Objective: To develop a depression recognition model by integrating the spirit-expression diagnostic framework of traditional Chinese medicine (TCM) with machine learning algorithms. The proposed model seeks to establish a TCM-informed tool for early depression screening, thereby bridging traditional diagnostic principles with modern computational approaches. Methods: The study included patients with depression who visited the Shanghai Pudong New Area Mental Health Center from October 1, 2022 to October 1, 2023, as well as students and teachers from Shanghai University of Traditional Chinese Medicine during the same period as the healthy control group. Videos of 3 – 10 s were captured using a Xiaomi Pad 5, and the TCM spirit and expressions were determined by TCM experts (at least 3 out of 5 experts agreed to determine the category of TCM spirit and expressions). Basic information, facial images, and interview information were collected through a portable TCM intelligent analysis and diagnosis device, and facial diagnosis features were extracted using the Open CV computer vision library technology. Statistical analysis methods such as parametric and non-parametric tests were used to analyze the baseline data, TCM spirit and expression features, and facial diagnosis feature parameters of the two groups, to compare the differences in TCM spirit and expression and facial features. Five machine learning algorithms, including extreme gradient boosting (XGBoost), decision tree (DT), Bernoulli naive Bayes (BernoulliNB), support vector machine (SVM), and k-nearest neighbor (KNN) classification, were used to construct a depression recognition model based on the fusion of TCM spirit and expression features. The performance of the model was evaluated using metrics such as accuracy, precision, and the area under the receiver operating characteristic (ROC) curve (AUC). The model results were explained using the Shapley Additive exPlanations (SHAP). Results: A total of 93 depression patients and 87 healthy individuals were ultimately included in this study. There was no statistically significant difference in the baseline characteristics between the two groups (P > 0.05). The differences in the characteristics of the spirit and expressions in TCM and facial features between the two groups were shown as follows. (i) Quantispirit facial analysis revealed that depression patients exhibited significantly reduced facial spirit and luminance compared with healthy controls (P < 0.05), with characteristic features such as sad expressions, facial erythema, and changes in the lip color ranging from erythematous to cyanotic. (ii) Depressed patients exhibited significantly lower values in facial complexion L, lip L, and a values, and gloss index, but higher values in facial complexion a and b, lip b, low gloss index, and matte index (all P < 0.05). (iii) The results of multiple models show that the XGBoost-based depression recognition model, integrating the TCM “spirit-expression” diagnostic framework, achieved an accuracy of 98.61% and significantly outperformed four benchmark algorithms—DT, BernoulliNB, SVM, and KNN (P < 0.01). (iv) The SHAP visualization results show that in the recognition model constructed by the XGBoost algorithm, the complexion b value, categories of facial spirit, high gloss index, low gloss index, categories of facial expression and texture features have significant contribution to the model. Conclusion This study demonstrates that integrating TCM spirit-expression diagnostic features with machine learning enables the construction of a high-precision depression detection model, offering a novel paradigm for objective depression diagnosis.

Objective To explore the effects of home-based exercise rehabilitation on cardiac structure, valvular function, and exercise capacity in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). Methods 49 patients with severe AS who underwent TAVR at Zhongshan Hospital, Fudan University, from January 2024 to February 2025 were enrolled. They were divided into an exercise group (n＝25) or a non-exercise group (n＝24) based on participating or not in home-based rehabilitation after TAVR. The exercise group received 12 weeks of home-based exercise training (aerobic exercise plus resistance training every week); the non-exercise group received routine care. Transthoracic echocardiography (TTE) was used to assess cardiac structural parameters before discharge (T0) and after 12 weeks of exercise (T1). Functional outcomes including the 6-minute walk test (6MWT), Duke Activity Status Index (DASI), and Short Physical Performance Battery (SPPB) were compared between the two groups. A linear mixed-effects model was used to analyze the effect of home-based rehabilitation on echocardiographic parameters. Patients were stratified by baseline 6MWT (＜240 m as low-function subgroup, ≥240 m as high-function subgroup) to compare exercise-related outcomes between subgroups. Results At T1, the exercise group had a longer 6MWT distance than the non-exercise group (P＝0.012). The linear mixed-effects model showed that after 12 weeks of exercise, the left ventricular end-diastolic diameter (LVEDD) decreased in the exercise group but slightly increased in the non-exercise group, with a significant difference in changes over time between the two groups (P_interaction＝0.030). The exercise group also showed greater improvement in effective orifice area index (P_interaction＝0.028) and effective orifice area (P_interaction＝0.042) than the non-exercise group. Subgroup analysis revealed that in the low-function subgroup, the exercise group showed greater improvement in the 6MWT (P_interaction＝0.035) and the effective orifice area index (P_interaction＝0.046) compared to the non-exercise group; in the high-function subgroup, the exercise group showed greater improvement only in LVEDD compared to the non-exercise group (P_interaction＝0.046). Conclusions Home-based exercise rehabilitation improves exercise capacity, optimizes left ventricular remodeling, and enhances valvular function in patients with severe AS after TAVR, with greater benefits observed in patients with lower baseline 6MWT.

Objective To explore the compatibility and combination patterns of traditional Chinese medicine(TCM)formulas in treating kidney deficiency and blood stasis type osteoporosis,to identify the most frequently used drug pairs,and to explore their mechanisms of action in treating kidney deficiency and blood stasis type osteoporosis through network pharmacology and molecular docking,providing theoretical guidance for clinical medication.Methods Formulas used for treating kidney deficiency and blood stasis type osteopo-rosis in the past 10 years were screened from databases such as CNKI and Wanfang.SPSS,Origin,and IBM SPSS Modeler software were used for frequency,taste and meridian statistics,and drug combination analysis.Cluster analysis was applied to identify the core drug combinations.The best drug pair for treating kidney de-ficiency and blood stasis type osteoporosis was selected.Network pharmacology analysis was conducted on this drug pair to identify core targets,main components,and signaling pathways.Molecular docking was performed using AutoDockTools,AutoDock Vina,and PyMOL software to further verify the possibility of their interac-tions.Results A total of 117 formulas containing 148 TCMs were screened out.The frequently used drugs and combinations were mainly kidney-yang and kidney-yin tonics and blood-activating and stasis-eliminating drugs,with sweet and warm tastes,mostly attributed to the liver and kidney meridians.Further cluster analy-sis of drugs with a frequency greater than 20 yielded five categories.The Epimedium-Bupleurum combination was selected for network pharmacology analysis,which identified 89 targets.Core targets included STAT3,IL-6,and JUN.Main components were cryptotanshinone,kaempferol,luteolin,and quercetin.Molecular docking was performed on the main components and core targets to verify the treatment effect of the drugs on osteopo-rosis.Conclusion TCM treatment of kidney deficiency and blood stasis type OP mainly focuses on tonifying the liver and kidney and activating blood circulation to remove stasis,supplemented by tonifying the spleen and boosting qi.This can provide a theoretical basis for the clinical treatment of OP.Additionally,the Epime-dium-Bupleurum drug pair can exert therapeutic effects on osteoporosis through a multi-target and multi-pathway mechanism,laying the foundation for subsequent experiments and clinical applications.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the correlations of KCNJ5 gene mutations and pathological subtypes based on 11β-hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) immunohistochemistry with clinical characteristics and postoperative outcomes in patients with unilateral primary aldosteronism undergoing adrenalectomy.Methods:This retrospective study enrolled 155 patients with primary aldosteronism who underwent unilateral adrenalectomy at the Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between May 2023 and May 2024. KCNJ5 mutations were detected by Sanger sequencing, and patients were stratified into KCNJ5-mutant and wild-type groups based on genetic results. The KCNJ5-mutant cohort was further subclassified into complete remission and partial remission groups according to surgical outcomes. For KCNJ5-mutant cases, postoperative tissues underwent immunohistochemical subtyping for CYP11B1/CYP11B2 expression, and were divided into the CYP11B2 mono-positive group (CYP11B1 -/CYP11B2 +) and the CYP11B1/CYP11B2 co-expression group (CYP11B1 +/CYP11B2 +). Correlations of KCNJ5 mutations and pathological subtypes with baseline characteristics, biochemical profiles, and postoperative outcomes in unilateral primary aldosteronism patients were analyzed. Results:A total of 100 patients were included in the final analysis, aged (51.1±11.0) years, including 35 females (35%). The somatic KCNJ5 mutation rate was 69% (69/100), with 69 KCNJ5-mutant and 31 wild-type cases. Compared to wild-type patients, KCNJ5-mutant patients were younger ((48.4±10.8) years vs. (56.9±9.3) years, P=0.000 2), had a higher female proportion (45% vs. 13%, P=0.004 0), exhibited lower preoperative renin levels (3.4 (1.1, 39.5) ng/L vs. 9.7 (2.7, 19.6) ng/L, P=0.009 1) and had a higher rate of complete clinical remission (55% vs. 16%, P=0.000 3). Among KCNJ5-mutant patients, 38 achieved complete remission and 31 achieved partial remission. The complete remission group demonstrated younger age ((45.6±10.2) years vs. (52.0±10.5) years, P=0.012 6), shorter hypertension duration ((6.2±6.1) years vs. (10.7±10.1) years, P=0.020 4), higher preoperative plasma (951.5 (652.2, 1 690.8) pmol/L vs. 749.8 (518.5, 955.4) pmol/L, P=0.027 7) and urinary ((86 271.4±51 873.8) pmol/24 h vs. (61 860.2±24 411.2) pmol/24 h, P=0.019 2) aldosterone levels, greater lateralization index (22.6 (10.1, 42.5) vs. 11.1 (5.1, 19.8), P=0.022 7), fewer baseline antihypertensive defined daily dose (2.6±1.3 vs. 4.0±1.3, P<0.000 1), and larger tumor diameter (1.5 (1.2, 1.8) cm vs. 1.1 (1.0, 1.5) cm, P=0.000 7). Immunohistochemical subtyping revealed CYP11B2 mono-positivity in 24 mutant cases and CYP11B1/CYP11B2 co-expression in 45. The CYP11B2 mono-positive group showed more pronounced postoperative reduction in antihypertensive defined daily dose (2.9±1.3 vs. 2.2±1.2, P=0.018 3), though no significant difference in complete remission rates (46% vs. 60%, P=0.259 8) was observed. Conclusion:In patients with unilateral primary aldosteronism, those carrying KCNJ5 somatic mutations exhibit characteristics such as younger age and a higher proportion of females compared to wild-type patients, along with significantly better surgical outcomes. Moreover, among patients with KCNJ5 mutations, those whose pathological subtype shows pure CYP11B2 expression demonstrate a more pronounced reduction in postoperative antihypertensive defined daily dose than those with co-expression of CYP11B1/CYP11B2.

This article mainly introduces Professor Xu Zhenye's experience in treating advanced colorectal cancer.According to Professor Xu,the pathogenesis of advanced colorectal cancer is mainly based on deficiency,supplemented by evils and realities,and most of the patients are suffering from deficiency of essence and Qi.The treatment should focus on replenishing the deficiency,followed by removing the evils and poisons.Professor Xu innovatively put forward the theory of"spleen deficiency and essence deficiency,supporting the positive to fight against cancer",treating intestinal cancer by strengthening the spleen,tonifying the kidney and nourishing the essence,supplemented by clearing heat and removing toxins to fight against tumour.

Objective To analyze the differences of brain activity between first-episode untreated depressive patients with and without suicidal ideation(SI),and its correlations with clinical characteristics.Methods A total of 40 major depressive disorder(MDD)patients with SI(MDD+SI group),40 patients without SI MDD(MDD+NSI group),and 40 healthy controls(HC)(HC group)were enrolled.The 17-item Hamilton depression scale(HAMD-17)and Beck scale for suicide ideation(BSI)were used to assess the severity of depression and SI,respectively.MRI data were collected.The values of fractional amplitude of low-frequency fluctuation(fALFF)were calculated.Results(1)Compared with the HC group,the MDD+NSI group showed decreases in the fALFF val-ues of the default network and attention network.The fALFF values of the attention network in the MDD+SI group showed decreases.Compared with the MDD+NSI group,the MDD+SI group showed decreases in the fALFF values of the attention network.(2)The fALFF values in the left middle frontal gyrus were negatively correlated with the total score of HAMD-17(r=-0.55;P<0.001)in the MDD+NSI group,while the fALFF values in the left middle frontal gyrus were negatively correlated with the total score of HAMD-17(r=-0.53;P<0.001)and the total score of BSI(r=-0.51;P<0.001)in the MDD+SI group.(3)The optimal critical value of fALFF value in left middle frontal gyrus for predicting SI occurrence in MDD patients was-0.039,area under the curve(AUC)was 0.76,sensitivity was 0.63,and specificity was 0.80.Conclusion The decreased local activity intensity in the left middle frontal gyrus of the brain might be the central mechanism for the occurrence of SI in MDD patients.In addition,the left middle frontal gyrus might have certain value in identifying SI and predicting the severity of SI.

Objective To investigate the predictive value of serum human epididymis protein 4(HE4)levels in primary Sj?gren's syndrome(pSS)patients for renal injury.Methods A retrospective analysis of 77 pSS patients admitted to the Second People's Hospital of Yichang from September 2021 to August 2023 was performed,including 43 cases of renal injury group 34 instances of non-renal injury group,and 54 healthy physical examination subjects(HCs)as control group.Fasting peripheral venous blood(4ml)was collected to detect the serum levels of HE4,Cys-C,TNF-α,CR,C3,C4,immunoglobulin,Anti-SSA,Anti-SSB and other indicators,and analyzed the value of HE4 in the early diagnosis of kidney injury in pSS patients.Results Compared with HCs,the pSS patients had increased levels of HE4(120.02±103.86 pmol/L vs 57.5±16.52 pmol/L),Cys-C(1.30±0.81mg/L vs 0.87±014 mg/L),and the differences were statistically significant(t=4.382,3.860,all P<0.05).The serum levels of HE4,CR and TNF-α in the renal damage group were higher than those in the non-renal damage group,and the differences were statistically significant(t/χ2=2.552～4.371,all P<0.05).Pearson correlation analysis showed that,the levels of serum HE4,Cys-C,CR and TNF-α were all positively correlated with renal damage in pSS(r=0.287～0.546,all P<0.05).Logistic regression analysis showed that elevated serum HE4 level might be an independent risk factor for inducing renal damage in pSS(Wald χ2=11.932,P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the best cut-offvalue of serum HE4 for the diagnosis of pSS renal damage was 70.46pmol/L,the maximum Youden index was 0.625,AUC(95%CI)=0.876(0.799～0.954).Conclusion The serum HE4 level in patients with pSS is positively correlated with renal injury and has predictive value for the occurrence of renal injury.