[A brief discussion on the inspiration and thinking of the Metaverse concept to promote the innovative development of intelligent medicine in China].

Created by digital technology,the Metaverse is a digital platform where the digital virtual world and the actual real world can coexist to some extent. Based on the integration of Metaverse and medical science,this article describes the great development of intelligent medicine in the fields of medical practice,medical education and medical research,especially in the field of surgery. First,the technical source of the Metaverse concept in the field of intelligent medicine can be traced back to technology to generate actual digital data sets from human anatomy. Second,the successful industrial practice of Metaverse in the field of intelligent medicine conforms to the authentic and credible fundamental purpose of "taking people as the first priority and serving people"， that is， "virtual" must be based on "actual" for "actual".

[The surgical management of benign diseases of the gallbladder should be treated with caution].

Surgical treatment of benign gallbladder disease seems relatively simple, but it causes many problems and controversies, which should not be ignored. According to the currently published related spirit of consensus guidelines and clinical practice, the treatment choices for five aspects of clinical problems should be paid attention to, and the problem for"blindly cholecystolithotomy"and "prudent choice cholecystectomy indications and surgical timing" were summarized and analyzed in order to cause enough attention for careful diagnostic and treatment of benign gallbladder diseases.

[Multiple factors analysis of early postpartum pelvic floor muscles injury in regenerated parturients].

Objective: To investigate the risk factors for multiparous pelvic floor muscles injury during 6-8 weeks after delivery. Method: From June 2015 to April 2017, 1917 women (1 523 primigravidas and 294 multiparas) were accepted postpartum pelvic floor function screening during 6-8 weeks after delivery in Beijing Hospital.Pelvic examination and pelvic floor muscle strength testing were carried out in these women.All the data were analyzed with multivariate logistic regression method to explore the related factors for postpartum pelvic floor muscle injury. Result: The incidence of muscle strength grades less than third grade was 63.60 % (type Ⅰ muscle fiber) and 24.83 % (type Ⅱ muscle fiber). Multivariate analysis showed that time interval, between two deliveries, less than 3 years (OR=2.16, 95%CI 1.21-3.86), and maternal BMI<18.5 (OR=3.04, 95%CI 1.10-9.30) and BMI≥28 (OR=3.04, 95%CI 1.10-9.30) before pregnancy were risk factors for postpartum injury of type Ⅰ muscle fiber. Gestational age more than 40 weeks increased the risk of damaging type Ⅱ muscle fiber (OR=2.79, 95%CI 1.156-6.76). Compared with cesarean section, vaginal delivery significantly increased the risk of injury of type Ⅰ and Ⅱ pelvic floor muscle fibers (P<0.05). Conclusion: The incidence of multiparous pelvic floor muscle injury was high in early postpartum period.Several factors are related to the pelvic floor muscle injury.Pelvic floor rehabilitation in early postpartum and maternal education may be helpful to reduce the radio of injury.

Prediction of digestible energy of feed ingredients for growing pigs using a computer-controlled simulated digestion system.

The objectives of this experiment were to evaluate in vitro DE (IVDE) of selected feed ingredients using a computer-controlled simulated digestion system (CCSDS) and predict DE of ingredients for growing pigs. Samples of 6 ingredients with a wide range in energy and nutrient profile were collected. The CP and GE contents ranged from 9.9 to 50.9% and 4,493 to 4,841 kcal/kg (DM basis), respectively. Two control diets were formulated to achieve different CP contents (12.5 and 20.0%). Three experimental diets were formulated by replacing 20% of the high-CP control diet with corn, wheat, or wheat bran, whereas 3 additional diets were formulated by replacing 20% of the low-CP control diet with soybean meal, rapeseed meal, or cottonseed meal. The DE was determined using barrows (n = 24; initial BW = 35.9 ± 1.9 kg) in 2 periods with 6 observations per diet treatment and ranged from 2,769 to 4,368 kcal/kg. The equation for the DE content (kcal/kg of DM) using chemical components as independent variables was DE = 4,186 + 0.06 × CP + 79.33 × ether extract - 14.57 × NDF - 47.99 × ADF, with R(2) = 0.995, residual SD (RSD) = 89.5 kcal/kg, CV = 2.4%, and P = 0.10 (chemical component values; %). The IVDE ranged from 2,289 to 3,724 kcal/kg and was highly related to the determined DE content of the ingredients (R(2) = 0.91, RSD = 193 kcal/kg, and CV = 5.2%). The relationship between IVDE:GE and DE:GE was very high (R(2) = 0.93, RSD = 3.8%, and CV = 4.7%). The average values of CV for IVDE (0.75%) and IVDE:GE (0.73%) were less than that for determined DE (2.58%) and DE:GE (2.54%), respectively. In conclusion, the IVDE content determined, using a CCSDS with relatively high accuracy and acceptable repeatability, might be used to predict DE of feed ingredients for growing pigs.

Effect of graded levels of fiber from alfalfa meal on intestinal nutrient and energy flow, and hindgut fermentation in growing pigs.

The objective of this experiment was to determine the effects of fiber level from alfalfa meal and collection period on intestinal nutrient and energy flow, and hindgut fermentation in growing pigs. Twenty-four pigs (initial BW = 21.4 ± 1.5 kg) were prepared by T-cannula insertion into the distal ileum and allotted to 4 treatments. The pigs were provided a corn-soybean meal control diet or a diet in which corn and soybean meal were partly replaced by 5%, 10%, or 20% alfalfa meal to give the graded levels of dietary fiber during two 10-d collection periods. The BW of pigs at the start of periods 1 and 2 were 32.2 ± 2.4 and 37.7 ± 4.2 kg, respectively. The final BW at the end of period 2 was 46.8 ± 4.0 kg. The apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of nutrients and energy were measured. The VFA concentration was also determined in the ileal and fecal samples. Nutrient digestibility was not affected by inclusion of 5% alfalfa meal in the diet. The AID, ATTD, and hindgut fermentation of DM, carbohydrates (CHO), and GE decreased (linear, P < 0.05) as the level of alfalfa meal in the diet increased. The intestinal flow of DM, CHO, ADF, and GE increased (linear, P < 0.05) by increasing the level of dietary alfalfa. The pH in ileal digesta and concentration of acetate, propionate, and total VFA in the feces increased (linear, P < 0.01) as the level of alfalfa meal in the diet increased. From experiment period 1 to 2, ATTD and hindgut fermentation of CHO decreased (P < 0.01), whereas concentrations of propionate, valerate, and total VFA in ileal samples increased (P < 0.05). A multiple linear regression analysis, taking into account both soluble dietary fiber and insoluble dietary fiber intake, explained the variation (P < 0.01) in total tract flow of NDF (93%), ADF (84%), GE (73%), DM (71%), and CHO (62%). In conclusion, the diet containing 5% of alfalfa meal did not affect nutrient and energy digestion. Intestinal flow of CHO decreased during the 10-d collection period. The VFA concentration increased with fiber level and 10-d exposure to the experimental diets. Soluble and insoluble fibers from alfalfa meal have differential roles in nutrient digestion, which may help explain the variation observed in the intestinal flow of nutrients.