Functional gastrointestinal disorders (FGIDs), the most common diseases in gastroenterology, are recognized by morphologic and physiological abnormalities which often occur in combination including motility disturbance, increased vagal excitability, altered mucosal and immune function, altered gut microbiota, and altered central nervous system processing.Research on these gut-brain interaction disorders is based on using specific diagnostic criteria.The Rome Foundation has played a pivotal role in creating diagnostic criteria, thus new knowledge in the field of FGIDs should be disseminated.Rome Ⅳ is a compendium of the accumulated knowledge since Rome Ⅲ was published 10 years ago.It improves upon Rome Ⅲ by: (1)updating the basic and clinical literatures; (2)offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross-disciplinary understandings of FGIDs; (3)reducing the use of imprecise and occasionally stigmatizing terms when possible; (4)using updated diagnostic criteria; (5)incorporating information on illness experience, and physiological subgroups or biomarkers of patient that may lead to more targeted treatment.This introductory article offers a historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome Ⅲ, reviews the Rome committee, provides a biopsychosocial and pathophysiological conceptualization of FGIDs, and offers an approach to patient care.

To explore the clinical characteristics and gene mutations of a family with maternally inherited diabetes and deafness (MIDD).

A diabetic patient with a family history of MIDD admitted to the Department of Endocrinology and Metabolic Diseases of the First Affiliated Hospital of Anhui Medical University on April 20, 2020 was enrolled. The peripheral blood specimens of the 4 family members were collected, sent for examination and subjected to polymerase chain reaction was used for high-sensitivity sequencing analysis of mitochondrial DNA (mtDNA) to determine whether there were mtDNA mutations.

Among the 4 family members involved in the test, 2 patients had MIDD, 1 member had hearing loss but did not have diabetes, and 1 member had no hearing loss or abnormal blood sugar. And the 4 family members had mtDNA 3243 A>G mutation, of which 3 had mtDNA 10398 A>G mutation and mtDNA 15043 G>A mutation.

The clinical manifestations of MIDD in this family are quite typical, which are consistent with the characteristics of early onset, thin body type, neurological deafness and maternal inheritance. The mtDNA 3243 A>G mutation is the main cause of MIDD in this family.

To explore the influencing factors of clinical nurses′ self perceived stress during the prevention and control of Corona Virus Disease 2019 (COVID-19).

Through the "Questionnaire Star" platform from February 10 to March 20, 2020, 260 clinical nurses from 3 grade A hospitals in Guangzhou who participating in epidemic prevention and control were investigated, and 245 valid questionnaires were recovered. They were surveyed by the general situation questionnaire, workload questionnaire, emergency response ability questionnaire and perceived stress scale. Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of self perceived stress in clinical nurses, and the specific paths among the influencing factors were discussed through path analysis.

In this study, 245 nurses were included, 133 of whom had high perceived stress during the outbreak of COVID-19, accounting for 54.29%. Nurses with high workload accounted for 60.41%(148/245), and nurses with strong emergency ability accounted for 55.51%(136/245). Univariate analysis results showed that education, department, whether children living with them, whether they having contacted with suspected or confirmed patients, self-rated mental health status and workload had effects on the self perceived stress of clinical nurses (χ²=7.59, 24.13, 5.21, 6.07, 7.47, 5.19, all P<0.05). The results of Logistic regression model showed that different education levels, such as undergraduate (OR=0.208), master′s degree and above (OR=0.331), self-rated mental health (OR=1.933) and workload (OR=2.100) were the influencing factors of nurses′ self perceived stress (all P<0.05). Path analysis showed that workload had direct and indirect effects on self perceived stress, and mediating effects were regulated by self-rated mental health.

The self perceived pressure of clinical nurses is at a high level during the prevention and control of COVID-19. Nurses with lower education level, heavier workload and worse self-rated mental health status are at greater risk of high self perceived stress.

With the development of Internet, cloud computing and biotechnology and genomics technology, we enter in to an era of large medical data and large diagnosis.Collection of human diagnostic information also has been changed significantly.The transition of medical model, the development of molecular diagnostic techniques, the arrival of precision medicine times and the rapid development of medical mobile communications platform promote the formation of new pattern of diagnostics information collection.While this also makes new demand on the adjustment of diagnostics education structure and diagnostics teaching.

Critical lung ultrasound was originated from in France, as we know, professor Daniel A. Lichtenstein who was regarded as the father of critical lung ultrasound in the world, pushed the great development of critical lung ultrasound, concluded twelve signs of lung ultrasound, created the BLUE-protocol which allows fast causal diagnosis of acute respiratory failure, the FALLS-protocol used in acute circulatory failure without obvious causes and the SESAME-protocol used during cardiac arrest. Critical lung ultrasound as a new interdisciplinary subject, will provide more new ideas and solutions for diagnosis and treatments in critically ill patients.

The idea of mind-body integration existed in practice of traditional Chinese medicine (TCM) at the very beginning, and psychosomatic medicine as a special term was from western world.Discussion about psychosomatic medicine was basically limited within philosophy and psychiatrics before 1980s.It did not find extensive application in practice of non-psychiatric medicine to manage psycho-social factors in medical setting until 1980s.Brife history and worldwide development of psychosomatic medicine, the diversification of its definition, its incorporation into clinical practice and the development and expection of its incorporation into clinical gastroenterology will be discussion in the article.

To explore the diagnostic characteristics of hemichorea associated with non-ketotic hyperglycemia (HC-NH).

A retrospective analysis of the clinical data of a patient with HC-NH admitted to the Psychology Department of Affiliated Hospital of Guizhou Medical University on November 10, 2019, and relevant literatures were reviewed.

A 64-year-old male patient was admitted to the hospital for involuntary movement of the right limb for more than 10 days. The clinical manifestations were hemichorea-like movements, increased blood sugar, and negative urine ketones. Brain magnetic resonance imaging (MRI) T₁WI showed abnormally high signal in the left basal ganglia region. The patient was diagnosed with HC-NH, and the blood glucose was actively controlled. After treatment with haloperidol and clonazepam, the patient′s chorea-like symptoms disappeared. Followed up for 3 months, brain CT reexamination showed that the lesions shrunk, and the condition was stable without recurrence so far.

Chorea-like symptoms, high blood sugar, negative urine ketones, abnormal signal in the basal ganglia region in brain MRI, are important diagnostic features of HC-NH, which could be improved after blood glucose control, sedation and antipsychotic treatment.

To explore the diagnostic features of four antibody-positive patient with myasthenia gravis (MG) combined with rheumatoid arthritis(RA).

The clinical data of a MG patient with four antibody-positive combined with RA in the Rheumatology Department of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed, and related literatures were reviewed.

The patient was diagnosed with MG and RA with ptosis, fatigue, dysphagia, symmetrical polyarticular swelling and pain four years and six months ago. He was given pyridostigmine bromide, prednisone acetate, methotrexate, leflunomide and hydroxychloroquine, and the above symptoms improved. Due to the discontinuation of pyridostigmine bromide and prednisone acetate reduction, the disease recurred. After perfecting the MG-related antibodies examinations, it was found that the acetylcholine receptor (AChR) antibody, the muscle-specific tyrosine kinase (MuSK) antibody, the ryanodine receptor (RyR) antibody, and the acetylcholinesterase (AChE) antibody were positive at the same time. Adjusting the treatment plans to prednisone acetate, cyclosporine and pyridostigmine bromide, the condition was gradually eased.

Four kinds of antibodies can be detected in patients with MG and RA, suggesting that different antibody-mediated pathogenic mechanisms may exist in autoimmune overlap.

To evaluate the clinical application of 3D cephalometric in orthodontics and compare conventional cephalometric with 3D cephalometric, which reconstructed by cone beam computed tomography (CBCT) images.

From May 2012 to December 2012, there were 13 patients going with orthodontic therapy, among which 5 patients with severe dental maxillofacial malocclusion and 8 patients with impacted tooth. All patients were detected by regular pantomography and lateral cephalogram, then CBCT scans with consent. All patients were detected by 3D cephalometric analytics with professional software compared with conventional cephalometric.

3D constructed CBCT form showed more accurate images.Compared with 2D, 3D cephalometric measurements showed differences in ANB, MP-FH, L1-NB, SNA, U1-NA parameters(t=2.63, 2.59, 2.68, 3.08, 3.21; P<0.05), there was no significant difference between other parameters.(t=1.32, 1.17, 1.46, 1.37, 1.62, 1.03; P>0.05).

CBCT combined with 3D cephalometric takes great advantage to conventional cephalometric. It has important clinical guidance to establish treatment scheme for patients with dental maxillofacial deformity.

To enhance the recognition of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) combined with small cell lung cancer by analyzing the clinical symptoms, imaging features, pathological features.

The clinical status, serum biochemical and computed tomography (CT) data of ANCA-associated vasculitis combined with small cell lung cancer confirmed by serum biochemical and pathology were analyzed retrospectively, and relevant literatures were reviewed.

Clinical manifestations of ANCA-associated vasculitis with small cell lung cancer were fever, cough, sputum, effect of anti-infection treatment was poor, laboratory results: myeloperoxidase, pANCA were positive; routine urine: 2+ of red blood cells; cANCA, glomerular basement membrane antibody qualitative resistance, anti-proteinase 3 antibodies, anti-cardiolipin antibody IgG, IgM, carcino-embryonic (CEA), neuron specific enolase (NSE), antinuclear antibodies were negative.Enhanced chest CT showed left lower lobe placeholder and multiple swollen lymph nodes in mediastinal; peripheral lung cancer might be considered.Double pulmonary interstitial changed.

For patients with pulmonary interstitial and pulmonary consolidation, the use of symptoms did not improve after repeated use of antibiotics, we should check the vasculitis screening and positively definite lung lesions in pathology, especially when therapy effect is poor.We should consider the possibility of AAV combined with lung cancer, avoiding the occurrence of missed diagnosis and misdiagnosis.

To explore the teaching effect based on the training of clinical diagnosis thinking in the teaching of symptomatology.

A total of 350 clinical medical students who were in grade 3 were selected from March to July 2019 in Southern Medical University. According to cluster sampling, two classes were randomly selected and divided into two groups. The experimental group consisted of 40 students, who were given teaching reform based on the training of clinical diagnosis thinking, including integrating the teaching content, comprehensively applying the teaching methods of thinking map, flipped classroom, case teaching. In the control group, 60 students were given traditional teaching. The evaluation model of theoretical knowledge assessment and student feedback were used to evaluate the teaching effect.

The total score of theoretical knowledge assessment in the experimental group [(85.33±15.44)points] was better than that in the control group [(70.05±18.51)points], the difference was statistically significant (t=8.66, P<0.01). The total score of feedback evaluation in the experimental group [(79.68±5.56)points] was higher than that in the control group [(48.08±6.45)points], the difference was statistically significant (t=20.42, P<0.01).

The teaching reform based on the training of clinical diagnosis thinking is of great significance to improve the teaching effect and the feedback evaluation of students.

To explore the potential key genes of lung adenocarcinoma (LUAD) and their diagnostic and prognostic value.

We downloaded the ChIP data (GSE10072, GSE32867, GSE43458) from the GEO database, and analyzed these data using online tool GEO2R to obtain the differentially expressed genes (DEGs) between cancer tissues and normal tissues. These DEGs were analyzed by the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). We used the STRING database to build a protein-protein interaction (PPI) network, then ranked the genes by the descending order of the links between proteins, finally the top 8 genes were considered as the key genes. The expression profile, prognosis, and the tumor mutation burden (TMB) were analyzed using R (4.0.0).

A total of 240 genes differentially expressed among three ChIP data were screened out, and the GO outcome showed that these DEGs mainly concentrated in cell adhesion and drug resistance. Cytological components were mainly located in cytoplasm, cell membrane, and extracellular exosome. The molecular function was enriched in calcium ion binding. KEGG signaling pathway analysis showed that the DEGs were mainly involved in PI3K/AKT/MAPK pathway. The 8 genes all expressed differentially between tumor and normal tissues, and patients with higher expression of CDC20, TIMP1, CCNB2, KIAA0101 and TOP2A had worse overall surviver (OS) than the patients with lower expression (all P<0.01). What's more, the key genes also affect the immune infiltration in the tumor, and the expression levels of CCNB2 (r=0.43), CDC20(r=0.46), GNG11(r=-0.11), KIAA0101(r=0.32), TIMP1(r=-0.10), TOP2A(r=0.43) were associated with the TMB (all P<0.05).

There are DEGs in patients with LUAD, a part of these key genes may be involved in the occurrence, development, metastasis, invasion, and drug resistance of LUAD cells and other biological functions, and are expected to become potential markers for individualized diagnosis and prognostic evaluation of LUAD.

To explore the clinical diagnostic features of embryonal rhabdosarcoma(ERMS).

One patient with ERMS caused by tumor was diagnosed and the clinical data were retrospectively analyzed.The relevant literatures were reviewed.

The patient presented with bellyache, palpable abdominal mass.Gastroscopy revealed space occupying lesion of cecus minor ventriculi, gastric fundus and gastric body, Biermer-Ehrlich anemia and polyps of gastric antrum.Pathologic diagnosis was ERMS.Microscopically, tumor cells shaped aerie and sheet.The tumor cells were round and small, with less cytoplasm.The nucleus was located in the central or the partial position, with apparent hyperchromatism and fission.Immunohistochemically, it was positive for Myogenin and Desmin.

ERMS in stomach of adult is a high grade malignant soft tissue neoplasm, and it is rarely to be found.Careful analysis of the clinicopathological features and immunohistochemisitry will be helpful to make accurate diagnosis.

To explore the digestive system damage and mental health features of patients with Corona Virus Disease 2019 (COVID-19) in Guangzhou.

The clinical data of 123 patients with confirmed COVID-19 in Guangzhou Eighth People′s Hospital from January 25, 2020 to February 20, 2020 were collected, and 85 healthy controls were selected at the same time. The differences of digestive tract symptoms and the characteristics of liver injury among common (n=87) and severe and critical patients (n=36)were compared. The time-effect relationship of digestive tract damage was evaluated, and the main symptoms were analyzed by multivariate analysis. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Pittsburgh Sleep Quality Index (PSQI) were evaluated and compared between some patients (85 cases) and healthy control group (85 cases).

Among the general symptoms, fever and cough were the most common symptoms [112 patients (91.06%) and 94 patients (76.42%), respectively]. In terms of accompany digestive tract symptoms, anorexia was the most common symptom (55 patients, 44.72%), followed by diarrhea (23 patients, 18.70%). A total of 2 patients (1.63%) with the first clinical manifestation of digestive system symptoms. Among severe and critical patients, the numbers of patients with anorexia [28 patients(77.78%)] and abdominal pain [5 patients(13.89%)] were more than those in the common group [27 patients (31.03%), 2 patients (2.30%)], the differences were statistically significant (all P<0.05). The symptoms of diarrhea were significantly relieved 1-4 days later, (2.69±0.87)days on average, while the anorexia lasted for 5-15 days, with an average of (9.67±2.54) days. Alanine aminotransferase (ALT) [36.60(19.57, 57.50)] and aspartate aminotransferase (AST) [39.70(22.40, 61.75)] levels of severe and critical patients were significantly higher than those of common group [20.50(12.70, 27.88), 18.80 (13.40, 22.90)](Z=-3.91, -5.36, all P<0.05), while albumin (ALB) level was significantly lower than that of common group [33.35(30.02, 35.30), 38.10(34.90, 39.90)] (Z=-5.61, P<0.05). Logistic regression analysis showed that oxygenation index (OR=0.99, 95%CI: 0.98-0.99), anxiety or depression (OR=0.18, 95%CI: 0.03-0.97) had significant influence on anorexia (all P<0.05). The incidences of anxiety [28(32.94%)], depression [29(34.12%)] and sleep disorder [40(47.06%)] in patients infected by COVID-19 were significantly higher than those in healthy control group [9(10.59%), 8(9.41%), 10(11.76%)], the differences were significant (χ²=12.47, 15.23, 25.50, all P<0.05).

Anorexia was the most common digestive tract symptom in COVID-19 patients. Some COVID-19 patients may be accompanied by anxiety, depression or sleep disorders, and oxygenation index, anxiety or depression are important influencing factors of anorexia.

To explore the diagnostic features of infantile neuroaxonal dystrophy (INAD).

The clinical data of a 13 month female baby with INAD who was diagnosed in the Department of Pediatric Rehabilitation of First People′s Hospital of Jining on May 15, 2020 were retrospectively analyzed, and relevant literatures were reviewed.

The infant was mainly presented with progressive psychomotor deterioration, truncal hypotonia and positive pathological signs. The cerebral magnetic resonance imaging (MRI) showed signal hyperintensity of the globus pallidus in T₂-weighted images (T₂WI). An electromyography also showed denervation in the peripheral nervous system. The diagnosis was confirmed by molecular genetic study of the phospholipase A2 type 6 (PLA2G6) gene, and there were two missense mutations, c. 1771 C>T (p.R591W) and c. 2150 T>C (p.L717P). The results of Sanger sequencing showed that the 2 mutations were from her mother and father respectively and were compound heterozygous mutations. The c. 1771 C>T site had been reported to be a pathogenic mutation. The c. 2150 T>C which was first reported had not been detected in the nomal population and predicted to be harmful.

INAD has the main clinical manifestations of psychomotor regression, muscular dystonia, and positive pathological signs.Next-generation sequencing technologies can be considered to be the preferred means of clinical diagnosis of INAD.

To investigate the prenatal ultrasonic diagnostic features of tetralogy of Fallot(TOF) in early pregnancy.

The prenatal ultrasound data of a case of 14-week-old fetus with TOF, who was confirmed by pathological anatomy in the Ultrasound Department of Laizhou Maternity and Child Healthcare Hospital on September 22, 2019 were retrospectively analyzed, and literatures were reviewed.

The prenatal echocardiography of TOF showed abnormal cardiac axis and tricuspid regurgitation in four chamber view. Perimembranous ventricular septal defect, widened aorta straddling the interventricular septum were showed in left ventricular outflow tract. Color Doppler flow imaging showed the color "y" sign, which was formed by left ventricular blood flow and right ventricular blood flow through ventricular septal which entered the aortic in systole together. Narrowed pulmonary artery was showed in right ventricular outflow tract. Pathological anatomy confirmed the diagnosis of TOF.

TOF is a common conotruncal defect. Ultrasonic examination is noninvasive and simple, which can provide imaging evidence for prenatal diagnosis of TOF.

To study the expression level of apelin and angiotensin receptor AT1(APJ)in gastric cancer and explore possible association between the expression of Apelin/APJ and clinical significance.

Cancer tissues and normal mucosa tissues with wax block of 123 cases of gastric cancer patients, who received surgery of gastrointestinal surgery in Jining medical college affiliated hospital from January 2015 to December 2015 were collected from pathology department.SP immunohistochemical staining was used to explore the expression level of apelin and APJ.Semi-quantitative analysis was carried out.Through calculating microvasculars labelled by CD34 markers, " hot spots" microvessel densitic (hMVD) was calculated.

Both apelin and APJ showed positive expression in cytoplasm of normal gastric mucosa, but no expression was found in the upper cortex.Apelin was mainly expressed in the cytoplasm and nucleus of gastric cancer cells, but no APJ was expressed in gastric cancer.CD34 was significantly higher in tumor tissue than that in normal gastric mucosa.There were no significant difference for apelin expressing levels in different age (3.56±2.13, 3.98±2.08), sex (3.62±2.21, 3.96±2.27) and TNM (3.66±2.36, 4.14±2.12) staging of gastric cancer patients.However, there were significant differences between different tumor differentiation degree (3.16±2.10, 3.55±2.01, 4.36±2.18; F=20.56, P<0.05) and high-microvessel densitie (hMVD)(3.35±2.14, 4.23±2.05; z=12.37, P<0.05).

Apelin is involved in the development of gastric cancer, and its expression level is related to the degree of tumor differentiation and hMVD.High expression level of apelin is presented in tumor tissues with low differentiation and high density hMVD.