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.

OBJECTIVE: To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). METHODS: A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups ( n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups ( P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. RESULTS: In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels ( P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group ( P>0.05), there were significant differences at other time points of two groups compared to preoperative score ( P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours ( P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points ( P<0.05). No significant difference was found in Bromage motor block scores between the groups ( P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference ( P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups ( P>0.05). CONCLUSION Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Nerve Block/methods* ; Male ; Female ; Pain, Postoperative/etiology* ; Tourniquets/adverse effects* ; Prospective Studies ; Middle Aged ; Ropivacaine/administration & dosage* ; Aged ; Ultrasonography, Interventional ; Anesthetics, Local/administration & dosage* ; Pain Measurement ; Fascia ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Arthritis, Rheumatoid/surgery*

In recent years,with the advancement of microbial detection technologies,an increasing number of studies have revealed significant differences in the gut microbiota composition of kidney transplant recipients before and after surgery.These changes in the gut microbiota may influence graft function and the occurrence of post-transplant complications through a variety of factors.This article will review the research progress in the relationship between gut microbiota and kidney transplantation.It focuses on the changes in gut microbiota after kidney transplantation.The role of gut microbiota in immune regulation,drug metabolism,graft function protection,and post-transplant complications is also studied.At the same time,these effects may be of great significance in improving the short-term and long-term prognosis of kidney transplant recipients,thus providing a novel idea for further improving kidney transplant prognosis.

Objective To evaluate the predictive value of a nomogram model developed by integrating clinical and ultrasound multiparameters for HER-2-positive breast cancer.Methods This study retrospectively enrolled 343 patients with pathologically confirmed breast cancer from three medical centers and randomly divided them into training and validation cohorts.Univariate analysis,LASSO regression,and multivariate logistic regres-sion were conducted on the training set to identify independent prognostic factors and construct a nomogram model.Bootstrap resampling with 1000 iterations was performed to evaluate the model's robustness.Model calibration was assessed using calibration curves and the Hosmer-Lemeshow goodness-of-fit test.Receiver operating characteristic(ROC)curves were generated to evaluate model discrimination,and the area under the curve(AUC)along with other performance metrics were calculated.Decision curve analysis was employed to assess the clinical utility of the model,and the validation cohort was used for external validation.Results Univariate,LASSO,and multivariate regression analyses demonstrated that age,TTP(time to peak),and the presence of a filling defect sign were independent predictors of HER-2-positive breast cancer(all P<0.05).Based on these independent predictors,a nomogram model was constructed.Bootstrap validation with 1,000 resamples indicated that the model's predictive performance was stable.The Hosmer-Lemeshow test confirmed satisfactory model calibration,while the calibration curve illustrated accurate prediction probabilities.The area under the curve(AUC)for the training set was 0.863(95%CI:0.806～0.920),and for the validation set,it was 0.846(95%CI:0.764～0.929),indicating strong discriminative and generalization capabilities.Additionally,the clinical decision curve analysis demonstrated favor-able clinical utility.Conclusion A nomogram model integrating clinical and multimodal ultrasound parameters demonstrates potential utility in predicting HER-2-positive breast cancer.

Objective:To explore latent class of symptoms related to psychological trauma and characteristics in patients with pregnancy loss, and to analyze the related influencing factors.Methods:From July 2022 to June 2024, a convenience sampling method was used to select 709 cases of pregnancy loss patients who visited the Maternity Department of the First Affiliated Hospital of Zhengzhou University as the survey subjects. The survey was conducted using the general information questionnaire, the post-traumatic stress disorder (PTSD) self-assessment scale, the hospital anxiety and depression scale, and the pittsburgh sleep index scale. Exploratory latent class analysis (LCA) of symptoms related to psychological trauma was performed by Mplus8.3, and then multivariate logistic regression was used to identify the factors influencing the latent classes.Results:A total of 691 patients with pregnancy loss were eventually investigated, with a total PTSD score of 24.00 (19.00, 33.00), a total anxiety score of 6.00 (3.00, 9.00), a total depression score of 6.00 (3.00, 9.00), and a total sleep disorder score of 7.00 (4.00, 9.00). Symptoms related to psychological trauma could be classified into 3 potential categories named high symptom group [20.4% (141/691)], anxiety-depression group [15.3% (106/691)] and low symptom group [64.3% (444/691)]. The result of multivariate logistic regression analysis showed that per capita monthly household income >8 000 yuan ( OR=0.477, 95% CI: 0.272-0.835, P=0.010) and having a spouse accompanying the patient at the time of admission ( OR=0.352, 95% CI: 0.234-0.532, P<0.001) were protective factors for the high symptom group, and gestational week≥28 weeks ( OR=3.192, 95% CI: 1.619-6.292, P=0.001) and assisted reproductive pregnancy ( OR=1.877, 95% CI: 1.075-3.277, P=0.027) were risk factors for the high symptom group. Conclusion:Symptoms associated with psychological trauma in patients with pregnancy loss have distinct categorical characteristics, and healthcare professionals should focus on patients with pregnancy loss in the high symptom group during hospitalization, and adopt targeted interventions according to the symptoms related to psychological trauma in different categories of patients with pregnancy loss in order to avoid serious psychological problems.

Objective To investigate the occupational health status of the radiation workers in Xiamen, China, and provide direction and basis for improvement of occupational health surveillance. Methods After excluding duplicate records, a total of 7000 individuals who underwent occupational health examinations due to radiation exposure in Xiamen City from 2022 to 2023 were selected. Among them, 2499 individuals underwent examinations before employment, 4090 during employment, and 411 at the time of job separation. The results were analyzed. Results A total of 6979 (99.7%) individuals were deemed fit to engage (or continue engaging) in radiation work or to leave the position, while 21 (0.3%) individuals were found unfit. In the routine medical examinations of different genders, the items with relatively high abnormal rates included overweight and obesity (35.22%, χ² = 43.29, P < 0.01), abnormal liver function (33.74%, χ² = 153.53, P < 0.01), abnormal renal function (25.83%, χ² = 195.22, P < 0.01), and hyperuricemia (24.53%, χ² = 267.78, P < 0.01). For all of these items, the abnormality rates were significantly higher in males than in females. The abnormal rates of examination items related to radiation hazard factors were generally higher for females than for males. Statistically significant gender differences were observed in lens abnormality rate (χ² = 11.38, P < 0.001), the decrease rate of white blood cells (χ² = 12.04, P < 0.001), the abnormal rate of red blood cells (χ² = 25.47, P < 0.01), the abnormal rate of platelets (χ² = 88.07, P < 0.01), and the micronucleus rate of peripheral blood lymphocytes (χ² = 6.98，P = 0.008). The difference in micronucleus rate of peripheral blood lymphocytes among groups with different years of radiation exposure was statistically significant, and the rate increased with increasing exposure years. Conclusion Long-term exposure to radiation has a certain impact on the health of radiation workers. Radiation workers should enhance radiation protection measures, increase the awareness of protection, and reduce radiation-related damage.

Objective:To explore latent class of symptoms related to psychological trauma and characteristics in patients with pregnancy loss, and to analyze the related influencing factors.Methods:From July 2022 to June 2024, a convenience sampling method was used to select 709 cases of pregnancy loss patients who visited the Maternity Department of the First Affiliated Hospital of Zhengzhou University as the survey subjects. The survey was conducted using the general information questionnaire, the post-traumatic stress disorder (PTSD) self-assessment scale, the hospital anxiety and depression scale, and the pittsburgh sleep index scale. Exploratory latent class analysis (LCA) of symptoms related to psychological trauma was performed by Mplus8.3, and then multivariate logistic regression was used to identify the factors influencing the latent classes.Results:A total of 691 patients with pregnancy loss were eventually investigated, with a total PTSD score of 24.00 (19.00, 33.00), a total anxiety score of 6.00 (3.00, 9.00), a total depression score of 6.00 (3.00, 9.00), and a total sleep disorder score of 7.00 (4.00, 9.00). Symptoms related to psychological trauma could be classified into 3 potential categories named high symptom group [20.4% (141/691)], anxiety-depression group [15.3% (106/691)] and low symptom group [64.3% (444/691)]. The result of multivariate logistic regression analysis showed that per capita monthly household income >8 000 yuan ( OR=0.477, 95% CI: 0.272-0.835, P=0.010) and having a spouse accompanying the patient at the time of admission ( OR=0.352, 95% CI: 0.234-0.532, P<0.001) were protective factors for the high symptom group, and gestational week≥28 weeks ( OR=3.192, 95% CI: 1.619-6.292, P=0.001) and assisted reproductive pregnancy ( OR=1.877, 95% CI: 1.075-3.277, P=0.027) were risk factors for the high symptom group. Conclusion:Symptoms associated with psychological trauma in patients with pregnancy loss have distinct categorical characteristics, and healthcare professionals should focus on patients with pregnancy loss in the high symptom group during hospitalization, and adopt targeted interventions according to the symptoms related to psychological trauma in different categories of patients with pregnancy loss in order to avoid serious psychological problems.

In recent years,with the advancement of microbial detection technologies,an increasing number of studies have revealed significant differences in the gut microbiota composition of kidney transplant recipients before and after surgery.These changes in the gut microbiota may influence graft function and the occurrence of post-transplant complications through a variety of factors.This article will review the research progress in the relationship between gut microbiota and kidney transplantation.It focuses on the changes in gut microbiota after kidney transplantation.The role of gut microbiota in immune regulation,drug metabolism,graft function protection,and post-transplant complications is also studied.At the same time,these effects may be of great significance in improving the short-term and long-term prognosis of kidney transplant recipients,thus providing a novel idea for further improving kidney transplant prognosis.

Objective To evaluate the predictive value of a nomogram model developed by integrating clinical and ultrasound multiparameters for HER-2-positive breast cancer.Methods This study retrospectively enrolled 343 patients with pathologically confirmed breast cancer from three medical centers and randomly divided them into training and validation cohorts.Univariate analysis,LASSO regression,and multivariate logistic regres-sion were conducted on the training set to identify independent prognostic factors and construct a nomogram model.Bootstrap resampling with 1000 iterations was performed to evaluate the model's robustness.Model calibration was assessed using calibration curves and the Hosmer-Lemeshow goodness-of-fit test.Receiver operating characteristic(ROC)curves were generated to evaluate model discrimination,and the area under the curve(AUC)along with other performance metrics were calculated.Decision curve analysis was employed to assess the clinical utility of the model,and the validation cohort was used for external validation.Results Univariate,LASSO,and multivariate regression analyses demonstrated that age,TTP(time to peak),and the presence of a filling defect sign were independent predictors of HER-2-positive breast cancer(all P<0.05).Based on these independent predictors,a nomogram model was constructed.Bootstrap validation with 1,000 resamples indicated that the model's predictive performance was stable.The Hosmer-Lemeshow test confirmed satisfactory model calibration,while the calibration curve illustrated accurate prediction probabilities.The area under the curve(AUC)for the training set was 0.863(95%CI:0.806～0.920),and for the validation set,it was 0.846(95%CI:0.764～0.929),indicating strong discriminative and generalization capabilities.Additionally,the clinical decision curve analysis demonstrated favor-able clinical utility.Conclusion A nomogram model integrating clinical and multimodal ultrasound parameters demonstrates potential utility in predicting HER-2-positive breast cancer.

Objective:To explore the application effects of application of rehabilitation care decision-making scheme based on case management model in severe burn patients.Methods:The study was a non-randomized historical control study. Thirty patients who met the inclusion criteria and received routine rehabilitation nursing in the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the hospital) from April 2021 to March 2022 were included in routine rehabilitation nursing group (26 males and 4 females, aged 48.50 (31.75, 56.25) years), and 30 patients who met the inclusion criteria and received case management rehabilitation nursing in the hospital from April 2022 to March 2023 were included in case management rehabilitation nursing group (22 males and 8 females, aged 46.00 (36.75, 55.25) years). The length of intensive care unit (ICU) stay, total hospitalization day, and total hospitalization cost of the patients in two groups were recorded. At admission, convalescence, discharge, and 6 months after injury, the patients' life quality was evaluated by the concise burn specific health scale, the sleep quality was evaluated by the Pittsburgh sleep quality index, and the functional independence was evaluated by the functional independence rating scale. At convalescence, discharge, and 6 months after injury, the patients' scar status was evaluated by the Vancouver scar scale. At 6 months after injury, a third-party satisfaction questionnaire was used to investigate the efficacy satisfaction of patients.Results:The length of ICU stay and total hospitalization day of patients in case management rehabilitation nursing group were both significantly shorter than those in routine rehabilitation nursing group (with Z values of -1.97 and -1.99, respectively, P<0.05), and the total hospitalization cost was less than that in routine rehabilitation nursing group ( Z=-1.99, P<0.05). At discharge and 6 months after injury, the life quality scores of patients in case management rehabilitation nursing group were significantly higher than those in routine rehabilitation nursing group (with t values of -3.19 and -4.43, respectively, P<0.05), while the sleep quality scores were significantly lower than those in routine rehabilitation nursing group (with Z values of -2.18 and -3.33, respectively, P<0.05). There were no statistically significant differences in cognitive function scores of functional independence of patients between the 2 groups at admission, convalescence, discharge, and 6 months after injury ( P>0.05). The exercise function scores and total scores of functional independence of patients in case management rehabilitation nursing group at convalescence, discharge, and 6 months after injury were significantly higher than those in routine rehabilitation nursing group (with Z values of -4.37, -2.73, -4.10, -4.37, -2.64, and -4.06, respectively, P<0.05). The scar pigmentation scores of patients in case management rehabilitation nursing group at 6 months after injury were significantly lower than those in routine rehabilitation nursing group ( Z=-2.05, P<0.05), and the scar vascularity scores of patients in case management rehabilitation nursing group at discharge and 6 months after injury in case management rehabilitation nursing group were significantly lower than those in routine rehabilitation nursing group (with Z values of -3.16 and -2.07, respectively, P<0.05). The scar pliability scores (with Z values of -3.16, -2.45, and -4.38, respectively, P<0.05), thickness scores (with Z values of -2.56, -2.35, and -4.70, respectively, P<0.05), and total scores (with Z values of -3.77, -3.04, and -3.13, respectively, P<0.05) of patients in case management rehabilitation nursing group at convalescence, discharge, and 6 months after injury were significantly lower than those in routine rehabilitation nursing group. At 6 months after injury, the efficacy satisfaction scores of patients in case management rehabilitation nursing group were 4.00 (3.00, 4.25), which were significantly higher than 3.00 (2.00, 4.00) in routine rehabilitation nursing group ( Z=-2.72, P<0.05). Conclusions:The implementation of rehabilitation care decision-making scheme based on case management model can optimize the cost efficiency, improve the effectiveness of clinical treatment, and enhance the life quality and satisfaction of the curative effect of severe burn patients.