OBJECTIVE To explore the potential mechanisms of astragalin （AG） in allevating ulcerative colitis （UC） in mice through modulation of the intestinal flora. METHODS Male C57BL/6 mice were randomly divided into normal group （CON group）， model group [dextran sodium sulfate （DSS） group]， 5-aminosalicylic acid group （5-ASA group）， AG low-dose group and high-dose group （AGL and AGH groups）， with 8 mice in each group. The mice UC model was established by drinking 3% DSS solution continuously for 7 days in all groups except the CON group. After that， 3% DSS solution was replaced by water， and the mice of each drug group were gavaged with the corresponding drug solution. Mice in the CON and DSS groups were gavaged with an equal volume of normal saline， once a day， for 7 days. After the last gavage， the body weight change index， disease activity index （DAI） score， colon length and spleen index， and levels of inflammatory factors （tumor necrosis factor-α， interleukin-1β， interleukin-6） were compared among the mice in each group； pathological changes in colonic tissues of the mice were observed in each group， and the pathological score and the percentage of goblet cells were compared； mRNA expressions of barrier-related factors [occludin and ZO-1] and inflammation-related factors [silencing information regulatory factor 1 （SIRT1）， c-Jun N-terminal kinase （JNK） and p38 mitogen-activated protein kinase （p38 MAPK）] were detected in each group of mice； the changes in the intestinal flora of mice in each group were analyzed and the contents of intestinal metabolites short-chain fatty acids （SCFAs） was determined. Using DSS and AG-treated fecal bacterial liquid as an intervention， the mechanism of anti-UC effect of AG was further verified by a fecal microbiota transplant experiment. RESULTS Compared with the CON group， the intestinal mucosal structure of mice in the DSS group was severely damaged， with obvious infiltration of inflammatory cells collapsing the wall； their body weight change index， colon length， the percentage of goblet cells， mRNA expressions of occludin， ZO-1 and SIRT1， Chao1 and Shannon indexes， and contents of acetic acid and butyric acid were significantly reduced， shortened or down-regulated （P＜0.05）； however， DAI score， spleen index， levels of inflammatory factors， pathological score， as well as mRNA expressions of p38 MAPK and JNK， were all significantly increased or up-regulated （P＜0.05）. Compared with the DSS group， colon tissue lesions of AG mice in all dose groups showed different degrees of improvement， and the above quantitative indexes were generally regressed （P＜0.05）， and the intervention effect of AG-treated fecal bacterial fluid was basically the same as that of AG. CONCLUSIONS AG can improve relevant symptoms in UC mice and reduce their inflammatory response and colonic histopathological changes. The above effects may be related to regulating the diversity of intestinal flora in mice， increasing the contents of butyric acid and propionic acid， and promoting the repair of the colonic mucosal barrier， thus regulating the expressions of genes related to the SIRT1/p38 MAPK inflammatory pathway.

Background: The function of CD69 expressed on T cells in chronic hepatitis B (CHB) remains unclear. We aimed to elucidate the roles of CD69 on T cells in the disease process and in antiviral therapy for CHB. Methods: We enrolled 335 treatment-naive patients with CHB and 93 patients with CHB on antiviral therapy. CD69, antiviral cytokine production by T cells, T-helper (Th) cells, and inhibitory molecules of T cells were measured using flow cytometry, and clinical-virological characteristics were examined dynamically during antiviral therapy. Results: CD69 expression on CD3+, CD4+, and CD8+ T cells was the lowest in the immune-active phase and was negatively correlated with liver transaminase activity, fibrosis features, inflammatory cytokine production by T cells, and Th-cell frequencies but positively with inhibitory molecules on T cells. CD69 expression on CD3+, CD4+, and CD8+ T cells decreased after 48 weeks of antiviral therapy, and patients with hepatitis B e antigen (HBeAg) seroconversion in week 48 showed lower CD69 expression on T cells at baseline and week 48. The area under the ROC curve of CD69 expression on T cells at baseline for predicting HBeAg seroconversion in week 48 was 0.870, the sensitivity was 0.909, and the specificity was 0.714 (P = 0.002). Conclusions CD69 negatively regulates T-cell immunity during CHB, and its expression decreases with antiviral therapy. CD69 expression predicts HBeAg seroconversion in week 48. CD69 may play an important negative role in regulating T cells and affect the efficacy of antiviral therapy.

Objective:To compare the clinical efficacy of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the treatment of elderly patients with early gastric cancer.Methods:Ninety-two elderly patients with early gastric cancer admitted to the 923th Hospital of the Joint Service Support Force of PLA from June 2019 to February 2022 were enrolled, and they were divided into ESD group (60 cases) and EMR group (32 cases) according to different surgical methods. The ESD group was treated with ESD surgery, while the EMR group was treated with EMR surgery. The short-term clinical efficacy of the two groups was compared. The gastric function including pepsinogen Ⅰ(PGⅠ), pepsinogenⅡ(PGⅡ), PGⅠ /PGⅡ ratio and the tumor markers including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), and invasion genes within the lesion including vascular endothelial growth factor C (VEGF-C), E-cadherin, microtubule depolymerin (Stathmin), Krüppel like factor 4 (KLF4) were detected before and 3 d after surgery. Followed up for 1 year, the recurrence rate and complications between the two groups were compared.Results:All of 92 patients successfully removed the diseased tissue as a whole, and the R0 and R1 resection rate between the two groups had no statistical differences ( P>0.05). At 3 d after surgery, the levels of PG Ⅰand PGⅠ/PG Ⅱin the both groups were higher than those before surgery, and the level of PG Ⅱ in the both groups was lower than that before surgery; the levels of PG Ⅰand PGⅠ/PG Ⅱ in the ESD group were higher than those in the EMR group: (86.50 ± 8.23) μg/L vs. (77.47 ± 7.40) μg/L, 5.29 ± 0.54 vs. 3.65 ± 0.50; the level of PG Ⅱ ratio in the ESD group was lower than that in the EMR group: (16.34 ± 3.05) μg/L vs. (21.20 ± 3.27) μg/L, there were statistical differences ( P<0.05). At 3 d after surgery, the levels of CEA, CA19-9 and CA125 in the two groups were decreased, and the levels of the above indicators in the ESD group were lower than those in the EMR group: (2.42 ± 0.45) μg/L vs. (3.29 ± 0.40) μg/L, (8.55 ± 2.10) kU/L vs. (10.62 ± 2.76) kU/L, (13.75 ± 4.28) kU/L vs. (17.20 ± 4.90) kU/L, there were statistical differences ( P<0.05). At 3 d after surgery, the mRNA expression of E-cadherin and KLF4 in the two groups were increased, and the mRNA expression of VEGF-C, Stathmin in the two groups were decreased, and the mRNA expression of E-cadherin and KLF4 in the ESD group were lower than those in the EMR group: 2.89 ± 0.31 vs. 3.03 ± 0.21, 2.90 ± 0.28 vs. 3.12 ± 0.37, and the mRNA expression of VEGF-C, Stathmin in the ESD group were higher than those in the EMR group: 0.45 ± 0.11 vs. 0.41 ± 0.07, 0.52 ± 0.23 vs. 0.43 ± 0.09, there were statistical differences ( P<0.05). The complication rate in the ESD group was lower than that in the EMR group: 5.00%(3/60) vs. 23.33% (14/60) , there was statistical difference ( χ2 = 8.32, P<0.01). The recurrence rate in the 1-year between the two groups had no statistical difference ( P>0.05). Conclusions:Compared with EMR, ESD is effective in the treatment of elderly early gastric cancer, which can better correct the abnormal secretion of pepsinogen, promote the functional recovery of gastric cells and glands, reduce the level of serum tumor markers, inhibit the metastasis and proliferation of tumor cells, and has good safety.

Objective:To study the overall training effect of segmented training model on key fiberoptic bronchoscopy techniques for anesthesiology residents and the influence of key technique training order on the training effect.Methods:Different fiberoptic bronchoscopy simulators were used for specialized training in different key techniques of fiberoptic operation. To examine the effect of key technique learning order on the teaching effect, 40 anesthesiology residents who participated in fiberscope simulation training at Ruijin Hospital, Shanghai Jiaotong University School of Medicine between November 2022 and March 2023 were selected for this study. They were randomly divided into two groups (Group S and Group M) using a numerical table method. The teaching was completed using two orders of key techniques. The operation time, operation quality score, and theoretical knowledge mastery score of the two groups were recorded to compare the effect of key technique learning order on the mastery of fiberoptic skills. SPSS 29.0 statistical software was used for data analysis. Measurement data that conformed to normal distribution were expressed as mean ± standard deviation, and the independent samples t-test or Fisher's exact test were used for comparison between groups. The chi-square test was used for comparison of enumeration data. Results:After segmented training in each key technique, both groups of trainees were able to shorten the operation time of the corresponding key technique [SM simulator operation time (132.25±14.69) s vs. (49.80±4.46) s in group S, P<0.01; M simulator operation time (82.30±11.60) s vs. (57.10±6.77) s in group S, P<0.01; SM simulator operation time (83.10±10.62) s vs. (52.10±5.20) s in group M, P<0.01; M simulator operation time (132.25±14.69) s vs. (55.40±5.91) s in group M, P<0.01)]. Moreover, both groups showed a reduced number of wall touches [SM simulator wall touches (3.35±0.93) times vs. (0.65±0.49) times in group S, P<0.01; M simulator wall touches (2.50±1.05) times vs. (0.70±0.80) times in group S, P<0.01; SM simulator wall touches (1.55±1.15) times vs. (0.40±0.50) times in group M, P<0.01; M simulator wall touches (5.90±1.29) times vs. (1.10±0.79) times in group M, P<0.01]. There were no significant differences between the two groups in the performance score of fiberoptic-guided tracheal intubation after training [(92.50±5.97) points vs. (91.75±5.45) points] and in the lung segment localization time [(23.15±4.39) s, (21.40±4.84) s, (22.85±4.42) s vs. (22.75±5.11) s, (21.00±5.40) s, (21.50±5.10) s]. Conclusions:Segmented training on key fiberoptic bronchoscopy techniques is an effective model of fiberscope training for anesthesiology residents, and the order of training key techniques does not affect the effectiveness of training.

The 7th edition of "Resources for Optimal Care of the Injured Patient (2022 Standards)" was released in December 2023. The main contents including establishment of trauma centers, clinical practice guidelines for the care of the trauma patients, resource allocation for trauma care, trauma care quality management, trauma data registry system, trauma care education and training, etc were introduced and analyzed to explore its implication for the construction of China′s trauma care system.Accordingly, the following measures were proposed to improve the construction of China′s trauma care system: establishing graded standards for a trauma care system covering the entire population in China, developing diagnosis and treatment regimens that cater to special groups, optimizing the allocation of trauma care resources, formulating plans to improve trauma care quality and patient safety that conform with China′s national conditions, setting unified standards for trauma data, and enhancing education and training in trauma care. This paper provides decision-making references for promoting the overall construction of China′s trauma care system and improving trauma care quality.

Objective:To compare the prognosis of percutaneous versus laparoscopic microwave ablation in patients with hepatocellular carcinoma (HCC) classified as Barcelona Clinic Liver Cancer (BCLC) stage 0 to A, and evaluate the impact of these two ablation modalities on treatment outcome.Methods:Clinical data of 198 patients with HCC of BCLC stages 0 to A undergoing microwave ablation treatment at the Second Hospital of Jiaxing and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed, including 149 males and 49 females, aged (57.4±9.6) years. Patients were divided into two groups based on the treatment modality: percutaneous microwave ablation group ( n=133) and laparoscopic microwave ablation group ( n=65). Survival rates were calculated using the Kaplan-Meier method, and the log-rank test was used to compare survival rates. Univariate and multivariate analyses were performed using Cox regression to assess the impacts of percutaneous and laparoscopic microwave ablation on prognosis. Results:The median overall survivals for the percutaneous and laparoscopic microwave ablation groups were 54 months and 77 months, respectively. The 1-, 3-, and 5-year cumulative survival rates postoperatively were 95.6%, 67.3%, 47.4% for the percutaneous group, and 100.0%, 79.9%, 60.4% for the laparoscopic group, respectively, with the latter showing superior cumulative survival rates ( χ2=4.53, P=0.033). The median recurrence-free survival (RFS) was 27 months for the percutaneous group and 52 months for the laparoscopic group. The 1-, 3-, and 5-year RFS postoperatively were 67.4%, 41.1% and 32.8% for the percutaneous group, and 81.5%, 58.1%, and 46.7% for the laparoscopic group, respectively, with the latter showing superior RFS, and the difference was statistically significant ( χ2=7.20, P=0.007). Multivariate analysis indicated that percutaneous microwave ablation was associated with an increased risk of death ( HR=2.475, 95% CI: 1.423-4.305, P=0.001) and recurrence ( HR=1.996, 95% CI: 1.255-3.176, P=0.004). Conclusion:Laparoscopic approach was superior to percutaneous microwave ablation in patients with HCC of BCLC stages 0 to A, and percutaneous microwave ablation could be a risk factor for poor prognosis in these patients.

Adipose progenitor cells(APCs) represent a prominent stromal cellular component of adipose tissue and are now identified as highly heterogenous populations. However, the role of APCs in regulating systemic metabolism remains unknown. Using single cell RNA-sequencing, we investigated the role of the APC subpopulations in regulating development of type 2 diabetes. CD9 + CD55 low APCs are the novel subset identified in this study, which is significantly increased in type 2 diabetic patients. Transplantation of these cells from type 2 diabetic patients into adipose tissue caused glycemic disturbance in mice. Depletion of pathogenic APCs improved obesity-related glycemic disturbance. Collectively, our data provide deeper insights into human APC functionality and highlights APCs as a potential therapeutic target to combat type 2 diabetes. This study has been published in Nature Communications, 2024, 15(1): 4827.

Background and aims:Hepatocellular carcinoma(HCC),which is prevalent worldwide and has a high mortality rate,needs to be effectively diagnosed.We aimed to evaluate the significance of plasma microRNA-15a/16-1(miR-15a/16)as a biomarker of hepatitis B virus-related HCC(HBV-HCC)using the machine learning model.This study was the first large-scale investigation of these two miRNAs in HCC plasma samples. Methods:Using quantitative polymerase chain reaction,we measured the plasma miR-15a/16 levels in a total of 766 participants,including 74 healthy controls,335 with chronic hepatitis B(CHB),47 with compensated liver cirrhosis,and 310 with HBV-HCC.The diagnostic performance of miR-15a/16 was examined using a machine learning model and compared with that of alpha-fetoprotein(AFP).Lastly,to validate the diagnostic efficiency of miR-15a/16,we performed pseudotemporal sorting of the samples to simulate progression from CHB to HCC. Results:Plasma miR-15a/16 was significantly decreased in HCC than in all control groups(P＜0.05 for all).In the training cohort,the area under the receiver operating characteristic curve(AUC),sensitivity,and average precision(AP)for the detection of HCC were higher for miR-15a(AUC=0.80,67.3％,AP=0.80)and miR-16(AUC=0.83,79.0％,AP=0.83)than for AFP(AUC=0.74,61.7％,AP=0.72).Combining miR-15a/16 with AFP increased the AUC to 0.86(sensitivity 85.9％)and the AP to 0.85 and was significantly superior to the other markers in this study(P＜0.05 for all),as further demonstrated by the detection error tradeoff curves.Moreover,miR-15a/16 impressively showed potent diagnostic power in early-stage,small-tumor,and AFP-negative HCC.A validation cohort confirmed these results.Lastly,the simulated follow-up of patients further validated the diagnostic efficiency of miR-15a/16. Conclusions:We developed and validated a plasma miR-15a/16-based machine learning model,which exhibited better diagnostic performance for the early diagnosis of HCC compared to that of AFP.