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.

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 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 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 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 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 immunological diagnostic characteristics in serum and cerebrospinal fluid (CSF) of neurosyphilis patients.

Thirty-five patients with neurosyphilis admitted to Xuanwu Hospital of Capital Medical University during June 2013 to July 2016 were selected for retrospective analysis, including 32 patients with serum and CSF immunological test results. Fisher exact test was used to compare the differences of IgA and IgM between serum group and cerebrospinal fluid group meanwhile, the difference of IgG between serum and cerebrospinal fluid group was compared using Chi-square test. The positive detection rate of oligoclonal bands (OB) and the 24-hour synthesis rate of immunoglobulin in cerebrospinal fluid were also analyzed.

Serum and CSF Immunoglobulin levels were in 32 patients with neurosyphilis. In serum group, IgG level elevated in 53.13%(17/32) patients, IgA level elevated in 6.25% (2/32) patients, and IgM level elevated in 0% (0/32) patient. Nevertheless, CSF-IgG increased in 84.38% (27/32) patients, CSF-IgA increased in 100.00% (32/32) patients and CSF-IgM increased in 90.63% (29/32) patients. There were statistically significant differences in the elevation rate of IgA and IgM between the serum and cerebrospinal fluid group (χ²=56.47, 53.03, P<0.01). There was no statistically significant difference in the elevation rate of IgG between the two groups(χ²=7.27, P>0.05). The positive rate of oligoclonal band in cerebrospinal fluid was as high as 100.00%, the 24-hour synthesis rate of immunoglobulin in cerebrospinal fluid increased in 96.00% (24/25) patients.

Neurosyphilis, with various clinical manifastations, is a treatable and easily misdiagnosed disease. Humoral immunity may play an important role in its development. Serum and CSF IgG increase, CSF IgA and IgM elevation and serum IgA and IgM are normal, CSF OB positive, CSF-24 h IgG synthetic ratio elevation are meaningful immunological characteristics for neurosyphilis diagnosis.

To explore the diagnostic cutoff value of the Silverman Anderson score(SA) predict to preterm infant with respiratory failure(RF).

From January 2013 to December 2013, 160 cases of the preterm infants with RF who needed for oxygen therapy were randomly selected from the Huaian Maternity and Child Healthcare Hospital.SA scores of all preterm infants at admission were respectively recorded, while extracting radial arterial for blood gas analysis. The diagnosis of RF were determined by comprehensive analysis. The diagnostic cutoff of the SA predicting preterm RF were confirmed by receiver operating characteristic (ROC) curve.

RF rate was 63.8%.SA score was 5.24±1.22. The area under the ROC curve was 0.91, area of the standard error was 0.023. 95% confidence interval area was 0.866-0.955.There was statistically significance in SA value for the diagnosis of preterm RF(P=0.000). The higher value of SA was, the greater the likelihood of preterm RF was. When the dangers of missed diagnosis rate is equal to that of misdiagnosis rate, the optimal SA diagnostic cutoff value was 5.5, the sensitivity was 67.6%, misdiagnosis rate was 3.4% and missed diagnosis rate was 37.1%.When sensitivity and misdiagnosis were rate dominant, the optimal SA diagnostic cutoff value was 4.5, the sensitivity was 93.1%, misdiagnosis rate was 31.0% and missed diagnosis rate was 14.9%.

The SA score can early predict preterm RF. It might help the clinicians to rapidly assess the severity extent of preterm infants with RF and give appropriate measures to the preterm infants at the bedside.Therefore, it might improve the quality of treatment of the preterm infants with RF.

To explore the clinical diagnostic features of encapsulated papillary carcinoma (EPC) of breast.

The clinical data of 5 cases of EPC in Yantai Affiliated Hospital of Binzhou Medical University from January 2014 to November 2018 were analyzed retrospectively.

EPC patients were all female, aged from 54 to 70 years old. The first diagnosis was due to breast mass, including 1 case of nipple overflow and 1 case of breast pain. The maximum diameter of the mass was from 1.0 to 4.0 cm, with tough and hard texture, smooth surface, fair movement, no redness or swelling of skin, no dimple or orange skin signs, and no lymph node metastasis in axilla. Breast ultrasound showed that the mass was a solid mass with clear boundary and irregular shape, while MRI showed that the mass was a solid mass with clear boundary and wide base surrounded by cystic fluid and irregular shape. In 5 cases of EPC pathology, there were crispy, round like cystic solid nodules by perusal. Microscopic appearance: there was a layer of thick fibrous capsule surrounded by papillary hyperplasia, which presented a disordered branching papillary structure. No myoepithelial cells were found in the lumen. Immunohistochemical staining showed that estrogen receptor (ER) and progesterone receptor (PR) were all positive. In 4 cases, human epidermal growth factor receptor 2 (HER-2) was negative. In 1 case, HER-2 was positive. In all 5 cases, Ki-67%<5%, CK5/6 and p63 were negative. Four patients were treated with modified radical mastectomy and one with breast conserving surgery.

EPC is prone to occur in elderly women. The first diagnosis is mostly due to a breast mass. Under the microscope, it presents a messy branch papillary structure surrounded by thick fibrous capsule. Immunohistochemical staining shows that the myoepithelium around the lesion is significantly reduced or even absent. These are the important clinical diagnostic features of the disease.

To investigate the characteristics and detection methods of secondary agglutination of cross matching in children with polyagglutination of red blood cells (RBCs).

The detection results of 8 child cases with cross matching secondary hemagglutination from January to December 2019 in Blood Group Reference Laboratory of Jining Blood Center were retrospectively analyzed. After ABO and Rh blood type identification, direct antiglobulin test (DAT), antibody screening and cross matching methods, false agglutination was excluded. Polyagglutinated RBCs were confirmed by 3 normal adults of homotypic blood serum, 3 normal adult AB serum and peanut agglutinin.

In the 8 cases, the DAT of RBCs antibody screenings and the primary side of cross matching blood were negative. While the results from the secondary saline method and anti-human globulin method were positive. The RBCs of the children were agglutinated with AB serum and peanut agglutinin. All the elements showed an agglutination reaction, and the saline was used to eliminate false agglutination like rouleaux.

The polyagglutinated RBCs agglutinate with most adults sera, which lead to secondary positive in cross matching test. Confirming the polyagglutination of erythrocytes will help to identify the causes of cross matching difficulties and avoid delaying transfusion for child patients.

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.

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.

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.

Depression, a very prevalent, disabling, and moderately inherited mental illness, is a serious threat to human health, causing serious psychological and economic burden to family and society.The pathogenesis of depression is complex, and the cause is of great diversity.One promising approach to the prevention and clinical treatment of depression lies in uncovering the genetic determinants of the disorder.Genome-wide association studies (GWAS) has become an effective method to study complex traits and genetic variation.Focusing on the findings from GWAS, the review summarizes what is currently known about the genetic determinants of depression, and discusses the challenges and valuable research directions of GWAS on depression, which aim to provide the basis for the etiology study and the prevention and treatment measures of depression.