With the rapid advancement of hemodynamic indices and monitoring technologies, their classification methods and application processes have become increasingly complex. Currently, no unified standard hasbeen established, making it difficult to fully meet the clinical requirements for hemodynamic management. To assist in hemodynamic monitoring assessment and therapeutic decision-making in critically ill patients, the Critical Hemodynamic Therapy Collaborative Group, in conjunction with the Critical Ultrasound Study Group, has jointly developed the Standard for the Application of Hemodynamic Monitoring Techniques in Critical Care. The first part of this standard systematically categorizes hemodynamic indicators into flow indicators, pressure and its derivative indicators, and tissue perfusion indicators, while elaborating on the clinical application of each. The second part establishes a standardized clinical implementation pathway for hemodynamic monitoring. It proposes a tiered monitoring strategy-comprising basic, advanced, indication-specific, and special scenario monitoring-tailored to different clinical settings. It emphasizes the central role of critical care ultrasound across all levels of monitoring and establishes hemodynamic assessment standards for organs such as the brain, kidneys, and gastrointestinal tract. This standard aims to provide a unified framework for clinical practice, teaching, training, and research in critical care medicine, thereby promoting standardized development within the discipline.

ObjectiveTo evaluate the feasibility of various strength levels of deep learning image reconstruction （DLIR） algorithms for improving non-contrast abdominal CT image quality at ultra-low radiation doses， by comparing ultra-low-dose DLIR images with low-dose filtered back projection （FBP） images. MethodsA prospective collection of 85 patients undergoing non-contrast abdominal CT scans was performed， and a self-controlled study method was employed to conduct low-dose （LD） group and ultra-low-dose （ULD） group scans. The LD group used a noise index of 10 and employed FBP for image reconstruction （LD-FBP group）. The ULD group used a noise index of 30 and employed DLIR at different levels （low， medium， high）， resulting in three subgroups of reconstructed images： ULD-DLIR-L， ULD-DLIR-M， and ULD-DLIR-H. For each group， CT values， standard devia-tion （SD）， signal-to-noise ratio （SNR）， and contrast-to-noise ratio （CNR） were measured and calculated for the liver， spleen， kidneys， aorta， psoas major， and subcutaneous fat. Effective dose （ED） was also recorded. Two radiologists independently performed subjective evaluations of image quality using a 5-point scale. ResultsCompared with the LD-FBP group， the ULD-DLIR-L group showed significantly lower SNR and CNR values in the liver， spleen， kidneys， aorta， and psoas major （P<0.001）， while the ULD-DLIR-H group exhibited significantly higher values （P<0.001）. The difference of SNR and CNR values for the ULD-DLIR-M group showed no statistically significant difference. For subjective evaluation， the scores of the ULD-DLIR-L and ULD-DLIR-M groups were lower than those of the LD-FBP group， while there was no statistically significant difference in scores between the ULD-DLIR-H group and the LD-FBP group. The ED value of the ULD group was approximately 88% lower than that of the LD group. ConclusionCompared with the LD-FBP group， the ULD-DLIR-H group significantly reduces SD values while increasing SNR and CNR values， effectively improving the image quality of non-contrast abdominal CT scans.

Objective Watch the proprioceptive neuromuscular facilitation(PNF)in the treatment of patients with shoulder-hand syndrome,and to explore its relevant therapeutic mechanisms.Methods Sixty patients with shoulder-hand syndrome were split into two groups at random:thirty cases each for observation and control.The control group received both standard medication and training in rehabilitation.Intradermal needles were inserted at the Jianjing,Jianyu,Binao,Qing Lengyuan,Shouwuli,and Quchi points and left in place for 48 hours for the treatment group.The PNF treatment was administered for thirty minutes every day,five times a week,whereas the control group underwent four weeks of traditional drug treatment and rehabilitation training.Before and after therapy,the following measures were used:the Disability of the Arm,Shoulder and Hand(DASH),the Activity of Daily Living Scale(ADL),the Simplified Fugl-Meyer Scale(FMA),and the Visual Analog Scale(VAS).In order to measure changes in endothelin-1(ET-1),nitric oxide(NO),and bradykinin(BK),serum was collected.Result Scale score:①Within-group comparison,compared with before treatment,VAS and DASH scores were significantly lower,FMA,a significant rise in ADL scores,differences were statistically significant(P<0.01).②Comparison between groups,compared with the control group,observation group of DASH score significantly lower after treatment(P<0.05),a significant rise in FMA and ADL scores(P<0.05),VAS score has no obvious difference(P>0.05).Laboratory index test:①Intra-group comparison:compared with before treatment,BK and ET-1 expression levels increased,NO and CGRP expression levels decreased,the differences were statistically significant(P<0.01).②Comparison between groups:Following treatment,the observation group showed increases in BK and ET-1 expression degrees as well as decreased NO and CGRP expression degrees.This difference was statistically significant(P<0.01).Conclusions Intradermal needle combined with PNF can promote shoulder pain symptoms,increase upper limb mobility,also improve quality of life in patients with shoulder-hand syndrome.One of the mechanisms may be to upregulate the expression level of BK and ET-1,and downregulate the expression level of NO and CGRP,so as to improve the microcirculation function and reduce the neurogenic inflammatory response.

Pneumonia complicated by diarrhea in children is a common clinical phenomenon.During fluid resuscitation,it is essential to prevent fluid deficiency while avoiding excessive fluid administration,which can lead to pulmonary interstitial edema or heart failure.A conservative fluid resuscitation strategy is recommended,initially utilizing a balanced crystalloid solution for resuscitation.If a significant volume of fluid is still required after assessment,colloid solutions may be considered.In accordance with the ROSE strategy for fluid resuscitation in sepsis,a staged fluid management approach should be implemented for children with pneumonia and diarrhea.Continuous monitoring of the patient's response to resuscitation and the improvement of clinical symptoms is crucial.If feasible,advanced hemodynamic monitoring should be employed.It is advisable to utilize multiple parameters and diverse methods to comprehensively assess the patient's clinical condition,thereby enabling the formulation of individualized fluid management plans.

Background and Aims:Mucinous adenocarcinoma of the colorectum(MAC)is a distinct histologic subtype of colorectal cancer characterized by high malignancy and low diagnostic accuracy of preoperative biopsy,posing challenges for clinical decision-making.Given the critical role of the inflammatory microenvironment in tumor progression,this study aimed to develop and validate a nomogram model integrating preoperative systemic inflammatory indicators and clinical features to improve the preoperative diagnosis of MAC.Methods:Clinical data of 293 patients with colorectal cancer who underwent radical resection between June 2017 and June 2022 at the First Affiliated Hospital of the University of South China were retrospectively analyzed.Based on postoperative pathology,patients were classified into the mucinous adenocarcinoma(MAC)group and the non-specific adenocarcinoma(AC)group.Propensity score matching(PSM,1∶1)was used to balance age,T stage,and N stage.Differences in preoperative inflammatory indices were compared between groups.Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MAC,which were incorporated into a diagnostic nomogram.The model's discrimination,calibration,and clinical utility were evaluated using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA).Results:Among the 293 patients,46 had MAC and 247 had AC,with a preoperative colonoscopic diagnostic rate of 54%for MAC.After PSM(43 pairs),platelet count,platelet lymphocyte ratio(PLR),systemic immune inflammation index(SII),inflammation related prognostic index(IPI),and systemic inflammation score(SIS)were significantly higher in the MAC group,while lymphocyte monocyte ratio(LMR)was lower(all P<0.05).Multivariate analysis identified tumor location,maximum tumor diameter,and preoperative IPI as independent predictors.The AUCs of the nomogram in the training(n=206)and validation(n=87)cohorts were 0.759(95%CI=0.662-0.856)and 0.776(95%CI=0.649-0.903),respectively.Calibration plots showed good agreement between predicted and observed probabilities,and DCA demonstrated satisfactory clinical applicability.Conclusion:A nomogram model integrating tumor location,tumor size,and preoperative IPI was successfully developed and validated for preoperative diagnosis of colorectal MAC.This model provides a practical,quantitative tool with good predictive performance to assist clinicians in individualized treatment planning,particularly for patients ineligible for surgical biopsy.

Background Irritable bowel syndrome with diarrhea(IBS-D)is a common gastrointestinal dysfunction disease,but currently,single Western medicine treatments have significant side effects and are prone to recurrence.Probiotics and traditional Chinese medicine have certain therapeutic effects on IBS-D,but the exact treatment mechanism is still unclear,and there is limited research on the combination of the two.Objective To investigate the effects of Chongkang Capsules combined with Bifidobacterium on gut microbiota,mucosal barrier function,and neurotransmitter levels in patients with IBS-D and comorbid anxiety and depression,and to analyze its therapeutic mechanisms.Methods A total of 150 patients with irritable bowel syndrome with diarrhea(IBS-D)and anxiety and depression who were treated in the gastroenterology department of our hospital from January 2021 to June 2022,were selected as the study subjects.A randomized controlled trial was designed with three treatment groups:50 patients in the observation group received Chongkang Capsules combined with Bifidobacterium for 4 weeks;50 patients in the positive control group received Rifaximin combined with Bifidobacterium for 4 weeks;and 50 patients in the blank control group received Bifidobacterium alone for 4 weeks(to exclude interference from the bacterial species in the Bifidobacterium capsules in intestinal flora detection).The changes in IBS-D symptom severity,stool consistency,anxiety and depression scores(HAM-A/HAM-D),intestinal flora(lactobacilli,Bifidobacterium,bacteroides,enterobacteria),intestinal barrier markers(serum D-lactic acid,DAO),inflammatory factors(IL-6,IL-8,TNF-α),intestinal tight junction proteins(Occludin,ZO-1),neurotransmitters(5-HT),and recurrence rates were compared among the three groups before and after treatment.Results Symptom improvement:the improvement in IBS-SSS scores,stool classification,and HAM-A/HAM-D scores in the observation and positive control groups was significantly better than that in the blank control group(all P<0.001),but there was no significant difference between the two groups(P>0.05).Flora regulation:after treatment,the observation and positive control groups showed a significant increase in beneficial bacteria(lactobacilli and Bifidobacterium)and a significant decrease in pathogenic bacteria(bacteroides and enterobacteria)compared to the blank control group(all P<0.001).The improvement in flora persisted up to 6 months after treatment(P<0.001).Barrier and inflammation:the reduction in serum D-lactic acid,DAO,and IL-6/IL-8/TNF-α levels was significantly greater in the observation and positive control groups than in the blank control group(all P<0.001).The expression of intestinal barrier proteins(Occludin and ZO-1)was significantly upregulated(P<0.001).Neurotransmitters:the increase in serum 5-HT levels were significantly higher in the two groups than in the blank control group(P<0.001).Recurrence rate:the 3-month recurrence rates in the observation group(8.0%)and positive control group(10.0%)were significantly lower than that in the blank control group(30.0%).The 6-month recurrence rates(14.0%vs.16.0%vs.44.0%)also showed significant differences(all P<0.05).Conclusion Chongkang Capsules combined with Bifidobacterium can effectively alleviate clinical symptoms in patients with IBS-D and comorbid anxiety and depression.The mechanism may be related to regulating intestinal flora balance,repairing the intestinal mucosal barrier,suppressing inflammatory responses,and increasing 5-HT levels.Additionally,the low recurrence rate suggests its clinical application value.

Background and Aims:Mucinous adenocarcinoma of the colorectum(MAC)is a distinct histologic subtype of colorectal cancer characterized by high malignancy and low diagnostic accuracy of preoperative biopsy,posing challenges for clinical decision-making.Given the critical role of the inflammatory microenvironment in tumor progression,this study aimed to develop and validate a nomogram model integrating preoperative systemic inflammatory indicators and clinical features to improve the preoperative diagnosis of MAC.Methods:Clinical data of 293 patients with colorectal cancer who underwent radical resection between June 2017 and June 2022 at the First Affiliated Hospital of the University of South China were retrospectively analyzed.Based on postoperative pathology,patients were classified into the mucinous adenocarcinoma(MAC)group and the non-specific adenocarcinoma(AC)group.Propensity score matching(PSM,1∶1)was used to balance age,T stage,and N stage.Differences in preoperative inflammatory indices were compared between groups.Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MAC,which were incorporated into a diagnostic nomogram.The model's discrimination,calibration,and clinical utility were evaluated using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA).Results:Among the 293 patients,46 had MAC and 247 had AC,with a preoperative colonoscopic diagnostic rate of 54%for MAC.After PSM(43 pairs),platelet count,platelet lymphocyte ratio(PLR),systemic immune inflammation index(SII),inflammation related prognostic index(IPI),and systemic inflammation score(SIS)were significantly higher in the MAC group,while lymphocyte monocyte ratio(LMR)was lower(all P<0.05).Multivariate analysis identified tumor location,maximum tumor diameter,and preoperative IPI as independent predictors.The AUCs of the nomogram in the training(n=206)and validation(n=87)cohorts were 0.759(95%CI=0.662-0.856)and 0.776(95%CI=0.649-0.903),respectively.Calibration plots showed good agreement between predicted and observed probabilities,and DCA demonstrated satisfactory clinical applicability.Conclusion:A nomogram model integrating tumor location,tumor size,and preoperative IPI was successfully developed and validated for preoperative diagnosis of colorectal MAC.This model provides a practical,quantitative tool with good predictive performance to assist clinicians in individualized treatment planning,particularly for patients ineligible for surgical biopsy.

Background Irritable bowel syndrome with diarrhea(IBS-D)is a common gastrointestinal dysfunction disease,but currently,single Western medicine treatments have significant side effects and are prone to recurrence.Probiotics and traditional Chinese medicine have certain therapeutic effects on IBS-D,but the exact treatment mechanism is still unclear,and there is limited research on the combination of the two.Objective To investigate the effects of Chongkang Capsules combined with Bifidobacterium on gut microbiota,mucosal barrier function,and neurotransmitter levels in patients with IBS-D and comorbid anxiety and depression,and to analyze its therapeutic mechanisms.Methods A total of 150 patients with irritable bowel syndrome with diarrhea(IBS-D)and anxiety and depression who were treated in the gastroenterology department of our hospital from January 2021 to June 2022,were selected as the study subjects.A randomized controlled trial was designed with three treatment groups:50 patients in the observation group received Chongkang Capsules combined with Bifidobacterium for 4 weeks;50 patients in the positive control group received Rifaximin combined with Bifidobacterium for 4 weeks;and 50 patients in the blank control group received Bifidobacterium alone for 4 weeks(to exclude interference from the bacterial species in the Bifidobacterium capsules in intestinal flora detection).The changes in IBS-D symptom severity,stool consistency,anxiety and depression scores(HAM-A/HAM-D),intestinal flora(lactobacilli,Bifidobacterium,bacteroides,enterobacteria),intestinal barrier markers(serum D-lactic acid,DAO),inflammatory factors(IL-6,IL-8,TNF-α),intestinal tight junction proteins(Occludin,ZO-1),neurotransmitters(5-HT),and recurrence rates were compared among the three groups before and after treatment.Results Symptom improvement:the improvement in IBS-SSS scores,stool classification,and HAM-A/HAM-D scores in the observation and positive control groups was significantly better than that in the blank control group(all P<0.001),but there was no significant difference between the two groups(P>0.05).Flora regulation:after treatment,the observation and positive control groups showed a significant increase in beneficial bacteria(lactobacilli and Bifidobacterium)and a significant decrease in pathogenic bacteria(bacteroides and enterobacteria)compared to the blank control group(all P<0.001).The improvement in flora persisted up to 6 months after treatment(P<0.001).Barrier and inflammation:the reduction in serum D-lactic acid,DAO,and IL-6/IL-8/TNF-α levels was significantly greater in the observation and positive control groups than in the blank control group(all P<0.001).The expression of intestinal barrier proteins(Occludin and ZO-1)was significantly upregulated(P<0.001).Neurotransmitters:the increase in serum 5-HT levels were significantly higher in the two groups than in the blank control group(P<0.001).Recurrence rate:the 3-month recurrence rates in the observation group(8.0%)and positive control group(10.0%)were significantly lower than that in the blank control group(30.0%).The 6-month recurrence rates(14.0%vs.16.0%vs.44.0%)also showed significant differences(all P<0.05).Conclusion Chongkang Capsules combined with Bifidobacterium can effectively alleviate clinical symptoms in patients with IBS-D and comorbid anxiety and depression.The mechanism may be related to regulating intestinal flora balance,repairing the intestinal mucosal barrier,suppressing inflammatory responses,and increasing 5-HT levels.Additionally,the low recurrence rate suggests its clinical application value.

Diabetic neuropathy(DN)is a prevalent chronic complication of diabetes,characterized by a com-plex pathogenesis involving various cell types and molecular pathways.Research indicates that microglia,serving as the innate immune cells of the central nervous system,are pivotal in the development of DN.In recent years,with the in-depth understanding of the pathogenesis of DN,targeting microglia polarization has become a new research hotspot.This article provides an overview of current research on the regulatory mechanisms of microglia polarization,the impact of mi-croglia polarization on DN,and treatment strategies that target microglia polarization to improve DN.The objective is to elucidate the pivotal role of microglia in the pathogenesis of DN,and assess the efficacy and constraints of existing and emerging treatment methods targeting microglia,in order to offer a fresh perspective for future research and clinical treat-ment of DN.

Pneumonia complicated by diarrhea in children is a common clinical phenomenon.During fluid resuscitation,it is essential to prevent fluid deficiency while avoiding excessive fluid administration,which can lead to pulmonary interstitial edema or heart failure.A conservative fluid resuscitation strategy is recommended,initially utilizing a balanced crystalloid solution for resuscitation.If a significant volume of fluid is still required after assessment,colloid solutions may be considered.In accordance with the ROSE strategy for fluid resuscitation in sepsis,a staged fluid management approach should be implemented for children with pneumonia and diarrhea.Continuous monitoring of the patient's response to resuscitation and the improvement of clinical symptoms is crucial.If feasible,advanced hemodynamic monitoring should be employed.It is advisable to utilize multiple parameters and diverse methods to comprehensively assess the patient's clinical condition,thereby enabling the formulation of individualized fluid management plans.