BACKGROUND:The regulation of intestinal flora by exercise is closely related to human health,but intestinal flora involves many factors.Existing studies have lacked consistent evidence on the effect of exercise on the intestinal flora of college students. OBJECTIVE:To explore the effects of exercise on intestinal flora diversity and species composition of college students. METHODS:Through systematic search of PubMed,Web of Science,Embase,Medline,Cochrane Library,CNKI,WanFang Database and VIP database,eight empirical studies were selected and included,and semi-quantitative analysis was performed on them. RESULTS AND CONCLUSION:In terms of the species diversity of the intestinal flora,both high-intensity interval training and Tai Chi exercise significantly enhance the species diversity of intestinal flora in college students,while aerobic exercise does not have a significant effect on the enhancement of intestinal flora diversity in college students.In terms of the species composition of the intestinal flora,all three exercise modalities significantly alter the compositional structure of the intestinal flora in college students,which can increase the abundance of beneficial bacteria such as Ruminalococcus,Faecalis prevotelli,Blautia,and decrease the abundance of harmful bacteria such as Escherichia spp.Compared with high-intensity interval training,aerobic and Tai Chi exercise causes more elevated abundance of beneficial bacteria.In addition to changes in intestinal flora characteristics,exercise improves body composition,cardiorespiratory function,and executive function in college students,and these health benefits are closely linked to exercise-induced changes in intestinal flora that can produce health benefits for the body through metabolic regulation,barrier function,and neuromodulation.Although studies have confirmed the association between exercise and intestinal flora,the mechanism by which exercise affects intestinal flora has not yet been clarified,and at the same time,localizing the flora related to the host health is the key to targeting intestinal flora as a therapeutic target in the future,all of which are worthy of further attention and investigation.

Objective To explore the relationship between the degree of compression and shape grading of the cerebral cistern ambiens in hypertensive cerebral hemorrhage(HCH)patients after neural endoscopic intracranial hematoma evacuation(NEIHE)and prognosis.Methods 246 HCH patients who underwent NEIHE surgery from January 2020 to June 2023 were selected as the research subjects.According to the postoperative 6 month Glasgow outcome score(GOS),the patients were divided into good prognosis group(n=158)and poor prognosis group(n=88).Hierarchical regression model was used to analyze the relationship between clinical pathological features and the degree of compression and shape grading of the cerebral cistern ambiens.Multivariate logistic regression model was used to analyze the independent risk factors affecting the poor prognosis of patients with HCH after NEIHE,and a prediction model was constructed.Receiver operating characteristic curve(ROC curve)was drawn with poor prognosis as the outcome variable.Area under the curve(AUC),integrated discrimination improvement(IDI)and net reclassification improvement(NRI)of different prediction models were compared.Hosmer-Lemeshow was used to test the goodness of fit.Generalized additive model(GAM)was used to analyze the relationship between GOS and related factors.Results Compared with the good prognosis group,the poor prognosis group had more preoperative blood loss,lower preoperative Glasgow coma score(GCS),and higher proportion of patients with midline deviation,hypertension history ≥10 years,hemorrhage breaking into the brain ventricle,and operation time in the late stage,the differences were statistically significant(P＜0.05).Compared with the good prognosis group,the proportions of patients with ipsilateral and contralateral cerebral cistern ambiens compression of 3 to 4 points and the morphological classification of cerebral cistern ambiens of grade V in the poor prognosis group were higher,and the differences were statistically significant(P＜0.05).The location of bleeding,midline deviation,and intracranial pressure all had an impact on the degree of compression and morphological grading of the cerebral cistern ambiens,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis(model 2:including the degree of compression and shape grading of the cerebral cistern ambiens)showed that midline deviation,history of hypertension ≥10 years,preoperative bleeding volume＞37 mL,bleeding into the brain ventricles,preoperative GCS＜7 points,late surgical timing,degree of compression of the cerebral cistern ambiens(3 to 4 points on the same side of hematoma,3 to 4 points on the opposite side of hematoma),and grade V morphology were all risk factors influencing the poor prognosis of patients with HCH after NEIHE(P＜0.05).After incorporating the degree of compression and morphological grading of the cerebral cistern ambiens into model 1(excluding the degree of compression and shape grading of the cerebral cistern ambiens),the AUC increased to 0.812(95％CI:0.763～0.872),and both the IDI(0.081,95％CI:0.049～0.095)and NRI(0.611,95％CI:0.510～0.674)of the model improved,with statistically significant differences(P＜0.05).Compared with model 1,model 2 showed an increase in AUC(0.826,95％CI:0.771～0.863),IDI(0.085,95％CI:0.052～0.110),and NRI(0.628,95％CI:0.510～0.709),with statistically significant differences(P＜0.05).The Hosmer-Lemeshow test showed that model 2(P=0.878)had a better fit for predicting poor prognosis than model 1(P=0.691).GAM analysis showed that the higher the degree of compression and morphological grading of the cerebral cistern ambiens,the lower the GOS,and the difference was statistically significant(P＜0.05).ROC curve analysis showed that the combined application of degree of compression and morphological grading of the cerebral cistern ambiens had a high predictive value for poor prognosis,with AUC of 0.935(95％CI:0.890～0.971),sensitivity of 70.26％,and specificity of 93.84％.Conclusion The degree of compression and shape changes of the cerebral cistern ambiens in HCH patients after NEIHE are closely related to prognosis,and the combined application has certain predictive value for poor prognosis.The location of bleeding,midline deviation,intracranial pressure,and other factors significantly affect the compression degree and shape change of the cerebral cistern ambiens.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Background and Aims:Infected necrotizing pancreatitis(INP),particularly with diffuse distribution,is a life-threatening condition.The optimal initial intervention-minimally invasive step-up therapy vs.direct open necrosectomy-remains controversial.Moreover,the impact of necrosis morphology("wet"or"dry")and the presence of severe acute pancreatitis(SAP)on treatment selection has not been fully clarified.This study aimed to compare the efficacy and safety of these two approaches in diffuse INP and to evaluate the guiding value of CT-based necrosis type and SAP status in clinical decision-making.Methods:A retrospective analysis was conducted on 458 patients with diffuse INP admitted to the Third Xiangya Hospital of Central South University from January 2012 to March 2023.Patients were divided into a minimally invasive step-up group(n=256)and a direct open surgery group(n=202).SAP was defined according to the determinant-based classification,and necrosis was categorized as"wet"or"dry"based on CT features.The primary endpoint was a composite of death or major complications,while secondary endpoints included mortality,length of hospital stay,and incision-related complications,were compared between the two groups,with subgroup analyses performed accordingly.Results:Overall,the open surgery group had higher rates of the primary endpoint(62.4%vs.48.1%,P=0.003)and mortality(27.2%vs.16.8%,P=0.008)compared with the step-up group.Among SAP patients,the step-up approach resulted in a significantly lower primary endpoint rate(66.7%vs.97.7%,P=0.003).In non-SAP patients,the primary endpoint rates were similar,but open surgery was associated with a shorter hospital stay[(36.5±10.4)d vs.(45.6±18.6)d,P<0.001]and higher incidences of wound infection and incisional hernia(both P<0.001).Multivariate analysis identified infection onset time,effusion characteristics,gas bubbles,and necrosis location as independent predictors of prolonged hospitalization in the step-up group(all P<0.05).Patients with"wet"necrosis benefited more from the step-up approach,whereas those with"dry"necrosis experienced shorter hospitalization following open surgery.Conclusion:For diffusely distributed INP,treatment strategies should be individualized based on SAP status and necrosis liquefaction/imaging characteristics.The step-up minimally invasive approach is preferred for SAP patients and those with"wet"necrosis on CT,while direct open necrosectomy may be advantageous for"dry"necrosis(particularly with limited liquefaction)by shortening hospital stay and reducing certain major outcomes,though at the cost of increased incision infection and incision herina.CT imaging features and SAP classification can serve as valuable tools for risk stratification and guiding individualized timing and modality of intervention.

Objective To explore the relationship between the degree of compression and shape grading of the cerebral cistern ambiens in hypertensive cerebral hemorrhage(HCH)patients after neural endoscopic intracranial hematoma evacuation(NEIHE)and prognosis.Methods 246 HCH patients who underwent NEIHE surgery from January 2020 to June 2023 were selected as the research subjects.According to the postoperative 6 month Glasgow outcome score(GOS),the patients were divided into good prognosis group(n=158)and poor prognosis group(n=88).Hierarchical regression model was used to analyze the relationship between clinical pathological features and the degree of compression and shape grading of the cerebral cistern ambiens.Multivariate logistic regression model was used to analyze the independent risk factors affecting the poor prognosis of patients with HCH after NEIHE,and a prediction model was constructed.Receiver operating characteristic curve(ROC curve)was drawn with poor prognosis as the outcome variable.Area under the curve(AUC),integrated discrimination improvement(IDI)and net reclassification improvement(NRI)of different prediction models were compared.Hosmer-Lemeshow was used to test the goodness of fit.Generalized additive model(GAM)was used to analyze the relationship between GOS and related factors.Results Compared with the good prognosis group,the poor prognosis group had more preoperative blood loss,lower preoperative Glasgow coma score(GCS),and higher proportion of patients with midline deviation,hypertension history ≥10 years,hemorrhage breaking into the brain ventricle,and operation time in the late stage,the differences were statistically significant(P＜0.05).Compared with the good prognosis group,the proportions of patients with ipsilateral and contralateral cerebral cistern ambiens compression of 3 to 4 points and the morphological classification of cerebral cistern ambiens of grade V in the poor prognosis group were higher,and the differences were statistically significant(P＜0.05).The location of bleeding,midline deviation,and intracranial pressure all had an impact on the degree of compression and morphological grading of the cerebral cistern ambiens,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis(model 2:including the degree of compression and shape grading of the cerebral cistern ambiens)showed that midline deviation,history of hypertension ≥10 years,preoperative bleeding volume＞37 mL,bleeding into the brain ventricles,preoperative GCS＜7 points,late surgical timing,degree of compression of the cerebral cistern ambiens(3 to 4 points on the same side of hematoma,3 to 4 points on the opposite side of hematoma),and grade V morphology were all risk factors influencing the poor prognosis of patients with HCH after NEIHE(P＜0.05).After incorporating the degree of compression and morphological grading of the cerebral cistern ambiens into model 1(excluding the degree of compression and shape grading of the cerebral cistern ambiens),the AUC increased to 0.812(95％CI:0.763～0.872),and both the IDI(0.081,95％CI:0.049～0.095)and NRI(0.611,95％CI:0.510～0.674)of the model improved,with statistically significant differences(P＜0.05).Compared with model 1,model 2 showed an increase in AUC(0.826,95％CI:0.771～0.863),IDI(0.085,95％CI:0.052～0.110),and NRI(0.628,95％CI:0.510～0.709),with statistically significant differences(P＜0.05).The Hosmer-Lemeshow test showed that model 2(P=0.878)had a better fit for predicting poor prognosis than model 1(P=0.691).GAM analysis showed that the higher the degree of compression and morphological grading of the cerebral cistern ambiens,the lower the GOS,and the difference was statistically significant(P＜0.05).ROC curve analysis showed that the combined application of degree of compression and morphological grading of the cerebral cistern ambiens had a high predictive value for poor prognosis,with AUC of 0.935(95％CI:0.890～0.971),sensitivity of 70.26％,and specificity of 93.84％.Conclusion The degree of compression and shape changes of the cerebral cistern ambiens in HCH patients after NEIHE are closely related to prognosis,and the combined application has certain predictive value for poor prognosis.The location of bleeding,midline deviation,intracranial pressure,and other factors significantly affect the compression degree and shape change of the cerebral cistern ambiens.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Background and Aims:Infected necrotizing pancreatitis(INP),particularly with diffuse distribution,is a life-threatening condition.The optimal initial intervention-minimally invasive step-up therapy vs.direct open necrosectomy-remains controversial.Moreover,the impact of necrosis morphology("wet"or"dry")and the presence of severe acute pancreatitis(SAP)on treatment selection has not been fully clarified.This study aimed to compare the efficacy and safety of these two approaches in diffuse INP and to evaluate the guiding value of CT-based necrosis type and SAP status in clinical decision-making.Methods:A retrospective analysis was conducted on 458 patients with diffuse INP admitted to the Third Xiangya Hospital of Central South University from January 2012 to March 2023.Patients were divided into a minimally invasive step-up group(n=256)and a direct open surgery group(n=202).SAP was defined according to the determinant-based classification,and necrosis was categorized as"wet"or"dry"based on CT features.The primary endpoint was a composite of death or major complications,while secondary endpoints included mortality,length of hospital stay,and incision-related complications,were compared between the two groups,with subgroup analyses performed accordingly.Results:Overall,the open surgery group had higher rates of the primary endpoint(62.4%vs.48.1%,P=0.003)and mortality(27.2%vs.16.8%,P=0.008)compared with the step-up group.Among SAP patients,the step-up approach resulted in a significantly lower primary endpoint rate(66.7%vs.97.7%,P=0.003).In non-SAP patients,the primary endpoint rates were similar,but open surgery was associated with a shorter hospital stay[(36.5±10.4)d vs.(45.6±18.6)d,P<0.001]and higher incidences of wound infection and incisional hernia(both P<0.001).Multivariate analysis identified infection onset time,effusion characteristics,gas bubbles,and necrosis location as independent predictors of prolonged hospitalization in the step-up group(all P<0.05).Patients with"wet"necrosis benefited more from the step-up approach,whereas those with"dry"necrosis experienced shorter hospitalization following open surgery.Conclusion:For diffusely distributed INP,treatment strategies should be individualized based on SAP status and necrosis liquefaction/imaging characteristics.The step-up minimally invasive approach is preferred for SAP patients and those with"wet"necrosis on CT,while direct open necrosectomy may be advantageous for"dry"necrosis(particularly with limited liquefaction)by shortening hospital stay and reducing certain major outcomes,though at the cost of increased incision infection and incision herina.CT imaging features and SAP classification can serve as valuable tools for risk stratification and guiding individualized timing and modality of intervention.

[Objective]To evaluate the knowledge,attitude and practice(KAP)of medication use and safety among the patients with acquired immune deficiency syndrome(AIDS)in a 3A-grade hospital of Guangzhou city,and to provide scientific basis for AIDS prevention and treatment.[Methods]A questionnaire survey was conducted among AIDS patients aged 18 years and above in our hospital to investigate their KAP regarding medication use and safety.[Results]A total of 549 questionnaires were collected,of which 503 were valid,with an effective recovery rate of 91.6%.The average scores of KAP were(14.58±8.49),(25.21±6.92)and(47.58±3.33),respectively,with the scoring rates of 36.46%,63.02%,and 95.16%,respectively.There were statistically significant differences(P＜0.05)in knowledge scores among people with different ages,education levels and occupations.Multiple linear regression showed that education level and medical insurance status had most significant impact on knowledge scores(P<0.05).Significant differences were found in attitude scores among people with different education levels(P<0.05),as well as in practice scores among people with different occupations(P<0.05).Multiple linear regression revealed that age,occupation,knowledge score and attitude score had a significant impact on practice scores(P<0.05).Patients expected to receive pharmaceutical care services from the pharmacists via face-to-face communication,network platform and telephone consultation on medication knowledge such as adverse drug reactions and response measures,drug-drug interactions,missed medication and response measures,medication adherence measures,etc.[Conclusions]AIDS patients in this hospital have a good awareness of medication safety,but their knowledge of medication use needs improvement.Some bad habits may affect their compliance,resulting in safety hazards.Therefore,there is an urgent demand for pharmaceutical care services related to rational drug use.

Objective To investigate the correlation between serum indirect bilirubin(IBIL)levels and carotid intima-media thickness(CIMT)of acute cerebral infarction patients.Methods A total of 229 patients with acute cerebral infarction at Wuxi No.2 Chinese Medicine Hospital from July 2021 to November 2023 were divided into the intima-media thickness group(CIMT≥0.9mm,n=108)and intima-media normal group(CIMT<0.9mm,n=121)according to CIMT values.The differences in gender,age,body mass index,smoking history,history of alcohol drinking,hypertension,coronary heart disease,diabetes,hyperlipidemia,total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglyceride,fasting blood glucose,uric acid,and cystatin C were compared between the two groups.To further elucidate the association between serum bilirubin levels and CIMT using both univariate and multivariate analysis.Results The two groups showed significant differences in gender,body mass index and IBIL in the results(P<0.05).However,there was no significant difference in age,history of alcohol drinking,smoking history,diabetes,coronary heart disease,hypertension,hyperlipidemia,TBIL,DBIL,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglyceride,fasting blood glucose,uric acid and cystatin C levels(P>0.05).Binary Logistic regression analysis indicated that gender,body mass index and IBIL were significant independent predictors of CIMT values(P<0.05).Conclusion Serum indirect bilirubin level is inversely associated with CIMT in acute cerebral infarction patients,which may be one of the protective factors of atherosclerosis.

Objective:To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.