OBJECTIVE To investigate the application status of prescription pre-review systems in healthcare institutions of Yunnan province， evaluate their system functions and management capabilities， and provide a practical basis for promoting rational drug use. METHODS A questionnaire survey was conducted among public healthcare institutions at or above the secondary level in Yunnan province to investigate the deployment status of the systems. A capability maturity assessment framework was constructed， encompassing 6 dimensions and 39 indicators， including real-time prescription review， prescription correlation review， rule setting， evidence-based information support， prescription authority management， and system operation management. This framework was then used to evaluate the institutions that had implemented the pre-review systems. RESULTS A total of 100 valid questionnaires were collected， with 37 institutions having adopted prescription pre-review systems， mainly tertiary hospitals. The system predominantly adopted a modular architecture and was embedded into the hospital information system through application programming interfaces and middleware， providing certain capabilities for real-time prescription risk identification. Evaluation results indicated that basic functions such as reviewing indications， contraindications， and drug compatibility performed well， while deficiencies remained in functions related to parenteral nutrition prescription， review of drug dosage for specific diseases， individual patient characteristic recognition， and rule setting. Moreover， the construction of review centers and establishment of management systems were also not well-developed. CONCLUSIONS The overall application rate of prescription pre-review systems in Yunnan province remains low. System functions and management mechanisms require further improvement. It is recommended to enhance information infrastructure in lower-level institutions and explore regionally unified review models to promote standardized and intelligent development of prescription review practices.

Objective To explore the efficacy and safety of treatment of intramural ureteral tumors via transurethral resection. Methods A retrospective analysis was conducted on the clinical data of 26 patients with ureteral cancer who underwent transurethral resection of intramural ureteral tumors at the First Affiliated Hospital of Naval Medical University from May 2020 to May 2023. All patients were treated using the “outer-wedge, inner-rotation” resection technique, with ureteral stents placed intraoperatively. Clinical indicators including operation time, intraoperative blood loss, length of postoperative hospital stay, ureteral stent indwelling duration, intraoperative and postoperative complications, postoperative pathological results, and bladder tumor recurrence rate were analyzed. Results All surgeries were successfully completed. The operation time was 45(35, 60) min, intraoperative blood loss was 5(3, 10) mL, length of postoperative hospital stay was 4(3, 5) d, and the ureteral stent indwelling duration was (33.8±9.7) d. All patients did not experience intraoperative complications, the postoperative hydronephrosis rate was 3.8%. Postoperative pathology confirmed urothelial carcinoma in all cases, including 6 cases of stage pT_a, 16 cases of pT₁, and 4 cases of pT_2a. The follow-up period ranged from 12 to 48 months. Intravesical recurrence occurred in 2 patients, and recurrence rate was 7.7%. There were no tumor-related deaths during the follow-up period. Conclusions Transurethral resection of intramural ureteral tumors is minimally invasive, resulting in less blood loss, and has low rates of postoperative complications such as hydronephrosis and hydroureter. It achieves favorable surgical outcomes while better preserving renal function.

Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.

Acute kidney injury (AKI) is one of the most common and severe nephropathy syndromes in clinical practice and also one of the most common serious complications after organ transplantation, with high incidence and fatality. Iron is an essential trace element in the body. Ferroptosis is a form of programmed cell death induced by the accumulation of iron-mediated lipid peroxidation, and its occurrence is closely related to iron metabolism, lipid metabolism, amino acid metabolism and multiple signaling pathways. Recent studies have shown that ferroptosis plays a key role in the occurrence and development of AKI and provides therapeutic targets for AKI. This article summarizes the regulatory mechanism of ferroptosis and its role in AKI, as well as the compounds that play an important role in the prevention and treatment of AKI by inhibiting ferroptosis, providing new ideas for the future treatment and research of AKI.

Objective:To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus.Methods:This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age ( M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results:Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy ( P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively ( P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively ( P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions:HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients′ survival.

Objective:To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus.Methods:This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age ( M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results:Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy ( P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively ( P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively ( P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions:HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients′ survival.

This paper investigated the corresponding relationships between wuji （无极）， taiji （太极）， yin-yang （阴阳） and certain mathematical concepts， i.e. wuji directly corresponds to the empty set， the number 0 and the intial origin； taiji corresponds to the universe set， the number 1 and the unit circle； yin-yang directly corresponds to the binary opposition division of universe set， the combination of numbers or characters 0 and 1， and the binary division of unit circle （into upper and lower semicircles， or left and right semicircles）. In addition， the definitions of set descrication， set partitioning， and the set of basic equations （in a generalised sense） for yin and yang were given. The relationships between two set equations A⋂B=∅, A⋃B=I  and unity of opposites were discussed， and the relationships between yin-yang sets and mutual complementary sets， oppositional events of yin and yang were explored. The basic properties of yin-yang sets are illustrated by the definition of yin-yang set partitioning， so as to reveal the basic laws of yin-yang transformation.

Based on the knowledge background of ancient Chinese technology， including odd-even numbers to yin-yang， diurnal （day-night） cycle and annual （four seasons） cycle， changes of solar light manifestation and land surface temperature， a method of deduction and verification for Hetu （《河图》） and Luoshu （《洛书》） was proposed in this paper. To ensure the scientific rigor of research， the equivalent numbers to yin-yang were defined， and the diurnal as well as annual cycle models under coordinate system were constructed. On this basis， the Hetu and the Luoshu were derived by means of the variation regulations of solar irradiance and surface atmospheric temperature within one day and one year， which provided a solid foundation for the correct comprehension and application of Hetu and Luoshu. In addition， it was proved that Hetu and Luoshu could be derived from each other by using the equivalent numbers to yin-yang， which means the feature of unity. Multiple equivalent numerical forms for Hetu and Luoshu were presented.

The primordial Bagua （eight trigrams） diagram derived from the eight combinations formed with three lines of yin-symbols and/or yang-symbols， as the hexagrams， with the yin-yang variation regulations of the hexagrams as the basis. The symbolic representations of primordial Bagua diagram， of binary numerical system， and of odd-even numbers to yin-yang and of all their interrelations were discussed. Similarly， the relationship between the primordial Bagua diagram and Hetu （《河图》） and Luoshu （《洛书》） were discussed. The logic of the primordial Bagua diagram and Hetu Luoshu is rigorous， reflecting the pattern of change of the solar irradiance and surface atmosphere temperature in the daily and yearly cycles， and they can be derived from each other， which explains the unity of the theoretical foundations of Chinese culture， including traditional Chinese medicine， at the root. In addition， the evolution process of the primordial to the manifested Bagua diagram was analyzed from two aspects， including concrete multi-factoral analysis and abstract coordinate rotation transformation. This paper also discussed interrelations involving the Hetu and Luoshu and the five phases， and also provided the unifying explanation for the following concepts of "the earth governs four seasons"， "the earth governs four extremities"， "the earth governs long summer".

This paper presented a unifying derivation based on the yin-yang manifesting-subduing ascending-descending model， leading to Hetu （《河图》）， Luoshu （《洛书》）， the primordial Bagua diagram， and taiji diagram. From the geometric generative models of concepts including wuji， taiji， yin-yang， three elements， four images and five phases， we discussed the yin-yang manifesting-subduing ascending-descending model with details， and further derived the basic model for expressing changes of yin-yang. Such yin-yang change basic model could be divided into discrete and continuous change. Discrete changes include quadratic， octonionic， and fractional models. Continuous changes include circular motion models and simple harmonic vibration models. From the quadratic model， the Hetu and Luoshu could be deduced. From the octonionic model， the primordial Bagua diagram， Hetu and Luoshu could be deduced. From the simple harmonic vibration model， taiji diagram and the basic laws of motion of yin and yang could be deduced. Finally， a logical framework for modern formulation of yin-yang theory was given.