Diarrhea-predominant irritable bowel syndrome （IBS-D） is a common digestive system disease with high prevalence and recurrence rates for years， high treatment costs， and serious impacts on patients' quality of life and economic burden. Therefore， it is important to explore new and safe treatment methods. The pathogenesis of IBS-D is complex， in which the gut-brain axis is a key factor. The gut-brain axis， a bidirectional signaling pathway connecting the gastrointestinal tract and the central nervous system， regulates gastrointestinal motility， secretion， and immune responses， playing a key role in the occurrence and development of IBS-D. Up to now， antidiarrheal agents， probiotics， and neurotransmitter modulators are the main methods for the clinical treatment of IBS-D. Although they can partially curb the progression of this disease， the therapeutic effects remain to be improved. Studies have confirmed that traditional Chinese medicine （TCM） has significant advantages in the treatment of IBS-D since it can regulate the gut-brain axis via multiple pathways and targets to improve the gastrointestinal motility and strengthen immune defenses. However， there is a lack of systematic reviews on the regulation of the gut-brain axis by TCM in the treatment of IBS-D. Based on the review of IBS-D-related articles published in recent years， this paper systematically summarized the relationship between the gut-brain axis and IBS-D and the role of TCM in the treatment， providing new ideas for the treatment of IBS-D.

Objective To investigate the correlation between novel bone metabolism markers and the degree of aortic calcification as well as cardiovascular event risk in elderly patients treated by PD.Methods A prospective trial was conducted on 230 elderly patients receiving continuous am-bulatory PD in our department from February 2022 to February 2024.According to the occur-rence of cardiovascular events during dialysis treatment,they were divided into a cardiovascular event group(n=92)and a control group(n=138).Relevant clinical data were collected,aortic calcification was assessed using AAC scores,and serum levels of bone metabolism markers,inclu-ding osteoprotegerin,TRACP,and PINP were measured.Results The serum levels of osteoprote-gerin,TRACP and PINP were significantly higher in the cardiovascular event group than the con-trol group(P＜0.01).The cardiovascular event group had obviously severe calcification and higher AAC score than the control group(P＜0.01).The serum levels of the three bone metabolism markers were notably higher in the patients with severe calcification than those with moderate calcification,followed by mild calcification in turn(P＜0.01).Spearman correlation analysis indi-cated that the levels of the three indicators were positively correlated with the degree of aortic cal-cification in elderly PD patients(r=0.465,P=0.000;r=0.396,P=0.000;r=0.434,P=0.000).Multivariate logistic regression analysis showed that these three indicators were risk factors for cardiovascular events in elderly PD patients(P＜0.01).Conclusion The three bone metabolism markers are significantly correlated with aortic calcification severity and cardiovascular event risk in elderly PD patients.Monitoring these marker levels may be helpful for the assessment and man-agement of cardiovascular risk.

Objective:To investigate the clinical application effects of free transplantation of lobulated inguinal flaps.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 34 patients with skin defect wounds whose wounds in one part met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 28 males and 6 females, aged 26 to 59 years. The wound area in the recipient area ranged from 3.0 cm×2.0 cm to 25.0 cm×20.0 cm. The lobulated inguinal flap pedicled with the branch of the superficial circumflex iliac artery were obtained in 19 patients, and the lobulated inguinal flap pedicled with the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery were obtained in 15 patients. The total area of the flaps ranged from 6.0 cm×2.2 cm to 27.0 cm×23.0 cm. The flaps were divided into 2 to 4 lobes, and the area of each lobe ranged from 2.0 cm×1.0 cm to 17.0 cm×12.0 cm. Each lobe of the flaps was reassembled, spliced, or directly transplanted onto the wounds, and the donor wounds were sutured in layers. The survival of each lobe of the flaps and wound healing in the recipient and donor areas were observed, and the wound recovery in the recipient and donor areas were followed up. At the last follow-up, the patient's satisfaction with the efficacy was assessed by 5-grade Likert scale.Results:A small amount of necrosis appeared in the tip of one lobe of the flaps in 4 patients after surgery, which healed after trimming. The flaps of the remaining 30 patients survived. The wounds in the recipient areas healed smoothly. There was a small amount of necrosis at the suture edge of the donor areas in 3 patients, which healed after local trimming and dressing change. The donor wounds healed well in the remaining 31 patients. During the follow-up of 6 to 42 months, all the recipient wounds were well repaired, and the shape of the donor areas was good. At the last follow-up, 15 patients were very satisfied with the efficacy, 15 were relatively satisfied, and 4 were generally satisfied.Conclusions:Through preoperative ultrasonic examination and positioning, the inguinal flap is designed according to the course of blood vessels and lobulated with the branch of the superficial circumflex iliac artery or the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery as the pedicles. The anatomical process is reliable and the blood flow of the flap after being lobulated is rich, which can meet the repair needs of various skin defect wounds. The repair effect is good, and the damage in the donor area is small, which is worthy of promotion.

Objective:To explore the feasibility of applying deep learning image reconstruction (DLIR) in low-radiation dose liver dual-energy CT to further improve image quality, diagnostic confidence of lesion, and accuracy of iodine concentration (IC) measurement.Methods:This prospective cohort study enrolled 60 patients scheduled for enhanced liver CT at the First Affiliated Hospital of Anhui Medical University from June 2023 to January 2024. The participants were randomly assigned into the standard dose group and low radiation dose group with 30 cases in each using randomized block method. The standard radiation dose group underwent standard-radiation dose 120 kVp scans during the venous phase, while the low radiation dose group underwent low radiation dose scans with a rapid kVp-switching spectral scanning mode at 80 kVp and 140 kVp. The effective radiation dose (ED) was calculated for both groups. The standard radiation dose group was reconstructed using adaptive statistical iterative reconstruction-V (ASIR-V) algorithm 40% (AR40 120 kVp). The low radiation dose group using high-intensity DLIR (DLIR-H) to reconstructed 40 keV and 50 keV virtual monoenergetic images (VMI) (DH-VMI 40 keV, DH-VMI 50 keV). The image quality of the above three groups was objectively evaluated through the measurement of image noise and calculation of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) for the liver and portal vein; and the image quality was subjectively scored for image noise, contrast, lesion conspicuity, and diagnostic confidence. In the low radiation dose group, DLIR-H and ASIR-V40% reconstructed iodine maps were used to measure the liver and portal vein of IC values, standard deviations (SD), and coefficients of variation (CV). One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences of subjective and objective image quality among the three groups, and paired t-test was used to compare the differences in measurement indexes between DLIR-H and ASIR-V40% reconstructed iodine maps. Results:The ED in the low radiation dose group [(2.2±0.5) mSv] was reduced by 56.8% compared to the conventional radiation dose group [(5.4±1.4) mSv]. Objective evaluations demonstrated that DH-VMI 40 keV had higher image noise, CNR, and SNR for liver and portal veins compared to AR40 120 kVp ( P<0.001). DH-VMI 50 keV had lower image noise ( P=0.200), with higher CNR and SNR for the liver and portal vein compared to AR40 120 kVp( P<0.001). In subjective evaluation, there was no statistically significant difference in image noise scores between DH-VMI 40 keV and AR40 120 kVp ( P>0.05), while the image noise score for DH-VMI 50 keV was lower than that of AR40 120 kVp ( P<0.05). Both DH-VMI 40 keV and DH-VMI 50 keV had higher scores for contrast, lesion conspicuity, and diagnostic confidence compared to those of AR40 120 kVp ( P<0.05). In the low radiation dose group, there was no statistically significant difference in IC values for the liver and portal vein between the ASIR-V40% and DLIR-H algorithm reconstructed iodine maps ( P>0.05). The SD and CV of liver and portal vein in the DLIR-H reconstructed iodine maps were lower than those in the ASIR-V40% reconstructed iodine maps ( P<0.001). Conclusions:DLIR can effectively reduce the image noise of low-energy (40, 50 keV) VMI, enhance lesion conspicuity and diagnostic confidence, and improve measurement accuracy without affecting IC values.

Objective:To explore the clinical efficacy of modified Yiqi Huayu pelvic inflammation decoction combined with retention enema of traditional Chinese medicine (TCM) and moxibustion at Shenque acupoint in the treatment of patients with chronic pelvic inflammatory disease (CPID).Methods:A total of 120 CPID patients admitted to the Qian′an City Traditional Chinese Medicine Hospital from January 2023 to June 2024 were prospectively enrolled and randomly divided into the control group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction) and the observation group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction plus TCM retention enema and moxibustion at Shenque acupoint) using a random number table. Each course of treatment was 3 weeks, with drug withdrawal for 1 week during menstruation, and continuous treatment for 2 courses. The clinical efficacy of the two groups was observed. The TCM symptom scores, blood microcirculation indicators [whole blood low shear viscosity (LBV), whole blood high shear viscosity (HBV), platelet aggregation rate (PAR), hematocrit (HCT)], and serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), high mobility group box 1 (HMGB1), granulocyte-macrophage colony-stimulating factor (GM-CSF)] before and after treatment were compared. The patients were followed up for 3 months after treatment to compare the incidence of adverse reactions and recurrence between the two groups.Results:The total clinical effective rate of the observation group (95.00%, 57/60) was higher than that of the control group (83.33%, 50/60) ( P<0.05). After treatment, the individual scores of main and secondary symptoms and the total score of TCM syndrome in the observation group were lower than those in the control group (all P<0.05). After treatment, the levels of LBV, HBV, PAR, HCT, TNF-α, IL-2, HMGB1, and GM-CSF in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups ( P>0.05). During the 3-month follow-up after treatment, the recurrence rate of the observation group was 3.33%(2/60), which was lower than 15.00%(9/60) of the control group ( P<0.05). Conclusions:Modified Yiqi Huayu pelvic inflammation decoction combined with TCM retention enema and moxibustion at Shenque acupoint has a definite efficacy in the treatment of CPID. It can effectively relieve clinical symptoms, improve blood microcirculation and inflammatory factor levels of patients, with a low short-term recurrence rate and no significant increase in the incidence of adverse reactions.

Objective:To explore the clinical efficacy of modified Yiqi Huayu pelvic inflammation decoction combined with retention enema of traditional Chinese medicine (TCM) and moxibustion at Shenque acupoint in the treatment of patients with chronic pelvic inflammatory disease (CPID).Methods:A total of 120 CPID patients admitted to the Qian′an City Traditional Chinese Medicine Hospital from January 2023 to June 2024 were prospectively enrolled and randomly divided into the control group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction) and the observation group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction plus TCM retention enema and moxibustion at Shenque acupoint) using a random number table. Each course of treatment was 3 weeks, with drug withdrawal for 1 week during menstruation, and continuous treatment for 2 courses. The clinical efficacy of the two groups was observed. The TCM symptom scores, blood microcirculation indicators [whole blood low shear viscosity (LBV), whole blood high shear viscosity (HBV), platelet aggregation rate (PAR), hematocrit (HCT)], and serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), high mobility group box 1 (HMGB1), granulocyte-macrophage colony-stimulating factor (GM-CSF)] before and after treatment were compared. The patients were followed up for 3 months after treatment to compare the incidence of adverse reactions and recurrence between the two groups.Results:The total clinical effective rate of the observation group (95.00%, 57/60) was higher than that of the control group (83.33%, 50/60) ( P<0.05). After treatment, the individual scores of main and secondary symptoms and the total score of TCM syndrome in the observation group were lower than those in the control group (all P<0.05). After treatment, the levels of LBV, HBV, PAR, HCT, TNF-α, IL-2, HMGB1, and GM-CSF in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups ( P>0.05). During the 3-month follow-up after treatment, the recurrence rate of the observation group was 3.33%(2/60), which was lower than 15.00%(9/60) of the control group ( P<0.05). Conclusions:Modified Yiqi Huayu pelvic inflammation decoction combined with TCM retention enema and moxibustion at Shenque acupoint has a definite efficacy in the treatment of CPID. It can effectively relieve clinical symptoms, improve blood microcirculation and inflammatory factor levels of patients, with a low short-term recurrence rate and no significant increase in the incidence of adverse reactions.

Objective To investigate the correlation between novel bone metabolism markers and the degree of aortic calcification as well as cardiovascular event risk in elderly patients treated by PD.Methods A prospective trial was conducted on 230 elderly patients receiving continuous am-bulatory PD in our department from February 2022 to February 2024.According to the occur-rence of cardiovascular events during dialysis treatment,they were divided into a cardiovascular event group(n=92)and a control group(n=138).Relevant clinical data were collected,aortic calcification was assessed using AAC scores,and serum levels of bone metabolism markers,inclu-ding osteoprotegerin,TRACP,and PINP were measured.Results The serum levels of osteoprote-gerin,TRACP and PINP were significantly higher in the cardiovascular event group than the con-trol group(P＜0.01).The cardiovascular event group had obviously severe calcification and higher AAC score than the control group(P＜0.01).The serum levels of the three bone metabolism markers were notably higher in the patients with severe calcification than those with moderate calcification,followed by mild calcification in turn(P＜0.01).Spearman correlation analysis indi-cated that the levels of the three indicators were positively correlated with the degree of aortic cal-cification in elderly PD patients(r=0.465,P=0.000;r=0.396,P=0.000;r=0.434,P=0.000).Multivariate logistic regression analysis showed that these three indicators were risk factors for cardiovascular events in elderly PD patients(P＜0.01).Conclusion The three bone metabolism markers are significantly correlated with aortic calcification severity and cardiovascular event risk in elderly PD patients.Monitoring these marker levels may be helpful for the assessment and man-agement of cardiovascular risk.

Objective:To investigate the clinical application effects of free transplantation of lobulated inguinal flaps.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 34 patients with skin defect wounds whose wounds in one part met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 28 males and 6 females, aged 26 to 59 years. The wound area in the recipient area ranged from 3.0 cm×2.0 cm to 25.0 cm×20.0 cm. The lobulated inguinal flap pedicled with the branch of the superficial circumflex iliac artery were obtained in 19 patients, and the lobulated inguinal flap pedicled with the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery were obtained in 15 patients. The total area of the flaps ranged from 6.0 cm×2.2 cm to 27.0 cm×23.0 cm. The flaps were divided into 2 to 4 lobes, and the area of each lobe ranged from 2.0 cm×1.0 cm to 17.0 cm×12.0 cm. Each lobe of the flaps was reassembled, spliced, or directly transplanted onto the wounds, and the donor wounds were sutured in layers. The survival of each lobe of the flaps and wound healing in the recipient and donor areas were observed, and the wound recovery in the recipient and donor areas were followed up. At the last follow-up, the patient's satisfaction with the efficacy was assessed by 5-grade Likert scale.Results:A small amount of necrosis appeared in the tip of one lobe of the flaps in 4 patients after surgery, which healed after trimming. The flaps of the remaining 30 patients survived. The wounds in the recipient areas healed smoothly. There was a small amount of necrosis at the suture edge of the donor areas in 3 patients, which healed after local trimming and dressing change. The donor wounds healed well in the remaining 31 patients. During the follow-up of 6 to 42 months, all the recipient wounds were well repaired, and the shape of the donor areas was good. At the last follow-up, 15 patients were very satisfied with the efficacy, 15 were relatively satisfied, and 4 were generally satisfied.Conclusions:Through preoperative ultrasonic examination and positioning, the inguinal flap is designed according to the course of blood vessels and lobulated with the branch of the superficial circumflex iliac artery or the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery as the pedicles. The anatomical process is reliable and the blood flow of the flap after being lobulated is rich, which can meet the repair needs of various skin defect wounds. The repair effect is good, and the damage in the donor area is small, which is worthy of promotion.

Objective:To explore the feasibility of applying deep learning image reconstruction (DLIR) in low-radiation dose liver dual-energy CT to further improve image quality, diagnostic confidence of lesion, and accuracy of iodine concentration (IC) measurement.Methods:This prospective cohort study enrolled 60 patients scheduled for enhanced liver CT at the First Affiliated Hospital of Anhui Medical University from June 2023 to January 2024. The participants were randomly assigned into the standard dose group and low radiation dose group with 30 cases in each using randomized block method. The standard radiation dose group underwent standard-radiation dose 120 kVp scans during the venous phase, while the low radiation dose group underwent low radiation dose scans with a rapid kVp-switching spectral scanning mode at 80 kVp and 140 kVp. The effective radiation dose (ED) was calculated for both groups. The standard radiation dose group was reconstructed using adaptive statistical iterative reconstruction-V (ASIR-V) algorithm 40% (AR40 120 kVp). The low radiation dose group using high-intensity DLIR (DLIR-H) to reconstructed 40 keV and 50 keV virtual monoenergetic images (VMI) (DH-VMI 40 keV, DH-VMI 50 keV). The image quality of the above three groups was objectively evaluated through the measurement of image noise and calculation of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) for the liver and portal vein; and the image quality was subjectively scored for image noise, contrast, lesion conspicuity, and diagnostic confidence. In the low radiation dose group, DLIR-H and ASIR-V40% reconstructed iodine maps were used to measure the liver and portal vein of IC values, standard deviations (SD), and coefficients of variation (CV). One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences of subjective and objective image quality among the three groups, and paired t-test was used to compare the differences in measurement indexes between DLIR-H and ASIR-V40% reconstructed iodine maps. Results:The ED in the low radiation dose group [(2.2±0.5) mSv] was reduced by 56.8% compared to the conventional radiation dose group [(5.4±1.4) mSv]. Objective evaluations demonstrated that DH-VMI 40 keV had higher image noise, CNR, and SNR for liver and portal veins compared to AR40 120 kVp ( P<0.001). DH-VMI 50 keV had lower image noise ( P=0.200), with higher CNR and SNR for the liver and portal vein compared to AR40 120 kVp( P<0.001). In subjective evaluation, there was no statistically significant difference in image noise scores between DH-VMI 40 keV and AR40 120 kVp ( P>0.05), while the image noise score for DH-VMI 50 keV was lower than that of AR40 120 kVp ( P<0.05). Both DH-VMI 40 keV and DH-VMI 50 keV had higher scores for contrast, lesion conspicuity, and diagnostic confidence compared to those of AR40 120 kVp ( P<0.05). In the low radiation dose group, there was no statistically significant difference in IC values for the liver and portal vein between the ASIR-V40% and DLIR-H algorithm reconstructed iodine maps ( P>0.05). The SD and CV of liver and portal vein in the DLIR-H reconstructed iodine maps were lower than those in the ASIR-V40% reconstructed iodine maps ( P<0.001). Conclusions:DLIR can effectively reduce the image noise of low-energy (40, 50 keV) VMI, enhance lesion conspicuity and diagnostic confidence, and improve measurement accuracy without affecting IC values.