Objective:The process of myocardial infarction is generally characterized by the activation of host immune cells and the occurrence of inflammation. However, it is unknown which immune cells are preferentially activated and participated into the progression of myocardial infarction. Methods:A total of 55 patients with myocardial ischemia including 13 of stable angina ( SA) ,25 of unstable angina (UA) and 17 of acute myocardial infarction (AMI) as well as 12 of healthy controls (HCs) were enrolled in the study. The frequency and the immune activation marker CD38 expression by peripheral CD3 T cells,CD4 T cells,CD8 T cells,CD4+NKT cells, CD4- NKT cells, CD3-CD56+ NK cells and B cells were comprehensively analyzed. Results:There was no significant difference in the frequencies of these immune cell subsets in peripheral blood among these four groups. Importantly,it was found that CD38 expression was significantly increased on CD8 T cells,NKT cells and NK cells in patients with acute coronary syndromes ( ACS) including UA and AMI patients as compared with those in SA and HC subjects. These data indicated that multiple immune cells were activated in ACS patients,which were possibly participated into the pathogenesis of ACS. Conclusion:The activation of multiple immune cells was closely associated with the progression and outcome in ACS patients. This study provides immune hyper-activation mechanism underlying the development of ACS and may favor for finding a novel immune marker to predict the progression of ACS.

Objective To evaluate the effects of fructose-1 ,6-diphosphate (FDP) pretreatment on lung injury induced by hepatic cold liver ischemia-reperfusion in rats .Methods Eighteen healthy male Sprague-Dawley rats were randomly divided into 3 groups (n= 6 each) using a random number table :sham operation group (S group) ,hepatic cold liver ischemia-reperfusion model group (M group) ,and FDP pretreatment group (FP group) . The animals were anesthetized with intraperitoneal chloral hydrate and kept spontaneous breathing .Laparotomy was performed ,and the related blood vessels were only isolated in group S .Hepatic cold ischemia-reperfusion was induced in M and FP groups .In FP group ,FDP 250 mg/kg was injected via the caudal vein at 15 min before skin incision .At 6 h of reperfusion ,the bronchoalveolar lavage fluid (BALF) was collected to detect the levels of tumor necrosis factor-α(TNF-α) ,interleukin-10 (IL-10) and nitric oxide (NO) by ELISA .Lungs were removed for microscopic examination of the pathological changes by light microscopy .Real-time PCR was used to detect the expression of iNOS mRNA .Results Compared with S group , the levels of TNF-α and NO in BALF were significantly increased , the expression of iNOS mRNA was up-regulated , and the level of IL-10 in BALF was decreased in M and FP groups ( P<0.05 ) .Compared with M group ,the levels of TNF-αand NO in BALF were significantly decreased ,the expression of iNOS mRNA was down-regulated ,and the level of IL-10 in BALF was increased in FP group ( P<0.05 ) .The pathological changes of lungs were significantly attenuated in FP group as compared with M group .Conclusion FDP pretreatment can obviously attenuate lung injury induced by hepatic cold ischemia-reperfusion in rats ,and inhibition of iNOS expression ,reduction of NO synthesis ,and decrease in inflammatory responses are involved in the mechanism .

Background: Chronic atrophic gastritis (CAG) is a precancerous lesion of gastric cancer.The diagnostic value of serum gastrin-17 (G-17) level for CAG differs substantioulsy, and Helicobacter pylori (Hp) infection may play an important role.Aims: To explore the effect of Hp infection on serum G-17 level, and the diagnostic value of serum G-17 level for CAG under different Hp infection status.Methods: A total of 204 patients with chronic non-atrophic gastritis and 81 patients with CAG from May 2014 to May 2015 at the three different hospitals were enrolled.Gastroscopy was performed, fasting serum G-17 level, postprandial serum G-17 level and Hp-IgG antibody were determined by ELISA.Results: Fasting serum G-17 level was significantly increased in Hp positive group than in Hp negative group (P=0.001), and postprandial serum G-17 level was significantly decreased in CAG group than in non-atrophy group (P=0.002).AUC of fasting serum G-17 level for diagnosing Hp positive and negative CAG were 0.634 (95% CI: 0.537-0.732) and 0.576 (95% CI: 0.478-0.675), respectively, the accuracy were 62.6% and 54.9%, respectively.AUC of postprandial serum G-17 level for diagnosing Hp positive and negative CAG were 0.675 (95% CI: 0.581-0.769) and 0.595 (95% CI: 0.495-0.694), respectively, the accuracy were 61.8% and 53.1%, respectively.Conclusions: Hp infection has impact on serum G-17 level, as a result, the diagnostic value of G-17 level for CAG is different for patients with and without Hp infection.Diagnostic values of fast and postprandial serum G-17 for Hp positive CAG are higher than Hp negative CAG.

Objective To evaluate the diagnostic value of gastrin?17( G?17) and pepsinogen( PG) for gastric cancer. Methods A multicenter cross?sectional study of patients with continuous stomach discomfort from four centers including Changhai Hospital Affiliated to Second Military Medical University, the First Hospital Affiliated to Anhui Medical University, Qinghai Provincial People′s Hospital and the First Hospital Affiliated to Zhejiang University of Chinese Medicine from May 2014 to September 2015 was conducted. Before gastroscopy, fasting serum gatrin?17 and pepsinogen were analyzed by enzyme?linked immunosorbent assay(ELISA). The efficacy of G?17 and PG were evaluated according to endoscopic and pathological results. Results Based on the results of the pathological diagnosis, 1 122 cases were enrolled and divided into chronic atrophic gastritis group ( 548 cases ) , chronic non?atrophic gastritis group ( 370 cases), and gastric cancer group(204 cases). Serum G?17 and PGⅡ levels significantly increased(P<0?05) and PGR significantly decreased( P<0?05) in gastric cancer group compared with other groups. There was no significant difference in PGⅠlevel among three groups. The cut?off value of G?17 to diagnose gastric cancer was 7 pmol/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of G?17 for gastric cancer were 59?31%, 70?59%, 68?54%, 30?95% and 88?65% respectively. The cut?off value of PG Ⅰ/PG Ⅱ( PGR ) to diagnose gastric cancer was 7. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGR for gastric cancer were 41?18%, 83?01%, 75?40%, 35?00% and 86?39% respectively. The cut?off value of PGⅡto diagnose gastric cancer was 10 μg/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGⅡfor gastric cancer were 73?53%, 53?05%, 56?77%, 25?82% and 90?02% respectively. If G?17>7 pmol/L and PGR<7 was regarded as the cut?off value of diagnosis of gastric cancer, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 25?00%, 91?29%, 79?23%, 38?93%and 84?56%respectively. If G?17>7 pmol/L and PGⅡ>10μg/L was regarded as the cut?off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 48?04%, 79?74%, 73?98%, 34?51% and 87?35% respectively. If PGR<7 and PGⅡ>10 μg/L was regarded as the cut?off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 33?82%, 84?86%, 75?58%, 33?17% and 85?23% respectively. Based on logistic regression analysis of the independent variables of high serum G?17 value(>7 pmol/L), low serum PGR value(<7) and high serum PGⅡvalue(>10 μg/L), their OR value were 2?592, 2?237 and 1?864 respectively, and high serum G?17 value showed the highest risk of gastric cancer. Conclusion High serum G?17 and PGⅡ, low PGR are indicators of gastric cancer. Combination of G?17 and PGR has the best diagnostic value for gastric cacer. Gastric cancer can be screened in large scale by combining G?17 and PGR in order to improve the early diagnostic rate of gastric cancer and reduce the mortality of gastric cancer in our country.

Objective:To investigate the teaching effect of the single-circulation organ system integration course Nervous System and Disease for pediatrics 5+3 program, to guide the teaching practice of the integration course, and to promote the education and teaching reform of pediatrics.Methods:A total of 56 students of the class of 2019 in the pediatrics 5+3 program of Shanghai Jiao Tong University School of Medicine were selected as subjects, and the single-circulation organ system integration course was used for teaching. With the course of Nervous System and Disease as an example, evaluation results and questionnaires were used to assess the teaching effect of the single-circulation organ system course for pediatrics from the aspects of general information, course scores, student satisfaction, and expert supervision. SPSS 22.0 was used to perform descriptive statistics and analyses.Results:The course of Neurological System and Diseases integrated the contents of 11 related disciplines, with a mean score of (74.60±7.52) points. The scores of the students for course content, teaching mode, teaching resources, teaching effect, and the degree of overall satisfaction with the course were (4.71±0.54), (4.35±0.81), (4.50±0.69), (4.50±0.72), and (4.30±0.66), respectively. The score of expert supervision was (26.38±2.06) for teaching content and (26.52±2.03) for teaching methods, which still needed to be improved.Conclusions:The construction of the single-circulation organ system integration course provides new ideas for the curriculum reform of pediatrics; however, it is necessary to improve the construction of system and mechanism, explore the coordinated development of teachers, and strengthen deep integration and student guidance, thereby improving the teaching effect of the integrated course of pediatrics and promoting the training of medical talents in pediatrics.

Medical homogenization in multi-campus hospital plays an essential role in leveraging the advantages of public hospitals, promoting the expansion of high-quality medical resources and balancing regional layout. The Second Affiliated Hospital Zhejiang University School of Medicine deeply used digital intelligence technology to build a new integrated mobile health service system consisting of internet hospital and 5G intelligent applications, which empowered medical efficiency in multi-campus hospital. This system broke the limitations of inconsistent medical resources, unbalanced discipline layout, and insufficient information connectivity in the construction of multi-campus hospitals, and achieved remarkable results in practice. It could provide reference for the multi-campus construction of other large public hospitals.

Talaromyces Marneffei infection is rarely reported in patients with chronic active Epstein-Barr virus (EBV) infection. We reported an old man with chronic fever, pleomorphic rash, cough, EBV viraemia, and secondary hemophagocytic syndrome. Repeated histological biopsy and culture of skin lesions revealed Talaromyces Marneffei. This patient was diagnosed as chronic active EBV infection, and Talaromyces Marneffei infection. After treated with glucocorticoid steroids and anti-fungal therapy, the patient finally recovered. EBV infection is usually seen in immune compromised patients, who are susceptible to opportunistic pathogens rarely as Talaromyces Marneffei in this case.

Objective:To investigate the effects of gelatin methacrylate anhydride (GelMA) hydrogel loaded with small extracellular vesicles derived from human umbilical cord mesenchymal stem cells (hUCMSCs-sEVs) in the treatment of full-thickness skin defect wounds in mice.Methods:This study was an experimental study. hUCMSCs-sEVs were extracted by ultracentrifugation, their morphology was observed through transmission electron microscope, and the expression of CD9, CD63, tumor susceptibility gene 101 (TSG101), and calnexin was detected by Western blotting. The human umbilical vein endothelial cells (HUVECs), the 3 rd and 4 th passages of human epidermal keratinocytes (HEKs) and human dermal fibroblasts (HDFs) were all divided into blank control group (routinely cultured) and hUCMSC-sEV group (cultured with the cell supernatant containing hUCMSCs-sEVs). The cell scratch test was performed and the cell migration rates at 6, 12, and 24 h after scratching were calculated, the cell Transwell assay was performed and the number of migration cells at 12 h after culture was calculated, and the proportion of proliferating cells was detected by 5-acetylidene-2'-deoxyuridine and Hoechst staining at 24 h after culture, with sample numbers being all 3. The simple GelMA hydrogel and the GelMA hydrogel loaded with hUCMSCs-sEVs (hereinafter referred to as hUCMSC-sEV/GelMA hydrogel) were prepared. Then the micromorphology of 2 kinds of hydrogels was observed under scanning electron microscope, the distribution of hUCMSCs-sEVs was observed by laser scanning confocal microscope, and the cumulative release rates of hUCMSCs-sEVs at 0 (immediately), 2, 4, 6, 8, 10, and 12 d after soaking hUCMSC-sEV/GelMA hydrogel in phosphate buffer solution (PBS) were measured and calculated by protein colorimetric quantification ( n=3). Twenty-four 6-week-old male C57BL/6J mice were divided into PBS group, hUCMSC-sEV alone group, GelMA hydrogel alone group, and hUCMSC-sEV/GelMA hydrogel group according to the random number table, with 6 mice in each group, and after the full-thickness skin defect wounds on the back of mice in each group were produced, the wounds were performed with PBS injection, hUCMSC-sEV suspenson injection, simple GelMA coverage, and hUCMSC-sEV/GelMA hydrogel coverage, respectively. Wound healing was observed on post injury day (PID) 0 (immediately), 4, 8, and 12, and the wound healing rates on PID 4, 8, and 12 were calculated, and the wound tissue was collected on PID 12 for hematoxylin-eosin staining to observe the structure of new tissue, with sample numbers being both 6. Results:The extracted hUCMSCs-sEVs showed a cup-shaped structure and expressed CD9, CD63, and TSG101, but barely expressed calnexin. At 6, 12, and 24 h after scratching, the migration rates of HEKs (with t values of 25.94, 20.98, and 20.04, respectively), HDFs (with t values of 3.18, 5.68, and 4.28, respectively), and HUVECs (with t values of 4.32, 19.33, and 4.00, respectively) in hUCMSC-sEV group were significantly higher than those in blank control group ( P<0.05). At 12 h after culture, the numbers of migrated HEKs, HDFs, and HUVECs in hUCMSC-sEV group were 550 ±23, 235 ±9, and 856 ±35, respectively, which were significantly higher than 188 ±14, 97 ±6, and 370 ±32 in blank control group (with t values of 22.95, 23.13, and 17.84, respectively , P<0.05). At 24 h after culture, the proportions of proliferating cells of HEKs, HDFs, and HUVECs in hUCMSC-sEV group were significantly higher than those in blank control group (with t values of 22.00, 13.82, and 32.32, respectively, P<0.05). The inside of simple GelMA hydrogel showed a loose and porous sponge-like structure, and hUCMSCs-sEVs was not observed in it. The hUCMSC-sEV/GelMA hydrogel had the same sponge-like structure, and hUCMSCs-sEVs were uniformly distributed in clumps. The cumulative release rate curve of hUCMSCs-sEVs from hUCMSC-sEV/GelMA hydrogel tended to plateau at 2 d after soaking, and the cumulative release rate of hUCMSCs-sEVs was (59.2±1.8)% at 12 d after soaking. From PID 0 to 12, the wound areas of mice in the 4 groups gradually decreased. On PID 4, 8, and 12, the wound healing rates of mice in hUCMSC-sEV/GelMA hydrogel group were significantly higher than those in the other 3 groups ( P<0.05); the wound healing rates of mice in GelMA hydrogel alone group and hUCMSC-sEV alone group were significantly higher than those in PBS group ( P<0.05). On PID 8 and 12, the wound healing rates of mice in hUCMSC-sEV alone group were significantly higher than those in GelMA hydrogel alone group ( P<0.05). On PID 12, the wounds of mice in hUCMSC-sEV/GelMA hydrogel group showed the best wound epithelization, loose and orderly arrangement of dermal collagen, and the least number of inflammatory cells, while the dense arrangement of dermal collagen and varying degrees of inflammatory cell infiltration were observed in the wounds of mice in the other 3 groups. Conclusions:hUCMSCs-sEVs can promote the migration and proliferation of HEKs, HDFs, and HUVECs which are related to skin wound healing, and slowly release in GelMA hydrogel. The hUCMSC-sEV/GelMA hydrogel as a wound dressing can significantly improve the healing speed of full-thickness skin defect wounds in mice.

Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors.Methods Ninety-seven patients on MHD and 34 healthy people were recruited.Muscle mass was measured by bioelectrical impedance analysis and compared.Patients'age,sex,height,body weight,walking activity,modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded.The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression.Results Compared with normal cohort,the MHD patients showed lower body fat rate and lower ASM/H2 (both P ＜ 0.05).In 97 MHD patients,21.4％ of male patients suffered from sarcopenia,and 24.4％ of female patients suffered from sarcopenia.Patients were divided into two groups according to the level of ASM/H2 (male ＜ 7.0 kg/m2,female ＜ 5.8 kg/m2).The grip strength,serum creatinine,1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group,and the differences were significant (all P ＜ 0.05).In multivariable regression model,male (β=0.534,P=0.003),1,25(OH)2D (β=0.582,P=0.024),creatinine (β=0.421,P=0.037),grip strength (β=0.681,P=0.001),and lg[NT-proBNP] (β=-1.760,P=0.042) were independently associated with ASM/H2 in MHD patients.Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people.The levels of grip strength,NT-proBNP,creatinine and 1,25(OH)2D are the important influential factors for muscle mass in MHD patients.