The endogenous microorganism in paridis rhizoma mainly includes bacteria and fungi,and shows different physiological activities,such as microorganism inhibition and anti-tumor activity. The principal active substance steroid saponin in paridis rhizoma can be generated from the fermentation liquor of some endogenous bacteria,and the chemical structure of vancomycin and progesterone can be transformed by the endophyte. It is supposed that paridis rhizoma may benefit from the attributions of the endogenous bacteria against illness and environment changes. It would also benefit in productivity, transformation and modification of the other active sub-metabolites and compounds in paridis rhizoma. Thus,it is valuable in drug development and source insufficiency alleviation of Chinese medicines through separation,identification,screening and clone of the endogenous microorganism in paridis rhizoma.

ObjectiveTo investigate the clinical significance of inflammatory factors and adiponectin in type 2 diabetes milletus complicated with non-alcoholic fatty liver disease.Methods Two hundred and ten subjects aging from 25.0 to 65.0 years old,including 106 men and 104 women,were recruited into this study.They were divided into four groups: Forty cases of healthy control (NC),60 cases with newly-diagnosed type 2 diabetes (T2DM),65 cases with simple non-alcoholic fatty liver disease (NAFLD) and other 45 cases with newly-diagnosed T2DM complicated with NAFLD.The physical examination was performed for each patient.Serum levels of alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),fasting plasma glucose (FPG),glycation hemoglobin A 1 c ( GHbA1c ),creatinine ( Cr),uric acid ( UA ),2 hours postprandic plasma glucose (2hPG),fasting insulin (FINS),lipid profiles were measured.Insulin resistance index (HOMAIR) was calculated.Tumor necrosis factor-α (TNF-α),high sensitive C-reactive protein (hs-CRP) and adiponectin were also detected.Results The serum levels of ALT and GGT,body mass index and waist/hip ratio were higher in the NAFLD,T2DM with NAFLD patient groups than that in T2DM and NC group ( P ＜0.05or P ＜0.01 ).The serum levels of TG and LDL-C were significantly higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.And serum TG levels in T2DM with NAFLD group were higher than that of T2DM group (P ＜ 0.05).FPG and GHbAl c were higher in T2DM and T2DM with NAFLD groups than that of NAFLD and NC groups.The serum levels of TNF-α,hs-CRP and HOMA-IR were higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.T2DM with NAFLD group had higher levels of TNF-α,hs-CRP and HOMA-IR compared with T2DM group.However,serum adiponectin levels of T2DM,NAFLD and T2DM with NAFLD groups were lower than that of NC group.And it was lower in T2DM with NAFLD group when compared with NC group ( P ＜ 0.05 ).Adiponectin was negatively associated with TNF-α,hs-CRP and HOMA-IR (r =-0.635,-0.668,-0.752 respectively,P ＜ 0.0l ).But HOMA-IR was positively associated with TNF-α,hs-CRP( r =0.667,0.706 respectively,P ＜ 0.01 ).ConclusionInflammatory factors and adiponectin may play important roles in the pathophysiology and progression of T2DM and NAFLD.The protective effects of adiponectin may come from its anti-inflammatory activity to relieve insulin resistance for NAFLD.

[Objective] To investigate the clinical characteristics and risk factors of lower-extremity arterial disease in the patients with newly diagnosed type 2 diabetes mellitus combined with nonalcoholic fatty liver disease (NAFLD). [Methods] One hundred fifty-one patients were investigated respectively. The patients were divided into two groups (NAFLD-Group and non-NAFLD group) by liver ultrasonography and disease history, then their clinical data were collected and compared in order to find the differences of biochemical indicators and the morbidity of lower-extremity arterial disease between two groups. [Results] Ninety-two cases (60.93%) were complicated with NAFLD. NAFLD group had higher levels of fast insulin and C peptide level, postprandial insulin and C peptide level, uric acid, body mass index (BMI), homeostasis model assessment (HOMA-IR) and lower level of high-density lipoprotein cholesterol and insulin sensitive index than those of without NAFLD (P<0.05). One hundred and one cases(66.89%) were complicated with lower-extremity arterial disease. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group (75% vs. 54.24%, P<0.01). [Conclusion] Both lower-extremity arterial disease and NAFLD are common complicated with type 2 diabetes. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group.

Objective To study the effects of thymus transplantation(TT)combined with CD4--DLI on T cell reconstitution after allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods BALB/c mice were randomly divided into three groups:hematopoietic stem cell transplantation (HSCT group),hematopoietic stem cell transplantation combined with thymus transplantation(TT group)and hematopoietic stem cell transplanta-tion combined with thymus transplantation plus CD4+ T cell-depleted lymphocyte infusion(CD4--DLI group). On day-1,the mice were treated with the lethal dose of radiotherapy. On day 0,C57BL/6 mice were used as donor for hematopoietic stem cell transplantation. The mice were sacrificed on 5 days,2 weeks,4 weeks and 3 months after transplantation,respectively. The peripheral blood and spleen cells of mice were collected for determinations of T cell surface antigen,T cell receptor,naive T cells and intracellular cytokines. HE staining was used to assess the development of donor thymus. Results TT and CD4--DLI did not impair each other′s effects on T cell reconstitu-tion. TT combined with CD4--DLI increased the number of T cell reconstruction. CD4--DLI promoted the effect of TT on enlargement naive CD4+and CD8+T cell pool. Combination of TT and CD4--DLI enhanced the cytokine pro-duction of T cells. Conclusion TT combined with CD4--DLI had no side effects on TCR repertoire and thymus. Conclusion TT combined with CD4--DLI can enhance the reconstitution of T cell number and function via thymus dependent and thymus independent mechanism.

Objective To summarize the clinical features,diagnosis and treatment and prognosis of trocar site hernia(TSH).Methods Clinical data of 12 patients with TSH receiving laparoscopic surgery from January 2019 to January 2023 were retrospectively analyzed.The clinical manifestations included intestinal obstruction in 8 cases,trocar incision prolongation with fluid seepage in 1 case,and no obvious symptoms in 3 cases.The patients were diagnosed by abdominal CT in 9 cases,by small intestine contrast imaging in 1 case,by abdominal MRI in 1 case,and by abdominal plain film combined with abdominal color ultrasound in 1 case.The hernia was located in the right lower abdomen in 5 cases,the left lower abdomen in 4 cases,and the right upper abdomen in 3 cases.The trocar diameter was 12 mm in 6 cases,10 mm in 5 cases,and 5 mm in 1 case.A drainage tube was placed at trocar site in 5 cases.Open operations were performed in 11 cases,including small intestine reduction and abdominal wall layer-by-layer suture in 4 cases,partial small intestine resection and anastomosis in 3 cases,Onlay repair in 3 cases,and partial omentectomy,transverse colon reduction and Onlay repair in 1 case.Another case developed trocar site refractoriness which did not heal,and the patient refused surgery,who was given dynamic observation.Results The operation was successful in the 11 cases.Postoperatively,1 case of inflammatory intestinal obstruction underwent intestinal decompression tube implantation,1 case of incision bleeding underwent emergency operation again to stop bleeding,and the rest recovered smoothly.All the 12 patients were followed up for 5-48 months,with a median of 13 months.The patient without surgery had persistent induration and intermittent exudation at the trocar site.One case died due to tumor metastasis,and none of the others had hernia recurrence.Conclusions The most common manifestation of TSH is intestinal obstruction,which mostly occurs at trocar with diameter≥10 mm.If there are symptoms,it should be treated by surgery as soon as possible.

Objective To analyze the impact of controlled hypotension(CH)by cerebral oxy-gen saturation(rSO2)monitoring on brain protection and cognitive function in anesthetized patients.Methods A total of 200 patients undergoing rSO2-monitored CH were enrolled.Patients were divid-ed into normal group(n=137)and postoperative neurocognitive disorder(PND)group(nt=63)based on whether they developed PND after surgery.Preoperative clinical data were collected.Univa-riate analysis was performed to identify factors influencing the occurrence of PND in rSO2-monitored CH patients.Multivariate binary logistic regression analysis was used to screen for independent risk factors.A predictive model was constructed based on the identified independent risk factors,and its predictive value was evaluated using receiver operating characteristic(ROC)curve analysis.Results Age,intr-aoperative blood loss,vascular surgery,20-minute rSO2 monitoring values,20-minute central venous pressure(C VP),history of hypertension,stroke and operative time were identified as factors affecting the occurrence of PND in rSO2-monitored CH patients(P＜0.05).Independent risk factors for PND included age＞55 years,high CVP during 20 minutes of surgery,low rSO2 monitoring values during 20 minutes and undergoing vascular surgery(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)for the predictive model was 0.855.Conclusion Clinically,the risk of PND in rSO2-monitored CH patients(age＞55 years,undergoing vascular surgery)can be reduced by controlling intraoperative CVP to minimize blood loss and by timely adjustment of treatment plans based on rSO2 monitoring results.

Objective To analyze the impact of controlled hypotension(CH)by cerebral oxy-gen saturation(rSO2)monitoring on brain protection and cognitive function in anesthetized patients.Methods A total of 200 patients undergoing rSO2-monitored CH were enrolled.Patients were divid-ed into normal group(n=137)and postoperative neurocognitive disorder(PND)group(nt=63)based on whether they developed PND after surgery.Preoperative clinical data were collected.Univa-riate analysis was performed to identify factors influencing the occurrence of PND in rSO2-monitored CH patients.Multivariate binary logistic regression analysis was used to screen for independent risk factors.A predictive model was constructed based on the identified independent risk factors,and its predictive value was evaluated using receiver operating characteristic(ROC)curve analysis.Results Age,intr-aoperative blood loss,vascular surgery,20-minute rSO2 monitoring values,20-minute central venous pressure(C VP),history of hypertension,stroke and operative time were identified as factors affecting the occurrence of PND in rSO2-monitored CH patients(P＜0.05).Independent risk factors for PND included age＞55 years,high CVP during 20 minutes of surgery,low rSO2 monitoring values during 20 minutes and undergoing vascular surgery(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)for the predictive model was 0.855.Conclusion Clinically,the risk of PND in rSO2-monitored CH patients(age＞55 years,undergoing vascular surgery)can be reduced by controlling intraoperative CVP to minimize blood loss and by timely adjustment of treatment plans based on rSO2 monitoring results.

Objective:To translate Lee's Visual Analogue Scale for Fatigue (VAS-F) into Chinese, and test its reliability and validity in patients with acute pancreatitis.Methods:We performed translation, back translation and cultural debugging of Lee's VAS-F to form the Chinese version of VAS-F. The expert consultation was used to evaluate the content validity of VAS-F. Convenient sampling was used to select 322 inpatients with acute pancreatitis in the Department of Hepatobiliary Surgery in Affiliated Hospital of Zunyi Medical University from November 2019 to December 2020. The General Information Questionnaire, the Chinese version of VAS-F and the Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) were used for investigation. The discrimination test was used for item analysis, and the reliability and validity of the Chinese version of VAS-F were evaluated through Cronbach's α coefficient, content validity index, exploratory factor analysis, and Pearson correlation analysis.Results:The Chinese version of the VAS-F contained two subscales, namely the Fatigue Severity (13 items) and the Energy Level (5 items) . The Cronbach's α coefficient of the total scale was 0.843, and the Cronbach's α coefficients of the two subscales were 0.965 and 0.959, respectively. The scale-level content validity index of the total scale and the two subscales were 0.89, 0.85 and 1.00, respectively, and the item-level content validity index of each item was from 0.83 to 1.00. After exploratory factor analysis, only one common factor was extracted from the two subscales, and the variance contribution rates were 71.196% and 86.135%, respectively. The factor loads of each item of the two subscales ranged from 0.698 to 0.859 and from 0.852 to 0.906, respectively. The scores of two subscales were negatively correlated ( r=-0.604, P<0.01) , and the total score of Fatigue Severity subscale was negatively correlated with the FACIT-F score ( r=-0.897, P<0.01) . Among 322 patients with acute pancreatitis, there were 3 cases (0.93%) without fatigue, 41 cases (12.73%) with mild fatigue, 181 cases (56.21%) with moderate fatigue and 97 cases (30.12%) with severe fatigue. Conclusions:The Chinese version of VAS-F has good reliability and validity and can be used to measure the fatigue and energy level of patients with acute pancreatitis in China.

Objective To investigate the training expectations and training strategies of orthopedic clinical specialist nurses (OCSN).Methods Totally 5 020 orthopedic nurses from 342 hospitals from 30 provinces and cities were selected bv convenience sampling.Participants were investigated hy WeChat platform with self-designed questionnaire.Results A total of 4 982 effective questionnaires were collected.Among investigated nurses,13.7％ of them received orthopedic specialist nurses training;91.4％ believed that training should be carried out.Qualifications should be:college degree and above,senior nurse and above,at least 3 ～5 years of nursing experience,1～3 years of nursing experience in orthopedic department.For curriculum,public courses expected to be arranged were communieation skills,nursing teaching,nursing management,and nursing research;expected professional courses were functional exercises,pain management,extremity injury nursing,common treatment techniques in orthopedic department,traction nursing,and position nursing.It was suggested that training was divided into subspecialties and off-duty;classroom teaching,teaching rounds,case discussion and experience exchange were expected training methods;"theory-practice-theory-practice" was most preferable traiuing mode.The preferred teachers were orthopedic doctors,orthopedic head nurses,orthopedic specialist nurses,and senior orthopedic nurses.The length of training was expected to be three months,time for clinical practice should be greater than or equal to theoretical teaching,and the practice bases should be tertiary hospitals.Evaluation should be performed before completion,recertification could be later than completion,and the interval time of recertification should be within 5 years.Conclusion Training needs of orthopedic nurses for OCSN are strong.Training expectations(contents,length,modes and teachers) of orthopedic nurses should be considered when designing systematic training program on OCSN.

Post-intensive care syndrome (PICS) is the most common complication in patients discharged from intensive care unit (ICU), which seriously affects the life quality of the patients. At present, there is still lack of standardevaluation methods for PICS. Continuous and dynamic assessment can earlyidentify PICS, moreover, early identification and intervention of PICS can improve the life quality of patients those patients, which is critical to improve the long-term outcome of the patients. In this paper, we reviewed the current research states of evaluation timing, contents, tools and modalities of PICS domestic and abroad, analyzed the problems and prospects of the existing evaluation methods, aiming to provide a reference for clinical staff to effectively and comprehensively evaluate PICS.