Study on the correlation between telomere dysfunction of human gastric mucosa and chronic atrophic gastritis / 中华消化杂志

Objective:To investigate the correlation between telomere dysfunction of human gastric mucosa and chronic atrophic gastritis (CAG).Methods:From February 12, 2019 to July 10, 2020, at Endoscopy Center, Guang′anmen Hospital, China Academy of Chinese Sciences, 30 patients received endoscopy and pathological diagnosed with CAG (CAG group) were collected, and 30 patients with chronic non-atrophic gastritis (CNAG) were collected at the same time (CNAG group). The relative telomere length was detected by real time fluorescent quantitative polymerase chain reaction. The expression of telomere repeat binding factor (TRF) 1, TRF2 and protection of telomere (POT) 1 at protein level were detected by immunohistochemical staining and semi-quantitative analysis. Spearman analysis was used to analyze the correlation between the relative telomere length of gastric mucosa and the protein expression levels of TRF1, TRF2 and POT1. Mann-Whitney U test and independent sample t test were used for statistical analysis. Results:The relative telomere length of the gastric mucosa in the CAG group was shorter than that in the CNAG group (0.67 (0.51 to 1.17) vs. 1.06(0.69 to 1.37)), and the difference was statistically significant ( U=297.00, P=0.024). The protein expression levels of TRF1, TRF2, and POT1 in the CAG group were all higher than those in the CNAG group, respectively (4.26±2.49 vs. 1.86±1.34, 10.12±2.76 vs. 8.78±2.81, 4.22±2.48 vs. 2.53±1.62), and the differences were statistically significant ( t=8.05, 3.23, 5.39; P<0.001, =0.001, and <0.001). In the CAG group, the protein expression levels of TRF2 and POT1 in gastric mucosa were negatively correlated with the relative telomere length ( r=-0.477 and -0.417, P=0.008 and 0.022). Conclusions:The telomere dysfunction is related to the pathogenesis of CAG. The change of telomere binding protein expression level is involved in the shortening of telomere and pathological process of CAG patients.

Analysis of incidence and influencing factors of congenital heart disease in perinatal infants in Henan province / 新乡医学院学报

Objective To analyze the incidence, trend and influencing factors of congenital heart disease(CHD) in perinatal infants in Henan province. Methods From 2011 to 2020,1 356 838 perinatal infants born from 28 weeks of pregnancy to 7 days after delivery were selected from 37 national birth defect monitoring points in Henan province as the research subjects, and the incidence of CHD in perinatal infants from different regions, fetal sex and maternal age were compared. The Joinpiont regression model was established to analyze the temporal change trend of the incidence rate of CHD in perinatal infants in Henan province from 2011 to 2020; the annual percentage change (APC) represented the internal trend of each segment, and the average annual percentage change (AAPC) represented the overall change trend. The trend of gap in incidence rate of CHD in different regions, mother's age and perinatal sex was compared by the Joinpiont parallel test. Results From 2011 to 2020,19 004 cases of perinatal infants with CHD were detected in Henan province, with a total incidence of 140.06/10 000; the incidence of CHD in perinatal infants showed an increasing trend year by year (AAPC=43.3% ,P<0.05) From 2011 to 2020, the incidence of CHD in urban perinatal infants in Henan province was significantly higher than that in rural areas, the incidence of CHD in male perinatal infants was significantly higher than that in female perinatal infants，and the incidence of CHD in perinatal infants in older mothers was significantly higher than that in younger mothers (X2=7 259.160,5 415.473,499.520; P<0.05). From 2011 to 2020,the incidence of CHD in perinatal infants in urban and rural areas of Henan province showed an increasing trend year by year (AAPC=42.5% ,44.5% ;P<0.05); the difference between urban and rural areas in the incidence of CHD in perinatal infants was increasing year by year(P<0.05). From 2011 to 2020,the incidence of CHD in male perinatal and famale perinatal infants in Henan province showed an increasing trend year by year(AAPC=44.3%，42.7% ;P<0.05). From 2011 to 2020, the incidence of CHD in perinatal infants of non-elderly and elderly pregnant women in Henan province showed an increasing trend year by year (AAPC=42.9% ,42.7% ;P<0.05).the difference between the elderly arid non-elderly pregnant women in the incidence of CHD In perinatal infants was increasing year by year (P<0.05). Conclusion From 2011 to 2020 ,the incidence of CHD in perinatal infants in Henan province showed an upward trend, and the regional distribution, fetal sex and maternal age were related to the incidence of perinatal CHD.

Factors associated with readmission within three months of surgery for gastric cancer and their long-term effects on patients' nutritional status and quality of life / 中华胃肠外科杂志

Objective: To analyze the factors associated with readmission within three months of surgery for gastric cancer and the impact of readmission on patients' long-term nutritional status and quality of life. Methods: This was a prospective cohort study comprising patients who underwent radical gastrectomy in the Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences from October 2018 to August 2019. Patients who failed to complete postoperative follow-up, whose body mass index (BMI) could not be accurately estimated, or who were unable to complete a quality-of-life questionnaire were excluded. The patients were followed up for 12 months. Time to, cause(s) of, and outcomes of readmission were followed up 1, 2 and 3 months postoperatively. BMI was followed up 1, 3, 6 and 12 months postoperatively. Results of blood tests were collected and patients' nutritional status and quality of life were assessed 12 months postoperatively. Nutritional status was evaluated by BMI, hemoglobin, albumin, and total lymphocyte count. Quality of life was evaluated using the European Organization for Research in the Treatment of Cancer (EORTC) Quality of Life scale. The higher the scores for global health and functional domains, the better the quality of life, whereas the higher the score in the symptom domain, the worse the quality of life. Results: The study cohort comprised 259 patients with gastric cancer, all of whom were followed up for 3 months and 236 of whom were followed up for 12 months. Forty-four (17.0%) patients were readmitted within 3 months. The commonest reasons for readmission were gastrointestinal dysfunction (16 cases, 36.3%), intestinal obstruction (8 cases, 18.2%), and anastomotic stenosis (8 cases, 18.2%). Logistic regression analysis showed that preoperative Patient-Generated Subjective Global Assessment score ≥ 4 points (OR=1.481, 95% CI: 1.028‒2.132), postoperative complications (OR=3.298, 95%CI:1.416‒7.684) and resection range (OR=1.582, 95% CI:1.057‒2.369) were risk factors for readmission within 3 months of surgery. Compared with patients who had not been readmitted 12 months after surgery, patients who were readmitted within 3 months of surgery tended to have greater decreases in their BMI [-2.36 (-5.13,-0.42) kg/m2 vs. -1.73 (-3.33,-0.33) kg/m2, Z=1.850, P=0.065), significantly lower hemoglobin and albumin concentrations [(122.1±16.6) g/L vs. (129.8±18.4) g/L, t=2.400, P=0.017]; [(40.9±5.0) g/L vs. (43.4±3.3) g/L, t=3.950, P<0.001], and significantly decreased global health scores in the quality of life assessment [83 (67, 100) vs. 100 (83, 100), Z=2.890,P=0.004]. Conclusion: Preoperative nutritional risk, total or proximal radical gastrectomy, and complications during hospitalization are risk factors for readmission within 3 months of surgery for gastric cancer. Perioperative management and postoperative follow-up should be more rigorous. Readmission within 3 months after surgery may be associated with a decline in long-term nutritional status and quality of life. Achieving improvement in long-term nutritional status and quality of life requires tracking of nutritional status, timely evaluation, and appropriate interventions in patients who need readmission.

The role of glutamine metabolism in castration-resistant prostate cancer / 亚洲男科学杂志(英文版)

Reprogramming of metabolism is a hallmark of tumors, which has been explored for therapeutic purposes. Prostate cancer (PCa), particularly advanced and therapy-resistant PCa, displays unique metabolic properties. Targeting metabolic vulnerabilities in PCa may benefit patients who have exhausted currently available treatment options and improve clinical outcomes. Among the many nutrients, glutamine has been shown to play a central role in the metabolic reprogramming of advanced PCa. In addition to amino acid metabolism, glutamine is also widely involved in the synthesis of other macromolecules and biomasses. Targeting glutamine metabolic network by maximally inhibiting glutamine utilization in tumor cells may significantly add to treatment options for many patients. This review summarizes the metabolic landscape of PCa, with a particular focus on recent studies of how glutamine metabolism alterations affect therapeutic resistance and disease progression of PCa, and suggests novel therapeutic strategies.

Diagnostic methods for peritoneal molecular residual disease in gastric cancer / 中华胃肠外科杂志

Peritoneal metastasis of gastric cancer serving as the most frequent form of metastasis, is one of the leading causes of death. A portion of surgically treated patients often suffer from small peritoneal residual metastasis, which will lead to recurrence and metastasis of gastric cancer patients after surgery. Given these, the prevention and treatment of peritoneal metastasis of gastric cancer deserves more attention. Molecular residual disease (MRD) refers to the molecular abnormalities of tumor origin that cannot be found by traditional imaging or other laboratory methods after treatment, but can be found by liquid biopsy, representing the possibility of tumor persistence or clinical progress. In recent years, the detection of MRD based on ctDNA has gradually become a research hotspot in the prevention and treatment of peritoneal metastasis. Our team established a new method for MRD molecular diagnosis of gastric cancer, and reviewed the research achievements in this field.

Epidemiological characteristics of Yersinia enterocolitica in patients with diarrhea from 2013 to 2019 in Pudong New Area, Shanghai / 中华预防医学杂志

Objective: To investigate the epidemiological characteristics of Yersinia enterocolitica in patients with diarrhea in Pudong New Area, Shanghai. Methods: Active surveillance of diarrhea was conducted in 14 sentinel hospitals (three tertiary-level hospitals, nine secondary-level hospitals, and two primary-level hospitals) from January 2013 to December 2019 in Pudong New Area of Shanghai, China base on their location, catchment area, and patient volume. Cold enrichment method was used to isolate Y. enterocolitica and further detection of bioserotype, virulence genes and antimicrobial susceptibility of the isolates were conducted. The difference of rates was determined using chi-square test or Fisher's exact test. Results: A total of 12 941 diarrhea cases were included, and 0.7% (88/12 941) cases were confirmed with Yersinia enterocolitica infection. 67.0% (59/88) cases were single infection, 33.0% (29/88) cases were mixed infections. Detection rates of Y. enterocolitica increased annually (0.3%-1.2%) and were highest in children<5 years of age (1.1%, 37/3 218) and in spring (1.1%, 32/2 998) (χ2 were 18.64 and 9.76, respectively, P<0.05). 58.0% (51/88) cases had watery diarrhea, 15.9% (14/88) had fever and 14.8% (13/88) had vomiting. The predominant bioserotypes were 3/O:3 (53.4%, 47/88), followed by 1A/O:8 (15.9%, 14/88) and 1A/O:5(6.8%, 6/88), respectively. Bioserotype 3/O:3 counted for the highest proportions (89.2%, 33/37) in children <5 years of age. All the strains of bioserotype 3/O:3 harbored ail, ystA, yadA and virF genes, which encoded pathogenic Y. enterocolitica. 11/14 strain of 1A/O:8 and 4/6 strains of 1A/O:5 harbored ystB gene. Most strains were resistant to ampicillin (80.7%,71/88) and amoxicillin/clavulanic acid (71.6%,63/88), and 63.8% (56/88) strains were multidrug resistance (MDR). The difference of antimicrobial resistance rates between 3/O:3 and non 3/O:3 was statistically significant in ampicillin, cefoxitin, nalidixic acid, tetracycline and ampicillin/sulbactam (χ2 was 14.68, 43.80, 41.86, 30.54 and 5.07, respectively, P<0.05). Conclusion: The detection rate of Yersinia enterocolitica was higher in children than in adults in Pudong New Area , Shanghai. The predominant bioserotype was pathogenic 3/O:3 with multidrug resistance.

Antigen sparing with influenza virus vaccine formulated with crude polysaccharides from Cistanche deserticola Y. C.Ma adjuvant / 中华微生物学和免疫学杂志

Objective:To investigate the antigen-sparing effects of crude polysaccharides from Cistanche deserticola Y. C.Ma (CPCD) for influenza virus vaccine (IVV). Methods:ICR mice were immunized subcutaneously with CPCD combined with different doses of IVV (0.01 μg and 0.1 μg). Hemagglutinin inhibition (HI) assay was used to detect HI titers in serum samples. Indirect ELISA was performed to detect the levels of specific IgG antibodies and their subtypes in serum samples. The proliferation of splenic lymphocytes was detected by MTT assay. The percentages of CD4 + , CD8 + and CD44 + T cells and the levels of IFN-γ in splenic cells isolated from the vaccinated mice were analyzed by flow cytometry. Results:CPCD significantly increased HI titers (234.67±47.70 vs 149.33±47.70, P<0.05), promoted the production of IgG ( A450 value: 1.16±0.63 vs 0.30±0.21, P<0.05) and IgG1 ( A450 value: 1.09±0.60 vs 0.26±0.21, P<0.05) and enhanced splenic lymphocyte proliferation ( P<0.05). CPCD also significantly up-regulated the expression of CD4 + [(41.97±4.58)% vs (25.43±1.48)%, P<0.05], CD8 + [(12.67±0.33)% vs (9.02±1.07)%, P<0.05], CD4 + CD44 + [(11.77±0.69)% vs (8.64±0.71)%, P<0.05] and CD8 + CD44 + [(6.70±0.67)% vs (4.66±0.39)%, P<0.05] T cell subsets as well as the secretion of IFN-γ in CD4 + [(1.36±0.07)% vs (0.87±0.06)%, P<0.05] and CD8 + [(2.09±0.20)% vs (1.42±0.08)%, P<0.05] T cells. In addition, there was no significant difference between CPCD combined with low-dose IVV group and high-dose IVV alone group ( P>0.05), implying a 10-fold antigen sparing. Conclusions:CPCD, as an adjuvant for influenza virus vaccine, could enhance humoral and cellular immune responses and reduce antigen dose, which might be a potential adjuvant for seasonal or pandemic influenza vaccines.

Clinical, neuroimaging and gene mutation characteristics of McLeod syndrome and literature review / 中华神经科杂志

Objective:To study the characteristics of clinical, laboratory, imaging, genetic and differential diagnosis of McLeod syndrome.Methods:The clinical characteristics of 2 cases of McLeod syndrome confirmed by gene detection in Qilu Hospital (Qingdao) on June 27, 2018 and in Qilu Hospital of Shandong University on September 11, 2019 were analyzed retrospectively. And the characteristics of patients of McLeod syndrome reported in China were analyzed in combination with literature review.Results:Both of the 2 patients were adult male, aged 57 and 61 years, respectively, with a slowly progressive course, beginning with gradually involuntary movement of trunk and extremities, involving involuntary biting of the tongue and dysphagia. Two patients had mild cognitive impairment; one patient had emotional agitation. Imaging study showed atrophy of caput nuclei caudate. Neuroelectrophysiological examination of case 1 showed sensory axon neuropathy in both upper limbs with severe damage to the left ulnar nerve. Creatine kinase (CK) was mildly elevated in 2 patients. The peripheral blood smear of 1 patient showed increased acanthocytes, accounting for 13%, the other patient showed no increased acanthocyte. McLeod syndrome related gene was tested in the 2 patients, case 1 with deletion mutation of exon 2 of XK gene, and case 2 with hemizygotic mutation of XK gene c.898delC p.L300 *. Conclusions:The clinical manifestations of McLeod syndrome are various and the differential diagnosis is crucial. For elderly male with cephalic facial chorea, elevated CK level and neuromuscular diseases, the possibility of McLeod syndrome should be screened.

Value of different tumor markers for the diagnosis and prognosis prediction of colon cancer in patients / 中国基层医药

Objective:To comprehensively analyze the clinical values of serum tumor markers of colon cancer, including carbohydrate antigen 724 (CA724), cytokeratin 19 fragment antigen (CYFRA21-1), carbohydrate antigen199 (CA199) and carcinoembryonic antigen (CEA) in the diagnosis and prognosis prediction of colon cancer in patients.Methods:The clinical data of 160 patients with colon cancer who received treatment in Zhuji Central Hospital from January 2018 to December 2020 (observation group) and the clinical data of 156 patients with benign colon polyps who concurrently received physical examination (control group) were retrospectively analyzed. All patients underwent CA724, CYFRA21-1, CA199 and CEA tumor marker screening. The levels of tumor markers, the positive rate of a single tumor marker, and the positive rate of a combination of four markers were compared between the control and observation groups. The levels of tumor markers were compared among different pathological stages. The levels of serum tumor markers were compared among patients with different prognoses based on 1-year follow-up data.Results:CA199-positve rate, CEA-positive rate, CYFRA21-1-positve rate, CA724-positive rate, and the positive rate of a combination of four tumor markers were 85.63% (137/160), 86.88% (139/160), 71.88% (115/160), 85.00% (136/160), and 95.63%(153/160), respectively, which were significantly higher than those in the control group ( χ2 = 8.64, 10.28, 8.33, 9.93, 7.27, all P < 0.001). Serum CA199, CEA, CYFRA21-1 and CA724 levels in patients with stage III-IV colon cancer were (58.96 ± 13.59) U/mL, (38.69 ± 11.84) μg/L, (14.78 ± 3.68) μg/L, (23.68 ± 5.38) U/mL, respectively, which were significantly higher than those in patients with stage I-II colon cancer [(48.35 ± 9.03) U/mL, (23.96 ± 12.25) μg/L, (9.57 ± 2.53) μg/L, (13.02 ± 4.32) U/mL, t = 10.29, 12.02, 8.47, 10.54, all P < 0.001). One-year follow-up results showed that serum levels of CA199, CEA, CYFRA21-1, CA724 in patients with recurrence and metastasis of colon cancer were (38.68 ± 3.04) U/mL, (17.12 ± 4.96) μg/L, (8.94 ± 2.32) μg/L, (11.22 ± 1.94) U/mL, which were significantly higher than those in patients without recurrence of colon cancer [(30.02 ± 2.95) U/mL, (3.75 ± 1.06) μg/L, (3.06 ± 1.15) μg/L, (6.28 ± 1.53) U/mL, t = 8.73, 11.02, 7.72, 7.57, all P < 0.001]. Conclusion:Serum levels of CEA, CA199, CA724 and CYFRA21-1 can be used as important indicators for diagnosis and prognosis prediction of colon cancer.

Correlation analysis of serum inflammatory factors, coagulation function and immune function with the condition of elderly patients with chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To investigate the correlation among serum inflammatory factors, coagulation function and immune function and the condition of elderly patients with chronic obstructive pulmonary disease (COPD).Methods:One hundred and twenty-eight elderly patients with COPD treated in Zhuji Central Hospital from January 2018 to December 2019 were selected and divided into acute attack group (72 cases) and stable group (56 cases) according to the patient′s condition; another 60 elderly healthy people from January 2018 to January 2019 were selected as the control group. The levels of amyloid A (SAA), C-reaction protein (CRP) and procalcitonin (PCT), D-Dimer (D-D), fibrinogen (FIB) and T lymphocyte subsets were compared among the three groups. The percentage of the first second expiratory volume to predicted value (FEV 1%) and the ratio of the first second expiratory volume (FEV 1) and forced vital capacity (FVC) were compared among the three groups. The arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2) were compared among the three groups. Results:The levels of serum CRP, SAA and PCT in the acute attack group and stable group were higher than those in the control group and the levels of serum CRP, SAA and PCT in the acute attack group were higher than those in the stable group: (37.29 ± 7.67) mg/L vs. (18.29 ± 3.54) mg/L, (41.32 ± 5.45) mg/L vs. (14.35 ± 3.19) mg/L, (3.87 ± 0.65) ng/L vs. (1.02 ± 0.15) ng/L, the differences were statistically significant ( P<0.05). The serum D-D and FIB levels in the acute attack group and stable group were higher than those in the control group and the serum D-D and FIB levels in the acute attack group were higher than those in the stable group: (3.27 ± 0.36) mg/L vs. (1.08 ± 0.27) mg/L, (3.98 ± 0.56) mg/L vs. (3.07 ± 0.45) mg/L, the differences were statistically significant ( P<0.05). The CD 3+, CD 4+ and CD 4+/CD 8+ levels in the acute attack group and stable group were lower than those in the control group and the CD 3+, CD 4+ and CD 4+/CD 8+ levels in the acute attack group were lower than those in the stable group:0.598 ± 0.062 vs. 0.678 ± 0.046, 0.345 ± 0.032 vs.0.383 ± 0.034, 1.25 ± 0.21 vs. 1.48 ± 0.19, the differences were statistically significant ( P<0.05). The FEV 1% and FEV 1/FVC levels in the acute attack group and stable group were lower than those in the control group and the FEV 1% and FEV 1/FVC levels in the acute attack group were lower than those in the stable group: (43.21 ± 3.65)% vs. (58.98 ± 4.52)%, (42.19 ± 3.25)% vs. (54.38 ± 4.87)%, the differences were statistically significant ( P<0.05). The PaO 2 in the acute attack group and stable group was lower than that in the control group, while PaCO 2 in the acute attack group and stable group was higher than that in the control group, the PaO 2 in the acute attack group was lower than that in the stable group and PaCO 2 in the acute attack group was higher than that in the stable group: (54.53 ± 5.45) mmHg(1 mmHg = 0.133 kPa) vs. (78.71 ± 7.40) mmHg, (68.68 ± 6.54) mmHg vs. (45.23 ± 4.25) mmHg, the differences were statistically significant ( P<0.05). Conclusions:The elderly patients with COPD have obvious inflammatory reaction, abnormal coagulation function and decreased immune function. With the progress of the disease, the inflammatory reaction, abnormal coagulation function and decreased immune function are more obvious.

Characteristics of thrombelastography in patients with different severity of sepsis and their value in assessment of prognosis / 中华急诊医学杂志

Objective:To investigate the correlation and predictive value of thromboelastography (TEG) in the severity and prognosis of patients with sepsis.Methods:Clinical data of 147 patients with sepsis admitted to Intensive Care Unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019 were retrospectively analyzed. Inflammation indicators and TEGt were performed within 24 h after admission, and APACHE Ⅱ score was evaluated. According to APACHE Ⅱ score, the patients were divided into the mild group and severe group. TEG indicators were compared between the two groups. Patients with sepsis were divided into the death group and survival group to assess the value of TEG for prognosis of patients with sepsis.Results:Compared with patients with mild sepsis, patients with severe sepsis had lower α angle ( P=0.015), longer K time ( P=0.015), and higher maximum amplitude ( P=0.045). The K time of the death group was significantly longer than that of the survival group. When K time ≥2.2 min (sensitivity 77.27% and specificity 95.2%), the risk of sepsis death was the highest ( P<0.001). Conclusions:Patients with severe sepsis show marked hypocoagulability, and K time has predictive value for the prognosis of patients with sepsis.

Application prospects of organoids in organ transplantation / 器官移植

In recent years, organoid technology has become one of the major technological breakthroughs in biomedical field. As miniature organs constructed by three-dimensional culture of tissue stem cells in vitro, organoids are highly consistent with the source tissues in terms of tissue structures, cell types and functions, which serve as an ideal model for biomedical basic research, drug research and development and clinical precision medicine, and show important potential value in regenerative medicine. Organ transplantation is one of the most effective approaches to treat organ failure. However, the source of donor organs is currently limited, which could not meet the patients' needs. Identifying suitable graft substitutes is the key to breaking through the predicament. Organoids could be derived from the autologous tissues of patients. Multiple studies have demonstrated that organoids possess potent transplantation and repairing capabilities and may effectively avert the risk of immune rejection and tumorigenicity, etc. In this article, the development process and main application directions of organoid technology were summarized, and the application prospect and challenges of organoids in organ transplantation were reviewed and predicted.

Low molecular weight heparin reduces arterial blood lactic acid content and increases estimated glomerular filtration rate in patients with moderate Covid-19 pneumonia / 中华医学杂志(英文版)

BACKGROUND@#Coronavirus disease 2019 (Covid-19) remains a serious health threat worldwide. We aimed to investigate whether low molecular weight heparin (LMWH) can promote organ function recovery in moderate Covid-19 pneumonia patients.@*METHODS@#We initiated an LMWH protocol in Covid-19 patients with increased D-dimer, body mass index >30 kg/m2 or a history of diabetes from January 18, 2020 at Shanghai Public Health Clinical Center. In this retrospective study, we assigned moderate Covid- 19 pneumonia patients admitted between January 18th and April 18, 2020 receiving the LMWH protocol to the LMWH group. Moderate patients who met the inclusion criteria but did not receive LMWH protocol were included in the control group by 1:2 propensity score matching. General clinical information, indicators for renal function, arterial blood gas analyses, arterial blood lactic acid content (mmol/L), and coagulation indexes at 0 day, 3 days, 7 days, and 11 days after admission were recorded and compared between the two groups.@*RESULTS@#There were 41 patients in the LMWH group and 82 patients in the control group. General information in both groups were similar. Compared to the control group, the arterial blood lactic acid content (mmol/L) at day 11 (1.3 [1.1, 1.7] vs. 1.2 [0.9, 1.3], P = 0.016) was reduced in the LMWH group. The estimated glomerular filtration rate (eGFR) in the LMWH group was higher than that in the control group at day 7 (108.54 [89.11, 128.17] vs. 116.85 [103.39, 133.47], P = 0.039) and day 11 (113.74 [94.49, 126.34] vs. 128.31 [112.75, 144, 12], P  = 0.003). The serum creatinine levels (Scr) in the LMWH group were lower than that in the control group at day 7 (62.13 [51.47, 77.64] vs. 55.49 [49.50, 65.75], P = 0.038) and day 11 (63.35 [50.17, 75.73] vs. 51.62 [44.62, 61.24], P = 0.005).@*CONCLUSIONS@#LMWH treatment can reduce arterial blood lactic acid levels and improve eGFR in moderate Covid-19 pneumonia patients. Randomized controlled trials are warranted to further investigate this issue.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR2000034796.

Structural and physiological changes of the human body upon SARS-CoV-2 infection / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Since December 2019, the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) has spread to many countries around the world, developing into a global pandemic with increasing numbers of deaths reported worldwide. To data, although some vaccines have been developed, there are no ideal drugs to treat novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)). By examining the structure of the coronavirus and briefly describing its possible pathogenesis based on recent autopsy reports conducted by various teams worldwide, this review analyzes the possible structural and functional changes of the human body upon infection with SARS-CoV-2. We observed that the most prominent pathological changes in COVID-19 patients are diffuse alveolar damage (DAD) of the lungs and microthrombus formation, resulting in an imbalance of the ventilation/perfusion ratio and respiratory failure. Although direct evidence of viral infection can also be found in other organs and tissues, the viral load is relatively small. The conclusion that the injuries of the extra-pulmonary organs are directly caused by the virus needs further investigation.

Epidemiology and risk factors for hospital acquired Clostridium difficile infection and colonization in emergency intensive care unit of a general hospital in Shanghai / 中华危重病急救医学

Objective:To investigate the clinical features, risk factors and prognosis of Clostridium difficile infection/colonization (CDI/CDC) in emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, then provides theoretical basis for clinical treatment. Methods:A retrospective case-control study was conducted. The data of EICU patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2016 to June 2020 were collected. Taking the CDI/CDC patients as research objects [ Clostridium difficile (CD) positive group] and the CD negative patients with the same gender and age difference less than 5 years who were admitted to the hospital during the same period as the control (CD negative group). Demographic information, risk factors, prognosis and stool samples were collected. Single factor analysis and binary Logistic regression were used to analyze the CD positive infection rate, risk factors, and hospital death of patients with different clinical characteristics. Results:About 487 patients in EICU were included, 76 cases were taken into CD positive group, CD positive rate was 15.6%, including CDI 11 cases, CDC 65 cases. Among the CD positive group, all of the cases used proton pump inhibitor (PPI), and 75 cases used at least one antibiotic. Seventy-six CD negative patients with or without diarrhea (CD negative group) were included in this study. Among them, 75 patients used PPI and 74 patients used at least one antibiotic. Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), duration of hospitalization, and carbapenem use were the risk factors for CDI/CDC. There were significant differences in the above indicators between CD positive group and CD negative group [APACHEⅡ: 18.0 (12.2, 25.8) vs. 10.0 (7.0, 14.0), duration of hospitalization (days): 46.0 (30.5, 72.5) vs. 18.5 (9.2, 37.0), proportion of carbapenems: 81.6% (62/76) vs. 64.5% (49/76), all P < 0.05]. Binary Logistic analysis regression analysis showed that APACHEⅡ score [odds ratio ( OR) = 0.802, 95% confidence interval (95% CI) was 0.730-0.882, P < 0.01] and duration of hospitalization ( OR = 0.960, 95% CI was 0.942-0.978, P < 0.01) were independent risk factors for CDI/CDC. There was no difference in overall mortality between the CD positive group and CD negative group [27.6% (21/76) vs. 38.2% (29/76), P = 0.167]. Conclusions:Critically ill patients in EICU routinely use PPI and antibiotics, and the use of antibiotics does not affect the CD positive rate. The independent risk factors of CDI/CDC are the APACHEⅡ score and the duration of hospitalization, but fecal CD positive has no obvious influence on death.

Application of Modified Preparation Method of Compound Polyethylene Glycol Electrolyte Powder in Colonoscopy for Patients with Constipation / 中国药房

OBJECTIVE：To inves tigate the application effect and safety of modified compound polyethylene glycol electrolyte powder（SF-PEG）in intestinal preparation method for patients with constipation undergoing colonoscopy. METHODS ：From Jan. 2020 to Aug. 2020，160 patients with constipation undergoing colonoscopy in anorectal department of the affiliated hospital of North Sichuan Medical College were randomly divided into observation group and control group ，with 80 cases in each group. The patients in the control group took 2 boxes of SF-PEG （mixed into 3 000 mL warm water ）orally at 3：00 a.m. on the day of examination，and finished within 2 hours. The patients in the observation group took 1 box of SF-PEG （mixed into 1 500 mL warm water）at 20：00 the night before the examination and 5：00 in the morning of the day of examination ，and drank it within 1 hour；1 bottle of Dimethylsiloxane powder （mixed into 75 mL warm water ）was taken orally at 7：00 a.m. on the inspection day. The satisfaction of intestinal preparation ，intestinal bubble score ，operation time of colonoscopy ，detection of polyps ，tolerance rate ， acceptance rate of repeating intestinal preparation of patients and incidence of adverse reactions were compared between the two groups. RESULTS ：The patients of 2 groups successfully completed bowel preparation and colonoscopy. The intestinal preparation total satisfaction rate ，intestinal bubble satisfaction rate ，polyp detection rate ，tolerance rate and repeating intestinal preparation acceptance rate of patients of observation group were significantly higher than control group （P＜0.05），while the incidence of nausea and vomiting and total incidence of adverse reactions were significantly lower than control group （P＜0.05），and the operation time of colonoscopy was significantly shorter than control group （P＜0.05）. CONCLUSIONS ：Oral administration of SF-PEG in batches combined with Dimethylsiloxane powder for bowel preparation in patients with constipation before colonoscopy have the advantages of high satisfaction with bowel preparation ，less intestinal bubbles ，short operation time ，high detection rate of polyps，high tolerance rate of patients ，high acceptance rate of repeating intestinal preparation and less adverse reactions. It is a safe and effect method for intestinal preparation.

Evaluation on the risk management effect of cluster infectious disease in schools of Jingzhou / 中国学校卫生

Objective@#To evaluate the effect of risk management on cluster infectious disease prevention and control in schools, and to provide a scientific basis for the further development of its methods and strategies.@*Methods@#A two year risk management program of cluster infectious disease control and prevention in 92 schools was carried out in urban area of Jingzhou. In the process of intervention, comprehensive measures were implemented, such as improving organizational management and rules, strengthening routine hygiene management, supervising the implementation of epidemic prevention and control measures, increasing training and guidance. On site investigation was conducted to evaluate the risk management effects before and after the risk management, with the other 7 counties of Jingzhou having got no risk management chosen as the control group.@*Results@#Through two-year risk management, the implementation rate covering all aspects regarding cluster infectious disease prevention and control were 6.5-45.7 percentage point higher than that before. The proportion of low and medium risk school increased by 19.6 and 5.4 percentage point, respectively, while the proportion of high risk schools decreased by 25.0 percentage point(Z=7.41, P<0.01). The annual incidence of clustered infectious diseases in 92 schools decreased by 23.9 percentage point. Compared with other counties in Jingzhou City, the trend of decline was significant(χ 2=18.17, P<0.01).@*Conclusion@#Risk management can effectively improve the implementation rate of prevention and control measures regarding epidemic disease in schools, reduce risk severity, and decrease the incidence of cluster infectious diseases.

Discovery of thiosemicarbazone derivatives as effective New Delhi metallo-β-lactamase-1 (NDM-1) inhibitors against NDM-1 producing clinical isolates

@#New Delhi metallo-β-lactamase-1 (NDM-1) is capable of hydrolyzing nearly all β-lactam antibiotics, posing an emerging threat to public health. There are currently less effective treatment options for treating NDM-1 positive “superbug”, and no promising NDM-1 inhibitors were used in clinical practice. In this study, structure–activity relationship based on thiosemicarbazone derivatives was systematically characterized and their potential activities combined with meropenem (MEM) were evaluated. Compounds 19bg and 19bh exhibited excellent activity against 10 NDM-positive isolate clinical isolates in reversing MEM resistance. Further studies demonstrated compounds 19bg and 19bh were uncompetitive NDM-1 inhibitors with Ki = 0.63 and 0.44 μmol/L, respectively. Molecular docking speculated that compounds 19bg and 19bh were most likely to bind in the allosteric pocket which would affect the catalytic effect of NDM-1 on the substrate meropenem. Toxicity evaluation experiment showed that no hemolysis activities even at concentrations of 1000 mg/mL against red blood cells. In vivo experimental results showed combination of MEM and compound 19bh was markedly effective in treating infections caused by NDM-1 positive strain and prolonging the survival time of sepsis mice. Our finding showed that compound 19bh might be a promising lead in developing new inhibitor to treat NDM-1 producing superbug.

Prognosis and Related Factors of Patients with Pathological Complete Response after Neoadjuvant Therapy for Gastric Cancer / 中国医学科学院学报

Objective To investigate the related factors of pathological complete response(pCR)of patients with gastric cancer treated by neoadjuvant therapy and resection,and to analyze the risk factors of prognosis. Methods The clinical and pathological data of 490 patients with gastric cancer who received neoadjuvant therapy followed by radical gastrectomy from January to December in 2008 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify the risk factors affecting pCR and prognosis. Results Among the 490 patients,41 achieved pCR,and the overall pCR rate was 8.3%(41/490).The pCR rate was 16.0% in the neoadjuvant chemoradiation group and 6.4% in the neoadjuvant chemotherapy group.The results of multivariate analysis showed that neoadjuvant chemoradiation(

Correlation between classic Wnt signaling pathway and radioresistance of esophageal cancer cells / 中华放射肿瘤学杂志

Objective:To clarify the role of classic Wnt signaling pathway in the radioresistance of esophageal cancer cells (ECC), and investigate the underlying mechanism, aiming to identify critical molecular targets for clinically enhancing the radiosensitivity of esophageal cancer.Methods:The radiosensitivity of four types of ECCs (EC9706, ECA109, KYSE70 and KYSE150) were assessed by colony formation assay. Western blot and RT-PCR were used to detect the activation of classical Wnt signaling pathway after irradiation. Classic Wnt signaling pathway activator (AZD2858) and inhibitor (XAV-939) were utilized to comprehensively evaluate the effect of classic Wnt signaling pathway on the radiosensitivity of ECCs. Cellular immunofluorescence staining was performed to detect the production and repair of DNA double-strand breaks (DSB), as well as the foci formation of DSB repair proteins after irradiation.Results:The results of colony formation assay showed that the radiosensitivity of four types of ECCs from high to low was EC9706, ECA109, KYSE70 and KYSE150. In KYSE150, a radioresistant cell type, the level of nuclear β-catenin and the transcription of c-Myc gene were significantly increased after irradiation (both P<0.05). However, in EC9706, a radiosensitive cell type, the level of nuclear β-catenin and c-Myc gene transcription were not affected by irradiation (both P>0.05). Moreover, EC9706 cells showed enhanced radioresistance in the presence of AZD2858( P<0.05), whereas XAV-939 treatment decreased the radioresistance in KYSE150 cells ( P<0.05). AZD2858 accelerated the DSB repair in EC9706 cells ( P<0.05), whereas XAV-939 delayed the DSB repair in KYSE150 cells ( P<0.05). Furthermore, the results of immunofluorescence staining showed that XAV-939 reduced the DSB repair capacity by inhibiting homologous recombination repair-related proteins (BRCA1 and RAD51) rather than non-homologous end junction repair-related proteins (Ku80 and XRCC4). Conclusions:The classic Wnt signaling pathway participates in the regulation of radiosensitivity in ECCs by regulating the homologous recombination repair of DSB after irradiation. Inhibition of the classic Wnt signaling pathway can counteract the radioresistance of ECCs and enhance the killing effect of irradiation on ECCs.