Objective: To investigate the association between uric acid level and elevated blood pressure among children and adolescents in Guangzhou, so as to provide a scientific basis for prevention and control of hypertension in the pediatric population. Methods: From March to December 2019, using stratified cluster random sampling, 3 626 children and adolescents aged 6-17 years without elevated blood pressure at baseline were recruited from 6 primary and secondary schools in Guangzhou. Serum uric acid levels were measured at baseline, and divided into four groups ( Q1-Q 4) based on age and sex specific quartiles for analyses. Two waves of follow up were carried out from October 2020 to May 2021 and from October 2021 to May 2022, respectively. Multilevel robust Poisson regression was used to evaluate the association between uric acid level and elevated blood pressure among children and adolescents. The additive interaction between high uric acid level and sugar sweetened beverage (SSB) intake on elevated blood pressure was assessed by stratification analysis and calculation of the relative excess risk due to interaction (RERI). Results: A total of 1 131 new cases of elevated blood pressure were identified during the two follow ups, with an incidence density of 130.5 cases 1 000 person years. Multilevel robust Poisson regression analysis showed that after adjusting for confounders such as gender, age and annual family income, compared with those in the uric acid Q 1 level, the risk of elevated blood pressure in individuals in the Q 4 level increased by 25% ( RR=1.25, 95%CI =1.08-1.44), and the risk of elevated systolic blood pressure increased by 20% ( RR=1.20, 95%CI =1.05-1.36) (both P <0.05); no statistical association was observed between uric acid and elevated diastolic blood pressure (all P >0.05). In the stratified analysis, the statistical associations of uric acid Q 4 level with elevated blood pressure ( RR=1.34, 95%CI =1.13-1.58) and elevated systolic blood pressure ( RR=1.33, 95%CI =1.14-1.55) were only observed in the group with SSB intake ≥ 250 mL/week (both P <0.05). The RERI values for the effect of uric acid Q 4 and Q 3 levels with SSB intake ≥ 250 mL/week on elevated systolic and diastolic blood pressure were 0.29 and 0.44 (both P <0.05). Conclusions High uric acid level is a risk factor for elevated blood pressure among children and adolescents, with a predominant effect on systolic blood pressure. High uric acid level and SSB intake synergistically promote the increase of blood pressure of children and adolescents.

Objective This study investigated feasible cases and their significance in promoting the"generalized"development of inspection through digital-intelligent equipment.Methods A qualitative research approach was used,involving interviews conducted between February 2025 and March 2025 with experts in traditional Chinese medicine diagnostics,clinical research methodology,medical engineering integration,and related disciplines,using both online and offline methods.In accordance with the Consolidated Criteria for Reporting Qualitative Research,feasible cases involving the specific application of digital equipment in various parts of observation were collected through item enrichment.The significance of extending observation capabilities via these cases was analyzed,along with the overall implications of integrating digital technologies with traditional inspection method.Results Interviews were completed with 11 experts from domestic universities and research institutes in the fields of traditional Chinese medicine diagnosis,medical engineering integration,and related disciplines.A total of 78 feasible cases of digital-intelligent inspection were identified,along with 69 insights regarding the significance of enhancing the inspection capabilities.These insights were synthesized into two dimensions and 23 holistic meanings.The first dimension is to expand the scope of inspection,including obtaining internal environmental characteristics,observing external environmental characteristics,expanding thermodynamic characteristic data,and crossing time and space.The second dimension is to improve the quality of observation and diagnosis information collection and analysis,including 19 specific meanings,such as standardized collection environment,objective quantification,and refined observation.Conclusion Digital-intelligent equipment plays a significant role in expanding the scope of inspection content and achieving high-quality acquisition and analysis of extensive inspection information.These advancements extend and enrich the capabilities of traditional inspection method in traditional Chinese medicine.

Objective To develop an automated system that can accurately determine the relationship between the mandibular third molar and the mandibular nerve canal from panoramic images.Methods A dataset consisting of 600 panoramic images of the oral cavi-ty was selected,and the positions of the mandibular third molar and the mandibular nerve canal were accurately labeled.We compared the research designed TI-YOLOv5 with PANet,Faster R-CNN,Mask R-CNN,ResNeSt-101,and the original YOLOv5 in image seg-mentation tasks,with evaluation metrics of AP and AP50.Results TI-YOLOv5 achieved AP(average precision)54.0％and AP5094.9％,an increase of 4.9 and 6.7 percentage points respectively compared to the original YOLOv5(AP 49.1％,AP50 88.2％),and surpassed other SOTA methods such as Mask R-CNN(AP 45.1％,AP50 84.2％).Conclusion TI-YOLOv5 is significantly superior to mainstream networks in automatic positioning and relationship classification of mandibular wisdom teeth and neural tubes,with high de-tection accuracy and discrimination accuracy,and can provide reliable technical support for preoperative risk assessment of mandibular wisdom tooth extraction.

Objective To develop an automated system that can accurately determine the relationship between the mandibular third molar and the mandibular nerve canal from panoramic images.Methods A dataset consisting of 600 panoramic images of the oral cavi-ty was selected,and the positions of the mandibular third molar and the mandibular nerve canal were accurately labeled.We compared the research designed TI-YOLOv5 with PANet,Faster R-CNN,Mask R-CNN,ResNeSt-101,and the original YOLOv5 in image seg-mentation tasks,with evaluation metrics of AP and AP50.Results TI-YOLOv5 achieved AP(average precision)54.0％and AP5094.9％,an increase of 4.9 and 6.7 percentage points respectively compared to the original YOLOv5(AP 49.1％,AP50 88.2％),and surpassed other SOTA methods such as Mask R-CNN(AP 45.1％,AP50 84.2％).Conclusion TI-YOLOv5 is significantly superior to mainstream networks in automatic positioning and relationship classification of mandibular wisdom teeth and neural tubes,with high de-tection accuracy and discrimination accuracy,and can provide reliable technical support for preoperative risk assessment of mandibular wisdom tooth extraction.

The surgical management of gastroesophageal reflux disease (GERD) has completed a paradigm shift from symptomatic palliation to curative intervention. For high-risk patients with pathological acid exposure (AET>6%), progressive anatomical destruction (e.g., ≥2 cm hiatal hernia or Hill grade III/IV lesions), or those requiring interruption of carcinogenic progression (such as Barrett's esophagus with dysplasia), anti-reflux surgery provides superior long-term efficacy compared to pharmacotherapy. Surgical indications require a three-dimensional assessment integrating anatomical, functional, and risk factors: patients with dominant anatomical defects are recommended to undergo combined hernia repair and fundoplication (biological mesh reinforcement for recurrent hernias reduces recurrence rates to 16.7%); functionally decompensated groups require decision-making based on objective reflux metrics (e. g.,>75 reflux events/24 hours); special populations such as post-bariatric GERD should preferentially undergo Roux-en-Y gastric bypass (reflux control rate: 93%), while those with motility disorders (e. g., scleroderma) are suitable for partial fundoplication to mitigate dysphagia risk (OR=0.285). Precision decision-making is achieved through a stepwise evaluation pathway (endoscopy→pH-impedance monitoring→high-resolution manometry). Intraoperative strategies are individualized based on motility status: patients with normal esophageal motility undergo the Nissen procedure, the elderly or those with ineffective esophageal motility are prioritized for Toupet fundoplication for optimized long-term safety, and magnetic sphincter augmentationenables 96% of PPI-responsive but medication-averse patients to discontinue drug dependency. The core value of surgical intervention lies in simultaneously achieving anatomical restoration and functional reconstruction, along with blocking Barrett's esophageal carcinogenesis (OR=0.41). This dual mechanism signifies a fundamental transformation in GERD management strategy.

Objective:To evaluate the clinical diagnosis and laparoscopic surgical management of diaphragmatic rupture.Methods:Clinical data of 19 patients diagnosed with diaphragmatic hernia secondary to diaphragmatic rupture, admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2022 to Sep 2024 was retrospectively analyzed.Results:There were 7 males and 12 females. Traumatic etiology was confirmed in 9 cases, all developed after closed injuries, including one vehicular accident, seven blunt traumas, and one fall from height. Iatrogenic factors accounted for the remaining 10 cases. Left-sided diaphragmatic hernias were observed in 13 patients, while right-sided hernias occurred in 6 patients. Hiatal hernias were complicated in 5 patients. All patients underwent elective laparoscopic tension-free repair using composite patch for defect closure. Postoperatively, one patient was readmitted into ICU due to reexpansion pulmonary edema but was subsequently discharged following recovery. The median postoperative hospital stay was 10 days.Conclusions:The incidence of diaphragmatic rupture is relatively uncommon, primarily occurring as a result of traumatic or iatrogenic injuries. Early diagnosis coupled with prompt laparoscopic surgical intervention has proven to be effective in managing this condition.

Objective This study investigated feasible cases and their significance in promoting the"generalized"development of inspection through digital-intelligent equipment.Methods A qualitative research approach was used,involving interviews conducted between February 2025 and March 2025 with experts in traditional Chinese medicine diagnostics,clinical research methodology,medical engineering integration,and related disciplines,using both online and offline methods.In accordance with the Consolidated Criteria for Reporting Qualitative Research,feasible cases involving the specific application of digital equipment in various parts of observation were collected through item enrichment.The significance of extending observation capabilities via these cases was analyzed,along with the overall implications of integrating digital technologies with traditional inspection method.Results Interviews were completed with 11 experts from domestic universities and research institutes in the fields of traditional Chinese medicine diagnosis,medical engineering integration,and related disciplines.A total of 78 feasible cases of digital-intelligent inspection were identified,along with 69 insights regarding the significance of enhancing the inspection capabilities.These insights were synthesized into two dimensions and 23 holistic meanings.The first dimension is to expand the scope of inspection,including obtaining internal environmental characteristics,observing external environmental characteristics,expanding thermodynamic characteristic data,and crossing time and space.The second dimension is to improve the quality of observation and diagnosis information collection and analysis,including 19 specific meanings,such as standardized collection environment,objective quantification,and refined observation.Conclusion Digital-intelligent equipment plays a significant role in expanding the scope of inspection content and achieving high-quality acquisition and analysis of extensive inspection information.These advancements extend and enrich the capabilities of traditional inspection method in traditional Chinese medicine.

The surgical management of gastroesophageal reflux disease (GERD) has completed a paradigm shift from symptomatic palliation to curative intervention. For high-risk patients with pathological acid exposure (AET>6%), progressive anatomical destruction (e.g., ≥2 cm hiatal hernia or Hill grade III/IV lesions), or those requiring interruption of carcinogenic progression (such as Barrett's esophagus with dysplasia), anti-reflux surgery provides superior long-term efficacy compared to pharmacotherapy. Surgical indications require a three-dimensional assessment integrating anatomical, functional, and risk factors: patients with dominant anatomical defects are recommended to undergo combined hernia repair and fundoplication (biological mesh reinforcement for recurrent hernias reduces recurrence rates to 16.7%); functionally decompensated groups require decision-making based on objective reflux metrics (e. g.,>75 reflux events/24 hours); special populations such as post-bariatric GERD should preferentially undergo Roux-en-Y gastric bypass (reflux control rate: 93%), while those with motility disorders (e. g., scleroderma) are suitable for partial fundoplication to mitigate dysphagia risk (OR=0.285). Precision decision-making is achieved through a stepwise evaluation pathway (endoscopy→pH-impedance monitoring→high-resolution manometry). Intraoperative strategies are individualized based on motility status: patients with normal esophageal motility undergo the Nissen procedure, the elderly or those with ineffective esophageal motility are prioritized for Toupet fundoplication for optimized long-term safety, and magnetic sphincter augmentationenables 96% of PPI-responsive but medication-averse patients to discontinue drug dependency. The core value of surgical intervention lies in simultaneously achieving anatomical restoration and functional reconstruction, along with blocking Barrett's esophageal carcinogenesis (OR=0.41). This dual mechanism signifies a fundamental transformation in GERD management strategy.

Objective:To evaluate the clinical diagnosis and laparoscopic surgical management of diaphragmatic rupture.Methods:Clinical data of 19 patients diagnosed with diaphragmatic hernia secondary to diaphragmatic rupture, admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2022 to Sep 2024 was retrospectively analyzed.Results:There were 7 males and 12 females. Traumatic etiology was confirmed in 9 cases, all developed after closed injuries, including one vehicular accident, seven blunt traumas, and one fall from height. Iatrogenic factors accounted for the remaining 10 cases. Left-sided diaphragmatic hernias were observed in 13 patients, while right-sided hernias occurred in 6 patients. Hiatal hernias were complicated in 5 patients. All patients underwent elective laparoscopic tension-free repair using composite patch for defect closure. Postoperatively, one patient was readmitted into ICU due to reexpansion pulmonary edema but was subsequently discharged following recovery. The median postoperative hospital stay was 10 days.Conclusions:The incidence of diaphragmatic rupture is relatively uncommon, primarily occurring as a result of traumatic or iatrogenic injuries. Early diagnosis coupled with prompt laparoscopic surgical intervention has proven to be effective in managing this condition.

Background and Aims:The repair of giant incisional hernia is challenging,as closing the significant defect in the abdominal wall can lead to life-threatening complications like abdominal compartment syndrome(ACS).Botulinum toxin type A(BTA)can temporarily relax the abdominal wall muscles,facilitating defect repair,while preoperative progressive pneumoperitoneum(PPP)can increase intra-abdominal volume,reducing intra-abdominal pressure caused by hernia content reintegration.Combining BTA with PPP for the preoperative preparation of giant incisional hernia repair may have a complementary effect.This study was conducted to evaluate the clinical value of combining BTA and PPP in the repair of giant abdominal incisional hernia. Methods:The clinical data of 213 patients with giant abdominal incisional hernia treated at the Sixth Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2019 were retrospectively analyzed.Two weeks after receiving combined BTA and PPP treatment,changes in bilateral abdominal wall muscle,intra-abdominal adhesions,abdominal circumference,abdominal cavity volume,and hernia sac volume ratio were assessed using CT.Intraoperative details,incidence of complications,and postoperative follow-up outcomes were recorded. Results:Following combined BTA and PPP treatment,CT scan showed a significant extension of bilateral lateral abdominal wall muscles towards the midline in all 213 patients,with an average increase of 2.45(1.53-3.29)cm on the left side and 2.54(1.68-3.40)cm on the right side;muscle thickness was reduced by an average of 0.84(0.64-1.00)cm on the left and 0.82(0.62-1.05)cm on the right,the average distance between viscera and the abdominal wall increased to(7.52±1.78)cm,with a mean increase of 6.1(4.2-6.9)cm;the mean increase in abdominal cavity volume was 1 802(1 494.98-2 316.26)mL,and the hernia sac volume ratio decreased by an average of 9％(6％-12％),all changes were statistically significant(P＜0.05).Post-PPP CT scan revealed no abdominal adhesions in 18 patients(8.45％),while 195 patients(91.55％)had varying degrees of adhesions,including 39 cases(18.31％)of sheet adhesions and 156 cases(73.24％)of mixed adhesions.Adhesions mainly consisted of omentum and intestinal tissues in 59.15％of cases.There were 43 cases(20.19％)of grade Ⅰ complications during the BTA-PPP process,including abdominal pain(28 cases),shoulder pain(9 cases),subcutaneous emphysema(6 cases),and dyspnea(3 cases).Dyspnea improved with oxygen therapy,while other complications required no special intervention.All 213 patients successfully underwent laparoscopic incisional hernia repair without conversion to open surgery or organ resection for volume reduction.Fascial closure was achieved in 209 cases(98.12％),with 4 cases(1.88％)having incomplete defect closure.The average time for adhesiolysis was 28(11.00-44.50)min,with a total operative time of 178.0(132.50-255.00)min and an average blood loss of 20(10-30)mL.The median intra-abdominal pressure(IAP)after operation was between 10 mmHg(9.00-12.00 mmHg),Among them,47 cases(22.07％)had IAP exceeding 12 mmHg,and after implementing proactive measures such as diuresis and diachoresis to reduce intra-abdominal contents,the IAP in these patients decreased to below 12 mmHg.No severe complications such as skin flap necrosis or ACS were observed.There were no deaths within postoperative 30 d,and during a follow-up period of 26(16.50-33.00)months,13 cases(6.10％)had surgical site events,including infections in 5 cases(2.35％),seromas in 7 cases(3.29％),and hematoma in 1 case(0.47％),with no hernia recurrence. Conclusion:The combination of BTA and PPP not only aids in identifying abdominal wall adhesion areas,improving preoperative surgical planning and enhancing surgical safety,but also significantly increases abdominal cavity volume and extends lateral abdominal wall muscles,facilitating the closure of giant incisional hernia defects and reducing the incidence of severe postoperative complications like ACS.This approach is worthy of clinical promotion.