Objective To investigate the diversity and composition of gut fungi microbiota in patients with polycystic kidney disease(PKD)and its correlation with clinical indicators.Methods A total of 44 PKD patients,44 patients with non-polycystic chronic kidney disease(NPCKD)and 22 healthy controls(HC)admitted to our hospital from February 2023 to February 2024 were recruited.ITS1 DNA sequencing was applied to analyze the gut fungal composition.Bioinformatics analysis was used to compare the diversity and structural differences of fungi among the 3 groups.Pearson correlation analysis was performed to analyze the relationship between gut fungi and clinical indicators.Results There were no significant differences in baseline characteristics(gender,age,body mass index,etc.)among the 3 groups,but statistical differences were seen in terms of serum indicators(such as serum creatinine,blood urea nitrogen,uric acid,estimated glomerular filtration rate,etc.)(P<0.01).Alpha diversity analysis showed no significant difference was seen between the PKD and HC groups,but the PKD group had significant differences to the NPCKD group(P<0.01).Beta diversity analysis revealed significant differences among the 3 groups and in pairwise comparisons(P=0.001).Fungi composition analysis found that the abundance of Candida was significantly higher in the PKD group than the other 2 groups(P<0.01),while the abundances of Aspergillus and Cladosporium were significantly lower in the PKD group than the HC group(P<0.05).Linear discriminant analysis(LEFSe)indicated that Candida was significantly enriched,while Aspergillus and Cladosporium were significantly reduced in the PKD group.Correlation analysis revealed that the abundance of Cladosporium was negatively correlated with cyst diameter and immunoglobulin light chain Kappa/Lambda ratio in the PKD group(P<0.05),while the abundance of Candida was positively correlated with liver/kidney cyst diameter(P<0.01).Conclusion PKD patients exhibit characteristic changes in gut fungi diversity and composition.The abundances of Cladosporium and Candida are closely associated with clinical indicators of PKD patients.

A local context fusion based segmentation model which uses a local context attention mechanism to filter out irrelevant feature information and enhance the attention to important regions is presented for accurate polyp segmentation. The features at different scales are captured by multi-kernel dilated convolution for improving the accuracy of polyp boundary segmentation. Pyramid context selection module utilizes shallow encoder features to compensate for the low-level information lost by the deeper encoder,enabling the model to adapt to polyps of various sizes. The proposed model achieves accuracies of 97.67％,97.19％ and 99.23％ on Kvasir-SEG,EndoScene and CVC-ClinicDB datasets,respectively,with mIoU of 91.20％,88.31％ and 94.75％,respectively,exhibiting higher accuracy and generalizability than the existing classical methods and validating its superior performance in polyp segmentation. The proposed model can improve polyp segmentation accuracy and provide a more accurate aid for polyp segmentation.

A local context fusion based segmentation model which uses a local context attention mechanism to filter out irrelevant feature information and enhance the attention to important regions is presented for accurate polyp segmentation. The features at different scales are captured by multi-kernel dilated convolution for improving the accuracy of polyp boundary segmentation. Pyramid context selection module utilizes shallow encoder features to compensate for the low-level information lost by the deeper encoder,enabling the model to adapt to polyps of various sizes. The proposed model achieves accuracies of 97.67％,97.19％ and 99.23％ on Kvasir-SEG,EndoScene and CVC-ClinicDB datasets,respectively,with mIoU of 91.20％,88.31％ and 94.75％,respectively,exhibiting higher accuracy and generalizability than the existing classical methods and validating its superior performance in polyp segmentation. The proposed model can improve polyp segmentation accuracy and provide a more accurate aid for polyp segmentation.

Acute lung injury (ALI) is a prevalent and severe clinical condition characterized by inflammatory damage to the lung endothelial and epithelial barriers, resulting in high incidence and mortality rates. Currently, there is a lack of safe and effective drugs for the treatment of ALI. In a previous clinical study, we observed that Jinyinqingre oral liquid (JYQR), a Traditional Chinese Medicine formulation prepared by the Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, exhibited notable efficacy in treating inflammation-related hepatitis and cholecystitis in clinical settings. However, the potential role of JYQR in ALI/acute respiratory distress syndrome (ARDS) and its anti-inflammatory mechanism remains unexplored. Thus, the present study aimed to investigate the therapeutic effects and underlying molecular mechanisms of JYQR in ALI using a mouse model of lipopolysaccharide (LPS)-induced ALI and an in vitro RAW264.7 cell model. JYQR yielded substantial improvements in LPS-induced histological alterations in lung tissues. Additionally, JYQR administration led to a noteworthy reduction in total protein levels within the BALF, a decrease in MPAP, and attenuation of pleural thickness. These findings collectively highlight the remarkable efficacy of JYQR in mitigating the deleterious effects of LPS-induced ALI. Mechanistic investigations revealed that JYQR pretreatment significantly inhibited NF-κB activation and downregulated the expressions of the downstream proteins, namely NLRP3 and GSDMD, as well as proinflammatory cytokine levels in mice and RAW2647 cells. Consequently, JYQR alleviated LPS-induced ALI by inhibiting the NF-κB/NLRP3/GSDMD pathway. JYQR exerts a protective effect against LPS-induced ALI in mice, and its mechanism of action involves the downregulation of the NF-κB/NLRP3/GSDMD inflammatory pathway.
Humans ; NF-kappa B/metabolism* ; Lipopolysaccharides/metabolism* ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Acute Lung Injury/metabolism* ; Lung ; Phosphate-Binding Proteins/therapeutic use* ; Pore Forming Cytotoxic Proteins/therapeutic use*

Objective:To investigate the association of peripheral axial lengths and retinal curvatures with refractive status.Methods:A cross-sectional study was conducted out.Two hundred and eighty-seven eyes of 287 consecutive children aged 6-15 years old who recieved eye examinations at Beijing Tongren Hospital from July to October 2021 were enrolled, including 154 males and 133 females.Uncorrected and best corrected visual acuity were tested with a standard logarithmic visual acuity chart.Spherical equivalent (SE) was measured via an auto refractometer after cycloplegia with tropicamide.The hyperopic, emmetropic and myopic groups were defined with a SE >+ 0.5 D, SE >-0.5 D to ≤+ 0.5 D and SE≤-0.5 D, respectively.Central and 30° peripheral eye lengths (nasal, temporal, superior, inferior) were obtained using the Lenstar LS900.Retinal coordinates were derived from partial coherence interferometry modeling and converted to retinal curvatures.According to the median horizontal peripheral eye length differences (absolute difference between nasal and temporal), participants were assigned to H1 group (absolute difference <0.35 mm) or H2 group (absolute difference ≥0.35 mm). According to the median vertical peripheral eye length differences (absolute difference between superior and inferior), participants were assigned to V1 group (absolute difference <0.32 mm) or V2 group (absolute difference ≥0.32 mm). Four groups of V1H1, V1H2, V2H1 and V2H2 were constructed according to the grouping methods in both directions above.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2021-162). Written informed consent was obtained from guardians of each subject prior to any medical examination.Results:The central axial length was 23.53(22.93, 24.10)mm.Peripheral eye lengths of temporal, nasal, superior and inferior were 22.75(22.11, 23.22)mm, 22.99(22.32, 23.45)mm, 23.24(22.58, 23.75)mm and 23.12(22.52, 23.56)mm, respectively.Temporal eye length was shorter than nasal, showing a statistically significant difference ( Z=-3.58, P<0.01). Compared with H2 group, H1 group had shorter central, nasal, superior and inferior eye lengths, showing statistically significant differences (all at P<0.05). Compared with V2 group, V1 group had shorter central, nasal and superior eye lengths, showing statistically significant differences (all at P<0.05). SE of H1 group was + 0.06 (-1.06, + 0.75) D, which was significantly greater than -0.32 (-1.64, + 0.56) D of H2 group ( Z=-2.10, P=0.04). SE of V1 group was + 0.13 (-0.81, + 0.80) D, which was significantly greater than -0.56 (-1.83, + 0.48) D of H2 group ( Z=-3.39, P<0.01). The myopia ratio of V1 group was 33.5% (58/173), which was significantly lower than 50.5% (53/105) of V2 group ( χ2=7.83, P<0.01). There was a significant overall difference in SE among VIH1, V1H2, V2H1 and V2H2 groups ( H=24.79, P<0.01). SE was greater in V1H1 group than V1H2, V2H1 and V2H2 groups (all at P<0.01). There was a significant difference in both horizontal and vertical retinal curvatures among different refractive groups ( H=22.34, 19.30; both at P<0.01). The retical curvature in both directions of hyperopic and emmetropic groups were significantly larger than those of myopic group (both at P<0.01). Conclusions:Peripheral eye lengths are asymmetric in school-aged children.Higher asymmetry is associated with myopic shifts.Myopic children have a steeper retina than the hyperopic and emmetropic children.

Objective:To investigate the application effect of problem-based learning (PBL) in the teaching of professional postgraduate students in hepatobiliary surgery.Methods:A total of 60 professional postgraduate students in the same grade who were accepted by Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, were selected as research subjects. The students were randomly divided into PBL teaching group and lecture-based learning (LBL) teaching group, and the training effect was compared between the two groups. SPSS 25.0 software was used for t test and chi-square test. Results:Compared with the LBL group, the PBL group had significantly higher scores of written examination [(90.3±4.5) vs. (85.2±7.1), P<0.05] and skill examination [(92.3±4.9) vs. (86.3±7.9), P<0.05] and significantly better comprehensive abilities such as scientific research ability, clinical ability, organizing ability, literature review, collaboration and cooperation, and language expression [(85.0±7.5) vs. (73.0±9.1), P<0.05], as well as a significantly higher overall evaluation score [(90.2±3.2) vs. (83.3±3.9), P<0.05]. The PBL group also had a higher degree of satisfaction than the LBL group (83.3% vs. 56.7%). Conclusion:Application of PBL in the teaching of professional postgraduate students can improve the quality of teaching.

Objective:To compare the clinical outcomes of internal fixation of McCrory-Bladin type III fracture of the lateral process of the talus (FLPT) with Kirschner wire Double-pully technique under subtalar arthroscopy and open reduction with Kirschner wire fixation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 42 patients (42 feet) with McCrory-Bladin type III FLPT admitted to Xuzhou Central Hospital from May 2017 to May 2022, including 15 males (15 feet) and 27 females (27 feet); aged 18-55 years [(33.3±9.8)years]. Among them, 24 patients were treated with Kirschner wire Double-pully technique under subtalar arthroscopy (arthroscopy+Kirschner group), and 18 with open reduction and Kirschner wire fixation (open reduction+Kirschner group). The surgical duration, wound healing status, and assessment outcomes at 12 weeks, 12 months and the last follow-up, including American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) score, and Foot and Ankle Ability Measure (FAAM) [Activities of Daily Living (ADL) and Sports (S) subscores], were compared between the two groups, respectively. Complication rates were also compared at the last follow-up.Results:All the patients were followed up for 12-27 months [(17.6±4.9)months]. The surgical duration in the arthroscopy+Kirschner group [(53.7±11.8)minutes] was longer than that in the open reduction+Kirschner group [(43.9±7.2)minutes] ( P<0.05). Bone grafting was not required in either group and all incision healing was achieved by primary intention. At 12 weeks, 12 months and the last follow-up, the arthroscopy+Kirschner group had higher AOFAS ankle-hindfoot score [(91.3±4.4)points, (94.0±4.2)points, (94.7±4.5)points] compared with the open reduction+Kirschner group [(74.7±11.2)points, (77.9±12.0)points, (79.2±12.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher PROMIS-PF score [(69.5±3.7)points, (71.6±3.3)points, (72.5±3.2)points] compared with the open reduction+Kirschner group [(61.7±6.7)points, (62.9±6.8)points, (63.3±7.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher FAAM-ADL score [(89.8±3.8)points, (92.5±3.3)points, (93.2±3.4)points] compared with the open reduction+Kirschner group [(70.3±15.2)points, (72.1±15.2)points, (73.1±16.0)points] (all P<0.01); and the arthroscopy+ Kirschner group had higher FAAM-S score [(91.5±3.6)points, (94.4±3.6)points, (94.9±3.5)points] compared with the open reduction+Kirschner group [(76.9±15.0)points, (78.6±16.2)points, (79.0±16.0)points] (all P<0.01). Subtalar joint arthritis developed in 2 patients [8.3% (2/24)] in the arthroscopy+Kirschner group at the last follow-up, but in 6 [33.3% (6/18)] in the open reduction+Kirschner group ( P<0.05). No nerve injury was found in either group. Conclusion:For McCrory-Bladin type III FLPT, the Kirschner wire Double-pully technique under subtalar arthroscopy, despite longer surgical duration, results in better physical function, improved activities of daily living, enhanced ankle function, and a lower rate of subtalar joint arthritis compared with open reduction with Kirschner wire fixation.

Objective:To explore the status and influencing factors of incontinence-associated dermatitis among elderly inpatients in 52 hospitals nationwide, and to analyze the nursing of elderly inpatients with incontinence, so as to provide a reference for clinical intervention.Methods:On March 31, 2021, convenience sampling was used to select 14 675 elderly inpatients from 52 hospitals across the country as the research object. The self-designed Incontinence-associated Dermatitis Questionnaire for Elderly Inpatients was used to collect general demographic data, health status, incontinence, and skin nursing. Binomial Logistic regression was used to investigate the influencing factors of incontinence-associated dermatitis in elderly inpatients.Results:Among 14 675 elderly inpatients, the prevalence rates of xerosis cutis, incontinence and incontinence-associated dermatitis were 38.78% (5 691/14 675) , 11.06% (1 623/14 675) and 1.91% (280/14 675) , respectively. The prevalence of mild, moderate and severe incontinence-associated dermatitis were 1.27% (186/14 675) , 0.55% (81/14 675) , and 0.09% (13/14 675) , respectively. Among the nursing of 1 623 elderly inpatients with incontinence, the items with low implementation rate were the use neutral lotion to clean skin (14.17%, 230/1 623) , use of skin protectant after moisturizing (17.68%, 287/1 623) , moisturizing after cleansing the skin (28.90%, 469/1 623) . The results of binomial Logistic regression analysis showed that xeroderma, fecal incontinence, urinary and fecal incontinence, ≥2 kinds of combined medication, and hospital stay >30 days were risk factors for incontinence-associated dermatitis in elderly inpatients.Conclusions:The risk factors of incontinence-associated dermatitis in elderly inpatients mainly include xerosis cutis, type of incontinence, ≥2 kinds of combined medication, and hospital stay >30 days.

Methods:A retrospective case-series study was performed to analyzed the data of 38 patients (38 feet) with displaced intra-articular calcaneal fractures admitted to Xuzhou Central Hospital from January 2016 to May 2018. There were 21 males (21 feet) and 17 females (17 feet), with the age of (33.7±6.2)years (range, 21-53 years). According to the Sanders' classification, 7 patients were classified as type II, 27 as type III and 4 as type IV. All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure. The operation time, intro-operative management, incision healing, and post-operative complications (nerve, vessels and tendon injuries)were recorded. B?hler angle, Gissane angle, length, width and height of the calcaneus, and bone healing time were recorded at postoperative 2 days and at final follow-up. The visual analogue score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scale, and Foot and Ankle Outcome Score (FAOS) were recorded at final follow-up, and were used to evaluate the clinical and functional outcomes.Results:All patients were followed up for 12-42 months [(18.7±5.3)months]. The operation time ranged from 45 to 100 minutes [(72.4±22.6)minutes]. Bone grafting was not observed, and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients. The first-stage incision healing was achieved in all patients, without early complications of nerve, vessel and tendon injuries. The post-operative angles of B?hler and Gissane, length, width and height of the calcaneus were significantly improved compared to preoperative values ( P<0.01), while there were no significant difference at postoperative 2 days and at final follow-up ( P>0.05). At final follow-up, the VAS decreased from 5(3, 9)points to 0(0, 3)points, AOFAS improved from (68.3±10.5)points to (90.6±5.0)points, and FAOS improved from (66.9±9.1)points to (89.8±4.3)points, respectively ( P<0.01). According to the AOFAS ankle and hindfoot scale, the result was excellent in 27 patients, good in 8, and fair in 3, with the excellent and good rate of 92%. Conclusions:For displaced intra-articular calcaneal fractures, subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction, low postoperative complications and reliable functional outcomes.

Objective: To understand the change of smoking status among middle school students in Quzhou City from 2012 to 2017, and to provide a basis for school tobacco control. Methods: Through stratified cluster sampling method, Zhejiang youth health-related behavior questionnaire survey was conducted among 1 454 students in May 2012 and among 1 655 students in May 2017. Results: Among middle school students in Quzhou, attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate decreased from 31.36%, 17.81% and 8.73% in 2012 to 21.70%,12.45% and 6.22% in 2018 respectively, with statistically significant differences(χ2=37.30,17.52,7.12,P<0.01). Among the current-smoking students, the rate of smoking frequency≥20 d/month and heavy-smoking rate decreased from 30.71% and 7.09% in 2012 to 15.53% and 0.97% respectively. It showed that attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate of male students were higher than that of female students(χ2=117.50,63.99;47.14,51.26;110.18,22.50), and the non-ordinary high school students were higher than that of ordinary high school students and middle school students across two waves surveillance(χ2=47.14,51.26;70.34,43.77;62.67,22.50)(P<0.01). Conclusion School tobacco control have made a great progress，the tobacco use behavior of middle school students declines sharply in Quzhou.