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Abnormal brain-gut interaction is considered the core pathological mechanism behind the disorders of gut-brain interaction (DGBI), in which the intestinal microbiota plays an important role. Microglia are the "sentinels" of the central nervous system (CNS), which participate in tissue damage caused by traumatic brain injury, resist central infection and participate in neurogenesis, and are involved in the occurrence of various neurological diseases. With in-depth research on DGBI, we could find an interaction between the intestinal microbiota and microglia and that they are jointly involved in the occurrence of DGBI, especially in individuals with comorbidities of mental disorders, such as irritable bowel syndrome (IBS). This bidirectional regulation of microbiota and microglia provides a new direction for the treatment of DGBI. In this review, we focus on the role and underlying mechanism of the interaction between gut microbiota and microglia in DGBI, especially IBS, and the corresponding clinical application prospects and highlight its potential to treat DGBI in individuals with psychiatric comorbidities.
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Humanos , Microbioma Gastrointestinal , Síndrome del Colon Irritable/terapia , Microglía , Encefalopatías , EncéfaloRESUMEN
Background/Aims@#Irritable bowel syndrome (IBS) is accepted as a disorder of gut-brain interactions. Berberine and rifaximin are non-absorbed antibiotics and have been confirmed effective for IBS treatment, but there is still lack of direct comparison of their effects. This study aims to compare the effect of the 2 drugs on the alteration of gut-brain axis caused by gut microbiota from IBS patients. @*Methods@#Germ-free rats received fecal microbiota transplantation from screened IBS patients and healthy controls. After 14 days’ colonization, rats were administrated orally with berberine, rifaximin or vehicle respectively for the next 14 days. The visceral sensitivity was evaluated, fecal microbiota profiled and microbial short chain fatty acids were determined. Immunofluorescence staining and morphological analysis were performed to evaluate microglial activation. @*Results@#Visceral hypersensitivity induced by IBS–fecal microbiota transplantation was relieved by berberine and rifaximin, and berberine increased sucrose preference rate. Microbial α-diversity were reduced by both drugs. Compared with rifaximin, berberine significantly changed microbial structure and enriched Lachnoclostridium. Furthermore, berberine but not rifaximin significantly increased fecal concentrations of acetate and propionate acids. Berberine restored the morphological alterations of microglia induced by dysbiosis, which may be associated with its effect on the expression of microbial gene pathways involved in peptidoglycan biosynthesis.Rifaximin affected neither the numbers of activated microglial cells nor the microglial morphological alterations. @*Conclusions@#Berberine enriched Lachnoclostridium, reduced the expression of peptidoglycan biosynthesis genes and increased acetate and propionate. The absence of these actions of rifaximin may explain the different effects of the drugs on microbiota-gut-brain axis.
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Objective:Reflux esophagitis (RE) may be negatively correlated with Helicobacter pylori ( H. pylori) infection, but the conclusion and relevant mechanism is still controversial. This study proposed to explore the correlation between RE and H. pylori infection based on natural population. Methods:From July 2013 to December 2014, 3 940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method. All the subjects underwent gastroscopy, and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry (WS) staining to identify H. pylori infection. Venous blood samples of some subjects were collected for H. pylori immunoglobulin G ( H. pylori-IgG) detection. Also, demographic and sociological data were collected. Chi-square test and logistic regression were used to analyze the correlation between RE and H. pylori infection. Results:A total of 359 cases of RE were detected. Excluding RE and other upper gastrointestinal organic diseases, 3 382 cases were considered as controls. Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group ( P=0.023), but there was no significant difference in the positive rate of H. pylori-IgG between the two groups ( P=0.281). There were significant differences between RE group and control group in gender composition, age, body mass index (BMI), smoking, alcohol consumption, education level and mucosal active inflammation. Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation [ OR=0.754 (95% CI 0.600-0.949), P=0.016], and positively correlated with male [ OR=4.231 (95% CI 3.263-5.486), P<0.001], age ≥60 years, BMI≥24 kg/m 2 [ OR=1.540 (95% CI 1.220-1.945), P<0.001]. Compared to those aged 40-49 years and 50-59 years, the odds ratio ( OR) of RE in these aged ≥60 years were 1.566 (95% CI 1.144-2.143, P=0.005) and 1.405 (95% CI 1.093-1.805, P=0.008). Conclusion:RE is more closely related to H. pylori present infection. Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H. pylori infection, and positively correlated with male, overweight and aged ≥60 years.
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Objective:To evaluate the diagnostic value of hydrogen sulfide breath test(SBT) for small intestinal bacterial overgrowth (SIBO).Methods:College students were enrolled to complete gastrointestinal symptom scale, food frequency questionnaire, lactulose hydrogen- methane breath test (LHMBT) and SBT. Based on the correlation between hydrogen sulfide(H 2S) and hydrogen or methane gas,the receiver operating characteristic (ROC) curve of H 2S was drawn and diagnostic criteria of SBT was defined. Results:A total of 300 subjects including 84 males and 216 females with age 17-32 (21.6±2.4) years were enrolled from April 2019 to December 2019 and divided into two groups.Two hundred and three patients reported SIBO discomforts with 99 (48.8%) LHMBT positive, while 38 (39.2%) were LHMBT positive in 97 health controls. Rise of H 2S at 90 min was positively related with that of hydrogen ( r=0.516, P<0.01), and H 2S levels at 90 min were positively correlated with methane ( r=0.632, P<0.01). A rise in H 2S of ≥25.0 ppb or H 2S levels ≥62.5 ppb at 90 min during lactulose breath test was considered positive for SIBO, that sensitivity, specificity and accuracy were 66.4%,79.1% and 73.3% respectively. H 2S levels were significantly related to the amount of Vitamin B 12 intake ( P=0.011). H 2S-positive subjects exhibited a constipation-predominant pattern. Conclusion:SBT is consistent with LHMBT, especially in constipation-predominant patients, which may provide a reference to the diagnosis of SIBO.
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Objective:To analyze the clinical characteristics and pathogenesis of refractory gastroesophageal reflux disease(RGERD).Methods:The patients with acid regurgitation, heartburn and extraesophageal symptoms were enrolled in the study from November 2015 to September 2017 at Peking University Third Hospital. All the subjects filled the informed consent.Questionnaire, SCL-90, SAS and SDS scales were recorded. A 24 hour pH-impedance monitoring and esophageal high resonance manometry were carried out. According to the response to proton pump inhibitor(PPI), the patients were divided into RGERD and non-RGERD(NRGERD)groups. The clinical characteristics were compared between these two groups. Logistic regression was used to analyze the risk factors of RGERD.Results:One hundred and nineteen patients were finally enrolled in the study including 61 RGERD (51.3%) and 58 NRGERD patients (48.7%).The body mass index (BMI) and rates of, typical GER symptoms including acid regurgitation in RGERD patients were significantly lower than those in NRGERD patients ( P<0.05).While the atypical GER symptoms such as poststernal discomfort or chest pain were more common in RGERD group ( P<0.05).RGERD patients presented less acid reflux events and lower proximal segment reflux ratio than NRGERD patients. No obvious differences were found in the manometry metrics between these two groups. The scores of somatization, depression and hostility in RGERD patients by SCL-90 scales were significantly higher than those in NRGERD patients ( P<0.05), and depression score was an independent risk factor for RGERD [ OR=3.915 (95% CI1.464-10.466), P =0.007]. Conclusions:RGERD patients present more atypical symptoms and pathological non-acid reflux.Depression is an independent risk factor for RGERD.
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Objective To understand the current situation of research innovation ability of medical academic PhD students,combining with the comprehensive reform of education of the university's doctoral postgraduate students,and put forward suggestions for improving the scientific research innovation ability of medical academic PhD students.Methods Analyzing the evaluation results of academic doctoral dissertation of the medical department in 2017 and conducting questionnaire survey among graduates with SO JMUP,a professional online questionnaire platform,are the main methods.Results Among all the indexes of medical academic doctoral dissertation,innovation achievement was evaluated lowest,and only 34.9 % of the evaluation experts considered it as excellent.In terms of innovation results and research ability,the eight-year PhD is better than the five-year and three-year PhD significantly.The mentor's guidance and education are believed to be the primary factors to enhance their interest in scientific research by graduates.Conclusions The ability of medical academic PhD students needs to be strengthened.It is suggested to build a platform for cultivating top-notch innovative talents,and enhance the academic vitality of the tutor to ensure the research training of graduates as well as provide an international exchange platform to broaden the academic horizon of the graduates.
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With the opportunity of the comprehensive reform of professional postgraduate education,Peking University design the professional postgraduate education structure to social need,explore the training mode of DrPH,PharmD,MMT with international standards;To implement the spirit of medical cooperation,promote the organic linking of training of MD and specialist.
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Objective To explore the diet features of diarrhea predominant irritable bowel syndrome (IBS-D) with small intestinal bacterial overgrowth (SIBO).Methods IBS-D patients were enrolled in outpatient department of Peking University Third Hospital from March 2015 to April 2016.Healthy volunteers were recruited as controls (HC).All the subjects completed screening examinations,clinical and food investigation,and lactulose methane and hydrogen breath test (LMHBT).The high fat diet is defined as the daily total calories supplying from fat is more than 50%.Results Eighty-eight IBS-D patients and 32 HC were finally enrolled.The positive rate of LMHBT in IBS-D was significantly higher than that of HC [39.8% (35/88) vs 12.5% (4/28),P=0.005].The 28 HC with negative LMHBT were enrolled in the follow-up analysis.(1) The BMI of IBS-P (IBS-D with positive LMHBT) was significantly lower than IBS-N (IBS-D with negative LMHBT) [(21.57 ±0.54) vs (23.30 ±0.53) kg/m2,P=0.032].IBS-D patients with SIBO had higher scores of abdominal pain assess.(2) The proportion of dietary protein and carbohydrate in IBS-D was significantly higher than that of HC (14.39% vs 12.22%,P =0.001;53.94% vs 46.25%,P =0.003,respectively).The proportion of diet fat was significantly higher in IBS-P than IBS-N[(47.19 ± 2.62) % vs (40.74 ± 1.66) %,P =0.038].(3) The baseline of breath methane in IBS-P was significantly higher than that of in IBS-N [(8.69 ± 0.39) × 10-6 vs (6.39 ± 0.47) × 10-6,P =0.002].IBS-D patients with high fat diet had higher LMHBT positive rate than that of non-high fat diet patients[54.2% (13/24) vs 17.2% (11/64),P =0.001].Breath methane peak value was positively correlated with the fat proportion of diet (r =0.413,P =0.022).Conclusions About 39.8% IBS-D patients diagnosed by Rome 11Ⅲ are combined with SIBO.SIBO may affect IBS-D patients' nutritional status.High fat diet might be one of the risk factors for IBS-D with SIBO.Proper diet structure might reduce the prevalence of IBS-D,especially for IBS-D with SIBO.
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This study conducted questionnaire survey to graduate medical students in Medicine (M.D.) and Stomatological Medicine (S.M.D) enrolled at Peking University Health Science Center in the year 2013,analyzed on the understanding,period,forms,mentoring and effect of research training.Suggestions are proposed to strengthen the research training,for example,focusing on clinical training as well as research training,aiming at clinical issues,emphasize of clinical scientific research,permeating the concept oftransformation medicine,promotion of intense full-time research,strengthen the mentoring of professors.
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Academic ethics is closely related to the construction of the world class disciplines,the academic ethics of university mentors and their graduate students are especially important to the development of disciplines and Universities.This article was based on a survey which used two-way evaluation conducted at Peking University Health Science Center,investigated the cognition,current status,misconduct and possible causes,as well as related trainings of academic ethics between mentors and mentees,furthermore,this article also analyzed the application of mentor-mentee two-way evaluation in the academic ethics trainings for post graduate students.
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Objective Joint-PhD program is an effective way to cultivate international creative talents.Survey on intrinsic value factors of this mode is significant to improve the quality of medical education.Methods According to the questionnaire results and reports of 104 medical doctorates who attended the Joint-PhD program in PUHSC,Baldrige Performance Excellence was taken as theoretical framework.Results It showed that index influencing the quality of Joint-PhD education include social responsibility;stakeholders' expectation and market requirements;information and knowledge management support and so on.Conclusion In the process of doctoral education,advocating value of social responsibility,paying attention to the expectations of stakeholders,and attaching importance to the validity of education management services help to understand the intrinsic value of the quality management from the top universities in the world,in order to fundamentally improve the quality of doctoral education.
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Objective To analyze the problems of doctor of medicine in China,and to explore the efforts to improvethe training quality of doctor of medicine.Methods The paper selected 5medical colleges which participated the thematic evaluation of doctor of medicinedegreeauthorization centers in 2014,then analyzed the relevant data of doctor of medicine during 2011-2015,such as education condition,enrollment scale,training objective,curriculum setting,scientific research trainingand clinical practice by descriptive study.Results The average of affiliated hospitals is 6.0.The number of medical doctor entrance exam increased by 1.5 times during 2011-2015.The training institutions set up clear training objective of applied talents.A three-stage cultivation mode of course learning,clinical practice and scientific research training is widespread enforcement.However,the subject and basiccondition varies in different schools.The teachers’ professional level is uneven.The quality of candidates needsto be improved.Curriculum design is lack of pertinence.Standardization of clinical practice andscientiFlc training system is not enoughat the same time.Conclusions The suggestions to promote the reform of full-time doctor of medicineare:improving the subject building;increasethe number of students enrollment appropriately;strengthening pertinence of curriculum system;perfecting quality evaluating system;exploring the training mode called “5 + 3 + X”.
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Objective The study analyzes the inadequacies of the research integrity educational practice for the medical postgraduate students in the present stage of China.Furthermore,the paper puts forward improvement suggestions and clears the direction for further efforts.Methods From the perspective of the educational law about cognition,emotion,will and behavior,the comparative analysis method is used,based on the rich experience in the United States.Results There are inadequacies of the research integrity educational practice for the medical postgraduate students in China,including that students lack knowledge learning motivation,and the pattern of education is simple.There are not enough emotional experience channels and the participation of students.Students lack honesty will training,and the intensity of supervision and punishment is not strong.The honesty recognition mechanism is weak,and cannot be used to guide practice.Conclusions In order to improve the level of the research integrity for the medical postgraduate students in China,we should optimize the system,follow the law of education,strengthen the transmission of knowledge,put the academic honesty education into normal work,enhance the emotional experience,build a participatory mechanism,highlight the positive guide,and increase the intensity of punishment.
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Objective:To analyze the trend relevant factors leading to death and their patterns over a 10-year period in inpatients with connective tissue diseases (CTDs).Methods:All clinical data about death in inpatients with CTDs were retrospectively reviewed between 2005 and 2014 at the Department of Rheumatology and Immunology in Xiangya Hospital of Central South University.Results:In the 10-year time period,the overall hospital mortality was 15.689‰.The disease itself accounted for 44.71% of the total causes of death,infection accounted for 42.94%,and comorbidities accounted for 12.35%.The constituent ratio of deaths and the average hospital mortality caused by the disease itself declined gradually year by year,and the constituent ratio of deaths caused by infection and comorbidities increased gradually year by year (P<0.05).In 2013-2014,infection was the leading cause of death,which accounted for 51.06%.The survival time for CTDs inpatients with interstitial lung disease (ILD) was shorter than that of CTDs inpatients without ILD,and even the risk of death was 1.722 times of the latter.The proportion of deaths caused by the disease itself was the highest in systemic sclerosis and systemic lupus erythematosus,that by infection was the highest in idiopathic inflammatory myopathy (IIM),and that by comorbidities was the highest in rheumatoid arthritis.Conclusion:The proportion of deaths and the hospital mortality in CTDs inpatients caused by the disease itself show a declining trend,while the proportion of deaths caused by infection and comorbidities increase.CTDs patients with ILD have shorter survival time and an increase in risk of death.
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In the process of construction of the professional degree clinical master's standardized and regulated training system, training institutions have encountered some disparities and problems such as lack of correct recognition, no strict restrictions on enrollment, curriculum system construction not meeting the requirements of medical education, lack of perfect clinical evaluation system, inadequate clinical re-search and the role of elimination mechanism being ignored. To resolve these problems, feasible suggestions are raised: strengthening the cognition of training model reform, strictly checking on candidates' qualifica-tions to ensure the quality of students, refining courses and reforming teaching method, completing examin-ing system and enhance the management of practical training, focusing on the feature of clinical scientific research, emphasizing the construction of mechanism of elimination and diversion to improve the quality of training.
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Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P < 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P < 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P < 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86% and specificity 51.52%.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.
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Objective To gain a better knowledge of the education for masters in clinical medicine (general practice) and provide a reference for the better exploration of the training mode of GP students.Methods 9 colleges and universities enrolling students for this program were selected with stratified sampling.A questionnaire was conducted in terms of admission,curriculum setting,clinical training,guidance and evaluation through officials in charge of graduate affairs from February to July in 2014.Descriptive analysis was performed to the investigation results,using SPSS 20.0 statistical software.Results A full-time undergraduate degree in clinical medicine was explicitly required in 88.9% (8/9) of colleges and universities.The average total credits of the course were 23.7 and the average clinical training duration was 32.4 months.Tutor group was adopted in all colleges and universities.The assessment and evaluation of the GP masters was mainly composed of multiple forms of process assessment and final evaluation.Conclusion We suggest attaching more importance to the improvements of enrollment policy,curriculum system,clinical training,standardized training base construction,teaching staff,and evaluation system in order to explore GP training mode in accord with the law of general practice and suitable for China's national conditions.
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Objective To investigate the current situation and related risk factors of healthcare-associated infection (HAI),so as to provide evidence for making prevention and control measures of HAI.Methods On November 26, 2014,a combination method of bedside visiting and medical record reviewing was adopted to survey HAI status, pathogen examination,and antimicrobial application in all hospitalized patients in a tertiary first class military hospi-tal.Results A total of 1 657 hospitalized patients were investigated,66 patients developed 71 times of HAI,HAI rate and HAI case rate were 3.98% and 4.28% respectively.The top 4 departments with HAI prevalence rates were departments of neurosurgery (24.49%),hematology(19.05%),cadre ward(13.73%),and burn surgery (10.91 %).The top 5 HAI sites were lower respiratory tract (40.85%),urinary tract(23.94%),upper respirato-ry tract(12.68%),surgical site(9.86%),and gastrointestinal tract(5.63%).Of 66 cases of HAI,39 (59.09%) patients sent specimens for culture,a total of 48 pathogens were cultured,the major isolated bacteria was Esche-richia coli (n = 10,20.84%),followed by Staphylococcus aureus ,Klebsiella pneumoniae ,and Pseudomonas aeruginosa ,each was 7 (14.58 %)respectively.The usage rate of antimicrobial agents was 34.40%,specimen de-tection rate in patients receiving therapeutic and therapeutic+prophylactic antimicrobial agents was 59.28%.Risk factors for HAI were age 60 years,with respirator,tracheotomy,urinary tract catheterization, arteriovenous catheterization,hemodialysis,and surgery,difference was significant(all P <0.05).Conclusion Mo-nitoring on key departments and key sites of HAI should be strengthened,antimicrobial agents should be used rationally based on pathogenic detection results,specimen pathogenic detection rate should be improved,and effective prevention and control measures needs to be taken according to the risk factors of HAI.
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Objective To gain a better knowledge of the changes of education funds investment for postgraduates of professional master's degree of clinical medicine before and after reform of the investment mechanism of graduate education. Methods 16 universities in which pilot reform of connection between postgraduate education and standardized training for residents were established were selected. A survey was conducted in terms of education funds investment, cost and living treatment during the period of clinical training. It also included the situation of standardized medical residency training. Descriptive analysis and t-test were performed to investigation results, using SPSS 20.0 statistical software. Results The average education funds were (17 100 ±11 100) yuan per person and (20 700 ±11 800) yuan per person, living treatments were (11 600±8 700) yuan per person per year and (10 200±8 700) yuan per person per year, tuition fees were (7 700±3 600) yuan per person per year and (8 800±2 100) yuan per person per year, tuition fees paid by students were (3 600±3 900) yuan per person per year and (7 700±3 400) yuan per person per year respectively before and after reform. Differences of average education funds, living treat-ments and tuition fees were not significant, while the difference between tuition fees paid by students were significant. After the re-form, students pay more tuition fees than before. Funds investment and living treat-ment of residents were significantly higher than that of graduate students. Conclusion Differences of edu-cation funds investment for professional master's degree of clinical medicine are great. And the training funds are difficult to fully meet the requirements of the culture. The life treatment is difficult to achieve equal pay to residents. We suggest perfecting the medical colleges financing mechanism and management, unifying and improving all kinds of medical college student funding standards, and setting up special funds to improve the postgraduate life treatment.
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Objective To understand the current situation of medical postgraduates'!honesty edu-cation, find the weak point and explore new ways of the honesty education. Methods The honesty educa-tion survey questionnaire was designed and conducted to the postgraduates of Grade 2014 in Peking University Health Science Center. The research contents included the basic information of postgraduates, honesty cognition, clean and self-discipline, honesty education, the recommendation of honesty education and the application of honesty education carrier. 1 038 questionnaires of a total of 1 142 questionnaires were recovered and the recovery rate was 90.9%. EPIData3.0 software was used for double entry and database establishment, and SPSS 19.0 software for statistical treatment. Results 82.3% (854) of the postgraduates recognized the work of clean government, but only 62.1% (644) of the postgraduates concerned about it. 78.3% (813) of the postgraduates expressed hatred for the dishonest behavior and hoped to eliminate it. 77.6%(806) postgraduates often paid attention to honest education content which was pushed by the new media. 16.5% (171) postgraduates thought that the new media was very important to the honest cognition. Conclusions We should pay more attention to medical postgraduates'!honesty education, find its weak points according to the investigation and make full use of the network and new media. And at the same time we should combine the actual environment to establish a hierarchy of honesty education system, and carry out honesty education through total environment which contains the school administrators, instructors/head teachers and tutors.