Objective:To investigate the impact of metformin on the Beh?et's disease (BD) mice model via the Treg/Th17 axis.Methods:The BD mice model was established by subcutaneous injection of HSV-1. Four groups were established, including healthy control group, model group, high-dose metformin group, and low-dose metformin group. The HSV-1 DNA copy number in the peripheral blood was measured using qRT-PCR. Plasma levels of TGF-β 1, IL-10, IL-17, IL-23, IL-6, and TNF-α were assessed by ELISA. Flow cytometry was employed to determine the proportion of Treg and Th17 cells in the spleen. One-way analysis of variance was used for inter-group comparisons, pairwise comparisons were performed using SNK- q test. Results:Thirty-eight BD models were successfully established, with 28 survived. Compared to the BD model group, the metformin treatment groups showed faster healing of genital ulcers, joint redness/swelling, and skin ulcers, along with better mental status. HSV-1 copy numbers decreased in the metformin groups compared to the model group at 20 and 30 days post-treatment. Compared to the healthy control group, the model group exhibited elevated levels of TGF-β 1, IL-17, IL-6, IL-23, and TNF-α, but a decrease in IL-10. Following high-dose metformin treatment, TGF-β 1, IL-17, IL-6, IL-23, and TNF-α were significantly reduced ( q=16.17, P<0.001; q=8.76, P<0.001; q=6.78, P=0.004; q=4.45, P=0.020; q=12.08, P<0.001), accompanied by elevated IL-10 (specific value) ( q=6.28, P<0.001). Compared with the control group [Treg: (1.82±0.68)%; Th17: (2.12±0.86)%], the model group showed significantly elevated proportions of Treg cells[(6.03±2.42)%] ( q=5.01, P<0.001) and Th17 cell [(3.40±0.58)%] ( q=2.96, P=0.017). After high-dose metformin treatment, both Treg cell proportion [(3.20±1.66)%] and Th17 cell proportion [(2.16±0.78)%] decreased compared to the model group ( q=3.05, P=0.014). No significant differences were observed between the high-and low-dose metformin groups across all measured indicators, indicating similar efficacy. Conclusion:Metformin could reduce HSV-1 virus replication, reduce the levels of inflammatory cytokines and regulate Treg/Th17 axis to alleviate the BD symptoms. This study provides evidence for repurposing metformin in the treatment of Beh?et's disease.

Objective:To compare the efficacy of endoscopic mucosal resection with grasping forceps (EMR-G) and endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors (NET)≤10 mm.Methods:Data of 74 patients with ≤10 mm rectal NET admitted to Shantou Central Hospital from August 2020 to June 2024 were retrospectively analyzed. Patients were divided into the ESD group and the EMR-G group according to the surgical method. Outcomes included R0 resection rate, margin-to-base distance, operative time, cost, and hospital stay.Results:The EMR-G group demonstrated significantly higher R0 resection rates [100.0% (37/37) VS 81.1% (30/37), χ2=7.731, P=0.006], greater margin-to-base distance (median 330 μm VS 110 μm, Z=-5.890, P<0.001), shorter operative time (15.22±2.94 min VS 27.95±6.50 min, t=-10.854, P<0.001), lower cost (2 409.51±205.00 yuan VS 7 899.19±420.14 yuan, t=-71.430, P=0.001), and reduced hospital stay (1.08±0.27 days VS 2.76±0.80 days, t=-12.095, P<0.001). Conclusion:EMR-G outperforms ESD for ≤10 mm rectal NETs by improving R0 resection, shortening procedure duration and hospitalization, and reducing costs, which is worth promotion.

Autism spectrum disorder(ASD),characterized by unknown etiology and high heterogeneity,ne-cessitates precise diagnostic and intervention strategies.Neuroimaging techniques have shown great promise in un-covering the neural mechanisms of ASD,providing a foundation for aided diagnosis and transcranial magnetic stim-ulation(TMS)interventions.This review highlights that integrating multimodal neuroimaging and developing indi-vidualized indices with developmental specificity can significantly improve the accuracy of ASD diagnosis and clas-sification.Furthermore,TMS interventions guided by functional connectivity derived from functional magnetic reso-nance imaging(fMRI)offer a personalized approach to ASD treatment.

Autism spectrum disorder(ASD),characterized by unknown etiology and high heterogeneity,ne-cessitates precise diagnostic and intervention strategies.Neuroimaging techniques have shown great promise in un-covering the neural mechanisms of ASD,providing a foundation for aided diagnosis and transcranial magnetic stim-ulation(TMS)interventions.This review highlights that integrating multimodal neuroimaging and developing indi-vidualized indices with developmental specificity can significantly improve the accuracy of ASD diagnosis and clas-sification.Furthermore,TMS interventions guided by functional connectivity derived from functional magnetic reso-nance imaging(fMRI)offer a personalized approach to ASD treatment.

Objective:To investigate the impact of metformin on the Beh?et's disease (BD) mice model via the Treg/Th17 axis.Methods:The BD mice model was established by subcutaneous injection of HSV-1. Four groups were established, including healthy control group, model group, high-dose metformin group, and low-dose metformin group. The HSV-1 DNA copy number in the peripheral blood was measured using qRT-PCR. Plasma levels of TGF-β 1, IL-10, IL-17, IL-23, IL-6, and TNF-α were assessed by ELISA. Flow cytometry was employed to determine the proportion of Treg and Th17 cells in the spleen. One-way analysis of variance was used for inter-group comparisons, pairwise comparisons were performed using SNK- q test. Results:Thirty-eight BD models were successfully established, with 28 survived. Compared to the BD model group, the metformin treatment groups showed faster healing of genital ulcers, joint redness/swelling, and skin ulcers, along with better mental status. HSV-1 copy numbers decreased in the metformin groups compared to the model group at 20 and 30 days post-treatment. Compared to the healthy control group, the model group exhibited elevated levels of TGF-β 1, IL-17, IL-6, IL-23, and TNF-α, but a decrease in IL-10. Following high-dose metformin treatment, TGF-β 1, IL-17, IL-6, IL-23, and TNF-α were significantly reduced ( q=16.17, P<0.001; q=8.76, P<0.001; q=6.78, P=0.004; q=4.45, P=0.020; q=12.08, P<0.001), accompanied by elevated IL-10 (specific value) ( q=6.28, P<0.001). Compared with the control group [Treg: (1.82±0.68)%; Th17: (2.12±0.86)%], the model group showed significantly elevated proportions of Treg cells[(6.03±2.42)%] ( q=5.01, P<0.001) and Th17 cell [(3.40±0.58)%] ( q=2.96, P=0.017). After high-dose metformin treatment, both Treg cell proportion [(3.20±1.66)%] and Th17 cell proportion [(2.16±0.78)%] decreased compared to the model group ( q=3.05, P=0.014). No significant differences were observed between the high-and low-dose metformin groups across all measured indicators, indicating similar efficacy. Conclusion:Metformin could reduce HSV-1 virus replication, reduce the levels of inflammatory cytokines and regulate Treg/Th17 axis to alleviate the BD symptoms. This study provides evidence for repurposing metformin in the treatment of Beh?et's disease.

Objective:To compare the efficacy of endoscopic mucosal resection with grasping forceps (EMR-G) and endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors (NET)≤10 mm.Methods:Data of 74 patients with ≤10 mm rectal NET admitted to Shantou Central Hospital from August 2020 to June 2024 were retrospectively analyzed. Patients were divided into the ESD group and the EMR-G group according to the surgical method. Outcomes included R0 resection rate, margin-to-base distance, operative time, cost, and hospital stay.Results:The EMR-G group demonstrated significantly higher R0 resection rates [100.0% (37/37) VS 81.1% (30/37), χ2=7.731, P=0.006], greater margin-to-base distance (median 330 μm VS 110 μm, Z=-5.890, P<0.001), shorter operative time (15.22±2.94 min VS 27.95±6.50 min, t=-10.854, P<0.001), lower cost (2 409.51±205.00 yuan VS 7 899.19±420.14 yuan, t=-71.430, P=0.001), and reduced hospital stay (1.08±0.27 days VS 2.76±0.80 days, t=-12.095, P<0.001). Conclusion:EMR-G outperforms ESD for ≤10 mm rectal NETs by improving R0 resection, shortening procedure duration and hospitalization, and reducing costs, which is worth promotion.

Objective:To explore the validity and safety of flat-tipped injection needle and conical catheter these 2 instruments in the hydrodynamic releasing treatment of fecal calculus incarceration in the colonic diverticulum.Methods:From 1 May 2022 to 31 July 2023, 77 patients with fecal calculus incarceration in colonic diverticulum detected by colonscopy at the Endoscope Center of Shantou Central Hospital were prospectively selected. According to the random number table method, 77 patients were randomly divided into the flat-tipped injection needle group (39 cases, 51 fecal stone embedded) and the conical catheter group (38 cases, 49 fecal stone embedded). The successful rate of fecal stone releasing, operation time and complications of 2 groups were observed. Independent samples t test and chi-square test were used for statistical analysis. Results:The successful rate of fecalith releasing of flat-tipped injection needle group was higher than that of the conical catheter group (100.0%, 51/51 vs. 83.7%, 41/49), and the difference was statistically significant ( χ2=9.05, P=0.002). There was no significant difference in the operation time of successful cases between the flat-tipped injection needle group and the conical catheter group ((5.7±1.2) s vs. (5.9±0.8) s, P>0.05). There were no cases of intraoperative or postoperative bleeding or perforation in the process of fecal stone releasing in both groups. Missed submucosal injection occurred in 4 cases of the flat-tipped injection needle group and occurred in three cases of the conical catheter group, and there was no significant difference in the incidence of complications between the 2 groups ( P>0.05). Conclusion:Both instruments are effective and safe in the hydrodynamic releasing treatment of fecal calculus incarceration in the colonic diverticulum, and the success rate of flat-tipped injection needle is higher than that of conical catheter.

Objective:To explore the effect of the "organ system-based learning (OBL)" digestive system teaching model in the clinical internship teaching of undergraduate nursing students.Methods:A total of 84 nursing undergraduates who practiced in the digestive system department of a third-grade Class-A general hospital from July 2020 to May 2022 were selected as the research objects. According to the historical control study, they were divided into control group ( n=42) and experimental group ( n=42). The control group adopted traditional practice teaching, and the experimental group adopted OBL teaching. The admission theory scores of the two groups of nursing students in the department, graduation theory scores and technical scores, nursing students' core competency and clinical teaching satisfaction were compared. SPSS 24.0 was used for t-test and chi-square test. Results:There was no significant difference between the experimental group and the control group in admission theory scores. The graduation theory scores of the experimental group (93.27±1.47) and the control group (90.91±1.32) were statistically significant ( t=7.72, P<0.001). The graduation technical scores of the experimental group (94.51±1.81) and the control group (94.00±2.35) were not significantly different ( t=1.12, P=0.268). The core competency of nursing students in the experimental group (164.21±20.81) and the control group (152.79±15.76) was statistically significant ( t=2.84, P=0.006). Clinical teaching satisfaction of the experimental group (173.33±17.58) and the control group (152.67±19.74) was statistically significant ( t=5.07, P<0.001). Conclusion:The application of the OBL practice teaching model in the digestive system department is conducive to improving the theoretical knowledge of nursing students, and improving the core competence and clinical teaching satisfaction.

Apnea test (AT) is a key step in the diagnosis of adult brain death, which provides important basis for the loss of brainstem function in patients with adult brain death. In recent years, with extensive development of adult brain death determination and organ donation transplantation, discussion and research of AT have been gradually promoted. In formulation of adult brain death criteria, countries have paid more attention to the standardization and normalization of AT implementation, and medical staffs have improved the AT implementation process. This article reviews the current AT implementation standards, conventional AT procedures and complications, modified AT exploration, AT implementation with extracorporeal membrane oxygenation, and treatments and auxiliary examinations after AT failure, in order to deepen the understanding and cognition of adult brain death determination physicians on AT, and promote AT development in a more standardized and orderly way.

Objective:To evaluate the clinical value of endoscopic release therapy for fecal impaction in the colorectal diverticulum.Methods:Data of patients with fecal impaction in the colorectal diverticulum who received endoscopy in Shantou Central Hospital from January 2018 to September 2020 were included in this study. Among them, 85 patients treated with endoscopic release therapy were assigned to the observation group (2 patients were excluded from the observation group due to acute appendicitis), and 43 patients receiving no treatment were assigned to the control group. The relief of abdominal symptoms was used as an index to evaluate the clinical value of endoscopic release therapy for fecal impaction in the colorectal diverticulum.Results:In the observation group, 42.2% (35/83) were successfully released at one time. The successful comprehensive measures accounted for 25.0% (12/48) of the first release failure, and the total success rate was 56.6% (47/83). There were no complications related to endoscopy in the observation group. One week after the treatment, patients in the observation group were followed up by telephone. Among the 45 patients who were successfully released, positive symptoms of 30 patients disappeared or significantly improved with the effective rate of 90.9% (30/33). Among the 38 patients who failed to release the fecal impaction, 19 had positive symptoms and 16 improved in varying degrees with the effective rate of 55.2% (16/29). The overall effective rate of the observation group was higher than that of the control group [55.4% (46/83) VS 7.0% (3/43)], showing significant difference( χ2=23.354, P<0.01). The effective rate were significant differences in the successful release group [65.2% (30/46)], unsuccessful release group [29.7% (11/37)] and the control group [7.0% (3/43), χ2=33.792, P<0.01]. By pairwise comparison, the effective rate of the successful release group was the highest, followed by the unsuccessful release group, and that of the control group was the lowest with significant difference ( P<0.017). Conclusion:The endoscopic release therapy for fecal impaction in the colorectal diverticulum is relatively simple, which can relieve and reduce related symptoms, avoid complications, missed diagnosis and misdiagnosis, and show definite curative effects. When colorectal diverticulum with fecal impaction is found in the process of endoscopy, it is of great practical significance to release the incarcerated feces by means of different methods.