Objective:To explore differences in the radiation-induced intestinal injury in mice exposed to ultra-high dose rate (FLASH) and conventional-dose-rate (CONV) pulsed X-ray irradiation in order to provide evidence for the application of ultra-high dose rate pulsed X-rays in gastrointestinal radiotherapy.Methods:Using the random number table method, 32 C57BL/6J mice were randomly divided into four groups: a sham irradiation group (SHAM), two conventional dose rate groups (CONV0.067 and CONV0.1), and an ultra-high dose rate group (F215), with each group containing eight mice. All groups, except SHAM, received a single 12 Gy abdominal X-ray irradiation at dose rates of 0.067, 0.1, and 215 Gy/s, respectively. At 3 d post-irradiation, histopathological (hematoxylin-eosin staining, HE staining), immunohistochemical, and Western blot analysis were performed to assess the histopathological markers and oxidative stress indicators of intestinal tissues, as well as relevant proteins involved in signaling pathways.Results:At 3 d post-irradiation, mice in all irradiation groups suffered from varying degrees of intestinal tissue degeneration and necrosis, epithelial cell shedding, villus shortening, and crypt loss ( t = 5.75, 8.79, 5.71, P < 0.05). Regarding oxidative stress, at 3 d post-irradiation, mice in the CONV0.067 and CONV0.1 groups showed significantly lower levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX), glutathione (GSH), and total antioxidant capacity (T-AOC) compared to those in the F215 group ( t = 7.06-10.64, P < 0.01). In contrast, their malondialdehyde (MDA) levels were significantly elevated ( t = 11.06, 8.31, P < 0.01), with no statistical significance observed between them and mice in the F215 group ( P > 0.05). Immunohistochemical and Western blot analyses indicated that at 3 d post-irradiation, mice in the three irradiation groups exhibited an upward trend in the Nrf2 and HO-1 protein levels and a downward trend in the Keap1 protein level compared to those in the SHAM group. Notably, statistical significance was observed between the F215 group and the two conventional dose rate groups ( t = 4.89-20.95, P < 0.05). These result were consistent with the prior changes in antioxidant markers. Conclusions:Ultra-high-dose-rate X-ray irradiation reduces acute RIII by alleviating oxidative stress and modulating the expression of the Keap1-Nrf2-HO-1 signaling pathway.

BACKGROUND:Angiogenesis is the main treatment target of cardiovascular diseases.Bone morphogenetic protein 2 can modulate angiogenesis,but the regulatory effect of endothelial cell-specific bone morphogenetic protein 2 on angiogenesis is unclear. OBJECTIVE:To investigate the effect of endothelial-specific bone morphogenetic protein 2 on angiogenesis. METHODS:(1)Bioinformatics analysis:Cellular expression specificity and abundance of bone morphogenetic protein 2 were meta-analyzed by the PanglaoDB single-cell transcriptome database.The endothelial cell transcriptome sequencing dataset of the mouse hindlimb model and endocardial transcriptome dataset of mice overexpressing bone morphogenetic protein 2 were reanalyzed to evaluate the effect of endothelial cell bone morphogenetic protein 2 on the angiogenesis pathway.(2)Validation in vivo:After establishing the mouse hindlimb model,we compared the blood perfusion between the affected and sham limb at 7,14,and 21 days.The expression of the colocation of bone morphogenetic protein 2 and CD31 was explored by immunofluorescence and immunohistochemical staining.(3)Validation in vitro:The cultured human umbilical vein endothelial cells in vitro were divided into a control group,a hypoxia group,and a bone morphogenetic protein 2 inhibitor Noggin intervention group.After being cultured for 24 hours,the angiogenesis of endothelial cells in each group was observed. RESULTS AND CONCLUSION:(1)Endothelial cells are an important cell subgroup expressing bone morphogenetic protein 2.Both in the mouse hindlimb ischemia model and endocardial cells overexpressing bone morphogenetic protein 2,bone morphogenetic protein 2 was significantly up-regulated,and the angiogenesis pathway was significantly activated.(2)In the mouse hindlimb model,bone morphogenetic protein 2-positive blood vessels around neoangiogenesis increased significantly at 7 days of ischemia(P<0.05),and decreased significantly after 2 weeks of ischemia(P<0.001).(3)In umbilical vein endothelial cells cultured in vitro,after hypoxic intervention,the migration and sprouting of endothelial cells increased significantly,and the expression of angiogenesis factors vascular endothelial growth factor and platelet-derived growth factor was significantly increased.Noggin significantly reduced hypoxia-induced endothelial cell angiogenesis(P<0.001)and down-regulated the expression of vascular endothelial growth factor and platelet-derived growth factor(P<0.01).(4)These findings verify that endothelial cell-specific bone morphogenetic protein 2 can regulate angiogenesis,and targeting endothelial cell bone morphogenetic protein 2 is a promising way to improve angiogenesis.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma.Methods:A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared.Results:A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups ( P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant ( χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm2/min VS cecum group 0.24 cm2/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion:Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.

Objective:To explore differences in the radiation-induced intestinal injury in mice exposed to ultra-high dose rate (FLASH) and conventional-dose-rate (CONV) pulsed X-ray irradiation in order to provide evidence for the application of ultra-high dose rate pulsed X-rays in gastrointestinal radiotherapy.Methods:Using the random number table method, 32 C57BL/6J mice were randomly divided into four groups: a sham irradiation group (SHAM), two conventional dose rate groups (CONV0.067 and CONV0.1), and an ultra-high dose rate group (F215), with each group containing eight mice. All groups, except SHAM, received a single 12 Gy abdominal X-ray irradiation at dose rates of 0.067, 0.1, and 215 Gy/s, respectively. At 3 d post-irradiation, histopathological (hematoxylin-eosin staining, HE staining), immunohistochemical, and Western blot analysis were performed to assess the histopathological markers and oxidative stress indicators of intestinal tissues, as well as relevant proteins involved in signaling pathways.Results:At 3 d post-irradiation, mice in all irradiation groups suffered from varying degrees of intestinal tissue degeneration and necrosis, epithelial cell shedding, villus shortening, and crypt loss ( t = 5.75, 8.79, 5.71, P < 0.05). Regarding oxidative stress, at 3 d post-irradiation, mice in the CONV0.067 and CONV0.1 groups showed significantly lower levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX), glutathione (GSH), and total antioxidant capacity (T-AOC) compared to those in the F215 group ( t = 7.06-10.64, P < 0.01). In contrast, their malondialdehyde (MDA) levels were significantly elevated ( t = 11.06, 8.31, P < 0.01), with no statistical significance observed between them and mice in the F215 group ( P > 0.05). Immunohistochemical and Western blot analyses indicated that at 3 d post-irradiation, mice in the three irradiation groups exhibited an upward trend in the Nrf2 and HO-1 protein levels and a downward trend in the Keap1 protein level compared to those in the SHAM group. Notably, statistical significance was observed between the F215 group and the two conventional dose rate groups ( t = 4.89-20.95, P < 0.05). These result were consistent with the prior changes in antioxidant markers. Conclusions:Ultra-high-dose-rate X-ray irradiation reduces acute RIII by alleviating oxidative stress and modulating the expression of the Keap1-Nrf2-HO-1 signaling pathway.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma.Methods:A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared.Results:A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups ( P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant ( χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm2/min VS cecum group 0.24 cm2/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion:Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.

Objective:To investigate the internal structure and determinants of hospitalization expenses for uterine leiomyoma patients in DRG pilot and non-DRG pilot hospitals in Beijing,to fumish insights for the forthcoming phase of public hospital reform.Methods:The statistical data of 5 DRG pilot hospitals and 124 non-DRG pilot hospitals in Beijing from 2015 to 2021 were collected to analyze the correlation degree between each detail expense and the average hospitalization expense by using grey correlation analysis,and the influencing factors of the average hospitalization expense of hospitalized patients by using random forest model.Results:The results of the grey correlation analysis revealed that the highest correlations affecting hospitalization expense in the DRG pilot hospital group and the non-DRG pilot hospital group were the average expense in each surgical treatment and the average drug costs for each patient,respectively,and the lowest was the average expense of inspection and test in each patient.The results of random forest model showed that the top two influencing factors of DRG pilot hospital group were consumption ratio and the average length of hospitalization,while the average length of hospitalization,surgical treatment expense ratio and consumption ratio are more important than other influential factors of non-DRG pilot hospital group.Conclusion:DRG payment is conducive to optimizing the hospitalization expense structure of uterine leiomyoma hospitalized patients.The average length of hospitalization,consumption ratio,and surgical treatment expense ratio are important factors affecting the hospitalization expense of uterine leiomyoma hospitalized patients.Public hospitals should continue to optimize the expense structure in the future,pay equal attention to"reducing expenditure"and"open source",implement DRG payment and its supporting measures to enhance the efficiency of medical services,reinforce the comprehensive management of consumables,and empower hospitals and medical personnel.

Objective:To investigate the internal structure and determinants of hospitalization expenses for uterine leiomyoma patients in DRG pilot and non-DRG pilot hospitals in Beijing,to fumish insights for the forthcoming phase of public hospital reform.Methods:The statistical data of 5 DRG pilot hospitals and 124 non-DRG pilot hospitals in Beijing from 2015 to 2021 were collected to analyze the correlation degree between each detail expense and the average hospitalization expense by using grey correlation analysis,and the influencing factors of the average hospitalization expense of hospitalized patients by using random forest model.Results:The results of the grey correlation analysis revealed that the highest correlations affecting hospitalization expense in the DRG pilot hospital group and the non-DRG pilot hospital group were the average expense in each surgical treatment and the average drug costs for each patient,respectively,and the lowest was the average expense of inspection and test in each patient.The results of random forest model showed that the top two influencing factors of DRG pilot hospital group were consumption ratio and the average length of hospitalization,while the average length of hospitalization,surgical treatment expense ratio and consumption ratio are more important than other influential factors of non-DRG pilot hospital group.Conclusion:DRG payment is conducive to optimizing the hospitalization expense structure of uterine leiomyoma hospitalized patients.The average length of hospitalization,consumption ratio,and surgical treatment expense ratio are important factors affecting the hospitalization expense of uterine leiomyoma hospitalized patients.Public hospitals should continue to optimize the expense structure in the future,pay equal attention to"reducing expenditure"and"open source",implement DRG payment and its supporting measures to enhance the efficiency of medical services,reinforce the comprehensive management of consumables,and empower hospitals and medical personnel.

Objective:To investigate the internal structure and determinants of hospitalization expenses for uterine leiomyoma patients in DRG pilot and non-DRG pilot hospitals in Beijing,to fumish insights for the forthcoming phase of public hospital reform.Methods:The statistical data of 5 DRG pilot hospitals and 124 non-DRG pilot hospitals in Beijing from 2015 to 2021 were collected to analyze the correlation degree between each detail expense and the average hospitalization expense by using grey correlation analysis,and the influencing factors of the average hospitalization expense of hospitalized patients by using random forest model.Results:The results of the grey correlation analysis revealed that the highest correlations affecting hospitalization expense in the DRG pilot hospital group and the non-DRG pilot hospital group were the average expense in each surgical treatment and the average drug costs for each patient,respectively,and the lowest was the average expense of inspection and test in each patient.The results of random forest model showed that the top two influencing factors of DRG pilot hospital group were consumption ratio and the average length of hospitalization,while the average length of hospitalization,surgical treatment expense ratio and consumption ratio are more important than other influential factors of non-DRG pilot hospital group.Conclusion:DRG payment is conducive to optimizing the hospitalization expense structure of uterine leiomyoma hospitalized patients.The average length of hospitalization,consumption ratio,and surgical treatment expense ratio are important factors affecting the hospitalization expense of uterine leiomyoma hospitalized patients.Public hospitals should continue to optimize the expense structure in the future,pay equal attention to"reducing expenditure"and"open source",implement DRG payment and its supporting measures to enhance the efficiency of medical services,reinforce the comprehensive management of consumables,and empower hospitals and medical personnel.

Objective:To investigate the internal structure and determinants of hospitalization expenses for uterine leiomyoma patients in DRG pilot and non-DRG pilot hospitals in Beijing,to fumish insights for the forthcoming phase of public hospital reform.Methods:The statistical data of 5 DRG pilot hospitals and 124 non-DRG pilot hospitals in Beijing from 2015 to 2021 were collected to analyze the correlation degree between each detail expense and the average hospitalization expense by using grey correlation analysis,and the influencing factors of the average hospitalization expense of hospitalized patients by using random forest model.Results:The results of the grey correlation analysis revealed that the highest correlations affecting hospitalization expense in the DRG pilot hospital group and the non-DRG pilot hospital group were the average expense in each surgical treatment and the average drug costs for each patient,respectively,and the lowest was the average expense of inspection and test in each patient.The results of random forest model showed that the top two influencing factors of DRG pilot hospital group were consumption ratio and the average length of hospitalization,while the average length of hospitalization,surgical treatment expense ratio and consumption ratio are more important than other influential factors of non-DRG pilot hospital group.Conclusion:DRG payment is conducive to optimizing the hospitalization expense structure of uterine leiomyoma hospitalized patients.The average length of hospitalization,consumption ratio,and surgical treatment expense ratio are important factors affecting the hospitalization expense of uterine leiomyoma hospitalized patients.Public hospitals should continue to optimize the expense structure in the future,pay equal attention to"reducing expenditure"and"open source",implement DRG payment and its supporting measures to enhance the efficiency of medical services,reinforce the comprehensive management of consumables,and empower hospitals and medical personnel.

Objective:To investigate the internal structure and determinants of hospitalization expenses for uterine leiomyoma patients in DRG pilot and non-DRG pilot hospitals in Beijing,to fumish insights for the forthcoming phase of public hospital reform.Methods:The statistical data of 5 DRG pilot hospitals and 124 non-DRG pilot hospitals in Beijing from 2015 to 2021 were collected to analyze the correlation degree between each detail expense and the average hospitalization expense by using grey correlation analysis,and the influencing factors of the average hospitalization expense of hospitalized patients by using random forest model.Results:The results of the grey correlation analysis revealed that the highest correlations affecting hospitalization expense in the DRG pilot hospital group and the non-DRG pilot hospital group were the average expense in each surgical treatment and the average drug costs for each patient,respectively,and the lowest was the average expense of inspection and test in each patient.The results of random forest model showed that the top two influencing factors of DRG pilot hospital group were consumption ratio and the average length of hospitalization,while the average length of hospitalization,surgical treatment expense ratio and consumption ratio are more important than other influential factors of non-DRG pilot hospital group.Conclusion:DRG payment is conducive to optimizing the hospitalization expense structure of uterine leiomyoma hospitalized patients.The average length of hospitalization,consumption ratio,and surgical treatment expense ratio are important factors affecting the hospitalization expense of uterine leiomyoma hospitalized patients.Public hospitals should continue to optimize the expense structure in the future,pay equal attention to"reducing expenditure"and"open source",implement DRG payment and its supporting measures to enhance the efficiency of medical services,reinforce the comprehensive management of consumables,and empower hospitals and medical personnel.