Objective To evaluate the difference in coronary microcirculation and short term prognosis in patients with different collateral circulation and underwent elective percutaneous coronary intervention ( PCI) with complete occlusion of coronary artery. Methods The study included 42 patients who had been admitted in our hospital for NSTEMI or STEMI between 01/2012 to 12/2015 without receiving revascularization treatment and whose symptoms persisted for over 6 months. According to the results of coronary angiography and the Rentrop grade, the patients were divided into 2 groups: poor collateral circulation formation group (group A, Rentrop=0 -1, n=17) and well established collateral circulation group (group B, Rentrop=2-3, n=25). The basic clinical data and the result of coronary angiography were compared. A pressure-temperature sensor wire was used to measure index of mierocirculatory resistance ( IMR) immediately after PCI. An echocardiograph was used to measure left ventricular end systolic diameter ( LVEDd) and left ventricular ejection fraction ( LVEF) postoperatively and again at 3 months after operation to evaluate the changes in cardiac function. Results The IMR value of group A was significantly higher than group B (P﹤0. 05), the grade of collateral circulation had negative correlation with IMR value (r=-0. 671, P﹤0. 05). The mean changes in LVEDd in 3 months in group B was -0. 28 mm, while in group A was 5. 76 mm (P﹤0. 05). The mean changes in LVEF in 3 mouths in group B was 5. 36% and in group A was -3. 82% (P﹤0. 05). The grading of coronary collateral circulation had negative correlation with the changes of LVEDd in 3 months (r= -0. 669, P﹤0. 05), but had positive correlation with the changes of LVEF (r=0. 657, P ﹤0. 05). The IMR value had positive correlation with the changes of LVEDd in 3 months (r=0. 686, P﹤0. 05), but had negative correlation with the changes of the LVEF (r= -0. 664, P﹤ 0. 05 ) . Conclusions Patients with poor collateral circulation was more prone to coronary microcirculatory injury than patients with good collateral circulation. Patients with good collateral circulation and microcirculation had better prognosis after the revascularization of the infarction-related vessel.

Objective To investigate the distribution of vaginal microbiota in women with early-onset pre-eclampsia(PE)complicated by preterm premature rupture of membranes(PPROM)and the effect of differ-ent vaginal microbiota distribution on pregnancy outcomes.Methods A total of 120 pregnant women with early-onset PE admitted to this hospital from January 2019 to January 2022 were selected as the research ob-jects.Among them,67 pregnant women complicated with PPROM were selected as the observation group,and 53 pregnant women without PPROM were selected as the control group.The distribution of vaginal microflora was compared between the two groups,and the pregnancy outcomes of patients with early-onset PE complicat-ed with PPROM were analyzed.Results In terms of dominant bacteria,the proportion of Lactobacillus in the observation group was lower than that in the control group,and the proportion of Gram-positive bacilli,Gram-negative bacilli and Gram-positive cocci in the observation group were higher than that in the control group,and the differences were statistically significant(P＜0.05).In terms of pathogenic bacteria,the proportion of Glucococcus haemolyticus and Enterobacter cloacae in the observation group were higher than that in the con-trol group,and the differences were statistically significant(P＜0.05).In terms of vaginal flora density,the proportion of Ⅱ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).In terms of the diversity of vaginal flora,the proportion ofⅡ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).The imbalance rate of vaginal microecosystem in the observation group was 80.60％,which was higher than 45.28％in the control group,and the difference was statistically signifi-cant(x2=81.340,P＜0.001).Compared with the control group,the blood pressure was higher,24 h urine volume was lower,24 h urinary protein was higher,platelet was higher,prothrombin time and activated partial thromboplastin time were prolonged in the observation group after treatment(all P＜0.05).There were 10 cases of fetal growth restriction,8 cases of fetal intrauterine distress and 4 cases of neonatal asphyxia in the observation group,and 3 cases of fetal growth restriction,1 case of fetal intrauterine distress and 0 case of neo-natal asphyxia in the control group.The incidence of perinatal complications in the observation group(32.84％)was significantly higher than that in the control group(7.55％),and the difference was statistically significant(P＜0.05).Among 67 cases of early-onset PE complicated with PPROM,54 cases had dysbiosis(dysbiosis group)and 13 cases had normal microflora(normal microflora group).The incidence of adverse pregnancy outcomes in the dysbiosis group was 81.48％,which was higher than 46.15％in the normal micro-flora group(x2=5.089,P=0.024).Compared with the normal microflora group,the neonatal birth weight of the dysbiosis group was significantly lower(t=2.196,P=0.032),and the length of hospital stay was signifi-cantly longer(t=7.463,P＜0.001).Conclusion The imbalance of vaginal flora in women with early-onset PE complicated with PPROM may lead to adverse pregnancy outcomes.In clinical practice,it is necessary to pay attention to the changes of vaginal flora and intervene in time to reduce the risk of adverse pregnancy out-comes.

Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.

Objective:To evaluate the ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters using the color Doppler ultrasound technology and to determine its clinical significance.Methods:The clinical data of 99 patients who underwent liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively. There were 81 males and 18 females, aged (51±9) years old. These patients were divided into the portal vein complication ( n=23) and the non-portal vein complication ( n=76) groups, based on whether portal vein complications had developed within 2 years after surgery. In addition, 30 healthy volunteers at the Affiliated Hospital of Qingdao University, including 16 males and 14 females, aged (40±14) years old were selected to form the control group. The patients’ morphology of liver was studied using color Doppler ultrasound at days 1, 7, 14, 30, 180, 365 and 730 after liver transplantation, and the maximum portal vein blood flow velocity and portal blood flow were recorded. Results:Compared with the control group, the maximum portal venous flow velocity and portal venous blood flow significantly increased on days 1, 7, 14, 30, and 180 after liver transplantation in the non-portal complication group (all P<0.05). With time, these changes showed a decreasing trend. By day 365 after surgery, the differences between the maximum portal venous flow velocity and the portal venous blood flow between the two groups became not significant ( P>0.05). Of the 23 patients in the portal vein complication group, 9 developed portal vein stenosis (PVS) and 14 portal vein embolism. The 9 patients with PVS had a maximum portal flow velocity of 63.8 (46.0, 78.6) cm/s at 1 month after surgery, and this flow velocity was significantly higher than that in the non-portal complication group [35.0(29.6, 41.8) cm/s, Z=-3.35, P<0.001]. The portal blood flow was 993 (887, 1168) ml/min in the 9 patients with portal vein stenosis at 1 month after surgery, and it was significantly higher than those in the non-portal complication group [811(682, 1 018) ml/min, Z=-2.37, P=0.020]. Conclusions:After liver transplantation, both the portal venous blood flow velocity and the blood flow were at high levels in the early postoperative period and they returned to normal levels with time. Ultrasound dynamic monitoring of portal venous blood flow changes was of clinical significance in diagnosing portal vein stenosis and portal vein embolism after liver transplantation.

Objective? To explore the risk factors of incontinence-associated dermatitis(IAD) in intensive care uni(t ICU) patients, so as to provide evidence for early clinical prevention of IAD. Methods? The relevant literature about IAD in ICU patients were retrieved from multiple electronic databases including Cochrane library, PubMed, Ovid Medline, Web of Science, CBM, CNKI, Wanfang Data and VIP from buiding database to November 2018. The Meta-analysis was performed after searching databases, extracting data and assessing quality of included studies using the software of RevMan 5.3. Results? Finally, 14 articles were included with totally 691 case groups, and 1 377 cases in the control group with 2 068 subjects, the incidence of IAD was 20.00%-50.00%. The results of Meta-analysis indicated that feve[r OR=1.79, 95%CI (1.43-2.26), P＜0.05], diabetes[OR=2.73, 95%C(I 1.77-4.21), P＜0.05], the use of antibiotics[OR=2.45, 95%C(I 1.71-3.53), P＜ 0.05], level of albumin[OR=-3.81, 95%C(I -4.61- -3.00), P＜ 0.05], Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score[OR=1.70, 95%C(I 0.06-3.33), P＜0.05], fecal incontinence[OR=1.80, 95%C(I 1.07-3.03), P＜ 0.05], incontinence frequency (＞ 3 times/day) [OR=1.86, 95%CI(1.56-2.22), P＜ 0.05]and watery stoo[l OR=2.22, 95%CI(1.81-2.73), P＜0.05]significantly associated with the onset of IAD. Through the sensitivity analysis of the combined effect of the fixed effect model and the random effect model, it was found that the combined effect values were close, indicating that the analysis results were robust and credible. Conclusions? According to the present evidence, the risk factors of IAD in ICU patients are fever, diabetes, antibiotics, low albumin level, high APACHE score, fecal incontinence, incontinence frequency (＞ 3 times/day) and watery stool. Medical staff should pay attention to these risk factors in clinical practice, and actively implement targeted preventive measures to reduce the incidence of IAD in ICU patients and improve the quality of nursing practice.

Dissipative structure refers to a self-organized and orderly structure that exists far from equilibrium.The human body,considered a classical example,generates negative entropy through the exchange of matter,energy,and information with the environment to counteract the increase in entropy.In this paper,we organized theories and related research on dissipative structure and entropy,discussing their significance in regulating various aspects such as the human body,cancer,aging,and more.By selecting the special population of pregnant women,focusing on the information dimension,developing the corresponding information exchange scale(Cronbach's α>0.9),and proposing the information exchange index,we preliminarily explored the influence of the dissipative structure's information dimension on pregnancy health.The results showed a negative correlation between the information exchange index and anxiety scores during pregnancy(r =-0.35,P<0.001),with an OR value of 0.26(95%CI:0.08～0.80),preliminarily confirming the feasibility of conducting empirical research based on dissipative structure theory.If further relevant empirical studies are conducted,it is expected that new disease prevention strategies will be developed and new theories and methods will be provided for the field of public health.

Objective To observe the clinical manifestations of 3 cases with myelin oligodendro-cyte glycoprotein(MOG)antibody-associated disease and anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis antibody overlapping syndrome(MNOS),aiming to expand the understanding of the clinical spectrum of such syndromes.Methods Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies.Clinical features,neuroimaging characteristics,and outcomes were collected,and cell-based assay(CBA)tech-nique was used for diagnosis.Results One case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In one case,the clinical and cranial magnetic resonance imaging(MRI)features of demyelinating disease re-curred after anti-NMDAR encephalitis,with atypical symptoms of MNOS such as numbness and weakness in limbs,blurred vision,and diplopia.The last case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In MNOS,MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially,with epilepsy being the most common symptom.Cranial MRI findings showed that the pa-tients presented and mainly involved supratentorial lesions,which may also involve the brainstem,but no spinal cord lesions were found.All patients showed slightly abnormal cerebrospinal fluid.Patients showed a good response to first-line immunotherapy during the acute phase of the disease,with a fa-vorable prognosis.But most patients were prone to relapse.Conclusion In MNOS patients,anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simul-taneously or sequentially.The clinical manifestations of patients are complex and diverse.Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.

Objective To observe the clinical manifestations of 3 cases with myelin oligodendro-cyte glycoprotein(MOG)antibody-associated disease and anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis antibody overlapping syndrome(MNOS),aiming to expand the understanding of the clinical spectrum of such syndromes.Methods Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies.Clinical features,neuroimaging characteristics,and outcomes were collected,and cell-based assay(CBA)tech-nique was used for diagnosis.Results One case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In one case,the clinical and cranial magnetic resonance imaging(MRI)features of demyelinating disease re-curred after anti-NMDAR encephalitis,with atypical symptoms of MNOS such as numbness and weakness in limbs,blurred vision,and diplopia.The last case presented both positive MOG antibodies and NMDAR antibodies,but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis.In MNOS,MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially,with epilepsy being the most common symptom.Cranial MRI findings showed that the pa-tients presented and mainly involved supratentorial lesions,which may also involve the brainstem,but no spinal cord lesions were found.All patients showed slightly abnormal cerebrospinal fluid.Patients showed a good response to first-line immunotherapy during the acute phase of the disease,with a fa-vorable prognosis.But most patients were prone to relapse.Conclusion In MNOS patients,anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simul-taneously or sequentially.The clinical manifestations of patients are complex and diverse.Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.

ObjectiveTo compare the effects of different processing methods in ancient and modern times on the chemical components of Lilii Bulbus decoction， and to provide experimental support for the origin processing， decoction piece processing and clinical application of this herb. MethodUltra high performance liquid chromatography tandem quadrupole electrostatic field orbitrap high resolution mass spectrometry（UHPLC-Q-Orbitrap HRMS） was used for structural identification of the compounds using excimer ions， secondary MS and characteristic fragment ions， and referring to relevant literature and database information. Principal component analysis（PCA） and orthogonal partial least squares discriminant analysis（OPLS-DA） were used to screen the main differential components， the differential components were quantitatively studied by high performance liquid chromatography（HPLC）， in order to compare the types and contents of chemical components in the decoction of different processing products of Lilii Bulbus. ResultA total of 24 chemical components were identified from the decoction of different processed products of Lilii Bulbus， water extract and scalding liquid of fresh Lilii Bulbus， including 17 phenols， 5 saponins and 2 alkaloids. Compared with the fresh Lilii Bulbus decoction， the contents of regaloside A， p-coumaric acid， colchicine and other components in the decoction of dry Lilii Bulbus processed by scalding method decreased， the content of regaloside C in the decoction of dry Lilii Bulbus processed by steaming method decreased， and the contents of regaloside A and regaloside C in the decoction of fresh Lilii Bulbus processed by water immersion also decreased. Compared with the decoction of dry Lilii Bulbus processed by scalding method， the overall content of components in the fresh Lilii Bulbus decoction and the decoction of fresh Lilii Bulbus processed by water immersion was higher， the contents of components in the decoction of dry Lilii Bulbus processed by steaming method was higher， except for the slightly lower content of regaloside C. ConclusionDifferent processing processes have a certain effect on the types and contents of chemical components in Lilii Bulbus decoction. Scalding process is beneficial to the preservation of Lilii Bulbus， but can cause the loss of effective components. Compared with scalding method， steaming method can prevent browning of Lilii Bulbus and reduce the loss of its active ingredients. The processing method of removing foam after overnight immersion proposed by ZHANG Zhongjing may be more conducive to the treatment of Baihe disease， which can provide reference for the clinical rational application and mechanism research of different processed products of Lilii Bulbus.