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完整的心臟衰竭照護鏈應將流程緊密結合，整合組織內外具有關聯性的服務，並且提供持續性照顧。本院藉由疾病照護品質認證的三大架構，全面審視心衰竭照護實際運作狀況。在團隊推動下，主診斷心衰竭收縮分率≦40%之病人，死亡率由15.1%降低至13.0%；指引用藥RAS與Beta blocker比率由28.5%上升至40.0%，MRA由60.0%上升至68.8%；接受復健比率自9.3%提升到18.60%，有顯著上升。本院透過評鑑過程改善流程，有助於臨床人員將心衰竭照護融入實際照護。 A comprehensive heart failure care chain should contain a tightly interconnected process, integrate related services within and outside an organization, and provide continuous care. Using the three major frameworks of the Heart Failure Disease Care Certification, National Taiwan University Hospital (NTUH) comprehensively examined the status quo of heart failure care operation. After the NTUH medical team implemented the certification, the mortality rate of patients with heart failure with an ejection fraction of ≤40% as their principal diagnosis decreased from 15.1% to 13.0%; the percentage of guideline-directed medical treatment with renin-angiotensin system-acting agents and beta-blockers increased from 28.5% to 40.0%; the percentage of using magnetic resonance angiography increased from 60.0% to 68.8 %; and the percentage of patients receiving rehabilitation increased significantly from 9.3% to 18.60%. NTUH improved the care process through the certification, which helped clinical staff to integrate heart failure care into actual care. &nbsp

Intended stimulus effects are attenuated if expansionary policies are conducted at the cost of debt rollover, high interest payments, and heavy taxes. This paper examines the stimulus effects of fiscal instruments, considering a country's initial debt level. Using a neoclassical model calibrated to Greece, I find that: [1] increasing public consumption (investment) [wages] generates short-lived (long-lasting) [no] stimulus effects; [2] a rise in the interest rate spread reduces public consumption (investment) multiplier by 0.77 (only 0.27); [3] implementation delays in public investment yield the benefit of lower debt-to-GDP ratios, partly offsetting the cost of delays; [4] a high degree of consumption complementarity produces sizable expansionary effects, but it yields a worse fiscal position; [5] faster tax adjustments to government debt result in larger government-spending multipliers. In sum, whether to conduct stimulus measures or not hinges on a country's debt position, tools used, the speed at which debt is retired, and policy purposes.

Background. Optimal bowel preparation for colonoscopy is fundamental to a successful examination. The FODMAP diet can increase the content of intestinal water and gas, but its impact on bowel cleanliness and bubbles has not been reported. This study was therefore aimed at evaluating the effect of the FODMAP diet on the quality of bowel preparation and the adenoma detection rate (ADR). Methods. This was a multicenter, prospective cohort study involving consecutive patients who underwent colonoscopy in two centers in China. Patients were assigned to one of two groups: high-FODMAP or nonhigh-FODMAP diet. ODMP Software was used for the identification of FODMAP diet types. The primary outcome was ADR; secondary outcomes were the quality of bowel preparation, measured by the Boston bowel preparation scale and bubble scores. Results. There were 365 patients included. Patients in the high-FODMAP-diet group showed poor bowel cleansing efficacy: BBPS≥6 in 76.8% vs. 90.3% (P<0.01) and bubble scores of 2.42±1.69 vs. 1.32±1.63 (P<0.001). The intubation time was significantly longer in the high-FODMAP-diet group (7.07±5.18 vs. 5.46±3.05 min; P=0.002). The High-FODMAP diet was an independent risk predictor for inadequate bowel preparation. There were no statistically significant differences in ADR between the two dietary groups. Conclusion. The high-FODMAP diet significantly reduced the quality of bowel preparation. We recommend the consumption of nonhigh-FODMAP diet in bowel preparation as a reference standard for dietary regimen. This method was effective, flexible, referable, and well tolerated, which could help to provide patients a valuable dietary guidance in bowel preparation.

An efficient and simple metal-organic framework (MOF) assisted matrix solid-phase dispersion (MSPD) microextraction was developed for the extraction of the five saponins in P. ginseng leaves. The target analyses were detected by ultra high performance chromatography coupled with time-of-flight MS. Experimental conditions for MSPD microextraction were optimized by the Box-Behnken design of the response surface methodology. The optimal conditions were as follows: 20 mg adsorbent, 80% methanol-water solution for elution, 60 s grinding time, and the MOF-808 as the adsorbent. With the final optimized method, the calibration curves for five saponins showed good linearity (R2 > 0.998) within range of 0.01-100 μg/mL. In addition, analytical recoveries ranged from 87.04 to 103.78%, with the RSD below 5%. The limit of detection and LOQ range from 0.087 to 0.114 μg/mL and 0.292 to 0.379 μg/mL, respectively. Compared with the traditional extraction method and published methods, the newly MOF-assisted MSPD extract exhibited higher extraction efficiency, simpler operation, and provided a cleaner extract with low consumption of organic reagents that was applied for rapid evaluation and quality control of active compounds from plants.

Background & Aim: Exosomes are effective mediators of cell-to-cell interactions and carry many regulatory molecules, including miRNAs, that can play crucial roles in diverse fundamental biological processes. However, to date, no study has reported macrophage exosomal involvement in the development of inflammatory bowel disease (IBD). This study investigated the specific miRNAs in macrophage-derived exosomes in IBD and the potential molecular mechanism. Methods: Dextran sulfate sodium (DSS) was used to generate IBD mice. The supernatants of murine bone marrow-derived macrophages (BMDMs) with or without lipopolysaccharide (LPS) were collected for exome isolation and miRNA sequencing. Lentiviruses were used to modify miRNA expression and further investigate the role of macrophage-derived exosomal miRNAs. In vitro, both mouse and human organoids were applied to a Transwell system in co-culture with BMDMs as a cellular IBD-related challenge.Results: Here, we show that LPS-induced macrophages can release exosomes containing various miRNAs, aggravating IBD. We analyzed miRNA sequencing of macrophage-derived exosomes, and miR-223 was selected for further study. In vivo, exosomes with high miR-223 expression contributed to the exacerbation of intestinal barrier dysfunction, which was further verified in both mouse and human colon organoids. Furthermore, time-dependent analysis of the mRNAs of DSS-induced colitis mouse tissue combined with miR-223 target gene prediction was performed to select the candidate gene, and the barrier-related factor TMIGD1 was identified.Conclusion: Collectively, these data indicated that macrophage-derived exosomal miR-223 played a novel role in intestinal barrier dysfunction by inhibiting TMIGD1 in the progression of DSS-induced colitis.

Disconnected pancreatic duct syndrome (DPDS) is an important and common complication of acute necrotizing pancreatitis. Endoscopic approach has been established as the first-line treatment for pancreatic fluid collections (PFCs) with less invasion and satisfactory outcome. However, the presence of DPDS significantly complicates the management of PFC; besides, there is no standardized treatment for DPDS. The diagnosis of DPDS presents the first step of management, which can be preliminarily established by imaging methods including contrast-enhanced computed tomography, ERCP, magnetic resonance cholangiopancreatography (MRCP), and EUS. Historically, ERCP is considered as the gold standard for the diagnosis of DPDS, and secretin-enhanced MRCP is recommended as an appropriate diagnostic method in existing guidelines. With the development of endoscopic techniques and accessories, the endoscopic approach, mainly including transpapillary and transmural drainage, has been developed as the preferred treatment over percutaneous drainage and surgery for the management of PFC with DPDS. Many studies concerning various endoscopic treatment strategies have been published, especially in the recent 5 years. Nonetheless, existing current literature has reported inconsistent and confusing results. In this article, the latest evidence is summarized to explore the optimal endoscopic management of PFC with DPDS.

This article is to explore the antidepressant mechanism of Shugan Lipi recipe in regulating tryptophan metabolism,and to find out their common pharmacodynamic substances. UPLC-Q-TOF-MS technology was used to establish fingerprints of Shugan Lipi recipe,and 124 components were identified. The depressed mouse model was replicated by triple-one multiple stress method. Chaihu Shugan Powder,Sini Powder and Xiaoyao Powder were administered in groups to observe the changes in body weight and behavior of the mice. The results showed that compared with the model group,the body weight,sucrose preference percentage and autonomous activity behavior of each administration group were improved. Among them,the effect of Chaihu Shugan Powder was better than that of Sini Powder and Xiaoyao Powder. LC-MS/MS method was used to determine the contents of 5-hydroxytryptamine( 5-HT),kynurenine( KYN) and tryptophan( TPP) in blood,liver,brain,colon and other tissues,as well as TDO enzyme activity in liver. Western blot and RT-PCR were used to detect the protein and gene expression of TDO enzyme,respectively. It was found that the three prescriptions increased the ratio of 5-HT/KYN in different degrees,decreased the ratio of KYN/TRP in liver,colon and brain,and decreased the expression level and activity of TDO enzyme in liver. The order of their ability to regulate tryptophan metabolism was Chaihu Shugan Powdergt;Sini Powdergt;Xiaoyao Powder. In addition,the correlation between the chromatographic peaks in the fingerprints of Shugan Lipi recipes and the pharmacodynamic indexes of tryptophan metabolism was analyzed by the grey relation analysis. The grey relation analysis found that the chemical components with the highest correlation with tryptophan metabolism were mainly from Paeoniae Radix Alba,Citri Reticulatae Pericarpium,Aurantii Fructus Immaturus and Aurantii Fructus. UPLC-Q-TOF-MS was used to analyze the migration components in the plasma of mice after administration of Shugan Lipi recipe,and to verify the common pharmacodynamic substances of Shugan Lipi recipe. The migration of these detected components in plasma was studied,and a total of 18 prototype components and 36 metabolites were identified. Therefore,it was believed that Chaihu Shugan Powder,Sini Powder and Xiaoyao Powder could play an antidepressant role by reducing the expression of TDO enzyme in the liver and regulating the metabolism of tryptophan.The components contained in Paeoniae Radix Alba,Citri Reticulatae Pericarpium,Aurantii Fructus Immaturus and Aurantii Fructus were the common pharmacodynamic substances of Shugan Lipi recipe,which played an important role in regulating tryptophan metabolism.

The intestinal tract consists of various types of cells, such as epithelial cells, Paneth cells, macrophages, and lymphocytes, which constitute the intestinal immune system and play a significant role in maintaining intestinal homeostasis by producing antimicrobial materials and controlling the host-commensal balance. Various studies have found that the dysfunction of intestinal homeostasis contributes to the pathogenesis of inflammatory bowel disease (IBD). As a novel mediator, extracellular vesicles (EVs) have been recognized as effective communicators, not only between cells but also between cells and the organism. In recent years, EVs have been regarded as vital characters for dysregulated homeostasis and IBD in either the etiology or the pathology of intestinal inflammation. Here, we review recent studies on EVs associated with intestinal homeostasis and IBD and discuss their source, cargo, and origin, as well as their therapeutic effects on IBD, which mainly include artificial nanoparticles and EVs derived from microorganisms.

A rapid and effective method was successfully established for the extraction and determination of chlorogenic acid, protocatechuic acid, malic acid, caffeic acid and gallic acid in fruit (chaenomeles speciosa) via matrix solid-phase dispersion (MSPD) microextraction combined with ultra-high performance liquid chromatography with quadrupole time-of-flight tandem mass spectrometry (UHPLC-Q-TOF/MS). Several major extraction parameters were investigated and optimized, such as the type of sorbent, the amount of sorbent, the grinding time, the type and concentration of the eluting solvent. The optimal extraction conditions were obtained by using 20 mg of calix[8]arene as dispersing adsorbent, selecting 60 s as the appropriate grinding time and applying 250 mM of 1-dodecyl-3-methylimidazolium bromide as eluent solvent. Moreover, the calibration curves of the analytes were in the range of 0.01–500 μg/mL with the determination coefficients (r2) higher than 0.9995. The limits of detection and limits of quantification were in the range of 0.202–1.056 ng/mL and 0.674–3.521 ng/mL, respectively. The recoveries of the target compounds at two spiked levels were between 82.19 and 113.36%. Furthermore, this method had acceptable reproducibility (RSD ≤ 3.84%). The proposed approach combined the advantages of MSPD microextraction with UHPLC-Q-TOF/MS, and could be applicable for the analysis organic acids in fruit.

Psychosocial stress is a critical inducing factor of inflammatory bowel diseases (IBD), while autophagy is a novel central issue of IBD development. The present study investigated the potential role of autophagy in stress-related IBD in patients and animal model. The correlation between psychosocial stress and intestinal autophagy was determined in 23 patients with IBD. Corticotropin-releasing hormone (CRH), a well-established inducer of psychosocial stress, was administrated in dextran sulfate sodium (DSS)-induced IBD mice and lipopolysaccharide (LPS)-stimulated bone marrow-derived macrophages (BMDM). In IBD patients, the autophagy markers beclin-1, LC3-II/I ratio, Atg16L1, and Atg4B were significantly enhanced. The psychosocial stress score was positively associated with the levels of beclin-1 and the LC3II/I ratio in intestinal biopsy specimens. In IBD mouse model, CRH significantly aggravated intestinal inflammation, increased Paneth cell metaplasia, and enhanced intestinal autophagy (beclin-1, Atg16L1, PIK3R4, and Atg4B upregulation; GAA, CTSD, and PPKAA1 downregulation). Additionally, the CRH-induced gut microbial dysbiosis was evidenced by a marked increase in the number of detrimental bacteria. In LPS-stimulated BMDM, CRH substantially increased M1/M2 polarization and thus promoted inflammation. In both IBD mice and LPS-treated BMDM, blockade of autophagy by chloroquine abrogated the unbeneficial effects of CRH, whereas autophagy inducer rapamycin resulted in a pronounced protective effect against IBD lesion. Our data demonstrate that psychosocial stress may link the enhanced intestinal autophagy by modulating gut microbiota and inflammation to aggravate IBD. These data indicate autophagy as a promising therapeutic target for psychosocial stress-related IBD.

Alpha7 nicotinic acetylcholine receptor (α7nAChR) has been reported to be protective in several kinds of disorders through inflammatory suppression. Here, we investigated the role of α7nAChR in inflammatory bowel disease (IBD) on α7nAChR deficient mice (α7nAChR-/-) and the wild-type mice (α7nAChR+/+). Three percent dextran sulfate sodium (DSS) was used for the creation of IBD mice model and lipopolysaccharides (LPS)/DSS as an inflammatory stressor in murine bone marrow-derived macrophages (BMDMs). The severity of IBD was determined and HE staining as well as enzyme-linked immunosorbent assay (ELISA) and real-time PCR were used to detect the level of inflammatory activation. Western blot was used to determine the levels of autophagy-related proteins. Transmission electron microscopy and mRFP-GFP-LC3 plasmid were applied to determine the levels of autophagy. We demonstrated that deficiency in α7nAChR produced a detrimental effect on IBD severity and inflammatory reaction in DSS-induced colitis models. Those effects were led to via autophagy dysfunction. α7nAChR deficiency attenuated the protective and anti-inflammatory effect of autophagy inducer in IBD mice and BMDMs challenged with LPS/DSS. The alleviative effect of activating α7nAChR was attenuated through inhibiting adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)-mediated signaling. In conclusion, α7nAChR contributes to alleviate IBD through the induction of AMPK-mammalian target of rapamycin rabbit (mTOR)-p70 ribosomal protein S6 kinase (p70S6K)-mediated autophagy, thus providing a novel target for the treatment of IBD.

The Wulong deposit is the largest quartz vein-type gold deposit in the eastern Liaoning Province of China. The gold ore bodies are hosted by Mesozoic biotite-granites. The mineralization occurs as veins with lenticular shapes. Laser-ablation-ICP–MS zircon U–Pb dating was used to date the biotite-granite, granite porphyry, and fine-grained diorites at the Wulong deposit, yielding ages of 155.4 ± 0.9 Ma, 154.2 ± 1.2 Ma, and 123.1 ± 0.9 Ma, respectively. A sericite sample from the gold ore yields a 40Ar–39Ar plateau age of 122.8 ± 0.8 Ma (MSWD = 0.09). The calculated δ18Ow values for the quartz range from 4.8% to 8.6% and the δDW values of fluid inclusion waters in quartz vary from −98% to −77%. The H–O isotope data indicates that ore-forming fluids could be of a magmatic origin. The δ34S values of metallic sulfides range from +1.1% to +2.4%, with an average of +1.8%, suggesting that the sulfur is derived from a magmatic source. The 3He/4He ratios of fluid inclusions in pyrite range from 0.36 to 0.65 Ra with an average of 0.50 Ra. The mantle helium involved in the ore-forming fluid ranges from 3.9% to 7.2%, indicating a crustal fluid source. The Wulong gold deposit was formed at ca. 120 Ma and it has a genetic association with contemporaneous fine-grained diorite. The Wulong deposit was formed during lithospheric thinning of the eastern North China Craton during the early Cretaceous.

A 67-year-old woman presented with paroxysmal epigastric pain for 3 months, without jaundice. She gave a history of cholecystectomy. Physical examination and blood tests were unremarkable. Magnetic resonance cholangiopancreatography showed cystic dilatation of the common bile duct (CBD), intrahepatic and extrahepatic bile duct dilatation and suspicious intrahepatic bile duct stones (figure 1). CT scan showed intrahepatic and extrahepatic bile duct dilatation and multiple intrahepatic bile duct stones (figure 2). Figure 1 Magnetic resonance cholangiopancreatography showed cystic dilatation of the common bile duct, intrahepatic …

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, comprised of ulcerative colitis and Crohn's disease. Among the complicated pathogenic factors of IBD, the overaction of inflammatory and immune reaction serves as an important factor. Inflammasome is a form of innate immunity as well as inflammation. Among all kinds of inflammasomes, the NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome is the most studied one, and has been revealed to be involved in the pathogenesis and progression of IBD. Here, in this review, the association between the NLRP3 inflammasome and IBD will be discussed. Furthermore, several NLRP3 inflammasome inhibitors which have been demonstrated to be effective in the alleviation of IBD will be described in this review.

OBJECTIVE Adequate bowel preparation is essential for a successful colonoscopy; clinical studies suggest reinforced education can improve the preparation process. However, there have been no trials to compare WeChat directions (the most widely used social media app in China) with those of the short message service (SMS). This study was aimed to assess the effect of WeChat and SMS on the bowel preparation quality. PARTICIPANTS AND METHODS This was a single-center, prospective, endoscopically blinded, randomized, controlled study. Patients in reinforced education groups received additional reminder messages by WeChat and SMS 2 days before colonoscopy. The primary outcome was bowel preparation quality evaluated by the Boston bowel preparation scale (BBPS) score and the rate of adequacy (BBPS score ≥6). Secondary outcomes included polyp detection rate, adenoma detection rate, and mean total adenomas detected. Patient tolerance level and subjective feelings were also evaluated. RESULTS The total BBPS score and the percentage of adequacy were significantly higher in the reinforced education groups compared with the control (WeChat vs. control, P