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.

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

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.

Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09％vs.23.49％,P＜0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95％Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P＜0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P＜0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P＜0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P＜0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.

Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09％vs.23.49％,P＜0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95％Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P＜0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P＜0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P＜0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P＜0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.

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.

ObjectiveTo investigate the effect of modified Baduanjin exercise, as an rehabilitation exercise, on cardiopulmonary function, motor function and activities of daily living in patients with stroke. MethodsFrom January to September, 2023, 42 stroke patients in the Nanjing Qixia District Hospital were randomly divided into control group (n = 21) and experimental group (n = 21). The control group received routine rehabilitation, and the experimental group received modified Baduanjin exercise in addition, for four weeks. They were assessed with peak oxygen uptake (VO_2peak), anaerobic threshold (AT), peak oxygen pulse (VO_2peak/HR), forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), peak expiratory flow (PEF), Fugl-Meyer Assessment-upper extremities (FMA-UE), Berg Balance Scale (BBS) and modified Barthel Index (MBI) before and after intervention. ResultsVO_2peak, AT, and the scores of FMA-UE, BBS and MBI improved in the control group after intervention (|t| > 2.256, |Z| > 2.936, P < 0.05); while VO_2peak, AT, VO_2peak/HR, FVC, FEV₁, PEF, and the scores of FMA-UE, BBS and MBI improved in the experimental group (|t| > 4.390, |Z| > 3.451, P < 0.001); and all the indexes were better in the experimental group than in the control group (|t| > 4.136，|Z| > 2.751，P < 0.01), except the scores of BBS and MBI. ConclusionModified Baduanjin exercise can improve the cardiopulmonary function and upper limb motor function for stroke patients.

ObjectiveTo support intelligent clinical decision-making in traditional Chinese medicine（TCM）， this study utilized ontology and knowledge graph construction techniques to achieve the IT application of clinical practice guidelines. MethodBased on the principles of findability， accessibility， interoperability， and reusability （FAIR principles）， this study employed ontology techniques to construct an ontology for TCM clinical practice guidelines and built a knowledge graph using coronary heart disease as an example. Based on the Checklist for Reporting Practice Guidelines in Traditional Chinese Medicine and Recommendation Grading in TCM Clinical Guidelines/Consensus （T/CAS 530—2021），the ontology of TCM clinical practice guidelines was constructed using the seven-step ontology construction method. On this basis，the TCM diagnosis and treatment data from the Guidelines for the Diagnosis and Treatment of Stable Angina Pectoris in Coronary Heart Disease were stored in Neo4j in the form of triples through knowledge extraction，integration，and storage. ResultThe information in the clinical practice guidelines was divided into three categories： onset and prevention information， diagnosis information， and treatment information， and the TCM clinical practice guideline ontology was constructed. A total of 27 concepts related to TCM clinical diagnosis and treatment and 14 data attributes were obtained， and 12 conceptual relationships including hierarchical relationships and object attributes were established. By taking coronary heart disease as an example and the TCM clinical practice guideline ontology as the model layer， the knowledge map of TCM diagnosis and treatment guidelines for stable angina pectoris in coronary heart disease with 276 nodes and 336 relationships was constructed， realizing the visual display and query of the guideline content. ConclusionThe ontology of TCM clinical practice guidelines and the knowledge graph of stable angina pectoris in coronary heart disease constructed by combining the seven-step ontology construction method and Neo4j graph database technology are efficient and flexible，providing an intelligent TCM diagnosis and treatment scheme and promoting the standardization and objectification of TCM diagnosis and treatment.