ObjectiveTo explore the improving effects and its synergistic mechanism of Olibanum before and after processing with vinegar on glycodesoxycholic acid（GDCA） intervention in mice with ulcerative colitis（UC） based on the perspective of intestinal flora. MethodC57BL/6J male mice were randomly divided into the normal group， model group， GDCA group， Olibanum group（1.5 g·kg^-1） and vinegar-processed Olibanum（1.5 g·kg^-1） group， with 6 mice in each group. Mice in the normal group drank water freely， and mice in the other groups were given 2% dextran sulfate sodium（DSS） periodically to establish a UC mouse model. During the modeling， GDCA group， Olibanum group and vinegar-processed Olibanum group were intervened by intraperitoneally injection of GDCA（0.05 g·kg^-1）. From the 13^th day after modeling， Olibanum group and vinegar-processed Olibanum group were given the corresponding doses of drugs by gavage， once a day， for 36 d. During this period， the body mass of mice was recorded and the disease activity index（DAI） was assessed. On day 48， faeces were collected for 16S rRNA and metagenomic sequencing to analyse changes in intestinal flora. On the 49^th day， hematoxylin-eosion（HE） staining was used to observe the colon histological lesions， enzyme-linked immunosorbent assay（ELISA） was used to determine serum levels of tumour necrosis factor-α（TNF-α）， interleukin（IL）-1β and IL-6， and Spearman correlation analysis was used to explore the correlation between differential bacterial species and inflammatory factor levels. ResultCompared with the normal group， the model group showed a significant decrease in body weight（P<0.01）， a significant increase in DAI（P<0.05）， and a significant increase in TNF-α， IL-1β and IL-6 levels（P<0.01）， and there was partial infiltration of inflammatory cells in the colon. Compared with the model group， mice in the GDCA group showed a significant decrease in body weight， a significant increase in DAI and levels of TNF-α， IL-1β and IL-6（P<0.01）， and severe disruption of colonic crypt structure， extensive infiltration of inflammatory cells， and a significant decrease in goblet cells. Compared with the GDCA group， both the Olibanum and vinegar-processed Olibanum groups showed a significant recovery in body weight， a significant decrease in DAI and levels of TNF-α， IL-6 and IL-1β（P<0.05， P<0.01）， and the modulating effect of vinegar-processed Olibanum was significantly better than that of Olibanum. Alpha diversity showed that Chao1 index of UC mice significantly increased（P<0.01） and Shannon index decreased significantly（P<0.05） in UC mice after GDCA intervention. Beta diversity showed that the microbial community structure of the 5 groups had significant changes， Olibanum and vinegar-processed Olibanum could modulate the changes in the structure of the intestinal flora in UC mice after GDCA intervention. Microbial sequencing results indicated that， compared with the normal group， the Firmicutes/Bacteroidetes ratio in the model group was significantly higher（P<0.05）， and the relative abundance of 3 genera and 5 species of flora changed significantly（P<0.05， P<0.01）. Compared with the model group， the Firmicutes/Bacteroidetes ratio in the GDCA group was significantly higher（P<0.05）， the relative abundance of 7 pathogenic bacterial genera and four species was significantly increased（P<0.05， P<0.01）， and the relative abundance of three beneficial bacterial genera and Bacteroides_intestinalis was significantly decreased（P<0.05， P<0.01）. Olibanum group and vinegar-processed Olibanum group could modulate the Firmicutes/Bacteroidetes ratio， the relative abundance of pathogenic bacteria and beneficial bacteria， and the vinegar-processed Olibanum group was significantly superior to Olibanum group in terms of modulating the Firmicutes/Bacteroidetes ratio， the relative abundance of the three genera and five species of bacteria（P<0.01， P<0.05）. Correlation analysis showed that the relative abundance of Bacteroides_intestinalis was negatively correlated with the levels of TNF-α， IL-6 and IL-1β， the relative abundance of Prevotella_sp_CAG873， Bacteroides_sp_CAG927， Bacteroidales_bacterium_52_46 and Bacteroidales_bacterium was positively correlated with TNF-α， IL-6 and IL-1β levels. ConclusionGDCA can exacerbate UC colonic inflammation， and Olibanum and vinegar-processed Olibanum have an ameliorative effect on GDCA-mediated UC， with the vinegar-processed Olibanum showing a stronger ameliorative effect， the mechanism may be related to the regulation the abundance and structure of intestinal beneficial and pathogenic bacteria， and the reduction of inflammatory factor levels.

Objective To retrieve,analyse and integrate the best evidences in perioperative fluid management for elderly patients with hip fracture,therefore to provide references for patient care.Methods Following the 6S evidence model,databases and websites were searched to collect the evidences on perioperative fluid management of elderly patients with hip fracture.The searched databases including BMJ Best Practice,UpToDate,AAOS Clinical Practice Guidelines,ASBMR,ANZHFR,ESTES,NICE,SIGN,JBI,Cochrane Library,CINAHL,Embase,PubMed,Web of Science,CNKI,Wanfang Data,VIP database,CEBM Database,Medive,China Science and Technology Journal Database,SinoMed,and other websites about orthopaedics.The searched literatures included guidelines,clinical decision-making,best practices,expert consensus and systematic reviews.The time span for the published literatures was from the inception of the databases and websites to August 2022.Two researchers independently completed quality evaluations of the retrieved literatures,as well as extraction,assessment and integration of the abstracted evidences.Results A total of 15 articles were included,they were 2 guidelines,3 clinical decision-makings,1 best practice,7 expert consensus,and 2 systematic reviews.Thirty pieces of evidence were summarised from 7 aspects,covering multidisciplinary team collaboration,dynamic assessment and monitoring of fluid status,fluid resuscitation,fluid management before and after the surgery and health education.Conclusions This study summarised the best evidences in perioperative fluid management for elderly patients with hip fracture.The evidences provide an evidence-based solution which will enable the healthcare workers to fully combine the clinical scenarios,evaluate changes in fluid volume status dynamically,develope personalised fluid management strategies and improve patient outcomes.

To develop a rapid differential detection method for porcine epidemic diarrhea virus(PEDV)and transmissible gastroenteritis virus(PEDV),M gene sequences of PEDV and TGEV were compared,the inner and outer primer pairs and probes were designed according to the highly conserved region.PEDV-Probe was labeled with FAM at5'end and BHQ1 at 3'end.TGEV-Probe was labeled with CY5.5 at the 5'end and BHQ2 at the 3'end.After optimizing the reaction condi-tions and system,a dual fluorescent RT-LAMP assay for PEDV and TGEV rapid identification was established.The amplification could be completed within 60 min in a 63 ℃ water bath and then stopped at 85 ℃ for 10 min.Then the tubes were placed in a multicolor imaging system,and the re-sults could be observed under 520 nm and 690 nm dual channels.There was no cross-reaction when other common swine viral pathogens were detected by this method.The sensitivity of the assay was evaluated with a 10-fold diluted recombinant plasmid as templates.The lowest detection limit was 102 copies/μL recombinant plasmid,which was 10 times more sensitive than the conventional RT-PCR method.Seventy-two PEDV-positive samples,49 TGEV-positive samples,and 40 PEDV and TGEV co-infected samples were detected from 175 anal swab samples of diarrheic piglets by the established method,which were all higher than the detection rates of the conventional RT-PCR method.The dual fluorescent RT-LAMP method established in this study can be used to amplify the target gene in an ordinary water bath without gel electrophoresis,which provides technical sup-port for rapid and convenient differential diagnosis of PED and TGE and simultaneous detection of PEDV and TGEV co-infection.

Objective"Astragalus-Leech"medicine pair can reduce cerebral ischemia-reperfusion injury(CIRI),but its mechanism of action is not yet clear.Ferroptosis is a new target of CIRI.In this paper,the mechanism of the"Astragalus-Leech"medicine pair on regulating ferroptosis in the treatment of CIRI was investigated using the network pharmacology approach.Methods The active ingredients and targets of Astragalus-Leech were obtained by searching databases,such as PubChem,SwissTargetPrediction,Batman-TCM,UniProt,TCMSP and other databases,respectively;the CIRI-related targets were collected by searching GeneCards database;the Venny online tool was used to obtain the common targets of"Astragalus-Leech"medicine pairs for active ingredients and CIRI.Cytoscape software was used to construct a network of interrelationships between the active ingredients,disease and predicted targets of the"Astragalus-Leech"medicine pair,the protein interaction network was visualized,and CytoHubba plug-in was used to calculate the core targets.The GO analysis and KEGG analysis of the targets of"Astragalus-Leech"in the treatment of CIRI were performed using R language software.Using FerrDb database,the genes related to the regulation of ferroptosis were obtained,and the common genes among the active ingredients,CIRI and ferroptosis in the"Astragalus-Leech"medicine pair were analyzed to investigate their relationship and make predictions.AutoDockTools 1.5.7 and other softwares were used to verify the molecular docking between the active ingredients and key targets.Results Through searching the databases,28 active ingredients of"Astragalus-Leech"medicine pair,680 predicted gene targets of the drug pair,1513 targets related to CIRI,253 common targets of drug pair-disease,259 targets related to ferroptosis were obtained.28 potential targets,including PIK3CA,RELA,MAPK1,MAPK8,PTGS2,STAT3,SRC,NOS2,etc.on the regulation of ferroptosis and intervention in CIRI,and 279 signaling pathways including PI3K-Akt,Ras,TNF,MAPK,and HIF-1 were obtained through related prediction.Molecular docking showed that there was an interaction between the key components of the drug pair and the core targets.The"Astragalus-Leech"medicine pair may intervene in the development of CIRI by regulating ferroptosis and exert its therapeutic effects.Conclusion Using network pharmacology methods,the potential targets and related pathways of"Astragalus-Leech"on the active ingredients by regulating ferroptosis against CIRI were analyzed,suggesting that"Astragalus-Leech"may play its role in anti-CIRI through oxidative stress and anti-inflammatory pathways to regulate ferroptosis pathway,and provide a basis for further cell and animal experiments.

ObjectiveTo investigate the synergistic mechanism of vinegar-processed Olibanum on ulcerative colitis（UC） via the bile acids regulating "gut-liver" crosstalk. MethodRats were randomly divided into normal group， model group， Olibanum group and vinegar-processed Olibanum group. UC model of rats was induced by intracolonic instillation of 2，4，6-trinitrobenzenesulfonic acid（TNBS）. Ultra high performance liquid chromatography-triple quadrupole-mass spectrometry（UPLC-QQQ-MS） was used to perform the qualitative analysis of 30 bile acids in the colon of rats. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） and Western blot were used to detect changes in the expression of farnesoid X receptor（FXR）， fibroblast growth factor 15（FGF15） and FGF receptor 4（FGFR4） in "gut-liver" crosstalk at mRNA and protein levels. And with the help of HcoEpiC cell model intervened by conjugated bile acids， simulating the UC state， and according to the different modes of intervention， they were divided into the blank group， conjugated bile acid group， Olibanum group， vinegar-processed Olibanum group and 3-O-acetyl-9，11-dehydro-β-boswellic acid（ADHBA） group. The effect of Olibanum before and after processing with vinegar and the main differential component ADHBA on the mRNA expression of FXR and FGF19 were explored by Real-time PCR. ResultCompared with the normal group， the levels of conjugated bile acids in the model group increased significantly（P<0.01）， and the mRNA and protein expressions of "gut-liver" crosstalk factors FXR， FGF15 and FGFR4 decreased significantly（P<0.05， P<0.01）. Compared with the model group， the content of conjugated bile acids in the Olibanum group and vinegar-processed Olibanum group was significantly decreased（P<0.01）， the mRNA and protein expressions of FXR， FGF15 and FGFR4 were significantly elevated（P<0.05， P<0.01）， and vinegar-processed Olibanum exhibited superior effects than Olibanum. In cellular experiments， a significant decrease in mRNA expression of FXR and FGF19 was observed in the conjugated bile acid group when compared with the blank group（P<0.01）. Compared with the conjugated bile acid group， the mRNA expressions of FXR and FGF19 were significantly higher in the Olibanum， vinegar-processed Olibanum and ADHBA groups（P<0.05， P<0.01）， and the effect of vinegar-processed Olibanum was more favorable. ConclusionVinegar-processed Olibanum may enhance the ameliorating effect on UC by enhancing the down-regulation of conjugated bile acids in the colon and the up-regulation of FXR-FGF15/19-FGFR4 "gut-liver" crosstalk pathway， and ADHBA may be the main material basis for the synergy.

In June 2022, a carbon monoxide poisoning accident with hidden source occurred in a bonded gold/silver wire manufacturing enterprise in Guangzhou, causing 10 people to be poisoned, of which 1 was caused by carbon monoxide poisoning and 9 by carbon monoxide contact reaction. The symptoms were dizziness, fatigue and vomiting. After 5 to 7 h, the saturation of carboxyhemoglobin in finger pulse was 4% to 10%, and the saturation of carboxyhemoglobin in blood gas biochemical analysis was 1.9% to 5.8%. The concentration of carbon monoxide detected in the carbon borne purification plant of the enterprise was 34.46-37.26 mg/m 3. It was judged that the accident was carbon monoxide poisoning caused by carbon monoxide gas being transported to the work post along the gas transmission pipeline due to abnormal operation of the carbon borne purification plant. By investigating the source and cause of poison, this paper provides a warning for the similar process to prevent similar events, and provides a new idea for the identification of chemical poisoning risk. At the same time, it is warned that similar enterprises should fully consider the risk of poisoning under specific circumstances, strengthen equipment maintenance and repair, and prevent the occurrence of similar incidents.

In June 2022, a carbon monoxide poisoning accident with hidden source occurred in a bonded gold/silver wire manufacturing enterprise in Guangzhou, causing 10 people to be poisoned, of which 1 was caused by carbon monoxide poisoning and 9 by carbon monoxide contact reaction. The symptoms were dizziness, fatigue and vomiting. After 5 to 7 h, the saturation of carboxyhemoglobin in finger pulse was 4% to 10%, and the saturation of carboxyhemoglobin in blood gas biochemical analysis was 1.9% to 5.8%. The concentration of carbon monoxide detected in the carbon borne purification plant of the enterprise was 34.46-37.26 mg/m 3. It was judged that the accident was carbon monoxide poisoning caused by carbon monoxide gas being transported to the work post along the gas transmission pipeline due to abnormal operation of the carbon borne purification plant. By investigating the source and cause of poison, this paper provides a warning for the similar process to prevent similar events, and provides a new idea for the identification of chemical poisoning risk. At the same time, it is warned that similar enterprises should fully consider the risk of poisoning under specific circumstances, strengthen equipment maintenance and repair, and prevent the occurrence of similar incidents.

Objective:To identify the risk factors of heart failure in elderly patients with hip fracture by Meta-analysis.Methods:The clinical studies on perioperative heart failure in elderly patients with hip fracture were searched by computer in Pubmed, EMbase, Cochrane Library, Medline, Web of Science, CNKI, CBM, Wanfang and VIP database. The retrieval period was from the establishment of the databases to October 2021. The literature screening, data extraction and quality evaluation were completed by two researchers, and the selected literature were statistically analyzed by RevMan5.3 software.Results:A total of 17 articles were included in this study, involving 1 76 611 patients and 24 related risk factors. Cardiac history ( OR= 4.47, 95% CI 3.56-5.62), positive balance of perioperative inflow and outflow ( OR=5.99, 95% CI 3.30-10.87), anemia ( OR= 3.78, 95% CI 2.50-5.69), and the number of complications >4 ( OR=6.21, 95% CI 3.71-10.38), electrolyte disorder ( OR=7.40, 95% CI 3.77-14.54), preoperative cognitive impairment ( OR=3.60, 95% CI 1.39-9.31) and American Society of Anesthesiologists (ASA) grade ≥ 3 ( OR= 4.73, 95% CI 2.73-8.12) were statistically significant risk factors ( P<0.05). Conclusions:Cardiac history, positive balance of perioperative inflow and outflow, anemia, number of complications >4, electrolyte disorder, preoperative cognitive impairment and ASA grade ≥3 were the risk factors of perioperative heart failure in elderly patients with hip fracture.

Objective:To observe the effect of simulation combined with problem-based learning (PBL) in the clinical practice teaching of internal medicine.Methods:A total of 41 internal medicine interns accepted from January 2019 to August 2019 in The Third Hospital of Hubei Medical University were selected as the control group, and the traditional clinical teaching was adopted. Another 43 internal medicine interns received from September 2019 to August 2020 were selected as the experimental group, and the simulation combined with PBL teaching was adopted. The clinical skill knowledge and practical operation skills were compared between the two groups in the examination results, the changes in clinical ability before and after the internship, and the recognition of the teaching. SPSS 25.0 was used for t-test, Chi-square test, and rank sum test. Results:The clinical skill knowledge and practical operation skills of interns in the experimental group [(94.51±4.49), (91.05±7.66)] were higher than those in the control group [(89.20±9.23), (85.63±11.57)] ( P<0.05). There was no significant difference in various scores and total scores of clinical competences (including medical interview skills, physical examination skills, humanistic care skills, clinical judgment skills, communication skills, organizational effectiveness, and overall clinical competence) between the two groups before internship. After the internship, the above scores and total scores of the two groups were higher than those before the internship, and the experimental group was higher than the control group ( P < 0.05). The total recognition of the teaching by interns in the experimental group was 95.35% (41/43), which was significantly higher than 78.05% (32/41) in the control group. Conclusion:Simulation combined with PBL teaching can significantly improve the clinical skill knowledge, practical operation level, clinical ability, and recognition of teaching of medical interns.

Objective:To investigate the methylation status of SDC2, PPP2R5C and ADHFE1 genes in stool and their values in the screening of colorectal cancer and precancerous lesions.Methods:From August 2020 to March 2021, 64 patients with colorectal cancer, 72 patients with adenoma, 33 patients with hyperplastic polyps and 59 healthy people were recruited from Qingdao Central Hospital Affiliated to Qingdao University, and the morning stool samples were collected from the research subjects. The genomic DNA was extracted and modified with sulfite. The methylation status of SDC2, PPP2R5C and ADHFE1 genes were detected by methylation specific polymerase chain reaction (MSP), and the fecal occult blood test (FOBT) was performed. Taking the pathological results as the gold standard, receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to compare the effect of combined detection of methylation of three genes and FOBT in predicting colorectal cancer and precancerous lesions. R-Studio software was used to construct a nomogram for the prediction of colorectal cancer with combined detection of gene methylation in stool and other clinical features, and the calibration and validation were performed.Results:The positive rates of combined detection of methylation of SDC2, PPP2R5C and ADHFE1 genes in stool were higher than those of FOBT in colorectal cancer+adenoma [74.3% (101/136) vs. 47.1% (64/136), χ2 = 23.20, P = 0.001], colorectal cancer [90.6% (58/64) vs. 70.3% (45/64), χ2 = 8.91, P = 0.003] and adenoma [59.7% (43/72) vs. 26.4% (19/72), χ2 = 14.43, P = 0.002]. There was no significant difference in the positive rates in hyperplastic polyps [21.2% (7/33) vs. 6.1% (2/33), χ2 = 0.12, P = 0.125] and healthy controls [10.2% (6/59) vs. 8.5% (5/59), χ2 = 4.01, P = 1.000]. The combined detection of gene methylation was better than FOBT in the prediction of colorectal cancer + adenoma [AUC: 0.85 (95% CI 0.80-0.91) vs. 0.71 (95% CI 0.64-0.78), P < 0.05], especially in the prediction of adenoma [AUC: 0.82 (95% CI 0.74-0.89) vs 0.64 (95% CI 0.57-0.69), P < 0.001]. The sensitivity and specificity of ADHFE1 gene methylation status in predicting colorectal cancer were high (90.6% and 96.6%). In colorectal cancer patients over 50 years old, the positive rate of combined detection of gene methylation was higher than that of FOBT [90.2% (55/61) vs. 68.9% (42/61), P < 0.05]. The nomogram calibration curve for predicting colorectal cancer constructed based on the combined detection of gene methylation and each clinical feature showed a high degree of concordance between the predicted and observed diagnostic performance of colorectal cancer. Conclusions:The methylation levels of SDC2, PPP2R5C AND ADHFE1 genes in stool are increased in patients with colorectal cancer or adenoma. The combined detection of gene methylation is expected to be a non-invasive method for the screening of colorectal cancer and precancerous lesions.