Objective To explore the anti-inflammatory mechanism of Tong-Xie-Yao-Fang's intervention on irritable bowel syndrome with diarrhea(IBS-D),the effects of Tong-Xie-Yao-Fang on farnesol receptor(FXR),nuclear factor-κB(NF-κB)and inflammatory factors in IBS-D model rats were observed.Methods Healthy SD rats were randomly divided into blank group(Control group),model group(Model group),low-dose group of Tong-Xie-Yao-Fang(TXYF-L group,4.977 g/kg),middle-dose group of Tong-Xie-Yao-Fang(TXYF-M group,9.954 g/kg),and high-dose group of Tong-Xie-Yao-Fang(TXYF-H group,19.908 g/kg),Pivium bromide group(PWXA group,0.018 g/kg),with 10 rats in each group.Except for the blank group,the IBS-D rat models of liver depression and spleen deficiency were established by chronic restraint stress and senna intragastric administration.After the model was successfully established,the intervention was continued for 14 days according to the corresponding group treatment method.The general situation,diarrhea rate,fecal moisture content,water injection when abdominal wall retraction reflex reaches 3 scores,sugar water preference rate and serum D-xylose level were observed.The morphological and structural changes of rat colon were observed by HE staining.The expression of FXR gene in colon tissue was detected by real-time fluorescence quantitative PCR,the expression of FXR protein and NF-κB protein in colon tissue was detected by protein Western blot,and the levels of serum IL-6,IL-8 and TNF-α were detected by ELISA.Results After the treatment of Tong-Xie-Yao-Fang,the weight of each dosage group of Tong-Xie-Yao-Fang increased,the fecal water content decreased,the sugar water preference rate increased,the water injection volume increased when the rats reached the third grade of abdominal retraction reflex score,the serum D-xylose content increased and the food intake increased.HE staining showed that villous or finger-like structures appeared in the mucosal epithelium of model group,and inflammatory cells infiltrated in the upper mucosa.After treatment,the mucosal epithelium in TXYF-M group was smooth,villous or finger-like structures disappeared,and the infiltration degree of inflammatory cells decreased.Compared with the model group,the expression of FXR mRNA and FXR protein in the colon tissue of rats in the high-dose group of Tong-Xie-Yao-Fang increased significantly,while the concentration of IL-6,IL-8 and TNF-α in serum and the expression of NF-κB protein in the colon tissue of rats in the high-dose group of Tong-Xie-Yao-Fang decreased.Conclusion The mechanism of Tong-Xie-Yao-Fang in treating low-grade inflammation of IBS-D intestinal mucosa may be related to activating the expression of FXR in colon,inhibiting the expression of NF-κB in colon tissue,and then reducing the concentration of pro-inflammatory factors IL-6,IL-8 and TNF-α in serum.

Objective To explore the anti-inflammatory mechanism of Tong-Xie-Yao-Fang's intervention on irritable bowel syndrome with diarrhea(IBS-D),the effects of Tong-Xie-Yao-Fang on farnesol receptor(FXR),nuclear factor-κB(NF-κB)and inflammatory factors in IBS-D model rats were observed.Methods Healthy SD rats were randomly divided into blank group(Control group),model group(Model group),low-dose group of Tong-Xie-Yao-Fang(TXYF-L group,4.977 g/kg),middle-dose group of Tong-Xie-Yao-Fang(TXYF-M group,9.954 g/kg),and high-dose group of Tong-Xie-Yao-Fang(TXYF-H group,19.908 g/kg),Pivium bromide group(PWXA group,0.018 g/kg),with 10 rats in each group.Except for the blank group,the IBS-D rat models of liver depression and spleen deficiency were established by chronic restraint stress and senna intragastric administration.After the model was successfully established,the intervention was continued for 14 days according to the corresponding group treatment method.The general situation,diarrhea rate,fecal moisture content,water injection when abdominal wall retraction reflex reaches 3 scores,sugar water preference rate and serum D-xylose level were observed.The morphological and structural changes of rat colon were observed by HE staining.The expression of FXR gene in colon tissue was detected by real-time fluorescence quantitative PCR,the expression of FXR protein and NF-κB protein in colon tissue was detected by protein Western blot,and the levels of serum IL-6,IL-8 and TNF-α were detected by ELISA.Results After the treatment of Tong-Xie-Yao-Fang,the weight of each dosage group of Tong-Xie-Yao-Fang increased,the fecal water content decreased,the sugar water preference rate increased,the water injection volume increased when the rats reached the third grade of abdominal retraction reflex score,the serum D-xylose content increased and the food intake increased.HE staining showed that villous or finger-like structures appeared in the mucosal epithelium of model group,and inflammatory cells infiltrated in the upper mucosa.After treatment,the mucosal epithelium in TXYF-M group was smooth,villous or finger-like structures disappeared,and the infiltration degree of inflammatory cells decreased.Compared with the model group,the expression of FXR mRNA and FXR protein in the colon tissue of rats in the high-dose group of Tong-Xie-Yao-Fang increased significantly,while the concentration of IL-6,IL-8 and TNF-α in serum and the expression of NF-κB protein in the colon tissue of rats in the high-dose group of Tong-Xie-Yao-Fang decreased.Conclusion The mechanism of Tong-Xie-Yao-Fang in treating low-grade inflammation of IBS-D intestinal mucosa may be related to activating the expression of FXR in colon,inhibiting the expression of NF-κB in colon tissue,and then reducing the concentration of pro-inflammatory factors IL-6,IL-8 and TNF-α in serum.

Swift response to public complaints is a mechanism reform and efficiency driven approach for grassroots social governance, which plays a pivotal role in urban management. This study took Beijing as an example to introduce the overall development process of swift response to public complaints and its development status in the medical and health service system. It was believed that the work of handling complaints is a reform and innovation to deepen grassroots governance in the capital and a vivid practice of implementing the patient-centered development concept in the medical and health service system. This study summarized the research progress related to swift response to public complaints. From the perspective of mega city governance, the existing problems in the work of handling complaints in health field were explored, including inconsistent implementation of policies, the need to improve supervision and evaluation mechanisms; The coexistence of obstacles to patient demands and ineffective complaints, and the impact on patient participation; Difficulties in cross institutional collaboration, and the need to improve the level of information construction. In response to these issues, it was proposed to further deepen institutional and mechanism reforms to ensure the effective implementation of policies; build a patient-centered healthcare service system that involves patient participation; promote cross institutional information sharing and improve the efficiency of handling appeals; standardize the classification and management of demands, promote the overall improvement of medical quality, so as to provide references for the continuous improvement of the work of handling complaints immediately and the enhancement of the medical and health service system in China′s mega cities.

Objective:To investigate the changes in the white matter fiber structure of fetal brain with mild to moderate isolated ventriculomegaly (IVM) using diffusion tensor imaging (DTI) model and fixed based analysis (FBA) method of diffusion MRI (dMRI).Methods:This was a case-control study. Twenty fetuses diagnosed with mild to moderate IVM who were admitted to the Provincial Hospital Affiliated to Shandong First Medical University from August 2022 to August 2023 were included prospectively as the IVM group, with gestational age ranging from 24 to 36 (29.9±3.6) weeks. The control group included 22 normal control fetuses obtained from the dMRI atlas data of Chinese fetal brain, with gestational age ranging from 24 to 36 (30.2±3.7) weeks. The dMRI data were collected for all fetuses and the DTI model was used to obtain fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of 7 main fiber bundles, including the genu and splenium of the corpus callosum, middle cerebellar peduncle, bilateral cortico-spinal tract, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and anterior thalamic radiation. The FBA method was used to obtain fiber density (FD), fiber cross-sectional area (FC), and fiber density and cross-section (FDC) of the whole brain. The comparison of DTI parameters of each fiber bundle between the two groups was conducted using independent sample t test or Mann-Whitney U test. The comparison of FBA parameters between the two groups was performed using covariance analysis, and the MRtrix3 software package was used to display the brain regions with significant differences. Results:The FA values of the inferior longitudinal fasciculus in the IVM group and the control group were 0.142±0.012 and 0.133±0.015, respectively, and the difference was statistically significant ( t=2.21, P=0.033), while the DTI parameters of the other fiber bundles showed no statistically significant differences ( P>0.05). The whole brain FBA results showed that compared with the control group,FD decreased while FC increased in the corpus callosum, fornix, and sagittal stratum in IVM fetuses, while FDC decreased in the cortico-spinal tract. Conclusion:There are microstructural changes of the brain white matter fiber in intrauterine fetuses with mild to moderate IVM, which are mainly located in the white matter fiber bundles surrounding the body, atrium, and temporal horn of the lateral ventricle.

Swift response to public complaints is a mechanism reform and efficiency driven approach for grassroots social governance, which plays a pivotal role in urban management. This study took Beijing as an example to introduce the overall development process of swift response to public complaints and its development status in the medical and health service system. It was believed that the work of handling complaints is a reform and innovation to deepen grassroots governance in the capital and a vivid practice of implementing the patient-centered development concept in the medical and health service system. This study summarized the research progress related to swift response to public complaints. From the perspective of mega city governance, the existing problems in the work of handling complaints in health field were explored, including inconsistent implementation of policies, the need to improve supervision and evaluation mechanisms; The coexistence of obstacles to patient demands and ineffective complaints, and the impact on patient participation; Difficulties in cross institutional collaboration, and the need to improve the level of information construction. In response to these issues, it was proposed to further deepen institutional and mechanism reforms to ensure the effective implementation of policies; build a patient-centered healthcare service system that involves patient participation; promote cross institutional information sharing and improve the efficiency of handling appeals; standardize the classification and management of demands, promote the overall improvement of medical quality, so as to provide references for the continuous improvement of the work of handling complaints immediately and the enhancement of the medical and health service system in China′s mega cities.

Objective:To explore the application value of FilmArray detection in children with acute lower respiratory tract infection and conduct economics analysis.Methods:From December 1, 2016 to November 30, 2017, 1 380 patients were enrolled in our study.Some children(FilmArray group) were tested for respiratory pathogens with FilmArray, while others (control group) were tested by 7-box antigen test of respiratory virus, gold colloid test of influenza and mycoplasma antibody.Those with underlying diseases were excluded.A total of 160 cases in the FilmArray group and 160 cases in the control group were obtained with tendency score matching method.The physical examination of pathogens, clinical indicators, usage of anti-infective drugs and hospitalization related costs were compared.Results:The positive rate of FilmArray test was significantly higher than that in control group (86.88% vs. 45.91%). The most common pathogens detected by FilmArray were adenovirus(39 cases), rhinovirus(34 cases), and parainfluenza virus(30 cases). In the FilmArray group, nine cases were positive for botulinum pertussis, accounting for 5.6% of the total.The hospitalization time of FilmArray group was shorter than that in control group [(8.89±6.23 days vs.(11.51±14.43)days]. In FilmArray group, the antibiotics were used for a shorter time, and 18 children did not use antibiotics during hospitalization.Compared with the control group, the hospitalization cost had no significant difference in the FilmArray group, but the antibiotic cost was less, as well as hospitalization time was shorter.The average hospitalization cost saved by using the FilmArray test was nearly 2 000 yuan per person. Conclusion:The application of FilmArray detection in children with acute lower respiratory tract infection can quickly and accurately identify a various infections of virus, bacteria and atypical pathogen, which guides using anti-infective drugs more reasonably.The application of FilmArray detection shortens the average hospitalization days of children, increases the utilization efficiency of medical resources, and reduces the medical cost and indirect economic loss of children’s families, which has certain economics significance.

Objective To explore the clinical characteristics of acute lower respiratory tract infection in children after influenza,and to provide evidence-based basis for timely diagnosis and accurate treatment of acute lower respiratory tract infection in children after influenza. Methods Eighty- two patients with acute lower respiratory tract infection admitted to Shanghai Children′ s Medical Center from October 2016 to November 2017 were enrolled in our study. The clinical data of these patients were analyzed and influenza A or influenza B were confirmed by Filmarray platform. The clinical characteristics of patients with influenza A and influenza B,severe pneumonia and non-severe pneumonia,mechanical ventilation and non-mechanical ventilation were compared. Results The age distribution of the children ranged from 0. 13 to 15 years old, with 73 cases (89. 0％ ) being younger than 5 years old. There were 47 cases of influenza A (57. 3％ ) and 35 cases of influenza B (42. 7％ ). The proportions of cases in spring,summer,autumn and winter were 35. 3％ ,15. 9％ ,15. 9％ and 32. 9％ ,respectively. Congenital heart disease was the most common underlying disease (28 cases,34. 1％ ). Twenty-five(30. 5％ ) patients were diagnosed as severe pneumonia. Oseltamivir was added on the first to eighth days of the course with median time ( IQR) 2. 0 (3. 0) days. Thirteen (15. 9％ ) patients needed ventilator-assisted ventilation. There were significant differences in the incidence of influenza A and influenza B in summer (12 / 47 vs. 1 / 35,χ2 = 7. 7,P < 0. 01). Compared to non-severe pneu-monia,severe pneumonia was positively correlated with underlying diseases(17 / 25 vs. 18 / 57,χ2 = 9. 4,P <0. 01),digestive tract symptoms(10 / 25 vs. 6 / 57,χ2 = 9. 6,P < 0. 01) and high PCT level(8 / 23 vs. 8 / 56,χ2 = 3. 1,P < 0. 01),but negatively correlated with oseltamivir application[M(IQR)] [5. 0(2. 5) d vs. 2. 0 (1. 5)d,Z = - 6. 1,P < 0. 01]. There was significant difference in the proportion of influenza A/ B between ventilator group and non-ventilator group (11 / 2 vs. 36 / 33,χ2 = 4. 7,P < 0. 01). Conclusion Filmarray re-spiratory tract detection system can detect influenza virus infection quickly and accurately,providing a good basis for early diagnosis and treatment. Children under 5 years old are susceptible to influenza. Influenza in children mainly occurs in winter and spring. Influenza A mainly occurs in summer. Patients with influenza A infection,underlying diseases,digestive tract symptoms during the course of illness and elevated PCT are more likely to progress to severe illness or even use ventilator treatment. Early use of oseltamivir can improve the prognosis of the disease.

The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine.ultrasound is primarily used to evaluate blood volume and volume responsiveness,airway,lung and stomach volume,as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics.Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy,pathology and cardiac function.It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound,left auricular thrombosis,infective endocarditis,aortic dissection,intraoperative monitoring,etc.The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment,and improves the quality of perioperative and pain medical treatment.

A case control study including 45 acute pancreatitis and 44 healthy volunteers was performed to investigate the association between intestinal microbial community and acute pancreatitis. High-throughput 16S rRNA gene amplicon sequencing was used to profile the microbiological composition of the samples. In total, 27 microbial phyla were detected and the samples of pancreatitis patients contained fewer phyla. Samples from acute pancreatitis patients contained more Bacteroidetes and Proteobacteria and fewer Firmicutes and Actinobacteria than those from healthy volunteers. PCoA analyses distinguished the fecal microbial communities of acute pancreatitis patients from those of healthy volunteers. The intestinal microbes of acute pancreatitis patients are different from those of healthy volunteers. Modulation of the intestinal microbiome may serve as an alternative strategy for treating acute pancreatitis.

Objective To investigate the clinical value of the polymerase chain reaction (PCR) technique in detection of pediatric helicobacter pylori(HP) infection.Methods A total of 130 children with different digestive tract symptoms received esophagogastroduodenoscopy,and 120 children between 3 and 17 years old were enrolled.The gastric antrum mucosa was taken under the gastroscope for 2 blocks,and the gastric juice was absorbed as the specimen.One block of gastric antrum mucosa was examined histopathologi-cally,and the other block of gastric antrum mucosa and gastric juice were examined by PCR.We used the primers UreC,HP-16s,CSTP to detect HP,and then used the primers Cag750 and Cag595 to detect CagA. Results A total of 28 cases(23.33%) of upper gastrointestinal ulcer were detected by gastroscopy,and HP was detected by histopathological method in 26 cases(21.67%),and 41 cases(34.17%) were detected by PCR method.The detection rate of HP by PCR was significantly higher than that of HP in pathological method (χ2= 4.659,P = 0.031). By pathological examination of HP,14 cases (50%) and 12 cases (13.04%) with peptic ulcers and no peptic ulcers were detectd,and the difference in detection rate was statistically significant(χ2=17.275,P<0.001).Samples of children with peptic ulcers and no peptic ulcers were detected in 16 cases(57.14%) and 25 cases (27.17%) by PCR,and the difference in detection rate was statistically significant (χ2=8.572,P=0.003).The CagA were detected in 7 cases of peptic ulcers and 7 cases of non peptic ulcers by PCR,and the difference in detection rate was statistically significant(25.00%vs 7.61%,χ2=6.300,P=0.012).Conclusion The PCR method could quickly and sensitively detect the HP and its CagA gene,and the detection of gastric mucosa and gastric juice by PCR could improve the detection rate of HP.A combination of PCR and pathological method is suggested as the detection method for children′s HP infection.