In recent years， hyperuricemia （HUA） has shown a rapidly increasing incidence and tends to occur in increasingly young people， with a wide range of cardiac， renal， joint， and cancerous hazards and all-cause mortality associations. Western medicine treatment has limitations such as large liver and kidney damage， medication restriction， and easy recurrence. The intestine is the major extra-renal excretion pathway for uric acid （UA）， and the intestinal microecology can be regulated to promote UA degradation. It offers great potential to develop UA-lowering strategies that target the intestinal microecology， which are promising to provide safer and more effective therapeutic approaches. Traditional Chinese medicine （TCM） can treat HUA via multiple targets and multiple pathways from a holistic view， with low toxicity and side effects. Studies have shown that intestinal microecology is a crucial target for TCM in the treatment of HUA. However， its specific mechanism of action has not been fully elucidated. Focusing on the key role of intestinal microecology in HUA， this review explores the relationship between intestinal microecology and HUA in terms of intestinal flora， intestinal metabolites， intestinal UA transporters， and intestinal barriers. Furthermore， we summarize the research progress in TCM treatment of HUA by targeting the intestinal microecology， with the aim of providing references for the development of TCM intervention strategies for HUA and the direction of future research.

Endometrial cancer is one of the common malignant tumors of the female reproductive system.Its incidence rate in China is second only to cervical cancer,posing a serious threat to women's life and health,and the onset shows a trend of affecting younger individuals.Currently,the primary treatment for endometrial cancer is surgical intervention,and some postoperative patients and those with postoperative recurrence require adjuvant radiotherapy.Pelvic external beam radiotherapy(EBRT)and vaginal brachytherapy(VBT)are two modalities of postoperative radiotherapy.The appropriate postoperative radiotherapy approach should be selected based on individual conditions and guideline recommendations.Most patients can achieve satisfactory treatment outcomes through surgery and postoperative adjuvant radiotherapy.However,the specific indications for postoperative radiotherapy in endometrial cancer patients and the radiotherapy principles for those with postoperative recurrence are relatively complex,and recommendations for radiotherapy modalities in postoperative patients vary slightly across different guidelines.This article reviews the treatment principles for endometrial cancer patients in recent years,as well as the indications for postoperative and post operative recurrent radiotherapy and the radiotherapy techniques,aiming to provide a reference for radiotherapy in the endometrial cancer patients.

With the rapid evolution of medical information technology, internet hospitals had become an integral part of China′s healthcare service system and could play a unique role in multidisciplinary diagnosis and treatment (MDT). In 2023, Nanjing Drum Tower Hospital built a smart service platform for MDT based on its internet hospital under the design concept of " global collaboration, process re-engineering, and smart empowerment", and officially launched in November of the same year. The platform included a five-tier architectur: user interaction, application services, data management, system integration and infrastructure, and embeds functional modules such as consultation management, an AI-assisted engine and a workflow engine. This platform covered Nanjing Drum Tower Hospital Group members, implemented an online-offline integrated, end-to-end workflow (pre-intra-post consultation). It realized the integration and utilization of high-quality medical resources across regions and institutions, and improved the quality and efficiency of MDT. As of December 2024, the platform had covered 30 specialties and completed 75 MDT consultations. The consultation cycle had been shortened from the traditional MDT mode of 14.2 days to 2.4 days, effectively reducing the number of patients traveling to and from the hospital. This platform had expanded the business scope of internet hospitals, improved the utilization rate of medical resources, and could provide references for other public hospitals in China to optimize the MDT service mode.

With the rapid evolution of medical information technology, internet hospitals had become an integral part of China′s healthcare service system and could play a unique role in multidisciplinary diagnosis and treatment (MDT). In 2023, Nanjing Drum Tower Hospital built a smart service platform for MDT based on its internet hospital under the design concept of " global collaboration, process re-engineering, and smart empowerment", and officially launched in November of the same year. The platform included a five-tier architectur: user interaction, application services, data management, system integration and infrastructure, and embeds functional modules such as consultation management, an AI-assisted engine and a workflow engine. This platform covered Nanjing Drum Tower Hospital Group members, implemented an online-offline integrated, end-to-end workflow (pre-intra-post consultation). It realized the integration and utilization of high-quality medical resources across regions and institutions, and improved the quality and efficiency of MDT. As of December 2024, the platform had covered 30 specialties and completed 75 MDT consultations. The consultation cycle had been shortened from the traditional MDT mode of 14.2 days to 2.4 days, effectively reducing the number of patients traveling to and from the hospital. This platform had expanded the business scope of internet hospitals, improved the utilization rate of medical resources, and could provide references for other public hospitals in China to optimize the MDT service mode.

Objective:To analyze the bubble dynamic characteristics of shock wave enhanced emission photoacoustic streaming(SWEEPS)technique in free water region under different temporay delays.Methods:The Er∶YAG laser tip was activated in free water model with SWEEPS mode at 150-600 μs pulse delay.The bubble dynamic process during irrigation was recorded by a high-speed camera(200 000 Hz).Matlab was used to analyze the interaction between bubble made by the dual pulses frame by frame.The distance between bubble remnants and laser tip was measured before the bubble disappeared.The experimental data were statisti-cally analyzed by SPSS 19.0.Results:In free water region,different temporal delays caused different interaction between the bub-bles activated by the SWEEPS technique with a dual pulse modality.The interactions include bubble fusion,bubble collision and bubble separation.When the temporal delay between 360-440 μs,bubble collision was the most violent,and the farthest distance between bubble remnants and laser tip was reached.Conclusion:In free water region,the dual pulse of SWEEPS technique can lead to bubble interaction which may enhance the cavitation effect of Er∶YAG laser irrigation,and improve the debridement in clinic ap-plication.

Humans ; COVID-19/genetics* ; SARS-CoV-2/genetics* ; Clustered Regularly Interspaced Short Palindromic Repeats/genetics* ; CRISPR-Cas Systems/genetics* ; RNA, Viral/genetics*

Objective:To investigate the risk factors for intraoperative hemorrhage during endoscopic submucosal dissection (ESD) for colorectal lesions.Methods:Data of 386 patients with colorectal lesions, who underwent ESD at The Third People's Hospital of Datong and its cooperative hospital, Nanjing Drum Tower Hospital, from December 2019 to August 2021 were retrospectively analyzed. The patients were divided into the hemorrhage group ( n=85) and the non-hemorrhage group ( n=301) according to intraoperative hemorrhage. The correlationship of patients'basic information, lesion-related factors and hemorrhage during colorectal ESD was analyzed. Univariate and multivariate logistic regression were used to identify the risk factors for intraoperative hemorrhage during ESD. The risk predictive model of intraoperative hemorrhage during ESD was established according to the screened risk factors, and receiver operator characteristic (ROC) curve was used to evaluate the predictive model. Results:Univariate logistic regression showed that a history of diabetes ( OR=2.340, P<0.05), a history of coronary atherosclerotic heart diseases ( OR=3.100, P<0.05), the lesion located in the rectum ( OR=3.272, P<0.05), longer lesion ( OR=1.093, P<0.05), wider lesion ( OR=1.057, P<0.05), larger lesion ( OR=1.126, P<0.05), depressed lesion ( OR=6.128, P<0.05), the laterally spreading lesion ( OR=2.651, P<0.05), the lesion infiltrated into the SM-S layer ( OR=0.088, P<0.05), the lesion infiltrated into the SM-D layer ( OR=0.174, P<0.05), the diameter of hemorrhage vessels 0.5~<1.0 times of the diameter of incision knife ( OR=246.854, P<0.05), the postoperative pathology as early cancer ( OR=7.000, P<0.05) were risk factors for intraoperative hemorrhage during ESD. Considering the quantitative relationship between the length, the width and the area of lesions, multi-factor models were constructed using the length and area of lesions respectively. Forward stepwise regression was used to screen variables and determine the final model, and the results showed that a history of coronary atherosclerotic heart diseases, the depressed lesion, the longer lesion, the larger lesion, the diameter of hemorrhage vessels 0.5~<1.0 times of the diameter of the incision knife were independent risk factors for intraoperative hemorrhage during ESD. The two modeling results of the lesion length and the lesion area were very similar. Therefore, lesion length was recommended to describe lesions in clinical practice. Conclusion:A history of coronary atherosclerotic heart disease, the depressed lesion, the longer lesion, the larger lesion, the diameter of vessels 0.5~<1.0 times of that of the incision knife are independent risk factors for intraoperative hemorrhage during ESD.

Objective:To investigate the effect of bilateral repetitive transcranial magnetic stimulation (rTMS) on the pre-attentive processing of methamphetamine addicts.Methods:Forty methamphetamine addicts were screened and equally divided into the intervention group and the control group by random number table method.The intervention group was treated with bilateral simultaneous stimulation with 10 Hz on the left DLPFC and 1 Hz on the right DLPFC with 7 days of continuous intervention.The same scheme was used to intervene the control group, but with pseudo-stimulation. The changes of amplitude and latency of mismatch negative wave(MMN) before and after intervention were compared. SPSS 24.0 software was used for statistical analysis. Independent sample t-test was used for inter group comparison, and paired sample t-test was used for intra group comparison before and after intervention. Results:Before rTMS, there were no significant differences in MMN(F3, Fz, F4) amplitude (intervention group: (-0.90±0.28)μV, (-0.98±0.19)μV, (-0.96±0.19)μV; control group: (-0.92±0.21)μV, (-0.89±0.20)μV, (-0.94±0.16)μV)and latency(intervention group: (184.16±33.07)ms, (179.20±25.35)ms, (184.95±28.22)ms; control group: (184.91±26.96)ms, (180.99±25.29)ms, (181.55±23.19)ms) between the two groups (all P>0.05). After the intervention, there were significant differences in MMN(Fz, F4) amplitude(intervention group: (-1.38±0.16)μV, (-1.17±0.19)μV; control group: (-0.91±0.17) μV, (-0.99±0.16)μV) between the two groups (both P<0.01), but there were no significant differences in MMN (F3) amplitude(intervention group: (-1.01±0.59)μV; control group: (-0.80±0.50)μV), and in MMN (F3, Fz, F4) latency(intervention group: (177.38±26.45)ms, (172.17±23.87)ms, (179.84±23.60)ms; control group: (182.08±24.95)ms, (177.94±21.30)ms, (179.18±21.62)ms)between the two groups (all P>0.05). There were statistically significant differences in MMN( Fz, F4) amplitude (before-intervention: (-0.98±0.19)μV, (-0.96±0.19)μV; after-intervention: (-1.38±0.16)μV, (-1.17±0.19)μV)before and after intervention in the intervention group (both P<0.05), but there was no significant difference in MMN(F3) amplitude(before-intervention: (-0.90±0.28)μV; after-intervention: (-1.01±0.59)μV)before and after intervention in the intervention group ( P>0.05), and there were statistically significant differences in MMN(F3, Fz, F4) latency (before-intervention: (184.16±33.07)ms, (179.20±25.35)ms, (184.95±28.22)ms; after-intervention: (177.38±26.45)ms, (172.17±23.87)ms, (179.84±23.60)ms)before and after intervention in the intervention group(all P<0.05). After pseudo-stimulation, there were no statistically significant differences in MMN( F3, Fz, F4) amplitude(before-intervention: (-0.92±0.21)μV, (-0.89±0.20)μV, (-0.94±0.16)μV; after-intervention: (-0.80±0.50)μV, (-0.91±0.17)μV, (-0.99±0.16)μV)and latency (before-intervention: (184.91±26.96)ms, (180.99±25.29)ms, (181.55±23.19)ms; after-intervention: (182.08±24.95)ms, (177.94±21.30)ms, (179.18±21.62)ms) before and after intervention in the control group (all P>0.05). Conclusion:After repeated transcranial magnetic stimulation, the pre-attentive processing of the intervention group is improved, which shows that bilateral simultaneous stimulation of the rTMS program is effective.

OBJECTIVE: To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. METHODS: Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups. RESULTS: There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all CONCLUSIONS The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.
Bilirubin ; Erythroblastosis, Fetal/diagnosis* ; Female ; Humans ; Hyperbilirubinemia, Neonatal/diagnosis* ; Infant, Newborn ; Jaundice, Neonatal/diagnosis* ; Monitoring, Physiologic/methods* ; Phototherapy

Objective:To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer.Methods:Clinical data of 11 patients with inoperable locally advanced rectal cancer, 7 male and 4 female, admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed. All patients received pelvic external irradiation (50 Gy in 25 fractions), followed by a three-dimensional intracavitary brachytherapy boost (15-20 Gy in 3-4 fractions, 1 fraction/week). External beam radiotherapy was used to boost the dose to the perirectal lymph nodes (60-66 Gy in 30-33 fractions). All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy. Efficacy evaluation was performed using the RECIST standard. Survival and local control rates were calculated using the Kaplan- Meier method. Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria. Results:The CTV D 90% EQD 2 Gy of HDR 3D-ICBT among 11 patients was (21.3±1.60) Gy. The complete response (CR) and partial response (PR) rates were 64% and 27%, respectively, yielding an objective response rate (CR+PR) of 91%. With a median follow-up time of 36 months, the 1-, 2-, and 3-year overall survival rates were 82%, 64% and 46%, respectively. The 1-, 2-, 3-year disease-free survival rates were 64%, 45% and 27%, respectively. The 3-year local control rate was 46%. One patient presented with lung metastases after 8 months, 7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions, only one patient had grade 2 myelosuppression; long-term grade 1-2 intestinal reactions occurred in 5 patients, and 1 patient had long-term grade 1-2 bladder reaction. All the radiation-induced toxicities were alleviated by medication administration. Conclusions:External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer, which yields reliable clinical efficacy and tolerable adverse reactions.