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Objective:To analyze the endoscopic characteristics of early gastric cancer and precancerous lesions after Helicobacter pylori ( H. pylori) eradication. Methods:From May 2019 to June 2022, at Shanghai Sixth People′s Hospital affiliated to Shanghai Jiaotong University School of Medicine, the medical data of patients diagnosed with differentiated early gastric cancer and precancerous lesions were collected. A total of 93 patients with early gastric cancer and precancerous lesions who had previous history of H. pylori infection and had undergone standardized eradication treatment were selected, and their endoscopic characteristics were retrospectively analyzed. Independent sample t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among 93 patients with early gastric cancer and precancerous lesions after H. pylori eradication, there were 56 males and 37 females, with an average age of (66.9±8.2) years old. The time after H. pylori eradication was 3.4 years (range 1.0 to 7.0 years). A total of 109 early gastric cancer and precancerous lesions were found, including 79 patients with single lesion and 14 patients with multiple lesions (30 lesions). There were 60 cases with 73 lesions in the early gastric cancer group and 33 cases with 36 lesions in the precancerous group. Among 93 patients, 89 cases (95.7%) were diagnosed with atrophy level above C-2 according to Kimura-Takemoto classification under endoscopy. The long diameter of 109 lesions was (1.38±0.70) cm and the short diameter was (1.04±0.53) cm. A total of 80 lesions (73.4%) were located in the lower 1/3 part of the stomach, and 53 lesions (48.6%) were located in the lesser curvature. A total of 106 lesions (97.2%) were superficial type (0-Ⅱ) under the endoscopy. The long diameter and short diameter in the early gastric cancer group after H. pylori eradication were both greater than those in the precancerous lesion group ((1.54±0.78) cm vs. (1.06±0.35) cm, (1.16±0.58) cm vs. (0.78±0.33) cm), and the differences were statistically significant ( t=3.53 and 3.73, both P<0.001). There was statistically significant difference in the morphological types between early gastric cancer group after H. pylori eradication and precancerous lesion group ( χ2=11.01, P=0.012). The main morphological type of early gastric cancer after H. pylori eradication was superficial depression type (0-Ⅱc), accounting for 45.2% (33/73), while the precancerous lesions were mainly superficial protruded and flat type, both accounting for 38.9% (14/36). Conclusions:After H. pylori eradication, the endoscopic atrophy range of early gastric cancer and precancerous lesions is mostly above C-2. And the lesions are mostly located in the middle and lower 1/3 part of the stomach, long diameter of lesions <20 mm. The main morphological type is superficial type, especially superficial depression type.
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Objective To investigate the risk of fatal stroke mortality associated with short-term exposure to air pollution， and to determine the susceptible population. Methods In this study， daily stroke mortalities of adults between 2012 and 2014 in Songjiang District， Shanghai were collected. Time-stratified case-crossover approach was used to assess the association between daily concentrations of air pollutants and fatal stroke mortalities. Results This study included 514 patients who died from acute strokes. The average concentrations during the study period were 77.45 μg·m-3 for PM2.5， 21.22 μg·m-3 for SO2， and 57.59 μg·m-3 for NO2. The fatal stroke mortality of adults under the age of 65 was found to be significantly associated with NO2. At the time of a Lag of 2 d and 03 d， a significantly higher risk of fatal stroke mortality in relation to NO2 exposure was observed， and the OR values of ischemic stroke mortality for people were 3.86 （1.53-9.75） and 5.83 （1.40-24.34） respectively. People over the age of 65 were more sensitive to increased PM2.5 concentrations， at the time of a Lag of 03 d， fatal strokes increased by 28% when PM2.5 levels increased. A significantly higher risk of fatal stroke mortality in relation to increase of NO2 concentration was observed among people who were overweight or obese. Conclusion A significantly higher risk of fatal stroke mortality is associated with the increase of PM2.5 and NO2. The results also suggest that the susceptible population should take additional precautions to avoid or reduce the risk of fatal strokes.
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Objective To study the clinical characteristics of neonatal Serratia marcescens sepsis.Method A retrospective review of perinatal factors,clinical manifestations,laboratory findings,treatment and prognosis of Serratia marcescens sepsis in our unit from January 2012 to November 2017.Result A total of 21 cases of serratia marcescens sepsis were identified (diagnosed),all except one were prematurely born.Infection occurred on different days after birth,2 within 3 days,1 within 3 ～ 7 days and 9 in the second week,and the remainder,after 14 days.The clinical manifestations of neonatal Serratia marcescens sepsis were uncharacteristic,mainly manifested as gray pallor,lethargy,and recurrent apnea.Some infants had complications such as pulmonary hemorrhage,septic shock,necrotizing enterocolitis and scleroderma.Most infants had low white blood cell count,thrombocytopenia and high C-reactive protein at the onset of illness.All Serratia marcescens cases were sensitive to piperacillin/tazobactam,ceftazidime and meropenen.In total,17 cases had lumbar puncture,5 of them diagnosed with meningitis,with elevation of cerebrospinal fluid white blood cell count and protein,and 3 infants complicated with brain abscess.The duration of antibiotic therapy were 14 days or more depending on the clinical conditions.The overall mortality was 14.3％.Conclusion Serratia marcescens is an important opportunistic pathogen.It might cause serious infections in the premature infants including sepsis,brain abscess and meningitis.Regular neuro-imagings might be necessary for all sepsis infants.The infected and colonized neonates might be the hidden source of Serratia marcescens.The surveillance protocols,eradication of colonization,and strict adherence to hand disinfection/washing might help to prevent dissemination of invasive bacteria among premature infants.
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Objective@#To explore a model that workplace social capital is associated with intention to stay (ITS) in the nursing profession and that this association is partially mediated by organizational commitment, job satisfaction, and job stress among Chinese nurses.@*Methods@#A cross-sectional, observationalstudy was conducted in Shanghai, China between September and December 2014. Two thousandforty-two nurses from 23 healthcare organizations were recruited for the current study using a two-stage sampling process.Intention to stay, workplace social capital, job satisfaction, organizational commitment, and job stress was measured by validated scale. Measured variable path analysis (MVPA) was used to test their hypothesized relationships.@*Results@#There were significant positive direct effects from workplace social capital (=0.11, P<0.01) , organizational commitment (=0.81, P<0.01) and job satisfaction (=0.03, P<0.01) to ITS, and a negative direct effects from job strain to ITS (=-0.03, P<0.01) . The model explained 84% of the variability in ITS. Additionally, workplace social capital had significant positive direct effects on organizational commitment (=0.65, P<0.01) , job satisfaction (=0.44, P<0.01) and negative direct effects on job strain (=-0.35, P<0.01) . The indirect effect of social capital to ITS was 0.55. Job satisfaction was positively associated with organizational commitment (r=0.47, P<0.01) , and negtively associated with job stress (r=-0.12, P<0.01) . Job stress was negtively associated with organizational commitment (r=-0.20, P<0.01) .@*Conclusion@#This study suggests that greater workplace social capital may lead to higher ITS in nursing primarily by increasing commitment to the nursing occupation and their job satisfaction and by reducing their sense of job stress.
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Objective To investigate the effects of interleukin-10 on mice intestinal fibrosis and epithelial-mesenchymal transition(EMT),and the relation between these effects and endoplasmic reticulum stress(ERS).Methods Forty-two IL-10 knockout(IL-10-/-)mice were divided into fibrosis model group(n=18),IL-10 treatment group(n=12)and solvent control group(n =12),another 18 wild-type mice were taken as negative control group.IL-10 and 0.9％ NaCl were intraperitonealy injected in IL-10 treatment group and solvent control group respectively since 12th week,and mice were sacrificed at week 14th and 16th,and no treatment to fibrosis model group and negative control group.The injury and fibrosis in mice colon tissue were detected with HE staining and Masson collagen staining.The expressions of collagen Ⅰ,glucose-regulated protein78(GRP78),C/EBP homologous protein(CHOP)and a-smooth muscle actin(α-SMA)and E-cadherin(E-cad)at mRNA level were determined by realtime PCR.The expression of α-SMA and E-cad in mice colon tissue was examined by immunohistochemical staining.Results At 16th week,the colonic tissue injury scores(7.00±0.90,7.17±1.17)and collagen area ratio(17.78％±4.15％,18.56％±3.81％)of fibrosis model group and solvent control group significantly increased compared with negative control group(1.50±1.38 and 9.11％±2.99％)and IL-10 treatment qroup(4.33±0.82 and 12.56％±1.39％)(F=36.150,F=11.280； P=0.000).At week 12th,14th and 16th,the expressions of GRP78,α-SMA,collagen Ⅰ in fibrosis model group and solvent control group significantly increased compared with negative control group(all P＜0.05),however the expression of E-cad significantly decreased(P＜0.05).The expression of CHOP mRNA in fibrosis model group(0.95％ ±0.12％)significantly increased compared with negative control group(0.21％ ± 0.12％)at week 12th(t=5.188,P=0.000),however there was no statistical significant difference in groups at week 14th and 16th(P＞0.05).At week 14th and 16th,the expressions of GRP78,α-SMA and collagen Ⅰ(at week 14th:0.73％±0.31％,1.18％±0.11％ and 1.10％±0.49％； at week 16th:0.57％±0.16％,0.81％ ±0.50 ％ and 0.76 ％ ± 0.25 ％)in IL-10 treatment group were significantly lower than that of fibrosis model group(P＜0.05).The expression of E-cad(at week 14th:0.73％ ±0.29％ ； at week 16th:0.97％ ±0.25％)significantly increased compared with fibrosis model group(at week 14th:0.37％±0.17％； at week 16th:0.35％±0.20％)(F=6.524,P=0.003； F=17.493,P=0.000).However at week 16th,the expression of α-SMA in IL-10 treatment group was lower than that of solvent control group(1.82±0.22)％(F=9.842,P=0.000),and the expression of E-cad significantly increased than in solvent control group(0.47 ± 0.25)％(F=17.493,P =0.000).Conclusion IL-10 may have a role in inhibiting EMT and reducing intestinal fibrosis in mice,which may be related to the regulation of ERS by IL-10.
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Objective To investigate the anti-fibrotic effects of curcumin in trinitrobenzene sulphonic acid (TNBS) induced intestinal fibrosis in rats and its mechanism. Methods Forty SD rats were randomly divided into model group, treatment group, control group and normal group with 10each. Except the normal group, the other three groups were given 10, 15, 20, 25 and 30 mg of TNBS enema on the 1st, 8 th, 15th, 22nd and 29th days,respectively. The rats in treatment group were intraperitonealy injected with 30 mg/kg of curcumin daily. Control group was injected with 0. 9%NaCl solution and normal group received an equal volume of 50% ethanol enema without any treatment. The damage and fibrosis of colon were detected with HE staining and Masson collagen staining, respectively. The contents of interleukin (IL) -2, tumor necrosis factor (TNF) -α, IL-4 and IL-17 in colon were measured by enzyme-link immunosorbent analysis (ELISA). The expressions of intestinal fibrosis related cytokines such as transforming growth factor (TGF) -β1, connective tissue growth factor (CTGF), Smad3, collagen Ⅰ and collagen Ⅲ mRNA were determined by FQ-PCR.Results The macroscopic and micrpscopic colonic damage scores and collagen area were significantly higher in model group (6.14 ± 1.07, 8. 42 ± 1.40 and 36. 59% ± 4.07%, respectively) and control group (6.17 ± 1.47, 8. 17 ±1.47 and 37.18 %±4.05 %, respectively) than those in normal group (2.13±0.64, 2.25±1.28 and 25.43%±5.39% ,respectively)(P＜0.05). Contents of IL2, TNF-α, IL-17, as well as expressions of intestinal fibrosis related cytokines including TGF-β1, CTGF,Smad3, collagen Ⅰ and Ⅲ mRNA were also higher in model group [(378. 25±29. 90) ng/L,(87.11±23.85) ng/L, (47.80±5.62) ng/L, 4.71%±2.71%,10.33%±6.99%,9.35%±7.32%,1.52% ± 1.11% and 3.04% ±1.33%, respectively] and control group [(410. 06 ± 64.74) ng/L,(100.41±12.59) ng/L, (41.45±2. 12) ng/L, 4. 12%±3.01%,11.46%±4.72%,10. 11%±3.80%,1. 57% ± 1. 35% and 3. 03% ± 3. 53%, respectively] in comparision with normal group [(179.74±20. 73) ng/L, (35. 47±7. 13) ng/L, (14. 48±7. 52) ng/L and 0. 90%± 1. 13%,0.53%±0.47%, 0. 62%±0. 44%, 0. 16%±0. 09% and 0. 18%±0. 10%, respectively] (P＜0.05). While in treatment group, the macroscopic (4.00 ± 1.07 ) and micrpscopic (5. 13 ± 1.46)colonic damage scores, collagen area (30.01%±7.56%), contents of IL-2 [(223.91±28.04) ng/L],TNF-α [(44.19±4. 77) ng/L] and IL-17 [(14.89±4. 31) ng/L], expressions of TGF-β1 (0.85%±0.76%), CTGF (1.56%±1.13%), Smad3 (3.62%±3.03%), collagen Ⅰ (0.40%±0.31%) and Ⅲ (0.60 % ± 1.02 % ) mRNA were much lower than those in model group and control group (P＜0.05 ), but similar to those in normal group (P＞ 0.05 ). Conclusions Curcumin can inhibit intestinal fibrosis caused by excessive "wound-healing" reaction via reducing the overexpression of cytokines in colonic mucosa and attenuating the inflammation of colon.
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Objective To evaluate the feasibility of fecal occult blood test(FOBT).combined with colonoseopy,in screening of colorectal cancer.Methods From September 2006 to May 2007.healthv volunteers without any colorectal cancer(CRC)related symptoms in Songjiang District of Shanghai,aging from 40 to 49 or older than 50 years,were recruited.The subjects were firstly screened by FOBT with immunohistochemieal method in two of three consecutive stool samples,and colonoscopy was performed in those with positive FOBT in any of the stool samples.The number.type and distribution of detected polyps were recorded.Results Of 2692 subjects over 50 years old,FOBT was positive in 184(6.8%).in which 1 rectal cancer and 64 polyps,including 34 adenomatous polyps,15 inflammatory polyps and 15 hyperplastic polyps.Of 582 subjects aging from 40 to 49 years,FOBT was positive in 28(4.8%),in which 2 adenocarcinoma and 6 polyps,including 1 adenomatous polyp.Most polyps,including adenomatous polyp and high-risk polyp,were mainly found on the left side of colon.Conclusion CRC screening with FOBT and colonoscopy in asymptomatic average-risk people could detect colon polyps at an early stage.Colonoscopy in patients with positive FOBT would be suitable in large scale CRC screening in communities and rural areas.
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OBJECTIVE To investigate the flora distribution,enzyme producing and drug resistance of Citrobacter in our hospital,and analyzed multi drug resistance(MDR) character in order to guide the clinical medication.METHODS Totally 147 clinical isolates of Citrobacter were detected out ESBLs and AmpC ?-lactamases by three-dimensional test,MBL by the double-disk synergy test.at the same time,drug resistance to fifteen antibiotics was also detected by K-B method.RESULTS Hospital infection caused by Citrobacter.most commonly by C.freundii and then C.amalonaticus.Respiratory tract and urinary tract were prone to be infected than other sites(P0.05).The rate of ESBLs,AmpC,ESBLs+AmpC and MBL which produced by Citrobacter were 36.05% 10.20%,7.48% and 2.72%.The Citrobacter were sensitive to imipenem and meropenem,and their resistance rates to imipenem and meropenem were 4.76% and 3.40%,respectively.The resistance rate to cefoperazone/tazobactam was 23.81%.Otherwise,the resistance rate to 12 kinds of other antibiotics were all higher than 40.0%.MDR strains in the ICU ward were 81.08%,while in other wards were 53.64%,with significant difference(P
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Objectives:To investigate the pathogenesis of Chlamydia pneumoniae (C.pneumoniae) pneumoniae with immunohistochemical staining of tissue biopsies. Methods:The Icr mice were inoculated with C.pneumoniae, strain CWL 029, by the intranasal or intravenous routes. After a single inoculation, mice were killed on the 1st, 3rd, 7th, 14th, 21st, 28th and 60th day separately. Lung specimens were obtained from the acute stage of C.pneumoniae pneumonitis and stained using a C.pneumoniae specific monoclonal antibody. Results:In the intranasal inoculation of mice, the immunoperoxidase staining of C.pneumoniae in lung tissue was positive on day 3,7,14. The positive staining of inflammatory lung tissue was not even but local. The positive expressions of C.pneumoniaewas were mainly in the alveolar macrophages, the interstitial cells and the lymphoid tissues surrounding the bronchi. After iv inoculation, a similarly changes were found but the degree was lighter than that of intranasal inoculation group. The positive expressions of C.pneumoniaewas were mainly in the alveolar macrophages and the interstitial cells. Conclusions:Immunohistochemistry is beneficial to the diagnosis of the acute stage of C.pneumoniae pneumonitis in the mice, and the pathogenesis of infection in intranasal inoculation group was more serious than that of iv inoculation group.