Objective: To investigate the effect of Guangdong Shenqu (GSQ) on intestinal flora structure in mice with food stagnation through 16S rDNA sequencing. Methods: Mice were randomly assigned to control, model, GSQ low-dose (GSQL), GSQ medium-dose (GSQM), GSQ high-dose (GSQH), and lacidophilin tablets (LAB) groups, with each group containing 10 mice. A food stagnation and internal heat mouse model was established through intragastric administration of a mixture of beeswax and olive oil (1:15). The control group was administered normal saline, and the model group was administered beeswax and olive oil to maintain a state. The GSQL (2 g/kg), GSQM (4 g/kg), GSQH (8 g/kg), and LAB groups (0.625 g/kg) were administered corresponding drugs for 5 d. After administration, 16S rDNA sequencing was performed to assess gut microbiota in mouse fecal samples. Results: The model group exhibited significant intestinal flora changes. Following GSQ administration, the abundance and diversity index of the intestinal flora increased significantly, the number of bacterial species was regulated, and α and β diversity were improved. GSQ administration increased the abundance of probiotics, including Clostridia, Lachnospirales, and Lactobacillus, whereas the abundance of conditional pathogenic bacteria, such as Allobaculum, Erysipelotrichaceae, and Bacteroides decreased. Functional prediction analysis indicated that the pathogenesis of food stagnation and GSQ intervention were primarily associated with carbohydrate, lipid, and amino acid metabolism, among other metabolic pathways. Conclusion The digestive mechanism of GSQ may be attributed to its role in restoring diversity and abundance within the intestinal flora, thereby improving the composition and structure of the intestinal flora in mice and subsequently influencing the regulation of metabolic pathways.

Objective Based on TLR4/NF-κB/MLCK pathway,the therapeutic effect and mechanism of Baihe Dihuang Decoction on insomnia with intestinal flora disturbance in mice induced by p-chlorophenlalanine(PCPA)and multi-factor stimulation were studied.The aim is to provide theoretical basis for clinical use.Methods Eighty-four KM mice were randomly divided into normal group,model group,positive group(Diazepam,1.38 mg·kg-1),Baihe group(2.25 g·kg-1),Dihuang group(2.25 g·kg-1)and Baihe Dihuang Decoction group(4.5 g·kg-1).Insomnia mouse model was established by intraperitoneal injection of PCPA for 2 days combined with 4 weeks of multi-factor stimulation,including stimulating the tail with forceps clip for 2 minutes,reversing day and night for 24 hours,wetting the padding for 24 hours,tilting the cage at 45° for 24 hours,alternating the cages for 24 hours,fasting food for 24 hours,and getting cold bath for 3 minutes,etc.After successfully modeling,corresponding drug treatment was given.The anxiety-like behavior of mice was observed by elevated cross maze system.The latency and duration of sleep were observed by righting reflex experiment.16sRNA sequencing was used to analyze the composition and structure of intestinal flora in mice.The concentration changes of γ-aminobutyric acid(GABA),glutamic acid(Glu),tryptophan(Trp),5-hydroxytryptophan(5-HTP)and 5-hydroxytryptamine(5-HT)in brain and colon were detected by liquid chromatography-mass spectrometry(LC-MS).Immunohistochemical method was used to detect the expressions of zona atresia protein 1(ZO-1)and Occludin in colon.Real-time fluorescence quantitative PCR(qRT-PCR)was used to detect the genes including interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),ZO-1,Occludin,Toll-like receptor 4(TLR4),nuclear factor κB(NF-κB)and myosin light chain kinase(MLCK)in colonic tissue.Western Blot was used to detect the expressions of TLR4,NF-κB,phosphorylated nuclear factor κB(p-NF-κB),MLCK,myosin light chain(MLC)and phosphorylated myosin light chain(p-MLC)in colonic epithelial tissue.Results Compared with the normal group,the distance of entering the open arm and the duration of stay in the open arm of model group in the elevated cross maze were significantly shortened(P＜0.05).The sleep latency was significantly prolonged,and the sleep duration was significantly shortened(P＜0.05).The richness and uniformity of intestinal flora were decreased(P＜0.05,P＜0.01).The concentration of neurotransmitters GABA,Trp,5-HTP and 5-HT in the brain decreased significantly(P＜0.01),while the concentration of Glu increased significantly(P＜0.01).The concentration of GABA and Glu in colon decreased significantly(P＜0.01),while the concentration of Trp,5-HTP and 5-HT increased significantly(P＜0.01).The expression levels of inflammatory factors IL-1β,IL-6 and TNF-α in colonic tissue were significantly increased(P＜0.01),and the expression levels of ZO-1 and Occludin genes and proteins were significantly decreased(P＜0.01).The gene expression levels of TLR4,NF-κB and MLCK were significantly increased(P＜0.01),and the protein expression levels of TLR4,p-NF-κB,MLCK and p-MLC were significantly increased(P＜0.01).Compared with the model group,Baihe Dihuang Decoction could significantly prolong the distance of entering the open arm and the duration of stay in the open arm of insomnia mice in the elevated cross maze(P＜0.05).The sleep latency was significantly shortened,and the sleep duration was significantly increased(P＜0.05).The richness and uniformity of intestinal flora were increased(P＜0.05,P＜0.01).The concentration of neurotransmitters GABA,Trp,5-HTP and 5-HT in brain was increased(P＜0.05,P＜0.01),and the concentration of Glu was decreased(P＜0.01).The concentration of GABA and Glu in colon was increased(P＜0.01),while the concentration of Trp,5-HTP and 5-HT was decreased(P＜0.05,P＜0.01).The expression levels of IL-1β,IL-6 and TNF-α genes were down-regulated(P＜0.01),the expression levels of ZO-1 and Occludin genes and proteins were up-regulated(P＜0.01),TLR4,NF-κB,MLCK gene expression levels and TLR4,p-NF-κB,MLCK,p-MLC protein expression levels were down-regulated in the pathway(P＜0.01).Conclusion Baihe Dihuang Decoction can effectively treat insomnia with intestinal flora disorders.Its mechanism of action may be related to the regulation of brain and intestinal neurotransmitter disorders,down-regulating TLR4/NF-κB/MLCK signaling pathway,and up-regulating tight junction proteins expression,reducing inflammatory responses,and then repairing the mechanical barrier of intestinal mucosa.

Objective:To evaluate the effect of inhaled medication compliance intervention in elderly patients with chronic obstructive pulmonary disease (COPD) based on integrated theory of health behavior change.Methods:A total of 117 elderly COPD patients who visited Respiratory Department of Beijing Chaoyang Hospital Affiliated to Capital Medical University from July to December 2021 were selected by the convenient sampling method. According to the random number table method, they were divided into the experimental group and the control group. 7 cases fell off during follow-up, and a total of 110 cases were finally included in the study, of which 55 cases were in the experimental group and 55 cases in the control group. The control group adopted the conventional health education method, while the experimental group adopted the intervention plan of inhalation medication compliance of elderly COPD patients based on the integrated theory of health behavior change. The accuracy of inhalation device use, inhalant medication compliance, forced expiratory volume in the first second (FEV 1) and Chronic Obstructive Pulmonary Diseases Assessment Test (CAT) scores were compared between the two groups before intervention and 3 months after intervention. Results:After 3 months of intervention, the inhalation device use accuracy, inhalation medication compliance in experimental group were higher than those in the control group, the score of CAT in experimental group was lower than that in the control group, the differences were statistically significant ( P<0.05). There was no statistically significant difference in FEV 1 between two groups ( P>0.05) . Conclusions:The intervention plan for inhalation medication compliance in elderly patients with chronic obstructive pulmonary disease based on the integrated theory of health behavior changes can improve their inhalation medication compliance and improve their quality of life.

Objective:To investigate the regulation of intestinal microbiota by Roux-en-Y gastric bypass (RYGB) on patients with obesity or obesity combined with diabetes.Methods:The retrospective and descriptive study was conducted. The stool samples before and after surgery and clinical data of 20 patients with obesity, including 9 simple obesity cases and 11 obesity combined with diabetes cases, who underwent RYGB in the First Affiliated Hospital of Ji′nan University from July 2016 to August 2017 were collected. There were 11 males and 9 females, aged (33±11)years. Observation indicators: (1) changes in composition and structure of intestinal microflora; (2) changes of intestinal microflora in simple obesity patients after operation; (3) changes of intestinal microflora in obesity combined with diabetes patients after operation. Follow up was conducted using telephone interview or outpatient examinations to detect the body mass, the application of antimicrobial agent and the blood glucose control of patients. According to the unified training points, the stool samples were collected and stored into the DNA stabilizer, and then conducted to laboratory analysis within 45 hours. The follow up was up to November 2018. Measurement data with normal distribution were represented as Mean± SD, and independent-samples t test was used for inter-group comparison and paired-samples t test was used for intra-group comparison. Measurement data with skewed distribution were represented as M( Q1, Q3), and Wilcoxon signed rank test of two independent samples was used for inter-group comparison. Count data were described as absolute numbers, and the chi-square test, ANOSIM analysis, linear discriminant (LEfSe) analysis and the Metastats analysis were used for inter-group comparison. Results:(1) Changes in composition and structure of intestinal microflora. The Shannon index of α diversity of preoperative intestinal microflora in simple obesity patients and obesity combined with diabetes patients was 4.37±0.69 and 4.47±0.85, respectively, showing no significant difference between them ( t=0.28, P>0.05). Results of preoperative LEfSe analysis showed that there were differences in the bacterial abundance of Firmicutes and Bacteroidea between simple obesity patients and obesity combined with diabetes patients. The abundances of Parasutterella in simple obesity patients and obesity combined with diabetes patients was 0.000 113 0(0, 0.004 378 2) and 0.008 464 0(0.001 325 7, 0.034 983 1), respectively, showing a significant difference between them ( Z=2.12, P<0.05). Results of preoperative PCoA analysis showed that the contribution rates of principal component 1, principal component 2 and principal component 3 were 24.98%, 22.24% and 16.33% in simple obesity patients and obesity combined with diabetes patients and results of ANOSIM comparison showed that there was no significant difference in preoperative intestinal microflora between them ( r=?0.11, P>0.05). The Shannon index of α diversity of postoperative intestinal microflora in simple obesity patients and obesity combined with diabetes patients was 4.60±0.65 and 4.66±0.40, respectively, showing no significant difference between them ( t=0.24, P>0.05). Results of postoperative LEfSe analysis showed that there were differences in the bacterial abundance of Bacteroidea, Proteus and Firmicutes between simple obesity patients and obesity combined with diabetes patients. The abundances of Morganella and Coprococcus_2 in simple obesity patients and obesity combined with diabetes patients were 0.000 192 0(0.000 011 9,0.001 569 0), 0(0,0) and 0(0,0), 0.000 054 1(0,0.000 419 0), showing significant differences between them ( Z=2.70, 2.29, P<0.05). (2) Changes of intestinal microflora in simple obesity patients after operation. There were 10 genera of bacteria of intestinal bacteria changing after surgery, including 7 species of bacteria increasing in the Firmicutes and the Proteobacteria as Veillonella, Morganella, Granulicatella, Aeromonas, Streptococcus, Rothia and Megasphaera and the bacteria decreasing in the Firmicutes and the Actinobacteria as Ruminococcus_torques_group, Romboutsia and Erysipelo-trichaceae_UCG-003. Results of LEfSe analysis showed that the bacteria significantly enriched in simple obesity patients before surgery were Ruminococcus_torques_group, Romboutsia and Erysipelotri-chaceae_UCG-003, belonging to Firmicutes, and the bacteria significantly enriched in simple obesity patients after surgery were Rothia, Granulicatella, Enterococcus, Streptococcus, Megasphaera, Veillonella, A eromonas and Morganella, belonging to Actinobacteria, Firmicutes and Proteobacteria. (3) Changes of intestinal microflora in obesity combined with diabetes patients after operation. There were 16 bacteria of intestinal bacteria increasing after surgery, including Streptococcus, Veillonella, Haemophilus, Pluralibacter, Gemella, Lachnospiraceae_NC2004_group, Granulicatella,Aeromonas, uncultured_ bacterium_f_ Saccharimonadaceae, R uminiclostridium_9, Butyricicoccus, Fusobacterium, Anaerotruncus, Fusicateni-bacter, Klebsiella and E ubacterium_eligens_group, which belonged to the Firmicutes and the Proteo-bacteria. Results of LEfSe analysis showed that the bacteria significantly enriched in obesity combined with diabetes patients before surgery were Fusicatenibacter, Tyzzerella_3 and Butyricicoccus, belonging to the Firmicutes, and the bacteria significantly enriched in obesity combined with diabetes patients after surgery were Gemella, Granulicatella, Enterococcus, Streptococcus, Lachnospiraceae_NC2004_group, Eubacterium_eligens_group, Anaerotruncus, Ruminiclostridium_9, Anaeroglobus, Veillonella, Fusobacterium, uncultured_bacterium_f_Saccharimonadaceae, Aeromonas, Klebsiella, Pluralibacter, Proteus and Haemophilus, belonging to the Firmicutes and the Proteobacteria. Conclusions:RYGB can significantly increases the intestinal microflora abundance in simple obesity patients and obesity combined with diabetes patients. The two types of patients have specific changes in intestinal microflora at the genus level.

Objective:To study the effects of enhanced breastfeeding management on the neurodevelopmental outcomes of preterm infants in neonatal intensive care unit (NICU).Methods:From January to December 2020, preterm infants with gestational age (GA) ≥32 weeks admitted to NICU of our hospital were randomly assigned into the enhance group and the control group. Breast-feeding education using WeChat and routinely playing recorded mother's sound to the infants were carried out in the enhance group, while conventional management was carried out in the control group. Breastfeeding status was followed up regularly in both groups. Mental development index (MDI) and psychomotor development index (PDI) at 6-month of corrected GA were measured using Infant Intelligence Development Scale.Results:A total of 109 cases were included in the enhance group and 118 cases in the control group. The breast-feeding rates in the enhance group were significantly higher than the control group at discharge, 3-month and 6-month of corrected GA [88.1% (96/109) vs. 61.0% (72/118), 90.8% (99/109) vs. 67.8% (80/118), 88.1% (96/109) vs. 61.9% (73/118)] ( P<0.05). MDI and PDI at 6-month of corrected GA in the enhance group were significantly higher than the control group [(106.2±10.7) vs. (101.9±11.4), (103.4±13.7) vs. (99.5±11.6)] ( P<0.05). Conclusions:Enhanced breast-feeding management is helpful improving the breast-feeding rate of preterm infants in NICU and beneficial to the neurodevelopment of preterm infants.

Heart sound is one of the common medical signals for diagnosing cardiovascular diseases. This paper studies the binary classification between normal or abnormal heart sounds, and proposes a heart sound classification algorithm based on the joint decision of extreme gradient boosting (XGBoost) and deep neural network, achieving a further improvement in feature extraction and model accuracy. First, the preprocessed heart sound recordings are segmented into four status, and five categories of features are extracted from the signals based on segmentation. The first four categories of features are sieved through recursive feature elimination, which is used as the input of the XGBoost classifier. The last category is the Mel-frequency cepstral coefficient (MFCC), which is used as the input of long short-term memory network (LSTM). Considering the imbalance of the data set, these two classifiers are both improved with weights. Finally, the heterogeneous integrated decision method is adopted to obtain the prediction. The algorithm was applied to the open heart sound database of the PhysioNet Computing in Cardiology(CINC) Challenge in 2016 on the PhysioNet website, to test the sensitivity, specificity, modified accuracy and F score. The results were 93%, 89.4%, 91.2% and 91.3% respectively. Compared with the results of machine learning, convolutional neural networks (CNN) and other methods used by other researchers, the accuracy and sensibility have been obviously improved, which proves that the method in this paper could effectively improve the accuracy of heart sound signal classification, and has great potential in the clinical auxiliary diagnosis application of some cardiovascular diseases.
Algorithms ; Databases, Factual ; Heart Sounds ; Neural Networks, Computer

Objective:To discuss how to avoid the occurrence of adverse events and provides basis for improving the extracorporeal membrane oxygenation (ECMO) transport safety management to formulate the corresponding preventive measures through analyzing the causes and characteristics of adverse events in transport of ECMO.Methods:By using a self-designed ECMO transport observation table to collect data, with a retrospective study of adverse events in patients with ECMO transport in ECMO center of Beijing Chaoyang Hospital from January 2013 to June 2017, carrying out classification and analysis according to the causes of adverse events and the potential risks of the patients, thus put forward the feasible preventive measures.Results:There were 53 cases of ECMO transport in study period, with 18 cases (33.96%) of adverse events, among which the incidence of adverse events in inner-hospital transport was 34.21% (13/38) and that in inter-hospital transport was 33.33% (5/15). There was no patient died in ECMO transport. In the adverse events of ECMO transport, the main causes were related to transport staff, transport equipment and patient, which accounting for 1/3 of each. Among them, the most prominent was 4 cases (22.22%) of equipment lacking and 3 cases of battery and power supply (16.67%). In classification according to the risk degree of patients, 6 cases (33.33%) of third grade risk were found.Conclusions:It is safe and feasible to carry out ECMO transport in inner-hospital transport and inter-hospital transport based on ECMO transport team and transport process of this hospital. However the unexpected events of high risk or crisis of life is inevitable in ECMO transport. Through standardized training for ECMO team, with full assessment before transport, by the use of ECMO checklist and strict implementation of various transport processes and specifications, the incidence of adverse events in ECMO transport may be reduced.

Objective To evaluate the efficacy of Anzhong-Fuyuan decoction combined with western routine therapy in the treatment of helicobacter pyiori(H.pylori)-positive chronic atrophic gastritis (CAG).Methods A total of 110 H.pylori positive CAG patients who met the inclusion criteria were divided into two groups according to random number table method,55 in each group.The control group was treated with quadruple therapy.On the basis of the control group,the study group was treated with Anzhong-Fuyuan decoction.Both groups were treated continuously for 40 days.The serum level of pepsinogen Ⅰ (Pepsinogen Ⅰ,PG Ⅰ),pepsinogen Ⅱ (PG Ⅱ),gastrin (GAS),endothelin (ET),CRP,IL-6 and TNF-α were detected by ELISA.The eradication rate of H.pylori was measured by 14C urea breath test,and the clinical efficacy was evaluated.Results The total effective rate was 92.7％ (51/55) in the study group and 78.2％ (43/55) in the control group.There were significant differences between the two groups (x2=4.681,P=0.031).The eradication rate of H.pylori was 89.1％ (49/55) in the study group and 76.4％ (42/55) in the control group.There was significant difference between the two groups (x2=3.911,P=-0.048).After treatment,the level of serum PG Ⅰ (84.87 ± 13.95 g/L vs.78.05 ± 12.69 g/L,t=3.434) and PG Ⅰ/PG Ⅱ (6.71 ± 1.26 vs.5.86 ± 1.13,t=2.861) in the study group was significantly higher than those in the control group (P＜0.05),and PG Ⅱ (12.64 ± 1.94 g/L vs.13.31 ± 2.10 g/L,t=3.725) was significantly lower than those in the control group (P＜0.01).The serum level of gastrin (10.76 ± 3.06 mmol/L vs.8.11 ± 2.84 mmol/L,t=4.707) was higher than that of control group (P＜0.01),endothelin (56.64 ± 4.42 ng/L vs.60.42 ± 5.13 ng/L,t=4.140) was significantly lower than that of control group (P＜0.01).After treatment,the level of CRP,IL-6 and TNF-α in the study group was significantly lower than those in the control group (t=11.100,9.571 and 8.687,respectively,all Ps＜ 0.001).Conclusions The Anzhong-Fuyuan decoction combined with routine therapy can significantly enhance the gastric mucosal secretion ability of H.pylori positive CAG patients,increase the ratio of PG Ⅰ/PG Ⅱ,promote the repair and regeneration of gastric mucosa,reduce the level of inflammatory cytokines.

Objective To summarize the best evidence for the prevention of deep venous thrombosis (DVT) in critically ill patients, and to provide a reference for medical institutions and medical staff, so as to reduce the incidence of DVT in critically ill patients. MethodsThe PICO problem was raised for the prevention of DVT in critically ill patients during hospitalization. All evidence concerning the prevention of deep venous thrombosis in critically ill patients were retrieved from PubMed, Cochran Library, BMJ Best Practice, UpToDate,Ovid,Web of Science,Joanna Briggs Institute Evidence-based Health Care Center Database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Registered Nurses' Association of Ontario (RNAO) and China Biology Medicine disc (CBMdisc) by computer, which included guidelines, systematic evaluation, evidence summary and original data intimately related to evidence. The literature quality was evaluated and the recommendation level of evidence was determined according to the JBI evidence recommendation level system (2014 edition). ResultsA total of 15 references were included through electronic database retrieval, including 6 guidelines, 5 evidence summaries and 4 systematic evaluations. According to the judgment of comprehensive professionals, totally 21 evidence selected,including the risk assessment of deep venous thrombosis, drug prevention, mechanical prevention, combined prevention and educational management. ConclusionsThis study summarizes the best evidence for the prevention of DVT in critically ill patients, and helps nurses with ICU decision-making, through the application of best evidence, to promote the prevention of deep venous thrombosis in critical internal medicine patients, improve the outcome of patients and elevate the quality of nursing care.

Objective To explore the predictive value of Cubbin & Jackson Scale and Braden scale on skin postocclusive reactive hyperemia in intensive care unit (ICU) patients. MethodsFrom June 2016 to June 2018, we selected 150 surgical ICU at Xuanwu Hospital of Capital Medical University as subjects by convenient sampling. The Braden Scale and Cubbin & Jackson Scale were used to evaluate the risk of skin postocclusive reactive hyperemia in ICU within 14 days. We compared the sensitivity, specificity, positive predictive value and negative predictive value of two kinds of scale based on the best critical values. The areas under the receiver operating characteristic (ROC) curve were used to compare the predictive value for reactive hyperemia of two kinds of scale. ResultsTaking the concept of reactive hyperemia in "Science and practice of pressure ulcer management" as the gold standard, there were 46 (30.6%, 46/150) cases with reactive hyperemia and 6 (13.0%, 6/46) cases with pressure ulcer. The best critical values of Cubbin & Jackson scale and Braden scale were 29 and 13 respectively. The sensitivity, specificity, positive predictive value, negative predictive value and areas under the ROC of Cubbin & Jackson Scale and Braden Scale were 90%, 63%, 68%, 97%, 0.875 and 96%, 43%, 35%, 94%, 0.537 respectively. ConclusionsThe sensitivity in reactive hyperemia of Cubbin & Jackson Scale is lower,but the the holistic balance is higher than that of Braden scale which shows that the predictive value is higher than that of Braden.