Objective To establish a cell bank of extrahepatic cholangiocarcinoma (ECC)-derived organoids and investigate the key factors influencing the organoids generation. Methods The tumor samples from patients with portal cholangiocarcinoma (pCCA) and distal cholangiocarcinoma (dCCA) were used to isolate cells, and these cells were cultured using three-dimensional (3D) technique to establish ECC organoids. Histological characteristics of the organoids were evaluated and identified through hematoxylin-eosin (HE) and immunohistochemistry stainings. The success rates of organoids generation from different tumor types were compared. And clinical characteristics of patients between successful and failure culture groups were compared. Results The success rates of organoids establishment from pCCA and dCCA were all low, with 42.4% (14/33), 51.9% (14/27), respectively. The tumor was larger in successful group than that in failure group (P＜0.001); there was no statistical difference in tumor differentiation status, microvascular invasion, and perineural invasion between the two groups. Conclusions The successful rate of ECC-derived organoids establishment is low, and larger tumor has higher successful culture rate.

For patients receiving mechanical ventilation, mechanical ventilation is also an injury factor at the same time of treatment, which can lead to or aggravate lung injury, that is, ventilator-induced lung injury (VILI). The typical feature of VILI is that the mechanical stress is transmitted to cells through the pathway, leading to uncontrollable inflammatory cascade reaction, which causes the activation of inflammatory cells in the lung and the release of a large number of cytokines and inflammatory mediators. Among them, innate immunity is also involved in the occurrence and development of VILI. A large number of studies have shown that damaged lung tissue in VILI can regulate inflammatory response by releasing a large number of damage associated molecular pattern (DAMP). Pattern recognition receptor (PRR) participates in the activation of immune response by combining with DAMP, and releases a large number of inflammatory mediators to promote the occurrence and development of VILI. Recent studies have shown that inhibition of DAMP/PRR signaling pathway can play a protective role in VILI. Therefore, this article will mainly discuss the potential role of blocking DAMP/PRR signal pathway in VILI, and provide new ideas for the treatment of VILI.
Humans ; Respiration, Artificial ; Respiration ; Immunity, Innate ; Ventilator-Induced Lung Injury ; Inflammation ; Inflammation Mediators ; Lung

Objective:To observe the clinical characteristics of patients with familial vitreous amyloidosis (FVA) and the efficacy of vitrectomy (PPV) and the occurrence of complications.Methods:A retrospective clinical study. From June 2009 to March 2020, 32 eyes of 18 patients from 3 FVA families who were diagnosed and treated by PPV at Department of Ophthalmology of Jiaxing TCM Hospital were included in the study. Among them, there were 12 males with 22 eyes and 6 females with 10 eyes. The average age of onset was 42.28±3.25 years; the average duration of disease was 3.75±3.93 years. All the affected eyes underwent best corrected visual acuity (BCVA) and B-mode ultrasound examination. A logarithmic visual acuity chart was used in the BCVA examination, which was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity when recorded. The average logMAR BCVA of the affected eye was 1.72±0.53; the intraocular pressure was less than 21 mm Hg (1 mm Hg=0.133 kPa). The vitreous body of the affected eye was obviously cloudy. All the affected eyes underwent standard three-channel PPV through the flat part of the ciliary body, and vitreous specimens were collected for pathological examination during the operation. Peripheral venous blood of probands from 3 families was collected, and the whole exome gene sequencing was performed. The follow-up time after surgery was ≥6 months. The patient's clinical characteristics, fundus lesions in PPV, changes in BCVA after surgery, and complications was observed. One-way analysis of variance or t test was performed for measurement data comparison; χ2 test was performed for count data comparison. Results:The vitreous body of the affected eye showed gray-white dense and thick flocculent changes, and the posterior capsule attached to the lens showed "foot disc-like" turbidity; later the lens was mainly cystic opacity. Pathological examination of the vitreous body showed positive staining of Congo red; under a polarized light microscope, it showed apple green dots and sheet-like birefringence. The genetic test results showed that there was a c.307G>C (p.Gly103Arg) missense mutation in the TTR gene of the proband in Family 2. Peripheral retinal hemorrhages in 4 eyes (12.5%, 4/32), retinal tears in 5 eyes (15.6%, 5/32), retinal degeneration in 4 eyes (12.5%, 4/32), retinal detachment were found in PPV 3 eyes (9.4%, 3/32). The vitreous body was filled with C 3F 8 and silicone oil respectively for 2, 1 eye. Six months after the operation, the logMAR BCVA of the affected eye was 0.39±0.32, which was significantly higher than that before the operation, and the difference was statistically significant ( t=15.131, P=0.000). After the operation, high intraocular pressure occurred in 2 eyes (6.3%, 2/32), secondary glaucoma in 1 eye (3.1%, 1/32), retinal detachment in 2 eyes (6.3%, 2/32), neovascular glaucoma (NVG) in 2 eyes (6.3%, 2/32), cataract in 10 eyes (31.3%, 10/32). Conclusion:The vitreous body of FVA eyes are gray-white dense, thick and flocculent, attached to the posterior lens capsule, showing "foot disc-like" turbidity; PPV treatment can effectively improve the BCVA of the FVA eyes; secondary glaucoma, secondary retinal detachment, NVG can occur after surgery.

Objective:To explore the difficulties and measures of clinical medical postgraduates management during the national prevention of COVID-19 pandemic.Methods:This study mainly used the document review, interview and questionnaire survey methodologies, to investigate the clinical medical postgraduates school situation, online teaching, training, scientific research, psychological state during prevention of COVID-19 emergency.Results:Up to February 14, 2020, the return rate of professional degree postgraduates was 92.8% (256/276). The average score of postgraduates participating in epidemic prevention and control training was 86.59. The effect of online learning was basically the same as that of face-to-face classroom teaching. Up to March 6, 2020, the in-hospital submission rate of postgraduates’ thesis was 50.0% (65/130). Facing the pressures of COVID-19 emergency, 62.6% professional degree postgraduates (124/198) and 35.4% (70/198) academic postgraduates suffered some anxiety or depression, the difference was statistically significant ( P<0.05). Conclusions:During the COVID-19 prevention and control period, it is important to innovate work style, found the linkage system of education department-clinical department-tutor-postgraduates, pay attention to physical and mental health of postgraduates, ensure the quality of teaching, adopt various measures to do well in the education and management of clinical medical postgraduates.

Objective:To reveal the expression and regulation network of microRNA (miRNA) and mRNA in ovarian endometriosis using high-throughput sequencing, and then explore the potential pathogenesis.Methods:From January 2017 to January 2018, twenty patients with ovarian endometriosis in Xiangya Hospital of Central South University were enrolled. Ectopic endometrium and paired eutopic endometrium were collected when surgery was conducted. After total RNA was extracted, miRNA sequencing and mRNA sequencing were performed respectively. Differential miRNA and mRNA expression profiles were analyzed. Predicted mRNA were obtained by Targetscan and miRDB databases, and then intersected with differential mRNA to obtain candidate mRNA. miRNA-mRNA regulatory network was analyzed using Cytoscape software, whereas gene ontology (GO) and pathway function enrichment were performed by DAVID database.Results:Compared with eutopic endometrium, there were 369 miRNAs (197 up-regulated, 172 down-regulated) and 3 765 mRNAs (1 975 up-regulated and 1 790 down-regulated) differentially expressed in ectopic endometrium. Real time quantitative polymerase chain reaction (qRT-PCR) confirmed that the expression of mir-202-5p and mir-514a-5p in ectopic endometrium was higher than that in eutopic endometrium ( P<0.05), while the expression of mir-375-3p, mir-449b-5p in ectopic endometrium was lower than that in eutopic endometrium ( P<0.05). Bioinformatics found that the candidate mRNA related to these four miRNAs are mainly enriched in biological processes of nuclear steroid hormone receptor binding, transmembrane receptor and protein kinase activity, and participate in transforming growth factor β (TGF β) signal pathway, adhesion junction, Wnt signal pathway and Rap1 signal pathway. Conclusions:miRNA and mRNA are differentially expressed in endometriosis, and exact important regulatory network in the development of endometriosis by involving multiple biological processes.

Objective : To construct a visual literacy evaluation system for pupils by Delphi expert consultation method（Delphi method）. Methods : The visual literacy evaluation indices for pupils were preliminarily constructed through literature review. Twenty experts in relevant fields were invited and the visual literacy evaluation system for pupils was established by two rounds of expert consultation based on Delphi method. Results : The average age of 20 experts was（48.35±5.79）years old,of which 19 experts had senior titles,and 17 experts had master's degree or above. The enthusiasm of the experts in two rounds of consulting was both 100.00%. The average authoritative coefficient（W）of the experts was 0.88. For the first consulting round,the W of importance scores from experts was 0.91（P<0.01）;the W of operability scores from experts was 0.89（P<0.01）,which indicated satisfactory consistency. For the second consulting round,the W of importance scores from experts was 0.79（P<0.01）;the W of operability scores from experts was 0.77（P<0.01）,which also indicated satisfactory consistency. The finalized visual literacy evaluation system for pupils after two rounds of expert consultation included three primary indices（eye care knowledge literacy,eye care attitude literacy and eye care behavior literacy）,six secondary indices（basic knowledge,eye care behavior,eye care attitude,eye care willingness,bad eye care behavior and eye protection）and 40 tertiary indices（≥5.0 of eyesight among normal people,always wearing glasses due to poor eyesight and so on）. Conclusion The experts who participated in the construction of visual literacy evaluation system for pupils had strong professional representativeness,high enthusiasm,high authority and good coordination,and the evaluation system can be used for evaluating pupils visual literacy.

Objective To evaluate the survival and prognostic factors of esophageal cancer treated with definitive ( chemo ) radiotherapy by applying novel radiation techniques including three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Methods Clinical data of 2762 patients with non-operated esophageal squamous cell carcinoma who underwent definitive ( chemo ) radiotherapy from 2002 to 2016 in 10 hospitals were retrospectively analyzed.The prognostic factors were also identified and analyzed. Results The median follow-up time was 60. 8 months. The 1-, 2-, 3-and 5-year overall survival (OS) of all patients was 71. 4％,48. 9％,39. 3％,and 30. 9％,respectively.The 1-,2-,3-and 5-year progression-free survival (PFS) was 59.5％,41.5％,35.2％,and 30％,respectively.The median survival was 23 months.The median time to progression was 17. 2 months.Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and treatment mode were the independent prognostic factors for OS.Primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS. Conclusions In this first large-scale multi-center retrospective analysis of definitive ( chemo) radiotherapy for esophageal squamous cell carcinoma in China, the 5-year OS of patients with esophageal squamous cell carcinoma is significantly improved by 3DCRT, IMRT combined with chemotherapy drugs. However, the findings remain to be validated by prospective clinical trials with high-level medical evidence.

Objective To explore the effectiveness of 12-week exercises with different intensities on cardiorespiratory fitness(CRF)of rats,so as to provide theoretical evidences for evaluating effective exercise loads.Methods Forty male Wistar rats were randomly divided into a low intensity group(50％ VO2max),a moderate intensity group(65％VO2max),a high intensity group(80％VO2max)and a sedentary group,each of 10.All rats were measured the VO2max after three-day adaptive training,then they were repeated the VO2max test every two weeks on the non-training days and the load of the next two weeks was adjusted according to the test result.The treadmill speed was controlled to maintain the specific exercise intensity of each group in the training period.The rats in the exercise groups were trained 5 days per week and 60 minutes per day.After 12 weeks of exercise intervention,the ultrasonic cardiogram tests were conducted.Results After 12 weeks of exercise,compared with the sedentary group,the average weight of the low and high intensity groups decreased significantly(P＜0.05,P＜0.01).After the 12-week exercise intervention,the average VO2max of the three exercise groups were significantly higher than the sedentary group (P＜0.01).The average CRF of the moderate and high intensity group improved faster,with their peak value at the 6th and 8th week respectively.However,in the low intensity group significant improvement in the average CRF was observed from the 10th week,with the peak value appearing at the 12th week.The average left ventricular internal dimension systole of the high intensity group was lower than the low intensity group(P＜0.05),while the ejection fraction and left ventricular shortening fraction increased significantly (P＜0.05).Conclusions Exercises with different intensity can improve the CRF.However,compared with moderate and high intensity exercise,it requires longer time to improve CRF with low intensity exercise.Only exercise with 80％VO2max can significantly improve the cardiac pumping function.

Objective To explore the clinical significance of B7 family homology factor-3 (B7-H3),an expression membrane type of myeloid-derived suppressor cell (MDSC),in patients with acute pancreatitis (AP).Methods A total of 63 patients with AP initially treated in the Emergency Department at the First Affiliated Hospital of Soochow University from January,2014 to December,2015 were selected.Of them,25 suffered from mild AP (MAP),20 had moderate AP (MSAP) and 18 had severe AP (SAP).Another 20 healthy subjects with matching age and gender served as the control group.All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2013 in China.Patients with other underlying diseases that might influence the clinical outcomes were excluded,including those with tumors,autoimmune diseases,viral infections,trauma and other disorders.A flowcytometer was used to detect the expression rate of MDSC in peripheral venous blood and the expression of B7-H3 on MDSC membrane.The continuous monitoring was carried out for 24 h,48 h and 72 h in patients with AP.Results Compared with healthy subjects,the MDSC cells in patient groups 24 hours after AP onset increased notably (P ＜0.01) especially the highest increase in the SAP group,followed by the MSAP group and the lowest in the MAP group.There were significant differences in pairwise comparisons (P ＜ 0.05).From successive observation of each group,there was no significant difference in MDSC between the MAP group and the MSAP group 24 hours,48 hours and 72 hours after AP onset.However,MDSC reached its peak 48 hours after AP onset,but it declined 72 hours after AP onset in the SAP group (P ＜ 0.05).B7-H3 expressed significantly 24 hours after AP onset,but there was no expression of B7-H3 in the healthy group.Meanwhile,B7-H3 was expressed most highly in the SAP group,followed by the MSAP group and lowest in the MAP group.There were significant differences in expression of B7-H3 found in pairwise comparisons (P ＜ 0.05).The successive observation showed that there was no significant difference in B7-H3 expression between the MAP group and the MSAP group 24 hours,48 hours and 72 hours after AP onset.However,there was a trend of increase in B7-H3 expression as time prolonged found among 24 hours,48 hours and 72 hours after AP onset in the SAP group (P ＜ 0.05).Conclusions The expressions of MDSC and B7-H3 were high in AP,and there were significant differences in both expressions among MAP,MSAP and SAP groups.These phenomena offer clues in further understanding about the immunological disorders during AP giving better guidelines for clinical practice.

The authors analyzed the pros and cons for complete public transparency of medical records of medical institutions and came forward with constructive suggestions. These included standardizing and streamlining the medical records writing and combining the objective and subjective disease history;strengthening quality control of medical records and paying attention to informationization of such institutions;improving laws and norms;and strengthening publicity and deepening awareness of the public.