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.

This paper reports a case of recurrent peritoneal dialysis-associated peritonitis caused by Salmonella, as identified through metagenomic next-generation sequencing. This patient was treated regularly with peritoneal dialysis due to stage 5 chronic kidney disease. One month ago, she was hospitalized for peritoneal dialysis-associated peritonitis. The result of bacterial culture of the dialysate was Salmonella, and she was discharged after anti-infective treatment for 3 weeks. However, on the 12th day after discharge, the patient was readmitted to the hospital due to peritonitis.Both metagenomic next-generation sequencing and bacterial culture of the fluid confirmed the presence of Salmonella. After 3 weeks of intraperitoneal and intravenous anti-infection treatment, the patient underwent metagenomic next-generation sequencing to assess pathogen eradication before discharge.

Objective:To investigate the correlation between serum Vitamin D, uric acid levels and arterial calcification in maintenance hemodialysis patients.Methods:A total of 120 patients who received MHD treatment in Daxing Teaching Hospital, Capital Medical University, from March 2019 to March 2021 were retrospectively selected as research subjects, and their general clinical data were recorded in detail. X-ray was used to detect the arterial calcification of patients. Multivariate Logistic regression was used to analyze the risk factors of arterial calcification in MHD patients.Results:According to the arterial calcification score, 120 MHD patients were divided into non-calcification group (43 cases, 35.83%), mild calcification group (16 cases, 13.33%), moderate calcification group (42 cases, 35.00%) and severe calcification group (19 cases, 15.83%). There were significant differences in dialysis years, serum Vitamin D, serum uric acid, serum calcium, serum phosphorus, intact parathyroid hormone (iPTH) and arterial calcification score among the four groups ( P<0.05). According to serum Vitamin D level, 120 MHD patients were divided into deficient serum Vitamin D group (84 cases, 70.00%) and normal serum Vitamin D group (36 cases, 30.00%), serum calcium and phosphorus levels in the deficient serum Vitamin D group were lower than those in the normal serum Vitamin D group: (2.53 ± 0.28) mmol/L vs. (3.15 ± 0.31) mmol/L, (1.83 ± 0.26) mmol/L vs.(2.07 ± 0.31) mmol/L; serum uric acid and arterial calcification scores in the deficient serum Vitamin D group were higher than those in the normal serum Vitamin D group: (512.41 ± 65.21) μmol/L vs.(311.94 ± 72.56) μmol/L, (6.92 ± 2.34) scores vs. (2.18 ± 2.01) scores, there were statistical differences ( P<0.05). One hundred and twenty MHD patients were divided into hyperuricemia group (77 cases, 64.17%) and uric acid normal group (43 cases, 35.83%) according to the level of serum uric acid, the serum Vitamin D level in the hyperuricemia group was lower than that in uric acid the normal group: (12.28 ± 5.18) μg/L vs. (28.84 ± 4.69) μg/L; and iPTH level and arterial calcification scores were higher than those in the uric acid normal group: (372.45 ± 90.31) ng/L vs. (291.60 ± 98.52) ng/L, (6.22 ± 2.52) scores vs. (2.72 ± 2.63) scores, there were statistical differences ( P<0.05). The results of multivariate Logistic regression showed that serum Vitamin D and uric acid levels were risk factors for arterial calcification in MHD patients ( P<0.05). Conclusions:Serum Vitamin D and uric acid levels are correlated with arterial calcification in MHD patients, and are the risk factors leading to arterial calcification in patients.

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 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.

Objective:To explore the effects of low position lateral supramalleolar flap carrying periosteum and proximal leg propeller flap in relay repair of electric burn wounds of forefoot.Methods:A retrospective observational study was conducted. From January 2019 to January 2022, 12 patients with electric burn wounds of forefoot meeting the inclusion criteria were admitted to the Sixth Hospital of Shanxi Medical University, including 10 males and 2 females, aged 23-65 years. After debridement, the wound with an area of 6.0 cm×3.0 cm to 15.0 cm×7.0 cm was repaired with the lateral supramalleolar flap carrying part of the periosteum of the distal tibia and fibula with the rotation point moved down to the front of the ankle joint. The area of the cutted flap was 6.5 cm×3.5 cm-15.5 cm×7.5 cm. At the same stage, the donor site wound of lateral supramalleolar flap was repaired with peroneal artery or superficial peroneal artery perforator propeller flap in relay, with the relay flap area of 3.0 cm×1.5 cm-15.0 cm×4.0 cm. After operation, the survival of the lateral supramalleolar flap and relay flap, and the wound healing of the relay flap donor site were observed. During follow-up, the shapes of the lateral supramalleolar flap and its donor site were observed.Results:After operation, one patient developed secondary blisters in the superficial skin distal to the lateral supramalleolar flap, which healed after dressing change, and the lateral supramalleolar flap and relay flaps survived well in the other patients; the donor site wound of the relay flap healed well. During follow-up of 12-18 months, the lateral supramalleolar flaps were in good shape and not bloated, with only linear scar left in the donor site of the flap.Conclusions:The low position lateral supramalleolar flap carrying periosteum can repair electric burn wounds of forefoot with advantages including reliable blood supply, low rotation point, and better repair effects. The use of relay flap to repair the donor site of lateral supramalleolar flap can reduce the damage to the appearance and function of the donor site.

Objective:To compare the survival rate of secondary hyperparathyroidism (SHPT) patients with different dialysis modalities after parathyroidectomy (PTX), and analyze the influencing factors of survival prognosis.Methods:Clinical data of dialysis patients diagnosed with SHPT and treated with PTX in the First People′s Hospital of Foshan from April 2014 to May 2019 were retrospectively collected and analyzed. The patients were divided into hemodialysis (HD) group and peritoneal dialysis (PD) group according to preoperative dialysis modalities, and the differences in baseline clinical data and cardiac ultrasound results were compared between the two groups. Kaplan-Meier survival analysis was used to compare the difference in cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the influencing factors of all-cause death. Receiver operating characteristic curve (ROC curve) was used to predict the risk of all-cause death.Results:A total of 99 patients were enrolled in this study, and 94 patients completed follow-up, including 23 patients who died. Compared with PD group ( n=45), HD group ( n=54) had higher dialysis age, blood pressure, intact parathyroid hormone, alkaline phosphatase, total heart valve calcification rate, mitral valve calcification proportion, interventricular septal thickness (IVST) and left ventricular mass index (all P<0.05). The median follow-up time was 46.00(32.75, 60.25) months. Kaplan-Meier survival analysis showed that there was no significant difference in cumulative survival rate between HD group and PD group (Log-rank test χ2=0.414, P=0.520). Multivariate Cox regression analysis showed that increasing age ( HR=1.066, 95% CI 1.017-1.118, P=0.008), systolic blood pressure>140 mmHg ( HR=2.601, 95% CI 1.002-6.752, P=0.049) and increasing IVST ( HR=1.269, 95% CI 1.036-1.554, P=0.021) were independent influencing factors for all-cause death in dialysis patients after PTX. ROC curve analysis results showed that the cut-off values of age, dialysis age and IVST for predicting all-cause death after PTX were 51.5 years old ( AUC=0.673, 95% CI 0.545-0.802, P=0.013) and 75.0 months ( AUC=0.654, 95% CI 0.528-0.780, P=0.027) and 13.5 mm ( AUC=0.680, 95% CI 0.557-0.803, P=0.010) respectively. The area under the ROC curve for age, dialysis age, IVST, left ventricular hypertrophy in combination with systolic blood pressure>140 mmHg in the prediction of all-cause death after PTX was 0.776(95% CI 0.677-0.875, P<0.001). Conclusions:There is no significant difference in cumulative survival rate between HD and PD patients with SHPT after PTX. Increasing age, systolic blood pressure>140 mmHg and increasing IVST are independent risk factors for all-cause death in dialysis patients with SHPT after PTX.

Background Occupational noise-induced hearing loss (NIHL) is one of the most prevalent occupational diseases in the world. With the development of industry, noise sources in the workplace have become increasingly complex. Objective To apply kurtosis-adjusted cumulative noise exposure (CNE) to assess the occupational hearing loss among furniture manufacturing workers, and to provide a basis for revising noise measurement methods and occupational exposure limits in China. Methods A cross-sectional survey was conducted to select 694 manufacturing workers, including 542 furniture manufacturing workers exposed to non-Gaussian noise, and 152 textile manufacturing workers and paper manufacturing workers exposed to Gaussian noise. The job titles involving non-Gaussian noise were gunning and nailing, and woodworking, while those involving Gaussian noise were weaving, spinning, and pulping. High frequency noise-induced hearing loss (HFNIHL) and noise exposure data were collected for each study subject. Noise energy metrics included eight-hour equivalent continuous A-weighted sound pressure level (L_{Aeq,8 h}) and CNE. Kurtosis was a noise temporal structure metric. Kurtosis-adjusted CNE was a combined indicator of noise energy and temporal structure. Results The age of the study subjects was (35.64±10.35) years, the exposure duration was (6.71±6.44) years, and the proportion of males was 75.50%. The L_{Aeq,8 h} was (89.43±6.01) dB(A). About 81.42% of the study subjects were exposed to noise levels above 85 dB(A), the CNE was (95.85±7.32) dB(A)·year, with a kurtosis of 99.34 ± 139.19, and the prevalence rate of HFNIHL was 35.59%. The mean kurtosis of the non-Gaussian noise group was higher than that of the Gaussian noise group (125.33±147.17 vs. 5.86±1.94, t=−21.04, P<0.05). The results of binary logistic regression analysis showed that kurtosis was an influential factor of workers' HFNIHL after correcting for age, exposure duration, and L_{Aeq,8 h} (OR=1.49, P<0.05). The results of multiple linear regression analysis showed that the effects of age, exposure duration, L_{Aeq,8 h}, and kurtosis on noise-induced permanent threshold shift at frequencies of 3, 4, and 6 kHz of the poor hearing ear were statistically significant (all P<0.05). The results of chi-square trend analysis showed that when CNE ≥ 90 dB(A)·year, the HFNIHL prevalence rate elevated with increasing kurtosis (P<0.05). The mean HFNIHL prevalence rate was higher in the non-Gaussian noise group than in the Gaussian noise group (31.7% vs. 22.0%, P<0.05). After applying kurtosis-adjusted CNE, the linear equation between CNE and HFNIHL prevalence rate for the non-Gaussian noise group almost overlapped with that for the Gaussian noise group, and the mean difference in HFNIHL prevalence rate between the two groups decreased from 9.7% to 1.4% (P<0.05). Conclusion Noise kurtosis is an effective metric for NIHL evaluation. Kurtosis-adjusted CNE can effectively evaluate occupational hearing loss due to non-Gaussian noise exposure in furniture manufacturing workers, and is expected to be a new indicator of non-Gaussian noise measurement and assessment.

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.