ObjectiveTo introduce a fixation technique with the modified levonorgestrel-releasing intrauterine system （LNG-IUS） and evaluate its efficacy in the treatment of adenomyosis patients with previous LNG-IUS expulsion. MethodsA retrospective analysis was done on 22 adenomyosis patients who underwent modified LNG-IUS fixation due to LNG-IUS expulsion at three hospitals from June 2022 to June 2023. The baseline clinical characteristics， operative and postoperative details were collected and analyzed. The Visual analogu scale （VAS） scores and pictorial blood loss assessment chart （PBAC） scores were measured and compared before， 3 and 6 months after the LNG-IUS fixation. ResultsThe mean operative time was （19.51±7.41） min and intraoperative bleeding was （6.71±5.30） mL. Of the patients， 13 were operated under local anaesthesia and the other 9 under intravenous anaesthesia. There were 4 operations performed by a resident doctor， 15 by an attending doctor and 3 by a senior doctor. No intraoperative or postoperative complication was found. The mean follow-up was 11.51 months and no patient had a recurrence of LNG-IUS expulsion during the follow-up period. The mean level of hemoglobin at 1 month after operation was significantly higher than that before （P<0.001）. VAS scores and PBAC scores at 3 and 6 months postoperatively were all improved significantly than those preoperatively （P<0.001）. ConclusionsEffectively preventing the recurrence of LNG-IUS expulsion， modified LNG-IUS fixation is a safe and efficient method for adenomyosis patients with previous LNG-IUS expulsion. Modified LNG-IUS fixation deserves the clinical application due to its easy operation and wide range of use on women.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective In this study，we performed two sampie Mendelian Randomization to infer a causal association between Gastroesophageal reflux(GERD) and Atrial fibrillation(AF)，it can effectively avoid the problems such as reverse causation and confounds in traditional epidemiology. Methods We used the Summary data of GERD and AF from published Genome wide association study(GWAS) of European Individuals. Single Nucleotide Polymorphisms (SNPs) were extracted as Instrumental Variables (IVs).The main MR methods include Inverse Variance [] Weighted(IVW)，Weighted Median(WME)，MR-Egger，Simple Mode，and Weighted Mode.In addition，we used the sensitivity analysis such as MR-PRESSO，Cochran's Q test etc. Results The IVW shows a causal association between GERD and AF(P<0.0001，OR=1.16，95%CI:1.10-1.23).The WME shows P＜0.0001，OR=1.20，95%CI:1.11-1.30；Simple Mode shows P=0.01，OR=1.34，95%CI:1.07-1.69；Weighted Mode shows P=0.02，OR=1.33，95%CI:1.06-1.66. Conclusion This study based on genetic data supports the causal association between GERD and AF. The occurrence of GERD could increase the risk of AF.

Objective : To investigate the expression of N6-methyladenosine modification ( m6 A) and related en- zymes FTO，METTL3 and YTHDF2 in gastric epithelial cells infected with Helicobacter pylori (Hp) ，and to analyze its expression and clinical significance in gastric cancer by using online websites． Methods : Gastric epithelial cells GES-1 and AGS were infected with Hp GZ7 strain，and the multiplicity of infection was 30 ∶ 1．Total RNA and total protein were collected after infecting 24 h，and the m6 A modification level of total RNA was detected by RNA dot hybridization．The mRNA and protein expressions of FTO ，METTL3 and YTHDF2 were detected by q-PCR and Western blot．The expression difference of FTO，METTL3 and YTHDF2 in gastric cancer tissues and normal tissues and their expression in Stage classification were analyzed by GEPIA，and the relationship between the expression of FTO，METTL3 and YTHDF2 and prognosis was analyzed by Kaplan-Meier Plotter. Results : Compared with the un- infected group，the m6 A modification level of total RNA in both Hp-infected GES-1 and AGS cells significantly de- creased，the mRNA and protein expression levels of FTO increased，and the mRNA and protein levels of METTL3 and YTHDF2 decreased，with statistical significance (P＜0. 05) ．The expression level of FTO in gastric cancer tis- sues was higher than that in normal tissues，with statistical significance (P＜0. 05) ，YTHDF2 was higher than that in normal tissues，with no statistical significance，and the expression level of METTL3 was lower than that in nor- mal tissues，with no statistical significance．Patients with high expression of FTO and METTL3 had a lower survival rate，while patients with high expression of YTHDF2 had a higher survival rate．The expression of FTO was signifi- cantly correlated with Stage classification (P＜0. 05) ，while the expression of METTL3 and YTHDF2 was not sig- nificantly correlated with Stage classification． Conclusion Hp infection can change the level of m6 A and the ex- pression of related enzymes FTO，YTHDF2 and METTL3，suggesting that m6 A methylation may play a role in the occurrence and development of Hp-induced gastric cancer.

Objective:To investigate the status of self-perceived burden (SPB) in renal transplant recipients and analyze its related influencing factors.Methods:From June to November 2021, the convenient sampling was used to select 203 recipients of kidney transplantation donated by citizens after death in University Town Hospital of Guangdong Provincial Hospital of Chinese Medicine. The general condition questionnaire, self-perceived burden, social support and self-efficacy questionnaire were used for measurement. Univariate analysis and multiple linear stepwise regression were used to analyze the influencing factors of SPB.Results:The SPB score of 203 renal transplant recipients was 20.00 (14.00, 28.00) and 53.2% (108/203) of renal transplant recipients had varying degrees of SPB. Univariate analysis showed that there were significant differences in SPB scores among renal transplant recipients with different ages, marital status, occupational status and family monthly income ( P<0.01) , SPB were negatively correlated with social support and self-efficacy ( P<0.01) . Multiple linear stepwise regression analysis showed that age, family monthly income and self-efficacy had negative predictive effects on SPB ( P<0.01) , which could explain 27.1% of the variation of SPB in renal transplant recipients ( F=26.043, P<0.01) . Conclusions:More than half of renal transplant recipients have different degrees of SPB. The level of SPB is higher in young recipients, low-income recipients and low self-efficacy recipients. Nursing staff should adopt specific strategies to improve the level of SPB in renal transplant recipients.

Objective:To investigate the change of microalbuminuria (MA) in patients with RA and its clinical significance.Methods:From January 2018 to December 2019, data of 75 cases of RA patients were collected from outpatient and inpatient wardsof our hospital, and the data of 75 cases of physical examination wascollected as control. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) anti-cyclic citrullinated peptide (CCP) antibody, blood lipid, Homeostasis model assessment for insulin resistance (HOMA-IR), rheumatoid factor (RF), anti-CCP antibodyand MA levels were measured respectively. RA patients were obtained by ultrasound Carotid intima-media thickness (cIMT) and brachial artery flow mediated diastolic function (FMD) were measured. The statistical analysis was carried out with independent t-test, analysis of variance, Pearson correlation analysis and multiple stepwise regression. Results:The MA level of RA patients was significantly higher than that of the healthy control group [(31±5) mg/L vs (25±4) mg/L, t=5.982, P<0.05]. In RA patients, MA level was positively correlated with course of disease ( r=0.327, P=0.015), HOMA-IR ( r=0.576, P<0.01], CRP ( r=0.212, P=0.027), RF ( r=0.585, P<0.01), disease activity score in 28 joints (DAS28) ( r=0.472, P=0.013), cIMT ( r=0.611, P<0.01) and duration of nonsteroidal anti-inflammatory drugs (NSAIDs) use ( r=0.274, P<0.01), and urineMA level( OR=1.763, P<0.01) were independent correlation factors affecting cIMT. Conclusion:The level of MA in RA patients is significantly higher than that in normal controls, and is correlated with disease activity and subclinical atherosclerosis, which could be another important predictor of disease follow-up and early screening of subclinical atherosclerosis in RA patients.

Objective To explore the therapeutic effect of different doses of botulinum toxin A injections on bromhidrosis.Methods A total of 200 cases were divided into mild-to-moderate group (N=100) and severe group (N=100) based on the grade of bromhidrosis,and each group was further divided into two groups:low dose group (50 cases) were treated by botulinum toxin A injections (100 U) and high dose group (50 cases) were treated with 200 U for bilateral axillary.The total effective rate and recurrence rate in both groups were compared.Results In the mild to moderate group,after treatment for 3 months,the total effective rate of both groups had no statistical difference (P＞ 0.05),and the same with recurrence rate in 6 months follow-up (P＞0.05).In the severe group,after treatment for 3 months,the total effective rate of the high dose group (82％) was significantly higher than that of the low dose group (64％),with statistical significance (x2 =4.110,P＜0.05).After 6 months follow-up,recurrence rate in the high dose group (22％) was significantly lower than that of the low dose group (46％),with statistical significance (x2 =6.417,P ＜ 0.05).Conclusions A suitable dose of botulinum toxin A can be selected based on the severity of bromhidrosis,which is a individualized therapy for cost savings and might have potential benefits for patients with osmidrosis.

OBJECTIVE:To investigate improvement effect of external administration of water extract from Eriocarpous Glochidion on chronic dermatitis-eczema model mice, and to provide reference for developing new dermatological drug. METHODS:A total of 60 mice were randomly divided into blank group (distilled water), model group (distilled water), compound triamcinolone acetonide acetate group (positive control group, original liquid) , high-concentration, medium-concentration and low-concentration groups of water extract from Eriocarpous Glochidion(2.0,1.0,0.5 g/mL,calculated by crude drug),10 mice in each group. Except for blank group,other groups were given 2,4-dinitrochlorobenzene to induce chronic dermatitis-eczema model. Since the third day of the experiment,two sides of right ears of the mice were given relevant medicine twice at 7:00 and 15:00,15 μL each time,for consecutive 12 d. In the tenth,thirteenth,sixteenth day of the experiment,the difference of thickness of right ears of the mice was calculated(the difference value before experiment),the times of scratching in ear of mice were recorded within 30 min. In sixteenth day of the experiment,ear swelling degree of mice was determined,and thymus index and spleen index in mice were calculated. Optical microscope was used to observe the pathological changes of ear tissues of mice. RESULTS:Compared with blank group,the difference of thickness of right ears,ear swelling degree,spleen index and scratching times were increased significantly in model group(P<0.05 or P<0.01). The epidermis of the ear tissue was thickened,the cell proliferation was obvious,and cavernous edema was found in the epidermis. Compared with model group,other indexes in were decreased significantly,except that the difference value of thickness of right ears in sixteenth day of the experiment,scratching times in ninth and fifteenth day of the experiment were decreased slightly in low-concentration group of water extract from Eriocarpous Glochidion and the thymus index and spleen index in medium-concentration, low-concentration groups of water extract from Eriocarpous Glochidion (P<0.05 or P<0.01). The pathological changes of ear tissue were improved in administration groups to certain extent. CONCLUSIONS:External administration of water extract of Eriocarpous Glochidion has good improvement effect against chronic dermatitis-eczema in mice, which is worthy of further development and investigation.