Objective To explore the mechanism by which She-Ti-Zhi-Qiu decoction alleviates allergic rhinitis (AR) through gut microbiota-mediated regulation of T helper cell 17(Th17)/regulatory T cells(Treg) balance and related cytokines. Methods Twenty-eight female SD rats were randomly divided into four groups: the Control group, Model group, STZQ group, and Probiotics group. Except for the Control group, all other groups were sensitized with ovalbumin (OVA) to establish AR models. The Control and Model groups received intragastric administration of normal saline, while the STZQ group was administered She-Ti-Zhi-Qiu Decoction, and Probiotics group received probiotics. After two weeks of continuous intragastric administration, nasal mucosa, serum, peripheral blood, and colon contents were collected. The inflammation of nasal mucosal tissue was assessed via HE staining. 16S rDNA sequencing was used to detect and analyze the structure and content of bacteria in colon contents. Flow cytometry was used to detect the relative proportions of Treg and Th17 cells in peripheral blood. ELISA was used to measure the levels of Th17- and Treg-related cytokines in serum. Results Compared with the Control group, the Model group showed an inflammatory response in nasal mucosal tissue, along with increased IL-17A and IL-17E levels and decreased IL-10 levels. The percentage of Th17 cells in peripheral blood increased, while the percentage of Treg cells decreased. Beneficial bacteria in the intestine were decreased, while pathogenic bacteria were increased. Compared with the Model group, the STZQ group showed lower serum IL-17A and IL-17E levels and higher IL-10 levels. The percentage of Th17 in peripheral blood decreased, while the percentage of Treg increased. There was an increase in beneficial bacteria in the intestine and a decrease in pathogenic bacteria. The changes in the microbiota were correlated with IL-17A, IL-17E, and IL-10 levels. Conclusion She-Ti-Zhi-Qiu decoction can ameliorate the inflammation of AR by regulating gut microbiota and Th17/Treg immune balance.
Animals ; T-Lymphocytes, Regulatory/drug effects* ; Th17 Cells/drug effects* ; Gastrointestinal Microbiome/drug effects* ; Rats, Sprague-Dawley ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Rhinitis, Allergic/microbiology* ; Rats ; Cytokines

Objective:To analyze the changes in the costs of hospital rehabilitation after the reform of health insurance payments in the past 6 years, and to identify relevant factors which can provide a reference for the reform of the health insurance payment system in rehabilitation department.Methods:Information on 16, 827 patients hospitalized in the rehabilitation department of The First Affiliated Hospital of Xi′an Jiaotong University between May 2018 and May 2024 was collected and subjected to non-parametric analysis.Results:The average hospitalization cost of rehabilitation department patients over the six years was Y14, 574.92±10, 524.79. During that time the proportion of the cost attributable to Western medicine decreased from 17.1% in 2018 to 7.6% in 2024. The proportion of the patients with hypertension was 51.94%, followed by diabetes mellitus (20.10%). Those with infections had the highest total hospitalization costs. Motor disorders were the most common dysfunction (59.02%), followed by speech disorders (17.45%). Patients with swallowing disorders had the highest hospitalization costs. After the payment system shifted from fee-for-service (FFS) to payment by diagnosis-related group (DRG) in 2023, the average daily inpatient expenditures for rehabilitation patients with all types of diseases gradually declined, reaching its lowest level in 2024.Conclusions:After the health insurance payments shifted from FFS to DRG, the proportion of in patients′ total drug costs decreased annually, and the average daily costs of patients with different types of diseases also decreased significantly, but the comprehensive service fee and diagnostic costs increased.

Objective To systematically evaluate the psychological characteristics of adolescent inflammatory bowel disease(IBD)patients during the transition period and provide evidence-based guidance for healthcare professionals in developing transition management strategies.Methods A systematic search was conducted across The Cochrane Library,PubMed,Web of Science,CINAHL,Embase,SinoMed,CNKI,Wanfang,and VIP databases for qualitative studies on adolescent IBD patients during transition,from database inception to May 2024.Eligible studies were critically appraised,and themes were synthesized using the meta-aggregation approach of meta-synthesis.Results Twelve studies were included,yielding 13 findings that were synthesized into five categories:self-development challenges,healthcare system transition barriers,family support conflicts,social adaptation difficulties,and lack of societal support systems.Conclusion Adolescents with IBD experience complex psychological challenges during transition,characterized by excessive psychological burdens,inadequate healthcare support,and insufficient societal recognition.Targeted interventions are needed to improve psychological outcomes during this critical phase.

Objective To analyze the clinical characteristics of immune checkpoint inhibitor(ICI)-related hepatotoxicity(ICIH)in cancer patients.Methods A retrospective analysis was conducted on clinical data of cancer patients with ICIH from January 2019 to December 2024.Patients with Grade 1-2 liver injury were defined as the mild group,and those with Grade 3-4 liver injury were defined as the severe group.Results Among 13 patients with ICIH,10(76.92%)were males and 3(23.08%)were females,with a mean age of 67.8±5.2 years.Twelve patients(92.3%)were aged 60 years or above.ICIH first occurred between cycle 1 and cycle 14 after initial treatment,with the highest incidence observed within cycles 1-5.Combination therapy(combination chemotherapy or targeted agents)was used in 10 patients(76.92%).Among the 13 patients,the distribution of liver injury grades was as follows:1 case of Grade 1(7.69%),2 cases of Grade 2(15.38%),5 cases of Grade 3(38.46%),and 5 cases of Grade 4(38.46%).Liver injury types included hepatocellular(38.46%),cholestatic(38.46%),and mixed(23.08%).After drug discontinuation and supportive care,9 patients(69.23%)fully recovered,2(15.38%)improved,and 2(15.38%)showed no improvement.No significant differences were observed between the mild and severe groups in terms of age,body mass index,baseline lymphocyte count,platelet count,neutrophil count,monocyte count,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,alkaline phosphatase,lymphocyte-to-monocyte ratio,neutrophil-to-lymphocyte ratio,and platelet-to-lymphocyte ratio(P>0.05).Conclusion ICIH typically occurs within 1 to 5 cycles after ICI administration,with non-specific clinical manifestations,which lead to a diagnosis of exclusion.Despite a generally favorable prognosis,severe ICIH can be fatal,particularly in patients with primary liver cancer.Prompt discontinuation of ICIs and initiation of Corticosteroid therapy can lead to timely improvement of patient's condition.

Objective To systematically evaluate the psychological characteristics of adolescent inflammatory bowel disease(IBD)patients during the transition period and provide evidence-based guidance for healthcare professionals in developing transition management strategies.Methods A systematic search was conducted across The Cochrane Library,PubMed,Web of Science,CINAHL,Embase,SinoMed,CNKI,Wanfang,and VIP databases for qualitative studies on adolescent IBD patients during transition,from database inception to May 2024.Eligible studies were critically appraised,and themes were synthesized using the meta-aggregation approach of meta-synthesis.Results Twelve studies were included,yielding 13 findings that were synthesized into five categories:self-development challenges,healthcare system transition barriers,family support conflicts,social adaptation difficulties,and lack of societal support systems.Conclusion Adolescents with IBD experience complex psychological challenges during transition,characterized by excessive psychological burdens,inadequate healthcare support,and insufficient societal recognition.Targeted interventions are needed to improve psychological outcomes during this critical phase.

Objective To analyze the clinical characteristics of immune checkpoint inhibitor(ICI)-related hepatotoxicity(ICIH)in cancer patients.Methods A retrospective analysis was conducted on clinical data of cancer patients with ICIH from January 2019 to December 2024.Patients with Grade 1-2 liver injury were defined as the mild group,and those with Grade 3-4 liver injury were defined as the severe group.Results Among 13 patients with ICIH,10(76.92%)were males and 3(23.08%)were females,with a mean age of 67.8±5.2 years.Twelve patients(92.3%)were aged 60 years or above.ICIH first occurred between cycle 1 and cycle 14 after initial treatment,with the highest incidence observed within cycles 1-5.Combination therapy(combination chemotherapy or targeted agents)was used in 10 patients(76.92%).Among the 13 patients,the distribution of liver injury grades was as follows:1 case of Grade 1(7.69%),2 cases of Grade 2(15.38%),5 cases of Grade 3(38.46%),and 5 cases of Grade 4(38.46%).Liver injury types included hepatocellular(38.46%),cholestatic(38.46%),and mixed(23.08%).After drug discontinuation and supportive care,9 patients(69.23%)fully recovered,2(15.38%)improved,and 2(15.38%)showed no improvement.No significant differences were observed between the mild and severe groups in terms of age,body mass index,baseline lymphocyte count,platelet count,neutrophil count,monocyte count,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,alkaline phosphatase,lymphocyte-to-monocyte ratio,neutrophil-to-lymphocyte ratio,and platelet-to-lymphocyte ratio(P>0.05).Conclusion ICIH typically occurs within 1 to 5 cycles after ICI administration,with non-specific clinical manifestations,which lead to a diagnosis of exclusion.Despite a generally favorable prognosis,severe ICIH can be fatal,particularly in patients with primary liver cancer.Prompt discontinuation of ICIs and initiation of Corticosteroid therapy can lead to timely improvement of patient's condition.

Objective:To analyze the changes in the costs of hospital rehabilitation after the reform of health insurance payments in the past 6 years, and to identify relevant factors which can provide a reference for the reform of the health insurance payment system in rehabilitation department.Methods:Information on 16, 827 patients hospitalized in the rehabilitation department of The First Affiliated Hospital of Xi′an Jiaotong University between May 2018 and May 2024 was collected and subjected to non-parametric analysis.Results:The average hospitalization cost of rehabilitation department patients over the six years was Y14, 574.92±10, 524.79. During that time the proportion of the cost attributable to Western medicine decreased from 17.1% in 2018 to 7.6% in 2024. The proportion of the patients with hypertension was 51.94%, followed by diabetes mellitus (20.10%). Those with infections had the highest total hospitalization costs. Motor disorders were the most common dysfunction (59.02%), followed by speech disorders (17.45%). Patients with swallowing disorders had the highest hospitalization costs. After the payment system shifted from fee-for-service (FFS) to payment by diagnosis-related group (DRG) in 2023, the average daily inpatient expenditures for rehabilitation patients with all types of diseases gradually declined, reaching its lowest level in 2024.Conclusions:After the health insurance payments shifted from FFS to DRG, the proportion of in patients′ total drug costs decreased annually, and the average daily costs of patients with different types of diseases also decreased significantly, but the comprehensive service fee and diagnostic costs increased.

Objective:The study aimed to assess the scientific rigor, transparency, and practicality of Chinese geriatric medicine guidelines and consensus published in academic journals.Methods:A systematic search was conducted across 8 major Chinese and English databases to identify guidelines and consensus documents from Chinese scholars in 2022.Results:The selected documents were evaluated using the STAR rating tool, resulting in the inclusion of 2 guidelines and 19 expert consensuses.The total scores ranged from 9.0 to 50.6 points, with an average score of 29.6±13.1 points.The highest score rate in the'Consensus Methods’category of expert consensuses was 47.4%, while the lowest score rate in the'Registration’category was 0.For guidelines, the highest score rate in the'Consensus Methods’category was 42.9%, while the lowest score rates were observed in the'Registration’, 'Plan’, and'Others’categories at 0.Conclusions:The overall quality of geriatric medicine guidelines and consensus in China requires enhancement.There is a need to improve training in guideline consensus development, involve methodologists, elevate the standards for journal publication, and strive to enhance the scientific rigor, transparency, and practicality of guidelines and consensus documents.

Objective:To identify risk variables for prolonged postoperative length of stay (PPOLOS) in hip fracture patients by machine learning algorithms and construct Nomogram models.Methods:A retrospective case-control study was conducted to select 248 patients with hip fracture diagnosed and treated in Yingtan 184th Hospital from June 2019 to June 2023 by convenient sampling method. Two machine learning algorithms were used (least absolute shrinkage and selection operator, LASSO and support vector machine-Recursive Feature Elimination, SVM-RFE) to screen PPOLOS risk variables. Construct a Nomogram model to predict the risk of PPOLOS in patients with hip fracture based on intersection risk variables. The model was validated using internal data sets.Results:Among the 248 patients with hip fracture, there were 79 males and 169 females, aged (64.49 ± 8.02). The mean postoperative length of hospital stay of 248 patients was (7.98 ± 5.68) d, and the median was 7 d. LASSO algorithm identifies 7 risk variables, the SVM-RFE algorithm identified 8 risk variables. Intersectional risk variables were age, body mass index (BMI), Charlson comorbidity index (CCI), type of surgery, and central granulocytocyte ratio (NLR). Multivariate Logistic regression analysis(intersection risk variables) showed that age [ OR=1.649(1.235-2.202)], BMI [1.603(1.204-2.134)], CCI [ OR=1.670(1.236-2.258)], type of surgery [ OR=1.620(1.209-2.170), 1.699(1.243-2.321)], and NLR [ OR=3.258(2.299-4.617)] were independently associated with the risk of PPOLOS (all P<0.05). The results showed that the conformity index of the Nomogram model was 0.865 (95% CI=0.768-0.945). The area under the curve was 0.852 (95% CI=0.748-0.962). When the risk threshold was >0.08, it could provide significant clinical net benefit. The clinical impact curve showed effective identification of PPOLOS patients in high-risk groups. Conclusions:This Nomogram model can guide medical staff to make clinical diagnosis and treatment decisions as soon as possible to avoid risks, allocate medical resources rationally, and improve nursing quality.

Effectively assessing oxygen delivery and demand is one of the key targets for fluid resuscitation in sepsis. Clinical signs and symptoms, blood lactic acid levels, and mixed venous oxygen saturation (S O 2) or central venous oxygen saturation (ScvO 2) all have their limitations. In recent years, these limitations have been overcome through the use of derived indicators from carbon dioxide (CO 2) such as mixed veno-arterial carbon dioxide partial pressure difference (P -aCO 2, PCO 2 gap, or ΔPCO 2), the ratio of mixed veno-arterial carbon dioxide partial pressure difference to arterial-mixed venous oxygen content difference (P -aCO 2/Ca- O 2). P -aCO 2, PCO 2 gap or ΔPCO 2 is not a purely anaerobic metabolism indicator as it is influenced by oxygen consumption. However, it reliably indicates whether blood flow is sufficient to carry CO 2 from peripheral tissues to the lungs for clearance, thus reflecting the adequacy of cardiac output and metabolism. The P -aCO 2/Ca- O 2 may serve as a marker of hypoxia. S O 2 and ScvO 2 represent venous oxygen saturation, reflecting tissue oxygen utilization. When oxygen delivery decreases but tissues still require more oxygen, oxygen extraction rate usually increases to meet tissue demands, resulting in decreased S O 2 and ScvO 2. But in some cases, even if the oxygen delivery rate and tissue utilization rate of oxygen are reduced, it may still lead to a decrease in S O 2 and ScvO 2. Sepsis is a classic example where tissue oxygen utilization decreases due to factors such as microcirculatory dysfunction, even when oxygen delivery is sufficient, leading to decrease in S O 2 and ScvO 2. Additionally, the solubility of CO 2 in plasma is approximately 20 times that of oxygen. Therefore, during sepsis or septic shock, derived variables of CO 2 may serve as sensitive markers for monitoring tissue perfusion and microcirculatory hemodynamics. Its main advantage over blood lactic acid is its ability to rapidly change and provide real-time monitoring of tissue hypoxia. This review aims to demonstrate the principles of CO 2-derived variables in sepsis, assess the available techniques for evaluating CO 2-derived variables during the sepsis process, and discuss their clinical relevance.