Objective To investigate the causal relationship between gut microbiota and idiopathic pulmonary fibrosis (IPF). Methods Genome-wide association studies (GWAS) data of gut microbiota and IPF were obtained from MiBioGen and IEU OpenGWAS, respectively. Instrumental variables were screened by means of significance, linkage disequilibrium, weak instrumental variable screening, and removal of confounding factors (genetics, smoking, host characteristics). Inverse variance weighted (IVW) was used as the main Mendelian randomization (MR) analysis method, and the weighted median, simple mode, MR-Egger, and weighted mode were used to perform MR to reveal the causal effect of gut microbiota and IPF. The Cochrane's Q, leave-one-out, MR-Egger-intercept, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) and Steiger tests were used to analyze the heterogeneity, horizontal pleiotropy, outliers, and directionality, respectively. Results IVW analysis results showed that Actinobacteria [OR=1.773, 95%CI (1.323, 2.377), P<0.001], Erysipelatoclostridium [OR=2.077, 95%CI (1.107, 3.896), P=0.023], and Streptococcus [OR=1.35, 95%CI (1.100, 1.657), P=0.004] could increase the risk of IPF. Bifidobacterium [OR=0.668, 95%CI (0.620, 0.720), P<0.001], Ruminococcus [OR=0.434, 95%CI (0.222, 0.848), P=0.015], and Tyzzerella [OR=0.479, 95%CI (0.304, 0.755), P=0.001] could reduce the risk of IPF. No significant heterogeneity, horizontal pleiotropy, outliers, and reverse causality were found. Conclusion Actinobacteria, Erysipelatoclostridium and Streptococcus may increase the risk of IPF, while Bifidobacterium, Ruminococcus and Tyzzerella may reduce the risk of IPF. Regulation of the above gut microbiota may become a new direction in the study of the pathogenesis of IPF.

OBJECTIVE To explore the improvine mechanism of Yifei xuanfei jiangzhuo formula （YFXF） on vascular dementia （VAD） model rats based on the growth factor receptor-bound protein 2 （GRB2）/extracellular signal-regulated kinase （ERK）/cardiolipin synthase 1 （CRLS1） pathway. METHODS VAD rat model was established by permanent bilateral common carotid artery ligation. Forty-eight successfully modeled rats were randomly divided into the model group （normal saline）， donepezil hydrochloride group （positive control group， 0.2 g/kg）， and YFXF low- and high-dose groups （12.18 and 24.36 g/kg， calculated based on the total amount of crude drug）， respectively. In addition， a sham operation group （normal saline） was set up. There were 12 rats in each group. Daily intragastric administration of drug or normal saline was performed for 30 consecutive days. After the last administration， the spatial cognitive ability of the rats was evaluated， the pathological morphology of the hippocampus was observed， the contents of tumor necrosis factor-α （TNF-α） and interleukin-4 （IL-4） in serum were detected， the expression levels of GRB2/ERK/CRLS1 pathway-related proteins and the mRNA levels of GRB2， CRLS1， NADH dehydrogenase subunit 1（ND1）， Tafazzin （TAZ）， phospholipid scramblase 3（PLSCR3） and the ATP content in hippocampal tissue were measured. RESULTS Compared with the sham operation group， the escape latency of rats in the model group was significantly prolonged （ P ＜0.05）， and the number of crossing platform was significantly reduced （ P ＜0.05）， while the number of pyramidal cells and Nissl bodies in the hippocampus decreased sharply； the content of TNF-α in serum was significantly increased （ P ＜0.05）， and the content of IL-4 was significantly decreased （ P ＜0.05）； the expression levels of GRB2 and CRLS1 proteins， the phosphorylation level of ERK protein， the relative expression levels of GRB2， CRLS1，ND1， TAZ， and PLSCR3 mRNA， and the content of ATP in hippocampal tissue were significantly decreased （ P ＜0.05）. Compared with the model group， the above pathological changes in the hippocampal tissue of each administration group were alleviated， and the quantitative indicators were significantly restored （ P ＜0.05）. CONCLUSIONS YFXF may improve hippocampal neuron injury in VAD rats by activating the GRB2/ERK/CRLS1 pathway, maintaining cardiolipin homeostasis， and improving mitochondrial energy metabolism.

ObjectiveTo analyze the epidemiological characteristics of foodborne disease outbreaks in Wuhan from 2006 to 2023, and to provide a scientific basis for the development of foodborne disease prevention and control measures. MethodsDescriptive statistical analyses were performed on foodborne disease outbreaks confirmed by the district and municipal center for disease control and prevention (CDC) in Wuhan from 2006 to 2023, and the attack rate and case fatality rate were calculated as well. ResultsA total of 182 foodborne disease outbreaks were reported in Wuhan from 2006 to 2023, with a cumulative of 2 820 cases. Among which, 3 cases were dead, with an annual average attack rate of 1.22% and a case fatality rate of 0.11%. The highest number of outbreaks occurred in collective canteens (43.96%, 80/182), the highest attack rate was observed in catering facilities (11.03%), and the highest case fatality rate was found in households (1.45%). Among the foodborne disease outbreaks with identified etiologies, microbial factors were the leading causes (36.26%, 66/182), with the main pathogens being norovirus, Bacillus cereus, and other unspecified bacteria. Fungal factors were mainly attributed to poisonous mushrooms, with a relatively high fatality rate of 2.22% (2/90). Outbreaks caused by bacterial factors were more common in the central urban area (30.28%, 33/109), while fungal-related outbreaks were more frequent in the outlying urban areas (24.66%, 18/73). ConclusionCollective canteens are the main venues for foodborne disease outbreaks in Wuhan. Microbial factors are the main pathogenic factors, and poisonous mushrooms are the leading causes to death. It is necessary to strengthen the supervision on collective canteens, carry out various forms of public awareness campaigns on poisonous mushroom poisoning, and, if required, cooperate with the gardening department to eradicate wild poisonous mushrooms in the green belts. A collaborative cooperation involving multiple departments is essential to reduce the occurrence of foodborne disease outbreaks.

Objective: To explore the clinical manifestations and treatment plans of chronic recurrent parotitis (CRP), and to provide a reference for the clinical diagnosis and treatment of CRP. Methods: Approval was obtained from the hospital’s Medical Ethics Committee, and a retrospective analysis and summary of the clinical features, imaging characteristics, diagnosis, and treatment of 41 CRP patients with complete data were performed. Results: Among the 41 patients with CRP, 14 were male and 27 were female, with a male-to-female ratio of approximately 1:2 (14/27). The age at first-time onset ranged from 3 to 23 years, with a median age of 6 years, and there were 38 patients (92.7%, 38/41) with the first onset age of under 18 years old. The age of the first visit to our hospital ranged from 4 to 72 years old, with an average age of (41.0 ± 17.3) years; the disease duration was 0.5 to 66 years, with an average of 35.0 ± 16.1 years. Twenty-five cases had bilateral parotid gland involvement (61.0%, 25/41). The clinical manifestations of CRP are repeated swelling of one or both parotid glands, along with discomfort, and this may be accompanied by mild edema or skin flushing and pus or jelly-like secretions at the duct openings. The typical manifestations of parotid angiography are: the dominant duct and branch ducts of the parotid gland do not have specific dilation or narrowing, and the peripheral ducts show characteristic “punctate, spherical, or cavitary” dilation and delayed emptying. Of the cases, 34 had abnormal enlargement of the main duct orifice (82.9%, 34/41), and 37 presented with abnormal anterior displacement of the accessory glands (90.2%, 37/41). The treatment plan of “antibiotic perfusion + aspiration and removal of obstruction (or aspiration after obstruction dissolution)+ postprandia massage along the direction of the parotid duct (from posterior to anterior) with multiple courses for consolidation”achieved favorable outcomes. The mean follow-up period of this group was(71.1+21.9)months, and no recurrence was observed during the follow-up period. Conclusion CRP is more prevalent in young females and frequently presents with bilateral involvement. Congenital anatomical defects, such as abnormal enlargement of the main duct orifice and abnormal anterior displacement of the accessory glands, are important predisposing factors. The multi-course comprehensive therapy centered on antibiotic infusion, removal and dissolution of obstructions, and post-prandial massage along the direction of the parotid duct has significant therapeutic effects and deserves clinical application.

Objective:To explore the application effect of " visual nursing map" in coronary artery bypass grafting (CABG).Methods:A retrospective analysis was made on 76 patients who underwent CABG in Beijing Friendship Hospital, Capital Medical University from June 2021 to June 2023. 38 cases admitted from June 2021 to May 2022 were included in the control group, and 38 cases admitted from June 2022 to June 2023 were included in the observation group. The control group was given intraoperative routine nursing, and the observation group was given "visual nursing map" nursing measures on this basis. The preoperative preparation time and intraoperative pause time between the two groups were observed and compared. The measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. Counting data were expressed as cases and percentages, and Chi-square test was used for inter-group comparison. Results:In the control group, the preoperative preparation time was (93.2±8.5) min, and the longest procedure was the placement of electrosurgical equipment and instrument trolley, which were (6.4±0.8) min and (32.6±3.5) min, respectively. The intraoperative pause time was (7.3±0.7) min, and the longest time was the unskilled nursing cooperation of proximal and distal vascular anastomosis and the incomplete preparation of sterile surgical materials, which were (2.2±0.4) min and (1.4±0.3) min, respectively. In the observation group, the preoperative preparation time and intraoperative pause time were significantly reduced compared with the control group after the use of "visual nursing map" management on the basis of the control group, which were (79.4±5.4) and (93.2±8.5) min, (4.4±0.6) and (7.3±0.7) min, respectively, and the differences were statistically significant ( P<0.05). Conclusion:The application of "visual nursing graph" in CABG can effectively reduce the preoperative preparation time and intraoperative pause time, and should be further promoted.

This review briefs the anti-hyperuricemia(HUA)mechanism of nutrition targeting the gut,such as the gut microbiota promoting the catabolism of purine and uric acid(UA),and increased its metabolites like uric acid.The review also summarizes the probiotics and prebiotics that have the effect of lowering uric acid targeting at the gut,providing reference and guidance for further research.In addition,this paper reviews the effects of various di-ets,such as the dietary approaches to stop hypertension(DASH)diet,the Mediterranean diet,and the low-purine diet,as well as the effects of individual foods including alcohol,coffee and tea,cherries,dairy products,fructose,and vitamin C on hyperuricemia and gout outcomes.

Objective To evaluate the application of modified chairside case-based learning(CBL)in the teaching of dental residents in the prosthodontic clinic.Methods Dental residents in Peking Union Medical College Hospital from September 2022 to September 2024 were enrolled.Traditional CBL was conducted in control group.Modified chairside CBL was conducted in test group.The scores of department rotation examination and questionnaire results were analyzed with t-test statistical analysis.Results The score of"patient reception"in test group was significantly higher than control group(P＜0.05).24 valid questionnaires were collected in two groups each.The rate of approval in test group was significantly higher than control group in the following items of questionnaire,including"reduce learning pressure or burden""improve the capacity of doctor-patient communication""improve the capacity of literature review""improve the capacity of group cooperation"(P＜0.05).Conclusions Modified chairside CBL has showed good teaching effects in improving the capacity of patient reception,doctor-patient communication,literature review,group cooperation,and meanwhile reduced learning pressure or burden.

Objective:To investigate the correlation between the intensity of glycemic exposure over time [time-weighted average glucose (TWA-G)] and time-weighted average glucose variation (TWA-GV) with the prognosis of septic patients.Methods:Data for this study were obtained from the MIMIC-IV database and inpatients from The First People's Hospital of Lianyungang between 2020 and 2024. The study included all intensive care unit (ICU) patients who had blood glucose measured, were aged ≥18 years, and met the Sepsis-3.0 diagnostic criteria. The primary outcome was 28-day mortality. The relationship between the time-varying intensity of glycemic exposure and mortality was estimated using a piecewise exponential additive mixed model. Restricted cubic splines were further employed to assess the optimal proportion of time spent within specific blood glucose risk thresholds for septic patients.Result:This study incorporated 15 116 sepsis hospitalization records from the MIMIC-Ⅳ database and 565 septic patients from The First People's Hospital of Lianyungang. After adjusting for baseline characteristics and time-dependent confounding factors, the study found that both TWA-G and TWA-GV were associated with an increased risk of 28-day mortality. TWA-G values outside the range of 86-172 mg/dL or TWA-GV greater than 8% were significantly associated with an increased hazard ratio for mortality. Mild glycemic variability in the early stage was associated with slightly lower mortality. The short-term impact of TWA-G and TWA-GV on septic patients was significant, particularly affecting mortality in elective surgical, female, and obese diabetic patients. Subgroup analysis revealed that the diabetic population tolerated a wider glycemic range (86-215 mg/dL) compared to the non-diabetic population (86-172 mg/dL). Similarly, low-risk septic patients tolerated a wider range (87-193 mg/dL) compared to high-risk septic patients (84-170 mg/dL). Furthermore, the study found that an accumulated time spent outside the target glycemic range exceeding 72% ( HR=1.01, 95% CI: 1.00-1.02, P=0.04) was associated with increased patient mortality risk. Conclusions:Blood glucose levels and glycemic variability should be closely monitored during the early and middle phases following ICU admission in septic patients. High-intensity glycemic exposure is associated with an increased risk of mortality. Mild glycemic variability may be more physiologically adaptive in the early stages of sepsis.

OBJECTIVE: To explore the clinical features and genetic mutation sites of 28 patients with Congenital fibrinogen disorders (CFDs). METHODS: A total of 28 unrelated CFDs patients admitted to Wenzhou People's Hospital from June 2018 to April 2023 were enrolled into this research. A total of 2.7 mL of peripheral blood was collected from each patient for coagulation function tests, which included thrombin time (TT), fibrinogen activity (Fg:C), fibrinogen antigen (Fg:Ag), and gene detection. The Sanger sequencing method was employed to verify variations in the fibrinogen (Fg) protein-coding gene across 28 patients. Bioinformatics analyses, including harmfulness analysis, conservation analysis across different species, and spatial simulation predictions of variant proteins, were conducted byPolyPhen-2, PROVEAN, SnapGene, and Pymol softwares on the variant sites of these patients. Pathogenicity ratings for the detected variant sites were performed in accordance with the Standards and Guidelines for the Interpretation of Sequence variants by the American College of Medical Genetics and Genomics (ACMG) (hereafter referred to as the ACMG Guidelines). This study received approval from the Ethics Committee of Wenzhou People's Hospital (Approval No. KY-2023-269), and informed consent was obtained from all participants before enrollment. RESULTS: The clinical and genetic characteristics of 28 patients with CFDs in this study were as follows. CLINICAL DATA: Among the 28 patients, 2 cases were diagnosed with type I CFDs, while 26 cases were diagnosed with type II CFDs. And 50.0% (14/28) of the patients exhibited no clinical manifestations, while 28.6% (8/28) presented with bleeding manifestations, and 7.1% (2/28) exhibited thrombus manifestations, 3.6% (1/28) experienced both bleeding and thrombosis. Among female patients, 13.0% (3/23) exhibited a history of habitual abortion. All patients demonstrated TT and a significant decrease in Fg:C. Sanger sequencing revealed a total of 10 types of heterozygous variations in the FGA, FGB, and FGG genes across 28 patients, distributed among 9 loci. The variation at the γ c.902G>A/c.901C>T accounted for the highest proportion (35.7%, 10/28), followed by the Bβ c.569 A>G (28.6%, 8/28). Biological informatics analysis: the Aα c.180+1G>T mutation was predicted to be highly deleterious. And the Aα c.104G>A, Bβ c.425T>G, Bβ c.586C>T, and γ c.902G>A/c.901C>T variations were also predicted to be harmful. Conservation analysis indicates that the 9 variant sites were highly conserved among homo sapiens, musculus, ovis aries, scrofa, and rattus. Spatial conformation analysis revealed that some variations lead to an increase or decrease in the number of hydrogen bonds. ACMG guideline rating analysis: Among the ten variations in the Fg protein-coding genes FGA, FGB, and FGG identified in 28 patients, 9 variations (Aα c.104G>A, Aα c.180+1G>T, Bβ c.425T>G, Bβ c.569A>G, Bβ c.586C>T, Bβ c.643G>A, γ c.901C>T, γ c.902G>A, γ c.1001A>C) were classified as pathogenic, while one variation (γ c.908C>G) was classified as likely pathogenic. CONCLUSION In this study, the majority of CFDs patients are diagnosed with type II CFDs, with 50% presenting clinical symptoms predominantly manifesting as bleeding, thrombosis, and recurrent miscarriage. The mutation hotspots are mainly located in exon 2 of FGA, exon 4 of FGB, and exon 8 of FGG.
Humans ; Female ; Male ; Afibrinogenemia/congenital* ; Fibrinogen/metabolism* ; Mutation ; Genotype ; Adult ; Child ; Adolescent ; Child, Preschool ; Infant

Objective:To explore the clinical features and genetic mutation sites of 28 patients with Congenital fibrinogen disorders (CFDs).Methods:A total of 28 unrelated CFDs patients admitted to Wenzhou People′s Hospital from June 2018 to April 2023 were enrolled into this research. A total of 2.7 mL of peripheral blood was collected from each patient for coagulation function tests, which included thrombin time (TT), fibrinogen activity (Fg: C), fibrinogen antigen (Fg: Ag), and gene detection. The Sanger sequencing method was employed to verify variations in the fibrinogen (Fg) protein-coding gene across 28 patients. Bioinformatics analyses, including harmfulness analysis, conservation analysis across different species, and spatial simulation predictions of variant proteins, were conducted by PolyPhen-2, PROVEAN, SnapGene, and Pymol softwares on the variant sites of these patients. Pathogenicity ratings for the detected variant sites were performed in accordance with the Standards and Guidelines for the Interpretation of Sequence variants by the American College of Medical Genetics and Genomics (ACMG) (hereafter referred to as the ACMG Guidelines). This study received approval from the Ethics Committee of Wenzhou People′s Hospital (Approval No. KY-2023-269), and informed consent was obtained from all participants before enrollment.Results:The clinical and genetic characteristics of 28 patients with CFDs in this study were as follows. ①Clinical data: Among the 28 patients, 2 cases were diagnosed with type I CFDs, while 26 cases were diagnosed with type II CFDs. And 50.0% (14/28) of the patients exhibited no clinical manifestations, while 28.6% (8/28) presented with bleeding manifestations, and 7.1% (2/28) exhibited thrombus manifestations, 3.6% (1/28) experienced both bleeding and thrombosis. Among female patients, 13.0% (3/23) exhibited a history of habitual abortion. All patients demonstrated TT and a significant decrease in Fg: C. ②Sanger sequencing revealed a total of 10 types of heterozygous variations in the FGA, FGB, and FGG genes across 28 patients, distributed among 9 loci. The variation at the γ c. 902G>A/c.901C>T accounted for the highest proportion (35.7%, 10/28), followed by the Bβ c. 569 A>G (28.6%, 8/28). ③Biological informatics analysis: the Aα c. 180+ 1G>T mutation was predicted to be highly deleterious. And the Aα c. 104G>A, Bβ c. 425T>G, Bβ c. 586C>T, and γ c. 902G>A/c.901C>T variations were also predicted to be harmful. Conservation analysis indicates that the 9 variant sites were highly conserved among homo sapiens, musculus, ovis aries, scrofa, and rattus. Spatial conformation analysis revealed that some variations lead to an increase or decrease in the number of hydrogen bonds. ④ACMG guideline rating analysis: Among the ten variations in the Fg protein-coding genes FGA, FGB, and FGG identified in 28 patients, 9 variations (Aα c. 104G>A, Aα c. 180+ 1G>T, Bβ c. 425T>G, Bβ c.569A>G, Bβ c. 586C>T, Bβ c. 643G>A, γ c. 901C>T, γ c. 902G>A, γ c. 1001A>C) were classified as pathogenic, while one variation (γ c. 908C>G) was classified as likely pathogenic. Conclusion:In this study, the majority of CFDs patients are diagnosed with type II CFDs, with 50% presenting clinical symptoms predominantly manifesting as bleeding, thrombosis, and recurrent miscarriage. The mutation hotspots are mainly located in exon 2 of FGA, exon 4 of FGB, and exon 8 of FGG.