub genes by lasso regression. Logistics regression analysis showed that IL-6 and MMP2 were risk factors for the disease. Compared with the model group, the expressions of IL-6 and MMP2 mRNA and protein in the colon tissue of the TCM group decreased ( P<0.05), and the morphology of colon tissue was improved compared with the model group. Conclusion:IL-6 and MMP2 are risk factors for UC, the therapeutic effect of Jianpi Qingchang Decoction is to mediate Il-17 signal pathway, TNF signal pathway and AGE-RAGE signal pathway in diabetic complications through the targets of IL-6, and MMP2, thereby treating UC.