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Background Diagnostic checklists have been demonstrated to reduce errors in clinical reasoning. Building on previous validation studies, this research presents the development and clinical application of an etiology-based diagnostic framework for evaluating acute abdominal pain. The framework integrates a structured checklist of abdominal pain etiologies with a process-oriented diagnostic strategy, aiming to enhance diagnostic accuracy and clinical outcomes. This approach also serves as a potential model for the creation of diagnostic tools applicable to other symptom complexes encountered in emergency medicine. Methods A cognitive task analysis (CTA) was conducted with participation from five emergency medicine experts employing a think-aloud methodology. The experts described their diagnostic reasoning processes and queried relevant clinical data to extract foundational diagnostic principles. Based on these findings, a checklist categorizing etiologies of abdominal pain was constructed, drawing from anatomical and diagnostic considerations. The clinical utility of the checklist was evaluated through its application to a representative complex case. Results The diagnostic checklist was organized into five principal etiological categories: local organ disorders, diseases of adjacent organs, systemic diseases, psychogenic disorders, and gynecological conditions. Its implementation facilitated the accurate identification of atypical acute renal infarction in a diagnostically challenging case, enabling prompt clinical intervention. Conclusions CTA provides a robust method for modeling expert diagnostic reasoning and supports the development of structured, etiology-based diagnostic tools. This framework enhances diagnostic precision for individuals presenting with acute abdominal pain in emergency settings and may inform the development of similar tools for other clinical presentations.

In this study, we analyzed the factors influencing the development of delayed encephalopathy in patients with acute carbon monoxide poisoning (ACOP) (DEACMP) following conventional treatment such as hyperbaric oxygen therapy (HBOT). Between January 2012 and January 2022, we retrospectively analyzed 775 patients with ACOP, who were admitted to the Second Department of Rehabilitation Medicine and received HBOT in the Second Hospital of Hebei Medical University. These patients were divided into the non-DEACMP and DEACMP groups based on their follow-up; we then compared the general data, clinical characteristics, admission examination, and treatment between the two groups to identify risk factors for the development of DEACMP. The DEACMP group comprised of 168 cases, while the non-DEACMP group consisted of 607 cases. Univariate analysis showed that there were 20 possible prognostic factors in the non-DEACMP and DEACMP groups. The results of multivariable regression analyses suggested that the occurrence of DEACMP was significantly correlated with advanced age, the combination of multiple medical histories, the duration of CO exposure, the duration of coma, poisoning degree, the Interval between ACOP and the first HBOT, the total number of HBOTs, and the combination with rehabilitation treatment. DEACMP patients who are older, have more comorbidities, prolonged CO exposure, prolonged coma, severe intoxication, long intervals between ACOP and the first HBOT, fewer HBOT treatments, and who are not treated with a combination of rehabilitative therapies have a poor prognosis.

Objective To analyze the efficacy and associated factors affecting the prognosis in patients with disturbance of consciousness after hyperbaric oxygen (HBO) treatment. Methods A retrospective study was carried out on patients with disorders of consciousness (DOC) receiving HBO treatment from January to January 2022 in the Second Department of Rehabilitation Medicine of the Second Hospital of Hebei Medical University, China. Results HBO therapy improved the Glasgow Coma Scale (GCS) and Chinese Nanjing Persistent Vegetative State Scale (CNPVSS), as well as the clinical efficacy in patients with DOC. The comparison of GCS and CNPVSS scores in patients with DOC before and after HBO treatment was all statistically significant, with 325 patients (67.1%) showing effective results and 159 patients (32.9%) having unchanged outcomes. Univariate analysis indicated that there were statistically significant differences in age, HBO intervention time, HBO treatment times, pre‐treatment GCS score, and etiology and underlying diseases between the good and poor prognoses groups. Multivariate regression analysis showed that HBO intervention time ≤7 days, HBO treatment ＞ times, high GCS score before HBO treatment, and brain trauma were independent influencing factors in achieving a good prognosis for patients with DOC. Low pre‐treatment GCS scores were an independent risk factor for a poor prognosis in patients with brain trauma while being male, late HBO intervention time, fewer HBO treatment times, and low pre‐treatment GCS scores were independent risk factors for a poor prognosis in patients with DOC after a stroke. Being ≥50 years of age, late HBO intervention time, and low pre‐treatment GCS scores were independent risk factors for a poor prognosis in patients with DOC after hypoxic‐ischaemic encephalopathy. Conclusion HBO therapy can improve the GCS, CNPVSS scores and clinical efficacy in patients with DOC, and the timing of HBO intervention ≤7 days, times of HBO treatment, high pre‐treatment GCS score, and brain trauma were the independent influencing factors of good prognosis in patients with DOC. HBO therapy can improve the GCS, CNPVSS scores and clinical efficacy in patients with DOC, and the timing of HBO intervention ≤7 days, times of HBO treatment, high pre‐treatment GCS score and brain trauma were the independent influencing factors of good prognosis in patients with DOC.

Objective The objective of this study was to investigate the clinical efficacy of hyperbaric oxygen combined with right median‐nerve stimulation (RMNES) in patients with disorders of consciousness caused by brain injury. Methods A total of 120 patients with consciousness disorders caused by brain injury were selected. They were randomly divided into three groups, a control group, test group 1 (treated with RMNES after hyperbaric oxygen therapy [HBOT]), and test group 2 (treated with RMNES at the same time as HBOT), with 40 patients in each group. Before and after treatment, the Glasgow coma scale (GCS), brainstem auditory‐evoked potential (BAEP), electroencephalogram (EEG), and upper‐limb sensory‐evoked potential (USEP) were evaluated for the three groups of patients. Results The GCS score of patients in the three groups significantly improved compared with that before treatment (p < .05). There were significant differences in GCS scores among the three groups (p < .05), and the GCS score for the patients was test group 2>test group 1>control group. The EEG, BAEP, and USEP scores were significantly improved compared with those before treatment (p < .05), and the degree of improvement of patients in the three groups was test group 2>test group 1>control group (p < .05). The clinical efficacy of test group 2 was higher than that of test group 1, and the clinical efficacy of test group 1 was higher than that of the control group (p < .05). Conclusion Hyperbaric oxygen combined with RMNES can improve the state of consciousness and promote the recovery of consciousness for patients with consciousness disorders caused by brain injury, and the effect of RMNES combined with HBOT in the chamber on improving the recovery of consciousness is better than after HBOT outside the chamber.

Background Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is of increasing concern. This study aimed to investigate the molecular epidemiology and antimicrobial susceptibilities of toxigenic C. difficile isolated from IBD patients and to evaluate the risk factors for CDI in IBD population. Methods Loose or watery stools from IBD patients were tested for glutamate dehydrogenase, C. difficile toxins A&B and anaerobic culture. Toxigenic C. difficile isolates were characterized by multi‐locus sequence typing, ribotyping and antimicrobial susceptibility testing. Results The prevalence of CDI in IBD patients was 13.6% (43/317). The dominant sequence types (STs) were ST35 (20.9%), ST2 (18.6%) and ST37 (16.3%). The most common ribotypes (RTs) were RT 017 (18.6%), RT 012 (14.0%), and RT 220 (14.0%), whereas RT 027 and RT 078 were not detected in this study. All the isolates were susceptible to vancomycin and metronidazole. The multidrug resistance rate of C. difficile RT 017 was higher (p < 0.01) than that of other RT strains. Recent hospitalization, use of corticosteroids and proton pump inhibitors were related to increased risk of CDI in IBD patients; of these, recent hospitalization and proton pump inhibitors use were independent risk factors. Conclusion Patients with IBD have a relatively high incidence rate of CDI. C. difficile RT 017 is most frequently isolated from IBD patients in this region and warrants more attention to its high resistance rate. Clinicians should pay greater attention to CDI testing in IBD patients with diarrhea to ensure early diagnosis and initiation of effective treatment. Toxigenic Clostridioides difficile isolated from patients with IBD was mostly attributed to clade1, containing 7 STs and 33 strains. Clade 4 was split into two branches, including ST37 and ST375. Clade 3 consists of 2 STs and 2 strains. There is a correspondence between ST and RT, while one ST may contain several RTs. ST types of C. difficile isolated from patients with UC and CD did not show significant aggregation or predisposition.

Cannabis sativa (C. sativa) leaves are rich in cannabinoids and flavonoids, which play important antioxidant roles. Since the environmental factors may influence the accumulation of antioxidants in herbal medicines, which affects their activity, this study aimed to investigate the correlation between the chemical composition of C. sativa leaves and their geographical origin and antioxidant activity. Firstly, a high-resolution mass spectrometry method assisted by semi-quantitative feature-based molecular networking (SQFBMN) was established for the characterization and quantitative analysis of C. sativa leaves from various regions. Subsequently, antioxidant activity analysis was conducted on 73 batches of C. sativa leaves, and a partial least squares regression (PLS) model was employed to assess the correlation between the content of cannabinoids and flavonoids in the leaves and their antioxidant activity. A total of 16 cannabinoids and 57 flavonoids were annotated from C. sativa, showing a significant regular geographical distribution. The content of flavonoid-C glycosides in Sichuan leaves is relatively high, and their antioxidant activity is also correspondingly high. However, the leaves in Shaanxi and Xinjiang were primarily composed of flavonoid-O glycosides, and exhibited slightly lower antioxidant activity. A significant positive correlation (p < 0.001) was found between the total flavonoids and cannabinoids and the antioxidant activity of the leaves, and two flavonoids and one cannabinoid were identified as significant contributors.

This study developed a novel and inexpensive detection method based on a TaqMan probe-based insulated isothermal polymerase chain reaction (iiPCR) method for the rapid detection of Panama disease caused by Fusarium oxysporum f. sp. cubense (Foc) race 4, which is currently among the most serious fungal vascular diseases worldwide. By using the portable POCKIT™ device with the novel primer set iiFoc-1/iiFoc-2, the Foc race 4 iiPCR assay (including DNA amplification and signal monitoring) could be completed within one hour. The developed Foc race 4 iiPCR assay is thus a user-friendly and efficient platform designed specifically for the detection of Foc race 4. The detection limit of this optimized Foc iiPCR system was estimated to be 1 copy of the target standard DNA as well as 1 fg of the Foc genomic DNA. This approach can serve as a rapid detection method for in planta detection of Foc race 4 in field-infected banana. It was concluded that this molecular detection procedure based on iiPCR has good potential for use as an efficient detection method.

Background: In 1987, investigators in Liaoning Province, China, reported that mortality rates for all cancer, stomach cancer, and lung cancer in 1970-1978 were higher in villages with hexavalent chromium (Cr⁺⁶)-contaminated drinking water than in the general population. The investigators reported rates, but did not report statistical measures of association or precision. Methods: Using reports and other communications from investigators at the local Jinzhou Health and Anti-Epidemic Station, we obtained data on Cr⁺⁶ contamination of groundwater and cancer mortality in 9 study regions near a ferrochromium factory. We estimated: (1) person-years at risk in the study regions, based on census and population growth rate data, (2) mortality counts, based on estimated person-years at risk and previously reported mortality rates, and (3) rate ratios and 95% confidence intervals. Results: The all-cancer mortality rate in the combined 5 study regions with Cr⁺⁶-contaminated water was negligibly elevated in comparison with the rate in the 4 combined study regions without contaminated water (rate ratio = 1.13; 95% confidence interval = 0.86-1.46), but was somewhat more elevated in comparison with the whole province (1.23; 0.97-1.53). Stomach cancer mortality in the regions with contaminated water was more substantially elevated in comparison with the regions without contaminated water (1.82; 1.11-2.91) and the whole province (1.69; 1.12-2.44). Lung cancer mortality was slightly elevated in comparison with the unexposed study regions (1.15; 0.62-2.07), and more strongly elevated in comparison with the whole province (1.78; 1.03-2.87). Mortality from other cancers combined was not elevated in comparison with either the unexposed study regions (0.86; 0.53-1.36) or the whole province (0.92; 0.58-1.38). Conclusions: While these data are limited, they are consistent with increased stomach cancer risk in a population exposed to Cr⁺⁶ in drinking water.

BackgroundTranscription factors could regulate multiple aspects of plants growth and development, which is significant to plants. Ovate family proteins (OFPs) that are named due to contain OVATE domain, a 70-AA C-terminal conserved domain from the protein OVATE gene encodes, are plant-specific transcription factors family. Some members of OFPs have been shown to function as transcription factors to regulate plant growth and development, but little is known about the function of AtOFP8.ResultsHere, we found AtOFP8 maybe involve in transcriptional regulation of the epicuticular waxes in Arabidopsis thaliana. First, we observed that the distribution of epicuticular waxes of wild type plants was more than that of Atofp8-1 deletion mutants, but less than that of 35S:HA-AtOFP8 transgenic overexpression lines not only on the leaves but also on the stems utilizing scanning electron microscopes. Second, we extracted waxes from leaves and stems of three types of plants respectively to measure the waxes content and composition by gas chromatography–mass spectrometer (GC–MS), and the results of the total content of waxes were consistent with the results of scanning electron microscopes. Finally, we found that the expression of 12 genes related to the synthesis and metabolism of waxes was changed in the Atofp8-1 mutants and 35S:HA-AtOFP8 transgenic lines compared with wild type plants.ConclusionsThese findings suggest that AtOFP8 could change the accumulation of epicuticular waxes.

The present study aimed to explore the effectiveness of the etiology checklist and process thinking in the differential diagnosis for acute abdominal pain. A retrospective design was used to include 5,403 patients with acute abdominal pain in the Emergency Department of Hebei Provincial People's Hospital. The patients with acute abdominal pain between July and December 2017 in whom the etiology checklist and process thinking were not implemented were selected as the traditional group. Those with acute abdominal pain between July and December 2018 in whom the etiology checklist and process thinking were implemented were selected as the process thinking group. The clinical data, such as the emergency length of stay, hospitalization expenses, hospitalization length of stay, diagnostic accuracy, and outcome, were compared between the two groups. For patients at emergency level 2 and above, the average emergency length of stay was shorter in the process thinking group than in the traditional group, while the average emergency length of stay was longer for patients at emergency level 3. For hospitalized patients at emergency level 2 and above and patients at emergency level 3, those in the process thinking group had improved diagnostic accuracy, shorter average hospitalization length of stay, reduced average hospital expenses, and improved outcomes. In the comparison among six physicians, the results in the traditional group were inconsistent and statistically different in terms of the average emergency length of stay and diagnostic accuracy, while the results in the process thinking group tended to be consistent. The differences were not statistically different. The diagnostic model for acute abdominal pain based on the etiology checklist and process thinking could improve the diagnostic accuracy and outcomes for patients with acute abdominal pain.