Objective To explore the role of computer-based simulators in upper gastrointestinal endoscopy training.Methods Forty-one graduate students,residents and GI fellows for further cducation with no experience in endoscopy were randomly assigned to two groups and underwent one-month training with or without a 10-hour computer-based simulator.Each trainee performed upper endoscopy in 20 patients.Comparison was made between the two groups in terms of these performance parameters:esophageal intubation,retroflexion,pyloric intubation,intubation of the descending part of the duodenum and procedure time.Resuits There Was no significant difference in esophageal intubation(P=0.699)and intubation of the second part of the duodenum(P=0.141)between two groups.While the differences were significant in retroflexion (P<0.001),pyloric intubation(P<0.001)and procedure time(P=0.032),i.e.,the simulator group was much better in performance than the other group.Conclusion The computer-bascd simulator is effective in providing trainees with the skills needed for upper gastrointestinal endoscopy,shortening the teaching hours and lessening patients'pain.

Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients.Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively.The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters.Results Of all patients, 26.8%had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy.The 1-year overall survival rates of the patients with NRS-2002scores of ≤3 and ≥4 on admission were 91.1%and 61.9%, respectively (P=0.010).As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012).As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively ( P=0.018).The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036).The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005).Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.

Objective:To evaluate the role of hsa_circ_0025853 in hypothermia-induced reduction of oxygen-glucose deprivation and restoration (OGD/R) injury to neuroblastoma cells (SK-N-SH cells). Methods:SK-N-SH cells were cultured in vitro to the logarithmic phase and divided into 4 groups ( n=20 each) using a random number table method: control group (group C), group OGD/R, hypothermia group (group H) and hsa_circ_0025853 small interfering RNA (siRNA) plus hypothermia group (group S+ H). The cells were cultured in normal culture atmosphere in group C. The cells were subjected to OGD for 3 h followed by restoration of oxygen-glucose supply for 24 h in group OGD/R.The cells were subjected to OGD for 3 h followed by restoration of oxygen-glucose supply for 24 h at 32 ℃ in group H. The cells were transfected with siRNA at 48 h before establishing OGD/R model, and the other treatments were similar to those previously described in group H. At 24 h of restoration of oxygen-glucose, cell viability was measured by Cell Counting Kit-8, apoptosis rate were measured by flow cytometry.the expression of dynamin-related protein 1 (Drp1) mRNA and hsa_circ_0025853 was detected by quantitative real-time-polymerase chain reaction, and the expression of Drp1 protein was detected by Western blot. Results:Compared with group C, the cell viability was significantly decreased, the apoptosis rate of cells was increased, the expression of hsa_circ_0025853 was down-regulated, and the expression of Drp1 protein and mRNA was up-regulated in the other 3 groups ( P<0.05). Compared with group OGD/R, the cell viability was significantly increased, the apoptosis rate of cells was decreased, the expression of hsa_circ_0025853 was up-regulated, and the expression of Drp1 protein and mRNA was down-regulated in H and S+ H groups ( P<0.05). Compared with group H, the cell viability was significantly decreased, the apoptosis rate of cells was increased, the expression of hsa_circ_0025853 was down-regulated, and the expression of Drp1 protein and mRNA was up-regulated in group S+ H ( P<0.05). Conclusion:The mechanism by which hypothermia alleviates the OGD/R injury to SK-N-SH cells is related to the up-regulation of hsa_circ_0025853 expression, thus reducing the expression level of Drp1.

Objective:To evaluate the relationship between microRNA-93-5p and mitochondrial fusion protein-2 (Mfn2) in mouse nerve cells subjected to oxygen-glucose deprivation and reoxygenation (OGD/R).Methods:Mouse neuroblastoma cells were cultured in vitro to logarithmic growth phase.Experiment Ⅰ Cells were divided into 5 groups ( n=20 each) by the random number table method: control group (group C), group OGD/R, miR-93-5p inhibitor group (group I), siRNA-mfn2 plus miR-93-5p group (group siMfn2+ I) and miR-93-5p negative control group (group NC). Oxygen-glucose deprivation: the cells were cultured for 3 h in a low-glucose balanced salt solution at 37 ℃ in an environment of 5% CO 2-95% N 2.Restoration of oxygen and glucose: the cells were cultured in normal medium at 37℃ in 5% CO 2-95% air for 24 h. Group I, group siMfn2+ I and group NC were transfected with miR-93-5p inhibitor, miR-93-5p inhibitor plus siRNA-mfn2 and negative control miRNA, respectively, at 48 h before the OGD/R model was developed.Cell viability was measured by CCK-8 assay.Cell apoptosis rate was measured by flow cytometry.Quantitative real-time polymerase chain reaction was used to detect the expression of miR-93-5p and Mfn2 mRNA.Western blot was used to detect Mfn2 protein expression.Experiment Ⅱ The wild-type (WT)-Mfn2 and mutant (MUT)-Mfn2 were constructed and transfected into neuroblastoma cells with miR-93-5p mimic and miR-93-5p blank control (miR-93-5pNC), respectively.The cells were divided into 4 groups ( n=5 each) after 48 h of transfection by the random number table method: miR-93-5p NC-WT-Mfn2 co-transfection group, miR-93-5p mimic-WT-Mfn2 co-transfection group, miR-93-5p NC-MUT-Mfn2 co-transfection group, and miR-93-5p mimic-MUT-Mfn2 co-transfection group.The activity of luciferases was measured by double luciferase assay. Results:Experiment Ⅰ Compared with group C, the cell viability was significantly decreased, the apoptosis rate of cells was increased, the expression of miR-93-5p was up-regulated, and the expression of Mfn2 protein and mRNA was down-regulated in the other gorups ( P<0.05). Compared with group OGD/R or group NC, the cell viability was significantly increased, the apoptosis rate of cells was decreased, miR-93-5p expression was down-regulated, and the expression of Mfn2 protein and mRNA was up-regulated in group I ( P<0.05). Compared with group I, the cell viability was significantly decreased, the apoptosis rate of cells was increased, and the expression of Mfn2 protein and mRNA was down-regulated in group siMfn2+ I ( P<0.05). Experiment Ⅱ Compared with miR-93-5p NC-WT-Mfn2 co-transfection group, the luciferase activity was significantly decreased in miR-93-5p mimic-WT-Mfn2 co-transfection group ( P<0.05). There was no significant difference in luciferase activity between miR-93-5p NC-MUT-Mfn2 co-transfection group and miR-93-5p mimic-MUT-Mfn2 co-transfection group ( P>0.05). Conclusions:The miR-93-5p expression is up-regulated, which further targetedly down-regulates the expression of Mfn2, and this may be a mechanism of OGD/R in mouse nerve cells.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

Objective: To study the correlation of lifestyle characteristics with thyroid nodules in a population-based sample of centenarians in Hainan. Methods: The study was based on China Hainan Centenarian Cohort Study (CHCCS) conducted in 18 cities and counties in Hainan province from 2014 to 2016. A group of multidisciplinary team interviewed and examined local centenarians with structured questionnaires and ultrasonography procedures. A total of 918 centenarians were analyzed after excluding those who refused ultrasonographic examinations or had relevant missing data. Thyroids of centenarians were examined by 3-year experienced sonographer, details on lifestyle characteristics and dietary habits were collected by standard procedure. Results: Of the 918 centenarians, 683 (74.4%) had thyroid nodules under the ultrasonography procedures. The prevalence of thyroid nodules in different group of areca nut consumption varied significantly (P<0.05). In multivariate logistic regression model, the results showed female and areca nut intake were independently associated with thyroid nodules in centenarians (P<0.05). Conclusions The modifiable variables including areca nut intake as well as non-modifiable such as gender are independent determinants of thyroid nodules in centenarians. Further studies are warranted to explore and verify these associations in populations with different ranges of age.

Objective: To explore the correlation between epidermal growth factor receptor ( EGFR) mutation and brain metastasis in lung adenocarcinoma． Methods: Comparisons of brain metastasis between lung adenocarcinoma patients with EGFR exon 19 deletion ( 19 Del) and a single point mutation of L858R in exon 21 (21 L858R) at initial diagnosis and after EGFR-TKIs targeted therapy were analyzed．The CCK-8 assay was used to detect and calculate the semi-inhibitory concentration (IC50 ) of gefitinib against EGFR-mutated lung adenoma cell lines PC9 and H3255 . Results: Of the 410 patients with lung adenocarcinoma，a total of 153 (37. 3% ) cases had brain metastasis．Age，lymph node metastasis and 21 L858R mutation were high-risk factors for brain metastasis of lung adenocarcinoma．Among newly diagnosed 48 EGFR-mutated lung adenocarcinoma patients with brain metastasis ，the number of 19 Del and 21 L858R were 14 and 34，respectively (P = 0. 006) ．There were 17 patients with 19 Del and 20 patients with 21 L858R were observed to complicated by brain metastasis after receiving EGFR-TKIs targeted therapy．The median time of brain metastasis after EGFR-TKIs treatment were 15 months (8. 50，25. 00) and 7 months (4. 25，12. 25 ) ，respectively ( P = 0. 013 ) ． The IC50 of PC9 and H3255 to gefitinib were (0. 037 ± 0. 008) and (0. 150 ± 0. 040) μmol / L，respectively (P = 0. 007) ． Conclusion Age younger than or equal to 60 years，lymph node N2-3 stage，and EGFR 21 L858R mutation are high-risk factors for brain metastases in patients with lung adenocarcinoma，and the latter still has a shorter time to brain metastases than 19 Del mutations after treatment with EGFR-TKIs，which may be related to drug sensitivity.