ObjectiveBased on the theory of "spleen governing transportation and transformation"， this study investigates the efficacy of Atractylodis Macrocephalae Rhizoma processed with Aurantii Fructus Immaturus juice（AMR-AFI） in improving slow-transit constipation（STC）， as well as the synergistic regulatory mechanism involving the microbiota-metabolism axis， thereby elucidating the scientific basis of its processing theory. MethodsAnimals were randomly divided into the control group， model group， positive drug（mosapride） group（3 mg·kg^-1）， and low-， medium-， and high-dose groups of AMR-AFI（3.9， 7.8， 15.6 g·kg^-1）. Except for the control group， the remaining five groups were induced with STC using loperamide hydrochloride. Following modeling， interventions were administered. All groups received continuous administration for 15 d， during which fecal samples， colon tissue， and serum were collected. Constipation improvement was assessed by measuring fecal moisture content and small intestinal propulsion rate， histological morphology of colonic tissue was observed via hematoxylin-eosin（HE） staining， and the levels of interleukin（IL）-6， tumor necrosis factor（TNF）-α， and IL-2 in serum were detected using enzyme-linked immunosorbent assay（ELISA）. Furthermore， the microbial community structure in mouse feces was analyzed by 16S rRNA sequencing， while transcriptomic sequencing was employed to screen differentially expressed genes in colonic tissue， followed by gene ontology（GO） and Kyoto Encyclopedia of Genes and Genomes（KEGG） enrichment analyses. Finally， Spearman correlation analysis was conducted to explore the association between differential microbiota and differential genes. ResultsCompared with the control group， the intestinal propulsion rate and fecal moisture content in the model group were significantly decreased（P<0.01）， while serum levels of IL-6， TNF-α， and IL-2 were significantly elevated（P<0.01）. HE staining showed damage and shedding of colonic mucosal epithelial cells， along with a reduction in goblet cells in the model group. In comparison with the model group， all treatment groups improved the pathological state of the colonic mucosa to varying degrees and reduced serum levels of IL-6， TNF-α， and IL-2（P<0.01）. Among these， the high-dose group of AMR-AFI significantly increased the intestinal propulsion rate and fecal moisture content of rats（P<0.05， P<0.01）. Further transcriptomic analysis revealed that a total of 104 differentially expressed genes were identified from comparisons between the model group and the control group， as well as between the model group and the high-dose group of AMR-AFI. These genes were mainly enriched in pathways closely related to STC pathogenesis， such as arachidonic acid metabolism and aldosterone-regulated sodium reabsorption. 16S rRNA sequencing results indicated that AMR-AFI reversed the structural imbalance of the gut microbiota in model mice， increased species richness， downregulated the relative abundance of pro-inflammatory bacteria such as Parasutterella， and enriched beneficial and butyrate-producing bacteria， including Lachnospiraceae_NK4A136_group， Ruminococcaceae， and Lachnospiraceae. Spearman correlation analysis further showed that the beneficial bacteria enriched in the AMR-AFI group were negatively correlated with genes involved in the arachidonic acid metabolic pathway and positively correlated with genes in the aldosterone-regulated sodium reabsorption pathway. In contrast， pro-inflammatory bacteria in the model group exhibited the opposite correlation trends. ConclusionAMR-AFI can effectively exert synergistic therapeutic effects on STC by regulating intestinal microbiota， arachidonic acid-mediated inflammatory metabolism， and aldosterone-regulated water-salt balance pathways.

ObjectiveBased on the theory of "spleen governing transportation and transformation"， this study investigates the efficacy of Atractylodis Macrocephalae Rhizoma processed with Aurantii Fructus Immaturus juice（AMR-AFI） in improving slow-transit constipation（STC）， as well as the synergistic regulatory mechanism involving the microbiota-metabolism axis， thereby elucidating the scientific basis of its processing theory. MethodsAnimals were randomly divided into the control group， model group， positive drug（mosapride） group（3 mg·kg^-1）， and low-， medium-， and high-dose groups of AMR-AFI（3.9， 7.8， 15.6 g·kg^-1）. Except for the control group， the remaining five groups were induced with STC using loperamide hydrochloride. Following modeling， interventions were administered. All groups received continuous administration for 15 d， during which fecal samples， colon tissue， and serum were collected. Constipation improvement was assessed by measuring fecal moisture content and small intestinal propulsion rate， histological morphology of colonic tissue was observed via hematoxylin-eosin（HE） staining， and the levels of interleukin（IL）-6， tumor necrosis factor（TNF）-α， and IL-2 in serum were detected using enzyme-linked immunosorbent assay（ELISA）. Furthermore， the microbial community structure in mouse feces was analyzed by 16S rRNA sequencing， while transcriptomic sequencing was employed to screen differentially expressed genes in colonic tissue， followed by gene ontology（GO） and Kyoto Encyclopedia of Genes and Genomes（KEGG） enrichment analyses. Finally， Spearman correlation analysis was conducted to explore the association between differential microbiota and differential genes. ResultsCompared with the control group， the intestinal propulsion rate and fecal moisture content in the model group were significantly decreased（P<0.01）， while serum levels of IL-6， TNF-α， and IL-2 were significantly elevated（P<0.01）. HE staining showed damage and shedding of colonic mucosal epithelial cells， along with a reduction in goblet cells in the model group. In comparison with the model group， all treatment groups improved the pathological state of the colonic mucosa to varying degrees and reduced serum levels of IL-6， TNF-α， and IL-2（P<0.01）. Among these， the high-dose group of AMR-AFI significantly increased the intestinal propulsion rate and fecal moisture content of rats（P<0.05， P<0.01）. Further transcriptomic analysis revealed that a total of 104 differentially expressed genes were identified from comparisons between the model group and the control group， as well as between the model group and the high-dose group of AMR-AFI. These genes were mainly enriched in pathways closely related to STC pathogenesis， such as arachidonic acid metabolism and aldosterone-regulated sodium reabsorption. 16S rRNA sequencing results indicated that AMR-AFI reversed the structural imbalance of the gut microbiota in model mice， increased species richness， downregulated the relative abundance of pro-inflammatory bacteria such as Parasutterella， and enriched beneficial and butyrate-producing bacteria， including Lachnospiraceae_NK4A136_group， Ruminococcaceae， and Lachnospiraceae. Spearman correlation analysis further showed that the beneficial bacteria enriched in the AMR-AFI group were negatively correlated with genes involved in the arachidonic acid metabolic pathway and positively correlated with genes in the aldosterone-regulated sodium reabsorption pathway. In contrast， pro-inflammatory bacteria in the model group exhibited the opposite correlation trends. ConclusionAMR-AFI can effectively exert synergistic therapeutic effects on STC by regulating intestinal microbiota， arachidonic acid-mediated inflammatory metabolism， and aldosterone-regulated water-salt balance pathways.

Prostate cancer is a prevalent malignant tumor of the male genitourinary system in China, with a persistently elevated incidence rate.Given the insidious onset, propensity for metastasis in advanced stages, and poor efficacy of traditional treatments, new hormone therapies have garnered increasing attention in recent years.A number of clinical studies have demonstrated that second-generation androgen receptor inhibitors (SGARIs), including enzalutamide, apalutamide, darolutamide, and rezvilutamide, can be beneficial in different stages of advanced prostate cancer.Furthermore, their early application has been shown to delay disease progression while maintaining a controlled safety profile.At present, SGARIs have increasingly become the primary therapeutic agents for advanced prostate cancer in various stages.This article reviews the clinical research progress of SGARIs in recent years, with the aim of offering valuable clinical reference for clinicians.

Objective:To analyze the impact of diagnosis-intervention packet payment (DIP) reform on hospitalization service capacity and patients′ economic burden, for references for promoting China′s medical insurance payment reform.Methods:Data were collected from the discharge summarizes of 116 545 hospitalized patients from a tertiary hospital in Guangdong Province. Among them, there were 42 534 cases before the DIP reform (January 2016 to December 2017) and 74 011 cases after the reform (January 2018 to December 2020). The all-cause in-hospital mortality rate, length of hospital stay, disease severity, readmission rate within 30 days, total hospitalization costs, and patient out of pocket expenses were used as evaluation indicators for hospitalization service capacity and patient economic burden. Intermittent time series analysis was conducted to examine the changes in indicators before and after DIP reform.Results:The slope of the change trend of all-cause in-hospital mortality rate and readmission rate within 30 days before and after DIP reform was not statistically significant ( P<0.05); The length of hospital stay showed a decreasing trend before the reform ( P=0.047), but the trend after the reform was not statistically significant ( P=0.776); The change trend of disease severity before the reform was not statistically significant ( P=0.682), but showed a significant upward trend after the reform ( P=0.012); The total hospitalization costs significantly increased during the reform ( P<0.001), but the trend of change after the reform was not statistically significant ( P=0.431); The patient′s out of pocket expenses showed an upward trend before the reform ( P=0.001), but the change trend after the reform was not statistically significant ( P=0.757). Conclusions:DIP reform could help hospitals improve their inpatient service capabilities and enhance their functional positioning; Strengthen medical cost management and control the increase in economic burden on hospitalized patients.

In January 2023, a patient with soft tissue degloving defect of right index, middle, ring and little fingers was treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Seven free flaps from a leg were harvested to reconstruct the defected wound of fingers in primary surgery. Flap thinning and plastic surgery were performed in stage-II surgery. Over the 22 months of postoperative follow-up, the flaps in right index, middle, ring and little fingers survived well with the colour and texture close to proximal skin. There was no obvious swelling of the flaps and sensation of the flaps recovered to S 3. The donor sites healed well and the donor leg walked normally.

Objective:To evaluate the efficacy and feasibility of a domestically developed robotic surgical system based on fiber-optic dedicated line communication in cross-regional urological telesurgery.Methods:This was multicenter，single-arm，retrospective case series study. The data of patients who underwent urological telesurgeries using the telesurgical system between January 2023 and December 2024 were analyzed. The cohort included 59 patients from seven hospitals across China. Among the patients，47 were male（79.7%）and 12 were female（20.3%），with a median age of 63.0（56.0，68.0）years and a body mass index of（24.7 ± 3.0）kg/m 2. Surgical procedures included 32 radical prostatectomies，24 partial nephrectomies，one radical nephrectomy，one adrenalectomy，and one ureteral reconstruction. The perioperative indicators，pathological results and postoperative complications were analyzed. The network monitoring data were collected，and the perioperative data of patients，remote system monitoring data and costs were compared between the two communication modes of optical transport network（OTN）and cloud-connect network（CCN）. Results:All 59 remote surgeries were successfully completed，with a mean operative time of（138.0 ± 54.0）minutes，median intraoperative blood loss of 50.0（30.0，100.0）ml and a postoperative hospital stay of 5.0（4.0，6.0）days. No cases required reoperation，Clavien-Dindo grade ≥3 complications，or readmission. The geographical distance between the primary and remote surgical sites ranged from 450 to 2 800 km. Network monitoring revealed increased bidirectional latency with distance increasing：the shortest latency time（Hefei-Hangzhou，450 km）was（16.59 ± 0.80）ms，while the longest（Harbin-Hangzhou，2 200 km）latency time was（53.31 ± 0.31）ms. Average frame loss per procedure was 0?1.27 frames. The results of subgroup analysis comparing OTN and CCN communication modes showed no significant differences in operative time［（130.7 ± 70.5）minutes vs.（142.1 ± 42.9）minutes， P = 0.442］，postoperative hospitalization［6.0（4.0，8.0）d vs. 5.0（4.0，6.0）d， P = 0.581］，or readmission rates（0 vs. 0）. However，CCN demonstrated significant cost advantages with 500 RMB per operation vs. 3 000 RMB per operation for OTN. Conclusions:Urological telesurgery using fiber-optic communication is feasible. The CCN mode，with its cost-effectiveness，excellent usability，and multi-point interconnection flexibility，is currently the preferred communication model for telesurgical applications.

Objective:To analyze the impact of diagnosis-intervention packet payment (DIP) reform on hospitalization service capacity and patients′ economic burden, for references for promoting China′s medical insurance payment reform.Methods:Data were collected from the discharge summarizes of 116 545 hospitalized patients from a tertiary hospital in Guangdong Province. Among them, there were 42 534 cases before the DIP reform (January 2016 to December 2017) and 74 011 cases after the reform (January 2018 to December 2020). The all-cause in-hospital mortality rate, length of hospital stay, disease severity, readmission rate within 30 days, total hospitalization costs, and patient out of pocket expenses were used as evaluation indicators for hospitalization service capacity and patient economic burden. Intermittent time series analysis was conducted to examine the changes in indicators before and after DIP reform.Results:The slope of the change trend of all-cause in-hospital mortality rate and readmission rate within 30 days before and after DIP reform was not statistically significant ( P<0.05); The length of hospital stay showed a decreasing trend before the reform ( P=0.047), but the trend after the reform was not statistically significant ( P=0.776); The change trend of disease severity before the reform was not statistically significant ( P=0.682), but showed a significant upward trend after the reform ( P=0.012); The total hospitalization costs significantly increased during the reform ( P<0.001), but the trend of change after the reform was not statistically significant ( P=0.431); The patient′s out of pocket expenses showed an upward trend before the reform ( P=0.001), but the change trend after the reform was not statistically significant ( P=0.757). Conclusions:DIP reform could help hospitals improve their inpatient service capabilities and enhance their functional positioning; Strengthen medical cost management and control the increase in economic burden on hospitalized patients.

The nursing experience of buttonhole cannulation for an autogenous arteriovenous fistula with an Eluvia drug-eluting stent in a patient undergoing maintenance hemodialysis was summarized.Key nursing points included:developing a scientific and rational buttonhole cannulation plan for the autogenous arteriovenous fistula stent based on its characteristics post-stent implantation;conducting preoperative ultrasonic evaluations of the arteriovenous fistula and stent;establishing and maintaining a buttonhole tunnel at the stent site;regularly monitoring and following up on the cannulation site and the condition of the autogenous arteriovenous fistula;strengthening the observation and prevention of potential complications.Through rigorous and standardized assessments,procedures,and nursing care,the patient maintained good autogenous arteriovenous fistula function without stent-related complications such as fracture,stenosis,or infection over a 14-month follow-up period.

Current experimental and computational methods have limitations in accurately and efficiently classi-fying ion channels within vast protein spaces.Here we have developed a deep learning algorithm,GPT2 Ion Channel Classifier(GPT2-ICC),which effectively distinguishing ion channels from a test set con-taining approximately 239 times more non-ion-channel proteins.GPT2-ICC integrates representation learning with a large language model(LLM)-based classifier,enabling highly accurate identification of potential ion channels.Several potential ion channels were predicated from the unannotated human proteome,further demonstrating GPT2-ICC's generalization ability.This study marks a significant advancement in artificial-intelligence-driven ion channel research,highlighting the adaptability and effectiveness of combining representation learning with LLMs to address the challenges of imbalanced protein sequence data.Moreover,it provides a valuable computational tool for uncovering previously uncharacterized ion channels.

The nursing experience of buttonhole cannulation for an autogenous arteriovenous fistula with an Eluvia drug-eluting stent in a patient undergoing maintenance hemodialysis was summarized.Key nursing points included:developing a scientific and rational buttonhole cannulation plan for the autogenous arteriovenous fistula stent based on its characteristics post-stent implantation;conducting preoperative ultrasonic evaluations of the arteriovenous fistula and stent;establishing and maintaining a buttonhole tunnel at the stent site;regularly monitoring and following up on the cannulation site and the condition of the autogenous arteriovenous fistula;strengthening the observation and prevention of potential complications.Through rigorous and standardized assessments,procedures,and nursing care,the patient maintained good autogenous arteriovenous fistula function without stent-related complications such as fracture,stenosis,or infection over a 14-month follow-up period.