Objective To investigate the current distribution of radiotherapy resources in Gansu Province, evaluate the equity of resource allocation, and provide a scientific basis for optimizing regional resource allocation. Methods A questionnaire survey was carried out to assess radiotherapy resources in medical institutions across Gansu Province, China. The equity of radiotherapy resource distribution and associated disparities were assessed using the Gini coefficient, Lorenz curve, and Theil index. Results A total of 23 medical institutions in Gansu Province provided radiotherapy services, comprising 39 radiotherapy devices and 438 professionals, of whom medical physicists accounted for 16.9%. The radiotherapy frequency was 0.47 cases per thousand population. The Gini coefficients for radiotherapy resource distribution ranged from 0.38 to 0.56 by population and from 0.52 to 0.70 by geography. The Theil index for radiotherapy resources ranged from 1.36 to 3.67. Conclusion Radiotherapy resources in Gansu Province were insufficient, and the capacity of radiotherapy service was suboptimal. The equity of radiotherapy resource allocation by geography was worse than that by population. Therefore, it is imperative to address the shortage of radiotherapy resources, strengthen the professional workforce, enhance the capacity radiotherapy service and resource utilization, optimize resource allocation, and promote regional equity in radiotherapy provision in Gansu Province.

Objective: To investigate the effect of specific deletion of SET-domain-containing 2 (Setd2) in dental germ mesenchymal cells on early tooth development and provide a research basis for exploring the etiology of dental developmental disorders. Methods: This study was approved by the Animal Care and Ethical Committee of Wuhan University. Wnt1Cre mice with a C57BL/6J background were crossed with Setd2flox/flox mice to generate the Setd2 knockout experimental group (Wnt1Cre; Setd2flox/flox) and the control group (Setd2flox/flox). Tail tissues of mouse embryos were collected at embryonic day (E) 13.5, E15.5, and E18.5 for polymerase chain reaction (PCR)-based genotyping, and embryonic heads were collected for paraffin sectioning to observe the development of the first mandibular molar germs. Immunohistochemical (IHC) staining was performed to verify the specific knockout of Setd2 in dental germ mesenchymal cells; hematoxylin and eosin (HE) staining and subrenal culture were used to evaluate the effect of Setd2 knockout in dental germ mesenchymal cells on tooth development; Ki67 staining and a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were employed to evaluate the effects of specific Setd2 knockout on the proliferation and apoptosis of dental germ mesenchymal cells; immunofluorescence (IF) staining was conducted to observe the impact of Setd2 knockout on the trimethylation of lysine 36 on histone 3 (H3K36me3). Results: PCR-based genotyping showed that the experimental group presented a single band (266 bp) for the Setd2flox/flox homozygote and a characteristic band for Wnt1Cre, while the control group only showed a single band (266 bp) for the Setd2flox/flox homozygote. IHC staining confirmed the successful knockout of Setd2 in dental germ mesenchymal cells of the experimental group; HE staining and subrenal culture demonstrated that specific knockout of Setd2 in the experimental group led to reduced size of tooth germs and increased condensation of mesenchymal cells at E15.5 and E18.5 (E15.5, P < 0.05; E18.5, P < 0.01); Ki67 staining showed no statistically significant effect on the proportion of division of dental germ mesenchymal cells between the experimental and control groups at E13.5 and E15.5 (E13.5, P = 0.694; E15.5, P = 0.503); the TUNEL assay demonstrated increased apoptosis of dental germ mesenchymal cells in the experimental group at both E13.5 and E15.5 (P < 0.001); IF staining revealed the absence of H3K36me3 modification in the dental germ mesenchymal cells of the experimental group across E13.5, E15.5, and E18.5 (P < 0.000 1). Conclusion Specific knockout of Setd2 in dental germ mesenchymal cells leads to increased cell apoptosis by impairing H3K36me3 modification, resulting in early developmental defects in mouse teeth characterized by reduced tooth germ volume.

Background: Diabetic macrovascular and microvascular complications often coexist and may share similar risk factors and pathological pathways. We aimed to investigate whether 10-year atherosclerotic cardiovascular disease (ASCVD) risk, which is commonly assessed in diabetes management, can predict incident diabetic nephropathy (DN) and retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: This prospective cohort study enrolled 2,891 patients with clinically diagnosed T2DM who were free of ASCVD, nephropathy, or retinopathy at baseline in the Guangzhou (2017–2022) and Shaoguan (2019–2021) Diabetic Eye Study in southern China. The 10-year ASCVD risk was calculated by the Prediction for ASCVD Risk in China (China-PAR) equations. Multivariable- adjusted Cox proportional hazard models were developed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive capability. Results: During follow-up, a total of 171 cases of DN and 532 cases of DR were documented. Each 1% increment in 10-year ASCVD risk was associated with increased risk of DN (pooled HR, 1.122; 95% CI, 1.094 to 1.150) but not DR (pooled HR, 0.996; 95% CI, 0.979 to 1.013). The model demonstrated acceptable performance in predicting new-onset DN (pooled AUC, 0.670; 95% CI, 0.628 to 0.715). These results were consistent across cohorts and subgroups, with the association appearing to be more pronounced in women. Conclusion Ten-year ASCVD risk predicts incident DN but not DR in our study population with T2DM. Regular monitoring of ASCVD risk in routine diabetes practice may add to the ability to enhance population-based prevention for both macrovascular and microvascular diseases, particularly among women.

Background: Diabetic macrovascular and microvascular complications often coexist and may share similar risk factors and pathological pathways. We aimed to investigate whether 10-year atherosclerotic cardiovascular disease (ASCVD) risk, which is commonly assessed in diabetes management, can predict incident diabetic nephropathy (DN) and retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: This prospective cohort study enrolled 2,891 patients with clinically diagnosed T2DM who were free of ASCVD, nephropathy, or retinopathy at baseline in the Guangzhou (2017–2022) and Shaoguan (2019–2021) Diabetic Eye Study in southern China. The 10-year ASCVD risk was calculated by the Prediction for ASCVD Risk in China (China-PAR) equations. Multivariable- adjusted Cox proportional hazard models were developed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive capability. Results: During follow-up, a total of 171 cases of DN and 532 cases of DR were documented. Each 1% increment in 10-year ASCVD risk was associated with increased risk of DN (pooled HR, 1.122; 95% CI, 1.094 to 1.150) but not DR (pooled HR, 0.996; 95% CI, 0.979 to 1.013). The model demonstrated acceptable performance in predicting new-onset DN (pooled AUC, 0.670; 95% CI, 0.628 to 0.715). These results were consistent across cohorts and subgroups, with the association appearing to be more pronounced in women. Conclusion Ten-year ASCVD risk predicts incident DN but not DR in our study population with T2DM. Regular monitoring of ASCVD risk in routine diabetes practice may add to the ability to enhance population-based prevention for both macrovascular and microvascular diseases, particularly among women.

The preferred treatment for adrenal functional tumors is laparoscopic surgical resection. However, in recent years, various ablation techniques have gradually been applied in the treatment of adrenal tumors. This report presents the successful diagnosis and treatment experience of 4 aldosterone-producing adenomas and 1 cortisol-secreting adenoma treated with a combined cold and hot ablation system at Xi’an Daxing Hospital from Dec. 2023 to Dec. 2024, providing a new treatment approach for clinical exploration.

Objective:To investigate the application value of optimized mesenteric defect closure technique in laparoscopic-assisted right hemicolectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 26 patients who underwent laparo-scopic-assisted right hemicolectomy at Changzhi People′s Hospital Affiliated to Changzhi Medical College from May 2023 to June 2024 were collected. There were 11 males and 15 females, aged (65.7±1.8)years. All patients received optimized mesenteric defect closure using a combined extra-corporeal-laparoscopic suturing technique. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. Results:(1) Surgical and intraoperative conditions. All 26 patients underwent laparoscopic-assisted right hemicolectomy with optimized mesenteric defect closure. The time of optimized mesenteric defect closure was 9.8(8.8,12.8)minutes, time of digestive tract reconstruction was 10.0(8.7,13.0)minutes, operation time was (164±4)minutes, volume of intraoperative blood loss was 50(50,100)mL. One of the 26 patients had intraoperative mesenteric hematoma, which required no specific intervention. The patient recovered uneventfully and was discharged from hospital. (2) Postoperative conditions. The visual analog scale pain score of 26 patients on postoperative day 1 and day 3 were 5(4,5) and 3(2,3), respectively. Time to postoperative first anal flatus and bowel movement were both 3(3, 4)days. Time to postoperative first intake of liquid diet was 2(2,3)days, duration of postoperative abdominal drainage was 4(3,5)days, and duration of postoperative hospital stay was 9(8,12)days. The number of lymph node dissected in 26 patients was 25(18,27) and the number of positive lymph node was 1(0,2). Cases in stage Ⅰ, stage Ⅱ and stage Ⅲ of tumor TNM staging were 5, 6, 15. (3) Follow-up. All 26 patients were followed up for 15(range, 6?20)months. Of the 26 patients, one case had incom-plete intestinal obstruction on postoperative day 25, which was diagnosed as adhesive intestinal obstruction based on imaging examination and classified as Clavien-Dindo grade Ⅱ. The patient recovered and was discharged after conservative treatment. None of the 26 patients had bleeding, infection of incision, anastomotic leakage, internal hernia, or delayed gastric emptying. There was no tumor recurrence, metastasis or death.Conclusion:The optimized mesenteric defect closure tech-nique in combined extracorporeal-laparoscopic suturing procedure can be used in laparoscopic-assisted right hemicolectomy.

Objective To explore the impacts of different surgical methods under hysteroscopy on the surgical time and endometrial thickness of patients with endometrial polyp(EP).Methods 180 patients with EP from April 2021 to April 2023 were regarded as the subjects.They were separated into group A,group B,and group C according to surgical methods,with 60 cases in each.Group A underwent hysteroscopic resection,group B underwent hysteroscopic cold knife surgery,and group C underwent hysteroscopic curettage surgery.The pictorial blood loss assessment chart(PBAC)score before and after treatment,endometrial lesion,intraoperative bleeding volume,hospitalization time,surgical time,hospitalization cost,clinical efficacy,complications,pregnancy rate and recurrence rate were compared.Results The intraoperative bleeding volume in group C was obviously less than that in group A and group B,hospitalization time,and surgical time were obviously shorter than those in group A and group B,and the hospitalization cost was obviously higher than that in group A and group B,the differences were statistically significant(P<0.05).The PBAC score in groups C was obviously less than that in group A and group B,the endometrial thickness was obviously smaller than that in group A and group B,the differences were statistically significant(P<0.05).The clinical efficacy of group A was obviously lower than that of group B and group C,the differences were statistically significant(P<0.05),and there was no statistically obvious difference between group B and group C(P>0.05).The complication rate in group C and group B were obviously less than that in group A(P<0.05),and there was no statistically obvious difference between group B and group C(P>0.05).The recurrence rate within 12 months in three groups was not statistically significant(P>0.05).The pregnancy rate in group C was obviously higher than that in group B and group A,and group B was higher than group A,the differences were statistically significant(P<0.05).Conclusion Hysteroscopic curettage is more effective in clearing lesions,shortening surgical time,reducing intraoperative bleeding,lowering endometrial thickness,and promoting menstrual recovery in patients compared to other hysteroscopic surgical methods,with high safety.

This review aims to summarize the progress of multi-omics technologies in the study of antibi-otic resistance in Cronobacter,with the goal of gaining a deep understanding of its resistance mechanisms and providing a scientific basis for the development of new treatment methods and prevention strategies.By integrating genomics,transcriptomics,proteomics,and metabolomics,the study analyzes gene varia-tions,expression patterns,protein function changes,and metabolic pathway adjustments in Cronobacter.This includes the use of whole-genome sequencing to reveal gene variations related to antibiotic resist-ance,RNA-seq technology to monitor changes in gene expression patterns,proteomics to study protein expression and function,and metabolomics to analyze dynamic changes in metabolites.The research has found that factors such as biofilm formation and outer membrane proteins significantly affect the antibiotic resistance of Cronobacter.In addition,new potential influencing factors have been identified,including the expression changes of multidrug efflux pump genes,which may play a key role in enhancing antibiotic efflux and reducing intracellular antibiotic concentrations.Multi-omics technologies provide a comprehen-sive and in-depth perspective for the study of antibiotic resistance in Cronobacter,revealing multiple fac-tors and potential mechanisms that affect resistance.Although some new influencing factors have been i-dentified,their specific molecular mechanisms still require further investigation.The application pros-pects of multi-omics technologies are broad,and they are expected to provide important support for the development of new treatment methods and prevention strategies.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To search, evaluate, and summarize the best evidence regarding discharge preparation services for adult patients with bronchial asthma, providing references for clinical practice and guideline development.Methods:A computer search was conducted in BMJ Best Practice, UpToDate, PubMed, Australia Joanna Briggs Institute Evidence-based Healthcare Center Database, Cochrane Library, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and China Biology Medicine disc, as well as relevant guideline and professional websites. The search period covered from the establishment of the databases to June 30, 2024. Two researchers independently conducted quality assessments of the included literature, evidence extraction, and synthesis.Results:A total of 14 articles were included, comprising five guidelines, four expert consensus, and five systematic reviews. Twenty-three pieces of evidence were summarized across six aspects: discharge preparation objectives, discharge preparation principles, health guidance during hospitalization, pre-discharge preparation, discharge instructions, and post-discharge follow-up.Conclusions:The best evidence for discharge preparation services for adult patients with bronchial asthma summarized in this study can be applied by clinical healthcare providers in China, considering the specific clinical context, to help adult patients with bronchial asthma manage their condition.