Chronic obstructive pulmonary disease （COPD） is susceptible to systemic complications. Especially，sarcopenia is an independent risk factor for COPD patients that can exacerbate respiratory muscle fatigue，lead to a higher risk of falls and fractures，and lower the quality of life. The pathogenesis of sarcopenia involves such aspects as mitochondrial dysfunction，insulin resistance，changes in skeletal muscle fiber types，and an imbalance in protein synthesis and breakdown. As nutrition support and exercise rehabilitation therapy frequently have limited effectiveness，it is urgent to find a way to slow the progression of COPD with sarcopenia. Numerous studies conducted in recent years have discovered a potential link between pulmonary microbiome disorders and the gut microbiota of COPD patients. Furthermore，a wide range of functions of gut microbiota and its metabolites have been demonstrated，such as regulating inflammation and immunity，glucose and lipid metabolism，and mitochondrial function. According to the Zangxiang theory in Chinese medicine， there are intimate connections between the spleen， intestine，and muscle，and gut microbiota may be the most essential part of ameliorating "spleen governing muscle" and increasing muscle mass and strength. This study aims to expound on the effect mechanism of gut microbiota in slowing the progression of COPD with sarcopenia，thereby furnishing novel perspectives and recommendations for forthcoming investigations and therapeutic applications.

Objective:To reconstruct the three-dimensional (3D) dose distribution in radiotherapy based on the convolutional neural networks (CNN) through multi-perspective scintillation light processing.Methods:First, fluorescence images were captured from three orthogonal perspectives using a complementary metal-oxide-semiconductor (CMOS) imaging sensor. Then, the images were converted into 3D images, which were input to the trained CNN for dose reconstruction. Finally, the reconstructed doses in different fields were evaluated in terms of gamma pass rate, mean-square error (MSE), percentage depth dose (PDD), and cross beam profile (CBP). Additionally, as the CNN model, 3D-Unet was pre-trained on a virtual dataset.Results:With the 50% maximum dose of as the threshold and 3%/3 mm as the standard, the central-plane and stereo-mean gamma pass rates of all field reconstruction distributions were over 90%, with MSEs remained below 1%. Besides, the PDD and CBP curves showed MSEs below 1‰ and below 1%, respectively.Conclusions:The deep learning-based method for 3D dose reconstruction using scintillation light contributes to enhanced verification of instantaneous 3D relative dose based on plastic scintillation detectors.

Owing to the advancement of high-throughput microbial 16S ribosomal RNA （16S rRNA） gene sequencing， respiratory and intestinal flora has become a research hotspot in China and abroad in recent years. At the moment， it has been verified that intestinal flora is closely related to various respiratory diseases such as cystic fibrosis， chronic obstructive pulmonary disease （COPD）， asthma， and lung infection. The causal relationship between COPD and intestinal flora is still unclear. In clinical settings， COPD is characterized by gastrointestinal disorders such as anorexia， abdominal distension， and constipation， and malnutrition， which are closely related to the imbalance of intestinal flora. According to modern medicine， intestinal microbiota participates in the metabolism of energy and nutrients and immune defense in the host through the common mucosal immune system， thereby involving the progression of diseases. In addition， metabolites of intestinal flora mediate lung immune dysfunction through the immunoregulation of remote organs， causing pulmonary and intestinal microdysbiosis and affecting the occurrence and development of COPD. COPD belongs to the category of "lung distension" in traditional Chinese medicine （TCM）. The pathogenesis of microdysbiosis in COPD is closely related to the lung， spleen， and intestine. Particularly the transportation and transformation of water and grains and the defense against external pathogens in TCM are consistent with the mechanisms of intestinal flora disturbance in COPD in modern medicine. The interior-exterior relationship between lung and large intestine， linkage between spleen and small intestine， and lung and spleen in the meridian of taiyin in TCM can well explain the microdysbiosis in COPD. Based on available research outcomes in modern medicine， this paper discusses the relationship between the flora in lung and intestine and microdysbiosis in COPD in TCM. The author believes that the "lung-spleen-intestine" mode in TCM is a new perspective for the research on microdysbiosis in COPD， which is conducive to the prevention and treatment of COPD.

Objective:To explore the relationship between emotional trauma and depressive symptoms.Methods:In November 2021, a total of 1 650 university students were assessed using scales including childhood trauma questionnaire (CTQ), distress tolerance scale (DTS), rumination response scale (RRS) and the depression anxiety stress scale (DASS). SPSS 20.0 and AMOS 25.0 software were used to analyze the data with Spearman correlation analysis, Mann-Whitney U test and mediation analysis. Results:The differences of DTS, RRS and DASS were significant between high and low trauma group(all P<0.01). Emotional trauma (16.70(6.09)) was negatively correlated with distress tolerance(10.95(2.15)) ( r=-0.26, P<0.01), and positively correlated with rumination(39.51(10.74)) and depression(4.93(5.76)) ( r=0.31, 0.38, both P<0.01). The testing of mediating effect indicated that emotional trauma had direct effect ( β=0.20, P<0.001) and indirect effect on depression through distress tolerance and rumination. Conclusion:Emotional trauma, distress tolerance and rumination are important factors influencing depression, and it could provide guidance for undergraduate psychological intervention of depression.

Objective: To explore the relationship among self-regulatory focus and depression, anxiety symptoms and suicidal risks of medical college students. Methods: A total of 2 251 freshmen were recruited from a medical university by convenienee sampling methood. A cross-sectional questionnaire survey using Regulatory Focus Questionnaire (RFQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Psychache Scale (PAS), and Suicide Behaviors Questionnaire-Revised (SBQ-R) was conducted. Results: The prevalence rate of freshmen’s depression symptoms was as high as 20.4%, the prevalence rate of anxiety symptoms was 11.2%, and the risk of suicide increased by 5.85 times among students with depression-anxiety comorbid symptoms. Girls reported higher prevention focused scores than boys, as well as higher anxiety symptoms and suicidal risks(t=4.84,2.18,5.57,P<0.05). College students with a prevention focused self-regulation style had significantly higher scores on depression, anxiety symptoms and suicidal risks than those with a promotion focused regulatory style, the effect sizes of the differences were moderate or large (Cohen’s d>0.50). Conclusion Self-regulatory focus plays an important role in emotional health. The pursuit of promotion goals is beneficial to mental health, while the pursuit of prevention goals is more likely to be associated with depression, anxiety symptoms and a higher risk of suicide.

Objective To compare the community nursing employment intention of nursing students between Guangzhou and Macau, so as to provide references for the teaching reform of community nursing education for undergraduates. Methods From June to July 2017, a questionnaire investigation on community nursing employment intention of nursing students was conducted in 136 nursing undergraduates of Grade 2014 in Guangzhou University of Chinese Medicine and 33 nursing undergraduates of Grade 2014 in Kiang Wu Nursing College of Macau. Results 52.9% of the nursing undergraduates in Guangzhou were willing to work as a community nurse because of "High degree of freedom of community nursing and no night shift", while 45.5% of the students in Macau would like to be engaged in community nursing because of "Conforming to personal character and interest". There was significant difference in the expectation of individual career development between the students in the two areas (χ2=10.708, P<0.05). The percentage of nursing undergraduates who were willing to engage in community nursing work in Guangzhou and Macau was 71.3% and 75.8% respectively. Conclusions Compared with Macau, the nursing undergraduates in Guangzhou have more negative community nursing employment intention, whose vocational values are not mature, and they are easily affected by their parents when making employment decisions. The teaching reform of undergraduate community nursing education should focus on the school-hospital-community "trinity" practice teaching mode establishment, carrying out the community curriculum and practice as soon as possible, reforming the practice teaching methods, increasing the construction of practice bases in community, and strengthening the construction of community nursing faculty.

Objective To evaluate the value of DTI in mild articular cartilage injury in patellofemoral joint.Methods The DTI and arthroscopy data of 82 patients wih routine MRI diagnosed as mild articular cartilage injury were analyzed retrospectively.According to the results of arthroscopy,40 cases of mild articular cartilage injury with Outerbridge classification Ⅰ or Ⅱ were divided into experimental group,and 33 cases with normal patellofemoral articular cartilage were divided into control group.There were 8 articular cartilage injury patients with Outerbridge classification Ⅲ or Ⅳ in patello-femoral join were excluded.The DTI data were analyzed compared with arthroscopy.Results Arthroscopy detected 62 lesions of cartilage injury in experimental group.Totally 49 lesions (49/62,79.03 ％) were detected by ADC pseudocolor image and 51 lesions (51/62,82.25 ％) were detected by FA pseudocolor image.The DTI pseudocolor images of articular cartilage injury showed uneven levels.The red or pink levels can been observed.Compared with the control group,ADC value increased and FA value decreased significantly in experimental group (both P＜0.05).Conclusion DTI can clearly display and detect mild articular cartilage injury in patellofemoral joint,which provide valuable information for early cartilaginous injury.

Objective To explore application of bundles of care intervention in rehabilitation of pa-tients with breast cancer after radical mastectomy (BCARM), so as to improve the patients' quality of life, and to provide reference basis for rehabilitation nursing for patients with BCARM.Methods A total of 195 cases with BCARM treated in Department of Breast Surgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2014 to April 2015 were selected and divided randomly into experiment group with 97 cases and control group with 98 cases. Patients in the control group received routine care for breast cancer, while those in the experimental group received bundles of care intervention. Incidence of postoperative subcutaneous effu-sion, skin flap nectosis, upper limb edema, and bleeding of patients in the two groups were compared, together with motion range of joints in the affected limb when extending outward and backward, and quality of life of the patients.Results After the surgery, subcutaneous effusion occurred to 17 patients in the experiment group, and upper limb edema to 19, which were obviously less than that in the control group, with subcutaneous effusion to 20 and upper limb edema to 22 (χ2 =12.311, 14.030;P<0.01). 4 weeks and 12 weeks after the surgery, outward extending degree of the affected limb in the experiment group were (130.01±6.16)° and (135.51±4.65)° , and the backward extending degree (38.92±4.28)° and (39.53±4.02)° , obviously better than that in the control group, with outward extending degree of (128.18±7.35)°, (130.04±6.11)°, and backward extending degree of (36.61±4.13)° and (38.99±4.63)°. At 4 weeks and 12 weeks after the surgery, there was statistical difference between numbers of the time points, groups, and interaction between the groups and time (P<0.05). At 6 months and 12 months after the surgery, the measured scores of quality of life in the experiment group were (16.80±3.29) points and (19.00±2.27) points, with scores of additional attention (21.95±3.39) points and (22.24±3.06) points, with the scores in the control group (14.20±3.39), (15.59±2.91), (20.55±3.34) and (20.96±2.79). At 6 months and 12 months after the surgery, there was statistical difference between numbers of the time points, groups, and interaction between group and time (P<0.05).Conclusions The effect of bundles of care intervention on rehabilitation of patients with BCARM is far better than traditional nursing methods.

Objective To investigate nursing students′ attitudes, knowledge and career preference toward elder people and analyze its influencing factors, so as to provide references for teaching reform of undergraduate geriatric nursing education in universities of traditional Chinese medicine. Methods A total of 187 nursing undergraduates were investigated by facts on aging quiz ( FAQ1 ) , Kogan′s attitudes toward old people scale ( KAOP ) and employment intention scale of nursing students about nursing students′ attitudes, knowledge and career preferences toward elder people, from March to April 2015. Results The total score of KAOP scale of nursing students was (139.39±14.50); the mean score of FAQ1 scale of nusing students was (15.37±2.92), and the pass rate was 59.68%. 9.4% of nursing students selected the geriatric nursing positions among the top 3 jobs that nursing students want most. There were significant differences in nursing students′attitudes toward the elderly based on factors such as: being the only child or not, the relation between parents and the elderly, having experience in dealing with the elderly, and having intention to communicate with the elderly or not (P<0.05). According to the multiple regression analysis, nursing students′ attitude toward the elderly was influenced by being the only child or not, the relation between parents and the elderly, and having intention to communicate with the elderly or not (P<0.05).Conclusions Few nursing students would like to choose geriatric nursing work. The experimental teaching contents and methods should be improved in geriatric nursing, and the chance of nursing students should be increased for actual contact with the elderly.

BACKGROUNDWith the development of natural orifice trans-luminal endoscopic surgery, studies on transoral video-assisted thyroidectomy in preclinical experiments (e.g., human anatomy and animal trials) were progressing gradually. From 2009 to 2011, embalmed human cadavers were dissected to define the anatomical location, surgical planes, and related neural and vascular structures to create a safe transoral access to the front cervical spaces. Recently, experimental transoral endoscopic thyroidectomy was performed to verify the feasibility of this approach on 15 fresh specimens.

METHODSFifteen specimens were placed in the supine position with slight neck extension. Endoscopic incision was made on the midline between the Wharton's duct papillae and two other incisions were made on mandibular first premolar buccal mucosa. Sublingual combined bilateral vestibular tunnels were created from oral cavity to the cervical region. The neck subplatysmal working space was insufflated with CO2 at 6-8 mmHg. The bilateral thyroid lobes and central lymph nodes were dissected under craniocaudal view.

RESULTSThree incisions were made in the oral cavity without any incisions on the body surfaces. The distance from the oral cavity to front neck region was the shortest. Bilateral thyroid lobes and central neck region were fully resected via transoral approach. This approach provided a craniocaudal view, in which retrosternal thyroid gland and lymph nodes were easily accessible. The recurrent laryngeal nerve could be identified safely on the inferior cornu of the thyroid cartilage. The only structure at risk was the mental nerve. Camera motion was somewhat limited by the maxillary dentition. The volume of harvested thyroid nodule through sublingual tunnel in the fifteen human cadavers was (40 ± 15) cm(3).

CONCLUSIONThe transoral procedure is progressive and innovative which not only gives the best cosmetic result and minimal access trauma but also provides a craniocaudal view.

Cadaver ; Endoscopy ; methods ; Female ; Humans ; Male ; Neck Dissection ; methods ; Thyroidectomy ; Video-Assisted Surgery ; methods