In recent years， traditional Chinese medicine （TCM） has achieved significant progress in the treatment of inflammatory bowel disease （IBD）. A comprehensive literature search was conducted covering the period from January 1， 2010， to December 30， 2024， across Chinese databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP China Science and Technology Journal Database， and the Chinese Biomedical Literature Service System， as well as international databases such as PubMed， Web of Science， and Embase. The clinical applications and mechanistic studies of TCM in IBD were systematically reviewed. The current status of TCM research on the etiology and pathogenesis of IBD， innovative clinical practices， and multimodal therapeutic approaches， including Chinese herbal formulas， single herbs or active compounds， acupuncture， herbal retention enema， and acupoint application， were summarized， together with their synergistic effects when combined with western medical treatments. The development and application of Chinese patent medicines for IBD are undergoing a profound transition from efficacy validation to mechanistic exploration. Mechanistic studies on the effects of TCM in IBD mainly focus on regulating gut microbiota homeostasis， repairing the intestinal mucosal barrier， and modulating intestinal immune balance. Furthermore， future research directions for TCM-based IBD management are proposed， including the establishment of TCM diagnostic and treatment models， expanding integrated applications of external and internal TCM therapies， innovating personalized treatment strategies， and advancing drug development. These efforts aim to provide insights for the standardized and precision-oriented development of TCM in the diagnosis and treatment of IBD.

Objective:To analyze the prevalence of chronic diseases, the level of chronic disease prevention and control literacy and its influencing factors among middle-aged and elderly residents in Wenzhou from 2020 to 2023.Methods:Based on a cross-sectional research design, 19 528 usual residents aged 45-69 were retrospectively selected with a multi-stage stratified random sampling method from the health literacy monitoring survey in Wenzhou from 2020 to 2023. The χ2 tests and trend χ2 tests were employed to analyze chronic disease prevalence rates and health literacy possession rates across different population subgroups. Binary logistic regression models were used to identify determinants of chronic disease prevention health literacy among middle-aged and elderly residents in Wenzhou. The results were standardized using data from Wenzhou′s Seventh National Population Census. Results:The numbers of middle-aged and elderly respondents was 5 528, 4 822, 4 575 and 4 603 from 2020 to 2023, respectively, and the prevalence of self-rated chronic diseases was 39.56%, 37.33%, 41.29% and 39.00%, respectively (the standardized rate was 33.49%, 33.58%, 36.43% and 35.34%, respectively) in the each year, and the rates of chronic disease prevention and control literacy was 24.76%, 27.98%, 24.44% and 28.13%, respectively (the standardized rate was 27.95%, 30.11%, 27.57%, 29.78%, respectively). The rates of chronic disease prevention and control literacy was on an upward trend in middle-aged and elderly respondents in Wenzhou from 2020 to 2023 ( χ2trend=5.997, P=0.014). From 2020 to 2023, chronic disease prevention health literacy showed a positive educational gradient, with significantly higher levels observed among more educated populations (both P<0.05). Except for 2020, the residents with household income≥30 000 yuan had a higher chronic disease prevention and control literacy than those with household income less than 30 000 yuan (both P<0.05); in 2021 and 2022, the chronic disease prevention and control literacy in the people of 45-59 years was higher than that in the individuals of 60-69 years (both P<0.05); in 2020 and 2022, the rural residents had a higher chronic disease prevention and control literacy than the urban residents, and the rates of chronic disease prevention and control literacy of employees or retirees in government institutions/doctors/teachers were higher than that in the peasants (both P<0.05); in 2023, the chronic disease prevention and control literacy of the smokers was lower than that in the non-smokers ( P=0.014). Conclusions:The prevalence of chronic diseases among the middle-aged and elderly residents in Wenzhou is relatively low, people with chronic diseases, especially those with multiple chronic diseases, have a low level of chronic disease prevention and control literacy. To prevent and control chronic diseases among them, interventions should be differentiated by the chronic disease status, occupation and household income.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective:To construct a nanoparticle vaccine displaying the prefusion F (preF) protein of respiratory syncytial virus (RSV) using the I53-50 protein nanoparticle platform, and to systematically evaluate its immunogenicity and protective efficacy.Methods:The RSV preF trimer antigen was genetically fused to I53-50A and assembled in vitro with I53-50B to form preF-I53-50 nanoparticles, theoretically displaying 20 preF antigens per particle. The structure and purity were characterized by size-exclusion chromatography, SDS-PAGE, and negative-stain electron microscopy. BALB/c mice were intramuscularly immunized with varying doses (1 μg or 5 μg) of preF antigen or an equimolar amount of preF-I53-50 nanoparticles. Humoral immunity, B-cell responses, and protective efficacy were assessed following intranasal viral challenge.Results:The preF-I53-50 nanoparticles self-assembled into spherical structures (50-60 nm in diameter) with uniformly arrayed antigens. The nanoparticle vaccine enhanced RSV-specific IgG1 and IgG2a antibody responses, promoting a Th1-biased immune profile. At equimolar preF doses, the neutralizing antibody titers induced by 1 μg and 5 μg nanoparticle formulations were 2.8-fold and 2.3-fold higher, respectively, than those elicited by preF alone ( P<0.05). Notably, even the low-dose nanoparticle group outperformed the high-dose preF group (1.6-fold increase). Viral challenge experiments demonstrated that preF-I53-50 effectively suppressed pulmonary viral replication, mitigated pathological damage, and induced stronger germinal center and memory B-cell responses, suggesting enhanced B-cell affinity maturation and long-term immune memory. Conclusion:The preF-I53-50 vaccine improves the immunogenicity and protective efficacy of RSV preF through multivalent antigen display.

Objective:To observe the tumor control and the degree of radiation-induced lung injury (RILI) between FLASH irradiation and conventional dose rate (CONV) irradiation, and compare the changes in plasma proteomic profiles of mice following whole-lung FLASH and CONV irradiation using proteomics method.Methods:A mouse model with metastatic lung cancer was established. After whole-lung irradiation, changes in normal lung capacity were monitored using CT scans. Then, a RILI model was constructed to examine pathological alterations in lung tissues following whole-lung CONV and FLASH irradiation. Plasma samples were collected from mice receiving whole-lung CONV irradiation ( n = 5) and whole-lung FLASH irradiation ( n = 5), followed by comparison with samples from the control group of healthy mice (also referred to as the healthy control group). These plasma samples were analyzed using isobaric tags for relative and absolute quantification (iTRAQ)-based proteomics, followed by the screening and identification of differentially expressed proteins using high-throughput bioinformatics. Moreover, protein-protein interaction (PPI) network analysis was conducted to identify hub genes using the STRING database and Cytoscape software. Results:Whole-lung FLASH and CONV irradiation produced consistent tumor control, with the former significantly reducing RILI compared to the latter. A total of 609 proteins were identified through proteomic analysis. Among them, 89 differentially expressed proteins were detected in the whole-lung FLASH group. Gene Ontology (GO) enrichment analysis indicated that up-regulated genes were primarily associated with stress and inflammatory responses, whereas down-regulated genes were related to ATP metabolism and angiogenesis regulation. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis revealed that up-regulated genes were predominantly enriched in unfolded protein response pathways, while down-regulated genes were mainly involved in metabolic pathways and oxidative phosphorylation. Integrated PPI analysis and subsequent validation via reverse transcription-polymerase chain reaction (RT-PCR) revealed four key genes.Conclusions:Compared to the whole-lung CONV irradiation, whole-lung FLASH irradiation reduces the RILI of normal lung tissues while maintaining equivalent tumor control in metastatic lung cancer. Proteomic analysis of differentially expressed proteins in plasma after whole-lung FLASH and CONV irradiation provides valuable insights into the molecular mechanisms underlying the FLASH effect.

Objective:To conduct a comparative analysis of the oxygen depletion and oxygen effect of FLASH irradiation and conventional irradiation by direct measurement of oxygen content.Methods:The oxygen content in different tissues and organs of mice was measured using a phosphorescent probe. A subcutaneous xenograft tumor model in mice was established, to receive electron-beam irradiation at different doses and dose rates. The oxygen depletion of tumor and normal tissue was analyzed, and tumor control was evaluated. The oxygen depletion of conventional irradiation and FLASH irradiation was further analyzed using an in vitro model. The survival fraction (SF) of normal cells after conventional irradiation and FLASH irradiation was calculated using colony formation assay under different partial pressures of oxygen, and the data were fitted to the oxygen enhancement ratio (OER) curve. Results:The mean oxygen content of subcutaneous xenograft tumor in mice was 1.28%, suggesting hypoxia. The mean oxygen content of normal tissue ranged from 3.51% to 6.53%, suggesting physioxia. In animal experiments, oxygen depletion was not observed during conventional irradiation. High-dose-rate (20 Gy/s) and ultra-high-dose-rate (FLASH, 40 Gy/s) irradiation produced oxygen depletion. During FLASH irradiation, with the increase of oxygen content, the oxygen depletion was 0.1-0.2 mm Hg/Gy for tumor tissue and 0.19-0.21 mm Hg/Gy for skin tissue, which tended to stabilize. FLASH irradiation maintained equivalent tumor control compared to conventional irradiation. The tumoricidal effect was significantly enhanced with the increase of oxygen content in the tissue ( t=3.46, P<0.01). In in vitro experiments, the mean oxygen depletion rate was about 0.16 mm Hg/Gy for conventional irradiation and 0.16-0.18 mm Hg/Gy for FLASH irradiation, which did not change significantly with the increase of oxygen content. FLASH irradiation was associated with an oxygen effect. When the partial pressure of oxygen decreased from physioxia to hypoxia, the OER value significantly reduced. Conclusions:Normal tissues and organs are in physioxia, which exhibits a lower oxygen content than that in the air. FLASH irradiation can consume a proportion of oxygen, producing an oxygen effect. When oxygen content decreases, the oxygen depletion rate slows down after FLASH irradiation.

Objective:To analyze the payment policies for local special cases in China under the DRG payment mode, for references for improving the construction of China′s DRG payment system.Methods:Policy texts related to DRG settlement management measures and implementation rules were searched on the official websites of the people′s governments, medical security bureaus, and health commissions of prefecture level cities, county-level cities, and DRG payment pilot cities in China. The policy release time range was from May 2019 to March 2024. Content analysis method was used to summarize the judgment criteria and payment methods for determining unstable groups, high-rate and low-rate cases in various regions.Results:This study included a total of 74 policy texts covering 76 cities. 59 cities had established judgment criteria for unstable groups, using the number of enrolled cases and the threshold for the coefficient of variation of hospitalization expenses within the group as the basis for determination; 46 cities had established relevant payment methods, 40 cities of which adopted fee-for-service, or individual payment for special diseases (whole group). 72 cities had established judgment criteria and payment methods for high-rate cases. Among them, 68 cities used " hospitalization expenses for cases are higher than the prescribed multiple of the average cost or payment standard for this disease group" as the judgment criterion, and the majority of cities (40) adopt additional benchmark points for compensation payment. 70 cities had clarified the judgment criteria and payment methods for low-rate cases. Among them, 67 cities used " hospitalization expenses for cases that are less than the prescribed multiple of the payment standard or average cost per case" as the criteria, and pay based on point conversion or fee-for-service.Conclusions:There were certain differences in the judgment criteria and payment methods for special cases among different cities, which provided valuable references for the in-depth exploration of DRG payment reform in China. We should further strengthen the innovation of special case screening methods, attach importance to disease cost accounting, and improve the construction of special case payment systems.

OBJECTIVE To explore the application value of a diagnostic model based on machine learning and SHAP in the diagnosis of severe pneumonia caused by adenovirus infection in children.METHODS A total of 562 children with adenovirus infection who were admitted to Wuhan Third Hospital from Mar.2023 to Apr.2024 were selected and divided into a non-pneumonia group(n=236)and a pneumonia group(n=326).The pneumonia group was further divided into a training set(n=245)and a validation set(n=81)at a ratio of 3∶1.The training set was further categorized into a severe group(n=90)and a non-severe group(n=155)based on the severity of pneumonia.M ultivariate logistic regression analysis was used to identify the risk factors for severe pneumonia in children with adenovirus infection,and collinearity diagnosis was performed.Receiver operating characteristic(ROC)curves were used to validate the predictive performance of the model in both the training and validation sets,and the optimal model was selected.The optimal predictive model was interpreted using SHAP.RESULTS Compared with the non-pneumonia group,the pneumonia group had a high proportion of children aged＜2 years,with cough,wheezing,pulmonary consolidation,pleural effusion,mixed infections and allergic history,as well as long hospital stays and fever duration(P＜0.05).After univariate analysis and collinearity diagnosis to exclude confounding factors,the length of hospital stay(OR=1.112),fever duration(OR=1.964),wheezing(OR=2.430),pulmonary consolidation(OR=2.546),mixed infections(OR=2.617)and LDH level(OR=1.613)were identified as risk factors for severe pneumonia in children with adenovirus infection(P＜0.05).Among the eight machine learning models constructed based on these risk factors,the gradient boosting machine(GBM)model demonstrated the best performance in predicting severe pneumonia in children with adenovirus in-fection,with area under the curve(AUC)of 0.796 and 0.785 in the training and validation sets,respectively.SHAP analysis revealed that the top four contributing characteristics were LDH level,wheezing,fever duration and pulmonary consolidation.CONCLUSIONS The GBM model exhibits optimal performance in predicting the risk of severe pneumonia in children with adenovirus infection.Among the predictive characteristics,LDH level,wheezing,fever duration and pulmonary consolidation are significant,providing valuable reference for clinical di-agnosis and treatment.

Hepatic encephalopathy is a neuropsychiatric syndrome secondary to severe liver disease.Recent studies have shown that the development of hepatic encephalopathy is closely associated with bile acid/short-chain fatty acid metabolic disorder.As the core theory of traditional Chinese medicine,the theory of Yin and Yang provides a unique perspective for analyzing the association between bile acids/short-chain fatty acids and hepatic encephalopathy.Bile acids function like Yang,governing the free flow of Qi and assisting in metabolic processes,while short-chain fatty acids belong to Yin,maintaining internal stability and conservation,preserving the intestinal barrier,and combating inflammation and toxins.Bile acids and short-chain fatty acids constrain each other and are interdependent to regulate the dynamic equilibrium of the gut-liver-brain axis.On this basis,by regulating the metabolic imbalance of bile acids and short-chain fatty acids,it is expected to restore the dynamic balance of Yin and Yang in patients with hepatic encephalopathy under the synergistic intervention of traditional Chinese medicine and Western medicine.

Colon cancer is a complex disease characterized by the impairment of body,qi and spirit,as well as the establishment of a tumor immune microenvironment(TIME)induced by chronic stress.Chronic stress is classified as a micro-level mental disorder,while TIME serves as the biological foundation for qi disorders.The observable manifestation of colon cancer is the tangible representation of physical disease.The interconnected mechanism of"chronic stress-TIME-colon cancer"aligns with the traditional Chinese medicine's understanding of disease as involving the interplay between the body,qi and spirit.In treatment,we should cooperate to improve the"regulating mind"of chronic stress and reshape the"invigorating qi"of TIME,and finally achieve the purpose of shape treatment to delay the progression of colon cancer.The paper is to provide new insights into the treatment of colon cancer with traditional Chinese medicine.