Femoral nerve blocks (FNB) can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty (TKA). Adductor canal block (ACB) is a relatively new alternative providing pure sensory blockade with minimal effect on quadriceps strength. The meta-analysis was designed to evaluate whether ACB exhibited better outcomes with respect to quadriceps strength, pain control, ambulation ability, and complications. PubMed, Embase, Web of Science, Wan Fang, China National Knowledge Internet (CNKI) and the Cochrane Database were searched for RCTs comparing ACB with FNB after TKAs. Of 309 citations identified by our search strategy, 12 RCTs met the inclusion criteria. Compared to FNB, quadriceps maximum voluntary isometric contraction (MVIC) was significantly higher for ACB, which was consistent with the results regarding quadriceps strength assessed with manual muscle strength scale. Moreover, ACB had significantly higher risk of falling versus FNB. At any follow-up time, ACB was not inferior to FNB regarding pain control or opioid consumption, and showed better range of motion in comparison with FNB. ACB is superior to the FNB regarding sparing of quadriceps strength and faster knee function recovery. It provides pain relief and opioid consumption comparable to FNB and is associated with decreased risk of falls.

Background: Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty.Objective: We performed an updated systematic review and meta‐analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures.Methods: A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta‐analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI).Results: Twenty‐four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0–17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6–5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4–11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3–5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39–0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16–0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11–0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40–0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23–0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71–10.02; P < 0.001).Conclusion: This meta‐analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.

Efficient wound assessment is essential for healthcare teams to facilitate prompt diagnosis, optimize treatment plans, reduce workload, and enhance patients' quality of life. In recent years, non‐invasive techniques for aiding wound assessment, such as digital photography, 3D modelling, optical imaging, fluorescence and thermography, as well as artificial intelligence, have been gradually developed. This paper aims to review the various methods of measurement and diagnosis based on non‐invasive wound imaging, and to summarize their application in wound monitoring and assessment. The goal is to provide a foundation and reference for future research on wound assessment.

Objective: To clarify the effectiveness and safety of psycho-behavioral intervention combined with a non-benzodiazepine to improve perioperative sleep quality in patients undergoing knee arthroplasty, and also to explore the optimal dosage of non-benzodiazepine (oral zolpidem tartrate) to form a standardized sleep quality management process to promote accelerated recovery of patients.Methods: 240 patients undergoing initial unilateral total knee arthroplasty between January and December 2016 were prospectively included and randomly divided into blank control group (group A), psycho-behavioral intervention group (group B), zolpidem tartrate 10 mg group (group C), and psycho-behavioral intervention + zolpidem tartrate 5 mg group (group D). Sleep, pain, psychological, and knee function scores were compared.Results: There were significant differences between the four groups with respect to Pittsburgh sleep quality index scores, sleep efficiency, Epworth Sleepiness Scale scores, inflammatory indices, pain, and enhanced recovery after surgery indices during hospitalization (P < 0.05).Conclusion: Psychological behavioral intervention combined with non-benzodiazepine can improve the perioperative quality of sleep. Compared with drug intervention alone, it reduces the dosage of non-benzodiazepine, alleviates anxiety, improves patient satisfaction, and enhances the quality of life.

Importanc: Large language models (LLMs) with retrieval-augmented generation (RAG) show promise for clinical decision support. However, their application is constrained by limited & outdated vector databases, suboptimal evidence retrieval and poor contextual continuity. Objective: To develop and evaluate a novel LLM-based agent that integrates Evidence-Based Medicine (EBM) principles and contextual conversation capabilities in answering clinical questions. Design, Setting and Participants: The agent for clinical decision making was developed and evaluated between July 1, 2024, and July 31, 2025. The system incorporated an EBM-enabled workflow, a memory module and Thought-Action-Observation (TAO) loops. Evaluation 1 assessed the system’s performance on 150 initial clinical questions across 15 cancer types. Evaluation 2 involved 45 multi-turn dialogue tasks (across 3 types). Baselines were state-of-the-art traditional RAG method and commercial LLMs with plugins. All generated responses across both evaluations were independently rated by 3 experts with over five years of clinical experience. The study was performed at West China Medical Center. Main Outcomes and Measures: Each response in evaluation 1 was classified into one of three predefined categories—correct, inaccurate, or wrong. As for evaluation 2, tasks were deemed successful when previous conversation is remembered and answer is correct, otherwise the task was considered unsuccessful. Results: In evaluation 1, EBMChat generated the highest proportion of accurate responses (89% vs 78% for the best baseline method). The superior performance of EBMChat was associated with its ability to retrieve optimal evidence, demonstrated by significantly higher evidence hierarchy (100% vs 17.5% RCT-level or above), stricter evidence timeliness (within 5 years vs from the 1980s onwards), and more comprehensive retrieval (median of 693 vs 267 items/question). Regarding evaluation 2, EBMChat successfully completed 93% of the tasks. In contrast, GPT-4.1 with plugins (Web Search) achieved a success rate of only 31%. This performance gap was attributed to EBM-enabled workflow, memory module and TAO loops, which ensure robust contextual conversation capabilities. Conclusion and Relevanc: EBMChat identifies appropriate evidence by effectively balancing timeliness, hierarchy, and relevance. Meanwhile, its enhanced conversational capabilities facilitate the preservation of contextual data, enabling users to explore clinical problems more deeply or comprehensively in multi-turn dialogues. Our findings underscore that the effective promotion of clinical practice by AI requires deeper integration of core medical principles into the technology itself, rather than direct application of general-purpose AI tools.

Background: To ensure smooth surgical procedures, patient safety, and quality of perioperative care, perceived perioperative competence (PPC) is a daily and urgent requirement for operating room (OR) nurses. Understanding the status of PPC among OR nurses and its associated factors is essential for OR nurses/people in charge/researchers to pinpoint weaknesses and formulate interventions. Therefore, we aim to investigate the status of PPC and its associated factors. Furthermore, we explore the relationship between PPC, self-efficacy, and job burnout among OR nurses. Methods: Tertiary-A hospitals in various districts of Chengdu, China, were recruited using a stratified convenience sampling method. A cross-sectional survey was then administered to OR nurses in the selected hospitals. Data analysis included descriptive analysis, T-tests, one-way analysis of variance (ANOVA), multiple linear regression analysis, correlation analysis, and mediation analysis. Results: A survey of 640 OR nurses across 18 hospitals (with a 98.00% valid response rate) revealed an average PPC score of 3.66 ± 1.12/124.55 ± 26.54. Marital status, OR specialty education, and age significantly influenced PPC levels (p < 0.05). Self-efficacy was positively correlated with PPC, while job burnout was negatively correlated with PPC. Self-efficacy fully mediated the relationship between these two variables. Conclusions: The performances of PPC among Chinese OR nurses were acceptable. Marital status, OR specialty education, and age significantly influenced PPC levels. Self-efficacy fully mediates the relationship between job burnout and PPC.