ObjectiveTo explore the changes in volatile components， total polysaccharides， enzyme activity， and chromaticity value of Myristicae Semen Koji（MSK） during the fermentation process， and conduct correlation analysis. MethodsBased on gas chromatography-mass spectrometry（GC-MS）， the changes of volatile components in MSK at different fermentation times were identified. The phenol sulfuric acid method， dinitrosalicylic acid method（DNS）， and carboxymethyl cellulose sodium salt method（CMC-Na） were used to investigate the total polysaccharide content， amylase activity， and cellulase activity during the fermentation process. Visual analysis technology was used to explore the changes in chromaticity values， revealing the fermentation process of MSK and the dynamic changes of various measurement indicators， partial least squares-discriminant analysis（PLS-DA） was used to explore the differential compounds of MSK at different fermentation degrees， and Pearson correlation analysis was used to explore the correlation between volatile components of MSK and total polysaccharides， enzyme activity， and chromaticity values. ResultsA total of 60 volatile compounds were identified from MSK， the relative contents of components such as （+）-α-pinene， β-phellandrene， β-pinene， （+）-limonene， and p-cymene obviously increased， while the relative contents of components such as safrole， methyl isoeugenol， methyleugenol， myristicin， and elemicin significantly decreased. During the fermentation process， the total polysaccharide content showed an upward trend， while the activities of amylase and cellulase showed an initial increase followed by a decrease， and reached their maximum value at 40 h. the overall brightness（L^*） and total color difference（ΔE^*） gradually increased， while the changes in red-green value（a^*） and yellow-blue value（b^*） were not obvious. PLS-DA results showed that MSK could be clearly distinguished at different fermentation times， and 13 differential biomarkers were screened out. Pearson correlation analysis results showed that the contents of α-terpinene， β-phellandrene， methyleugenol， β-cubebene and myristic acid had an obvious correlation with chromaticity values. ConclusionAfter fermentation， the volatile components， total polysaccharides， amylase activity， and cellulase activity of MSK undergo significant changes， and there is a clear correlation between them and chromaticity values， which reveals the dynamic changes in the fermentation process and related indicators of MSK， laying a foundation for the quality control.

Objective To investigate the correlation between serum indirect bilirubin(IBIL)levels and carotid intima-media thickness(CIMT)of acute cerebral infarction patients.Methods A total of 229 patients with acute cerebral infarction at Wuxi No.2 Chinese Medicine Hospital from July 2021 to November 2023 were divided into the intima-media thickness group(CIMT≥0.9mm,n=108)and intima-media normal group(CIMT<0.9mm,n=121)according to CIMT values.The differences in gender,age,body mass index,smoking history,history of alcohol drinking,hypertension,coronary heart disease,diabetes,hyperlipidemia,total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglyceride,fasting blood glucose,uric acid,and cystatin C were compared between the two groups.To further elucidate the association between serum bilirubin levels and CIMT using both univariate and multivariate analysis.Results The two groups showed significant differences in gender,body mass index and IBIL in the results(P<0.05).However,there was no significant difference in age,history of alcohol drinking,smoking history,diabetes,coronary heart disease,hypertension,hyperlipidemia,TBIL,DBIL,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglyceride,fasting blood glucose,uric acid and cystatin C levels(P>0.05).Binary Logistic regression analysis indicated that gender,body mass index and IBIL were significant independent predictors of CIMT values(P<0.05).Conclusion Serum indirect bilirubin level is inversely associated with CIMT in acute cerebral infarction patients,which may be one of the protective factors of atherosclerosis.

ObjectiveTo rapidly identify the chemical constituents in Tongxie Yaofang decoction by ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-LTQ-Orbitrap-MS）. MethodChromatographic conditions were ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm）， mobile phase of 0.1% formic acid aqueous solution（A）-acetonitrile（B） for gradient elution （0-4 min， 5%-15%B； 4-10 min， 15%-25%B； 10-15 min， 25%-60%B； 15-20 min， 60%-90%B； 20-25 min， 90%-100%B； 25-27 min， 100%B； 27-30 min， 100%-5%B； 30-32 min， 5%B）， flow rate of 0.3 mL·min^-1， column temperature at 35 ℃ and injection volume of 3 μL. UPLC-LTQ-Orbitrap-MS was equipped with an electrospray ionization（ESI）， the MS and MS/MS data were collected in positive and negative ion modes， and detection range was m/z 100-1 250. Combining the reference substance， chemical databases and related literature information， TraceFinder 4.1 and Xcalibur 2.1 were used to identify the chemical constituents of Tongxie Yaofang decoction. ResultA total of 90 compounds， mainly including flavonoids， coumarins， monoterpene glycosides， chromones and lactones， were identified from Tongxie Yaofang decoction. By attributing the sources of Chinese medicines for all identified compounds， 9 of them were found to be derived from Atractylodis Macrocephalae Rhizoma， 21 from Paeoniae Radix Alba， 24 from Citri Reticulatae Pericarpium， 29 from Saposhnikoviae Radix， and 7 from at least two Chinese medicines. ConclusionThe method can effectively， quickly and comprehensively identify the chemical components of Tongxie Yaofang decoction， and clarify the chemical composition. These identified compounds cover the main active ingredients of the four herbs with high abundance， which indicates that the extraction method and the ratio of the medicinal materials of Tongxie Yaofang are scientific， and can provide a reference for the research on the material basis and quality evaluation of this famous classical formula.

Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

Objective:To construct a real-time monitoring system based on computer vision for monitoring withdrawal speed of colonoscopy and to validate its feasibility and performance.Methods:A total of 35 938 images and 63 videos of colonoscopy were collected in endoscopic database of Renmin Hospital of Wuhan University from May to October 2018. The images were divided into two datasets, one dataset included in vitro, in vivo and unqualified colonoscopy images, and another dataset included ileocecal and non-cecal area images. And then 3 594 and 2 000 images were selected respectively from the two datasets for testing the deep learning model, and the remaining images were used to train the model. Three colonoscopy videos were selected to evaluate the feasibility of real-time monitoring system, and 60 colonoscopy videos were used to evaluate its performance.Results:The accuracy rate of the deep learning model for classification for in vitro, in vivo, and unqualified colonoscopy images was 90.79% (897/988), 99.92% (1 300/1 301), and 99.08% (1 293/1 305), respectively, and the overall accuracy rate was 97.11% (3 490/3 594). The accuracy rate of identifying ileocecal and non-cecal area was 96.70% (967/1 000) and 94.90% (949/1 000), respectively, and the overall accuracy rate was 95.80% (1 916/2 000). In terms of feasibility evaluation, 3 colonoscopy videos data showed a linear relationship between the retraction speed and the image processing interval, which indicated that the real-time monitoring system automatically monitored the retraction speed during the colonoscopy withdrawal process. In terms of performance evaluation, the real-time monitoring system correctly predicted entry time and withdrawal time of all 60 examinations, and the results showed that the withdrawal speed and withdrawal time was significantly negative-related ( R=-0.661, P<0.001). The 95% confidence interval of withdrawal speed for the colonoscopy with withdrawal time of less than 5 min, 5-6 min, and more than 6 min was 43.90-49.74, 40.19-45.43, and 34.89-39.11 respectively. Therefore, 39.11 was set as the safe withdrawal speed and 45.43 as the alarm withdrawal speed. Conclusion:The real-time monitoring system we constructed can be used to monitor real-time withdrawal speed of colonoscopy and improve the quality of endoscopy.

Objective:To establish a deep convolutional neural network (DCNN) model based on YOLO and ResNet algorithm for automatic detection of colorectal polyps and to test its function.Methods:Colonoscopy images and videos collected from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University from January 2018 to March 2019 were divided into three databases (database 1, 3, 4). The public database CVC-ClinicDB (composed of 612 polyp images extracted from 29 colonoscopy videos provided by Barcelona Hospital, Spain) was used as the database 2. Database 1 (4 700 colonoscopy images from January 2018 to November 2018, including 3 700 intestinal polyp images and 1 000 non-polyp images) was used for establishing training and verifying the DCNN model. Database 2 (CVC-ClinicDB) and database 3 (720 colonoscopy images from January 2019 to March 2019, including 320 intestinal polyp images and 400 non-polyp images) were used for testing the DCNN model on image detection. Database 4 (15 colonoscopy videos in December 2019, containing 33 polyps) was used for testing the DCNN model on video detection. The sensitivity, specificity, accuracy and false positive rate of the DCNN model for detecting intestinal polyps were calculated.Results:The sensitivity of the DCNN model for detecting intestinal polyps in database 2 was 93.19% (602/646). In database 3, the DCNN model showed the accuracy of 95.00% (684/720), sensitivity of 98.13% (314/320), specificity of 92.50% (370/400), and false positive rate of 7.50% (30/400) for detecting intestinal polyps. In database 4, the DCNN model achieved a per-polyp-sensitivity of 100.00% (33/33), a per-image-accuracy of 96.29% (133 840/138 998), a per-image-sensitivity of 90.24% (4 066/4 506), a per-image-specificity of 96.49% (129 774/134 492), and a per-image-false positive rate of 3.51% (4 718/134 492).Conclusion:The DCNN model constructed in the study has a high sensitivity and specificity for automatic detection of colorectal polyps both in the colonoscopy images and videos, has a low false positive rate in the videos, and has the potential to assist endoscopists in diagnosis of colorectal polyps.

Objective To explore the effect of oral-muscle biofeedback system training on the rehabilitation of cognitive dysfunction in patients with obstructive sleep apnea (OSA) after ischemic stroke.Methods A total of 60 cases of poststroke OSA patients with cognitive dysfunction admitted to the rehabilitation center of deAn hospital in changzhou city from June 2017 to March 2018 were selected.On the basis of routine rehabilitation treatment,the control group was given positive pressure ventilation treatment,and the observation group was given oral muscle biofeedback system training.The changes of polysomnography (PSG) parameters,Montreal cognitive assessment (MoCA) score,serum matrix metalloproteinase-9 (MMP-9) and plasma homcysteinemia (Hcy) expression levels in the two groups before and after treatment were compared.Results Apnea hypopnea index and maximum apnea time of the two groups were significantly decreased after treatment compared with those before treatment,and the lowest SpO2 and average SpO2 were significantly higher than those before treatment(P＜0.05).After treatment,MoCA total score and the dimensions score of patients in the observation group were significantly higher than those in the control group at the same time (P＜0.05).After treatment,the levels of Hcy((12.38±4.54) μmol/L) and MMP-9((124.52± 12.94) μg/L) in the observation group were significantly lower than those in the control group at the same time(Hcy(17.52±6.27) μmol/L,MMP-9(268.25±20.5 7)μg/L),and the difference was statistically significant (Hcy:t=3.637,P＜0.05;MMP-9:t =32.395,P＜0.05).Conclusions Positive pressure ventilation and oral muscle biofeedback system training have the same effect on OSA after stroke,but oral muscle biofeedback system training can also effectively improve patients' cognitive function.

Objective: To compare the differences and caused of patients' utilization of Traditional Chinese Medicine service under three basic medical insurance systems.Methods: Using self-developed questionnaire,random sample survey was conducted among the basic medical insurance outpatients in five hospitals in Nanjing and Lanzhou.The survey content included the basic information of the patients,the utilization of Traditional Chinese Medicine outpatient clinics,the utilization of Traditional Chinese Medicine service items,and the suggestions for the Traditional Chinese Medicine service.Results:①The utilization rate of the Traditional Chinese Medicine out-patient clinics in new rural cooperative medical system patients was much lower than that in urban basic medical in-surance patients.②The utilization rate of Traditional Chinese Medicine service projects in patients under basic medical insurance for urban employees was higher than those under medical insurance for urban residents and new rural cooperative medical system patients.In all Traditional Chinese Medicine service projects,the utilization rate of cupping project was the highest(48.3％).③ The gap between urban and rural areas made the utilization rate of Traditional Chinese Medicine service projects different among patients participating in basic medical insurances.④ The most expected suggestion of patients was the improvement of the efficacy of Traditional Chinese Medicine(68.5％),followed by the improvement of medical insurance-related reimbursement ratio(65.2％)and the in-crease of reimbursement items(64.3％).Conclusion: The government should increase the financial input in new rural cooperative medical system and improve the basic medical insurance system.Traditional Chinese Medicine medical institutions should improve the quality of services in order to achieve the fairness in the provision of health services.

This study aimed to elucidate the effect of tryptophan (Trp) on gut hormone secretion as well as the roles of the calcium-sensing receptor (CaSR) and its downstream signaling pathway in gut hormone secretion by assessing swine duodenal perfusion in vitro. Swine duodenum was perfused with Krebs-Henseleit buffer as a basal solution. Various concentrations (0, 10, and 20 mM) of Trp were applied to investigate its effect on gut hormone secretion. A CaSR antagonist was used to detect the involvement of CaSR and its signal molecules. The 20 mM Trp concentration promoted the secretion of cholecystokinin (CCK) and glucose-dependent insulinotropic peptide (GIP), elevated the mRNA level of CaSR, and upregulated the protein levels of CaSR, protein kinase C (PKC), and inositol trisphosphate receptor (IP3R). However, NPS 2143, an inhibitor of CaSR, attenuated the CCK and GIP release, reduced the mRNA level of CaSR, and decreased the protein levels of CaSR, PKC, and IP3R with 20 mM Trp perfusion. The results indicate that CCK and GIP secretion can be induced by Trp in swine duodenum in vitro, and the effect is mediated by CaSR and its downstream signal molecules PKC and IP3R.
Cholecystokinin ; Duodenum ; Gastric Inhibitory Polypeptide ; In Vitro Techniques ; Inositol ; Perfusion ; Protein Kinase C ; Receptors, Calcium-Sensing ; RNA, Messenger ; Swine ; Tryptophan

OBJECTIVE:To investigate the effects of olmesartan medoxomil on cardiac function,plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and serum interleukin-23(IL-23)in patients with chronic heart failure(CHF),and to evaluation its safety. METHODS:A total of 40 CHF patients selected from Lianshui County People's Hospital of Jiangsu Province during Dec. 2014-May 2016 were divided into control group and observation group according to random number table,with 20 cases in each group. Control group was given Enalapril maleate tablets with initial dose of 5 mg,po,qd(increasing gradually after one week,limiting dose of 20 mg/d)+Metoprolol tartrate tablets 25 mg,po,bid+Isosorbide mononitrate tablets 40 mg,po,qd+Furose-mide tablets 20 mg,po,bid. Observation group was additionally given Olmesartan medoxomil tablets 20 mg,po,qd,on the basis of control group. Both groups received treatment for consecutive 8 weeks. Cardiac function indexes [LVEDD,LAD,IVST,LVP-WT,LVEF,early diastolic peak E filling velocity/late diastolic peak A filling velocity(E/A)],plasma NT-proBNP and serum IL-23 levels were observed in 2 groups before and after treatment. The incidence of ADR was recorded. RESULTS:Before treat-ment,there was no statistical significance in cardiac function indexes,plasma NT-proBNP or serum IL-23 levels between 2 groups (P>0.05).After treatment,LVEDD,LAD,plasma NT-proBNP and serum IL-23 levels of 2 groups were decreased significantly, while LVEF and E/A levels were increased significantly;the observation group was significantly better than control group,with sta-tistical significance(P<0.05). There was no statistical significance in IVST or LVPWT levels between 2 groups before and after treatment,and there was no statistical significance in the incidence of ADR between observation group(25.00%)and control group(20.00%)(P>0.05). CONCLUSIONS:Olmesartan medoxomil can decrease the levels of plasma NT-proBNP and serum IL-23 in CHF patients,and improve cardiac function with good safety.