ObjectiveTo investigate the modulating effect of modified Wumeiwan （MWMW） on the ulcerative colitis （UC）-associated intestinal helper T cell 17 （Th17）/regulatory T cell （Treg） balance and intestinal flora by using a human flora-associated model of UC patients with dampness-heat obstruction syndrome， thus providing a new idea for the UC-related research and therapeutic strategies. MethodsThe 24 male C57BL/6J mice were randomized into normal control， model， and MWMW groups （n=8）. Model and MWMW groups were first treated with an antibiotic cocktail （vancomycin， 0.1 g·kg^-1； neomycin sulfate， 0.2 g·kg^-1； ampicillin， 0.2 g·kg^-1； metronidazole， 0.2 g·kg^-1） for 21 days. At the end of antibiotic treatment， the gavage of fecal microbiota suspension from UC patients with dampness-heat obstruction syndrome was started at a dose of 0.2 mL·d^-1 for 19 consecutive days， by which a human flora-associated model of UC was obtained. The MWMW group was administrated daily with MWMW liquid （12.5 g·kg^-1）， while the normal control and model groups were administrated by gavage with an equal amount of sterile water for 7 consecutive days. The symptoms of dampness-heat obstruction were observed. The colon length and spleen index were measured and calculated， and the proportions of Th17 and Treg cells were detected by flow assay. The intestinal flora was analyzed by 16S rRNA high-throughput sequencing. ResultsCompared with the normal control group， the model group showed shortened colon （P<0.05） and increased spleen index （P<0.01）. Compared with the model group， the MWMW group showed prolonged colon （P<0.01） and decreased spleen index （P<0.05）. After the intervention of MWMW， the Th17 proportion and Th17/Treg ratio in the colon decreased （P<0.01）， and the proportion of Treg cells increased （P<0.05）. The number of species and alpha and beta diversity of intestinal flora in mice were regulated by MWMW （P<0.05）. In terms of intestinal flora composition， MWMW increased the relative abundance of several phyla （Firmicutes， Proteobacteria， Fusobacteriota， Actinobacteriota， and Gemmatimonadota）， the genus Bacteroides， and two species （Bacteroides thetaiotaomicron and B. fragilis） in model mice. Moreover， Spearman's correlation analysis showed that the relative abundance of B. thetaiotaomicron and B. fragilis were negatively correlated with the Th17 level （P<0.05）. In addition， the above changes in intestinal flora caused the changes in microbial genes involved in 14 pathways， such as glycolysis， amino acid degradation， inorganic nutrient metabolism， biosynthesis of pyrimidine deoxyribonucleotides， antibiotic resistance， and degradation of polysaccharides. ConclusionsThe human flora-associated model successfully simulated the changes （marked by a decrease in the abundance of Bacteroides） of intestinal flora in UC patients with dampness-heat obstruction syndrome. MWMW can enrich the abundance of beneficial bacteria such as B. thetaiotaomicron and B. fragilis and promote the synergistic intestinal immune modulation with the metabolic functions centered on glycolysis， amino acid metabolism， and nucleotide synthesis through bacterial polysaccharide utilization sites to reduce the Th17/Treg ratio， thereby exerting a protective effect on UC.

Obejective To explore whether it is possible to detect the 123I-prostate-specific membrane antigen(PSMA)radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of 123I-PSMA,a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue(1 906.50 cpm)was significantly higher than that of benign prostate tissue(415.00 cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50 cpm.The median radiation value of clinically significant prostate cancer tissue(2 652.50 cpm)was significantly higher than that of clinically insignificant prostate cancer(1 386.00 cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1 767.00 cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade(r=0.834).Conclusion It is preliminarily confirmed that detection of 123I-PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Objective:To compare the clinical efficacy of endoscopic posterior transforaminal lumbar interbody fusion (Endo-PTLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment lumbar degenerative diseases.Methods:A retrospective analysis was conducted on the clinical data of 56 patients with single-segment lumbar degenerative diseases treated at Xiuzhou District People's Hospital between September 2020 and March 2023. Patients were divided into two groups based on the surgical approach: the Endo-PTLIF group (24 cases, 11 males and 13 females; mean age: 56.5±8.4 years, range: 43-72 years) and the MIS-TLIF group (32 cases, 10 males and 22 females; mean age: 54.5±10.4 years, range: 37-73 years). Perioperative parameters, visual analog scale (VAS) scores for pain, Oswestry disability index (ODI), lumbar lordosis (LL), disc height (DH), and dural sac cross-sectional area (DSCA) were compared between the two groups.Results:No significant differences were observed between the two groups in baseline characteristics, preoperative VAS, ODI, LL, DH, or DSCA ( P>0.05). However, the operative time in the Endo-PTLIF group (173.9±12.3 minutes) was significantly longer than in the MIS-TLIF group (136.5±19.5 minutes, P<0.05). Similarly, the Endo-PTLIF group required more fluoroscopy exposures (15.9±1.8) than the MIS-TLIF group (13.0±1.6, P<0.05). In contrast, intraoperative blood loss in the Endo-PTLIF group (68.9± 12.9 ml) was significantly lower than in the MIS-TLIF group (126.7±35.4 ml, P<0.05). Additionally, the Endo-PTLIF group had a shorter hospital stay [7.00 (6.25, 7.75) days] compared to the MIS-TLIF group [10.00 (9.25, 11.00) days, P<0.05]. At one week and one month postoperatively, the Endo-PTLIF group had significantly lower back pain VAS scores [2.00 (2.00, 3.00) and 2.00 (2.00, 2.00), respectively] and a lower ODI (25.83%±3.83%) compared to the MIS-TLIF group [3.00 (2.25, 4.00), 2.50 (2.00, 3.00), and 30.09%±4.02%, respectively; P<0.05]. Beyond one month postoperatively, there were no significant differences in leg pain VAS scores between the groups, and back pain VAS and ODI showed no significant differences after six months ( P>0.05). At the final follow-up, the excellent and good rates, according to MacNab criteria, were 95.8% in the Endo-PTLIF group and 93.8% in the MIS-TLIF group, with no significant difference ( P>0.05). At 12 months postoperatively, both groups showed significant improvements in LL, DH, and DSCA compared to preoperative values ( P<0.05), but there were no significant differences between the two groups ( P>0.05). The fusion rates were 96% in the Endo-PTLIF group and 94% in the MIS-TLIF group, with no significant difference ( P>0.05). Complications included one case of dural tear in the Endo-PTLIF group, and one case of dural tear and one case of incision infection in the MIS-TLIF group. Conclusion:Endo-PTLIF achieves comparable clinical efficacy to MIS-TLIF in the treatment of single-segment lumbar degenerative diseases, with the added advantages of reduced intraoperative blood loss and faster postoperative recovery.

Objective Under the background of DIP payment reform,the data quality of medical record home pages has become a core factor affecting the efficiency of hospital medical insurance settlement and economic benefits.Methods This study aimed to address the issues in the completion of medical record home pages by residents in tertiary hospitals and constructed an improvement system based on the Six Sigma method and RBRVS.Results In 2023,the defect rate of medical record home pages was 5.97％,with major defects concentrated in the names of surgical procedures(19.9％)and the filling of primary diag-noses(18.15％).By establishing a closed-loop management scheme under the"structure-process-outcome"theoretical frame-work-including standardized entry processes,a"three-medical linkage"supervision mechanism,and an RBRVS-based perform-ance appraisal system-the error rate of medical record home pages dropped to 2.04％in 2024 after applying Six Sigma improve-ments.Conclusion The RBRVS performance indicators,through differentiated weight design,can motivate physicians'initia-tive and improve the data quality of medical record home pages,thereby achieving accurate medical insurance settlement.It is recommended to explore intelligent verification paths combined with AI technology in the future to achieve synergistic optimization of medical record quality and hospital operations.

Objective:To compare the clinical efficacy of endoscopic posterior transforaminal lumbar interbody fusion (Endo-PTLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment lumbar degenerative diseases.Methods:A retrospective analysis was conducted on the clinical data of 56 patients with single-segment lumbar degenerative diseases treated at Xiuzhou District People's Hospital between September 2020 and March 2023. Patients were divided into two groups based on the surgical approach: the Endo-PTLIF group (24 cases, 11 males and 13 females; mean age: 56.5±8.4 years, range: 43-72 years) and the MIS-TLIF group (32 cases, 10 males and 22 females; mean age: 54.5±10.4 years, range: 37-73 years). Perioperative parameters, visual analog scale (VAS) scores for pain, Oswestry disability index (ODI), lumbar lordosis (LL), disc height (DH), and dural sac cross-sectional area (DSCA) were compared between the two groups.Results:No significant differences were observed between the two groups in baseline characteristics, preoperative VAS, ODI, LL, DH, or DSCA ( P>0.05). However, the operative time in the Endo-PTLIF group (173.9±12.3 minutes) was significantly longer than in the MIS-TLIF group (136.5±19.5 minutes, P<0.05). Similarly, the Endo-PTLIF group required more fluoroscopy exposures (15.9±1.8) than the MIS-TLIF group (13.0±1.6, P<0.05). In contrast, intraoperative blood loss in the Endo-PTLIF group (68.9± 12.9 ml) was significantly lower than in the MIS-TLIF group (126.7±35.4 ml, P<0.05). Additionally, the Endo-PTLIF group had a shorter hospital stay [7.00 (6.25, 7.75) days] compared to the MIS-TLIF group [10.00 (9.25, 11.00) days, P<0.05]. At one week and one month postoperatively, the Endo-PTLIF group had significantly lower back pain VAS scores [2.00 (2.00, 3.00) and 2.00 (2.00, 2.00), respectively] and a lower ODI (25.83%±3.83%) compared to the MIS-TLIF group [3.00 (2.25, 4.00), 2.50 (2.00, 3.00), and 30.09%±4.02%, respectively; P<0.05]. Beyond one month postoperatively, there were no significant differences in leg pain VAS scores between the groups, and back pain VAS and ODI showed no significant differences after six months ( P>0.05). At the final follow-up, the excellent and good rates, according to MacNab criteria, were 95.8% in the Endo-PTLIF group and 93.8% in the MIS-TLIF group, with no significant difference ( P>0.05). At 12 months postoperatively, both groups showed significant improvements in LL, DH, and DSCA compared to preoperative values ( P<0.05), but there were no significant differences between the two groups ( P>0.05). The fusion rates were 96% in the Endo-PTLIF group and 94% in the MIS-TLIF group, with no significant difference ( P>0.05). Complications included one case of dural tear in the Endo-PTLIF group, and one case of dural tear and one case of incision infection in the MIS-TLIF group. Conclusion:Endo-PTLIF achieves comparable clinical efficacy to MIS-TLIF in the treatment of single-segment lumbar degenerative diseases, with the added advantages of reduced intraoperative blood loss and faster postoperative recovery.

Objective Under the background of DIP payment reform,the data quality of medical record home pages has become a core factor affecting the efficiency of hospital medical insurance settlement and economic benefits.Methods This study aimed to address the issues in the completion of medical record home pages by residents in tertiary hospitals and constructed an improvement system based on the Six Sigma method and RBRVS.Results In 2023,the defect rate of medical record home pages was 5.97％,with major defects concentrated in the names of surgical procedures(19.9％)and the filling of primary diag-noses(18.15％).By establishing a closed-loop management scheme under the"structure-process-outcome"theoretical frame-work-including standardized entry processes,a"three-medical linkage"supervision mechanism,and an RBRVS-based perform-ance appraisal system-the error rate of medical record home pages dropped to 2.04％in 2024 after applying Six Sigma improve-ments.Conclusion The RBRVS performance indicators,through differentiated weight design,can motivate physicians'initia-tive and improve the data quality of medical record home pages,thereby achieving accurate medical insurance settlement.It is recommended to explore intelligent verification paths combined with AI technology in the future to achieve synergistic optimization of medical record quality and hospital operations.

Obejective To explore whether it is possible to detect the 123I-prostate-specific membrane antigen(PSMA)radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of 123I-PSMA,a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue(1 906.50 cpm)was significantly higher than that of benign prostate tissue(415.00 cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50 cpm.The median radiation value of clinically significant prostate cancer tissue(2 652.50 cpm)was significantly higher than that of clinically insignificant prostate cancer(1 386.00 cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1 767.00 cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade(r=0.834).Conclusion It is preliminarily confirmed that detection of 123I-PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Objective:To study the regional distribution, temporal trend, and health inequity of burn incidence in the world from 1990 to 2019.Methods:The data related to burns worldwide from 1990 to 2019 were collected from the database of Global Burden of Disease (GBD). Based on the number of burn cases and age-standardized incidence rates, the incidence of burn was observed by age, region, socio-demographic index (SDI) area (divided into 5 categories of SDI areas: high, medium-high, medium, medium-low and low, the higher the area, the higher the degree of social development) and country, all of which were expressed as estimated values. Joinpoint regression analysis of the age-standardized incidence of burns from 1990 to 2019 was performed using Joinpoint 4.8.0.1 software to observe the average annual percentage change (AAPC). Rstudio software was used to analyze the Spearman correlation between the age-standardized incidence of burns and SDI from 1990 to 2019. The global inequities of burn incidence were evaluated using the slope index and concentration index from the health equity assessment toolkit, where the slope index reflected the absolute difference in burn incidence between countries with the lowest and highest SDI, and the concentration index indicated the degree to which burn incidence was concentrated in countries with low or high SDI.Results:From 1990 to 2019, the number of global burncases increased from 8 378 121.71 to 8 955 227.68, with an increase of 6.89%. However, the age-standardized incidence rate of burns showed an overall downward trend, from 149.86/100 000 in 1990 to 117.51/100 000 in 2019, with an AAPC of -0.80%. The incidence of burns in the population aged 10-19 years ranked the first in all age groups during the 30 years. Among the six regions of the world, the number of burn cases and the age-standardized incidence rate of burn in the Americas were the highest in 2019, but these two indexes were lower than those in 1999. In 2019, the number of burn patients in medium SDI areas was the highest, and the number of burn patients in low SDI areas was the lowest. The age-standardized incidence of burns was the highest in high SDI areas, and the lowest in medium-low SDI areas. From 1990 to 2019, the number of patients in high and medium-high SDI areas decreased, and the number of patients in other SDI areas increased. Compared with 1990, the age-standardized incidence rates of burns decreased in all SDI regions in 2019, with the greatest decline seen in high SDI and medium-high SDI regions. Cuba had the highest standardized incidence of burns, while Pakistan had the lowest. Spearman correlation analysis showed that from 1990 to 2019, the age-standardized incidence rates of burns in 204 countries and regions were positively correlated with SDI (all P<0.05), and the correlation coefficient decreased from 0.49 in 1990 to 0.37 in 2019. The health inequality slope index decreased from 212.90/100 000 in 1990 to 59.12/100 000 in 2019, and the concentration index decreased from 21.77% in 1990 to 8.38% in 2019. Conclusion:From 1990 to 2019, the global burn incidence rates are disproportionately concentrated in countries and regions with better development status. A significant reduction in the global burn incidence has been accompanied by a significant reduction in these inequities.

Objective:To introduce the health insurance fund supervision model in Japan,compare the current situation of health insurance fund supervision in China,learn from experiences,and propose suggestions for improvement.Methods:By combining cases and regulatory effects,it introduces Japan's"guidance-inspection"based health insurance fund supervision model.Results:Japan's"guidance-inspection"based health insurance fund supervision model is relatively effective.Compared with China,it has a higher level of organizational hierarchy,focuses on education in its supervisory approach,clarifies the direction of patients'self-paid expences,and has a well-developed dual-way communication mechanism.Conclusion:China should establish a comprehensive health insurance fund supervision pathway,clearly define the resolution pathway for self-paid expenses caused by violations,and improve the mechanisms for negotiation and dispute resolution during the process.

Objective:To introduce the health insurance fund supervision model in Japan,compare the current situation of health insurance fund supervision in China,learn from experiences,and propose suggestions for improvement.Methods:By combining cases and regulatory effects,it introduces Japan's"guidance-inspection"based health insurance fund supervision model.Results:Japan's"guidance-inspection"based health insurance fund supervision model is relatively effective.Compared with China,it has a higher level of organizational hierarchy,focuses on education in its supervisory approach,clarifies the direction of patients'self-paid expences,and has a well-developed dual-way communication mechanism.Conclusion:China should establish a comprehensive health insurance fund supervision pathway,clearly define the resolution pathway for self-paid expenses caused by violations,and improve the mechanisms for negotiation and dispute resolution during the process.