Objective Based on the theory of"stomach disharmony leads to restlessness",the causal relationship between gastroesophageal reflux disease and insomnia was discussed by Mendel randomization method with two samples.Methods The data were collected from genome-wide association studies,the exposure factor was gastroesophageal reflux disease,and the outcome variable was insomnia.Mendel randomization analysis is realized by inverse variance weighted method,MR-Egger method,simple model method,weighted model method and weighted median method.Sensitivity analysis includes pleiotropic test,heterogeneity test and one-by-one elimination test,and is calculated by MR-Egger method,Cochran Q test and one-out-of-one method in turn.Results A total of 75 single nucleotide polymorphisms(SNPs)were screened.The inverse variance weighted method showed that gastroesophageal reflux disease increased the risk of insomnia(OR=1.255,95%CI:1.071-1.470,P<0.05).The weighted median method also confirmed that there was a positive causal relationship between gastroesophageal reflux disease and insomnia(OR=1.403,95%CI:1.117-1.762,P<0.05).Multiple sensitivity analysis indicated that there was no pleiotropy and heterogeneity in the results of Mendelian randomized analysis,which verified the stability of the research results.Conclusion There is a positive causal relationship between gastroesophageal reflux disease and insomnia,which enriches the theoretical connotation of"stomach disharmony leads to restlessness"from the genetic point of view and lays a foundation for further study.

Objective Based on the theory of"stomach disharmony leads to restlessness",the causal relationship between gastroesophageal reflux disease and insomnia was discussed by Mendel randomization method with two samples.Methods The data were collected from genome-wide association studies,the exposure factor was gastroesophageal reflux disease,and the outcome variable was insomnia.Mendel randomization analysis is realized by inverse variance weighted method,MR-Egger method,simple model method,weighted model method and weighted median method.Sensitivity analysis includes pleiotropic test,heterogeneity test and one-by-one elimination test,and is calculated by MR-Egger method,Cochran Q test and one-out-of-one method in turn.Results A total of 75 single nucleotide polymorphisms(SNPs)were screened.The inverse variance weighted method showed that gastroesophageal reflux disease increased the risk of insomnia(OR=1.255,95%CI:1.071-1.470,P<0.05).The weighted median method also confirmed that there was a positive causal relationship between gastroesophageal reflux disease and insomnia(OR=1.403,95%CI:1.117-1.762,P<0.05).Multiple sensitivity analysis indicated that there was no pleiotropy and heterogeneity in the results of Mendelian randomized analysis,which verified the stability of the research results.Conclusion There is a positive causal relationship between gastroesophageal reflux disease and insomnia,which enriches the theoretical connotation of"stomach disharmony leads to restlessness"from the genetic point of view and lays a foundation for further study.

Objective To investigate the application and effectiveness of the 90°oblique lateral decubitus position in retroperi-toneal laparoscopic urological surgery,providing a clinical approach to effectively reduce the incidence of pressure injuries on the skin.Methods A retrospective study was conducted on 60 urology patients who were admitted to the Department of Urology in our hospital from September to December 2023 for retroperitoneal laparoscopic surgery.The patients were divided into a traditional group and a trial group based on the surgical position,with 30 patients per group.A conventional 90°lateral decubitus position during surgery was applied to the patients in control group,while a 90°oblique lateral decubitus position was offered to the patients in trial group.The two groups were compared in terms of the incidence rate of skin pressure injury,lumbar back pain on the healthy side within 24 hours after surgery and the score of satisfaction from the surgical team.After controlling for demographic variables using logistic regression analysis,the risk of intraoperative pressure injury occurrence in the two groups of patients was found to be related to the group type.The risk of occurrence in the control group was 6.22 times that of the trial group.Results The observation group demonstrated a significantly lower incidence rate of postoperative skin pressure injury,a significantly lower postoperative lumbar back pain on the healthy side within 24 hours,and a significantly higher score in the surgical team satisfaction compared with those of the control group(all P<0.05).Conclusion In retroperitoneal laparoscopic urological surgery,the 90° oblique lateral decubitus position shows a superiority to the conventional lateral decubitus position in reducing the incidence rate of postoperative pressure injury and decreasing the lumbar back pain on the healthy side.

Abstract: To investigate the effect and mechanism of pituitary adenylate cyclase activated peptide recombinant 13 peptide(PACAP13) on thymus at cell, organ and individual levels. Methods: Thymic epithelial cells(TEC) and bone marrow mesenchymal stem cells(MSC) were culturedin vitro, lymphocyte group, lymphocyte+TEC group, lymphocyte+MSC group and lymphocyte+TEC+MSC group were set up to detect the proliferation of lymphocytes in each group treated by PACAP13 peptide, and contents of cytokines interleukin(IL)-1, IL-2, IL-6 and transforming growth factor(TGF) in culture medium were detected. Dexamethasone(Dex) was added to induce cell apoptosis, and Annexin V-FITC/PI flow cytometry double staining was used to detect the effect of PACAP13 peptide on cell apoptosis. Thymus group, thymus+ TEC group, thymus+ MSC group, thymus+ TEC+ MSC group were set up, and PACAP13 peptide was added, the content of signal joint T cell receptor rearrangement excision cricles(sjTREC) in thymus was detected by real-time quantitative PCR(qRCR). The pristane-induced lupus model mice were randomly divided into model group and PACAP13 group. Model group was injected with 0.9% saline, and PACAP13 group was injected with PACAP13 peptide, thymus and spleen sjTREC levels were detected by qPCR, serum lupus-related autoantibodies were detected by ELISA and thymus-related mRNA expression levels were detected by reverse transcription quantitative PCR(qRT-RCR). Results: Compared with the lymphocyte group, the proliferation rate of thymus lymphocytes in the lymphocyte+TEC group, lymphocyte+ MSC group, lymphocyte+ TEC+ MSC group increased, and the apoptosis rate decreased(P<0.05), compared with the control group, the proliferation rate of lymphocytes in the PACAP13 group increased, the rate of apoptosis decreased, and the cytokines IL-1, IL-2, IL-6 and TGF in the cell culture medium increased(P<0.05). Compared with the thymus group, thymus+ TEC group, thymus+ MSC group, thymus+ TEC+ MSC group increased the content of thymus sjTREC, compared with the control group, PACAP13 peptide group thymus sjTREC content increased. Compared with the model group, the content of sjTREC in the thymus and spleen of lupus mice in the PACAP13 group increased(P<0.05), thymus mRNA expression level of AIRE, Fezf2, Foxp3 and TGF-β increased(P<0.01), and CXCL13 mRNA expression level decreased(P<0.01), the autoantibodies of anti-dsDNA antibody, anti-RNP/sm antibody and ANA decreased in serum(P<0.05). Conclusion Compared with the lymphocyte group, the proliferation rate of thymus lymphocytes in the lymphocyte+TEC group, lymphocyte+ MSC group, lymphocyte+ TEC+ MSC group increased, and the apoptosis rate decreased(P<0.05), compared with the control group, the proliferation rate of lymphocytes in the PACAP13 group increased, the rate of apoptosis decreased, and the cytokines IL-1, IL-2, IL-6 and TGF in the cell culture medium increased(P<0.05). Compared with the thymus group, thymus+ TEC group, thymus+ MSC group, thymus+ TEC+ MSC group increased the content of thymus sjTREC, compared with the control group, PACAP13 peptide group thymus sjTREC content increased. Compared with the model group, the content of sjTREC in the thymus and spleen of lupus mice in the PACAP13 group increased(P<0.05), thymus mRNA expression level of AIRE, Fezf2, Foxp3 and TGF-β increased(P<0.01), and CXCL13 mRNA expression level decreased(P<0.01), the autoantibodies of anti-dsDNA antibody, anti-RNP/sm antibody and ANA decreased in serum(P<0.05).

Objective To explore the serum anti-Mullerian hormone (AMH) level in women of childbearing age with normal menstrual cycles. Methods A total of 1 423 women with regular menstrual cycles were selected and divided into 5 groups according to their ages, i.e.≤25, 26-30, 31-35, 36-40,≥41 years. Their serum levels of AMH were measured, and the relationship between AMH and age was analyzed. Results The serum AMH levels of 5 groups according to ages (≤25, 26-30, 31-35, 36-40, ≥41 years) were 3.62, 3.10, 2.27, 1.07, 0.45μg/L, respectively. The comparison of serum AMH levels in different age groups had significant difference (P<0.01). Serum AMH level declined with increasing age,and dropped significantly after 36. The serum AMH level and age showed a negative correlation with significant difference (r=-0.374, P<0.01). Quadratic regression of logAMH proximally reflected the relationship between AMH and age. Conclusion AMH determination for women of childbearing age could provide reference for the evaluation of ovarian function.