Uric acid (UA) is the final metabolite of purines in the human body. An imbalance in UA production and excretion that disrupts homeostasis leads to elevated blood UA levels and the development of hyperuricemia (HUA). Approximately one-third of UA is excreted through the intestinal tract. As a crucial component of the intestinal microenvironment, the gut microbiota plays a pivotal role in regulating blood UA levels. Alterations or imbalances in gut microbiota composition are linked to the onset of HUA, which implies the potential of gut microbiota as a novel target for the prevention and treatment of HUA. This review introduces the occurrence mechanism and damage of hyperuricemia, examines the association between HUA and the gut microbiota and their metabolites, and explores the molecular mechanisms underlying gut microbiota-targeted therapies for HUA. Furthermore, it discusses the potential applications of probiotics, prebiotics, and traditional Chinese medicine (including both single herbs and compound formulas) with UA-lowering effects, along with cutting-edge technologies such as fecal microbiota transplantation and machine learning in HUA treatment. This review provides valuable perspectives and strategies for improving the prevention and treatment of HUA.
Hyperuricemia/microbiology* ; Humans ; Gastrointestinal Microbiome/physiology* ; Probiotics/therapeutic use* ; Uric Acid/blood* ; Fecal Microbiota Transplantation ; Prebiotics ; Medicine, Chinese Traditional

Objective:To analyze the incidence of adverse treatment outcome of rifampicin-resistant tuberculosis (RR-TB) patients and influencing factors in 9 provinces in China.Methods:The information about the basic characteristics, diagnosis and treatment of RR-TB patients registered from January 1, 2017 to December 31, 2021 in 9 provinces (Beijing, Jilin, Shanghai, Jiangsu, Zhejiang, Hubei, Henan, Yunnan and Guizhou) were collected from the tuberculosis information management sub-system of China Disease Control and Prevention Information System for a descriptive analysis, and the influencing factors of adverse treatment outcome were identified by binary logistic regression analysis.Results:In 18 204 RR-TB patients in this study a total of 6 852 had adverse treatment outcomes (37.64%). Treatment failure occurred in 1 031 patients, 1 272 patients died, 2 284 patients were lost to follow-up, and 2 265 patients were not evaluated. The results of multivariate logistic regression analysis showed that being man (a OR=1.54, 95% CI: 1.43-1.66), age ≥65 years (a OR=2.42, 95% CI: 2.20-2.67), being from other ethnic groups (a OR=1.18, 95% CI: 1.03-1.35), being farmer (a OR=1.22, 95% CI: 1.13-1.32), being retired with honours or being retired (a OR=1.16, 95% CI: 1.00-1.35) and being floating population (a OR=1.23, 95% CI: 1.13-1.34), re-treatment (a OR=1.33, 95% CI: 1.24-1.42), long-term treatment therapy (a OR=3.26, 95% CI: 2.52-4.23), living in central provinces (a OR=2.76, 95% CI: 2.55-2.99), living in western provinces (a OR=2.31, 95% CI: 2.08-2.57) were the influencing factors for adverse treatment outcome of RR-TB. Conclusions:The incidence of adverse outcomes in RR-TB patients in 9 provinces in China was higher from 2017 to 2021. There were many influencing factors associated with adverse treatment outcome in RR-TB patients, especially the area specific factors. The national tuberculosis control program should strengthen the follow-up and treatment management of RR-TB in men, the elderly, floating population, people in central and western provinces and other key groups, actively promote the short-term treatment program and improve the allocation of medical resources to reduce the influencing for adverse treatment outcomes in RR-TB patient.

OBJECTIVE To observe the effect of electroacupuncture on insomnia symptoms and blood pressure levels in patients with hypertension and insomnia.METHODS A randomized controlled clinical trial was conducted.A total of 60 patients with hyper-tension and insomnia were enrolled in Jiangsu Province Hospital of Chinese Medicine from December 2021 to December 2022 and ran-domly divided into a treatment group and a control group at a ratio of 1:1,with 30 cases in each group.During the treatment period,2 cases dropped out of the control group and 1 case dropped out of the treatment group.Both groups of patients received sleep and hy-pertension health education and conventional hypertension drug treatment.The treatment group was given electroacupuncture interven-tion,and the control group was given sham electroacupuncture intervention.The treatment course of both groups was 4 weeks.Before and after treatment,the Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI)scale and portable polysomnography(PPSG)were used to evaluate the changes in sleep quality of the two groups of patients;home blood pressure measurement(HBPM)was adopted to evaluate the changes in blood pressure levels of the two groups of patients.Spearman correlation analysis and linear re-gression analysis were used to study the relationship between blood pressure levels and PPSG parameters.RESULTS After treatment,only the sleep onset latency(SOL)and sleep efficiency(SE)of the control group were significantly improved(P<0.05);the PSQI,ISI scores,morning and night systolic blood pressure(SBP),and diastolic blood pressure(DBP)of the treatment group were signifi-cantly reduced(P<0.01),which was better than that of the control group(P<0.05,P<0.01);the sleep parameters of PPSG were significantly improved(P<0.01),which was better than that of the control group(P<0.05,P<0.01).The results of Spearman corre-lation analysis showed that the morning SBP level of patients before treatment was related to the wake time after sleep onset(WASO)and the number of micro-arousals(MAS).After treatment,the decrease in the morning SBP of patients was related to the reduction of MAS and the shortening of SOL.CONCLUSION Electroacupuncture can effectively improve the insomnia symptoms and blood pres-sure levels of patients with hypertension.Its therapeutic mechanism may be related to reducing the number of MAS and improving the degree of sleep fragmentation.

OBJECTIVE: To construct and validate a predictive model for the therapeutic effect of acupuncture at Tongdu Yangxin prescription (acupoint prescription for promoting the circulation of the governor vessel and nourishing the heart) on insomnia, so as to develop an open-access interactive artificial intelligence (AI)-assisted decision-making platform. METHODS: Clinical data of 139 insomnia patients treated with Tongdu Yangxin acupuncture therapy were included. All the patients had received acupuncture at Baihui (GV20), Yintang (GV24⁺), bilateral Shenmen (HT7), and bilateral Sanyinjiao (SP6); and electric stimulation was attached to Baihui (GV20) and Yintang (GV24⁺), using a continuous wave and a frequency of 2 Hz. The treatment was delivered once every other day, 3 treatments a week, and for 2 consecutive weeks. Patients with Pittsburgh sleep quality index (PSQI) score reduction rate <50% were classified as the "no response group", and those with ≥50% were as the "response group". Outliers were addressed using the 1.5×IQR rule, and missing values were imputed via predictive mean matching. Key features were selected by intersecting the feature importance results from eXtreme Gradient Boosting (XGBoost) and random forest algorithms. After balancing class distribution using the Synthetic Minority Over-sampling Technique (SMOTE), 20% of the data was reserved as a validation set. The remained data underwent the stratified sampling iterations to generate 200 pairs of 3∶1 training-test sets, which was employed for training and internal validation of 8 machine learning algorithms. The optimal algorithm and data partitioning strategy were selected to construct the final model, followed by external validation. The best-performing model was deployed online via Streamlit to create an interactive AI platform. RESULTS: Key predictive features for model construction included insomnia duration, the total PSQI score, PSQI sleep efficiency subscore, the proportion of N1 and N2 sleep stages in total sleep duration, and the maximum pulse rate during sleep. The CatBoost-based model achieved an AUC of 0.92, the average precision of 0.77, and accuracy, average recall, and average F1-score of 0.75 on the test set. On the validation set, it attained an AUC of 0.84, with accuracy, average precision, average recall, and average F1-score all at 0.72, demonstrating robust predictive performance. An interactive AI platform was subsequently developed (https://tdyx-catboost.streamlit.app/). CONCLUSION This study successfully establishes and validates a CatBoost-based efficacy prediction model for Tongdu Yangxin acupuncture therapy in treatment of insomnia. The developed AI platform provides data-driven decision support for acupuncture-based insomnia management.
Humans ; Sleep Initiation and Maintenance Disorders/physiopathology* ; Acupuncture Therapy ; Male ; Acupuncture Points ; Female ; Middle Aged ; Adult ; Artificial Intelligence ; Aged ; Young Adult

The paper discusses the scientific connotation of"heart and brain co-dominating the mind",including the connotation of"heart and brain co-dominating the mind"in traditional Chinese medicine and the physiological and pathological relationship be-tween heart and brain in modern medicine.Based on the understanding of"heart and brain co-dominating the mind",this paper be-lieves that"restlessness of mind"is the core pathogenesis of insomnia,and regulating mind is the key to the acupuncture and moxibus-tion treatment of insomnia.The autonomic nervous system(ANS)is a bridge connecting the heart and brain,and is closely related to the central anatomy,neurotransmitters and physiological rhythms of sleep.The imbalance of ANS is highly consistent with the patho-genesis of"heart and brain restlessness"in traditional Chinese medicine.The Governor Vessel runs through the brain and the heart,and the"Governor Vessel regulating spirit acupuncture"can communicate the heart and brain,regulate ANS function,and thus im-prove sleep quality.

OBJECTIVE To observe the effect of electroacupuncture on insomnia symptoms and blood pressure levels in patients with hypertension and insomnia.METHODS A randomized controlled clinical trial was conducted.A total of 60 patients with hyper-tension and insomnia were enrolled in Jiangsu Province Hospital of Chinese Medicine from December 2021 to December 2022 and ran-domly divided into a treatment group and a control group at a ratio of 1:1,with 30 cases in each group.During the treatment period,2 cases dropped out of the control group and 1 case dropped out of the treatment group.Both groups of patients received sleep and hy-pertension health education and conventional hypertension drug treatment.The treatment group was given electroacupuncture interven-tion,and the control group was given sham electroacupuncture intervention.The treatment course of both groups was 4 weeks.Before and after treatment,the Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI)scale and portable polysomnography(PPSG)were used to evaluate the changes in sleep quality of the two groups of patients;home blood pressure measurement(HBPM)was adopted to evaluate the changes in blood pressure levels of the two groups of patients.Spearman correlation analysis and linear re-gression analysis were used to study the relationship between blood pressure levels and PPSG parameters.RESULTS After treatment,only the sleep onset latency(SOL)and sleep efficiency(SE)of the control group were significantly improved(P<0.05);the PSQI,ISI scores,morning and night systolic blood pressure(SBP),and diastolic blood pressure(DBP)of the treatment group were signifi-cantly reduced(P<0.01),which was better than that of the control group(P<0.05,P<0.01);the sleep parameters of PPSG were significantly improved(P<0.01),which was better than that of the control group(P<0.05,P<0.01).The results of Spearman corre-lation analysis showed that the morning SBP level of patients before treatment was related to the wake time after sleep onset(WASO)and the number of micro-arousals(MAS).After treatment,the decrease in the morning SBP of patients was related to the reduction of MAS and the shortening of SOL.CONCLUSION Electroacupuncture can effectively improve the insomnia symptoms and blood pres-sure levels of patients with hypertension.Its therapeutic mechanism may be related to reducing the number of MAS and improving the degree of sleep fragmentation.

Objective:To analyze the incidence of adverse treatment outcome of rifampicin-resistant tuberculosis (RR-TB) patients and influencing factors in 9 provinces in China.Methods:The information about the basic characteristics, diagnosis and treatment of RR-TB patients registered from January 1, 2017 to December 31, 2021 in 9 provinces (Beijing, Jilin, Shanghai, Jiangsu, Zhejiang, Hubei, Henan, Yunnan and Guizhou) were collected from the tuberculosis information management sub-system of China Disease Control and Prevention Information System for a descriptive analysis, and the influencing factors of adverse treatment outcome were identified by binary logistic regression analysis.Results:In 18 204 RR-TB patients in this study a total of 6 852 had adverse treatment outcomes (37.64%). Treatment failure occurred in 1 031 patients, 1 272 patients died, 2 284 patients were lost to follow-up, and 2 265 patients were not evaluated. The results of multivariate logistic regression analysis showed that being man (a OR=1.54, 95% CI: 1.43-1.66), age ≥65 years (a OR=2.42, 95% CI: 2.20-2.67), being from other ethnic groups (a OR=1.18, 95% CI: 1.03-1.35), being farmer (a OR=1.22, 95% CI: 1.13-1.32), being retired with honours or being retired (a OR=1.16, 95% CI: 1.00-1.35) and being floating population (a OR=1.23, 95% CI: 1.13-1.34), re-treatment (a OR=1.33, 95% CI: 1.24-1.42), long-term treatment therapy (a OR=3.26, 95% CI: 2.52-4.23), living in central provinces (a OR=2.76, 95% CI: 2.55-2.99), living in western provinces (a OR=2.31, 95% CI: 2.08-2.57) were the influencing factors for adverse treatment outcome of RR-TB. Conclusions:The incidence of adverse outcomes in RR-TB patients in 9 provinces in China was higher from 2017 to 2021. There were many influencing factors associated with adverse treatment outcome in RR-TB patients, especially the area specific factors. The national tuberculosis control program should strengthen the follow-up and treatment management of RR-TB in men, the elderly, floating population, people in central and western provinces and other key groups, actively promote the short-term treatment program and improve the allocation of medical resources to reduce the influencing for adverse treatment outcomes in RR-TB patient.

The paper discusses the scientific connotation of"heart and brain co-dominating the mind",including the connotation of"heart and brain co-dominating the mind"in traditional Chinese medicine and the physiological and pathological relationship be-tween heart and brain in modern medicine.Based on the understanding of"heart and brain co-dominating the mind",this paper be-lieves that"restlessness of mind"is the core pathogenesis of insomnia,and regulating mind is the key to the acupuncture and moxibus-tion treatment of insomnia.The autonomic nervous system(ANS)is a bridge connecting the heart and brain,and is closely related to the central anatomy,neurotransmitters and physiological rhythms of sleep.The imbalance of ANS is highly consistent with the patho-genesis of"heart and brain restlessness"in traditional Chinese medicine.The Governor Vessel runs through the brain and the heart,and the"Governor Vessel regulating spirit acupuncture"can communicate the heart and brain,regulate ANS function,and thus im-prove sleep quality.

Objective:To analyze the clinicopathological features of giant ovarian masses(mean diameter≥10 cm)and analyze the clinical characteristics of patients in different age groups.Methods:The clinicopathological characteristics of 311 patients diagnosed with giant ovarian masses by surgery at Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 2014 to December 2022 were retrospectively analyzed.Patients were further stratified by age and mass size to compare the differences of clinical and patho-logical features among different age groups and different mass diameter groups.Results:①The median age of thepatients were 44(24,60)years old.The first symptoms were as follows:ovarian mass discovered during physi-cal examination,abdominal pain,bloating,conscious abdominal distension,and symptoms of compression.②The surgical methods were as follows:unilateral oophorectomy(30.5％,95/311),ovarian cystectomy(28.9％,90/311),tumor staging or cytoreductive surgery(28.0％,87/311),total hysterectomy with bilateral adnexectomy(12.5％,39/311).③The pathological types were benign(49.5％,154/311),malignant(31.8％,99/311)and borderline(18.7％,58/311).④ Patients complained abdominal distension in＜20 years old group were signifi-cantly higher than the other two groups(P＜0.05).The ovarian resection rate in the＞50-year-old group was higher than that of the other two groups(P＜0.05),and the rate of unilateral ovarian resection in the＜20-year-old group was still as high as 30.1％(15/49).⑤ The size of the mass correlated with the duration of the disease.When the disease course was between 1 to 6 months,the mass diameter line＞30 cm was the most common(P＜0.05).The incidence of borderline tumors in the＞30 cm group was significantly higher than that in the other two groups,and the difference was statistically significant(P＜0.05).Conclusions:Ovarian mucinous and mucinous borderline tumors are the most common types of giant adnexal masses.The size of the mass tends to increase with the prolongation of the disease course.The incidence of borderline tumors increases with the in-crease of mass.Health education for young people should be strengthened.When abdominal pain,abdominal bloating,especially lower abdominal distension occurs,they should seek medical treatment in time to avoid adnex-ectomy due to borderline tumors.

OBJECTIVE: To identify phytochemical constituents present in the extract of flowers of Xanthoceras sorbifolia and evaluate their anti-oxidant and anti-hyperglycemic capacities. METHODS: The AlCl₃ colorimetric method and Prussian Blue assay were used to determine the contents of total flavonoids and total phenolic acids in extraction layers, and the bioactive layers was screened through anti - oxidative activity in vitro. The Waters ACQUITY UPLC system and a Waters ACQUITY UPLC BEH C₁₈ column (2.0 mm × 150 mm, 5 μm) were used to identify the ingredients. And anti-oxidative ingredients were screened by off-line UPLC-QTOF-MS/MS-free radical scavenging. The ameliorative role of it was further evaluated in a high-fat, streptozotocin-induced type 2 diabetic rat model and the study was carried out on NADPH oxidase (PDB ID: 2CDU) by molecular docking. RESULTS: Combined with the results of activity screening in vitro, the anti - oxidative part was identified as the ethyl acetate layer. A total of 24 chemical constituents were identified by liquid chromatography-mass spectrometry in the ethyl acetate layer and 13 main anti-oxidative active constituents were preliminarily screened out through off-line UPLC-QTOF-MS/MS-free radical scavenging. In vivo experiments showed that flowers of X. sorbifolia could significantly reduce the blood glucose level of diabetic mice and alleviate liver cell damage. Based on the results of docking analysis related to the identified phytocompounds and oxidase which involved in type 2 diabetes, quercetin 3-O-rutinoside, kaempferol-3-O-rhamnoside, isorhamnetin-3-O-glucoside, and isoquercitrin showed a better inhibitory profile. CONCLUSION The ethyl acetate layer was rich in flavonoids and phenolic acids and had significant anti-oxidant activity, which could prevent hyperglycemia. This observed activity profile suggested X. sorbifolia flowers as a promising new source of tea to develop alternative natural anti-diabetic products with a high safety margin.