The strategy of pelvic lymph node dissection in patients with localized intermediate- and high-risk prostate cancer（PCa）has been one of the research hotspots in recent years. This review synthesizes recent progress in clinical，diagnostic imaging and immunological aspects of pelvic lymph node dissection.It is found that the detection rate of metastatic lymph nodes in patients with localized intermediate-risk PCa is relatively low，and the survival benefit after dissection is not significant. PSMA PET/CT examination can be used instead of lymph node dissection for staging. Extended lymph node dissection in patients with localized high-risk PCa can achieve a higher detection rate of metastatic lymph nodes and possible survival benefits. However，excessive lymph node dissection can weaken the response ability to immunotherapy. The strategy for pelvic lymph node dissection in patients with localized intermediate-high-risk PCa needs further study.

Objective To explore the prognostic value of plasma sST2 in the population of coronary heart disease(CHD)complicated with chronic kidney disease(CKD).Methods A total of 326 elderly patients with CHD or CKD undergoing physical examination in the Second Medical Center of Chinese PLA General Hospital from April 2021 to July 2022 were continuously enrolled,and according to whether having CHD or CKD,they were divided into a CHD-CKD comorbidity group(n=117),a CHD group(n=124),and a CKD group(n=85).Their baseline data were compared,and the plasma concentration of sST2 was detected using chemiluminescence assay.Multiple linear regression analysis was used to identify the relevant factors of sST2.Kaplan-Meier survival curve and Cox proportional hazards regression analyses were applied to determine the impact of plasma sST2 on all-cause mortality and major adverse cardiovascular events(MACE).Results There were significant differences among the three groups in terms of age,sST2 and NT-proBNP levels,Log(NT-proBNP),eGFR,ratios of hyperuricemia,cerebral infarction,tumors,and using anti-platelet drugs and statins,PR interval,LVEF,and TC,TG,HDL-C and Hb levels(P＜0.05,P＜0.01).Multiple linear regression analysis showed that the sST2 level was positively correlated with logNT-proBNP and negatively with Hb level in the comorbidity group(t=2.266,P=0.025;t=-2.235,P=0.021).Kaplan-Meier survival curve analysis indicated that during a median fol-low-up of 31.5(22.0,32.2)months,the comorbidity group had a lower survival rate than the two single-disease groups(P＜0.05,P＜0.01),and higher incidence of MACEs than the CKD group(P＜0.01).ROC curve analysis suggests that the AUC value of sST2 in predicting all-cause mor-tality in the comorbid group was 0.692.Cox proportional hazards regression model revealed that after adjustment for cofounders,sST2 was still an independent risk factor for all-cause mortality in the comorbid patients(HR=4.461,95％CI:1.640-8.399,P=0.024),although this prognos-tic value may be influenced by NT-proBNP.Conclusion sST2 can independently predict the risk of mortality in elderly patients with CHD-CKD comorbidity.

ObjectiveTo construct a large language model （LLM）-based intelligent pre-consultation system for traditional Chinese medicine （TCM） to improve efficacy of clinical practice. MethodsA TCM large language model was fine-tuned using DeepSpeed ZeRO-3 distributed training strategy based on YAYI 2-30B. A weighted undirected graph network was designed and an agent-based syndrome differentiation model was established based on relationship data extracted from TCM literature and clinical records. An agent collaboration framework was developed to integrate the TCM LLM with the syndrome differentiation model. Model performance was comprehensively evaluated by Loss function， BLEU-4， and ROUGE-L metrics， through which training convergence， text generation quality， and language understanding capability were assessed. Professional knowledge test sets were developed to evaluate system proficiency in TCM physician licensure content， TCM pharmacist licensure content， TCM symptom terminology recognition， and meridian identification. Clinical tests were conducted to compare the system with attending physicians in terms of diagnostic accuracy， consultation rounds， and consultation duration. ResultsAfter 100 000 iterations， the training loss value was gradually stabilized at about 0.7±0.08， indicating that the TCM-LLM has been trained and has good generalization ability. The TCM-LLM scored 0.38 in BLEU-4 and 0.62 in ROUGE-L， suggesting that its natural language processing ability meets the standard. We obtained 2715 symptom terms， 505 relationships between diseases and syndromes， 1011 relationships between diseases and main symptoms， and 1 303 600 relationships among different symptoms， and constructed the Agent of syndrome differentiation model. The accuracy rates in the simulated tests for TCM practitioners， licensed pharmacists of Chinese materia medica， recognition of TCM symptom terminology， and meridian recognition were 94.09%， 78.00%， 87.50%， and 68.80%， respectively. In clinical tests， the syndrome differentiation accuracy of the system reached 88.33%， with fewer consultation rounds and shorter consultation time compared to the attending physicians （P＜0.01）， suggesting that the system has a certain pre- consultation ability. ConclusionThe LLM-based intelligent TCM pre-diagnosis system could simulate diagnostic thinking of TCM physicians to a certain extent. After understanding the patients' natural language， it collects all the patient's symptom through guided questioning， thereby enhancing the diagnostic and treatment efficiency of physicians as well as the consultation experience of the patients.

Objective To analyze the epidemiological characteristics and immunization history of pertussis cases in Yichang City, Hubei Province from 2018 to 2023. Methods Data on the incidence and immunization history of pertussis cases were collected in Yichang City from 2018 to 2023, and the epidemiological characteristics was analyzed and described. Results A total of 109 cases of pertussis were reported in Yichang from 2018 to 2023, and the annual average reported incidence rate was 0.45/100,000. The incidence rate reported in each year was between 0～1.58/100,000. The area with the highest annual reported incidence rate was Xiling District (1.19/100,000). There was a statistically significant difference in the incidence rate between different years (χ²=208.26, P < 0.001). The annual reported incidence rate showed a significant increasing trend (χ² trend =125.71, P < 0.001). The ratio of male to female cases was 1.22. There was no significant difference in the annual reported incidence rates between males and females (χ²=0.85, P=0.36). Children aged 3-9 years accounted for 60.55%. Students and scattered children accounted for 45.87% and 36.70%, respectively. Before the onset of the disease, 72.48% had a history of immunization with pertussis-containing vaccine, and 27.52% had no history of immunization. The shortest interval between the last dose of pertussis-containing vaccine and the onset of the disease was 8 days, the longest was 4057 days, and the median was 1882 days. Conclusion From 2018 to 2023, the reported incidence of pertussis in Yichang City has been on the rise, with the majority of cases occurring in children and students under the age of 9. It is recommended to strengthen pertussis disease monitoring.

Objective To assess the effectiveness of the Regulations on Medical Dispute Prevention and Resolution(hereafter referred to as the Regulations)and to provide evidence-based recommendations for enhancing the legal governance sys-tem of medical dispute management.Methods A cross-sectional study was conducted involving physicians,nurses,techni-cians,clinical department directors,and head nurses.The investigation was conducted through literature review,questionnaire surveys,and expert interviews.Factor analysis and chi-square tests were employed for statistical analysis.Results Significant differences(P＜0.01)were observed among healthcare practitioners in Guangxi concerning their understanding of the Regula-tions,preferences for dispute resolution methods,implementation of informed consent,and risk intervention practices.However,no significant differences emerged in medical quality and safety evaluations or recommendations for surgical accident insurance.Conclusion This study suggests it is a need to refine the legal framework for medical dispute prevention and resolution.It is rec-ommended to strengthen medical personnel's compliance with informed consent obligations and deepen their understanding of rel-evant laws and regulations.Efforts should be intensified to promote third-party mediation mechanisms such as the Medical Dispute Mediation Committee(MedMC)and medical accident insurance coverage.Additionally,pre-dispute risk assessments should be enhanced,and a risk early intervention model integrating artificial intelligence,healthcare practices,and legal regulations should be established.

Background and Aims:Gastroesophageal reflux disease(GERD)is a common complication following sleeve gastrectomy(SG),particularly in patients with concomitant hiatal hernia,where symptoms tend to be more persistent and refractory,significantly impairing postoperative quality of life.This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia,providing clinical reference for revisional surgical strategies.Methods:The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital,Fudan University,between January 2023 and June 2024 were retrospectively analyzed.GerdQ scores,proportion of endoscopically confirmed reflux esophagitis,and proton pump inhibitor(PPI)usage were compared before and after surgery.Surgical parameters and follow-up outcomes were also recorded.Results:All patients successfully completed the surgery without major intraoperative complications,and the mean postoperative hospital stay was 5.22 d.After a mean follow-up period of 15.27 months,the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48.The proportion of patients with GerdQ score≥8 decreased from 100.00％to 44.44％,and the rate of endoscopically confirmed GERD dropped from 88.89％to 11.11％;PPI use also significantly declined,with all differences reaching statistical significance(all P＜0.05).Conclusion:Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia,demonstrating favorable short-term efficacy and high safety.This approach may be a preferable surgical option for selected patients.

Hyperuricemia is a chronic metabolic disease resulting from purine metabolic dysfunction and is classified under the category of"blood turbidity"in traditional Chinese medicine.Our team termed it"acid turbidity,"and its pathogenesis is closely related to the dynamic evolution of the clear and the turbid components.With the change of modern people's diet structure,the incidence of hyperuricemia is increasing annually owing to the intake of fatty,sweet foods and alcohol.Therefore,this paper explores hyperuricemia from the"indigestion of spleen and stomach"theory.The core pathogenesis of hyperuricemia is indigestion of spleen and stomach,the inversion of clear and turbid substances,and endogenous acid turbidity.The initial manifestation of hyperuricemia is the internal retention of acid turbidity and ascending-descending disharmony;the gradual manifestation of this disease is that indigestion causes heat,and acid turbidity transforms into poison;the final manifestation of this disease is that secular indigestion causes deficiency and the inversion of clear and turbid substances.It can be summarized into three syndromes:syndromes of internal retention of dampness-turbidity,dampness-heat toxin amassment,and dampness-heat due to spleen deficiency.Therefore,this paper proposes to treat the disease according to different syndromes,with ascending the clear and descending the turbid as the core of treatment.And the therapeutic approach employs the flexible application of three methods:transportation,resolving,and transformation.For syndrome of internal retention of dampness-turbidity,treatment focuses on promoting spleen transportation to eliminate dampness;for syndrome of dampness-heat toxin amassment,the strategy is to resolve indigestion and purge heat;and for syndrome of dampness-heat due to spleen deficiency,the aim is to resolve turbidity and clear heat.By ascending the clear and descending the turbid,so that"returning the clear and the turbid to the original,"the spleen and stomach regain harmony,functions of ascending and descending are reestablished,and hyperuricemia can be effectively managed.

The strategy of pelvic lymph node dissection in patients with localized intermediate- and high-risk prostate cancer（PCa）has been one of the research hotspots in recent years. This review synthesizes recent progress in clinical，diagnostic imaging and immunological aspects of pelvic lymph node dissection.It is found that the detection rate of metastatic lymph nodes in patients with localized intermediate-risk PCa is relatively low，and the survival benefit after dissection is not significant. PSMA PET/CT examination can be used instead of lymph node dissection for staging. Extended lymph node dissection in patients with localized high-risk PCa can achieve a higher detection rate of metastatic lymph nodes and possible survival benefits. However，excessive lymph node dissection can weaken the response ability to immunotherapy. The strategy for pelvic lymph node dissection in patients with localized intermediate-high-risk PCa needs further study.

Hyperuricemia is a chronic metabolic disease resulting from purine metabolic dysfunction and is classified under the category of"blood turbidity"in traditional Chinese medicine.Our team termed it"acid turbidity,"and its pathogenesis is closely related to the dynamic evolution of the clear and the turbid components.With the change of modern people's diet structure,the incidence of hyperuricemia is increasing annually owing to the intake of fatty,sweet foods and alcohol.Therefore,this paper explores hyperuricemia from the"indigestion of spleen and stomach"theory.The core pathogenesis of hyperuricemia is indigestion of spleen and stomach,the inversion of clear and turbid substances,and endogenous acid turbidity.The initial manifestation of hyperuricemia is the internal retention of acid turbidity and ascending-descending disharmony;the gradual manifestation of this disease is that indigestion causes heat,and acid turbidity transforms into poison;the final manifestation of this disease is that secular indigestion causes deficiency and the inversion of clear and turbid substances.It can be summarized into three syndromes:syndromes of internal retention of dampness-turbidity,dampness-heat toxin amassment,and dampness-heat due to spleen deficiency.Therefore,this paper proposes to treat the disease according to different syndromes,with ascending the clear and descending the turbid as the core of treatment.And the therapeutic approach employs the flexible application of three methods:transportation,resolving,and transformation.For syndrome of internal retention of dampness-turbidity,treatment focuses on promoting spleen transportation to eliminate dampness;for syndrome of dampness-heat toxin amassment,the strategy is to resolve indigestion and purge heat;and for syndrome of dampness-heat due to spleen deficiency,the aim is to resolve turbidity and clear heat.By ascending the clear and descending the turbid,so that"returning the clear and the turbid to the original,"the spleen and stomach regain harmony,functions of ascending and descending are reestablished,and hyperuricemia can be effectively managed.

Objective To investigate the relationship between serum soluble suppression of tumori-genicity 2(sST2)and cardiac diastolic function in elderly patients with coronary heart disease(CHD)and chronic kidney disease(CKD).Methods A total of 116 elderly CHD patients suffer-ing from CKD taking physical examinations at the Second Medical Center of Chinese PLA General Hospital from April 2021 to July 2022 were recruited,and according to their serum sST2 level,they were divided into high sST2 group(＞28.65 μg/L,58 cases)and low sST2 group(≤28.65μg/L,58 cases).The baseline data of all subjected patients were collected,including N-terminal pro-B-type natriuretic peptide(NT-proBNP),as well as peak early diastolic mitral flow velocity(E),peak early diastolic mitral annular velocity(e'),isovolumetric relaxation time(IVRT)and some other indicators in echocardiography.Serum sST2 level was measured using chemilumines-cence assay.Pearson correlation analysis and multiple linear regression analysis were used for analysis.Results The high sST2 group had significantly larger proportion of diabetes and usingβ-blockers,higher levels of sST2,urea and logNT-proBNP,increased left ventricular mass index,thicker left ventricular posterior wall thickness,and elevated E/e'and IVRT,and lower levels of hemoglobin and triacylglycerol,and decreased e'value when compared with the low sST2 group(P＜0.05,P＜0.01).The correlation analysis showed that sST2 was positively correlated with taking β-blockers,urea and logNT-proBNP levels,and E/e'ratio(r=0.226,P=0.015;r=0.362,P=0.001;r=0.374,P=0.001;r=0.257,P=0.005),and negatively correlated with triglycerides,hemoglobin and e'value(r=-0.227,P=0.014;r=-0.314,P=0.001;r=-0.203,P=0.029).Multiple linear regression analysis displayed that sST2 was linearly correlated with triglycerides,urea and NT-proBNP levels,and E/e'(P＜0.05,P＜0.01).Conclusion Serum sST2 level is cor-related with cardiac diastolic function in elderly patients with comorbidities of CHD and CKD.