ObjectiveTo investigate the changes of intestinal microbiota in type 2 diabetic diarrhea （T2DD） patients with dampness-heat syndrome and spleen-kidney deficiency syndrome. MethodT2DD patients who were admitted to the Department of Endocrinology Ⅰ of the Affiliated Hospital of Shaanxi University of Chinese Medicine from March 2020 to May 2021 were selected， including 14 patients with type 2 diabetes mellitus （T2DM）， 12 T2DD patients with dampness-heat syndrome， and 13 T2DD patients with spleen-kidney deficiency syndrome. Twelve healthy subjects receiving medical examination were selected as control group. Their body mass index （BMI）， fasting plasma glucose （FPG）， 2 h postprandial blood glucose （2 h PBG） and glycosylated hemoglobin （HbA1c） were compared. Fecal samples were collected for DNA extraction to build a database. High-throughput 16S rDNA sequencing was used to compare the composition of intestinal microbiota and the differential bacteria among the four groups. ResultCompared with the conditions in control group， the levels of FPG， 2 h PBG and HbA1c in the other groups were increased （P<0.05）. Alpha diversity showed no significant difference in species richness， evenness and diversity of intestinal microbiota among the groups. Beta diversity indicated that intestinal microbiota tended to be consistent in each group， and there was no marked difference between groups. The top 5 phylum by relative abundance were Bacteroidetes，Proteobacteria， Firmicutes， Actinobacteria， and Fusobacteria， among which，Bacteroidetes， Proteobacteria and Firmicutes were dominant. Compared with the control group， the three diabetic groups had elevated relative abundance of Bacteroidetes while decreased relative abundance of Firmicutes. The relative abundance of Actinomycetes in spleen-kidney deficiency T2DD group was significantly higher than that in the other groups， and the relative abundance of Firmicutes and Fusobacteria in the dampness-heat T2DD group was significantly lower than that in the other groups. At the genus level， the top 10 bacteria by relative abundance were Phocaeicola， Bacteroides， Pseudescherichia， Prevotella， Bifidobacterium， Faecalibacterium， Fusobacterium， Roseburia， Citrobacter， and Cetobacterium. LEfSe analysis revealed that the relative abundance of Prevotella， Mediterraneibacter， Parabacteroides， and Fusicatenibacter in diabetic patients was remarkably higher than that in healthy patients. Bacteroides and Sutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome， while Faecalibacterium， Limosilactobacillus， Eubacterium， Gemmiger， Enterocloster， Alistipes， Parasutterella and Oscillibacter might be the characteristic microbiota of T2DD patients with spleen-kidney deficiency syndrome. ConclusionBacteroides and Parasutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome and spleen-kidney deficiency syndrome， respectively. This paper provided reference for studying the mechanism， diagnosis and treatment of modern traditional Chinese medicine for T2DD of dampness-heat type and spleen-kidney deficiency type.

Objective:To investigate the current situation of medical social worker supervision in Shanghai, for reference to promote the high-quality development of medical social work.Methods:From June to July 2022, a questionnaire survey was conducted on the in-service medical social workers in all medical institutions with medical social work departments or posts in Shanghai. The questionnaire mainly included demographic information, current status of supervision implementation, and effectiveness of supervision. The data were analyzed descriptively with t test for comparison between groups and the Pearson test was for correlation analysis. Results:A total of 99 medical social workers were included in this study, 65 had received supervision, and medical institutions where 58 people located had established the supervision system. The average scores of actual and expected supervisory support received by medical social workers were 3.71 and 4.20 respectively, and the mean burnout level score was 32.91. The effect of establishing a supervision institutions on burnout was statistically significant ( P<0.05) and actual access to supervision support was negatively associated with burnout ( P<0.05). Conclusions:The overall situation of medical social work supervision in Shanghai was positive, but the demand for supervision was not fully satisfied; Supervision had a positive impact on reducing the burnout level. It is suggested that medical social work should further strengthen the cultivation of supervisory talents, promote the construction of supervisory systems, and improve the quality of supervision.

BackgroundHome-based intervention occupies a prominent place in the treatment of autism spectrum disorder （ASD） in children， whereas previous studies on the effect of home-based early intensive behavioral intervention on verbal ability of children with ASD are somewhat inadequate. ObjectiveTo study the effects of intensive family behavioral of intervention based on Verbal Behavior Milestones Assessment and Placement Program （VB-MAPP） on the language ability of children with ASD， so as to provide references for the development of family intervention strategies for children with ASD. MethodsChildren aged 2 to 3 years old who attended the Children's Rehabilitation Department of the Second Affiliated Hospital of Shantou University Medical College from September 2020 to December 2021 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for ASD were selected as the study objects. A non-randomized concurrent control trial was conducted to compare a study group （n=24） receiving home-based early intensive behavioral intervention using VB-MAPP with a control group （n=14） receiving training from other special institutions or early childhood education institutions. The intervention lasted for 6 months in both groups. Before and after the intervention， the VB-MAPP milestone assessment was performed in the two groups， and the VB-MAPP milestone score， mand， trac and listener responds were selected as the study indicators. Then the intervention effect was compared between two groups， and the multiple linear regression was performed to screen the related influencing factors. ResultsAfter intervention， the total milestone assessment score， mand， tact and listener responds scores of study group were higher than those of control group， with statistical difference （Z=-4.339~-2.195， P<0.05 or 0.01）. Multiple linear regression analysis denoted that the average weekly hours of home-based intervention in the first three months had certain effect on listener responds （β=1.029， P<0.05）. ConclusionApplication of home-based early intensive behavior intervention using VB-MAPP may contribute to the improvement of verbal abilities such as mand， tact and listener responds in children with ASD. ［Funded by 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund （number， 20200601）］

Objective To investigate the impact of anemia and chronic kidney disease(CKD)on the prognosis of elderly patients with HFpEF.Methods A retrospective cohort study was conducted on 224 very old patients(age ≥80 years)with HFpEF admitted to Department of General Medi-cine of No.960 Hospital of PLA Joint Logistics Support Force from January 2016 to March 2023.According to their estimated glomerular filtration rate(eGFR)and hemoglobin level at admis-sion,they were divided into non-CKD+non-anemia group(88 cases),CKD group(14 cases),ane-mia group(79 cases)and CKD+anemic group(43 cases).The patients in the anemic group were further divided into mild(67 cases)and moderate-to-severe anemia subgroups(12 cases),and those of the CKD+anemia group were divided into CKD+mild anemia subgroup(31 cases)and CKD+moderate anemia subgroup(12 cases).The endpoints of follow-up included all-cause death,cardiovascular death and the end of follow-up.The relationships of CKD and anemia with progno-sis in elderly HFpEF patients were analyzed.Results During the follow-up period,all-cause mor-tality occurred in 100 patients(44.6％)and cardiovascular death in 32 patients(14.3％).Kaplan-Meier survival curve analysis showed that the CKD+anemia group had significantly higher rates of all-cause and cardiovascular death than the non-CKD+non-anemia,CKD and anemia groups(P＜0.01).Cox regression analysis indicated that the risk of all-cause mortality and cardiovascu-lar mortality was significantly higher in the CKD+moderate anemia subgroup than the non-CKD+non-anemia group(HR=6.43,95％CI:2.82-14.68,P=0.000;HR=10.63,95％CI:2.17-51.95,P=0.004).The risk of cardiovascular death was obviously higher in the moderate-to-severe anemia subgroup than in the non-CKD+non-anemia group(HR=4.96,95％CI:1.19-20.72,P=0.028).Conclusion Moderate-to-severe anemia is an independent risk factor for cardiovascular death in elderly HFpEF patients,and CKD complicated with moderate anemia significantly increa-ses the risk of all-cause mortality and cardiovascular death in elderly HFpEF patients.

Objective:To compare the clinical outcomes of one and two blastocysts in the freeze-thaw transplantation cycle.Methods:Totally 3 675 cycles of frozen thawed blastocyst transplantation in Reproductive Medical Center of the Second Nanning People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. According to the quantity and quality of transferred blastocysts, all the patient were divided into two groups: (1) one embryo group, including the single excellent group (one high quality blastocyst) and the single non excellent group (one non high quality blastocyst); (2) two embryo groups, including the double excellent group (two high quality blastocysts), the one excellent and one non excellent group (one high quality blastocyst+one non high quality blastocyst), and the two non excellent group (two non high quality blastocysts were transplanted). Then the patients were divided into subgroups according to their ages: less than 35 years old, 35-40 years old and over 40 years old. On this basis, the implantation rate, clinical pregnancy rate, multiple birth rate and live birth rate were compared.Results:(1) The implantation rate, clinical pregnancy rate, multiple birth rate, preterm birth rate and live birth rate were all significantly increased, while the abortion rate was significantly reduced in the double blastocyst group (all P<0.05). (2) In the group of<35 years old, the rates of multiple birth and preterm birth in the double blastocyst group were significantly higher than those in the single optimal group ( P<0.01). (3) In the 35-40 years old group, the clinical pregnancy rate, multiple birth rate and live birth rate of the double excellent group were significantly higher than those of the single excellent group ( P<0.01); while the clinical pregnancy rate and live birth rate of the one excellent and one non excellent group and the double non excellent group were not significantly different from those of the single excellent group ( P>0.05), but the multiple birth rate and preterm birth rate were significantly increased ( P<0.01). The clinical pregnancy rate, live birth rate and multiple birth rate of double non optimal group were significantly higher than those of single non optimal group ( P<0.01). (4) In the group>40 years old, there were no significant differences in clinical pregnancy rate and live birth rate between the two groups ( P>0.05). There were no significant differences in implantation rate, clinical pregnancy rate and live birth rate between double non optimal group and single non optimal group ( P>0.05). Conclusion:No matter the age of the patients, if the couple have high quality blastocysts, we should give priority to single high quality blastocyst transplantation; even if they have no high quality blastocysts, we should also consider single blastocyst transplantation, in order to reduce the risk of multiple pregnancy and improve the cumulative live birth rate, so as to improve the pregnancy outcome.

Gestational diabetes mellitus (GDM) refers to the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.In recent years,the growing prevalence of obesity and GDM has been of long-standing interest.Maternal obesity is an independent risk factor of GDM,which can lead to adverse pregnancy outcomes.This review describes the relationship between maternal obesity and GDM from the aspects of the evaluation index and the management of obesity during pregnancy.

Placenta, the direct and vital connection between mother and fetus, can be considered as an inflammatory organ that plays an essential role in maternal-fetal immune tolerance in maintaining pregnancy and mediating inflammation in some gestational complications. When gestational diabetes mellitus (GDM) occurs, the mother and placenta are in a state of mild inflammation. We hypothesize that the placental immune cells may participate in the pathogenesis of GDM. This review discusses the relation between placental immune cells and GDM from three aspects: the regulatory function of the placental immune cells, the association between abnormal placental immune cells and GDM, and the function of placental immune cells during clinical management of GDM.

Wuling powder, which is from Treatise on Cold Damage and Miscellaneous Diseases of Zhang Zhongjing, is a famous formula from thousand years now on. As people have a deeper understanding of Wuling powder, its application range is more extensive. In Treatise on Cold Damage and Miscellaneous Diseases and Essentials from the Golden Cabinet, there are a total of 11 articles concerning Wuling powder. Wuling powder syndrome can be classified as pulse floatation, fever, thirst, irritability, vomiting and urination, which can also occur in dehydration by sorting out and analyzing these articles. This paper talks about the relationship between Wuling powder syndrome and dehydration from the etiology, the symptom and the clinical application as well as to the thought of Wuling powder syndrome several aspects.

Objective To systematically evaluate the effectiveness of Chinese medicine(CM) combined with chemotherapy in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis. Methods Databases of PubMed, EMBase, Cochrane Library, China National Knowledge Information(CNKI), VIP Database, Wanfang Database, and SinoMed were retrieved to collect randomized controlled trials(RCTs) of CM combined with chemotherapy in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis. And then the quality of the included RCTs was evaluated systematically. Results Seven RCTs involving 700 cases of stageⅡ-Ⅲ colorectal cancer patients were included, 355 patients in treatment group were treated with CM combined with chemotherapy, and 345 patients in control group were treated with chemotherapy alone. The results of Meta-analysis showed that treatment group was superior to the control group in preventing the recurrence and metastasis of colorectal cancer one , 2 and 3 year(s) after the radical surgery, showing statistically significant differences(P < 0.05), while the difference of five-year recurrence and metastasis rate was not statistically significant between the two groups(P > 0.05). At the same time, CM combined with chemotherapy had better effect than chemotherapy alone on prolonging the time for recurrence and metastasis, improving performance status and relieving the symptoms, the difference being significant(P<0.05). Conclusion CM combined with chemotherapy exerts better effect than chemotherapy alone in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis and onimproving the quality of life of the patients. However, for the low methodological quality of the included trials, the conclusion still needs more large-size sample, multiple-center, and high-quality clinical trials to be confirmed.

Objective:To analyze the causes and associated factors of fetal death and to explore effective preventive measures so as to reduce the incidence rate of fetal death .Methods:Clinical data of 85 pregnant women ,who suffered from intrauterine fetal death with gestational age of 20‐42 weeks ,in Obstetrics & Gynecology Hospital of Fudan University during Jan 2010 and Dec 2014 were analyzed retrospectively .Results:The incidence rate of fetal death was 2 .36‰ .The highest incidence rate of fetal death emerged at the gestational age of 28‐31+6 weeks ,and accounted for 31 .8% .The causes ,in turn ,were maternal factors for 54 cases ,fetal factors for 28 cases ,umbilical cord factors for 13 cases ,placental factors 10 cases ,unexplained factors for 10 cases .And 27 cases saw a doctor for abnormal fetal irritability .The rate of pathological examination was 21 .12% .And 11 pa‐tients had more than two kinds of causes of fetal death .Conclusions:Maternal complications were the most common causes of fetal death .In order to reduce the perinatal rate of fetal death ,actions such as attaching importance to prenatal examination and early intervention and treatment ,enhancing fetal monitoring and terminating pregnancy at proper time point ,should be taken .