The purpose of this study is to summarize the “One Exemption and Three Priority Policy” model based on tight medical consortia （hereinafter referred to as “medical consortia”），and to conduct field research on the current implementation status and problems of existing medical consortia in primary gastrointestinal tumor screening. Combined with relevant data，the actual effects，advantages and disadvantages are compared and analyzed，and the experience and lessons learned from their development are summarized，providing data support，theoretical reference，and countermeasures for promoting the development of medical consortia. At the same time，the research content on medical consortia is enriched，providing reference for future research on medical consortia.
To investigate the expression level of miR-34a-5p in patients with colon cancer and analyze its correlation with the clinical characteristics and prognosis of these patients.
Methods
A prospective cohort study was conducted. Patients with colon cancer accompanied by peritoneal metastasis who underwent treatment in Xinjiang Medical University Affiliated Traditional Chinese Medicine Hospital from January 1，2021 to December 31，2021 were selected. A sample of 60 patients was planned，and the cancer focus and adjacent tissue samples of the patients were collected.Real-time quantitative PCR was used to detect the relative expression level of miR-34a-5p in the cancer focus and adjacent tissue samples，and the correlation between the relative expression level of miR-34a-5p and the clinical characteristics of colon cancer patients was analyzed. The patients with colon cancer were followed up，Kaplan-Meier curves were drawn，and prognostic factors were analyzed using COX regression.
Results
In the end，58 patients with colon cancer were included，and the relative expression level of miR-34a-5p in cancer focus tissues was significantly lower than that in adjacent tissues，with a statistically significant difference （P＜0.001）. Grouped by the average relative expression level of miR-34a-5p in cancer focus tissues of colon cancer patients，the results showed that N staging and differentiation degree were related to the expression level of miR-34a-5p. Drawing Kaplan-Meier survival curves，the results showed that the survival rate of the low expression group of miR-34a-5p in colon cancer was significantly lower than that of the high expression group，with a statistically significant difference（P=0.028）. Univariate analysis showed that T staging，N staging，differentiation degree，and miR-34a-5p expression level were related to the survival period of colon cancer patients，with statistically significant differences （P＜0.05）. Multivariate COX regression model results suggested that differentiation degree and miR-34a-5p expression level were independent factors affecting the prognosis and survival period of colon cancer patients.
Conclusion
In the lesion tissues of colon cancer patients，the expression level of miR-34a-5p decreases，and the expression level of miR-34a-5p is related to N staging and differentiation degree. The expression level of miR-34a-5p is an independent factor affecting prognosis and survival period.
To investigate the effects of long non-coding RNA LINC00839 on the proliferation，apoptosis，and migration of colorectal cancer （CRC） cells by regulating the microRNA-17-5p（miR-17-5p）/serine/threonine protein kinase 1 （WEE1） axis.
Methods
The expression levels of LINC00839，miR-17-5p，and WEE1 mRNA in CRC cell lines were detected to screen the optimal cell line.LS513 cells were separated into Control group，LINC00839 knockdown negative control group （si-NC group），LINC00839 knockdown group （si-LINC00839 group），LINC00839 knockdown+miR-17-5p inhibition negative control group （si-LINC00839+NC inhibitor group），and LINC00839 knockdown+miR-17-5p inhibitor expression group （si-LINC00839+miR-17-5p inhibitor group）. qRT-PCR was applied to detect the expression levels of LINC00839，miR-17-5p，and WEE1 mRNA in cells. Dual luciferase reporter gene experiment was applied to verify the targeting relationship between LINC00839，miR-17-5p，and WEE1. MTT was applied to detect cell viability. Edu was applied to detect cell proliferation. Scratch experiment was applied to detect the migration ability of cells. Flow cytometry was applied to detect cell apoptosis. Western blot was applied to detect protein levels of WEE1，PCNA，Bax，Bcl-2，caspase-3，E-cadherin，and N-cadherin.
Results
In the CRC cell line，LINC00839 and WEE1 mRNA were highly expressed，while miR-17-5p was low expressed. LS513 cells were selected for the experiment. Dual luciferase reporter gene experiment confirmed a targeted relationship between miR-17-5p and LINC00839，WEE1. Knocking down LINC00839 up-regulated miR-17-5p expression and down-regulated WEE1 expression. Knocking down LINC00839 greatly reduced LS513 cell viability，Edu positive rate，scratch healing rate，and expression of PCNA，Bcl-2，N-cadherin，and WEE1 proteins （P＜0.05），while greatly increased the expression of Bax，caspase-3，and E-cadherin proteins （P＜0.05）. Inhibiting the expression of miR-17-5p was able to reverse the inhibitory effect of LINC00839 knockdown on the malignant biological behavior of LS513 cells （P＜0.05）.
Conclusion
LINC00839 is up-regulated in CRC cells，and knocking down LINC00839 may inhibit CRC cell proliferation and migration by regulating the miR-17-5p/WEE1 axis，promoting cell apoptosis.
To investigate the construction and validation of a model for prediction of colorectal cancer （CRC） by circulating tumor DNA （ctDNA） methylation.
Methods
Prospectively enrolled colorectal cancer patients between August 2021 and July 2023 were selected as the study subjects（CRC group），and age-and gender-matched healthy medical check-ups in the same period served as the control group. The two groups were compared in terms of clinical data and serum ctDNA methylation levels； DNA methylation markers of CRC were obtained from the public database “Marmal-aid”； DNA methylation markers were screened by LASSO and RF analyses. The model of CRC prediction based on the screened DNA methylation markers was constructed by ROC curve and logistic multifactorial regression analysis； the prediction efficacy of the model for CRC was clarified by the training cohort and validation cohort，respectively.
Results
A total of 3997 differentially DNA methylated CpGs （DMCs）were identified by screening through public databases，and 19 methylation markers were retained by stepwise screening through hierarchical clustering and KEGG showing the different methylation patterns and enrichment pathways between CRC and normal colorectal mucosa in these DMCs. The stability of the 19 markers was assessed by LASSO and RF analyses，and three DNA methylation markers （cg08131100，cg16934178，and cg24171907） were obtained，with predicted AUCs of 0.887，0.841，and 0.715 for CRC，respectively. Logistic regression analyses showed that cg08131100，cg16934178 and cg24171907 were independent risk factors influencing the onset of CRC； the methylation scores of CRC were significantly higher than those of the control group in both the training and validation cohorts； and the efficacy of the methylation model in predicting CRC was evaluated by ROC curves，and the model had an AUC of 0.841 in the training group （95% CI： 0.756-0.927），and the AUC of the model in the validation group was 0.823 （95%CI： 0.728-0.919）.
Conclusion
This study constructs a model for prediction of CRC patients based on ctDNA methylation，which provides a clinically translatable tool for noninvasive detection and screening of CRC.
To analyze the correlation between multi-slice spiral CT，carcinoembryonic antigen （CEA），mismatch repair gene （MMR） protein level，pathological indicators and prognosis in patients with colorectal cancer.
Methods
A total of 100 patients with colorectal cancer admitted to Huainan Oriental Hospital Group General Hospital from January 2019 to September 2021 were included. According to their 3-year survival，the patients were divided into survival group and death group. The differences in multi-slice spiral CT characteristics，CEA levels，and MMR protein detection results of the pathological tissues removed during operation between the two groups were sorted out and compared. Logistic multivariate regression analysis was used to summarize the related factors affecting the prognosis of patients with colorectal cancer.
Results
All 100 patients were effectively followed up，with a median follow-up time of 69 months. At the end of 3-year follow-up，31 patients died and 69 patients survived，with a 3-year mortality rate of 31.00%.Logistic multivariate regression analysis showed that the plain scan CT value ≤40 HU，enhanced scan CT value ≤75 HU，increased peripheral fat density，thickened blood vessels，uneven tumor enhancement，lymph node metastasis，CEA ≥13.50 μg/L，tumor diameter ≥5 cm，TNM stage Ⅲ，and moderate to poor differentiation were independent risk factors affecting the 3-year survival rate of colorectal cancer，and the loss of MMR protein expression was a protective factor （P＜0.05）.
Conclusion
The prognosis of colorectal cancer patients is closely related to the characteristics of multi-slice spiral CT，CEA and pathological indexes，and the loss of MMR protein may be associated with a higher 3-year survival rate.
To thoroughly analyze the two main subtypes of familial adenomatous polyposis （FAP），to understand the similarities and differences in their clinical characteristics，and to explore the relationship between APC gene mutations and disease progression.
Methods
This retrospective study encompassed 65 FAP patients who were treated and treated at the People's Hospital of Wuhan University from January 2013 to December 2023，including 36 classical FAP （CFAP） and 29 attenuated FAP （AFAP） cases. By analyzing the clinical data of these patients and datasets from gene expression databases，we identified differentially expressed genes （DEGs） and conducted Gene Ontology（GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis，as well as Gene Set Enrichment Analysis （GSEA）.
Results
Clinical data analysis revealed significant differences between CFAP and AFAP patients in terms of age of onset，symptom manifestation，and risks of colorectal cancer development. Gene expression analysis highlighted significant differences between these two FAP subtypes，especially in terms of cell proliferation，apoptosis，and signal pathway regulation. The DEGs were primarily involved in biological processes such as response to symbiont，viral processes，and positive regulation of cytokine production，with KEGG pathway enrichment analysis indicating their involvement in NOD-like receptor signaling pathways. GSEA suggested that fundamental biological processes like the cell cycle，mitosis，and DNA synthesis played crucial roles in the development of CFAP.
Conclusion
By integrating bioinformatics methods and clinical data analysis，this study has revealed significant clinical and molecular differences between the CFAP and AFAP subtypes of FAP. These differences are vital for understanding the disease progression mechanisms of different FAP subtypes，providing new insights and potential targets for clinical diagnosis and treatment of FAP，and providing an important foundation for future treatment and management.
To analyze the consistency between preoperative multi-slice spiral CT（MSCT） and dynamic contrast enhanced MRI （DCE-MRI） diagnosis of TNM staging and postoperative pathological results of gastric cancer，in order to provide reliable imaging data for clinical treatment.
Methods
A total of 102 patients with gastric cancer confirmed by gastroscopy biopsy and pathology in our hospital from January 2022 to December 2023 were selected，who underwent MSCT and DCE-MRI examinations and underwent concurrent surgical treatment. MSCT and MRI images were reviewed by two radiologists with more than 10 years of experience in double-blind method. Postoperative pathologic results were used as the gold standard to calculate the accuracy of different examinations in evaluating TNM staging of gastric cancer. Kappa test was used to analyze the consistency of MSCT and DCE-MRI examination results with postoperative pathological findings.
Results
The postoperative pathological results of 102 patients showed that there were 20，18，21 and 43 cases in T1-4 stage，respectively，and 28，19，18 and 37 cases in N0-3 stage，respectively. There were 98 cases of M0 stage and 4 cases of M1 stage.Compared with postoperative pathological findings，the total accuracy of MSCT examination in the diagnosis of gastric cancer T stage was 72.54% （74/102），which was significantly lower than that of DCE-MRI （91.17%，93/102）. The total accuracy of MSCT in the diagnosis of N stage of gastric cancer was 72.54% （74/102），which was significantly lower than 86.27% （88/102） of DCE-MRI. The overall accuracy of MSCT in the diagnosis of M stage of gastric cancer was 92.15% （94/102），which was not significantly different from that of DCE-MRI （97.05%，99/102）. The Kappa value of MSCT and DCE-MRI in the diagnosis of M stage of gastric cancer was similar （0.927 vs. 0.958）. The Kappa values of DCE-MRI in the diagnosis of T and N stage of gastric cancer were 0.927 and 0.876，respectively，which were better than those of MSCT.
Conclusion
Compared with MSCT examination，DCE-MRI has higher accuracy in evaluating TNM staging of gastric cancer and more significant consistent with postoperative pathology，which can provide powerful imaging support for preoperative diagnosis of gastric cancer.
To investigate the mechanism of miR-181a-5p targeting ATG5 to inhibit autophagy in rat pancreatic acinar AR42J cells induced by cerulein.
Methods
AR42J cells were treated with 100 nmol/L cerulein in vitro to simulate acute pancreatitis （AP）. miR-181a-5p mimics and oe-ATG5 were transfected into AR42J cells. AR42J cells were divided into Control group （without any treatment），AP group （model group），AP+mimic NC and AP+mimic miR groups （transfected mimic NC or miR-181a-5p mimic into AR42J cells for 24 h，and then modeled induced by cerulein），and AP+mimic miR+oe-NC and AP+mimic miR+oe-ATG5 groups （transfected miR-181a-5p mimic，oe-NC or oe-ATG5 into AR42J cells for 24 h，and then modeled induced by cerulein）. ELISA was used to determine the expression levels of TNF-α and IL-6，and RT-qPCR was performed to determine the expression of miR-181a-5p. MTT assay was used to assess cell viability，and immunofluorescence was conducted to detect the autophagy marker LC3. The miRWalk database predicted potential binding sites between miR-181a-5p and ATG5，and the dual-luciferase reporter assay was used to verify the targeting relationship between miR-181a-5p and ATG5. Western blot analysis was employed to measure the expression levels of autophagy-related proteins （Beclin-1，LC3 Ⅱ/I） and ATG5 protein.
Results
An in vitro AP model was successfully established. Significantly increased levels of TNF-α and IL-6 were noticed in the AP group compared to the Control group. miR-181a-5p expression was down-regulated in cerulein-induced AR42J cells. Compared to the AP+mimic NC group，the AP+mimic miR group showed increased cell viability，down-regulated expression patterns of autophagy-related proteins Beclin-1 and LC3 Ⅱ/I，and a reduced number of LC3-positive cells. Dual-luciferase reporter assay revealed that miR-181a-5p negatively regulated ATG5. Further experiments indicated that re-expression of ATG5 could partially reverse the inhibitory effect of miR-181a-5p overexpression on autophagy induced by cerulein in AR42J cells.
Conclusion
miR-181a-5p inhibits cerulein-induced autophagy in AR42J cells by targeting ATG5. This mechanism may play a crucial role in autophagy regulation in AP.
To study the correlation between CT and color Doppler ultrasound diagnostic parameters and the condition and prognosis of patients with acute pancreatitis （AP） complicated with fatty liver.
Methods
A total of 150 AP patients with fatty liver admitted to The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2023 were selected. According to the condition of the patients，they were divided into mild，moderate and severe groups； according to the prognosis of the patients，they were divided into survival group and death group. The characteristics of CT and color Doppler ultrasound parameters of patients with different conditions and prognosis were compared，and the correlation between CT and color Doppler ultrasound parameters and the condition and prognosis of patients was summarized by Logistic multivariate regression analysis.
Results
Among the 150 AP patients with fatty liver，there were 76 cases of mild AP，44 cases of moderate AP，and 30 cases of severe AP； 10 patients died within 28 days of treatment，and the mortality rate was 6.67%. Multivariate analysis showed that severe fatty liver，liver CT value ≤40 HU，spleen CT value ≥70 HU，L/S ≤0.50，and CT showed reduced pancreatic density，perirenal fascia thickening，ascites and CT grading D-E were independent risk factors affecting the condition of AP patients with fatty liver （P＜0.05）； age ≥60 years，severe fatty liver，liver CT value ≤40 HU，spleen CT value ≥70 HU，L/S≤0.50，and CT showed perirenal fascia thickening and CT grading D-E were independent risk factors affecting the prognosis of AP patients with fatty liver （P＜0.05）.
Conclusion
CT and color Doppler ultrasound signs and parameters can provide certain reference for the condition evaluation and prognosis prediction of AP patients with fatty liver.
To investigate the predictive value of prognostic nutritional index （PNI），serum procalcitonin （PCT），serum cystatin C （CysC），and serum retinol binding protein （RBP） for patients with acute pancreatitis （AP） complicated with acute kidney injury （AKI）.
Methods
A retrospective analysis was conducted on 350 patients with AP admitted to Wuxi Xishan People's Hospital from June 2022 to June 2024. Patients were divided into two groups based on whether they had concurrent AKI： the AP group and the AP+AKI group. The differences in PNI，PCT，CysC，and RBP levels between the two groups were compared，and their correlations with AP evaluation indicators APACHEⅡ score，Ranson score，and Balthazar CTSI score were analyzed through Spearson analysis. The predictive abilities of PNI，PCT，CysC，and RBP levels for AP combined with AKI were evaluated through ROC curve and multivariate logistic analysis.
Results
The PNI level，APACHE Ⅱ score，Ranson score，and Balthazar CTSI of patients in the AP group were significantly higher than those in the AP+AKI group，while the serum PCT，CysC，and RBP levels were significantly lower than those in the AP+AKI group （P＜0.05）；Spearson correlation analysis showed that PNI was negatively correlated with APACHE Ⅱ score，Ranson score，and Balthazar CTSI score，while PCT，CysC，and RBP were positively correlated with APACHE Ⅱscore，Ranson score，and Balthazar CTSI score （P＜0.05）. The ROC curve showed that the area under the PNI+PCT+CysC+RBP joint curve was 0.923，with a 95% confidence interval of 0.861-0.984 （P＜0.05）.Multivariate logistic analysis showed that PNI [OR=0.425，95% CI （0.193-0.755）]，PCT [OR=4.632，95%CI （2.131-5.085）]，CysC [OR=2.076，95% CI （1.635-2.978）]，and RBP [OR=3.261，95% CI （2.478-4.639）]were independent risk factors for AKI in AP patients.
Conclusion
PNI，PCT，CysC，and RBP levels can be used as indicators for predicting AKI in AP patients，which are conducive to early detection of high-risk patients with AP prone to AKI，optimization of treatment strategies，and improvement of patient prognosis，and have high clinical significance for promotion.
To explore the diagnostic value of CT and ultrasound in acute pancreatitis patients complicated with fatty liver.
Methods
A retrospective analysis was performed on clinical and imaging data of 100 patients with acute pancreatitis in Yilong County People's Hospital between May 2021 and July 2023. All patients underwent CT and color Doppler ultrasound examinations. The imaging characteristics of acute pancreatitis and the detection of fatty liver of the two detection methods were analyzed.The detection of fatty liver by CT and color ultrasound was analyzed by Kappa analysis.
Results
Among 100 patients with acute pancreatitis，there were 67 cases with fatty liver and 33 cases without. CT examination showed that there were 91 cases （91.00%） with increased CT volume of pancreas，86 cases （86.00%） with decreased density and 40 cases （40.00%） with decreased CT density of liver [including 19 cases （47.50%）with diffuse decrease and 21 cases （52.50%） with limited decrease]. The ultrasound examination showed that there was pancreas enlargement to different extent，including 48 cases （48.00%） with blurred edge and decreased echo，52 cases （52.00%） with blurred contour and uneven echo. There were 32 cases （32.00%）with non-obvious hepatic vessels and strong echo，and 18 cases （18.00%） with uneven ultrasonic texture of liver. CT showed that there were 40 cases with fatty liver，with Kappa consistency of 0.650. Color ultrasound showed that there were 50 cases with fatty liver，with Kappa consistency of 0.520. There were no statistically significant differences in accuracy，sensitivity and specificity between CT and color ultrasound in the diagnosis of fatty liver （65.00%，59.70%，75.80% vs 77.00%，74.60%，81.80%，P＞0.05）.
Conclusion
There is few difference between CT and color Doppler ultrasound in diagnosis of patients with acute pancreatitis，and both have high diagnostic value in fatty liver.
To analyze the clinical effect of transjugular intrahepatic portosystemic shunt （TIPS） in preventing upper gastrointestinal bleeding.
Methods
A total of 120 patients with acute upper gastrointestinal bleeding admitted to the Second Affiliated Hospital of Xingtai Medical College from February 2021 to February 2023 were selected and randomly divided into ligation group （n=60） and TIPS group （n=60）.The two groups were treated with endoscopic variceal ligation and TIPS respectively. The changes of portal pressure gradient，blood routine，blood flow and liver function were compared between the two groups before and after operation，and the patients were followed up for 12 months to record the incidence of cumulative rebleeding.
Results
The pressure gradient of portal vein decreased after operation in both groups. The portal vein pressure gradient，portal vein blood flow and splenic vein blood flow in TIPS group were lower than those in ligation group （P＜0.05）. Platelet，hemoglobin and red blood cell in the two groups were all higher than those before operation on the 3rd day after operation （P＜0.05）. At the same time，there was no statistical difference in blood routine indexes between the two groups （P＞0.05）. The levels of total bilirubin，alanine transaminase and aspartate transaminase in the two groups decreased on the 3rd day after operation，while those in the TIPS group were higher than those in the control group （P＜0.05）. The incidence of cumulative rebleeding in ligation group was 21.67% at 12 months after operation，which was higher than 8.33% in TIPS group （P＜0.05）.
Conclusion
Both TIPS and endoscopic ligation can achieve good hemostasis effect for upper gastrointestinal bleeding. TIPS is more effective in improving portal vein pressure gradient and blood flow and preventing rebleeding，but it has certain influence on the recovery of liver function.
To analyze and identify CT imaging characteristics and clinical indicators that can predict increased intra-abdominal pressure，in order to establish a reliable nomogram for the prediction of intra-abdominal hypertension （IAH）.
Methods
A retrospective collection was made of patients who were admitted to the ICU of Xuzhou Central Hospital from January 2021 to March 2023 and underwent bladder pressure measurement and abdominal CT scans. A total of 58 patients were included in this study，with 25 patients constituting the IAH group and 33 patients forming the non-IAH group. Clinical indicators and CT imaging features of these patients were collected. Logistic regression was used to perform statistical analysis on these clinical and CT imaging characteristics. The results were then used to construct a nomogram，which was validated and judged for clinical value.
Results
The study found that the transverse to longitudinal ratio of the abdominal wall （P=0.043； OR=3.102； 95% CI： 1.034-9.307），the ratio of the abdominal cavity to the abdominal wall longitudinal diameter （P=0.002； OR=12.105； 95% CI：2.575-56.897） were independently associated with IAH. The AUC of the nomogram prediction model was 0.925. The calibration curve indicated that the predicted probabilities of the nomogram were consistent with the actual probabilities. Decision curve analysis revealed that the nomogram model had good clinical utility within a threshold range of 0.1 to 1.0. The clinical impact curve suggested that the nomogram model was feasible across a broad range of threshold probabilities，particularly notable when the threshold exceeded 0.4.
Conclusion
Using the abdominal CT imaging features and clinical indicators，a nomogram model is constructed to predict the risk level of IAH in patients，which is helpful to indicate IAH and abdominal compartment syndrome.
Objective To analyze the prognostic nutritional index （PNI） combined with immunoglobulin，fasting blood glucose （FPG） and serum alpha-fetoprotein （AFP） in predicting poor prognosis of patients with HBV associated chronic acute liver failure （HBV-ACLF） after treatment.
Methods
A total of 220 patients with HBV-ACLF admitted to Qingdao Municipal Hospital from October 2020 to October 2023 were included. According to the prognosis after treatment，the patients were respectively included in the good prognosis group （n=118） and the poor prognosis group （n=102），and patients with poor prognosis were divided into survival group （n=68） and death group （n=34） according to whether they died or not. The indexes of PNI，immunoglobulin （IgG，IgM，IgA），FPG and AFP were compared among patients in different groups at admission. Logistic multivariate regression analysis and receiver operating characteristic curve （ROC） were used to calculate the value of these indexes in predicting the poor prognosis of patients with HBV-ACLF after treatment.
Results
Among 220 patients，102 patients had poor prognosis （46.36%），and 34 patients died （15.45%）. Age，immunoglobulin IgG，IgA，IgM，AFP PNI and blood glucose of patients in the good prognosis group were higher than those in the poor prognosis group，and FPG was lower than that in the poor prognosis group. Comparison between the death group and the survival group in the poor prognosis group was made，age，immunoglobulin IgG，IgA，IgM，AFP，PNI and blood glucose in the death group were higher than those in the survival group，and FPG was lower than that in the survival group （P＜0.05）. Logistic multivariate regression analysis showed that Stage Ⅲ and Ⅳ of hepatic encephalopathy，immunoglobulin IgG≥17 g/L，IgA≥3.8 g/L，IgM≥2.5 g/L，FPG＜6.2 mmol/L，AFP≥80 mmol/L and PNI≥35 were all risk factors for poor prognosis in patients with HBV-ACLF （P＜0.05）. Combined with hepatic encephalopathy Ⅲ and Ⅳ，IgG，IgA，IgM，PNI，FPG and AFP，the AUC of patients with poor prognosis was 0.856，and the sensitivity and specificity were 85.89%and 87.69% （P＜0.05）.
Conclusion
The prognosis of patients with HBV-ACLF is closely correlated with PNI，IgG，IgM，IgA，FPG and AFP，and the combined monitoring of these factors is helpful to provide a more reliable reference for prognosis prediction.
To explore the therapeutic effect of vitamin D combined with povidone bromide tablets in the treatment of diarrhea predominant irritable bowel syndrome （IBS-D） and its impact on intestinal barrier function indicators.
Methods
A total of 108 patients with IBS-D who received treatment at Qinhuangdao First Hospital from January 2022 to January 2024 were selected and randomly divided into two groups based on the order of admission. Among them，54 patients in the control group received treatment with povidone bromide tablets，while 54 patients in the observation group received treatment with vitamin D combined with povidone bromide tablets，both of which were treated for 4 weeks.The clinical efficacy，gut microbiota，gut barrier function indicators，25 hydroxyvitamin D [25-（OH）]levels，and IBS Clinical Symptom Severity Scale （IBS-SSS） scores were compared between the two groups.
Results
The total clinical effective rate of the observation group was 94.44%，which was higher than that of the control group （79.63%，χ2=5.441，P＜0.05）. After 2 and 4 weeks of treatment，the numbers of Lactobacilli and Bifidobacteria in the observation group were higher than those in the control group，and the number of Enterobacilli was lower than that in the control group （t=2.164，2.843，3.016，2.850，3.117，2963，P＜0.05）. The serum 25 hydroxyvitamin D [25-（OH）] in the observation group was higher than that inthe control group，and the serum diamine oxidase （DAO），D-lactate，and intestinal fatty acid binding protein （IFBP） were lower than those in the control group （t=3.152，4.274，3.975，4.628，3.728，3.415，4.416，3.521，P＜0.05）. The IBS-SSS scores in all dimensions in the observation group were lower than those in the control group （t=5.729，5.823，4.962，4.683，5.382，5143，4.670，4.527，5.106，5.317，P＜0.05）.
Conclusion
The combination of vitamin D and povidone bromide tablets can effectively alleviate the clinical symptoms of IBS-D，regulate intestinal microbiota，repair intestinal barrier function，and thus improve the therapeutic effect.
To investigate the value of ultrasonic signs in the diagnosis of intestinal volvulus and the evaluation of intestinal ischemic changes in children.
Methods
The clinical and ultrasonic data of 77 cases with intestinal volvulus confirmed by operation and pathology and preoperative ultrasound examination were retrospectively analyzed. According to the presence or absence of intestinal ischemic changes during operation，they were divided into an ischemic group （with intestinal ischemic changes） and a control group （without intestinal ischemic changes），and differences of clinical features and incidence of each ultrasonic sign between the two groups were compared.
Results
The comparison of clinical data between the two groups showed that the age distribution of the ischemic group was significantly lower than that of the control group，with a statistically significant difference （P＜0.05）.Comparison of the ultrasonic signs between the two groups showed that the incidence of turbid ascites，intestinal dilation，mesenteric edema，and enhanced intestinal wall echo in the ischemic group were higher than that in the control group，with a statistically significant differences （P＜0.05）. The results of ROC showed that the AUC of turbid ascites，intestinal dilatation，mesenteric edema and enhanced intestinal wall echo predicting ischemic changes of intestinal torsion were 0.677，0.654，0.612 and 0.596，respectively.
Conclusion
In children with intestinal volvulus，the younger the age，the more ultrasound signs such as turbid ascites，intestinal dilation，mesenteric edema，and enhanced intestinal wall echo are present，which are prone to intestinal ischemia.
To analyze the influence of paravertebral nerve block on blood flow，postoperative stress and rehabilitation quality of obese patients undergoing minimally invasive gastrectomy.
Methods
One hundred and twenty-six obese patients undergoing minimally invasive gastrectomy in Peking University First Hospital Taiyuan Hospital from January 2022 to December 2023 were selected and randomly divided into observation group （n=63） and control group （n=63）. The control group was anesthetized with epidural block，while the observation group was anesthetized with paravertebral nerve block. Both groups of operations were completed by the cooperation of the same medical team and anesthesia team. The operation and recovery，intraoperative hemodynamic changes，postoperative stress indexes and postoperative complication rate were compared between the two groups.
Results
The time of getting out of bed for the first time in the observation group was shorter than that in the control group （P＜0.05）. At the beginning of operation，30 min，60 min and after operation，MAP and HR in the observation group were lower than those in the control group （P＜0.05）. Epinephrine （E） and norepinephrine （NE） in the observation group were higher than those in the control group after operation，and dopamine was lower than that in the control group. E，NE and dopamine in the observation group were lower than those in the control group at 24 h after operation （P＜0.05）. The numeric rating scale （NRS）scores in the observation group were lower than those in the control group at 2 h，6 h，12 h and 24 h afteroperation （P＜0.05）. No complications such as abdominal infection，hematoma and nerve injury occurred in both groups after operation.
Conclusion
Compared with epidural block，paravertebral nerve block anesthesia can maintain the stability of blood flow and postoperative stress indexes in obese patients during minimally invasive gastrectomy，which is beneficial to relieve postoperative pain and improve the quality of rehabilitation.
