OBJECTIVE To evaluate the quality of evidence in the systematic evaluation/meta-analysis of traditional Chinese medicine （TCM） for diabetes retinopathy （DR） based on the GRADE system. METHODS Chinese and English databases were searched to obtain the relevant studies of systematic evaluation/meta-analysis of traditional Chinese medicine in the treatment of DR. The search time was from the establishment of each database to January 13th， 2024. According to the inclusion and exclusion criteria， literature screening was conducted. After extracting relevant information from the included literature， the GRADE system was used to evaluate the quality level of the evidence body in the included studies， and the evidence of the outcome indicators was integrated and summarized. RESULTS A total of 51 studies were ultimately included， encompassing 135 outcome indexes. Among these， 19 indicators （14.1%） were of high quality， 87 （64.4%） were of medium quality， 26 （19.3%） were of low quality， and 3 （2.2%） were of very low quality. Overall， the evidence quality of the outcome indicators in the included studies was medium to low quality. The integrated results of evidence on the efficacy of outcome indexes showed that compared with conventional Western medicine， calcium dobesilate or placebo， TCM had significant advantages in improving overall efficacy， reducing bleeding spot area， reducing macular foveal thickness， and increasing visual improvement rate. In addition，the combination of TCM and conventional Western medicine or calcium dobesilate was significantly more effective than using conventional Western medicine or calcium dobesilate alone. CONCLUSIONS The overall quality of the evidence in the systematic evaluation/meta-analysis study on the treatment of DR with TCM is medium to low quality. Based on existing research findings， TCM demonstrates good clinical efficacy in the treatment of DR.

Objective To investigate the difference of surgical effect of exclusion,simple continuous suture and circular suture suspension in TAPP for the treatment of false hernia sac in patients with direct inguinal hernia.Method From May 2020 to May 2022,120 patients diagnosed with direct inguinal hernia and treated with TAPP in our hospital were retrospectively.The false hernia sacs were divided into three groups according to different methods of treatment patients treated with false hernia sac exclusion were included in group A,those treated with simple continuous suture were included in group B,and those treated with circular suture suspension were included in group C.There were 40 patients in each group.The perioperative indicators(operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost)and postoperative effects(chronic pain,seroma,incision or mesh infection,foreign body traction feeling)were compared among the three groups.Results All 120 patients successfully completed TAPP surgery.There was no significant difference in general condition,intraoperative blood loss,postoperative hospital stay,wound or mesh infection and chronic pain among the three groups(P＞0.05).The operation time of group B and C was longer than that of group A,and the incidence of seroma was significantly lower than that of group A,the difference was statistically significant(P＜0.05).The incidence of foreign body traction in group A and group C was lower than that in group B,and the difference was statistically significant(P＜0.05).The hospitalization cost of group B and group C was lower than that of group A,with statistically significant difference(P＜0.05).Conclusion In clinical practice,direct hernia and false hernia sac often need to be treated.In direct hernia TAPP operation,simple continuous suture method and circular suture suspension method have the effect of improving the condition of the false hernia sac,but in terms of economy and postoperative effect,the circular suture suspension method can benefit patients more.

The study explores the thermal dose of experimental animals exposed in electromagnetic field.The simulation environment containing electromagnetic and thermal doses is established based on the bioheat equation and the three-dimensional rat model,and the effects of specific absorption rate,metabolic rate and boundary condition on temperature distribution and variation are assessed.The result shows that the core temperature rises with increasing whole body average specific absorption rate(WBASAR).At WBASAR of 4 W/kg,the midbrain and testes have higher specific absorption rates due to the skin effect,resulting in a more significant temperature rise in organ tissues than in the core;and at WBASAR of 0.4 W/kg,the temperature variation of the shallow organs caused by the sudden changes of metabolic and external environment reaches 1℃,which is much larger than that of the core.The experiment demonstrates target organs such as the head and testicles as critical subjects in thermal dose assessment.The experimental conditions should be regulated to reduce the effects of metabolic rate and boundary condition on thermal dose.The study has guiding significance for bioelectromagnetic experimental design and effect evaluation on thermal dose.

Objective To analyze the bioelectromagnetic dose of human blood-brain barrier opening induced by electromagnetic pulse.Methods A typical exposure platform was used to establish an environment for human brain dosimetric study.The bioelectromagnetic dose was evaluated with electromagnetic simulation method using a 3D digital human model.Results The electric field at the centre of the head reached a peak of 1.49 kV/m,and there was a decrease of 41.6 dB from the excitation field.The maximum electric field amplitude on the surface of the nose tip was 1795 kV/m.The head had an average absorption rate of 4.16×10-8 J/kg under one pulse,while under extreme conditions with a repetition frequency of 1000 s-1,the average specific absorption rate of the head was 4.16×10-5 W/kg.Conclusion Local high-intensity electric fields pose significant safety risks in clinical application,and it is necessary to study the means of inhibiting local high-intensity electric field in combination with the dose-effect relationship of blood-brain barrier opening.The human brain bioelectromagnetic doses provided by the study can be used to evaluate the clinical efficacy.

Group B Streptococcus(GBS)is a major member of the Gram-positive Streptococcus family,which occupies a dominant position in the infection spectrum of newborns and young infants.GBS infections occurring 0?6 days after birth are called GBS early-onset disease(GBS-EOD),and those occurring 7?89 days are called GBS late-onset disease(GBS-LOD).With the use of intrapartum antibiotic prophylaxis,the incidence of neonatal GBS-EOD has declined without a notable impact on GBS-LOD,which brings great pressure and challenge to clinical diagnosis and nursing work.However,the specific mechanisms by which GBS transmission triggers illness in newborns and young infants are not fully elucidated.Some factors,such as maternal GBS colonization,maternal characteristics(age,weight and ethnicity),preterm birth,GBS infection in multiple births,and exposure to human immunodeficiency virus,have been identified as risk factors for GBS-LOD.To prevent maternal and infant GBS infection,some measures,such as vaccination of pregnant women,gut microbiota regulation and lactoferrin supplementation,are developing.In addition,strengthening maternal health care and health education,along with some other conventional infection control strategies(including enhancing hand hygiene awareness among caregivers and making good disinfection of the environment and equipment)is also effective in the prevention of GBS-LOD.This review elaborates the prevalence,transmission,risk factors and prevention of GBS-LOD in infants,aiming to improve the understanding and clinical practice ability of the medical staff.

Nuclear emergency medical rescue is one of the important courses of military medical professional education, and improving the training level of nuclear emergency medical rescue plays a very important role in improving post competency of trainees. Based on the problem of disconnection between "teaching" and "need" in the occupational education of nuclear emergency medical rescue in the past, this study proposes the curriculum goal of "the combination of three abilities" and performs the optimization and practice of the occupational education curriculum system of nuclear emergency medical rescue from the aspects of curriculum setting, curriculum content, teaching methods, and assessment and evaluation. The results show that the new curriculum system can significantly improve the comprehensive ability of nuclear emergency medical rescue among trainees and better meet the requirements for their posts, thereby playing an important role in cultivating high-quality military medical talents in nuclear emergency medical rescue.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the risk factors of postoperative depression in patients with esophageal cancer, and to develop a risk prediction model which providing a theoretical basis for the early detection of depression in high-risk groups by clinical staff.Methods:From September 2022 to March 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 269 hospitalized patients with esophageal cancer (191 in depression group, 78 in non-depression group) were selected as the model construction set. From March to May 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 78 hospitalized patients with esophageal cancer were selected as the external validation set. The patients with Beck depression inventory-Ⅱ score ≥5 and depression diagnosed by two experts (chief psychiatrists of the Department of Psychiatry of Affiliated Hospital of Jiangnan University) were considered as depression and included in the depression group, and the other patients were enrolled in the non-depression group. The general data, blood routine examination, high-sensitivity C-reactive protein (hs-CRP), blood electrolytes, blood lipids, clinical symptoms (gastroesophageal reflux, sleep disturbance, appetite, etc.) and depression score were compared between the depression group and the non-depression group. Independent sample t-test and Mann-Whitney U test were used for statistical analysis. Multiple logistic regression model was performed to analyze the independent risk factors of postoperative depression in patients with esophageal cancer, and a risk warning model was constructed. The Hosmer-Lemeshow test and receiver operating characteristic curve (ROC) were used to evaluate the fitting degree and predictive efficiency of the model, and the cross-validation method was used to verify the effectiveness of the model. Results:The incidence of postoperative depression in patients with esophageal cancer was 71.0% (191/269). The total white blood cell count, hs-CRP, blood phosphorus β 2 microglobulin and the proportion of sleep disorders of the depression group were higher than those of the non-depression group (1.3 (1.1, 5.4) ×10 9/L vs. 0.9 (0.3, 1.1) ×10 9/L, 75.8 (54.8, 102.1) mg/L vs. 60.8 (3.6, 61.5) mg/L, (1.33±0.32) mmol/L vs. (1.02±0.19) mmol/L, (2.17±0.72) mg/L vs.(2.12±0.49) mg/L, 84.3% (161/191) vs. 33.3% (26/78), and the differences were statistically significant ( Z=9.24, 7.88, t=9.24, χ2=67.87 t=1.98; all P<0.001); hemoglobin, total platelet count, high-density lipoprotein (HDL) and the proportion of poor appetite were lower than those of the non-depression group ((119.91±24.51) g/L vs. (122.09±22.97) g/L, (203.43±58.45)×10 9/L vs. (311.55±83.54)×10 9/L, (1.04±0.30) mmol/L vs. (1.43±0.23) mmol/L, 73.3% (140/191) vs. 84.6% (66/78)), and the differences were statistically significant ( t=-2.00, -8.42 and -8.48, χ2=3.96; P=0.047, <0.001, <0.001, =0.047). The results of multifactorial logistic regression model analysis showed that sleep disorder ( OR=3.976, 95% confidence interval (95% CI 1.601 to 9.872)), loss of appetite ( OR=0.271, 95% CI 0.092 to 0.791), white blood cell count ( OR=31.808, 95% CI 2.879 to 351.401), hs-CRP ( OR=1.031, 95% CI 1.017 to 1.044), platelet count ( OR=0.990, 95% CI 0.982 to 0.997), and HDL ( OR=0.017, 95% CI 0.001 to 0.242) were independent influencing factors of postoperative depression in patients with esophageal cancer. The formula of risk warning model was probability of depression=1-1/{1+ exp[1.544+ 1.380×sleep disturbance (yes=1, no=0)-1.307×loss of appetite (yes=1, no=0)-0.010×platelet count (×10 9/L)-4.063×HDL (mmol/L)+ 0.030×hs-CRP (mg/L)+ 3.460×white blood cell count (×10 9/L)]}. The results of Hosmer-Lemeshow test showed that the model has a good fit ( χ2=2.01, P=0.981), with an area under the ROC of 0.949, a sensitivity of 0.874, and a specificity of 0.872. The cross-validation of the external validation set showed that the accuracy of the risk warning model was 67.9%. Conclusion:This study is a preliminary study on the risk warning model of postoperative depression in patients with esophageal cancer, which provides a novel approach for screening depression in patients with esophageal cancer after surgery.

Objective:To establish a multiplex detection method for monitoring viruses post-kidney transplantation based on droplet digital PCR (ddPCR) technology, evaluate its detection performance, and discuss its potential clinical application.Methods:We developed a ddPCR assay for the simultaneous detection of polyomavirus type 1 virus (BKV), polyomavirus type 2 virus (JCV), and torque teno virus (TTV), assessing its conformity rate, repeatability, and detection limit. 69 clinical urine samples were collected at the Shanghai Jiao Tong University School of Medicine affiliated with Renji Hospital between June and September 2023. The qPCR and ddPCR methods were employed to analyze the results, respectively. Spearman correlation analysis, Bland-Altman analysis, and Wilcoxon paired rank sum test were applied to analyze the detection results of the two methodologies.Results:The constructed ddPCR method had a 7/7 concordance rate for the seven reference samples. The precision reference samples were tested ten times, respectively, and their coefficients of variation were less than 10%. The detection limit was 10 copies/μl. The concordance rates of ddPCR and qPCR for BKV and JCV detection were more than 95% (66/69, 68/69). The correlation coefficients (R) of BKV and JCV viral loads were 0.874 and 0.840, respectively. The Bland-Altman analysis showed that the mean differences in BKV and JCV viral load detection between the two methods were -0.34 and -0.187, respectively. The Wilcoxon paired rank sum test showed that there were no statistically significant differences in the detection results of polyomaviruses between the two methods ( P>0.05). Conclusion:A ddPCR-based multiplex detection method for viruses post-renal transplantation was successfully developed, confirming its superior attributes of high accuracy, high sensitivity, and multi-detection capability. This method could be used for the quantitative detection of BKV, JCV, and TTV in clinical urine samples.

Abstract: Objective　To confirm three severe scrub typhus patients in Mianyang of Sichuan Province using laboratory diagnosis and analyze their clinical characteristics to provide theoretical evidence for the prevention and treatment of scrub typhus in this area. Methods　From June 2021 to August 2022, blood specimens and clinical data were collected from three severe scrub typhus patients in Mianyang of Sichuan Province. The epidemiological history was surveyed and the collected clinical data were analyzed. Acute-phase whole blood, serum samples at admission, and convalescent-phase serum samples two weeks later were collected, and the IgG titers of anti-Orientia tsutsugamushi were detected by indirect immunofluorescence assay (IFA) assays. Total DNA was extracted from anticoagulation whole blood using DNA extraction kit, and semi-nested polymerase chain reaction (PCR) was used to amplify the special gene of O. tsutsugamushi. Phylogenetic trees were constructed using the maximum likelihood (ML) method to determine the genotype of the strains. Results　The clinical symptoms of these three patients were extremely similar to other infectious febrile diseases, with two cases showing obvious eschars on physical examination and all three cases causing pneumonia. Epidemiological investigation revealed that all had a history of wild animal exposure or fieldwork. Specific IgG antibodies to O. tsutsugamushi tests showed that convalescent serum antibodies increased by four times or more compared to the acute-phase serum. The TSA56 gene sequence fragment was obtained by PCR amplification, and BLASTn comparison on the NCBI website showed a close phylogenetic relationship with the TA763 genotype and Karp genotype of Orientia tsutsugamushi. The results indicated that these three cases were indeed infections of O. tsutsugamushi. Conclusions　Laboratory diagnosis confirmed the clinical diagnosis of severe scrub typhus in three patients, providing specific evidence of etiology. This is the first report of etiology-confirmed cases of scrub typhus in Mianyang City, Sichuan Province. Analyzing their clinical features as well as the genotypes is of guiding significance for early diagnosis, differential diagnosis, and adjuvant therapy of scrub typhus in this region.