Objective To investigate the impact of early surgical intervention on mid-term prognosis in patients with Hirschsprung's disease(HSCR)and to evaluate the risk of Hirschsprung-associated enterocolitis(HAEC).Methods From February 2016 to February 2022,230 children with HSCR who underwent one-stage radical Soave surgery in our hospital were divided into two groups according to the surgical age:the ≤4 months old group(126 cases)and the＞4 months old group(104 cases).The basic conditions of the two groups were compared.The mid-term defecation function of the children was evaluated using the Kelly scoring system.The clinical outcomes were analyzed to assess the risk of HAEC.Results There was no statistically significant difference in postoperative defecation function between the two groups of children(P＞0.05).The incidence of postoperative HAEC was 10.32％in the ≤4 months age group and 21.15％in the＞4 months age group.There was a statistically significant difference between the two groups(P＜0.05).The length of intestinal resection,operation time and postoperative hospital stay in the ≤4 months age group were 19.00 cm,83.10 minutes and 6.30 days,respectively;those in the＞4 months age group were 22.83 cm,129.37 minutes and 8.40 days,respectively.There were statistically significant differences between the two groups(P＜0.05).Conclusion Early surgical intervention for HSCR has no significant impact on mid-term postoperative bowel function.However,early surgery can reduce the extent of bowel resection,expedite the surgical process,shorten postoperative hospital stay and overall disease course,and effectively decrease the incidence of HAEC.

Biliary atresia is one of the most serious hepatobiliary system diseases in infants and young children.Hepatojejunostomy (also called Kasai surgery) is the main method for early treatment of biliary atresia.Although the surgical technology and perioperative management are maturing, many children after Kasai surgery will inevitably suffer various complications, such as cholangitis, portal hypertension, cholestasis, and growth and development disorders.Therefore, further follow-up and diagnosis and treatment by pediatricians are necessary.These complications can seriously affect the quality of life of children and their families, resulting in poor long-term results in most children, who may eventually need liver transplantation.In order to correctly understand and prevent these complications as early as possible and improve the quality of life and long-term survival rate of the patients, progress in the diagnosis and treatment of complications after Kasai surgery for biliary atresia was reviewed in this article.

Objective To investigate the impact of early surgical intervention on mid-term prognosis in patients with Hirschsprung's disease(HSCR)and to evaluate the risk of Hirschsprung-associated enterocolitis(HAEC).Methods From February 2016 to February 2022,230 children with HSCR who underwent one-stage radical Soave surgery in our hospital were divided into two groups according to the surgical age:the ≤4 months old group(126 cases)and the＞4 months old group(104 cases).The basic conditions of the two groups were compared.The mid-term defecation function of the children was evaluated using the Kelly scoring system.The clinical outcomes were analyzed to assess the risk of HAEC.Results There was no statistically significant difference in postoperative defecation function between the two groups of children(P＞0.05).The incidence of postoperative HAEC was 10.32％in the ≤4 months age group and 21.15％in the＞4 months age group.There was a statistically significant difference between the two groups(P＜0.05).The length of intestinal resection,operation time and postoperative hospital stay in the ≤4 months age group were 19.00 cm,83.10 minutes and 6.30 days,respectively;those in the＞4 months age group were 22.83 cm,129.37 minutes and 8.40 days,respectively.There were statistically significant differences between the two groups(P＜0.05).Conclusion Early surgical intervention for HSCR has no significant impact on mid-term postoperative bowel function.However,early surgery can reduce the extent of bowel resection,expedite the surgical process,shorten postoperative hospital stay and overall disease course,and effectively decrease the incidence of HAEC.

Biliary atresia is one of the most serious hepatobiliary system diseases in infants and young children.Hepatojejunostomy (also called Kasai surgery) is the main method for early treatment of biliary atresia.Although the surgical technology and perioperative management are maturing, many children after Kasai surgery will inevitably suffer various complications, such as cholangitis, portal hypertension, cholestasis, and growth and development disorders.Therefore, further follow-up and diagnosis and treatment by pediatricians are necessary.These complications can seriously affect the quality of life of children and their families, resulting in poor long-term results in most children, who may eventually need liver transplantation.In order to correctly understand and prevent these complications as early as possible and improve the quality of life and long-term survival rate of the patients, progress in the diagnosis and treatment of complications after Kasai surgery for biliary atresia was reviewed in this article.

Objective: To understand and assess the current situation of primary and secondary school students health services in community health service organizations in Shenzhen, so as to provide a basis for upgrading the capacity of health services. Methods: A total of 684 community health service organizations and 587 part time health vice principals in the Shenzhen City were selected for the study in June 2022, and the special questionnaire surveys regarding primary and secondary school students health service capacity and the community health service organizations and part time health vice principals performance ability were administered in Shenzhen. SPSS 26.0 software was used for a descriptive analysis. Results: The staffing rate of general practitioners or clinical physicians in Shenzhen s community health service organizations was 99.9%, 67.1% of community health service organizations established counterpart collaborative relationships with schools, 50.8% of community health service organizations provided diagnostic and treatment services for students, 24.8% of community health service organizations provided health check up services for students, 85.2% of community health service organizations provided health guidance to schools, and 94.3% of community health service organizations had a part time vice principal of health with a score of (7.63±1.59) in the self assessment of their ability to carry out their duties, and space constraints and shortage of nursing were the main problems in promoting student medical check ups in the community health service organizations. Conclusions The community health service organizations in Shenzhen suffer from inadequate medical service resources and inadequate training for professional staff, resulting in low service capacity for providing physical examinations and health management for primary and secondary school students. There is a need to further promote the integrated development of education and health, and continuously enhance service capabilities, to promote the orderly development of student health work.

Non-coding RNAs (ncRNAs), which are thought to regulate articular cartilage through endochondral osteogenesis, consist of mRNA-interfering complementary RNA (miRNA) and long non-coding RNAs (lncRNA). More and more experimental evidence reveals the role of ncRNAs in chondrocyte differentiation and the pathogenesis of several skeletal diseases, including osteoarthritis. In the past few years, increasingly sophisticated DNA sequencing methods and a large number of sepigenetic modifications have greatly contributed to our understanding of the pathophysiological mechanisms of osteoarthritis. Recent studies have revealed that RNA interacts with RNA-binding proteins, regulates gene transcription and protein translation, and is involved in various pathological processes in OA, promising to be a therapeutic target for osteoarthritis.

Objective:To investigate the effect and molecular mechanism of procyanidin on the proliferation, apoptosis and reactive oxygen species (ROS) level of gastric cancer cell line SNU-1 in vitro. Methods:SNU-1 cells were divided into control group and 12.5, 50.0, 200.0 μg/ml procyanidin groups. The effect of procyanidin on the proliferation of SNU-1 cells was detected by CCK-8 assay. The apoptosis level and ROS positive rate of cells were detected by flow cytometry, and 2 mmol/L glutathione was added to SNU-1 cells added with 200.0 μg/ml procyanidin to detect the apoptosis level and ROS positive rate of cells. The expression of apoptosis-related protein in cells was detected by Western blotting.Results:The results of CCK-8 experiment showed that the proliferation activities of SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were 3.69±0.30, 3.29±0.41, 0.91±0.39, 0.45±0.22 respectively, with a statistically significant difference ( F=279.84, P<0.001) . Compared with the control group, the proliferation activities of SNU-1 cells in the three procyanidin groups were significantly inhibited ( P=0.006, P<0.001, P<0.001) . The results of flow cytometry showed that the early apoptosis rates of SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were (0.00±0.00) %, (0.00±0.00) %, (0.09±0.07) % and (0.45±0.22) % respectively, with a statistically significant difference ( F=7.14, P=0.003) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P=0.003, P=0.007) . The late apoptosis rates of SNU-1 cells in the four groups were (0.00±0.00) %, (0.01±0.00) %, (6.98±0.77) % and (33.32±2.78) % respectively, with a statistically significant difference ( F=654.28, P=0.003) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P<0.001, P<0.001) . The positive rates of ROS in SNU-1 cells in the four groups were (0.02±0.01) %, (0.10±0.05) %, (1.15±0.26) % and (1.58±0.22) % respectively, with a statistically significant difference ( F=162.24, P<0.001) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P<0.001, P<0.001) . The positive rates of ROS in SNU-1 cells in the 200.0 μg/ml procyanidin group and the glutathione intervention group were (1.25±0.63) % and (0.13±0.02) % respectively, with a statistically significant difference ( t=5.39, P=0.001) . The early apoptosis rates of the two groups were (10.56±3.24) % and (2.09±0.24) % respectively, and the late apoptosis rates were (29.65±6.01) % and (23.63±1.52) % respectively, with statistically significant differences ( t=2.61, P=0.048; t=3.97, P=0.012) . The expressions of Bcl-2 protein in SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were 1.00±0.00, 0.83±0.05, 0.60±0.14 and 0.41±0.23 respectively, with a statistically significant difference ( F=10.63, P=0.004) . The 50.0 and 200.0 μg/ml procyanidin groups decreased significantly compared with the control group ( P<0.001, P<0.001) . Conclusion:Procyanidin can inhibit proliferation and promote apoptosis of gastric cancer SNU-1 cells in vitro, which may be achieved by increasing intracellular ROS levels and reducing Bcl-2 protein expression.

Objective:To investigate the expressions of miR-20a-5p and lysine (K) demethylase 6B (KDM6B) in osteosarcoma tissues and the effects of miR-20a-5p targeting KDM6B on the proliferation, migration and invasion of osteosarcoma cells and tumor growth.Methods:The clinicopathological and paracancerous tissues of 20 patients with osteosarcoma admitted to the First Affiliated Hospital of Chinese Medical University from January 2017 to March 2019 were collected. Quantitative real-time PCR (qRT-PCR) was used to detect the expression levels of miR-20a-5p and KDM6B mRNA in tissues. The osteosarcoma MG63 cells were divided into control group, mimic NC group, miR-20a-5p mimic group, and NC+ empty vector group, miR-20a-5p+ empty vector group, miR-20a-5p+ KDM6B group. The expression levels of miR-20a-5p and KDM6B mRNA of all groups were detected by qRT-PCR. Western blotting was used to detect the expression level of KDM6B. CCK-8 assay, cell scratch test and Transwell test were used to detect cell proliferation, migration and invasion ability. According to the random number table method, nude mice were divided into NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group, with 5 mice in each group. Tumor growth ability was detected by tumor xenograft nude mouse models.Results:The relative expression level of miR-20a-5p mRNA in osteosarcoma tissues was 0.55±0.27, and that in paracancerous tissues was 1.22±0.28, with a statistically significant difference ( t=7.701, P<0.001). The relative expression level of KDM6B mRNA in osteosarcoma tissues was 1.66±0.19, and that in paracancerous tissues was 1.00±0.15, with a statistically significant difference ( t=12.219, P<0.001). After transfection of miR-20a-5p, KDM6B mRNA and protein expression levels decreased with the increase of miR-20a-5p expression level. After miR-20a-5p transfection for 48 h, the cell proliferation abilities of the blank control group, mimic NC group and miR-20a-5p mimic group were 0.83±0.04, 0.81±0.03 and 0.52±0.01 ( F=89.655, P<0.001), compared with the blank control group and mimic NC group, the cell proliferation ability was significantly inhibited in the miR-20a-5p mimic group (both P<0.001). The cell proliferation abilities of NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were 0.83±0.05, 0.52±0.01 and 0.67±0.05 ( F=43.919, P<0.001), compared with the NC+ empty vector group, the cell proliferation ability was significantly inhibited in the miR-20a-5p+ empty vector group ( P<0.001); compared with the miR-20a-5p+ empty vector group, the cell proliferation ability of miR-20a-5p+ KDM6B group increased significantly ( P<0.001). The scratch healing rates of the blank control group, mimic NC group and miR-20a-5p mimic group were (32.51±2.73)%, (30.26±3.22)% and (13.52±1.77)% ( F=46.314, P<0.001), compared with the control group and the mimic NC group, the scratch healing rate of the miR-20a-5p mimic group was significantly decreased (both P<0.001). The scratch healing rates of NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were (31.34±3.11)%, (12.15±1.64)% and (28.93±2.89)% ( F=47.511, P<0.001), compared with the NC+ empty vector group, the scratch healing rate of the miR-20a-5p+ empty vector group was significantly decreased ( P<0.001); compared with the miR-20a-5p+ empty vector group, the scratch healing rate of miR-20a-5p+ KDM6B group was significantly increased ( P=0.001). The numbers of transmembrane cells in the blank control group, mimic NC group and miR-20a-5p mimic group were 114±16, 108±11 and 42±6 ( F=36.282, P<0.001), compared with the control group and mimic NC group, the number of transmembrane cells of the miR-20a-5p mimic group was significantly decreased (both P<0.001). The numbers of transmembrane cells in the NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group was 143±11, 39±4 and 139±12 ( F=112.120, P<0.001), compared with the NC+ empty vector group, the number of transmembrane cells of the miR-20a-5p+ empty vector group was significantly decreased ( P<0.001); compared with the miR-20a-5p+ empty vector group, the number of transmembrane cells of the miR-20a-5p+ KDM6B group was increased significantly ( P<0.001). The tumor volumes of mice for 21 d in the NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were (1 667.50±250.40) mm 3, (129.20±21.00) mm 3 and (775.41±77.51) mm 3 respectively, with a statistically significant difference ( F=77.651, P<0.001). The tumor weights of the 3 groups were (1.35±0.18) g, (0.12±0.01) g and (0.61±0.03) g respectively, with a statistically significant difference ( F=104.191, P<0.001). Conclusion:The expression of miR-20a-5p is significantly decreased in osteosarcoma tissues, and the expression of KDM6B is significantly increased in osteosarcoma tissues. Overexpression of miR-20a-5p may inhibit the proliferation, migration and invasion of osteosarcoma cells and tumor growth by targeting to reduce the expression of KDM6B.

Objective To investigate whether preset epidural catheter and individualized onset time could improve the effect of epidural labor analgesia.Methods This was an open-label,random-ized,controlled trial.The nulliparae aged from 18 to 35 years,with single cephalic term pregnancy, were randomized into two groups.In the individualized group,epidural catheterization was performed at the beginning of labor (emergence of regular contractions and nearly disappearance of cervix),and epidural analgesia was initiated when asked by parturients and the numeric rating scale (NRS,a verbal rating score from 0 to 10 for pain,in which 0 represented no pain and 10 the worst pain imagi-nable)pain score ≥ 5 .In the control group,epidural analgesia was initiated at cervical dilation of≥ 1 cm.The primary outcome measures were the most severe NRS pain score during labor and the pro-portion of the most severe NRS pain score ≥ 7 evaluated at 24 hours after delivery.Results A total of 194 parturients completed the study,among whom 97 were in the individualized group and 97 in the control group.The most severe labor pain score during labor [median 9 (IQR 8-10)in the individ-ualized group vs 9 (8-10)in the control group,P=0.201]and the proportion having the most severe pain score ≥ 7 [94 cases (96.9%)in the individualized group vs 89 cases (91.8%)in the control group,P=0.1 2 1 ]did not differ significantly between the two groups.There were no significant differences of adverse events between the two groups.Conclusion For the nulliparae with single ce-phalic term pregnancy suitable for vaginal delivery, the effects of individualized epidural labor analgesia are comparable to that of traditional analgesia (beginning at cervical dilation of ≥ 1 cm). The individualized analgesia is safe.

Objective To evaluate the clinical value of acetic acid with narrow-band imaging ( NBI ) and magnifying endoscopy ( ME ) on diagnosis of small colorectal polyps. Methods In this prospective study, 261 small colorectal polyps from 122 patients were observed by ME, NBI-ME, and acetic acid with NBI-ME, and then received endoscopic treatment. Endoscopic images were stored electronically and randomly allocated to 3 experts and 3 non-experts for diagnosis using Kudo pit pattern. The postoperative pathologic results acted as gold standard to evaluate the diagnostic accuracy of different endoscopic modes for small colorectal polyps. The image definition and interobserver agreement were compared among different endoscopic modes. Results The diagnostic accuracy of ME, NBI-ME, and acetic acid with NBI-ME for small colorectal polyps was 65. 5％ ( 171/261) , 90. 0％ ( 235/261) , and 94. 6％ ( 247/261) , respectively, in the experts group, and 57. 1％ ( 149/261) , 83. 1％ ( 217/261) , and 89. 3％ ( 233/261) , respectively, in the non-experts group. All experts and non-experts diagnosed small colorectal polyps more accurately by acetic acid with NBI-ME than by NBI-ME ( all P<0. 05 ) and ME ( all P<0. 001 ) . The image definition scores of acetic acid with NBI-ME in the experts group and non-experts group were significantly higher than those of NBI-ME and ME ( all P<0. 001) . The results of interobserver agreement showed that Kappa values (95％CI) of ME, NBI-ME, and acetic acid with NBI-ME diagnosis were 0. 578 (0. 508-0. 648), 0. 669 (0. 599-0. 739), and 0. 940 (0. 870-1. 010), respectively, for experts and 0. 476 (0. 406-0. 546), 0. 534 ( 0. 464-0. 604) , and 0. 830 ( 0. 760-0. 900 ) , respectively, for non-experts. Acetic acid with NBI-ME showed good interobserver agreement. Conclusion Acetic acid with NBI-ME has a higher diagnostic accuracy and good reproducibility for colorectal small polyps compared with ME and NBI-ME.