Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

ObjectiveTo analyze the on-site technical evaluation results of the provincial-level health enterprises in Shandong Province. Methods A total of 88 provincial-level health enterprises in Shandong Province in 2021 were selected as the research subjects using the convenient sampling method. The scores of on-site technical assessments were analyzed. Results The total score of on-site technical evaluations for the 88 provincial health enterprises was (942.1±21.8) points. The scores for the first-level indicators, including management system, health environment, health management and services, and health culture, were (193.7±4.7), (191.6±5.2), (414.4±16.4), and (142.3±6.7) points, respectively. The score for health culture in large-sized enterprises was higher than that in medium-sized and below enterprises (P<0.05). State-owned enterprises had higher total scores than private enterprises and joint-stock enterprises (both P<0.05). The score for health management and services in the mining industry was higher than that in the manufacturing industry (P<0.05). Enterprises with high total investment in health promotion had higher scores for health culture than those with low investment (P<0.05). There were no significant differences in the scores for indicators of management system and health environment among enterprises of different sizes, natures, industries, and total investments in health promotion (all P>0.05). Conclusion The overall score of these 88 enterprises was higher than the standard for provincial health enterprises. Except for management systems and general environment, there were some differences in the scores for health management and services, and health culture assessments among enterprises of different sizes, natures, industries, and total investments in health promotion.

Objective:To further study the causes of acute occupational poisoning accidents, and to provide scientific basis and decision support for the prevention of accidents in advance.Methods:From September 2022 to May 2023, the literature was searched and 232 cases of acute occupational poisoning cases occurred from 2013 to 2022 were collected. The causal nodes of the accident were determined according to the expert score, and the interpretative structural model (ISM) was used to construct the correlation model between the causal nodes to obtain the hierarchical relationship between the factors. The influence of each causal node on the occurrence of acute occupational poisoning accidents was studied by using Bayesian network (BN), and the relationship and influence among the causal nodes were analyzed by Netica 5.18 software to establish the pre-prevention model of acute occupational poisoning accidents and identify the key causal factors.Results:A total of 23, 203, and 6 cases of significant, large, and medium acute occupational poisoning accidents were included, of which 179, 29, and 24 cases were asphyxiating gas, irritating gas, and mixed gas, respectively. ISM of acute occupational poisoning accidents divided the causal factors into a 7-layer and 3-level hierarchical structure model. Among them, operation conditions, protective measures, ventilation equipment, hidden trouble investigation, emergency management, illegal operation, equipment and facilities, and blind rescue were the direct causes of the occurrence and expansion of accidents. Warning devices, inspection situation, safety education situation, safety operation procedures, and technology in the production process were indirect influences that lead to the occurrence and expansion of accidents. Safety production responsibility system, enterprise supervision and management and government supervision were the deep-rooted influences. BN reasoning showed that the maximum probability causal chain of acute occupational poisoning accidents was as follows: safety production responsibility system→enterprise supervision and management→safety education and training→protective measures→accident occurrence. The key factors leading to the occurrence of acute occupational poisoning accidents were inadequate protective measures, equipment and facility failures, operational errors, ventilation equipment not being used properly and improper emergency management.Conclusion:In the prevention of acute occupational poisoning accidents, it is necessary to correctly use protective measures, test equipment and facilities before operation, operate according to regulations, ensure the normal use of ventilation equipment, and strengthen emergency management, so as to reduce the incidence of acute occupational poisoning accidents.

ObjectiveBased on the network pharmacology system and quantitative spectroscopy of traditional Chinese medicine（TCM） compounds， a topological network analysis method with equilibrium constant as the core was established to further explore the interaction between allergenic components and their network targets in Shuanghuanglian injection（SHLI）， in order to provide new ideas and experimental basis for identifying and screening potential allergens of SHLI. MethodAfter one week of adaptive feeding， 72 SPF-grade SD male rats were randomly divided into blank group， SHLI standard group， Lonicerae Japonicae Flos（LJF） group， Scutellariae Radix（SR） group， Forsythiae Fructus（FF） group， and 7 groups of SHLI matching groups（groups 1-7）， with 6 rats in each group. Rats in each group were administered the drug intravenously and blood samples were taken after steady state， high performance liquid chromatography（HPLC） characterization profiles of the testing drugs and plasma components in each group were established， and the peak area changes of the drugs and plasma components in each group were calculated after the component groups were classified. Enzyme-linked immunosorbent assay（ELISA） was used to determine the changes of immunoglobulin E（IgE）， histamine（HIS）， tryptase（TPS）， total complement（CH50） and terminal complement complex（C5b-9） in animal blood samples. MATLAB R2020b v9.9.0 software was used to calculate the network balance constants of the component groups with the targets， and the eigenvalues of the matrices composed of network equilibrium constants were calculated and ranked according to their values. ResultELISA results showed that， compared with the blank group， groups 1-3 could significantly increase the IgE level， groups 1-2， groups 4-6 and SHLI standard group could significantly increase the HIS level， group 4 could significantly increase the CH50 level， groups 1， 3-4， LJF group and FF group could significantly increase the TPS level， SR group could significantly increase the C5b-9 level， and the differences were all statistically significant（P<0.05）. According to the retention time of chromatographic peaks， it was classified into 6 component groups from C1 to C6 by HPLC. The order of the network balance constants of each component group was C6>C4>C1>C5>C3>C2， indicating that C6 had the greatest effect on the allergic reaction， and was most likely to be the allergen. The sequence of eigenvalues was C2>C5b-9>C3>C1>CH50>C6>C5>IgE>TPS>C4>HIS， indicating that component group C2 had the greatest contribution to the whole network. ConclusionBased on the correlation analysis of SHLI component group and allergy-like target network， this study clarified that component group C6 may be a potential allergen in SHLI， and the component group C2 may be a key node in the mechanism of drug action， which can provide new strategies and methods for the screening of allergens in TCM injections.

Objective:To further study the causes of acute occupational poisoning accidents, and to provide scientific basis and decision support for the prevention of accidents in advance.Methods:From September 2022 to May 2023, the literature was searched and 232 cases of acute occupational poisoning cases occurred from 2013 to 2022 were collected. The causal nodes of the accident were determined according to the expert score, and the interpretative structural model (ISM) was used to construct the correlation model between the causal nodes to obtain the hierarchical relationship between the factors. The influence of each causal node on the occurrence of acute occupational poisoning accidents was studied by using Bayesian network (BN), and the relationship and influence among the causal nodes were analyzed by Netica 5.18 software to establish the pre-prevention model of acute occupational poisoning accidents and identify the key causal factors.Results:A total of 23, 203, and 6 cases of significant, large, and medium acute occupational poisoning accidents were included, of which 179, 29, and 24 cases were asphyxiating gas, irritating gas, and mixed gas, respectively. ISM of acute occupational poisoning accidents divided the causal factors into a 7-layer and 3-level hierarchical structure model. Among them, operation conditions, protective measures, ventilation equipment, hidden trouble investigation, emergency management, illegal operation, equipment and facilities, and blind rescue were the direct causes of the occurrence and expansion of accidents. Warning devices, inspection situation, safety education situation, safety operation procedures, and technology in the production process were indirect influences that lead to the occurrence and expansion of accidents. Safety production responsibility system, enterprise supervision and management and government supervision were the deep-rooted influences. BN reasoning showed that the maximum probability causal chain of acute occupational poisoning accidents was as follows: safety production responsibility system→enterprise supervision and management→safety education and training→protective measures→accident occurrence. The key factors leading to the occurrence of acute occupational poisoning accidents were inadequate protective measures, equipment and facility failures, operational errors, ventilation equipment not being used properly and improper emergency management.Conclusion:In the prevention of acute occupational poisoning accidents, it is necessary to correctly use protective measures, test equipment and facilities before operation, operate according to regulations, ensure the normal use of ventilation equipment, and strengthen emergency management, so as to reduce the incidence of acute occupational poisoning accidents.

【Objective】 To reveal the integral in vivo polypharmacokinetics (PPK) similarity or difference between Jinyinhua (Lonicerae Japonicae Flos, LJF) and Shanyinhua (Lonicerae Flos, LF), and provide reference for their clinical application. 【Methods】 The PPK model and its total quantum statistical moment similarity (TQSMS) method were used to compare the integral PPK profiles of nine components with anti-inflammatory efficacy (rutin, caffeic acid, chlorogenic acid, cryptochlorogenic acid, dispsacoside B, macranthoidin B, isochlorogenic acid A, isochlorogenic acid B, and isochlorogenic acid C) of LJF and LF. A total of 54 Specific Pathogen Free (SPF) grade Kunming (KM) mice were randomized into LJF group and LF group (n = 27), and each group was divided into nine subgroups (n = 3) according to different time points. Subsequently, mice model of p-xylene-induced ear edema was constructed by oral administration of LJF and LF. The concentrations of the nine anti-inflammatory components in plasma samples of the mice were determined by ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS/MS). And the pharmacokinetics (PK) parameters of single component and the integral PPK parameters [total quantum statistical moment (TQSM) and TQSMS] of multiple components were calculated by Drug And Statistics (DAS) software and home-brew programs with Excel, respectively. 【Results】 There were significant differences in single-component PK parameters between LJF and LF (P < 0.05). Whereas, no significant differences were found in multi-component TQSM parameters, including total quantum zero moment (AUCT0-t, AUCT0-∞) and total quantum first moment (MRTT0-t, MRTT0-∞) for the total quanta (P > 0.05). Accordingly, single-component TQSMS varied from 0.220 4 to 0.968 9, and that for the total quanta was 0.828 4, suggesting no significant differences in the speed and extent of bioavailability between LJF and LF. Furthermore, in light of high TQSMS (0.828 4), the integral PPK profiles of the nine anti-inflammatory components of LJF and LF were similar under 90% confidence intervals. 【Conclusion】 The PPK model and its TQSMS method are appropriate and efficient to compare the similarity or difference of integral PPK profiles of multi-component herbal medicines. It is suggested in this research that LJF can be replaced with LF or vice versa for anti-inflammatory treatment.

Abstract: Objective To investigate the clinical features and risk factors for severe tsutsugamushi disease, so as to provide reference for diagnosis and differentiation of severe tsutsugamushi disease as soon as possible. Methods The clinical data of 178 cases of inpatients with tsutsugamushi disease admitted to the Guangzhou Eighth People's Hospital, Guangzhou Medical University from January 2016 to September 2021 were collected and analyzed according to their gender, age, underlying diseases, clinical characteristics at admission, laboratory examination results within 24 hours of admission and epidemiological history. The patients were divided into the severe group and the non-severe group according to the diagnostic criteria. The data of clinical characteristics, laboratory examination and prognosis of the two groups were compared. Multivariate logistic regression analysis was performed on the variables with statistical significance and the receiver operating characteristic curve (ROC) was drawn. Results A total of 178 patients were included in this study, with 37 in the severe group and 141 in the non-severe group. Compared with the non-severe group, the age of the severe group was older, the underlying diseases were more, the incidence of dyspnea and the levels of white blood cell, total bilirubin, aspartate aminotransferase, lactate dehydrogenase, cystatin C, uric acid and serum creatinine were significantly increased, the levels of platelet and albumin were significantly decreased (all P<0.05). The dyspnea [odds ratio (OR value)=8.93, 95% confidence interval (CI): 1.200-66.424; P=0.032], total bilirubin (OR=1.091, 95%CI: 1.028-1.159; P=0.004) and serum creatinine (OR=1.052, 95%CI: 1.004-1.102; P=0.033) were independent risk factors for severe tsutsugamushi disease. The area under ROC curve of total bilirubin and serum creatinine were 0.777 and 0.764, respectively (both P<0.01), indicating high predictive value for severe tsutsugamushi disease. The optimal cut-off value for total bilirubin was 23.01 µmol/L, with a sensitivity of 54.10% and a specificity of 90.60%; the optimal cut-off value for creatinine was 126.45 µmol/L, with a sensitivity of 43.20% and a specificity of 100.00%. The case fatality rate of severe tsutsugamushi disease was 2.70%. Conclusions The patients with severe tsutsugamushi disease are older, and have more underlying diseases. Dyspnea, increased total bilirubin and elevated serum creatinine are independent risk factors for severe tsutsugamushi disease, which can help in the early identification of severe tsutsugamushi disease early.

Objective:To analyze the epidemiological and clinical characteristics of patients with tsutsugamushi disease in Guangdong Province from 2016 to 2021, and to provide a reference for clinical diagnosis, treatment, scientific prevention and control of tsutsugamushi disease.Methods:A retrospective analysis was conducted to collect the information of patients with tsutsugamushi disease admitted to Guangzhou Eighth Hospital Affiliated to Guangzhou Medical University from 2016 to 2021, including the basic information, epidemiological characteristics, clinical manifestations, auxiliary examinations, complications, misdiagnosis at first diagnosis and treatment outcomes.Results:Among 155 patients with tsutsugamushi disease, there were 75 males (48.39%) and 80 females (51.61%), with an e age of (54.41 ± 13.78) years old, and 30 cases (19.35%) had other underlying diseases. The peak time of onset was from June to September. There were 97 local patients (62.58%) in Guangzhou, and 58 cases (37.42%) in other prefecture-level cities; 76.77% (119/155) had a history of field activities before the onset of the disease. 36.13% (56/155) were farmers. The most common clinical manifestations were fever (100.00%, 155/155), chills and/or shivering (77.42%, 120/155), headache and/or dizziness (74.19%, 115/155), fatigue (65.81%, 102/155), eschar or ulcer (92.90%, 144/155), and lymphadenopathy (49.68%, 77/155). The laboratory test results mainly showed a decrease in eosinophils (81.94%, 127/155), a decrease in hematocrit (78.71%, 122/155), a decrease in hemoglobin (52.26%, 81/155), a decrease in platelet count (50.97%, 79/155), a decrease in albumin (92.26%, 143/155), an increase in lactate dehydrogenase (90.32%, 140/155), an increase in adenosine deaminase (88.39%, 137/155), and an increase in alanine aminotransferase (85.16%, 132/155), elevated aspartate aminotransferase (85.16%, 132/155), and elevated procalcitonin (52.90%, 82/155); 30 cases (19.35%) were positive for the Weil-Felix Test. There were 95 cases (61.29%) with abnormal chest imaging results, and 34 cases (21.94%) with abnormal abdominal ultrasound or CT results. Common complications were toxic hepatitis, pulmonary infection, organ failure, and acute kidney injury, etc. The misdiagnosis rate of the initial diagnosis of this disease was 75.48% (117/155). Doxycycline and symptomatic and supportive therapy were given, 154 patients (99.35%) were cured or improved and discharged from hospital.Conclusions:Tsutsugamushi disease is prevalent in summer and autumn in Guangdong Province. Before the onset, most of the patients have a history of field activities. Farmers are susceptible people. Its clinical manifestations are diverse, and can affect multiple systems and organs. There are many complications, and doxycycline can be used for anti-infection treatment, with a high cure rate.

Objective:To explore the clinical characteristics of imported malaria from Africa, and the correlation between blood lipids and disease severity.Methods:The clinical data of 172 imported malaria patients from Africa were collected from January 1, 2018 to January 31, 2021 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment and prognosis of the patients were analyzed retrospectively. The independent samples t-test, Mann-Whitney U test and binary multivariate logistic regression analysis were used for statistical analysis when appropriate. Results:A total of 172 patients were divided into 39 severe cases and 133 non-severe cases in this study. The main infection species was Plasmodium falciparum, with a total of 153 cases (89.0%), and the severe cases were all falciparum malarias. Compared with the non-severe group, the white blood cell count and triacylglycerol level were increased in the severe group.The differences were both statistically significant ( Z=2.397 and 4.368, respectively; both P<0.05). The hemoglobin, hematocrit, platelet count, high-density lipoprotein cholesterol, apolipoprotein A (ApoA)Ⅰ and ApoAⅠ/apolipoprotein B (ApoB) were significantly decreased in the severe group. The differences were all statistically significant ( Z=-4.473, -4.464, -4.750, -4.826, -5.488 and -4.419, respectively; all P<0.01). The total cholesterol and low-density lipoprotein cholesterol were also reduced in the severe group. The differences were both statistically significant ( t=3.817 and 5.285, respectively; both P<0.01). The area under receiver operator characteristic curve of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, and ApoAⅠ/ApoB were 0.754, 0.727, 0.730, 0.789 and 0.733, respectively (all P<0.01). When the Youden index was at its maximum, the best cut-off value of ApoAⅠ was 0.535 g/L with sensitivity of the prediction for severe malaria of 79.5% and the specificity of 68.4%. ApoAⅠ had independent predictive value for severe malaria (odds ratio ( OR)=0.013, 95% confidence interval ( CI) 0.002 to 0.086, P<0.01), and stratified according to the best cut-off value, the risk of severe malaria when ApoA Ⅰ<0.535 g/L was 8.396 times of ApoA Ⅰ≥0.535 g/L ( OR=8.396, 95% CI 3.557 to 19.820, P<0.01). The case fatality rate of severe malaria was 2.6%(1/39). Conclusions:The imported malaria patients from Africa are mainly infected with Plasmodium falciparum and the case fatality rate of severe malaria is high. The high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, ApoAⅠ/ApoB of blood lipids show higher predictive value for severe malaria, among which, ApoAⅠ has independent predictive value for severe malaria. Changes in blood lipids will help to identify severe malaria as early as possible, improve the cure rate, and reduce the risk of death.

Objective:To investigate the application value of MRI in evaluating the disorders of pelvic floor in female stress urinary incontinence (SUI).Methods:From January 2017 to January 2019, the patients in the SUI group and the control group of Beijing Chaoyang Hospital, Capital Medical University were prospectively collected. Some patients in the SUI group were treated with tension-free vaginal tape (TVT). The dynamic MR was performed in both SUI patients and volunteers, and the following functional MR parameters were assessed between two groups: the urethral length and urethral hypermobility; the opening of urethral and bladder neck; and the pelvic organ prolapse. For SUI patients, the functional changes of the pelvic floor on MRI after TVT was also analyzed. Chi-square test, rank-sum test and t test were used. Results:Comparing with the control groups ( n=25), the urethral hypermobility, shortening functional urethral length, bladder neck funneling and urethra opening were significantly associated with SUI group ( n=33). Thirty one patients were treated with TVT, 12 of them were reexamined with MRI at 3 to 6 months after operation. Postoperative MR showed that SUI patients had lower risk of the urethral opening and bladder neck funneling ( P<0.05). There were significant differences in the length of functional urethra, angle of urethra movement, H-line, M-line, bladder funnel sign, urethra opening and bladder prolapse between the two groups ( P<0.05). There was a significant difference between the bladder funnel sign and urethra open sign before and after TVT ( P<0.05). There was no significant difference in the degree of bladder prolapse and uterus prolapse, length of urethra and angle of urethra movement between the two groups ( P>0.05). Conclusion:MRI can accurately evaluate pelvic floor function of SUI patients. However, TVT did not significantly improve weak pelvic supporting structures and pelvic organ prolapse.