ObjectiveTo investigate the effects of probiotics combined with bismuth quadruple therapy （BQT） on clinical efficacy、gastrointestinal adverse reactions and intestinal flora in Helicobacter pylori （HP） positive patients. MethodsThe patients who were positive for HP from May 2023 to July 2023 in the department of gastroenterology of Shanghai first people's hospital were randomly divided into2 groups with 40 people in each group. The probiotic group was given 2 weeks of quadruple therapy with probiotics and standard BQT， followed by 4 weeks of oral probiotics after quadruple discontinuation. The placebo group was given 2 weeks of probiotic placebo and standard BQT， followed by 4 weeks of oral probiotic placebo. ¹³C urea breath test was used to evaluate the clinical efficacy， gastrointestinal symptoms rating Scale was used to evaluate the gastrointestinal adverse reactions of patients before and after the intervention， and microbial diversity 16S rDNA sequencing technology was used to detect the level of intestinal flora of patients before and after the intervention. ResultsThere was no significant difference in the eradication rate between the two groups （P>0.05）. Before the intervention， there was no significant difference in the scores of the gastrointestinal symptom rating scale between the probiotic group and the placebo group. After the intervention， patients in the probiotic group had significantly lower pain scores on acid reflux （1.10±0.30 vs 1.35±0.53， P<0.05） and stomach or abdominal hunger than in the placebo group （1.07±0.26 vs 1.30±0.52， P<0.05）. Through the before-and-after comparison of the probiotic group， the scores of abdominal pain （1.24±0.44 vs 1.58±0.71， P<0.05）， stomach or abdominal hunger （1.07±0.26 vs 1.27±0.45， P<0.05） and dry and hard stool （1.24±0.49 vs 1.48±0.75，P<0.05） were significantly lower in the probiotic group than before the intervention in the probiotic group. ConclusionProbiotics combined with BQT can improve the gastrointestinal adverse reactions and intestinal flora disorders in the process of quadruple drug therapy， but it does not improve the eradication rate of HP.

Epimedin B(EB)is one of the main flavonoid ingredients present in Epimedium brevicornum Maxim.,a traditional herb widely used in China.Our previous study showed that EB was a stronger inducer of melanogenesis and an activator of tyrosinase(TYR).However,the role of EB in melanogenesis and the mechanism underlying the regulation remain unclear.Herein,as an extension to our previous investi-gation,we provide comprehensive evidence of EB-induced pigmentation in vivo and in vitro and eluci-date the melanogenesis mechanism by assessing its effects on the TYR family of proteins(TYRs)in terms of expression,activity,and stability.The results showed that EB increased TYRs expression through microphthalmia-associated transcription factor-mediated p-Akt(referred to as protein kinase B(PKB))/glycogen synthase kinase 3β(GSK3β)/β-catenin,p-p70 S6 kinase cascades,and protein 38(p38)/mitogen-activated protein(MAP)kinase(MAPK)and extracellular regulated protein kinases(ERK)/MAPK pathways,after which EB increased the number of melanosomes and promoted their maturation for melanogenesis in melanoma cells and human primary melanocytes/skin tissues.Furthermore,EB exerted repigmentation by stimulating TYR activity in hydroquinone-and N-phenylthiourea-induced TYR inhibitive models,including melanoma cells,zebrafish,and mice.Finally,EB ameliorated monobenzone-induced depigmentation in vitro and in vivo through the enhancement of TYRs stability by inhibiting TYR misfolding,TYR-related protein 1 formation,and retention in the endoplasmic reticulum and then by downregulating the ubiquitination and proteolysis processes.These data conclude that EB can target TYRs and alter their expression,activity,and stability,thus stimulating their pigmentation function,which might provide a novel rational strategy for hypopigmentation treatment in the pharmaceutical and cosmetic industries.

Objective: To explore the treatment options for congenitally missing teeth in patients with ectodermal dysplasia and provide a clinical reference. Methods: A patient with ectodermal dysplasia with a concave midface, anterior protrusion of the chin, and underdevelopment of the lower third of the face presented with congenital loss of multiple maxillary teeth, malocclusion of the remaining teeth, congenital loss of mandibular dentition, small dental arches, and upper and lower alveolar bone hypoplasia. The patient was treated by means of a removable partial maxillary prosthesis, implants in the anterior region of the lower mandible designed with the assistance of digital guides, and bar-clamped implant-overlay prostheses. A literature review of the protocol for the treatment of this condition was also conducted. Results: In addition to good retention and stability after denture wear, an excellent occlusal relationship, improvement of the patient's facial appearance, including upper and lower lip fullness, more equal balancing of the lower and middle 1/3 of the face, and improved masticatory function were achieved. The results of the literature review showed that patients with ectodermal dysplasia who are congenitally edentulous usually have a complex intraoral situation that makes restoration difficult, and common restorative modalities for these patients include fixed bridges, removable partial dentures, complete dentures, overdentures, and implant prostheses, which need to be selected according to the actual intraoral situation of each patient. Currently, there is no consensus on the treatment of congenitally missing teeth in patients with ectodermal dysplasia, and some scholars have suggested that fixed restorations be recommended for patients with fewer missing teeth, while the option of removable or implant-covered denture restorations should be given to patients with more missing teeth, with removeable prostheses for underage patients that are replaced with permanent fixed prostheses when the jaws have stabilized. Conclusion In patients with ectodermal dysplasia with congenital tooth loss, all factors should be taken into account, and an individualized restorative plan should be developed.

Major depressive disorder(MDD)is a common mental illness.Currently,nearly 16%of the global population is affected by depression-related symptoms,while the diagnosis and treatment rate of MDD patients in China is only 9.5%.MDD is characterised by high morbidity and low recovery rate,and how to effectively improve its therapeutic effect has been a hot research topic in recent years.Antidepressants,as the main treatment for MDD,have the disadvantages of many adverse effects and slow onset of action,prompting people to pay attention to the non-pharmacological treatments of MDD.Dietary intervention is a kind of non-pharmacological treatment by changing dietary structures and rhythms;the current application of dietary intervention to psychiatry is very extensive,and it has been proved to be effective in the treatment of depression.Recent research suggests that dietary interventions can treat and ameliorate depressive symptoms by influencing brain-gut axis-related eating mechanisms.This article reviews the multidimensional exploration of dietary interventions in the treatment of depression:dietary structure interventions,dietary rhythm interventions,and the role of intestinal flora.It details the modalities of dietary interventions and the related mechanisms involved,and provides reference for dietary interventions in the treatment of depression-related symptoms.

Objective:To observe the relationship between the distribution of chromosome 9p21 region rs10757274,rs7044859,rs4977574 and rs496892 gene polymorphisms and susceptibility to cerebral infarction in Uyghur patients with acute non-cardiogenic cerebral infarction(ANCCI)in Xinjiang.Methods:A total of 178 Uyghur ANCCI pa-tients who admitted to Second People's Hospital of Kashgar Prefecture of Xinjiang Uygur Autonomous Region from Jan 2012 to Dec 2015 were selected,including 117 cases with and 61 cases without carotid plaque.Gene polymor-phism analysis and comparison of rs10757274,rs7044859,rs4977574,rs496892 loci in chromosome 9p21 region of two groups was performed by applying polymerase chain reaction-high temperature ligase detection reaction(PCR-LDR)technique.Results:Compared with no carotid plaque group,there was significant rise in G allele frequen-cy of rs4977574(44.3％vs.53.0％),and significant reduction in AA genotype frequency of rs4977574(37.7％vs.20.5％)in carotid plaque group(P＜0.05 both).The risk of carotid plaque in patients carrying GG genotype and AG genotype of rs4977574 was 2.476 and 2.285 times of that of those with AA genotype.Compared with non-GG genotype group,there were significant rise in proportions of diabetes(16.3％vs.30.2％),small vessel disease(42.2％vs.60.5％)and systolic blood pressure[(135.91±20.89)mmHg vs.(143.57±20.34)mmHg]in GG genotype group(P＜0.05 all).Conclusion:The rs4977574 gene polymorphism in chromosome 9p21 is associated with susceptibility to developing carotid plaque in Uyghur patients with acute non-cardiogenic cerebral infarction,and GG-pure mutations at this locus may predict an increased risk of small vessel disease.

Objective:To gain a deep understanding of the disease experience of children with transition nephrotic syndrome, so as to provide a reference for developing targeted nursing measures and improving coping abilities in clinical practice.Methods:This study was a phenomenological study. From May to June 2023, a semi-structured interview was conducted using purposive sampling method to select children with transition nephrotic syndrome ( n=13) who received outpatient or inpatient treatment at Children's Hospital of Soochow University. Colaizzi 7-step method was used to analyze interview data and extract themes. Results:The disease experience of children with transition nephrotic syndrome were summarized into five themes, including inadequate disease self-management ability (lack of disease cognition and management knowledge, weak self-management awareness), excessive disease-related burden (significant academic impact, frequent adverse drug reactions, and heavy self-perceived burden), increased fear of negative evaluation, tense parent-child relationships, and growth and gain (feeling the care of others and achieving self-growth) .Conclusions:Children with transition nephrotic syndrome experience various challenges brought by growth, development, and disease, with heavy disease burden and psychological pressure. Medical and nursing staff should closely monitor children's emotional and psychological changes, value their disease experience, provide targeted psychological counseling and support in a timely manner, and reduce their adverse disease experience.

Bipolar disorder with mixed features is currently a prevalent clinical phenomenon,with patients exhibiting a heightened risk of suicidal behaviour,suboptimal therapeutic outcomes,poor prognostic indicators and frequently accompanied by significant impairment in psychosocial functioning.The current body of research on the pathological mechanisms of bipolar disorder with mixed features has proposed several mechanisms including neurotransmitter imbalance leading to abnormal emotion regulation,hypothalamic-pituitary-adrenal(HPA)dysfunction triggering an excessive stress response,circadian rhythm disorder affecting the sleep pattern,abnormal functional connectivity of the cerebral cortex and limbic system,independent and multidirectional changes in four dimensions,such as behaviour,cognition,mood,and sleep.Further studies are required to integrate the results of neurobiology,imaging,genetics and other multidisciplinary fields in order to provide more precise targets for the diagnosis and treatment of bipolar disorder with mixed features.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients’ factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men’s Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: “low libido”, “erectile dysfunction”, “ejaculatory dysfunction”, “premature ejaculation”, “retrograde ejaculation”, “delayed ejaculation”, “anejaculation”, and “orgasmic dysfunction” between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socioeconomic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient’s individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.