In recent years， hyperuricemia （HUA） has shown a rapidly increasing incidence and tends to occur in increasingly young people， with a wide range of cardiac， renal， joint， and cancerous hazards and all-cause mortality associations. Western medicine treatment has limitations such as large liver and kidney damage， medication restriction， and easy recurrence. The intestine is the major extra-renal excretion pathway for uric acid （UA）， and the intestinal microecology can be regulated to promote UA degradation. It offers great potential to develop UA-lowering strategies that target the intestinal microecology， which are promising to provide safer and more effective therapeutic approaches. Traditional Chinese medicine （TCM） can treat HUA via multiple targets and multiple pathways from a holistic view， with low toxicity and side effects. Studies have shown that intestinal microecology is a crucial target for TCM in the treatment of HUA. However， its specific mechanism of action has not been fully elucidated. Focusing on the key role of intestinal microecology in HUA， this review explores the relationship between intestinal microecology and HUA in terms of intestinal flora， intestinal metabolites， intestinal UA transporters， and intestinal barriers. Furthermore， we summarize the research progress in TCM treatment of HUA by targeting the intestinal microecology， with the aim of providing references for the development of TCM intervention strategies for HUA and the direction of future research.

Objective : To investigate the diagnostic value of combined detection of folate receptor-positive circulat- ing tumor cells ( FR + -CTCs) and hemostatic function indicators in improving the diagnosis of gastrointestinal tumors ( GITs) metastasis． Methods: A retrospective analysis was conducted on the clinical data of 115 patients aged 18 to 80 years who were diagnosed with gastrointestinal tumors via pathology and received treatment，including data on FR + -CTCs，hemostatic function indicators，and pathological staging．The collected data encompassed FR + -CTCs levels，coagulation parameters，and pathological staging．Statistical analysis included t-tests，chi-square tests，fish- er ’s exact test，Logistic regression analysis，and receiver operating characteristic ( ROC) curves to assess the diag- nostic value of combined FR + -CTCs and coagulation parameters in detecting tumor metastasis． Results: FR + -CTCs levels and positive rates demonstrated significant associations with clinicopathological characteristics ( gender，histo- logical type，N staging) in GITs patients ( P＜0. 05) ．In patients with metastasis，elevated fibrinogen levels were observed．Adithonallly，platelet counts showed significant increases in N1 －N3 stages ( P＜0. 05) ．Logistic regres- sion analysis showed that PLT and antithrombin Ⅲ ( AT-Ⅲ) were independent risk factors for GITs metastasis ( P＜0. 05) ． The areas under the ROC curves for predicting GITs metastasis were 0. 678 ( 95% CI: 0. 540 - 0. 816) and 0. 664 ( 95% CI: 0. 512 －0. 815) ，respectively．When combining multiple factors，including FR + - CTCs，PLT，AT-Ⅲ , pathological type，FIB，TT，and gender，for the diagnosis of GITs metastasis，the AUC in- creased to 0. 757 ( 95% CI: 0. 621 －0. 893) ，indicating higher sensitivity and specificity compared to using each indicator alone． Conclusion The combined detection of FR + -CTCs and anticoagulation function indicators has a higher diagnostic value for the diagnosis of GITs，providing a valuable basis for the early diagnosis of GITs，espe- cially in metastasis surveillance．

Carbon dioxide(CO2),a colorless,odorless,low-density negative contrast agent with no nephrotoxicity or allergic reactions,has seen increasingly widespread application in the field of vascular imaging in recent years,particularly in patients with iodine allergy or renal insufficiency.When combined with digital subtraction angiography,CO2 angiography has demonstrated high-quality imaging in various arterial and venous sites such as the abdominal aorta,renal arteries,iliac arteries,lower limb arteries,and inferior vena cava.It has also shown safety and efficacy in clinical scenarios such as peripheral arterial disease,dialysis access evaluation,and transjugular intrahepatic portosystemic shunt procedures.This review systematically summarizes domestic and international research progress on CO2 angiography,outlines its physicochemical properties,injection dosages and parameters,clinical indications,and imaging characteristics,and compares its image quality with that of iodine-based contrast agents.Common complications,their mechanisms,and preventive measures are also discussed.Although the image quality of CO2 is slightly inferior to that of iodine agents,it remains sufficient for most diagnostic and therapeutic needs,with a low overall incidence of mainly mild and transient adverse effects.With the development of automated injection systems and digital variance angiography technology,CO2 imaging quality is expected to continue improving,and its application scope is likely to expand further.Future efforts should focus on strengthening multicenter clinical research and establishing standardized operational protocols to promote the broader adoption and regulated use of this technology.

Objective:To investigate the influencing factors for sarcopenia in hospitalized patients,to construct a risk prediction model for sarcopenia in elderly hospitalized patients,and to provide a quantitative tool for early screening and intervention of sarcopenia based on the integration of multi-dimensional indicators.Methods:A retrospective analysis was performed for the data of 2105 elderly patients who were hospitalized in The First Affiliated Hospital of Chongqing Medical University from March 2016 to June 2023.The least absolute shrinkage and selection operator analysis was used for the screening of variables,and the logistic regression analysis was used to investigate the influencing factors for sarcopenia.A predictive model was constructed,and internal and external validation was performed.The Shapley additive explanations model was used to analyze feature contributions,and a nomogram model was constructed to visualize and interpret the results.Results:The 1259 patients from March 2016 to December 2020 were randomly divided into a training set with 882 patients and an internal test set with 377 patients at a ratio of 7∶3,and the 846 patients from January 2021 to June 2023 were established as the external validation set.A total of 489 cases of sarcopenia(55.44%)were detected in the training set.The logistic regression analysis based on the training set showed that asthenia,dependence on Activity of Daily Living,malnutrition,and in-creasing age were risk factors for sarcopenia(odds ratio[OR]>1,P<0.05),and male sex,normal body mass index,and overweight were protective factors against sarcopenia(OR<1,P<0.05).The model had an AUC of 0.876(95%CI=0.854-0.899)in the training set,0.883(95%CI=0.849-0.918)in the internal test set,and 0.750(95%CI=0.717-0.783)in the external validation set,suggesting that the model had good performance.The decision curve analysis showed that the nomogram model had a good clinical value.Conclu-sion:The predictive model for sarcopenia has good performance and holds promise for clinical application.

Objective To retrieve,analyze and synthesize evidence on post-transplant diabetes mellitus(PTDM)in lung transplant patients,providing reference for clinical healthcare professionals in preventing and managing PTDM in lung transplant patients.Methods Based on the"6S"evidence model,systematic searches were conducted across guideline websites,professional associations,and Chinese/English databases regarding post-transplant diabetes mellitus(PTDM)in lung transplant patients.The search period spanned from data-base inception to January 2025.Two researchers independently completed literature screening,quality assess-ment,and evidence extraction.Results A total of 14 articles were included,comprising 1 clinical decision,2 guidelines,5 expert consensuses,2 specifications,1 evidence summary,and 3 systematic reviews.Twenty-four pieces of best evidence were synthesized from seven aspects:risk factors,diagnosis,screening,prevention,treatment,glycemic control targets,and health education.Conclusion The best evidence for preventing and managing post-transplant diabetes mellitus in lung transplant patients provides an evidence-based foundation for clinical practice among healthcare professionals.Evidence should be selected and applied according to spe-cific clinical situations and patient needs.

Papillary thyroid carcinoma (PTC) is prone to lateral lymph node metastasis (LLNM). It is crucial to assess the status of lateral lymph nodes accurately before surgery, determine the appropriate surgical scope and minimize trauma to patients while thoroughly cleaning. Preoperative evaluation is constantly advancing towards intelligence and precision, and the use of contrast enhanced ultrasound, detection of fine needle aspiration eluent, three-dimensional visualization technology, and contrast enhanced CT-based deep learning model in clinical practice can improve the accuracy of diagnosing LLNM. The new directions for the development of preoperative evaluation include contrast enhanced US, new fine needle aspiration eluent markers, rapid detection of eluent, the combination of radiomics and artificial intelligence. The exploration of risk factors for LLNM has been a hot research topic in recent years, and clinical prediction models can be constructed based on different risk factors and applied in clinical practice. This article presents the top ten risk factors commonly used in clinical research and lists multiple new predictive indicators, which are combined with nomograms for personalized prediction. At the same time, the controversial points in the clinical management of occult LLNM are discussed, as well as the latest progress in the treatment of lateral lymph nodes in PTC.

Objective:To investigate the feasibility and effectiveness of three-dimensional visualization technology in the precise diagnosis and treatment of locally advanced differentiated thyroid cancer(DTC).Methods:A retrospective analysis was conducted on the clinical data of 196 patients with locally advanced DTC treated at the 960th Hospital of the PLA from December 2021 to August 2023. The cohort included 71 male and 125 female patients, with a mean age of 43.7 years (rangd from 18 to 77 years). All patients underwent neck-enhanced CT scans and were divided into two groups: the study group( n=102), which underwent preoperative three-dimensional visualization of CT data, and the control group( n=94), which did not. Baseline data for both groups were matched using SPSS27.0 with 1∶1 propensity score matching (PSM) and the caliper value was 0.02. A total of 49 patients were included in each group, including 35 first-time surgeries and 14 reoperation. Among the 70 first-time surgeries, 29 patients underwent robotic surgery and 41 underwent open surgery. Among the 28 reoperations, 4 underwent robotic surgery and 24 underwent open surgery. In the study group, three-dimensional visual models were used to comprehensively evaluate the tumor and metastatic lesion size, spatial location, and adjacent relationship with surrounding organs, surgical treatments were guided by these models, whereas the control group relied on two-dimensional imaging for guidance. The clinical data were statistically analyzed using SPSS27.0. Results:All operations were successfully completed. There were no statistical differences in baseline data between the two groups( P>0.05). Among first-time surgeries, the study group showed shorter operation times [175(145, 200) min vs 205(182, 249) min, P<0.001], a lower incidence of postoperative chyle leak (0 vs 8.57%, P=0.027), a higher rate of robotic surgery (48.57% vs 34.28%, P=0.225), a greater number of harvested lymph nodes [46(40, 62) vs 37(28, 56), P=0.032], a greater number of cervical lymph node metastasis[15(7, 22) vs 5(1, 14), P=0.004] and a larger diameter of metastasis lymph nodes[12(10, 16) mm vs 4(1, 10) mm, P<0.001]. There were no significant differences in intraoperative blood loss, postoperative drainage days and incidence of hypoparathyroidism( P>0.05). During the reoperation, the study group had shorter operation times[103.5(95.0, 122.5) min vs 146.50(133.25, 172.25) min, P<0.001], less intraoperative blood loss[12.50(8.75, 22.50) mL vs 30.00(17.50, 35.00) mL, P=0.021], fewer postoperative drainage days[5.00(4.00, 6.00) d vs 6.00(5.00, 7.25) d, P=0.016] and a lower incidence of hypoparathyroidism(7.14% vs 42.86%, P=0.038).The robotic surgery rate was higher in the study group (21.42% vs 7.14%, P=0.596). There were no significant differences in lymph node dissection numbers, metastatic lymph node counts, or chyle leak incidences between the two groups ( P>0.05). No acute bleeding or incision infection occurred in any patient postoperatively. Conclusion:Three-dimensional visualization technology is an effective preoperative assessment method for evaluating the resectability of tumors and metastases lesions in locally advanced DTC. It enhances the accuracy and safety of surgery for locally advanced DTC.

Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

Objective:To evaluate the efficacy of a low-fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser combined with light-emitting diode (LED) phototherapy in the treatment of melasma.Methods:A total of 46 female patients with melasma, with age ranging from 30 to 58 (41.4±5.8) years, were retrospectively collected from August 2022 to February 2024 at the Department of Plastic Surgery, the First Affiliated Hospital of Army Medical University. The patients were divided into two groups according to the treatment method. The experimental group received low-fluence Q-switched Nd:YAG laser treatment combined with LED phototherapy ( n=23), whereas the control group received low-fluence Q-switched Nd:YAG laser treatment alone ( n=23). The treatment interval for both groups was 4 weeks, and a total of four treatments were conducted. Treatment efficacy was evaluated at the 12-week follow-up after completion of the entire treatment course. Pre-treatment and post-treatment melasma area and severity index (MASI) scores were compared between the two groups. The pain visual analog scale (VAS) score was obtained immediately after each treatment. The occurrence of adverse reactions after treatment, including blisters, persistent erythema, hyperpigmentation, hypopigmentation, and scarring, was recorded in both groups. Results:The efficacy rates in the experimental and control groups were 87% (20/23) and 82.61% (19/23), respectively, with no statistically significant difference between them ( P=1.000). The pre-treatment MASI scores of the experimental and control groups were (24.60±8.69) and (21.48±9.01) scores, respectively, with no statistically significant difference between them ( P=0.239). The post-treatment MASI scores of the experimental group was (7.70±4.36) scores, which was significantly lower than that of the control group [(16.34±7.29) scores, P<0.001). In both groups, the post-treatment MASI scores were significantly lower than the pre-treatment MASI scores (all P<0.001). Both groups experienced mild pain during the treatment. The VAS scores for pain during laser treatment in the experimental and control groups were (1.78±0.90) and (1.61±0.89) scores, respectively, with no statistically significant differences between them ( P=0.514). In the experimental group, the VAS score for pain was zero during LED phototherapy, indicating no increase in pain. No adverse reactions such as blisters, persistent erythema, hyperpigmentation, hypopigmentation, or scarring were observed in either group. Conclusion:Low-fluence Q-switched Nd:YAG laser combined with LED phototherapy can effectively improve the efficacy of melasma treatment, without increasing pain or any other serious adverse effects during or after therapy.

This study investigates the feasibility of the VP8*protein as a subunit vaccine target for porcine rotavirus A(PoRVA),a major causative agent of diarrhea in piglets.The VP8* genes of PoRVA P[13]and P[23]genotype strains were amplified by RT-PCR.These genes were then liga-ted into the pET-28a(+)vector,yielding recombinant plasmids pET-28a-XJWF1-VP8*-P[23]and pET-28a-ShXYW13-VP8*-P[13].These plasmids were subsequently transformed into BL21(DE3)competent cells.The VP8*protein,induced by IPTG,was purified using affinity chroma-tography,and its expression and purification were verified by SDS-PAGE and Western blot.The purified VP8* protein was used to immunize mice,and serum samples were collected after three immunizations.Cross-neutralization assays were conducted to evaluate the ability of the VP8*protein immune serum to neutralize different genotype strains.The results demonstrated the ex-pression of soluble VP8*protein,with SDS-PAGE and Western blot analyses showing that the purified VP8*protein existed in both monomeric(27 kDa)and homodimeric(54 kDa)forms.ELISA results indicated that high levels of antibodies were produced in mice immunized with VP 8*-P[13]and VP8*-P[23]after three immunizations.Serum cross-neutralization assays revealed that the neutralizing titers of PoRVA VP8*-P[13]and VP8*-P[23]immune sera against homol-ogous genotype strains ranged from 1∶4 800 to 1∶19 200,significantly higher than those against heterologous genotype strains(1∶1 200).This suggests that the VP8*protein of different geno-type strains exhibits both antigenic conservation and distinct variability.The data obtained in this study provide a solid foundation for further exploration of the antigenic structure of the PoRVA VP8* protein and the development of novel subunit vaccines.