Objective To analysis of clinical symptoms and influencing factors of anti-platelet aggregation drugs in patients with upper gastrointestinal bleeding.Methods Using the research methods of retrospective analysis, collected 110 cases of gastrointestinal bleeding patients from June 2012 to June 2015 into the first affiliated hospital of xiamen university,and divided into two groups,the control group,79 patients were treated without antiplatelet aggregation drugs,the experimental group,31 patients were treated with single antiplatelet aggregation drug.observed the degree of gastrointestinal bleeding,the mode of bleeding, and the characteristics of endoscopic findings between two groups,according to the age,INR, and the type of drug taken, the clinical symptoms and influencing factors of the patients were analyzed further.Results The rate of gastrointestinal bleeding was significantly higher in the experimental group than in the control group(P<0.05).The older the patient,the higher rate of gastrointestinal bleeding,the main manifestations were gastritis or ulcers in endoscopy,patients with INR>3 had a significantly higher rate of gastrointestinal bleeding than patients with INR<3.Conclusion Anti-platelet aggregation drugs can significantly increase the chance of serious bleeding in the digestive tract,the patient's age, INR value and the type of medication can affect the incidence of gastrointestinal bleeding;long-term use of these drugs lead the most serious impact on the duodenum, can lead to the site intestinal mucosa damage,with the increasing age of patients,adverse reactions of the digestive tract increased.

Background: With the development of endoscopic diagnosis technology, the detection rate of multiple primary gastric cancer is increasing. Aims: To explore the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of synchronous multiple primary early gastric cancer (SMPEGC). Methods: Fifteen consecutive patients with SMPEGC treated with ESD from March 2018 to December 2019 at the First Affiliated Hospital of Zhejiang Chinese Medical University were collected. Clinical features and outcomes were retrospectively analyzed. The risk of lymph node metastasis was evaluated according to the eCura system. Results: In 15 patients, 32 lesions were resected and 31 specimens were obtained. Thirteen patients underwent simultaneous resection of multiple primary gastric lesions, and 2 patients underwent staged resection. The operation time of ESD was (138.80±58.06) minutes, the length of hospital stay was (11.47±4.63) days, the lesion diameter was (1.30±1.15) cm, the en bloc resection rate was 100% and the curative resection rate was 71.9%. Postoperative complications occurred in 2 patients. According to the eCura system, the risk of lymph node metastasis was low in the 4 patients with non-curative resection. Three months after the operation, no local residual or recurrence was found in 10 patients. Conclusions: ESD is a feasible choice for the treatment of SMPEGC. The length of hospital stay and overall medical costs can be reduced by resection multiple lesions in one operation. For patients with risk factors of complications, one-time surgical resection should be avoided. The risk of lymph node metastasis is not the same for all the patients with non-curative resection. Maybe the eCura system can better evaluate the risk of lymph node metastasis and provide individualized treatment strategy.

Objective:To investigate the status of satisfaction of postgraduates majoring in public health with the teaching material of The prevention and control of chronic non- communicable disease, so as to provide the basis for promoting the teaching and optimizing the reprint of the teaching material. Methods:An online survey was conducted among 180 public health postgraduates of Batch 2018 to Batch 2020 from China CDC who took the selective course of "prevention and control of chronic non-communicable diseases". The survey content included the overall satisfaction of the respondents with the teaching material and such four levels of satisfaction as primary indicators at the content level, thinking level, motivation level and arrangement level and 20 secondary indicators. The statistical analysis was made by SPSS 25.0.Results:The effective response rate was 90.56% (163/180), and the overall satisfaction of postgraduates with the teaching material was 88.96%. The satisfaction of "scientificity", "comprehensiveness", "internal coordination" and "hierarchy" at the content level, "systematic thinking" and "quality education" at the thinking level, "deepening the understanding and application of relevant knowledge in the field of chronic disease prevention and control" and "the content is convenient for self-study and helps guide the construction of new knowledge" at the motivation level, and "accurate words, fluent language and easy to read and understand" and "firm binding, good paper quality and clear printing" at the arrangement level of the teaching material was more than 90.00%. Only the satisfaction of "the critical thinking" at the thinking level and "stimulating learning enthusiasm" at the motivation level was less than 85.00%.Conclusion:The teaching material of The prevention and control of chronic non- communicable disease meets the learning needs of postgraduates majoring in public health, and students have high overall satisfaction evaluation on the teaching material. It is necessary to further optimize the two aspects of "the critical thinking" and "stimulating learning enthusiasm" in the revision of the teaching material.

Objective:To investigate the changes of reactive oxygen species (ROS) in pancreatic cancer cells under the effect of pulsed electric fields (PEF).Methods:Murine-derived pancreatic cancer cells Panc02 were treated with PEF at electric field strengths of 0, 250, 500, 750, and 1 000 V/cm, respectively. The intracellular ROS generation patterns under the different field strengths and at different times after the PEF were investigated in vitro by flow cytometry and immunofluorescence, meanwhile exploring the apoptosis of murine and human pancreatic cancer cells under different field strengths. Twenty 6- to 8-week-old male C57BL/6 SPF mice were prepared as orthotopic pancreatic cancer models and divided into five groups of four mice each: 250 V/cm PEF group, 500 V/cm PEF group, 750 V/cm PEF group, 1 000 V/cm PEF group, and sham operation group. ROS expression in the residual tumor tissues of mice in each group was detected by immunofluorescence.Results:Under the 500 V/cm, 750 V/cm and 1 000 V/cm electric field strength, the proportion of cells with intracellular ROS expression was decreased after 6 h, 12 h, 24 h and 48 h of the PEF compared with 2 h after the PEF, and the differences were statistically significant (all P<0.05). Compared with 0 V/cm PEF group, ROS expression increased in Panc02 cells treated with 500 V/cm and 750 V/cm PEF groups, and the differences were statistically significant (all P<0.05). Compared with 250 V/cm PEF group under the same time, ROS in Panc02 cells treated with 500 V/cm and 750 V/cm electric field strengths increased, and the differences were statistically significant (all P<0.05). The proportions of apoptosis of both Panc02 cells and MIA-PaCa-2 cells increased with rising field strength and peaked at the field strength of 750 V/cm. Compared with the sham-operated group, the expression of ROS was increased in pancreatic cancer tissues of mice in the 500 V/cm PEF-treated group (16.65±6.01 vs. 2.38±1.21, t=-6.53) and 750 V/cm PEF-treated group (16.54±4.41 vs. 2.38±1.21, t=-6.48), and the differences were statistically significant in both cases (both P<0.001). Conclusion:PEF treatment was able to increase the level of ROS in both pancreatic cancer cells and tissues, and more ROS were produced when the electric field strength was 500 and 750 V/cm.