OBJECTIVE To investigate ameliorative effects and mechanisms of two probiotics （Bacillus subtilis， Lactobacillus acidophilus） combined with Aurantii Fructus Immaturus （AFI） on functional dyspepsia （FD） in rats. METHODS Rats were randomly divided into blank group， model group， positive control group （domperidone group， 2.7 mg/kg）， AFI group （9 g/kg）， L. acidophilus group （5×107 cfu/kg）， B. subtilis group （5×107 cfu/kg）， L. acidophilus+ AFI group （L. acidophilus 5×107 cfu/kg+ AFI 9 g/kg）， and B. subtilis+AFI group （B. subtilis 5×107 cfu/kg+AFI 9 g/kg）， with 8 rats in each group. Except for the blank group， FD model was established by tail-clamping stimulation+hunger and satiety disorder+swimming exhaustion in other groups. After modeling， each group was given the corresponding drug/probiotic suspensions/physiological saline intragastrically， once a day， for 14 consecutive days. After the last medication， gastric emptying rate and the rate of propulsion of the small intestine in rats were measured； the levels of brain-gut peptide-related indicators [gastrin （GAS）， substance P （SP）， vasoactive intestinal peptide （VIP）， somatostatin （SS） and cholecystokinin （CCK）] in the serum of rats were measured. The pathological morphology of the gastric antrum tissue and duodenal tissue was observed. Cecal contents from the rats were collected for gut microbiota sequencing analysis. The protein expression levels of tyrosine kinase receptor c-Kit and stem cell factor （SCF） in the gastric antrum tissue， as well as Toll-like receptor 4 （TLR4）， myeloid differentiation factor 88 （MyD88）， and nuclear factor κB （NF-κB） in the duodenal tissue of the rats were detected. RESULTS Compared with the blank group， model group showed significantly lower gastric emptying rate， small intestinal propulsion rate， serum levels of GAS and SP， relative abundance of Firmicutes， Ace， Chao and Sobs indexes of the gut microbiota， and protein levels of SCF and c-Kit in gastric antrum （P＜0.05）， while serum levels of VIP， SS and CCK， relative abundance of Bacteroidetes， as well as protein expressions of TLR4， MyD88， and NF-κB， were significantly higher （P＜0.05）. The histological structure JZYC23S53） of the gastric antrum tissue appeared basically normal； however， abnormalities were observed in the duodenal structure， with a significant infiltration of inflammatory cells visible. Compared with the model group， all treatment groups significantly modulated most of the above indexes （P＜0.05）. The histological structure of the gastric antrum tissue was normal. Except for the B. subtilis group and the B. subtilis+AFI group， the pathological states of the duodenum in the remaining rats gradually recovered. Compared with each single drug group， most of above indexes in rats from each combination group showed further improvement （P＜0.05）. CONCLUSIONS The combination of AFI with two probiotics can improve gastrointestinal motility in FD rats， and the effect is superior to that of using the drugs alone. The specific underlying mechanisms may be related to the activation of the SCF/c-Kit signaling pathway and the inhibition of the TLR4/MyD88/NF-κB signaling pathway.

Objective To investigate the effects of remazolam on melatonin secretion,sleep rhythm and postoperative delirium(POD)in elderly patients undergoing spinal surgery.Methods A total of 160 elderly patients,76 males and 84 females,aged 65-80 years,BMI 18.5-24.0 kg/m2,ASA physical status Ⅱ or Ⅲ,from November 2023 to January 2024 undergoing spinal surgery(lumbar interbody fusion,posterior approach)under general anesthesia were selected.The patients were divided into two groups by random number table method:the remazolam group(group R)and the propofol group(group P),80 pa-tients in each group.Group R was given remazolam 0.3 mg/kg for anesthesia induction,and then continued to pump remazolam 0.3-0.8 mg·kg-1·h-1 for anesthesia maintenance.Group P was given propofol 2.0 mg/kg for anesthesia induction,and then continued to pump propofol 4-6 mg·kg-1·h-1 for anesthesia maintenance.The levels of melatonin and cortisol were recorded at 04:00 a.m.on the day of surgery,1 day,2 and 3 days after surgery.Pittsburgh sleep quality index(PSQI)and VAS pain scores at rest were recorded 1 day before surgery,1 day and 2 days after surgery and before discharge.The occurrence of POD and post-operative sleep disorder(POSD)were recorded.The duration of extubation,PACU stay time,total analgesia pump compressions,effective analgesia pump compressions,number of remedial analgesia cases,intraoperative hypotension,postoperative nausea and vomiting,dizziness,respiratory depression and other adverse events were recorded.Results Compared with group P,the extubation time and PACU residence time in group R were significantly shortened(P＜0.05),the level of melatonin was significantly increased while the level of cortisol was significantly decreased at 4:00 a.m.,and the PSQI was significantly decreased 1 day after surgery(P＜0.05),the incidence of POD,POSD,and intraoperative hypotension were signifi-cantly decreased(P＜0.05).There were no significant differences in extubation time,total and effective times of analgesic pump,rate of remedial analgesia,intraoperative hypotension,postoperative nausea,vom-iting,dizziness and respiratory depression between the two groups.Conclusion Remazolam has little effect on the secretion rhythm of melatonin and cortisol and the sleep rhythm after spinal surgery in elderly pa-tients,and the recovery is faster,which can reduce the incidence of POD and alleviate the sleep disorder af-ter spinal surgery.

Arteriovenous fistula dysfunction(AVF)is a frequent and often unforeseeable complication in hemodialysis patients,and the most common cause is venous outflow stenosis resulting from neointimal hyperplasia and outward remodeling.Currently,there have been few effective prevention and treatment measures for AVF,therefore,this paper reviews the interventions and preventive measures of the AVF.

BACKGROUND: There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. METHODS: Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. RESULTS: A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. CONCLUSIONS Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.
Female ; Humans ; China/epidemiology* ; Cities ; Cold Temperature ; Hot Temperature ; Mortality ; Temperature ; Time Factors ; Middle Aged ; Male

The ethics committee of organ transplantation technology and clinical application in a hospital has encountered some difficulties and typical cases in its review work and practice for many years. Sometimes, it is difficult to make a decision in these dilemmas. Based on the previous experience of the hospital in the ethical review of organ donation and transplantation, combined with two typical cases, this paper discussed and analyzed two review points of whether the voluntary unpaid donation and the principle of informed consent were met, and whether the risk-benefit ratio was reasonable, and put forward relevant ethical and legal countermeasure for further research by institutional ethics committees and other parties, in order to provide reference for discussing the practical problems and ethical confusion of ethical review of organ donation and transplantation.

Objective To analyze the frailty of patients with long-term maintenance dialysis(MD)and its influencing factors,and to explore the correlation of different dialysis modalities with the re-infection of novel coronavirus infection(COVID-19)and frailty syndrome.Methods Patients with regular dialysis in Nephrology Department of the Second Affiliated Hospital of Kunming Medical University from February to June 2023 were selected.A cross-sectional survey was conducted to collect clinical data of the patients,including dialysis modality(i.e.maintenance hemodialysis,abbreviated as hemodialysis,and continuous ambulatory peritoneal dialysis,abbreviated as peritoneal dialysis),and whether with re-infection of COVID-19.Patients were divided into 3 groups using Fried's frailty phenotype(FP):non-frailty group,pre-or-intermediate frailty group,and frailty syndrome group.The clinical characteristics of the FP were compared among the three groups.The correlation of frailty with clinical data,dialysis modality,re-infection of COVID-19 in each group was compared.Multifactorial logistic regression was used to analyze the factors influencing the development of frailty syndrome in patients.Results A total of 246 dialysis patients were included in this study,with 77(31.3%)in the non-frailty group,83(33.7%)in the pre-frailty group and 86(35.0%)in the frailty syndrome group.The frailty syndrome group showed characteristics of advanced age,high pre-dialysis creatinine level,low serum albumin level and combined pleural effusion(all P＜0.05).There was no statistically significant difference in the comparison of frailty between the hemodialysis and peritoneal dialysis group(P = 0.960).COVID-19 re-positive patients had higher frailty score than non-re-positive patients.Multifactor logistic regression showed that age,COVID-19 re-infection of COVID-19,serum albumin,pre-dialysis creatinine,and pleural effusion were factors influencing the development of frailty syndrome in dialysis patients(P＜0.05).Conclusion There is high incidence of frailty syndrome in dialysis patients,and there is no correlation of frailty with dialysis modality.High serum albumin level is a protective factor for the development of frailty syndrome in patients,whereas re-infection of COVID-19,advanced age,high pre-dialysis blood creatinine level and pleural effusion are risk factors for the development of frailty syndrome.

With the continuous development of medical science and the widespread use of antibiotics,the problem of bacterial resistance is increasing,especially the increasing carbapenem-resistant Enterobacteriaceae(CRE)infection,and the high mortality rate,which brings great challenges to clinical treatment.In this paper,the mechanism of drug resistance,existing antibac-terial drugs,and exploratory treatment options for CRE are reviewed,and the research progress in treating CRE infection is dis-cussed to provide more reliable evidence and a theoretical basis for clinical practice.

The release of Guidelines to Strengthen the Governance over Ethics in Science and Technology marked that China's ethical governance system of science and technology has entered a new stage.The research and practice on ethics in science and technology in China are carried out along two approaches.One approach is to derive the rules of specific science and practice from the principles of general ethics.The other is to gradually form ethical governance principles and consensus for a specific type of phenomenon or problem in the process of science and technology,starting from scientific research problems and scientific and technological events and cases.Medical ethics research has also formed the tradition of medical ethics and modern bioethics in this way.In the practice of ethical governance,medical ethics is at the forefront of scientific and technological ethics,forming a"pilot area"for the research and development of scientific and technological ethics,an"explorer"for the institutionalization of ethical review,and a"demonstration area"for scientific and technological ethical governance.The release of ethical governance opinions is not the end of research on medical ethics governance,and medical ethics needs to have new achievements.Firstly,rethinking the theoretical basis and methodology of medical ethics and adhering to the guidance of Marxist theory.Secondly,a rethinking of the two research paths and how they can balance development and support each other.Thirdly,rethinking the relationship between ethics and the rule of law,and continuously improving the level of legalization of ethical governance.

Objective:To analyze the dermoscopic and reflectance confocal microscopic (RCM) features of extragenital lichen sclerosus, and to identify their associations with histopathological manifestations.Methods:A total of 57 patients with histopathologically confirmed lichen sclerosus were retrospectively collected from the Department of Dermatology, Wuhan No.1 Hospital from October 2010 to April 2024. Dermoscopic and RCM images were collected from typical skin lesions in extragenital areas, and the consistency between dermoscopic or RCM characteristics and histopathological features was analyzed.Results:Among the 57 patients with extragenital lichen sclerosus, there were 15 males and 42 females, with ages ranging from 5 to 60 years and disease duration from 5 to 28 months. The skin lesions were mainly located on the face and neck (23 cases, 40.4%) and back (11 cases, 19.3%). Histopathological features included hyperkeratosis with follicular plugging, vacuolar degeneration of basal cells, edematous papillary and superficial dermis, collagen homogenization, and predominant infiltration of variable amounts of melanophages and lymphocytes in the superficial dermis. Dermoscopy showed yellowish-white structureless areas in 57 cases (100%), yellowish-white circular structures in 55 (corresponding to follicular keratotic plugs, 96.5%), characteristic vascular structures in 54 (94.7%), gray-brown punctate pigmentation in 56 (98.3%), xanthochromic patchy pigmentation in 20 (35.1%), white scales in 54 (94.7%), white scar-like hypopigmentation in 43 (75.4%), and hemorrhagic spots in 2 (3.5%). RCM images showed follicular plugging in 44 cases (77.19%), manifesting as dilated follicular infundibula containing highly refractive keratotic materials; liquefaction degeneration of the basal cell ring was observed in 57 cases (100%), manifesting as loss of the basal cell ring, blurred epidermal-dermal junction, and infiltration of variable amounts of melanophages and inflammatory cells in the superficial dermis; dilatation of superficial dermal blood vessels was seen in 46 (80.7%) ; all 57 cases (100%) showed reduced epidermal thickness compared to surrounding normal skin, epidermal atrophy and thinning, and rete ridge flattening; hyperkeratosis was observed in 57 cases (100%) ; 39 cases (68.42%) showed thickened fibers with increased refractivity in the superficial dermis. The detection rates of follicular keratotic plugs, patchy pigmentation, and white scar-like hypopigmentation by dermoscopy significantly differed from those by histopathological examinations (all P < 0.05), so did the detection rates of superficial dermal collagen thickening and vascular dilatation by RCM (both P < 0.05) . Conclusions:Extragenital lichen sclerosus has characteristic dermoscopic and RCM manifestations, which were highly consistent with its histopathological findings. Dermoscopy combined with RCM technology can provide effective support for the diagnosis and differential diagnosis of extragenital lichen sclerosus.

Objective:To develop dynamic management strategies for intraoperative acquired pressure injuries (IAPI) in neurosurgery patients and evaluate their implementation effects, so as to provide constructive suggestions for the management of IAPI.Methods:This study was conducted by a non-synchronous before and after control study. From January 2021 to December 2022, 220 patients undergoing neurosurgery in the Second Affiliated Hospital of Guilin Medical College were conveniently selected as the study objects, and divided into the control group and the observation group with 110 patients in each group according to the time of operation. The control group was given routine nursing measures to prevent IAPI, and the observation group was given dynamic management program based on timing theory on bisis of routine nursing. The score of preoperative stress injury,incidence of IAPI and the self-efficacy scores of nurses in the management of stress injury in operating room were compared between the two groups.Results:Before intervention, the scores of preoperative stress injury in control group and observation group were (14.69 ± 2.93) points and (14.78 ± 2.89) points, respectively, with no statistical significance ( t=-0.23, P>0.05).After the intervention, the incidence of IAPI was 3.64%(4/110) in the control group and 0 in the observation group, and the difference was statistically significant ( χ2=4.07, P<0.05). The self-efficacy scores of nurses in the management of stress injury before and after intervention were (29.13 ± 4.87) and (36.41 ± 5.83), respectively, and the difference was statistically significant ( t=-6.21, P<0.05). Conclusions:The implementation of dynamic management strategy of IAPI can effectively reduce the incidence of IAPI in neurosurgery patients and improve the self-efficacy of nurses in operating room.