Objective To analyze risk factors for diabetic kidney disease (DKD) in inpatients with type 2 diabetes.Methods A total of 930 inpatients with type 2 diabetes were enrolled in the study and grouped according to different levels of estimated glomerular filtration rate (eGFR),albuminuria,and diabetic retinopathy.Logistic regression analysis was adopted to explore the risk factors for DKD in inpatients with type 2 diabetes.Results (1) The prevalence of albuminuria in patients with type 2 diabetes mellitus was increased with declining eGFR (P ＜ 0.05).(2) The prevalences of DKD and non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus were 22.26％ and 8.92％,respectively.Compared with patients with NDRD,patients with DKD had longer diabetic duration,higher levels of systolic blood pressure,serum creatinine,and urinary albumin excretion,and lower levels of hemoglobin[(125.40 ± 21.95 vs 138.18 ± 19.67) g/L],serum albumin[(37.45 ± 5.54 vs 40.55 ± 3.55) g/L],and eGFR[(89.66 (59.10-108.25) vs 103.15 (85.39-114.88) ml · min-1 · (1.73 m2)-1,all P＜0.05].(3) Logistic regression analysis showed that age,diabetic duration,systolic blood pressure,serum uric acid,diabetic retinopathy,and hypertension are the independent risk factors for diabetic kidney disease in inpatients with type 2 diabetes,while serum albumin was the protective factor (all P＜0.01).Conclusions A variety of clinic risk factors were associated with DKD.Better control of blood pressure,serum uric acid,and hypoalbuminemia should be performed to delay the progress of DKD.

Objective: To explore the anesthetic effect of low dose remifentanil in patients undergoing sequential painless gastroscopy and painless colonoscopy in accordance with intravenous induction of propofol. Methods: From July 2017 to January 2018, 86 patients who needed painless gastroscopy and painless colonoscopy in sequence were selected as observation objects in the Second Hospital of Jiaxing and were divided into control group and observation group according to random number table method, with 43 cases in each group.The control group was anesthetized with propofol only, while the observation group was anesthetized with low dose remifentanil in accordance with propofol.The occurrence of adverse reactions and recovery were compared between the two groups. Results: The incidence rate of adverse reactions of the control group was 20.93%(9/43), which of the observation group was 13.95%(6/43), there was no statistically significant difference between the two groups (χ²=0.272, P=394). The recovery time and the observation time after awakening in the observation group were (7.19±1.98)min and (6.94±2.04)min, respectively, which were significantly shorter than those in the control group [(10.33±2.42)min and (11.69±3.21)min], the differences were statistically significant (t=6.585, 8.190, P=0.000, 0.000). Conclusion Intravenous induction with low dose remifentanil combined with propofol in patients undergoing painless gastroscopy and painless colonoscopy in sequence has less adverse reactions, good anesthesia persistence and short recovery time, which is worthy of clinical popularization.

Objective:To evaluate the effectiveness of Simplified Airway Risk Index (SARI) score in predicting difficult airway in Chinese patients.Methods:One thousand and three hundred patients of both sexes, aged 18-90 yr, with American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing tracheal intubation with the laryngoscope under general anaesthesia, were enrolled in this study.SARI scores (including 7 evaluation items: mouth opening, thyromental distance, Mallampati classification, neck mobility, mandibular protrusion, body weight, and history of difficulty in tracheal intubation) were determined before anesthesia induction.The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy.Results:The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult tracheal intubation were 0.91 (0.89-0.93), 0.84 (0.82-0.86), 0.81 (0.79-0.83) and 0.83 (0.80-0.85), respectively.The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult laryngoscopy were 0.90 (0.88-0.91), 0.79 (0.76-0.81), 0.76 (0.74-0.78) and 0.73 (0.70-0.75), respectively.The AUC of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy was significantly larger than that of the mouth opening, modified Mallampati classification and thyromental distance ( P<0.05). Conclusion:The SARI score produces better efficacy in predicting tracheal intubation and difficult laryngoscopy in Chinese patients.

Objective To evaluate the effect of the LEMON method in predicting difficult air-way.Methods A total of 1 528 patients scheduled for elective surgery requiring tracheal intubation under general anaesthesia,680 males and 848 females,aged 18-83 years,ASA physical status Ⅰ orⅡ,were enrolled in the study.We used the LEMON method to assess airway conditions before an-aesthesia and recorded the scores.The primary end point was difficult tracheal intubation.The sec-ondary end point was difficult laryngoscopy.Receiver operating characteristic (ROC)curve analysis and the area under the curve (AUC)were used to evaluate the clinical effect of the LEMON mothod. Results There were 37 cases with difficult tracheal intubation and 106 cases with difficult laryngosco-py.The incidence of difficult tracheal intubation and difficult laryngoscopy were 2.4% and 6.9%,re-spectively.The area under the curve of the LEMON method for predicting difficult laryngoscopy and difficult tracheal intubation were 0.884 (95% CI 0.867-0.899)and 0.934 (95% CI 0.921-0.946), respectively.Conclusion The LEMON method has good clinical effect in predicting difficult airway.

Advances in high-throughput sequencing (HTS) have fostered rapid developments in the field of microbiome research, and massive microbiome datasets are now being generated. However, the diversity of software tools and the complexity of analysis pipelines make it difficult to access this field. Here, we systematically summarize the advantages and limitations of microbiome methods. Then, we recommend specific pipelines for amplicon and metagenomic analyses, and describe commonly-used software and databases, to help researchers select the appropriate tools. Furthermore, we introduce statistical and visualization methods suitable for microbiome analysis, including alpha- and beta-diversity, taxonomic composition, difference comparisons, correlation, networks, machine learning, evolution, source tracing, and common visualization styles to help researchers make informed choices. Finally, a step-by-step reproducible analysis guide is introduced. We hope this review will allow researchers to carry out data analysis more effectively and to quickly select the appropriate tools in order to efficiently mine the biological significance behind the data.

ObjectiveBased on the experience of traditional quality evaluation， the quality of Atractylodis Macrocephalae Rhizoma（AMR） with different production methods such as direct seeding， transplanting after seedling raising， topping and non-topping， and difference in growth years was compared. MethodVernier caliper was used to measure the trait data of AMR in different production methods. Paraffin sections of AMR with different production methods were made by saffron solid green staining， and the microstructure was observed. The contents of water-soluble and alcohol-soluble extracts in AMR with different production methods were determined according to the 2020 edition of Chinese Pharmacopoeia. The content of water-soluble total polysaccharides in AMR with different production methods was detected by sulfuric acid-anthrone method. Fiber analyzer was used to detect the content of fiber components in AMR with different production methods. The contents of monosaccharides， oligosaccharides and some secondary metabolites in AMR with different production methods were detected by ultra performance liquid chromatography（UPLC）， and the differences of chemical components were compared by multivariate statistical analysis methods such as principal component analysis（PCA） and partial least squares-discriminant analysis（PLS-DA）. ResultIn terms of traits， the 3-year-old AMR with direct seeding and without topping was close to the high-quality AMR with "phoenix-head and crane-neck， strong sweetness and clear aroma" recorded in ancient materia medica， followed by the 3-year-old AMR with topping after transplanting， while the 2-year-old AMR with topping after transplanting with high market circulation rate was generally fat and strong with mild odor. In the microscopic aspect， the arrangement of xylem vessels and fiber bundles in the 3-year-old samples formed two obvious rings. Compared with the 2-year-old samples cultivated in Bozhou and Zhejiang， the 3-year-old samples without topping after transplanting had more wood fibers. In terms of chemical composition， the contents of 70% ethanol extract， fructose， glucose， sucrose， 1-kestose， atractylenolide Ⅰ， chlorogenic acid， neochlorogenic acid， cryptochlorogenic acid and other components in 3-year-old AMR with direct seeding and without topping were significantly higher than those in the other three samples（P<0.05）. The contents of cellulose， 70% ethanol extract， sucrose， atractylenolide Ⅰ， atractylone and other components in 3-year-old AMR with topping after transplanting were significantly higher than those in the 2-year-old AMR with high market circulation rate（P<0.05）， while the contents of water-soluble extract and water-soluble total polysaccharides in 2-year-old samples with topping after transplanting were significantly higher than those in the 3-year-old AMR with topping after transplanting， direct seeding and without topping（P<0.05）. ConclusionUnder the current mainstream production mode， too much manual intervention makes AMR heavily enriched in polysaccharides and increased the yield， but the accumulation of sweet substances， fragrant substances and fiber substances is insufficient， which affects its quality. The current quality standard of AMR has some shortcomings in guiding the high quality production of it， it is suggested to revise the quality standard of AMR， supplement the quantitative analysis of secondary metabolites， and strengthen the production of imitation wild AMR.