Objective Chronic atrophic gastritis(CAG)is often accompanied by intestinal flora disorder and intestinal symptoms,forming the phenomenon of"stomach disease involving intestine".This study explored the dynamic correlation between intestinal symptoms and qi-stagnation degree in patients with CAG qi-stagnation syndrome and analyzed the characteristics of gut microbiota from the perspective of"spleen-stomach system serving as the pivotal hub of qi movement"in TCM.Methods According to the syndrome element differentiation method,410 patients with CAG were divided into four groups:non-qi-stagnation group,mild qi-stagnation group,moderate qi-stagnation group and severe qi-stagnation group.Correlation analysis and 16S intestinal flora sequencing technology were used to analyze the correlation and differential flora between the degree of CAG qi-stagnation and intestinal symptoms.Results Patients with CAG qi-stagnation syndrome were often accompanied by intestinal symptoms such as frequent flatulence,poor defecation and alternating loose-constipated stools.The frequency of cases was significantly positively correlated with the degree of qi-stagnation"non-mild-moderate-severe"(P<0.05).There was a difference in the abundance of gut microbiota between the four groups of CAG qi-stagnation none,mild,moderate and severe.The relative abundance of Streptococcus,Subdoligranulum,Eubacterium_coprostanoligenes_group and Haemophilus was positively correlated with the degree of qi-stagnation.The relative abundance of Ruminococcus_torques_group and Butyricicoccus showed a negative correlation,and Haemophilus was statistically significant among the four groups(P<0.05).Conclusion This study can provide clinical evidence and micro-mechanism for the connotation of"gastrointestinal co-morbidities"and"different diseases with the same syndrome",which may open up new ideas for clinical diagnosis and treatment.

Objective Chronic atrophic gastritis(CAG)is often accompanied by intestinal flora disorder and intestinal symptoms,forming the phenomenon of"stomach disease involving intestine".This study explored the dynamic correlation between intestinal symptoms and qi-stagnation degree in patients with CAG qi-stagnation syndrome and analyzed the characteristics of gut microbiota from the perspective of"spleen-stomach system serving as the pivotal hub of qi movement"in TCM.Methods According to the syndrome element differentiation method,410 patients with CAG were divided into four groups:non-qi-stagnation group,mild qi-stagnation group,moderate qi-stagnation group and severe qi-stagnation group.Correlation analysis and 16S intestinal flora sequencing technology were used to analyze the correlation and differential flora between the degree of CAG qi-stagnation and intestinal symptoms.Results Patients with CAG qi-stagnation syndrome were often accompanied by intestinal symptoms such as frequent flatulence,poor defecation and alternating loose-constipated stools.The frequency of cases was significantly positively correlated with the degree of qi-stagnation"non-mild-moderate-severe"(P<0.05).There was a difference in the abundance of gut microbiota between the four groups of CAG qi-stagnation none,mild,moderate and severe.The relative abundance of Streptococcus,Subdoligranulum,Eubacterium_coprostanoligenes_group and Haemophilus was positively correlated with the degree of qi-stagnation.The relative abundance of Ruminococcus_torques_group and Butyricicoccus showed a negative correlation,and Haemophilus was statistically significant among the four groups(P<0.05).Conclusion This study can provide clinical evidence and micro-mechanism for the connotation of"gastrointestinal co-morbidities"and"different diseases with the same syndrome",which may open up new ideas for clinical diagnosis and treatment.

Objective:From the perspective of patients'emotions,to compare and study the effectiveness between experiential communication and GLTC communication of outpatient doctors,understand the main communication details that affect patients'emotions,and provide a reference for improving patient emotions and enhancing doctor-patient communication skills in the future.Methods:From July 2021 to January 2022,a pilot study of GLTC communication program in outpatient settings was conducted in a total of 24 departments from 4 tertiary comprehensive hospitals in Jiangsu Province.Descriptive analysis,independent sample t-test,multiple linear regression and other analyses were conducted on the relevant data.Results:After experiential communication in outpatient settings,patients showed improvements in dimensions of emotion such as anxiety,fatigue,confusion,and depression,but there was a decrease in patient vitality(P<0.05).After GLTC communication in outpatient settings,patients'emotions in all six dimensions improved(P<0.05).Meanwhile,the GLTC group had better emotions than the experiential group after communication(P<0.05).After training,the completion rate of relevant communication details of doctors in the GLTC group was mostly significantly higher than that in the experiential within the same unit time(P<0.05).Multiple linear regression showed that smiling,comforting language,and kind gaze were the main factors affecting patients'overall emotions.Conclusion:Experiential communication in outpatient settings has certain communication effects,but there is still a lot of room for improvement compared to GLTC communication in outpatient settings.GLTC communication in outpatient settings can improve patients'emotions,and doctors'smiles,comforting language,and other communication details need to be emphasized in outpatient settings.How to improve the execution of GLTC communication in outpatient settings plans is an important direction for future research.

Objective:To analyze the distribution and drug resistance of pathogens of bacterial bloodstream infection in patients with hematological diseases in the Department of Hematology of Tianjin Medical University General Hospital, and to provide etiological data for clinical empirical anti-infection treatment.Methods:A retrospective analysis was conducted on the general clinical information, pathogenic bacteria and drug susceptibility test results of patients with hematological diseases diagnosed with bacterial bloodstream infection by menstrual blood culture in our center from January 2016 to December 2022.Results:Patients included 498 inpatients, with a total of 639 bacterial strains. Among the patients, 86.9% patients had malignancies, and 76.7% had agranulocytosis. Symptoms of concurrent infections, including those of the respiratory tract, oral mucosa, skin and soft tissues, and abdominal sources were observed in 68.3% patients. Gram-negative bacteria (G -) accounted for 79.0% of the isolated bacteria, and gram-positive bacteria (G +) accounted for 21.0%. The top five isolated pathogens were Klebsiella pneumoniae (22.5%), Escherichia coli (20.8%), Pseudomonas aeruginosa (15.0%), Enterococcus faecium (5.5%), and Stenotrophomonas maltophilum (5.0%). Escherichia coli exhibited a decreasing trend of resistance to quinolones, cephalosporins, and carbapenems. Klebsiella pneumoniae exhibited increasing rates of resistance to quinolones and cephalosporins between 2016 and 2018, but the rated decreased after 2019. The resistance rate to carbapenems exhibited by Pseudomonas aeruginosa was approximately 20%. Carbapenem-resistant strains of Pseudomonas aeruginosa strains were first detected in 2017, with a peak resistance rate of 35.7%, detected in 2019. A 60.0% resistance rate to methicillin was observed in methicillin-resistant coagulase-negative staphylococci (MRCNS), and one case of linezolid-resistant MRCNS was detected. Conclusions:Pathogenic bacteria of bacterial bloodstream infections were widely distributed in our center, and precautions are warranted against carbapenem resistant P. aeruginosa and Klebsiella pneumoniae.

AIM:To investigate the effect of As-tragaloside Ⅳ(As-Ⅳ)on low-glucose mediated tu-mor immunosuppression microenvironment and its molecular mechanism.METHODS:MTT assay was used to detect the effect of As-Ⅳ on the prolifera-tion of CD4+T cells in low-glucose microenviron-ment in vitro.By ELISA experiment and qPCR detec-tion of interleukin 2(IL-2),interferon-gamma(IFN-γ),CD40L and transforming growth factor beta 1(TGF-β1)level;Western blot was used to detect the expression of glucose transporter 1(Glut-1),key glycolytic enzymes(HK,PFK1 and PK),AKT/mTOR signaling pathway and AKT/GSK3β signaling pathway in CD4+T cells.Molecular docking and AKT inhibitor experiments were used to verify the re-sults.B16-PKM2-OE was used to establish a low-glucose tumor microenvironment animal model for verification.RESULTS:MTT assay showed that As-Ⅳ promoted the proliferation of CD4+T cells in low-glucose microenvironment(P＜0.05).The results of ELISA and qPCR experiments showed that As-Ⅳcould increase the levels of IL-2,IFN-γ and CD40L,and reduce the level of TGF-β1 in tumor tissues(P＜0.05).Western blot results showed that As-Ⅳ pro-moted Glut-1 protein expression on the surface of CD4+T cells,up-regulated the expression of glycoly-sis key enzymes,and activated AKT/mTOR and AKT/GSK-3β signaling in a concentration-dependent manner.Molecular docking and join AKT inhibitors As the experiment results indicate-Ⅳ activated AKT/mTOR signaling and AKT/GSK-3β signal;Animal experiments showed that As-Ⅳ exerted anti-tumor effect by activating the proliferation and activation of CD4+T cells in low-glucose microenvironment.CONCLUSION:As-Ⅳ promote sugar by activation of AKT/Glut signal micro environment of CD4+T cell proliferation and activation play a role of anti-tu-mor.

AIM:To investigate the effect of As-tragaloside Ⅳ(As-Ⅳ)on low-glucose mediated tu-mor immunosuppression microenvironment and its molecular mechanism.METHODS:MTT assay was used to detect the effect of As-Ⅳ on the prolifera-tion of CD4+T cells in low-glucose microenviron-ment in vitro.By ELISA experiment and qPCR detec-tion of interleukin 2(IL-2),interferon-gamma(IFN-γ),CD40L and transforming growth factor beta 1(TGF-β1)level;Western blot was used to detect the expression of glucose transporter 1(Glut-1),key glycolytic enzymes(HK,PFK1 and PK),AKT/mTOR signaling pathway and AKT/GSK3β signaling pathway in CD4+T cells.Molecular docking and AKT inhibitor experiments were used to verify the re-sults.B16-PKM2-OE was used to establish a low-glucose tumor microenvironment animal model for verification.RESULTS:MTT assay showed that As-Ⅳ promoted the proliferation of CD4+T cells in low-glucose microenvironment(P＜0.05).The results of ELISA and qPCR experiments showed that As-Ⅳcould increase the levels of IL-2,IFN-γ and CD40L,and reduce the level of TGF-β1 in tumor tissues(P＜0.05).Western blot results showed that As-Ⅳ pro-moted Glut-1 protein expression on the surface of CD4+T cells,up-regulated the expression of glycoly-sis key enzymes,and activated AKT/mTOR and AKT/GSK-3β signaling in a concentration-dependent manner.Molecular docking and join AKT inhibitors As the experiment results indicate-Ⅳ activated AKT/mTOR signaling and AKT/GSK-3β signal;Animal experiments showed that As-Ⅳ exerted anti-tumor effect by activating the proliferation and activation of CD4+T cells in low-glucose microenvironment.CONCLUSION:As-Ⅳ promote sugar by activation of AKT/Glut signal micro environment of CD4+T cell proliferation and activation play a role of anti-tu-mor.

OBJECTIVE To screen the potential drug targets and signaling pathways of Acanthopanax senticosus for the treatment of Alzheimer’s disease(AD) by bioinformatics and network pharmacology-based approach, and to preliminarily validate its efficacy. METHODS The ingredients of Acanthopanax senticosus were obtained through literature, the ingredients were screened by Swiss ADME, and potential targets were predicted by Swiss Target Prediction. AD’s differentially expressed genes were screened from the GSE28146 dataset. The target of Acanthopanax senticosus and AD target were mapped to construct a “drug-ingredients-potential target-disease” network and protein-protein interaction network. The DAVID database was used for GO and KEGG enrichment analysis. Autodock software was used to verify the molecular docking between key active ingredients and core targets. AD mice model was induced by D-galactose combined with aluminum chloride. Morris water maze test was performed to examine the learning memory ability of each group of mice and to observe the pathological changes in the hippocampus of mice. RESULTS Screened to obtain 24 active components and 74 potential targets of Acanthopanax senticosus for the treatment of AD. “Drug-ingredients-potential target-disease” network indicated that quercetin and kaempferol were the main components of Acanthopanax senticosus for the treatment of AD, and the protein-protein interaction network indicated that STAT3, MAPK1 and PIK3CA were the key targets. Obtained 366 GO enrichment entries(P<0.01) and 109 KEGG enrichment pathways(P<0.01). It mainly involved PI3K-AKT, AGE-RAGE, TNF and other pathways. The molecular docking results showed that the main active ingredients of Acanthopanax senticosus were able to bind well to the main targets. The in vivo pharmacological results showed that Acanthopanax senticosus could significantly improve the learning and memory ability of mice, reduce hippocampal tissue damage, and decrease the content of TNF-α, IL-6, and IL-1β in hippocampal tissue. CONCLUSION Acanthopanax senticosus may exert anti-AD effects by inhibiting the expression of inflammatory factors and reducing inflammatory damage.

Objective To retrospectively analyze the clinical characteristics of patients with malignant tumors combined with new coronavirus pneumonia (COVID-19), and to provide a scientific basis for clinical treatment. Methods SPSS 20.0 was used for data analysis. The t-test was used for quantitative data, and chi-square test/Fisher-exact test was used for qualitative data. Binary logistic regression was used for multivariate analysis, and the correlation coefficient was used for multicollinearity test before regression analysis. Results A total of 61 COVID-19 infected cancer patients were included in this study. Their average age was 62.2±12.12. The most common admission symptoms were fever (54.1%), fatigue (39.3%), and cough (37.7%). The rate of the patients with severe COVID-19 was 54.1%. Having 3 or more complications (OR: 2.07, 95%CI: 3.14-2698.12), fever (OR: 12.22, 95%CI: 1.20-86.70), low percentage of lymphocytes (OR: 15.56, 95%CI: 1.78-136.24) and low serum albumin level (OR: 254.64, 95%CI: 8.56-7576.41) were risk factors for COVID-19 severity. The fatality rate of the subjects was 8.2%, and the average hospital stay was 26.7±19.69 days. Furthermore, the severity of COVID-19 had a statistically significant impact on the average hospital stay (t=-3.48, P<0.01). Conclusion Patients with malignant tumors combined with COVID-19 have a higher severity rate, fatality rate, and average hospital stay than ordinary COVID-19 patients. Underlying diseases, fever, low lymphocyte percentage, and low serum albumin levels are the factors for the increase of the illness severity in patients with malignant tumors combined with COVID-19.

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with the mirror therapy (MT) on the recovery of upper limb function recovery 3 to 6 months after a stroke.Methods Forty-five male patients were randomly assigned to an MT (A) group,an rTMS+MT (B) group or an MT +rTMS group (C),each of 15.All received conventional medical treatment and stroke rehabilitation.In addition,group A received 60 min of MT daily,5 days a week for 4 weeks.Group B received 10 min of rTMS over the M1 area of the affected hemisphere followed by 50 min of MT treatment,and group C received 50 min of MT treatment followed by 10 min of rTMS.rTMS was delivered at a frequency of 10 Hz and an intensity of 90％ resting motor threshold.The latency of motor evoked potential (MEP) for the affected abductor pollicis brevis muscle and its central motor conduction time (CMCT) were observed before and after the treatment.The upper extremity portion of the Fugl-Meyer assessment (FMA) was performed along with a functional test for the hemiplegic upper extremity (FTHUE).The motricity index (MI) was also quantified.Results Average MEP latency and CMCT had decreased significantly in all three groups after the treatments.The average MEP latency of group B was significantly shorter than that of group A,and CMCT was also significantly shorter than for groups A and C.Moreover,after the intervention,all of the groups had significantly improved their average FMA,MI and FTHUE scores,with the average FMA score of group B significantly better than those of groups A and C.The average FTHUE score of group B was also significantly better than that of group A.Conclusions MT either alone or in combination with rTMS can improve cerebral motor cortex excitability and motor recovery after a stroke.Ten minute rTMS sessions followed by 50 min of MT have the best effect.