Complexity science and traditional Chinese medicine （TCM） share a profound intrinsic compatibility. To address the limitations of reductionist approaches in guiding the dynamically holistic theory and practice of TCM， this paper develops​ a novel research pathway under the guidance of complexity science， using the open complex giant systems （OCGS） theory as its practical framework， upholding the fundamental principles of TCM and breaking new ground of artificial intelligence （AI）. The core tasks of this pathway involve the objectification and structured diagnosis-treatment systems， and the construction of a complex， large-scale TCM model. The paper further delineates the data architecture design and reinforcement learning training pathway. Acknowledging the differences in information processing between the human brain and computers， it proposes a training strategy that minimizes manual labeling of "syndromes" and instead focuses on the training paradigm of "herb-human interaction → syndrome manifestation → dosage adjustment". Under the guidance of complexity science theory， TCM is poised for deep integration with AI technology， driving technological innovation powered by data and computational capabilities.

Objective To explore the optimization effect of the nursing pathway driven by the theory of planned behavior(TPB)on postoperative rehabilitation in patients with senile cataract.Methods A total of 100 patients with senile cataract were selected as the research subjects and ran-domly divided into control group and study group using the random number table method,with 50 ca-ses in each group.The control group received routine nursing care,while the study group received TPB-driven nursing pathway intervention in addition to routine care.The postoperative recovery sta-tus,hospitalization expenses,visual quality[Visual Function Index Questionnaire(VF-14)score],self-care ability[Exercise of Self-care Agency Scale(ESC A)score],postoperative complications,and behavioral change intention were compared between the two groups.Results The postoperative visual acuity in the study group was higher,while the intraocular pressure and hospitalization expen-ses were lower than that in the control group.The visual acuity recovery time and hospitalization dura-tion were shorter in the study group than those in the control group,with statistically significant differ-ences(P＜0.05).After the intervention,the VF-14 score and ESC A score in the study group were higher than those in the control group;the overall incidence of postoperative complications in the study group was 4.00％,which was lower than 16.00％in the control group;the scores of each di-mension of behavioral change intention after the intervention in the study group were higher than those in the control group,with statistically significant differences(P＜0.05).Conclusion The TPB-driv-en nursing pathway can effectively optimize the postoperative rehabilitation effect in patients with senile cataract,improve their postoperative visual acuity,visual quality,and self-care ability,thereby enhancing the quality of rehabilitation.

With the advancements in artificial intelligence (AI), computational power, and surgical robotics, the analysis of surgical performance at the granular level of individual surgical gestures has become feasible. Surgical gestures, defined as the smallest independent units of inter-action between surgical instruments and tissues, offer a quantifiable framework for surgical skill assessment. Evidence suggests that the selection and execution of surgical gestures are strongly correlated with the expertise of the surgeon and patient outcomes, underscoring their significance in both surgical training and clinical practice. Moreover, the establishment of a standardized classifi-cation system for surgical gestures and the adoption of uniform terminology have the potential to improve communication efficiency during surgical education and training. The authors synthesize existing classification systems for surgical gestures, with a focus on their applications in diverse tasks such as suturing, exposure and dissection. By examining the latest advancements in AI models applied to surgical gesture, as well as the current research landscape of surgical gesture recognition in digestive surgery, the authors explore the potential applications of such technologies in assisting surgeons during operations in the future.

With the rapid development of minimally invasive techniques in surgery, arti-ficial intelligence (AI), particularly deep learning, is playing an increasingly important role in mini-mally invasive surgery. By automated analysis of surgical videos, AI can efficiently perform key tasks such as instrument recognition, surgical phase identification, action analysis, anatomical structure recognition, intraoperative diagnosis, adverse event monitoring and smart desmoking. These appli-cations provide essential support for real-time monitoring, surgical navigation and skill assessment during surgery. The authors summarize the current research progress of AI in minimally invasive surgery, including its applications in the fields of hepatobiliary and pancreatic surgery, as well as gastrointestinal surgery. It also explores the potential of AI in enhancing surgical safety, efficiency and skill assessment. By synthesizing the latest research achievements of AI technology in the field of surgery, as well as analyzing its technical challenges and risks, it aims to provide guidance for future innovations and clinical applications, promoting the advancement and implementation of AI in minimally invasive surgery.

This paper reported a case of fetal congenital chloride diarrhea (CCD) indicated by prenatal ultrasound and confirmed by whole-exome sequencing. At 26 weeks and two days of gestation, a routine prenatal ultrasound revealed fetal bowel dilation and numerous floating echogenic particles in the amniotic fluid, suggesting the possibility of CCD. Multiple follow-up ultrasounds in late pregnancy showed persistent bowel dilation, polyhydramnios with numerous floating echogenic particles, and fetal development larger than the gestational age. Whole-exome sequencing and Sanger validation revealed two compound heterozygous mutations in the fetal SLC26A3 gene: c.2006C>A (p.S669*) inherited from the mother and c.1355T>A (p.L452Q) inherited from the father, leading to a diagnosis of CCD. Postnatally, the infant exhibited persistent watery diarrhea. Based on prenatal ultrasound and diagnostic results, the infant was immediately given intravenous and oral electrolyte supplementation after birth, preventing severe electrolyte imbalance. As of June 2024, the infant was five months old, with follow-up showing good growth and development.

Objective:To explore the value of fetal heart quantification technology in assessing the morphology and function of the fetal heart during normal pregnancy.Methods:This prospective cohort study selected normal fetuses from healthy pregnant women who underwent prenatal ultrasound examinations at Hunan Provincial People's Hospital from January 2023 to October 2024. Using the GE Voluson E10 color Doppler diasonography, routine obstetric ultrasound and fetal echocardiography were performed to assess fetal growth and development and to exclude intracardiac and extracardiac malformations. Clear four-chamber view (4CV) dynamic images of the heart showing the endocardium (duration ≥3 s) were collected. Speckle-tracking analysis was performed using fetal heart quantification software. The measured indicators included the global spherical index (GSI), end-diastolic length of the heart (L-ED), end-diastolic width of the heart (W-ED), and the global longitudinal strain (GLS), fractional area change (FAC), and 24-segment spherical index (SI) of the left ventricle (LV) and right ventricle (RV). The cases were divided into five groups based on gestational age at the time of prenatal ultrasound: 20 +0 to 23 +6, 24 +0 to 27 +6, 28 +0 to 31 +6, 32 +0 to 35 +6, and 36 +0 to 40 +6 weeks. One-way analysis of variance, two independent samples t-test, univariate linear regression analysis, and Pearson correlation analysis were used to explore the differences in the above indicators among different gestational age groups and their correlation with gestational age. Results:A total of 200 pregnant women were included in the cohort, four cases were excluded due to poor image quality that prevented accurate tracking and measurement of relevant indicators. Ultimately, 196 cases (20 +0 to 23 +6 weeks 40 cases, 24 +0 to 27 +6 weeks 34 cases, 28 +0 to 31 +6 weeks 41 cases, 32 +0 to 35 +6 weeks 48 cases, and 36 +0 to 40 +6 weeks 33 cases) were included in the study, with a successful image analysis rate of 98.0%. (1) There were statistically significant differences in 4CV L-ED, 4CV W-ED, LV-FAC, and RV-FAC among the groups at 20 +0 to 23 +6, 24 +0 to 27 +6, 28 +0 to 31 +6, 32 +0 to 35 +6, and 36 +0 to 40 +6 weeks [4CV L-ED: 28.0±3.0, 32.6±4.3, 40.9±4.3, 46.7±4.8, 53.1±5.8, F=3.72; 4CV W-ED: 21.9±1.8, 25.1±4.2, 31.7±3.0, 37.4±4.0, 42.0±4.9, F=2.61; LV-FAC: (51.4±8.0)%, (49.0±10.4)%, (47.3±7.3)%, (43.1±7.5)%, (40.7±8.2)%, F=2.94; RV-FAC: (49.9±10.8)%, (46.2±12.0)%, (46.3±8.3)%, (43.2±8.0)%, (41.9±5.6)%, F=3.09; all P<0.05].(2) The size of the normal fetal heart gradually increased with gestational age, while the heart morphology remained relatively stable (4CV L-ED and 4CV W-ED were positively correlated with gestational age, with regression coefficients of 1.313 and 1.325, respectively, both P<0.001;LV-FAC and RV-FAC were negatively correlated with gestational age with regression coefficients of -0.783 and -0.552, respectively, both P<0.001; GSI, LV-GLS and RV-GLS had no correlations with gestational age, all P>0.05). (3) The SI of LV segments 1 to 17 were higher than the SI of the corresponding RV segments, and the SI of RV segments 20-24 were higher than that of the corresponding LV segments (all P<0.001). Conclusion:Fetal heart quantification technology has a certain value in the assessment of fetal cardiac morphology and function.

Objective:To evaluate the short-term efficacy of our modified anterior pelvic ring internal fixator(INFIX) in the treatment of anterior pelvic ring injuries.Methods:A retrospective study was conducted to analyze the clinical data from the 16 patients with pelvic anterior ring injury who had been treated with our modified INFIX at Department of Orthopaedics, The First Hospital Affiliated to Bengbu Medical University from June 2020 to June 2023. There were 9 males and 7 females with an age of (49.1±14.3) years. According to the AO/OTA classification, 10 cases were of type B2 and 6 cases of type C1. Their time from injury to surgery was (7.6±2.9) days. Fixation with our modified INFIX was as follows: Three pedicle screws were inserted into the anterior inferior iliac spine on one side and into the pubic symphysis on both sides. Next, a subcutaneous tunnel was created from the anterior inferior iliac spine incision toward the pubic symphysis, and connecting rods were inserted for fixation. The surgical incision length, intraoperative blood loss, surgical time, postoperative fracture reduction quality, fracture healing time, incidence of complications during follow-up, and pelvic functional recovery at the last follow-up were recorded in this cohort.Results:In this cohort, surgical incision length was (5.8±0.4) cm, intraoperative blood loss (75.4±11.9) mL, and surgical time (66.1±8.9) min. By the end of one week after surgery, the quality of fracture reduction was evaluated according to the Matta scoring criteria as excellent in 11 cases and as good in 5 cases. All patients were followed up for (17.4±3.1) months after surgery. The fractures got united in all the 16 patients after (11.2±1.2) weeks. At the last follow-up, the pelvic function recovery was evaluated according to the Majeed scoring system as excellent in 13 cases and as good in 3 cases, yielding a Majeed score of (90.1±4.2) points. During the follow-up period, no patient developed complications such as nerve injury, wound infection, or loosening, breakage or withdrawal of internal fixation devices.Conclusion:In the treatment of anterior pelvic ring injuries, our modified INFIX has the advantages of few complications, simple operation and minimal invasion, leading to good short-term efficacy.

This paper reported a case of fetal congenital chloride diarrhea (CCD) indicated by prenatal ultrasound and confirmed by whole-exome sequencing. At 26 weeks and two days of gestation, a routine prenatal ultrasound revealed fetal bowel dilation and numerous floating echogenic particles in the amniotic fluid, suggesting the possibility of CCD. Multiple follow-up ultrasounds in late pregnancy showed persistent bowel dilation, polyhydramnios with numerous floating echogenic particles, and fetal development larger than the gestational age. Whole-exome sequencing and Sanger validation revealed two compound heterozygous mutations in the fetal SLC26A3 gene: c.2006C>A (p.S669*) inherited from the mother and c.1355T>A (p.L452Q) inherited from the father, leading to a diagnosis of CCD. Postnatally, the infant exhibited persistent watery diarrhea. Based on prenatal ultrasound and diagnostic results, the infant was immediately given intravenous and oral electrolyte supplementation after birth, preventing severe electrolyte imbalance. As of June 2024, the infant was five months old, with follow-up showing good growth and development.

Objective:To explore the value of fetal heart quantification technology in assessing the morphology and function of the fetal heart during normal pregnancy.Methods:This prospective cohort study selected normal fetuses from healthy pregnant women who underwent prenatal ultrasound examinations at Hunan Provincial People's Hospital from January 2023 to October 2024. Using the GE Voluson E10 color Doppler diasonography, routine obstetric ultrasound and fetal echocardiography were performed to assess fetal growth and development and to exclude intracardiac and extracardiac malformations. Clear four-chamber view (4CV) dynamic images of the heart showing the endocardium (duration ≥3 s) were collected. Speckle-tracking analysis was performed using fetal heart quantification software. The measured indicators included the global spherical index (GSI), end-diastolic length of the heart (L-ED), end-diastolic width of the heart (W-ED), and the global longitudinal strain (GLS), fractional area change (FAC), and 24-segment spherical index (SI) of the left ventricle (LV) and right ventricle (RV). The cases were divided into five groups based on gestational age at the time of prenatal ultrasound: 20 +0 to 23 +6, 24 +0 to 27 +6, 28 +0 to 31 +6, 32 +0 to 35 +6, and 36 +0 to 40 +6 weeks. One-way analysis of variance, two independent samples t-test, univariate linear regression analysis, and Pearson correlation analysis were used to explore the differences in the above indicators among different gestational age groups and their correlation with gestational age. Results:A total of 200 pregnant women were included in the cohort, four cases were excluded due to poor image quality that prevented accurate tracking and measurement of relevant indicators. Ultimately, 196 cases (20 +0 to 23 +6 weeks 40 cases, 24 +0 to 27 +6 weeks 34 cases, 28 +0 to 31 +6 weeks 41 cases, 32 +0 to 35 +6 weeks 48 cases, and 36 +0 to 40 +6 weeks 33 cases) were included in the study, with a successful image analysis rate of 98.0%. (1) There were statistically significant differences in 4CV L-ED, 4CV W-ED, LV-FAC, and RV-FAC among the groups at 20 +0 to 23 +6, 24 +0 to 27 +6, 28 +0 to 31 +6, 32 +0 to 35 +6, and 36 +0 to 40 +6 weeks [4CV L-ED: 28.0±3.0, 32.6±4.3, 40.9±4.3, 46.7±4.8, 53.1±5.8, F=3.72; 4CV W-ED: 21.9±1.8, 25.1±4.2, 31.7±3.0, 37.4±4.0, 42.0±4.9, F=2.61; LV-FAC: (51.4±8.0)%, (49.0±10.4)%, (47.3±7.3)%, (43.1±7.5)%, (40.7±8.2)%, F=2.94; RV-FAC: (49.9±10.8)%, (46.2±12.0)%, (46.3±8.3)%, (43.2±8.0)%, (41.9±5.6)%, F=3.09; all P<0.05].(2) The size of the normal fetal heart gradually increased with gestational age, while the heart morphology remained relatively stable (4CV L-ED and 4CV W-ED were positively correlated with gestational age, with regression coefficients of 1.313 and 1.325, respectively, both P<0.001;LV-FAC and RV-FAC were negatively correlated with gestational age with regression coefficients of -0.783 and -0.552, respectively, both P<0.001; GSI, LV-GLS and RV-GLS had no correlations with gestational age, all P>0.05). (3) The SI of LV segments 1 to 17 were higher than the SI of the corresponding RV segments, and the SI of RV segments 20-24 were higher than that of the corresponding LV segments (all P<0.001). Conclusion:Fetal heart quantification technology has a certain value in the assessment of fetal cardiac morphology and function.

Objective To investigate the effects of Nel-like type 1 molecule(NELL-1)on the proliferation and osteogenic differenti-ation of stem cells from human exfoliated deciduous teeth(SHEDs).Methods SHEDs was isolated,cultured,and identified.The third generation SHEDs were used for subsequent experiments.SHEDs were divided into 4 groups,and NELL-1 was added to each group at concentrations of 0(control group),50,100,and 200 ng/mL.Cell activity was measured by CCK-8 assay and crystal violet staining.The changes in osteogenic ability were detected by alkaline phosphatase activity.The expression levels of osteogenesis-related genes ALP,OCN and Runx-2 by RT-qPCR were detected.Western blot was used to detect the expression of osteogenesis-related pro-teins ALP,Runx-2 and Col-Ⅰ.Results SHEDs exhibited stem cell characteristics,and 50 ng/mL of NELL-1 protein had a promo-ting effect on SHEDs proliferation(P＜0.01).Alkaline phosphatase activity assay showed that after the addition of NELL-1,the osteo-genic effect of each group was better than that of the control group and 50 ng/mL of NELL-1 was the best(P＜0.05).RT-qPCR and Western blot results showed that 50 ng/mL of NELL-1 significantly promoted the expression of osteoblast-related genes including ALP,OCN and Runx-2 and the protein expression of ALP,Runx-2 and Col-Ⅰ(P＜0.05).Conclusion NELL-1 can promote the prolifera-tion and osteogenic differentiation of SHEDs.