OBJECTIVE To investigate the efficacy and safety of metformin in the treatment of diabetes mellitus type 2 （T2DM） complicated with sarcopenia in elderly patients. METHODS From January 2022 to January 2024， clinical data from eligible patients with T2DM complicated with sarcopenia treated at the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College were collected. Patients were randomly assigned into control group （70 cases） and observation group （70 cases） using a random number table. Both groups received routine interventions； control group additionally received subcutaneous injections of Insulin glargine injection before bedtime and Human insulin injection 30 minutes before breakfast， lunch and dinner every day. In addition to the same treatments as the control group， the observation group was administered 0.5 g of Metformin hydrochloride sustained-release tablets orally once daily. Both groups were treated continuously for 24 weeks. Comparisons were made between the two groups in terms of glucose metabolism indexes [fasting blood glucose （FBG）， 2 h postprandial blood glucose （2 hBG）， and glycosylated hemoglobin （HbA1c）]， homeostasis model assessment of insulin resistance （HOMA-IR）， appendicular skeletal mass muscle index （ASMI）， grip strength， walking speed， lipid metabolism indexes [serum total triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C）]， serological markers [high-sensitivity C reactive protein （hs-CRP）， interleukin-6 （IL-6）， and ferritin levels] and quality of life. The occurrence of ADR was recorded in both groups. RESULTS 65 patients in the control group and 63 patients in the observation group completed this study， respectively. After treatment， the levels of FBG， 2 hBG， HbA1c， HOMA-IR，TG and TC in both groups， and the levels of hs-CRP， IL-6 and ferritin in observation group were all significantly reduced compared to those before treatment （P＜0.05）， and the HOMA-IR in observation group was significantly lower than control group （P＜0.05）； additionally， the grip strength， walking speed， and scores for daily living and activity abilities of observation group were increased than those before treatment and the control group （P＜0.05）. The incidence of adverse drug reactions in both groups was 2.86%. CONCLUSIONS Metformin can reduce inflammatory factors and ferritin levels， promote the recovery of muscle mass and strength， improve insulin resistance， and quality of life in elderly patients with T2DM complicated with sarcopenia， and does not increase the occurrence of adverse drug reactions.

OBJECTIVES: The risk factors and role of mother‒child gut microbiota in pediatric inflammatory bowel disease (PIBD) remain unclear. We aimed to explore the clinical risk factors associated with PIBD, analyze the characteristics of gut microbiota of children and their mothers, and examine the correlation of the microbial composition in mother‒child pairs. METHODS: We conducted a case-control study including children with PIBD and their mothers as the case group, as well as healthy children and their mothers as the control group. Questionnaires were used to collect information such as family illness history and maternal and early-life events. Fecal samples were collected from the children and mothers for microbiota 16S ribosomal RNA (rRNA) sequencing to analyze the composition and its potential association with PIBD. RESULTS: A total of 54 pairs of cases and 122 pairs of controls were recruited. A family history of autoimmune disease and antibiotic use during pregnancy were associated with an increased risk of PIBD, and a higher education level of the father was associated with a decreased risk of PIBD. Children with PIBD and mothers exhibited different gut microbiota compared to healthy children and mothers. Similarities were observed in the gut microbiota of mothers and children in the same groups. Some bacterial biomarkers of mothers discovered in this study had the power to predict PIBD in their offspring. CONCLUSIONS PIBD is influenced by maternal risk factors and has unique gut microbiota characteristics. The mother‒child gut microbiota is closely related, suggesting the transmission and influence of the gut microbiota between mothers and children. This study highlights the potential pathogenesis of PIBD and provides a basis for developing targeted interventions.
Humans ; Gastrointestinal Microbiome ; Female ; Risk Factors ; Case-Control Studies ; Male ; Child ; Inflammatory Bowel Diseases/etiology* ; Adult ; RNA, Ribosomal, 16S/genetics* ; Feces/microbiology* ; Mothers ; Pregnancy ; Child, Preschool

Objective This study aimed to investigate the differential effects of sevoflurane and propofol on perioperative HIF-1α levels and postoperative recovery in patients undergoing bariatric surgery.Methods A total of 40 obese patients(BMI≥44 kg/m2)were randomly allocated into two groups:sevoflurane(n=21)group and propofol(n=19)group.The quantitative measurement of HIF-1α levels in human serum at different time points was conducted using ELISA.The assessment of redness,swelling,pain,exudation,and prognosis-related indicators of the patient's umbilical incision was performed at 24 and 48 hours after surgery.Results On the day following surgery,there was a significant increase in HIF-1α levels in the sevoflurane group and a significant decrease in the propofol group.The frequency and type of opioid analgesics used in the sevoflurane group were signifi-cantly lower than those used in the propofol group after surgery.Conclusions Compared with propofol,sevoflurane is more suitable for maintaining anesthesia in obese patients undergoing bariatric surgery.Sevoflurane can promote enhanced recovery after surgery by reducing postoperative analgesic consumption and upregulating HIF-1α levels.

Objective:To explore the relationship among suicide risk,distress tolerance,and resilience in pa-tients with depression.Methods:A total of 130 patients with depression who met the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)diagnostic criteria were included.The Chinese version of the Mini International Neuropsychiatric Interview(MINI)suicide module was used to assess suicide risk.According to the interview results,the patients with depression were divided into suicide risk group(98 cases)and non-suicide risk group(32 cases).The Hamilton Depression Rating Scale(HAMD),Distress Tolerance Scale(DTS),10-item Connor-Davidson Resilience Scale(CD-RISC-10)were used to assess severity of depressive symptoms,level of distress tolerance and resilience,respectively.Results:The DTS total scores were positively correlated with the CD-RISC-10 total scores(r=0.50,P＜0.01).The total scores of MINI suicide module were negatively correlated with the total scores of DTS and CD-RISC-10(r=-0.34,-0.34,Ps＜0.01).Distress tolerance had a direct effect on suicide risk(β=-0.26,P＜0.05),and resilience played a mediating effect on the relationship between distress tolerance and suicide risk(β=-0.13,P＜0.05),and the mediating effect accounted for 33.5％of the total effect.Conclusion:Patients with depression with lower levels of distress tolerance may have higher suicide risk,and resilience may play a partially mediating role in the relationship between distress tolerance and suicide risk.

Hydroxychloroquine retinopathy is an ocular lesions that develops following long-term or excessive use of hydroxychloroquine. The early clinical presentation of this lesion is nonspecific and is often detected when severe central vision impairment occurs in late stage. It currently mainly includes hydroxychloroquine binding to melanin, inducing degeneration of the retinal pigment epithelium, increasing the pH of lysosomes in the retinal pigment epithelium and interfering with the visual cycle. In recent years, with the development of retinal imaging technology and the in-depth study of hydroxychloroquine retinopathy, characteristic fundus structural changes such as retinal and choroidal thickness and blood vessels may occur in the early stage. This not only provides an important basis for the early diagnosis of hydroxychloroquine retinopathy, but also provides important clues for investigating its pathogenesis. Clinicians' proficiency in relevant fundus changes and pathogenesis will facilitate early diagnosis and treatment, while also minimizing irreversible central vision impairment in patients.

Purpose To explore the application value of computed tomography enterography(CTE)in differentiating active staging of pediatric Crohn disease.Materials and Methods The clinical data of 83 pediatric Crohn disease children performed by CTE examination and conducted with pediatric Crohn disease activity index(PCDAI)from January 2019 to October 2022 were selected.According to their different PCDAI scores,the patients were divided into four groups,which were remission stage(11 cases),mild activity period(47 cases),moderate activity period(14 cases)and severe activity period(11 cases),and the parameters of CTE were analyzed.Then the results associated with CTE and the stages of pediatric Crohn disease activity were analyzed.Results The CTE images of different clinical PCDAI activity stages were manifested in the scope of the diseased intestine(χ2=49.934),the enhancement mode of diseased intestinal wall(χ2=56.561),the degree of intestinal cavity stenosis(χ2=31.932),the degree of intestinal wall thickened(χ2=46.535),lymph node enlargement(χ2=17.330);in which there was a significantly difference(P<0.05),respectively.With the aggravation of PCDAI activity stages,the extent of diseased intestinal canal(more than 50 mm,31 cases,37.3%),the layered reinforcement of diseased intestinal wall(27 cases,32.5%),the luminal stenosis(less than 5 mm,19 cases,22.9%),the thickening of intestinal wall(more than 5.0 mm,54 cases,65.1%)were more common.The proportion of occurrence in the enlargement of lymph nodes(more than 7 mm,16 cases,19.3%)was high,with significant statistical significance(P<0.05).Spearman correlation analysis showed that there was a significant positive correlation between pediatric Crohn disease clinical activity stage(all P<0.01)and the extent of the lesion intestinal canal(r=0.500),the enhancement mode of the lesion intestinal wall(r=0.574),the luminal stenosis(r=0.316),the thickening of intestinal wall(r=0.533).Conclusion With the extent of diseased intestinal canal,the degree of the luminal stenosis,the enhancement mode of diseased intestinal wall and intestinal wall thickened increase,and the clinical stage gradually increase.The above four parameters use as characteristic indicators to reflect the activity stage of pediatric Crohn disease.

Objective:To explore the effect of ointment massage on the postoperative recovery of newborns who had intestinal tract operation, aim to construct an effective post-operative ointment and massage scheme and to enrich the content of enhanced recovery after surgery in the field of newborns.Methods:Delphi expert inquiry method was used to construct the ointment message scheme. A total of 64 newborns undergone intestinal surgery from May 2022 to May 2023 in Guangdong Women and Children Hospital were selected as study subjects and divided into routine group (34 cases) and ointment group (30 cases) by random number table method. In addition to routine treatment and nursing, the newborns in the ointment group also received ointment massage. The postoperative gastrointestinal drainage volume, fasting days, the first feeding time, hospital stay and the number of cases of vomiting and abdominal distension between the two groups were compared.Results:A total of 16 experts with (38.93 ± 5.13) years old were inquired, 6 males and 10 females. The effective questionnaire response rates for the two rounds of expert inquiry were 16/16 and 15/16, the expert authority coefficients were both≥0.80, the Kendall′s W coefficients were 0.117 and 0.107, with statistically significant differences (both P<0.05). A ointment message scheme consisting of 8 acupoints and 7 kinds of traditional Chinese medicines was determined. In the routine group, there were 19 males and 15 females with (268.47 ± 11.27) gestational age. In the ointment group, there were 20 males and 10 femles with (271.93 ± 10.36) gestational age. The postoperative gastrointestinal drainage volume, fasting days, the first feeding time and the hospital stay in the ointment group were 74.0 ml, 6.0 d, 158.5 h and 13.0 d, which had significant differences with the 184.5 ml, 7.5 d, 192.0 h, 16.5 d in the routine group ( Z values were 2.07-2.45, all P<0.05). The incidence of vomiting and abdominal distension in the ointment group were both 8 cases, which were lower than the 19 and 18 cases in the routine group with a statistically significant difference ( χ2 = 5.58, 4.56, both P<0.05). Conclusions:The ointment massage in this study has a positive impact on the recovery of newborn infants after intestinal surgery, with high safety, in line with enhanced recovery after surgery concept, and is worthy of promotion.

Interleukin-10（IL-10）is an important anti-inflammatory cytokine in human body，which is mainly secreted by macrophages，Th1 cells and Treg cells.It can inhibit pro-inflammatory mediators，promote anti-inflammatory mediators，inhibit antigen presentation，inhibit immune cell development and promote repair by binding to IL-10 receptors.In recent years，the incidence of IL-10 receptor mutation-related inflammatory bowel disease（IBD）gradually have increased.It shows a younger trend，and the clinical manifestations are not typical，the effect of traditional treatment is not good，which affect the diagnosis and treatment of the disease，as well as the prognosis.This article describes the IL-10 axis and its immune function in IBD，the epidemiology，clinical characteristics and treatment of inflammatory bowel disease related to IL-10 receptor mutation.

Inflammatory bowel disease is a common and refractory chronic disease in digestive system diseases，and its prevalence is increasing year by year.Delayed diagnosis is prevalent in patients with inflammatory bowel disease，affecting the course and outcome of the patient's illness.Early identification and early diagnosis can significantly improve the prognosis of patients with inflammatory bowel disease.Because of the traumatic nature of endoscopic testing，it is important to find reliable non-invasive test markers.This paper aims to introduce the recent progress of blood biomarkers with early diagnostic value in pediatrics，and summarize several novel markers for distinguishing inflammatory bowel disease from non-inflammatory bowel disease，ulcerative colitis and Crohn's disease，as well as discussing the differences of inflammatory bowel disease between children and adults，and providing suggestions for future research to help clinicians identify inflammatory bowel disease accurately as soon as possible and improve patient prognosis.