The human gut harbours a certain quantity and variety of microbes called intestinal flora, which is in a state of balance under normal circumstances, and dysbacteriosis occurs when the balance of the intestinal flora is dis-turbed by the host and the changes of the external environment.Circadian clock is the biological regulation system to adapt to natural circadian rhythm, including central clock and peripheral clock.Circadian clock disturbance, particularly rotating shift-workers with irregular light-night schedules, is associated with an increased risk of immune-related diseases.The de-velopment of these diseases is closely related to intestinal dysbacteriosis.Therefore, the correlation between intestinal dys-bacteriosis and circadian clock disturbance has attracted much attention.This review aims to explore the pathophysiological basis of the development in some immune-related diseases based on the latest scientific findings about the relationship be-tween intestinal microbial flora and circadian clock.

Objective To develop a new treament strategy for Kasabach-Merritt syndrome.Methods Three infants who were diagnosed with Kasabach-Merritt syndrome and suffered from thrombocytopenia as well as bleeding and clotting disorders were treated with percutaneous selective digital subtraction angiography combined with transarterial hardened embolization under general anesthesia.Sclerosing agents included bleomycin A5 (4.0 mg),iodized oil (1.5 ml),dexamethasone (2.5 mg) and iopamidol (3 ml).Polyvinyl alcohol mixed with iopamidol (at a volume fraction of 0.5) served as the embolic material.Results All the three patients were successfully treated by the minimally invasive surgery.The amount of blood platelet returned to normal within 24 hours after the operation.On the fourth day,all the patients were discharged from hospital with the restoration of coagulation function.Revisits at one month and three months after the operation showed that hemangiomas markedly shrank and even subsided,and blood platelet count was maintained within normal range.Conclusions Percutaneous selective digital subtraction angiography combined with transarterial hardened embolization can result in a recovery of blood platelet count and shrinkage of hemangioma,and may serve as a minimally invasive treatment option for Kasabach-Merritt syndrome.

Objective To compare the analgesic effects of fire needling, conventional acupuncture and acupoint catgut embedding in rats with rheumatoid arthritis.Methods Fifty healthy male SD rats were randomized into control, model, acupuncture, fire needling and catgut embedding groups, 10 rats each. A SD rat model of rheumatoid arthritis was made by intracutaneous injection of complete Freund’s adjuvant into the right hind foot pad. Right Kunlun and Zusanli were selected as therapeutic points in the three groups and given fire needling, acupuncture or catgut embedding. The right paw mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were used as observation indices and measured in every group of rats at one day before and four days after model making and at one, seven and fourteen days after the beginning of treatment. Rat paw inflammatory tissues were separated after the completion of treatment. The IL-1 and TNF-α contents of them were measured. Results There were statistically significant differences in MWT and TWL between the model, acupuncture, fire needling or catgut embedding group and the control group after model making, and one, seven and fourteen days of treatment (P<0.01). There were statistically significant differences in MWT and TWL between the fire needling group and the model, acupuncture or catgut embedding group after one, seven and fourteen days of treatment (P<0.01,P<0.05). There was a statistically significant difference in MWT between the acupuncture or catgut embedding group and the model group after one, seven and fourteen days of treatment (P<0.01). There was a statistically significant difference in TWL between the acupuncture or catgut embedding group and the model group after seven and fourteen days of treatment (P<0.01,P<0.05). There were statistically significant differences in IL-1 and TNF-α contents between the model, acupuncture, catgut embedding or fire needling group and the control group after model making (P<0.01). after treatment, there were statistically significant differences in IL-1 and TNF-α contents between the acupuncture, catgut embedding or fire needling group and the model group and between the acupuncture or catgut embedding group and the fire needling group (P<0.05).Conclusions Fire needling can raise pain threshold in rats with rheumatoid arthritis. It alleviates rheumatoid arthritis-induced chronic pain by reducing the inflammatory factor content of affected muscular tissues.

OBJECTIVE:To study the effects of flow components C6 and C7 in n-butyl alcohol extract from the leaves of Ces-trum Nocturnum(CN)on the proliferation and apoptosis of human gastric cancer cell SGC7901. METHODS:C6 and C7 were ob-tained by using different ratio of chloroform and methanol(1:9,1:7)to the gradient elution of CN leaves. After cultured with 0 (blank control),5,10,20,40,80 μg/ml C6 and C7 for 72 h,inhibitory effect of C6 and C7 on the proliferation of SGC7901 was determined by MTT assay. Inhibitory rate and IC50 were calculated. After SGC7901 were cultured with 10 μg/ml C6 and C7 for 72 h,colony formation assay was utilized to detect the effects of C6 and C7 on the cell colony formation,and the rate of colony for-mation was calculated. In addition,Wright/Giemsa and Hoechst33258/PI staining assay were used to observe the change of cytomor-phology. RESULTS:MTT showed that C6 and C7 had inhibitory effect on the proliferation of SGC7901 to different extent;inhibi-tory rates were 22.1%-80.0% and 19.6%-79.7%,and IC50 were 16.4,18.05 μg/ml,respectively. Compared with blank control group,colony formation rate of C6 and C7 group decreased,with statistical significance(P<0.05). The number of apoptotic cells was more in treatment group than in other groups. CONCLUSIONS:Flow components C6 and C7 in n-butyl alcohol extract from the leaves of CN can inhibit the proliferation of SGC7901 cells and induce the apoptosis of them.

Objective To survey the satisfaction degree of the postgraduates in professional degree with The Joining Together of Double-Track education model in the current stage of professional degree graduate education and standardized training of residents in China. Methods According to various factors, such as the current situation of postgraduates in medical universities, we sought the opinions of relevant experts to design questionnaire. Meanwhile, to enhance the reliability of the questionnaire and the survey, we chose the postgraduates of Shengjing Hospital of China Medical University first to do the pre-survey, and according to the feedback, we adjusted part of the aspects, thus formed a formal questionnaire, which included the satisfaction with training of clinical practice ability, training of research ability, and tutors' assessment etc. Finally, the Chinese New Youth Forum online released the questionnaires, selecting the postgraduates in professional degree who were participating in, or had participated in the completion of the standardized training as the participants, which took place between March 2016 and May 2016. SPSS 16.0 was used for statistical analysis. The evaluation results of different majors were tested by Kruskal-Wallis rank sum test. Results According to the results of the survey, the aspects in the clinical resident standard-ized training that the 1000 postgraduates were more satisfied with were as follows: training time [42.8%(n=428)], training center [41.8% (n=418)], training of clinical practice ability [41.6% (n=416)], tutors [40.2%(n=402)], economic income [38.8%(n=388)], department arrangements [38.4% (n=384)], training of research ability [37.5%(n=375)]. There is a significant difference in the satisfaction degree of different pro-fessional graduate students in theJoining Together of Double-Trackeducation model (P<0.05). ConclusionThe Joining Together of Double-Track education model should be compatible with the training objectives of postgraduates in professional degree. Much more attention should be paid to the post-graduates, satisfac-tion degree with the clinical resident standardized training, as well as the requirements during the training period, improve the evaluation of graduate students' ability of scientific research, econo-mic income and so on, so as to improve the training system for the postgraduates.

Objective To analyze the characteristics of chest CT in children with invasive pulmonary fungal infections(IPFIs),and to explore the influencing factors on chest CT manifestations in children with IPFIs.Methods A retrospective case-control study was conducted to select 97 children with IPFIs from October 2010 to October 2016 in the department of respiratory medicine,PICU and hematology.The children were divided into CT characteristic change group(39 cases) and CT non-characteristic change group(58 cases) according to the chest CT manifestations. Non-conditional multivariate Logistic regression analysis was used to identify the independent influencing factors of CT characteristic changes in children with IPFIs. Results The ratios of less than 3-year-old infants, Candida, the proportion of ICU admission in the CT characteristic change group were lower than those in the CT non-characteristic change group(P<0.05). The proportions of more than 3-year-old, neutropenia,Aspergillus,central venous catheter,hematological malig-nancies were higher than those in the CT non-characteristic change group(P<0.05).Multivariate Logistic regression analysis showed that the hematological malignancies was an independent influencing factor for the characteristic changes of CT in children with IPFIs.Conclusion When children with blood system malignant tumors manifest as fever,cough and other symptoms of infection,chest CT manifestations show characteristic changes,Aspergillus infection should be considered,and empirical antifungal treatment should be focused.

BACKGROUND:Cell death and neuroinflammation are two important targets in the treatment of spinal cord injury.Pyroptosis is a programmed cell death closely related to neuroinflammation and targeted inhibition of pyroptosis after spinal cord injury is a promising therapeutic strategy. OBJECTIVE:To summarize the molecular mechanism,positive and negative regulatory factors and therapeutic strategies of pyroptosis in spinal cord injury. METHODS:The search terms were"spinal cord injury,pyroptosis,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),Caspase,Gasdermin D(GSDMD),IL-1β,IL-18"and 93 English literatures included in PubMed and Web of Science were finally selected for review. RESULTS AND CONCLUSION:As a newly discovered programmed cell death,pyroptosis has been shown to play an important role in the secondary injury stage after spinal cord injury.Among the regulatory factors of pyroptosis after spinal cord injury,CD73,NRF2,GDF-11,dopamine,FANCC and miR-423-5P could inhibit pyroptosis,while TLR4 and Aopps could promote pyroptosis.In terms of treatment,the active ingredients of traditional Chinese medicine(paeonol,tripterine,betulinic acid,piperine,kaempferol,and camptothecin),exosomes of various cell origins,and some drugs(metformin,topotecan,lithium,zinc,and carbon monoxide-releasing molecule 3)can effectively inhibit pyroptosis and reduce secondary spinal cord injury,but the toxicity and specific dose of these drugs need to be further studied.The specific molecular mechanism by which pyroptosis aggravates spinal cord injury is still poorly understood.The role of non-classical pathways and other inflammasomes is worth further exploration.At present,the research on pyroptosis after spinal cord injury only stays at the animal experiment stage.There are no related clinical studies and no approved targeted therapeutic drugs.(6)The application of pyroptosis after spinal cord injury has great potential,and its specific regulatory mechanism should be further studied in the future to provide a new target for the treatment of spinal cord injury.

BACKGROUND/AIMS: The relationship between C-peptide levels and gastrointestinal (GI) symptoms in type 2 diabetic patients is not clear. The purpose of this study is to examine the association between fasting C-peptide and GI symptoms of gastroparesis in type 2 diabetic patients. METHODS: We recruited 333 type 2 diabetic patients into the present study. All patients filled out questionnaires of gastroparesis cardinal symptom index (GCSI) to evaluate GI symptoms. Hospital anxiety and depression scale were adopted to define anxiety and depression. Patients with GCSI scores ≥ 1.9 were regarded as having symptoms of gastroparesis. RESULTS: In our study, 71 (21.3%) type 2 diabetic patients had GCSI scores ≥ 1.9. In comparison to patients with scores < 1.9, those with scores ≥ 1.9 had significantly lower fasting c-peptide levels (1.49 ng/mL vs 1.94 ng/mL, P < 0.001), higher prevalence of depression (40.9% vs 18.3%, P < 0.001) and anxiety (28.2% vs 13.0%, P = 0.002). Multivariate logistic regression revealed that fasting C-peptide was still significantly associated with symptoms of gastroparesis (odds ratio, 0.67; 95% confidence intervals, 0.48–0.94; P = 0.021), even after adjustments for age, sex, body mass index, HbA1c, current smoking and drinking status, anxiety, and depression. Furthermore, linear regressions showed that fasting C-peptide was independently and negatively related to GCSI scores (standardized regression coefficient, −0.29; P < 0.001) in patients with at least one GI symptom. CONCLUSION: GI symptoms of diabetic gastroparesis affect approximately 20% of type 2 diabetes patients and are associated with lower fasting C-peptide levels independent of depression and anxiety status.
Anxiety ; Anxiety Disorders ; Body Mass Index ; C-Peptide* ; Depression ; Depressive Disorder ; Diabetes Mellitus ; Drinking ; Fasting* ; Gastroparesis* ; Humans ; Linear Models ; Logistic Models ; Prevalence ; Smoke ; Smoking

Objective:To investigate the imaging characteristics and diagnosis of thalamic dementia caused by medial tentorial dural arteriovenous fistula (TDAVF).Methods:The clinical and imaging data of 4 patients with medial TDAVF diagnosed at Nanjing Brain Hospital from August 2022 to September 2023 were retrospectively collected, summarized and analyzed.Results:Four patients were all males, with an average age of 67 years. The duration of cognitive impairment varies from 13 days to 2 months, with an average of about 1 month. The average score on the Mini-Mental State Examination (MMSE) was 13, while the average score on the Montreal Cognitive Assessment (MoCA) was 15. One patient was unable to complete these tests. MRI showed bilateral thalamic swelling, with scattered microbleeding lesions on diffusion-weighted imaging and susceptibility-weighted imaging ( n=3). Enhanced scans showed patchy or clumpy enhancement of the bilateral thalamus. Magnetic resonance angiography showed abnormal blood vessels along the straight sinus area ( n=4), while magnetic resonance venography showed no straight sinus development ( n=4). Magnetic resonance spectroscopy showed neuronal swelling and damage ( n=3), with no increase in choline peak. Arterial spin labeling perfusion imaging showed decreased perfusion in the lesions. Digital subtraction angiography confirmed TDAVF with straight sinus thrombosis. Two patients underwent embolization, with significant improvement in postoperative memory impairment. One patient underwent surgical clipping, while the other was transferred to other hospital for treatment. Conclusions:Patients with medial TDAVF often present with thalamic dementia. Imaging examinations show typical bilateral thalamic swelling with microbleeds, and early visualization of vascular shadows, without development of straight sinus. These features would be beneficial for the early diagnosis of TDAVF.

Objective To investigate the current status of psychological capital, career plateau and turnover intention in ICU nurses and to analyze the influence of psychological capital and career on turnover intention. Methods A total of 233 ICU nurses from the 2nd Affiliated Hospital of Wenzhou Medical University who met the criteria were selected by convenient sampling from February to April 2017. The nurses were investigated with the Psychological Capital Questionnaire-Chinese (PCQC), Career Plateau Questionnaire (CPQ) and Turnover Intention Scule (TIS). Totally 233 questionnaires were handed out and 224 valid questionnaires were collected. Results The total score of psychological capital in the 224 ICU nurses was (88.53±13.16), and the highest score was found in the dimension of self-efficacy, while the lowest score was in the dimension of hope; the total average score of career plateau was (3.83±0.92); and the score of turnover intention was (16.82±5.01). According to the hierarchical stepwise regression analysis, contractual employment, hope, hierarchical plateau and content plateau were the main influencing factors of ICU nurses' turnover intention, which could account for 39.8% of the total variation. Conclusions ICU nurses show a strong turnover intention, and contractual employment, hope, hierarchical plateau and content plateau may affect their turnover intention. ICU nursing managers should formulate proper and effective improvement strategies for psychological capital and alleviation strategies for career plateau based on the current status of psychological capital and career plateau in nurses and take proper measures to enhance their enthusiasm and job satisfaction of contractually employed nurses, and reinforce the stability of ICU nursing team.