Objective:Summarize and analyze the clinical features of immune checkpoint inhibitor (ICI)-related colitis.Methods:From January 2019 to September 2020, the clinical data of 8 patients with ICI-related colitis from Peking Union Medical College Hospital were retrospectively collected and including the onset of ICI-related colitis, clinical symptoms, endoscopic and pathological findings, treatment, comorbidities and resuming of ICI. Independent sample t test was used for statistical analysis. Results:Eight patients were all male, and the median age (range) was 66 years old (55 to 74 years old), 7 cases were diagnosed with stage Ⅳ lung cancer and 1 case was diagnosed with stage Ⅲc pyelo-carcinoma. Among 8 patients, 4 cases of ICI-related colitis occurred during combination of anti-programmed death-1 (PD-1) treatment and chemotherapy, 2 cases occurred during anti-PD-1 monotherapy after combination of anti-PD-1 treatment and chemotherapy, and 2 cases occurred after anti-PD-1 monotherapy. The median time (range) was 44 d (27 to 128 d) from initial anti-PD-1 treatment to the onset of ICI-related colitis and the median time (range) was 8 d (6 to 35 d) from last anti-PD-1 treatment to onset of ICI-related colitis. The ICI efficacy of 4 patients had partial response, 2 patients had stable disease, 1 patient had disease progression, and 1 patient′s condition was not assessed. All 8 patients had moderate to severe extensive colitis. The main clinical manifestation was diarrhea (5/8), 3 patients accompanied by abdominal pain. The endoscopic findings were diffuse mucosal erosion, accompanied by ulcer in 2 patients. The main pathologic findings were cryptitis or crypt abscess, accompanied by apoptosis in 2 patients. Eight patients were all treated with glucocorticoids, among them 2 patients were further treated with biologics, due to the insufficient efficacy of glucocorticoid treatment, 4 patients had opportunistic infections. The initial prednisone dose for patients with opportunistic infections and patients without opportunistic infections was (85.00±52.60) and (60.00±23.09) mg, respectively. The prednisone treatment course was (8.75±4.03) and (7.50±3.11) weeks, respectively, and the differences were not statistically significant (both P>0.05). The colitis relapsed in all 3 patients after resuming of ICI. Conclusions:ICI-related colitis had corresponding ICI treatment history and clinical, endoscopic, and histopathological features. Glucocorticoid is the main treatment, and it is prone to relapse after resuming of ICI.

Objective: To investigate the changing trends in the prevalence of health literacy among rural residents in Zhejiang Province from 2016 to 2021, so as to provide the evidence for formulating the health promotion strategy in rural areas. Methods: Rural residents' health literacy surveillance data were retrieved in Zhejiang Province from 2016 to 2021. The prevalence of health literacy was evaluated among rural residents according to the criteria defined by Chinese Center for Health Education, and standardized by Zhejiang Provincial population data captured from the national population census in China. The 6-year cumulative increase from 2016 to 2021 was estimated to investigate the changing trends in the prevalence of health literacy. Results: Totally 55 568 rural residents were monitored in Zhejiang Province from 2016 to 2021, including 26 893 men (48.40%) and 28 675 women (51.60%) and 32 156 residents at ages of 45 to 65 years (57.87%). The prevalence of health literacy was 18.00%, 21.52%, 25.53%, 27.54%, 30.85%, and 34.32% among rural residents in Zhejiang Province from 2016 to 2021, appearing a tendency towards a rise (χ2trend=661.376, P<0.001), and a 16.32% 6-year cumulative increase was seen. The prevalence of basic knowledge and concept, healthy lifestyle and behaviors and basic skills all appeared a tendency towards a rise (P<0.05), with 6-year cumulative increase rates of 24.48%, 11.08% and 8.11%, respectively. Among six categories of health issues, the prevalence of chronic disease prevention, scientific health outlook and health information literacy showed a tendency towards a rise year by year (P<0.05), with 6-year cumulative increase rates of 29.73%, 21.07% and 15.98%, respectively, and the prevalence of basic medical care, safety and first aid, and infectious disease prevention literacy appeared a fluctuation (P<0.05), with 6-year cumulative increase rates of 12.85%, 6.36% and -0.47%, respectively. The prevalence of health literacy appeared an overall tendency towards a rise in rural residents with different genders, age groups, educational levels and occupations (P<0.05), with a minor 6-year cumulative increase in residents at ages of 55 years and older and farmers, while a tendency towards a decline was seen among illiterate rural residents, with a 6-year cumulative rise of -3.16%. Conclusions The prevalence of health literacy appeared a tendency towards a rise among rural residents in Zhejiang Province from 2016 to 2021; however, the rate of increase reduced year by year. Health education and promotion should be enhanced targeting the elderly, individuals with low educational levels and farmers.

Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients (71 fractured vertebrae) who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Ortbopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years (average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups (n =11) according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number [y =aln(x) + b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them (P ＞ 0.05).The total rate of accurate puncture was 95.8％ (68/71).The rates of accurate puncture were 92.9％ (13/14),94.4％ (17/18),94.7％ (18/19) and 100％ (20/20) for groups 1,2,3,and4,respectively,with no significant differences between groups (P ＞ 0.05).The total operation time for the 4 groups was respectively 56.6 ± 6.6 min,46.4 ± 8.5 min,40.2 ± 4.7 min and 40.4 ± 5.7 min and the robot operation time for the 4 groups was respectively 32.1 ±4.9 min,23.8 ±5.1 min,18.9 ±2.7 min and 19.6 ± 5.3 min,showing significant differences between the 4 groups (P ＞ 0.05) and a significant difference between groups 1 and 2 versus groups 3 and 4 (P ＞ 0.05) but no significant difference between group 3 and 4 (P ＞ 0.05).The natural logarithm regression analysis showed that the total operation time [y =-7.2861n(x) + 66.616,R2 =0.4889,P ＜ 0.001] and robot operation time [y =-5.6621n(x) +39.763,R2 =0.5196,P ＜ 0.001] decreased significantly with the increase of operation number but became stable in groups 3 and 4.There was no significant difference in PKP operation time among the 4 groups (P ＞ 0.05).The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space,with a total incidence of 8.5％ (6/71),showing no significant difference among the 4 groups (P ＞ 0.05).Conclusions The puncture accuracy of the Tianji orthopedic robot in assisting PKP for OVCF may not change with the increased operation number.The total operation time and robotic operation time decrease with the increased operation number.The learning curve of the Tianji orthopedic robot becomes stable very fast,indicating the surgical technique is easy to learn.

Objective: To investigate the effects of PRX-2 gene on phenotype changes in epidermal stem cells differentiating into sweat gland cells. Methods: Epidermal stem cells and sweat gland cells separated and cultured from healthy foreskin and adult full-thick skin respectively, were identified by immunofluorescence staining. Lentiviral vector-mediated overexpression and knockdown of PRX-2 gene in epidermal stem cells were performed respectively, with empty vector-mediated epidermal stem cells as a control group. Overexpression、blank control and knowdown group′s PRX-2 expressions in gene and protein levels were detected using RT-PCR and Western blot technology. The ESCs of each group were co-cultured with sweat gland cells through transwell plate, and the expressions of CEA and β1 integrin in epidermal stem cells were determined by flow cytometry before and after co-culturing. Results: Epidermal stem cells and sweat gland cells were in line with their respective specific antigens. Before co-cultured, epidermal stem cells highly expressed β1 integrin (98.69±0.67)%, hardly expressed CEA (6.20±3.15)%. After co-cultured, β1 integrin expression levels were showed as knockdown group (19.30±0.53)% blank control group (51.20±0.79)%> overexpress group (45.91±0.93)%. There had significant differences between those of each two groups. Conclusions PRX-2 gene can inhibit the phenotypic change of Epidermal Stem Cells differentiating into Sweat Gland Cells and improve the ability to maintain their own specific antigens.

Objective: To explore effects of histone deacetylase inhibitor Belinostat on the immunologic function of dendritic cells (DC) and its possible mechanism. Methods: Cultured mouse bone marrow-derived DC from C57BL/6 mouse in vitro. The experiments were divided into 0, 50, 100 nmol/L Belinostat + immature DC (imDC) group, and 0, 50, 100 nmol/L Belinostat mature DC (mDC). The changes of the ultrastructure of DC were observed by transmission electron microscope (TEM). Immunophenotype and CCR7 expression rate were detected by FCM, and the migration rate was observed by chemotaxis assay. The proliferation of lymphocytes stimulated by different DC was detected by mixed lymphocyte culture reaction. The cytokines in the culture supernatant, including TNF-α, IL-12 and IL-10, were examined by ELISA. RQ-PCR was used to examine the relative expression of mRNA in RelB. Results: Successful cultured and identified the qualified imDC and mDC. Belinostat decreased the expression of CCR7 on imDC [(25.82±7.25)% vs (50.44±5.61)% and (18.71±2.00)% vs (50.44±5.61)%], meanwhile increased the rate on mDC [(71.14±1.96)% vs (64.90±1.47)%]. Chemotaxis assay showed that the migration rate of Belinostat+imDC and Belinostat+mDC group were both decreased, but the difference in imDC was not significant. T lymphocyte proliferation rate stimulated by 100 nmol/L Belinostat+imDC group was lower than imDC group in condition irritation cell∶reaction cell=1∶2 [(227.09±13.49)% vs (309.49±53.69)%]. Belinostat significantly suppressed the secretion of cytokines TNF-α, IL-12 and IL-10 (all P<0.01). The relative expression of mRNA in RelB was slightly decreased in Belinostat+imDC and Belinostat+mDC group (all P<0.05). Conclusion Belinostat could effectly suppress DC maturation and regulate immune tolerance of DC, which may be due to the down-regulation of mRNA level of RelB in DC.

Objective To analyze the influence of plaque classification and bifurcation angle on hemodynamics in coronary artery, so as to further discuss the influence on vulnerable atherosclerotic plaques. Methods Based on average geometric parameters of human coronary bifurcation vessels, the model of fluid-solid interaction for coronary bifurcation vessels with different plaque classifications and vessel bifurcation angles was constructed, and the distributions of blood flow velocity, pressure and shear stress at critical positions were investigated. Results The upstream shoulder of the plaque was the site with the highest shear stress on plaque surface, which was prone to ulceration or rupture with further growth. When there were plaques on one side of the bifurcation vessels, the shear stress at the carina of bifurcations was greater than that at the bilateral plaques. The pressure and shear stress at the carina of bifurcations gradually increased as the bifurcation angle decreased. Conclusions When there are plaques on one side of the bifurcation vessels, the probability of ulceration or rupture is greater. The presence of plaque in main vessels can promote formation and growth of the plaque at bifurcations. The inner wall of blood vessels at the carina of bifurcations is more easily damaged in the case of small angle vessels. The results can provide theoretical references for the design and optimization of vulnerable atherosclerotic plaque treatment.

Objective:To compare the clinical efficacy of anti-reflux mucosectomy (ARMS) and endoscopic cardial constriction ligation (ECCL) on treatment of gastroesophageal reflux disease.Methods:A retrospective study was conducted on the data of 48 consecutive patients with gastroesophageal reflux disease, who underwent ARMS or ECCL at the First Affiliated Hospital of Zhengzhou University from December 2015 to August 2018. Twenty cases were in the ARMS group and 28 cases in the ECCL group. The short-term and long-term efficacies were compared between the two groups.Results:The success rate of operation was 100.0% in the both groups. The operation time of the ECCL group was significantly shorter than that of the ARMS group (8.43±1.59 min VS 34.05±12.35 min, t=-9.227, P<0.001). After 2 months follow-up, the symptom improvement rate of the ECCL group and the ARMS group was 89.3% (25/28) and 60.0% (12/20), respectively ( χ2=4.128, P=0.042). The GERD Q score of the ECCL group was significantly lower than that of the ARMS group (6.24 ±1.22 VS 7.35±1.79, t=-2.400, P=0.023). One year after operation, there were no significant differences in the symptom improvement rate, GERD Q score, DeMeester score and the time percentage of pH<4 between the two groups ( P>0.05). Conclusion:The long-term clinical effect of ARMS and ECCL is similar, but the short-term clinical effect of ECCL is superior to ARMS.

Data of 55 cases of gastric neuroendocrine neoplasms (G-NENS) with diameter ≤12 mm in the First Affiliated Hospital of Zhengzhou University from August 2014 to August 2019 were retrospectively analyzed. According to the methods of endoscopic resection, the patients were divided into two groups: the endoscopic mucosal resection with a cap (EMR-C) group (35 cases) and the endoscopic submucosal dissection (ESD) group (20 cases). The results showed that the success rates of operation, the whole resection rates and the complete resection rates were all 100.0% in the two groups. Compared with the ESD group, the EMR-C group had a shorter median operation time (12.00 min VS 28.35 min, P<0.001), less mean hospitalization costs (21 165.19 yuan VS 28 400.35 yuan, P=0.004), and a similar overall incidence of complications [2.86% (1/35) VS 0, P=1.000]. By March 2020, the recurrence rate of EMR-C group and ESD group were 28.6% (10/35) and 15.0% (3/20), respectively, without significant difference ( P=0.418). It is suggested that for G-NENS with diameter ≤12 mm, without muscular invasion, lymph node metastasis or distant metastasis, EMR-C and ESD are both safe and effective, but EMR-C has more advantages in terms of operation time and hospitalization costs.

Objective To investigate the effect of Mysm1 on the differentiation of neural stem cells(NSCs)into astrocytes and the possible mechanism.Methods NSCs were prepared from E12.5 cortices of wild-type C57BL/6 mice,cultured in vitro and induced to differentiate into astrocytes.Immunofluorescence staining,real-time quantitative PCR and Western blot assay were used to detect the expressions of Mysm1 during the differentiation of NSCs into astrocytes in vitro.Lentivirus was used to knock down Mysm1 expressions in NSCs before real-time quantitative PCR and Western blot assay were used to detect the knockdown efficiency.Immunofluorescence staining and Western blot assay were used to compare the differentiation of NSCs into astrocytes before and after Mysm1 knockdown in vitro.Transcriptomics was adopted to detect the differential gene after knockdown of Mysm1 in NSCs in vitro.Western blot assay was used to verify the changes of proteins associated with the differential gene.Cut-Tag was used to detect the enrichment of Mysm1 in the promoter region of glial fibrillary acidic protein(GFAP)genes during the differentiation of NSCs into astrocytes in vitro.After overexpression of GFAP following knockdown of Mysm1,immunofluorescence staining and Western blot assay were used to compare the differentiation of NSCs into astrocytes before and after overexpression in vitro.Results The expression of Mysm1 was gradually increased when NSCs were induced to differentiate into astrocytes in vitro.Mysm1 knockdown inhibited the differentiation of NSCs into astrocytes in vitro.Mysm1 affected the differentiation of NSCs into astrocytes by regulating the expression of GFAP.Overexpression of GFAP after Mysm1 knockdown partially rescued the ability of NSCs to differentiate into astrocytes.Conclusion Mysm1 regulates the differentiation of NSCs into astrocytes by epigenetically controlling GFAP transcription.

By reviewing the necessity, current status of cognitive attitudes, influencing factors, and improvement strategies of inpatients’ living wills, this paper proposed to strengthen the publicity and promotion of living wills to advance the development of death with dignity, improve relevant influencing factors, and provide feasible solutions for living wills, and actively develop tools to assess the cognition and attitude of living wills, with a view to providing reference for further promoting the application of living wills in inpatients and improving related research.