Objective:To evaluate the clinical efficacy of Cai's gynecological nourishing kidney therapy for patients with diminished ovarian reserve (DOR).Methods:A randomly controlled trail was conducted. A total of 63 patients with DOR who were treated in the gynecology outpatient clinic of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from September 2020 to January 2022 were set as observation subjects, and were divided into control group ( n=31) and observation group ( n=32) according to the random number table method. The patients in the control group were treated with Femoston, and the patients in the observation group were treated with Cai's gynecological nourishing kidney therapy on the basis of Femoston treatment. Both groups were treated for 3 menstrual cycles. Both antral follicle count (AFC) was performed by vaginal ultrasound, serum levels of TGF-β1, IL-1β, IL-2, IL-6 and IL-21 were detected by ELISA, and serum levels of FSH, LH, E2, anti-Müllerian hormone (AMH) and MDA were detected by biochemical methods. The TCM syndrome score was used to evaluate the severity of symptoms, and the menstrual score was used to evaluate the abnormal menstruation. Clinical efficacy was evaluated. Results:The total effective rate was 87.50% (28/32) in the observation group and 58.06% (18/31) in the control group, with statistical significance ( χ2=8.42, P=0.004). After treatment, the AFC in the observation group (3.93±2.32 vs. 2.21±2.18, t=3.03) was higher than that of the control group ( P<0.01). After treatment, the serum FSH level of the observation group [10.05 (8.35, 21.48) IU/L vs. 20.60 (8.00, 43.30) IU/L, Z=2.18] was lower than that of the control group ( P<0.05), and the level of AMH [0.19 (0.03, 0.47) μg/L vs. 0.02 (0.01, 0.24) μg/L, Z=-1.54] in the observation group was higher than that of the control group ( P<0.05). The serum levels of TGF-β1 [(68.27±11.76) ng/L vs. (55.33±13.03) ng/L, t=4.14] and IL-1β [(58.00±7.53) ng/L vs. (52.31±8.06) ng/L, t=2.89] in the observation group were higher than those in the control group, and the levels of IL-6 [(33.26±7.45) ng/L vs. (40.69±11.69) ng/L, t=3.02], the level of IL-21 [(118.37±15.56) ng/L vs. (140.43±25.51) ng/L, t=-4.04] was lower than that of the control group ( P<0.01). Conclusions:Cai's gynecological nourishing kidney therapy combined with Fenmaotong can effectively increase the AFC of DOR patients and improve clinical efficacy. Its mechanism of action may be related to reducing serum FSH and LH levels and increasing E2 levels.

BackgroundAttention deficit hyperactivity disorder （ADHD） is a neurodevelopmental disorder characterized by age-inappropriate inattention， excessive activities incongruous with setting， and emotional impulsivity. Subthreshold ADHD （sADHD） is clinically defined as the presence of ADHD symptoms that do not meet the full diagnostic criteria for ADHD. Children with sADHD exhibit deficits in executive function， demonstrate more conduct， learning， and anxiety-related problems compared to typically developing children， and show even poorer working memory performance than children diagnosed with ADHD. Currently， there is limited epidemiological research on sADHD in China， with few studies simultaneously investigating the prevalence of both ADHD and sADHD in children. ObjectiveTo investigate the prevalence of ADHD and sADHD among children aged 6–13 years in Chongqing， analyzing their distribution characteristics within this population， with the aim of providing references for developing preventive measures against both ADHD and sADHD. MethodsFrom October to November 2023， a total of 3 398 students in grades 1–6 from six primary schools in Jiangbei District， Chongqing were selected using a stratified cluster random sampling method. The occurrence of ADHD and sADHD was evaluated by using the short version （18-item version） of the Swanson， Nolan， and Pelham IV rating scales （SNAP-IV） and the Chinese vision of Schedule for Affective Disorder and Schizophrenia for School-aged Children-Present and Lifetime Version （K-SADS-PL）. ResultsThe ADHD detection rate among children in Chongqing was 1.90% （95% CI： 0.014–0.024）. Boys showed a significantly higher ADHD detection rate than girls （χ²=7.733， P=0.005）. No statistically significant differences were found in ADHD detection rates across different grades or age groups （χ²=7.347， 12.362， P>0.05）. The sADHD detection rate was 6.32% （95% CI： 0.054–0.072）. Similarly， boys exhibited significantly higher sADHD detection rates than girls （χ²=21.005， P<0.01）. Significant differences emerged across different grades （χ²=20.559， P=0.001）， while no statistically significant difference was observed in age groups （χ²=12.070， P=0.060）. ConclusionThe ADHD detection rates were comparable across all grade levels and age groups from 6–13 years old. Second-grade children demonstrated notably higher sADHD rates compared to other grades， while boys demonstrated higher prevalence rates than girls for both ADHD and sADHD. ［Funded by Science and Health Joint Medical Research Project in Jiangbei District， Chongqing City in the Second Half of 2023 （number， 2023JBKWLH022）］

Objective: To evaluate the effectiveness and safety of the tonifying spleen and reinforcing Qi (TSRQ) therapy combined with thyroid hormone replacement therapy (THRT) for treating Hashimoto’s hypothyroidism. Methods: From database foundation to January 14, 2025, PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), and China Biomedical Literature Database (CBM) were searched for relevant information. Randomized clinical trials (RCTs) evaluating the efficacy and safety of TSRQ therapy combined with THRT for Hashimoto’s hypothyroidism were eligible for inclusion. Following quality assessment, data were analyzed using Stata 15.1 to conduct a meta-analysis and systematic review. Subgroup analysis was used to identify the sources of heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to evaluate the certainty of the evidence. Results: This study included 30 RCTs, comprising 2 687 patients with Hashimoto’s hypothyroidism. Overall methodological quality was acceptable, with no studies exhibiting a high risk of bias. Meta-analysis demonstrated that TSRQ therapy combined with THRT significantly enhanced serum free triiodothyronine (fT3) levels [standardized mean difference (SMD) = 0.76, 95% confidence interval (CI): 0.57 to 0.94, P < 0.001] and free thyroxine (fT4) levels (SMD = 0.86, 95% CI: 0.61 to 1.11, P < 0.001), while reducing thyroid-stimulating hormone (TSH) levels (SMD = – 0.99, 95% CI: – 1.20 to – 0.78, P < 0.001) compared with THRT alone. Furthermore, the combination therapy significantly decreased anti-thyroid peroxidase antibody (TPOAb) levels (SMD = – 1.46, 95% CI: – 1.79 to – 1.13, P < 0.001) and anti-thyroglobulin antibody (TgAb) levels (SMD = – 1.46, 95% CI: – 1.80 to – 1.11, P < 0.001). TSRQ therapy did not adversely impact the safety profile of THRT. However, while some sources of heterogeneity have been identified (e.g., specific detection methodologies, I² = 0.0%, P = 0.938), there remains a portion of unexplained heterogeneity (e.g., publication year, I² = 93.4%, P < 0.001), which has undermined confidence in these pooled estimates. The evidence ratings for fT3, fT4, and TSH were limited, and those for TPOAb and TgAb were even more limited. Conclusion TSRQ therapy combined with THRT may strengthen thyroid function and modulate immune dysregulation in patients with Hashimoto’s hypothyroidism without increasing adverse event incidence.

Objective To explore the association between dynamic indexes of maternal progesterone in early pregnancy and the average level and growth rate of fetal head circumference(HC)in mid-and late pregnancy.Methods This study adopted a retrospective cohort design and included 255 singleton pregnant women in the maternal and infant cohort of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2024.The progesterone levels of their early venous blood were detected and divided into two groups of progesterone trajectories,namely,fluctuating type and increasing type,by morphology.The dynamic indicators of progesterone in early pregnancy were constructed:cumulative dynamic deviation index in the first trimester(CDDI-P1T),gestational age at progesterone peak(GA-PP),and maximal relative progesterone decline in the first trimester(MRD-P1T).The average head circumference level and linear growth rate of the fetuses in the middle and late pregnancy were calculated.Generalized linear regression(GLM)was used to analyze the linear association between progesterone dynamic indicators and head circumference development.The key gestational weeks of progesterone affecting fetal head development were explored by linear regression of gestational weeks.Ordinary least squares(OLS)regression and restricted cubic spline(RCS)plots were used to draw the nonlinear association between progesterone dynamic indicators and head circumference.Results Among the 255 pregnant women included,92.5％of the progesterone trajectories in early pregnancy were fluctuating,and 7.5％were increasing.The growth rates of the increasing progesterone trajectory group were higher in the second and third trimesters than in the fluctuating group,but the differences were not statistically significant(all P＞0.05).GLM analysis showed that for every 1 unit increase in CDDI-P1T,the head circumference in the middle and late pregnancy increased significantly by 1.574 cm and 1.193 cm(Z=3.714,2.885,P＜0.01).The delay of GA-PP was negatively correlated with the head circumference in the middle pregnancy(β=-0.190 cm,95％CI:-0.339--0.041,P=0.010)but positively correlated with the head circumference growth rate in the late pregnancy(β=0.022 cm/week,95％CI:0.003-0.041,P=0.025).A 10％decrease in the decline of CDDI-P1T increased the head circumference in the middle pregnancy by 0.200 cm(95％CI:0.016-0.384,P=0.033),and a 100％decrease in the decline increased the head circumference growth rate in the late pregnancy by 0.201 cm/week(95％CI:0.002-0.399,P=0.048).The analysis of the key time window showed that for every 20 nmol/L increase in progesterone during 9.5-13 weeks of pregnancy,the mid-term head circumference increased by 0.035-0.166 cm(Z=2.452-3.517,allP＜0.05),and the late-term head circumference increased by 0.767 cm during 9-13 weeks of pregnancy(Z=2.452-3.517,all P＜0.05).When progesterone increased during 9.5-10.5 weeks of pregnancy,the growth rate of mid-term head circumference increased by 0.013-0.023 cm/week(Z=2.074-2.243,all P＜0.01).When progesterone increased during 8.5-10.5 weeks of pregnancy,the growth rate of late-term head circumference increased by 0.010-0.026 cm/week(Z=2.061-3.137,all P＜0.05).Conclusion Progesterone dynamic index is a new sensitive tool for evaluating fetal head circumference development.There is a stage-specific window period for progesterone regulation.9.5-13 weeks of pregnancy is the critical period for progesterone to affect head circumference growth,and 9.5-10.5 weeks of pregnancy is the core window for regulating the growth rate of head circumference.Therefore,it is necessary to combine progesterone dynamic index and time window for individualized intervention to promote the transformation of prenatal care from pregnancy maintenance to eugenics intervention.

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 predict the potential suitability distribution of Vitex negundo in China;To analyze the key environmental factors influencing its suitability distribution.Methods Based on the geographic distribution data of Vitex negundo from 196 sites across China and 55 environmental variables,the Maximum Entropy(MaxEnt)model and ArcGIS 10.2 were employed to predict the potential distribution of suitable habitats for Vitex negundo in China.Results The constructed MaxEnt prediction model demonstrated high reliability.The primary environmental factors influencing the suitable distribution of Vitex negundo included the average temperature from June to October,precipitation in April and November,the mean temperature of the warmest season,soil type,and vegetation type.The predicted suitable habitats for Vitex negundo would be widely distributed,primarily concentrated in Jiangxi,central and southern Anhui,northwestern Zhejiang,eastern and northeastern Hunan,as well as eastern and southeastern Hubei.Conclusion The predicted potential distribution of Vitex negundo in China can provide a valuable reference for the conservation and sustainable utilization of this medicinal resource.

Objective:To construct an early rehabilitation exercise program for patients with agoraphobia after total knee arthroplasty (TKA) to provide guidance for orthopedic rehabilitation nursing practice.Methods:The first draft of an early rehabilitation exercise program for patients with agoraphobia after TKA was developed through literature search, semi-structured interviews, and group discussions. From November to December 2023, 20 experts from nine provinces and centrally administered municipalities were selected for two rounds of expert consultation using the Delphi method to form the final draft of the early rehabilitation exercise program for patients with agoraphobia after TKA.Results:In two rounds of consultation, the questionnaire recovery rates were 91.30% (21/23) and 95.24% (20/21), with authority coefficients of 0.92 and 0.96, and Kendall's coordination coefficients of 0.28 and 0.34, respectively ( P<0.05). After the second round of consultation, the mean importance assignment scores for all levels of indicators ranged from 3.90 to 5.00, with coefficients of variation ranging from 0 to 0.20. The finalized early rehabilitation exercise program for patients with agoraphobia after TKA contained two parts, including the preface and the main text, and the main text consisted of five first-level items, 21 second-level items, and 35 third-level items. Conclusions:The content of the early rehabilitation exercise program for patients with agoraphobia after TKA is scientific, reasonable, comprehensive, practical and targeted, which can provide a basis for clinical medical and nursing personnel to guide the early rehabilitation exercise for patients with agoraphobia after TKA.

Objective To explore the association between dynamic indexes of maternal progesterone in early pregnancy and the average level and growth rate of fetal head circumference(HC)in mid-and late pregnancy.Methods This study adopted a retrospective cohort design and included 255 singleton pregnant women in the maternal and infant cohort of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2024.The progesterone levels of their early venous blood were detected and divided into two groups of progesterone trajectories,namely,fluctuating type and increasing type,by morphology.The dynamic indicators of progesterone in early pregnancy were constructed:cumulative dynamic deviation index in the first trimester(CDDI-P1T),gestational age at progesterone peak(GA-PP),and maximal relative progesterone decline in the first trimester(MRD-P1T).The average head circumference level and linear growth rate of the fetuses in the middle and late pregnancy were calculated.Generalized linear regression(GLM)was used to analyze the linear association between progesterone dynamic indicators and head circumference development.The key gestational weeks of progesterone affecting fetal head development were explored by linear regression of gestational weeks.Ordinary least squares(OLS)regression and restricted cubic spline(RCS)plots were used to draw the nonlinear association between progesterone dynamic indicators and head circumference.Results Among the 255 pregnant women included,92.5％of the progesterone trajectories in early pregnancy were fluctuating,and 7.5％were increasing.The growth rates of the increasing progesterone trajectory group were higher in the second and third trimesters than in the fluctuating group,but the differences were not statistically significant(all P＞0.05).GLM analysis showed that for every 1 unit increase in CDDI-P1T,the head circumference in the middle and late pregnancy increased significantly by 1.574 cm and 1.193 cm(Z=3.714,2.885,P＜0.01).The delay of GA-PP was negatively correlated with the head circumference in the middle pregnancy(β=-0.190 cm,95％CI:-0.339--0.041,P=0.010)but positively correlated with the head circumference growth rate in the late pregnancy(β=0.022 cm/week,95％CI:0.003-0.041,P=0.025).A 10％decrease in the decline of CDDI-P1T increased the head circumference in the middle pregnancy by 0.200 cm(95％CI:0.016-0.384,P=0.033),and a 100％decrease in the decline increased the head circumference growth rate in the late pregnancy by 0.201 cm/week(95％CI:0.002-0.399,P=0.048).The analysis of the key time window showed that for every 20 nmol/L increase in progesterone during 9.5-13 weeks of pregnancy,the mid-term head circumference increased by 0.035-0.166 cm(Z=2.452-3.517,allP＜0.05),and the late-term head circumference increased by 0.767 cm during 9-13 weeks of pregnancy(Z=2.452-3.517,all P＜0.05).When progesterone increased during 9.5-10.5 weeks of pregnancy,the growth rate of mid-term head circumference increased by 0.013-0.023 cm/week(Z=2.074-2.243,all P＜0.01).When progesterone increased during 8.5-10.5 weeks of pregnancy,the growth rate of late-term head circumference increased by 0.010-0.026 cm/week(Z=2.061-3.137,all P＜0.05).Conclusion Progesterone dynamic index is a new sensitive tool for evaluating fetal head circumference development.There is a stage-specific window period for progesterone regulation.9.5-13 weeks of pregnancy is the critical period for progesterone to affect head circumference growth,and 9.5-10.5 weeks of pregnancy is the core window for regulating the growth rate of head circumference.Therefore,it is necessary to combine progesterone dynamic index and time window for individualized intervention to promote the transformation of prenatal care from pregnancy maintenance to eugenics intervention.

Objective To predict the potential suitability distribution of Vitex negundo in China;To analyze the key environmental factors influencing its suitability distribution.Methods Based on the geographic distribution data of Vitex negundo from 196 sites across China and 55 environmental variables,the Maximum Entropy(MaxEnt)model and ArcGIS 10.2 were employed to predict the potential distribution of suitable habitats for Vitex negundo in China.Results The constructed MaxEnt prediction model demonstrated high reliability.The primary environmental factors influencing the suitable distribution of Vitex negundo included the average temperature from June to October,precipitation in April and November,the mean temperature of the warmest season,soil type,and vegetation type.The predicted suitable habitats for Vitex negundo would be widely distributed,primarily concentrated in Jiangxi,central and southern Anhui,northwestern Zhejiang,eastern and northeastern Hunan,as well as eastern and southeastern Hubei.Conclusion The predicted potential distribution of Vitex negundo in China can provide a valuable reference for the conservation and sustainable utilization of this medicinal resource.

Objective:To construct an early rehabilitation exercise program for patients with agoraphobia after total knee arthroplasty (TKA) to provide guidance for orthopedic rehabilitation nursing practice.Methods:The first draft of an early rehabilitation exercise program for patients with agoraphobia after TKA was developed through literature search, semi-structured interviews, and group discussions. From November to December 2023, 20 experts from nine provinces and centrally administered municipalities were selected for two rounds of expert consultation using the Delphi method to form the final draft of the early rehabilitation exercise program for patients with agoraphobia after TKA.Results:In two rounds of consultation, the questionnaire recovery rates were 91.30% (21/23) and 95.24% (20/21), with authority coefficients of 0.92 and 0.96, and Kendall's coordination coefficients of 0.28 and 0.34, respectively ( P<0.05). After the second round of consultation, the mean importance assignment scores for all levels of indicators ranged from 3.90 to 5.00, with coefficients of variation ranging from 0 to 0.20. The finalized early rehabilitation exercise program for patients with agoraphobia after TKA contained two parts, including the preface and the main text, and the main text consisted of five first-level items, 21 second-level items, and 35 third-level items. Conclusions:The content of the early rehabilitation exercise program for patients with agoraphobia after TKA is scientific, reasonable, comprehensive, practical and targeted, which can provide a basis for clinical medical and nursing personnel to guide the early rehabilitation exercise for patients with agoraphobia after TKA.