In recent decades, the prevalence of hyperuricemia and gout has increased dramatically due to lifestyle changes. The drugs currently recommended for hyperuricemia are associated with adverse reactions that limit their clinical use. In this study, we report that berberine (BBR) is an effective drug candidate for the treatment of hyperuricemia, with its mechanism potentially involving the modulation of gut microbiota and its metabolite, succinic acid. BBR has demonstrated good therapeutic effects in both acute and chronic animal models of hyperuricemia. In a clinical trial, oral administration of BBR for 6 months reduced blood uric acid levels in 22 participants by modulating the gut microbiota, which led to an increase in the abundance of Bacteroides and a decrease in Clostridium sensu stricto_1. Furthermore, Bacteroides fragilis was transplanted into ICR mice, and the results showed that Bacteroides fragilis exerted a therapeutic effect on uric acid similar to that of BBR. Notably, succinic acid, a metabolite of Bacteroides, significantly reduced uric acid levels. Subsequent cell and animal experiments revealed that the intestinal metabolite, succinic acid, regulated the upstream uric acid synthesis pathway in the liver by inhibiting adenosine monophosphate deaminase 2 (AMPD2), an enzyme responsible for converting adenosine monophosphate (AMP) to inosine monophosphate (IMP). This inhibition resulted in a decrease in IMP levels and an increase in phosphate levels. The reduction in IMP led to a decreased downstream production of hypoxanthine, xanthine, and uric acid. BBR also demonstrated excellent renoprotective effects, improving nephropathy associated with hyperuricemia. In summary, BBR has the potential to be an effective treatment for hyperuricemia through the gut-liver axis.

Objective:To investigate the morphological difference and clinical significance of bilateral lumbar multifidus muscles in patients with unilateral lumbosacral radiculopathy due to lumbar disc herniation and lumbar spondylolisthesis.Methods:A retrospective analysis was conducted on patients with low back pain, lumbar disc herniation and lumbar spondylolisthesis. Patients with lumbar disc herniation or lumbar spondylolisthesis underwent single segment lesion either at L 4, 5 or L 5S 1, while those accompanied with unilateral lumbosacral radiculopathy underwent percutaneous endoscopic lumbar discectomy or conventional open surgery at Qingdao Municipal Hospital between January 2017 and January 2023. Patients with lumbar spondylolisthesis were subdivided into degenerative lumbar spondylolisthesis and isthmic spondylolisthesis. 53 patients with low back pain met the inclusion criteria. 170 patients with lumbar disc herniation met the inclusion criteria, with 101 at L 4, 5 and 69 at L 5S 1 level. 129 patients with lumbar spondylolisthesis met the inclusion criteria, including 91 of degenerative lumbar spondylolisthesis at L 4, 5 level and 9 at L 5S 1 level, and 11 of isthmic spondylolisthesis at L 4, 5 level and 18 at L 5S 1 level. Cross-sectional images at the mid-disc of L 3, 4, L 4, 5 and L 5S 1 segments in MRI were acquired. Relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), fat infiltration rate (FIR), relative fat distance (rFD) and differential value FIR (D-FIR) in bilateral lumbar multifidus muscle were measured respectively by using Image J software, and were then used to evaluate the atrophy and fat infiltration of bilateral lumbar multifidus muscles. Results:No significant difference was found between the both sides of multifidus muscle in low back pain patients. L 4, 5 lumbar disc herniation group had smaller rFCSA (0.34±0.10 and 0.35±0.10) and larger FIR [29.92(22.21, 36.46) and 26.48(17.54, 34.55)] and rFD [0.39(0.29, 0.54) and 0.32(0.21, 0.43)] on the affected side compared to the unaffected side in L 4, 5 segment, and had larger FIR (34.83±11.34 and 31.44±10.94) and rFD [0.59(0.43, 0.77) and 0.51(0.37, 0.69)] on the affected side in L 5S 1 segment. L 5S 1 lumbar disc herniation group had smaller rFCSA (0.41±0.11 and 0.42±0.12) and larger FIR [26.84(22.92, 35.29) and 24.02(20.03, 32.87)] and rFD (0.51±0.28 and 0.42±0.26) on the affected side in L 5S 1 segment. L 4, 5 degenerative lumbar spondylolisthesis group had larger FIR (36.49±9.76 and 34.72±9.86) on the affected side in L 4, 5 segment, and had larger FIR [35.03(28.64, 41.85) and 33.34(26.37, 39.76)] on the affected side in L 5S 1 segment. L 5S 1 degenerative lumbar spondylolisthesis group had larger FIR [42.53(37.94, 46.81) and 40.79(30.84, 43.53)] and rFD (1.12±0.79 and 0.94±0.79) on the affected side in L 5S 1 segment. L 4, 5 isthmic spondylolisthesis group had smaller rFCSA [0.24(0.20, 0.30) and 0.29(0.23, 0.34)]and larger FIR [34.19 31.30, 42.39) and 29.43(28.82, 36.89)] and rFD (0.39±0.15 and 0.29±0.15) on the affected side in L 4, 5 segment, and had larger FIR (43.18±12.71 and 34.12±11.63) on the affected side in L 5S 1 segment. L 5S 1 isthmic spondylolisthesis group had larger FIR (40.24±9.34 and 36.37±10.70) on the affected side in L 5S 1 segment. No significant difference was found of the multifidus muscle between the affected and unaffected sides in the proximal adjacent segment of the responsible segment in lumbar disc herniation or lumbar spondylolisthesis group patients. L 4, 5 isthmic spondylolisthesis group had larger D-FIR (6.75±8.46 and 1.78±5.77) in L 4, 5 segment, and had larger D-FIR (9.06±11.59 and 1.54±7.08) in L 5S 1 segment compared to L 4, 5 degenerative lumbar spondylolisthesis group. Grade Ⅱ L 4, 5 lumbar spondylolisthesis group had larger D-FIR (10.73±13.61 and 1.92±7.43) in L 5S 1 segment compared to grade Ⅰ L 4, 5 lumbar spondylolisthesis group. Conclusion:L 4, 5 or L 5S 1 lumbar disc herniation and lumbar spondylolisthesis patients with unilateral lumbosacral radiculopathy had asymmetric atrophy and fat infiltration of multifidus muscle. The atrophy and fat infiltration on the affected side showed greater. The asymmetry appeared in the responsible segment and its distal adjacent lumbar segment. Lumbar spondylolisthesis patients with a lager degree of slip or with isthmic type could be accompanied by more severe asymmetry of multifidus muscle.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

Objective:To investigate the risk factors affecting pathological diagnosis upgrading after resection of colorectal laterally spreading tumor (LST).Methods:From June 2018 to December 2022, the clinical data of 256 patients with LST (297 lesions) admitted to Shanxi Provincial Cancer Hospital were retrospectively included as an modeling group.From January 2023 to January 2024, 125 patients with LST (129 lesions) were collected as an external validation group. The pathological diagnosis of endoscopic forceps biopsy (EFB) samples and the resected LST tissue of modeling group were compared, and the patients were divided into pathological non-difference group and pathological upgrading group. The clinical data such as gender, age, body mass index (BMI), pre-resection carcinoembryonic antigen levels, drinking history, smoking history, family history of colorectal cancer, and whether complicated with underlying diseases as well as endoscopic surface morphological features such as lesion size, morphological features, and lesion location were compared between the two groups. Chi-square test was used for statistical analysis, and multivariate logistic regression analysis was used to identify the risk factors for pathological diagnosis upgrading after resection. Based on the independent risk factors, the prediction models were established and validated by nomogram. The receiver operating characteristic curve (ROC) of repeated samples within the modeling group and external validation growp was plotted, and the area under the curve (AUC) was used to evaluate the predictive value of the model.Results:The proportion of patients with family history of colorectal cancer in the pathological upgrading group was higher than that of the pathological non-difference group (38.7%, 12/31 vs. 22.2%, 50/225), and the difference was statistically significant ( χ2=4.04, P=0.045). There were statistically significant differences in lesion size (63.9% (23/36) and 44.4% (116/261) lesions with long diameter ≥2 cm, respectively), surface morphological characteristics (flat elevated type accounted for 8.3% (3/36) and 22.6% (59/261), granular uniform type accounted for 11.1% (4/36) and 28.0% (73/261), nodular mixed type accounted for 44.4% (6/36) and 24.9% (65/261), pseudo-depressed type accounted for 36.1% (13/36) and 24.5% (64/261)), and lesion location (distal colon accounted for 22.2% (8/36) and 33.3% (87/261), proximal colon accounted for 16.7% (6/36) and 28.7% (75/261), and rectum accounted for 61.1% (22/36) and 37.9% (99/261)) between the pathological upgrading group and the pathological non-difference group ( χ2=4.80, 12.62 and 7.08, all P<0.05). The results of multivariate logistic regression analysis showed that family history of colorectal cancer ( OR=2.211, 95% confidence interval (95% CI) 1.005 to 4.861, P=0.049), lesion length ≥ 2 cm ( OR=2.212, 95% CI 1.074 to 4.555, P=0.031), nodular mixed subtype ( OR=4.841, 95% CI 1.343 to 17.455, P=0.016), pseudo-depressed subtype ( OR=3.995, 95% CI 1.084 to 14.721, P=0.037), and lesion in rectum ( OR=2.417, 95% CI 1.024 to 5.705, P=0.044) were independent risk factors for pathological diagnosis upgrading after LST resection. A nomogram was established based on these four risk factors, with a ROC AUC of 0.833 (95% CI 0.752 to 0.913). The external validation results demonstrated that the ROC AUC was 0.848 (95% CI 0.736 to 0.960), the sensitivity was 0.737, the specificity was 0.972, the maximum Youden index was 0.712, and the overall accuracy was 0.868. Conclusions:Family history of colorectal cancer, lesion length ≥ 2 cm, lesion in rectum, and nodular mixed or pseudo-depressed subtypes may affect the accuracy of pathological diagnosis of LST lesions by EFB, and leading to pathological diagnosis upgrading after resection. The prediction model based on these four factors has good predictive efficacy in pathological diagnosis upgrading after LST resection.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Objective To explore the relevant relationship and specificity between the implicit and explicit loyalty of military cadets in order to provide a theoretical basis and objective indicators for a more comprehensive and objective assessment for individual loyalty.Methods E-Prime 2.0,a classic implicit association paradigm was employed to construct an implicit association loyalty test for 64 military cadets.Simultaneously,an explicit loyalty measurement was conducted using the Chinese Military Personnel Loyalty Scale.Results ① Significant implicit effect was observed in the loyalty assessment of military cadets,indicating a general tendency to perceive higher levels of personal loyalty and lower levels of loyalty to external entities.② Explicit loyalty assessment revealed that the participants had the highest loyalty score towards the Party,the Nation,and the People(4.79±0.34),followed by the loyalty score to their profession(4.38±0.53),and the relatively lower loyalty score towards the unit and leaders(4.03±0.83).Among the 3 dimensions of loyalty,the normative loyalty score ranked highest,while continuance loyalty score took lower.③ There were no correlations among the scores of loyalty to the Party,the Nation,and the People(r=-0.030,P=0.823),to the profession(r=-0.047,P=0.728),to the unit(r=0.050,P=0.710),or to the leaders(r=0.043,P=0.749).Conclusion The implicit effect in the loyalty assessment is significant in military cadets,and there is no significant correlation between explicit and implicit loyalty measurements.Thus,we cannot rely solely on explicit measurements to assess their loyalty attitudes.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Objective:To provide references for achieving long time continuous monitoring of cardiac functional changes of astronauts in spaceflight activities through continuously noninvasive assessment of left ventricular systolic function under exercise load by wearable cardiac sounds and ECG signals synchronization monitoring technology.Methods:Eleven healthy male youths were recruited for the study, and they did incremental load exercise on the recumbent power bicycle, starting at 50 W, increasing by 25 W every 3 minutes, until the maximum of 125 W reached. The subjects′ cardiac sounds and ECG signals at rest, 1 min after each level of load during exercise and 3 min after the end of exercise were selected; the transthoracic cardiac ultrasound examination of subjects was performed before and 5 min after exercise. The correlation between the cardiac sounds and ECG signals and left ventricular ejection fraction (LVEF) was analyzed, and a regression model was established to predict LVEF during exercise.Results:There were significant differences in heart rate, LVEF, electro-mechanical activation time (EMAT) and left ventricular ejection time (LVET) of subjects under different exercise loads ( F=53.22, 45.33, 3.65, 23.19, P<0.001, <0.001, =0.011, <0.001). Compared with the resting state, subjects showed increased heart rate and LVEF and a decreased EMAT and LVET during exercise loading, all of which were statistically significant ( P<0.01 or 0.05). In the correlation analysis, LVEF was negatively correlated with EMAT and LVEF ( r=-0.415, -0.758, P=0.002,<0.001), and positively correlated with the amplitude of the first heart sound ( r=0.606, P<0.001). The model for predicting LVEF was established by EMAT and LVET, and the multiple regression model was LVEF=108.698-0.092×LVET-0.134×EMAT ( r=0.87, P<0.001). Conclusions:The synchronous monitoring technology of cardiac sounds and ECG signals can continuously and non-invasively monitor LVEF changes during exercise. LVET is the most closely related to LVEF. LVEF is hopeful to predict the changes of cardiac function of astronauts in spaceflight activities.

Objective:To provide references for achieving long time continuous monitoring of cardiac functional changes of astronauts in spaceflight activities through continuously noninvasive assessment of left ventricular systolic function under exercise load by wearable cardiac sounds and ECG signals synchronization monitoring technology.Methods:Eleven healthy male youths were recruited for the study, and they did incremental load exercise on the recumbent power bicycle, starting at 50 W, increasing by 25 W every 3 minutes, until the maximum of 125 W reached. The subjects′ cardiac sounds and ECG signals at rest, 1 min after each level of load during exercise and 3 min after the end of exercise were selected; the transthoracic cardiac ultrasound examination of subjects was performed before and 5 min after exercise. The correlation between the cardiac sounds and ECG signals and left ventricular ejection fraction (LVEF) was analyzed, and a regression model was established to predict LVEF during exercise.Results:There were significant differences in heart rate, LVEF, electro-mechanical activation time (EMAT) and left ventricular ejection time (LVET) of subjects under different exercise loads ( F=53.22, 45.33, 3.65, 23.19, P<0.001, <0.001, =0.011, <0.001). Compared with the resting state, subjects showed increased heart rate and LVEF and a decreased EMAT and LVET during exercise loading, all of which were statistically significant ( P<0.01 or 0.05). In the correlation analysis, LVEF was negatively correlated with EMAT and LVEF ( r=-0.415, -0.758, P=0.002,<0.001), and positively correlated with the amplitude of the first heart sound ( r=0.606, P<0.001). The model for predicting LVEF was established by EMAT and LVET, and the multiple regression model was LVEF=108.698-0.092×LVET-0.134×EMAT ( r=0.87, P<0.001). Conclusions:The synchronous monitoring technology of cardiac sounds and ECG signals can continuously and non-invasively monitor LVEF changes during exercise. LVET is the most closely related to LVEF. LVEF is hopeful to predict the changes of cardiac function of astronauts in spaceflight activities.

Objective:To analyze the clinical characteristics of children with 2019 novel coronavirus (2019-nCoV) infection in Putian City, and to provide a reference for the diagnosis and treatment of children with 2019-nCoV infection.Methods:Clinical characteristics, laboratory examination, pulmonary compated tomography findings, treatment, and clinical outcomes of 78 children with 2019-nCoV infection who were admitted to Putian University Affiliated Hospital Medical Group Putian City Children′s Hospital from September 10 to October 20, 2021 were retrospectively collected and analyzed.Results:Of the 78 children included in the analysis, two cases (2.6%) were asymptomatic infection, 36 cases (46.2%) were mild and 40 cases (51.3%) were ordinary. Five children were vaccinated against 2019-nCoV. The main symptoms were fever (24 cases), cough (13 cases), and fatigue (nine cases). A total of 34 cases (43.6%) had neutropenia, 29 cases (37.2%) had lymphopenia, 36 cases (46.2%) had D-dimer increase, 38 cases (48.7%) had hypokalemia, 27 cases (34.6%) had hypoglycemia and 11 cases (14.1%) had elevated creatine kinase isoenzyme. The neutropenia mostly occurred two to four days after admission. Fifty-six cases (71.8%) showed pulmonary computed tomography abnormalities. The cycle threshold of virus open reading frame ( ORF)1 ab was 20.90±7.15 and the cycle threshold of N gene was 20.29±7.78 in the first nucleic acid detection of 78 children after admission. The time of nucleic acid negative conversion of the 78 children was (20.73±6.94) days. IgM antibody titer in five vaccinated children was 0.36 (0.34, 4.89) and IgG antibody was 10.42 (0.50, 19.42). IgM antibody titer was 1.82 (1.66, 8.12) and IgG antibody was 76.63 (16.92, 79.84) in cases with disease duration ≥10 days. Nine children (11.5%) had resurgence of virus and were sent to the isolation site. All the other children were cured and discharged from hospital. Conclusions:Children with 2019-nCoV infection have mild clinical symptoms, and some children have lymphopenia, neutropenia, and D-dimer elevation during the course of the disease. The overall prognosis is good. The children vaccinated against 2019-nCoV have higher antibody levels.