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.

Ocular diseases pose a significant challenge to global health. The field of metabolomics, which involves the systematic identification and quantification of metabolites within a biological system, has emerged as a promising research approach for unraveling disease mechanisms and discovering novel biomarkers. Through its application, metabolomics has yielded valuable knowledge pertaining to the initiation and advancement of various ocular diseases. This review presents an overview of metabolomics and examines recent research progess in four ocular diseases, specifically diabetic retinopathy, age-related macular degeneration, glaucoma, and dry eye, summarizing potential biomarkers and metabolic pathways associated with these diseases. Additionally, this review offers insights into the future prospects of utilizing metabolomics for the management and treatment of ocular diseases.

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.

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.

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 introduce a locating device for the entry point of intramedullary nail based on the inertial navigation technology,which utilizes multi-dimensional angle information to assist in rapid and accurate positioning of the ideal direction of femoral anterograde intramedullary nails'entry point,and to verify its clinical value through clinical tests.Methods After matching the locating module with the developing board,which are the two components of the locating device,they were placed on the skin surface of the proximal femur of the affected side.Anteroposterior fluoroscopy was performed.The developing angle corresponding to the ideal direction of entry point was selected based on the X-ray image,and then the yaw angle of the locating module was reset to zero.After resetting,the locating module was combined with the surgical instrument to guide the insertion angle of the guide wire.The ideal direction of entry point was accurately located based on the angle guidance.By setting up an experimental group and a control group for clinical surgical operations,the number of guide wire insertion times,surgical time,fluoroscopy frequency,and intraoperative blood loss with or without the locating device was recorded.Results Compared to the control group,the experimental group showed significant improvement in the number of guide wire insertion times,surgical time,fluoroscopy frequency,and intraoperative blood loss,with a statistically significant difference(P<0.01).Conclusion The locating device can assist doctors in quickly locating the entry point of intramedullary nail,effectively reducing the fluoroscopy frequency and surgical time by improving the success rate of the guide wire insertion with one shot,improving surgical efficiency,and possessing certain clinical value.