Objective:To investigate the protective effect of Dendrobium officinale polysaccharides(DOP)on intestinal mucosal barrier damage,and to elucidate the possible mechanism.Methods:Ten female C57BL/6 mice,aged 5 months,were selected as young group;twenty femal C57BL/6 mice,aged 15 months,were randomly divided into aged group and DOP treatment group(200 mg·kg-1,DOP group),with 10 mice in each group.The mice in DOP group were administrated with DOP by gavage.The body mass,food intakes and hanging time of the mice in various groups were detected.HE staining was used to observe the pathomorphology of intestinal and spleen tissues of the mice in various groups.Immunohistochemical staining was used to detect the expressions of intestinal atresin 1(ZO-1)and Mucin 2(MUC2)in intestinal tissue of the mice in various groups.The intestinal baterial metabolite medium(IBMM)were prepared to intervene the Caenorhabditis elegans(C.elegans),and the C.elegans were randomly divided into Young-IBMM group,Aged-IBMM group,and DOP-IBMM group.Immuno-fluorescence method was used to analyze the intestinal lipofuscin accumulation levels on the 1st day and the 12th day of the C.elegans in various groups.Brilliant blue staining was used to assess the intestinal leakage on the 1st day and the 12th day of C.elegans in various groups.The Caco-2 cells were randomly divided into Young-IBMM,Aged-IBMM and DOP-IBMM groups,and Western blotting method was used to detect the expression levels of ZO-1,Occludin,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),phosphorylated myosin light chain(p-MLC),myosin light chain kinase(MLCK)proteins in the Caco-2 cells in various groups.Results:Compared with young group,the body mass of the mice in aged group was increased(P＜0.05),the amount of food intake was decreased(P＜0.05),and the hanging time was decreased(P＜0.05);compared with aged group,the body mass of the mice in DOP group was significantly decreased(P＜0.01),the amount of food intake was increased(P＜0.05),and the hanging time was significantly extended(P＜0.01).The HE staining results showed that compared with young group,the thickness of intestinal mucosa of the mice in aged group became thinner,the goblet cells were reduced,the intestinal villi were disordered with different lengths,a large amount of hemosiderin was found on the surface of the spleen,the cell components in the red medullary were reduced,and the lymphatic sheath and lymphatic nodes around the intra-white pulp artery remained or almost disappeared;compared with aged group,the thickness of the intestinal mucosa of the mice in DOP group was increased,the goblet cells were increased,the length of the intestinal villi was consistent and neatly arranged,the overall function of the red pulp of the spleen was improved,and the components of the white pulp were increased.The immunohistochemical staining results showed that compared with young group,the expression levels of ZO-1 and MUC2 proteins in intestinal tissue of the mice in aged group were significantly decreased(P＜0.05 or P＜0.001);compared with aged group,the expression levels of ZO-1 and MUC2 proteins in the intestinal tissue of the mice in DOP group were significantly increased(P＜0.05 or P＜0.001).The immuno-fluorescence analysis showed that compared with Young-IBMM group,the intestinal lipofuscin accumulation level of C.elegans in Aged-IBMM group was significantly increased(P＜0.001);compared with Aged-IBMM group,the intestinal lipofuscin accumulation level of C.elegans in DOP-IBMM group was significantly reduced(P＜0.001).The brilliant blue staining showed that compared with Young-IBMM group,the bright blue dye leaked into the whole body of C.elegans from intestinal tissue in Aged-IBMM group,and the intestinal structure became blurred and was difficulted to be observed;compared with Aged-IBMM group,the leakage of bright blue dye of C.elegans in DOP-IBMM was reduced.The Western blotting results showed that compared with Young-IBMM group,the expression levels of TNF-α,IL-6,p-MLC,and MLCK proteins in the Caco-2 cells in Aged-IBMM group were significantly increased(P＜0.01 or P＜0.001),and the expression levels of ZO-1 and Occludin proteins were significantly decreased(P＜0.05 or P＜0.01);compared with Aged-IBMM,the expression levels of TNF-α,IL-6,p-MLC and MLCK proteins in the Caco-2 cells in DOP-IBMM group were significantly decreased(P＜0.01),and the expression levels of ZO-1 and Occludin proteins were significantly increased(P＜0.05 or P＜0.01).Conclusion:DOP has an ameliorating effect on intestinal mucosal barrier damage in the aged mice,and its mechanism may be related to the improvement of intestinal barrier damage by regulating intestinal bacterial metabolites,inhibiting the p-MLC/MLCK signal pathway,restoring the expression of tight junction complexes,and reducing the level of intestinal inflammation.

Objective:To investigate the effect of absorbable material internal fixation in the treatment of phalanx fracture and its effect on the complications related to hypersensitive C-reactive protein (hs-CRP), interleukin-10 (IL-10), adrenocorticotropic hormone (ACTH) and foreign body reaction.Methods:The clinical data of 98 patients with phalangeal fracture in Huishan District People′s Hospital of Wuxi City from January 2018 to January 2020 were divided into absorbable group (49 cases, treated with absorbable material internal fixation) and microplate group (49 cases, treated with minimally invasive plate internal fixation). The rates of excellent and good treatment, operation conditions, serum inflammatory stress response indexes levels before and 1 d and 1 week after surgery were compared, and recovery at 3 and 6 months after surgery, the incidence of complications and the degree of treatment satisfaction were counted.Results:The rates of excellent and good treatmentin the absorbable group were higher than that in the micro plate group: 95.92%(47/49) vs. 81.63%(40/49), χ2 = 5.02, P<0.05. The duration of operation in the absorbable group was longer than that in the microplate group: (43.28 ± 12.18) min vs. (31.29 ± 11.69) min; and the duration of hospital stay, fracture healing time and recovery time were shorter than those in the microplate group: (4.09 ± 1.18) d vs. (6.89 ± 2.12) d, (4.35 ± 1.05) weeks vs. (5.69 ± 1.38) weeks, (4.89 ± 1.10) d vs. (6.20 ± 2.01) d; the differences were statistically significant ( P<0.05). The levels of serum hs-CRP, IL-10 and ACTH in absorbable group were lower than those in microplate group at 1 d and 1 week after surgery ( P<0.05). At 3 and 6 months after surgery, the range of motion of metacarpophalangeal joint in the absorbable group was greater than that in the microplate group, and the loss of grip strength of the healthy side was less than that in the microplate group ( P<0.05). The incidence of complications in absorbable group was lower than that in microplate group: 6.12%(3/49) vs. 20.41%(10/49), χ2 = 4.35, P<0.05. Conclusions:The absorbable material internal fixation can achieve good results in the treatment of phalanx fracture, the postoperative recovery is fast, the incidence of complications is lower.

Primary adrenal small cell neuroendocrine carcinoma is clinically rare. This article reported a patient, who was diagnosed as primary adrenal small cell neuroendocrine carcinoma complicated with renal vein cancer thrombus, and underwent laparoscopic left adrenal + left kidney + left renal vein tumor embolectomy.The carcinoma relapsed after 19 months of follow-up after surgery. The patient and his family refused further treatment.

The shortage of pediatric resources and inadequate diagnosis and treatment capacity in primary hospitals are key problems for implementing hierarchic care system of children's diseases. To solve this difficulty, Zhejiang province has constructed a three-stage standardized pattern for pediatric diagnosis and treatment ability training for primary doctors, which integrates training promotion, continuing education and practice output. Training promotion includes the training courses, theoretical examination, and the certification of Zhejiang Pediatric Alliance. Continuing education includes mobile teaching resource library and online regular Q&A. Practical output includes graded diagnosis and treatment of children's diseases and public lectures. From 2018 to 2021, a total of 1 418 trainees participated in 7 training sessions, 327 of whom passed the examination. Finally, 53 participants completed the certification of Zhejiang Pediatric Alliance and were included in the hierarchical diagnosis and treatment system for children in Zhejiang Province, expanding the coverage of hierarchical diagnosis and treatment from 32 institutions in 24 districts to 73 medical institutions in 38 districts. Members of the alliance completed 40 public lectures, with a total audience of 13 233. The three-stage standardized pattern continuously improves the comprehensive ability of primary doctors by means of multi-forms, standardization and continuity. We hope our experience can provide a reference for the training of primary doctors and the construction of hierarchical diagnosis and treatment system in various regions.

Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.

Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.

Objective:To investigate abnormal urination and penile appearance satisfaction of preschool children (3-6 years old) after hypospadias repair.Methods:From January 2016 to December 2020, children with primary hypospadias, who had no postoperative complications for more than 1 year and were at pre-school age at the time of investigation (January 2022), were selected. The abnormal urination manifestations and satisfaction with penile appearance of the children after operation were investigated by questionnaires to their parents.The questionnaire was designed based on the reported abnormal urination after hypospadias surgery, including 4 items (urination spraying, urination dripping, deflection of urine line, small urine line). Another questionnaire was used to evaluate the penis appearance satisfaction according to the existing pediatric penile perception score (including 4 items: the position and shape of the external urethral orifice, the shape of glans, the appearance of the prepuce, and the overall appearance; items were scored according to the subjective satisfaction of the subjects: very satisfied 3 points, satisfied 2 points, dissatisfied 1 point, very dissatisfied 0 point). The patients were divided into two groups according to whether the penile curvature after degloving was more than 30°. In group Ⅰ (penile curvature≤30°), 28 patients without severe penile curvature underwent tubularized incised plate (TIP) surgery, with a median age of 3.2 years (ranged 1.1-5.4 years). In group Ⅱ (penile curvature>30°), there were 27 patients with severe penile curvature and they underwent staged flap operation. Their median age was 2.8 years (ranged 1.5-4.7 years). There was no significant difference in age at operation between the two groups ( P=0.82). The questionnaire content was analyzed and the differences between the two groups were compared. Results:Among the 55 children, 21(38%, 21/55) had abnormal urination, and there was a significant difference between group Ⅰ (25%, 7/28) and group Ⅱ (52%, 14/27)( P=0.04). All the items of penis appearance satisfaction were satisfactory (scores ≥2), and the total scores of group Ⅰ and group Ⅱ were respectively 10.3±2.2 and 9.0±2.9, with no significant difference between the two groups (P=0.63). Conclusions:In the postoperative follow-up of preschool children with hypospadias, parents were satisfied with the appearance of the penis.The abnormal urination was common. Compared with children without severe penile curvature treated by TIP surgery, abnormal urination was more common in children with severe penile curvature treated by staged flap operation.

Background/Aims: Lyon consensus differentiates acid exposure time (AET) as physiological, borderline, and pathological. Mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWi) are believed to increase diagnostic yield of gastroesophageal reflux disease (GERD) and correlate with symptom outcome of proton pump inhibitor (PPI) treatment. We aim to explore the clinical characteristics and the correlation of pH-impedance parameters with PPI response in Chinese patients with different AET levels. Methods: We retrospectively investigated 177 patients with typical reflux symptoms who received esophageal function tests. The demographics, GERD questionnaire scores, the proportion of esophagitis and PPI responders, and manometric and pH-impedance parameters were compared among patients with AET < 4%, 4-6%, and > 6%. In patients with AET ≥ 4%, manometric and pH-impedance parameters were compared between PPI responders and non-responders. Results: Among 177 patients, 69 (39.0%) had AET 4-6%, and 53 (29.9%) had AET > 6%. The demographics, esophagogastric junction type, and occurrence of ineffective esophageal motility were similar between patients with AET 4-6% and > 6%, but different from AET < 4%. MNBI and PSPWi were different among different AET levels, but similar between PPI responders and non-responders in patientswith AET ≥ 4%. Conclusions It is reasonable to set 4% as a threshold to define pathological AET in Chinese patients. MNBI and PSPWi could identify GERD patients, but may not correlate with PPI response of Chinese GERD patients.

The blood samples of 294 Chinese Han patients with type 1 diabetes mellitus(T1DM) and 199 controls were collected and their genomic DNAs were extracted. The single nucleotide polymorphisms rs17534481, rs12095738, rs2988276, and rs6668182 of CD247 gene were detected. The results showed that rs17534481 polymorphism of CD247 gene was associated with T1DM in Chinese Han population, and T allele was a protective factor for type 1 diabetes mellitus( OR=0.667, P=0.037). There was no significant difference in genotype frequency and allele frequency of rs12095738, rs2988276, and rs6668182 between type 1 diabetes group and control group( P>0.05).

Objective:To evaluate the effectiveness and safety of transepithelial photorefractive keratectomy (TransPRK) assisted by smart pluse technology (SPT) for the correction of high myopia.Methods:An observational case series study was conducted.Sixty high myopic patients (107 eyes) with spherical equivalent (SE)≥-6.0 D who received TransPRK assisted by SPT from January to December 2016 in Eye Hospital of Wenzhou Medical University were enrolled.Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) of the patients were examined and recorded in logarithm of the minimum angle of resolution (LogMAR) units, and refraction was examined with a subjective refractometer.The healing of corneal epithelium and corneal haze was observed with a slit lamp.Intraocular pressure (IOP) was measured with the non-contact tonometer.Safety index (SI) and efficacy index (EI) were analyzed.The follow-up time was 12 months.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Eye Hospital of Wenzhou Medical University (No.2019-197-k-177). Written informed consent was obtained from each patient prior to any medical examination.Results:The mean epithelial healing time was (3.77±1.02) days.There were statistically significant differences in UCVA and BCVA between before and after surgery ( Z=380.812, 267.313; both at P<0.001). And the 7-day, 6-month, and 12-month postoperative BCVA were better than preoperative BCVA, showing statistically significant differences (all at P<0.05). Mean SI was 1.10±0.12, and mean EI was 1.05±0.17 at 12 months after surgery.There was no significant difference between the attempted SE before surgery (-8.02±1.36)D and the achieved SE at 12 months after surgery (-8.04±1.51)D ( P=0.523). SE in the predictive range within ±0.50 D accounted for 79% (85/107) and that within ±1.0 D accounted for 92% (98/107). The IOP was slightly increased in 3 eyes at 7 days and 7 eyes at 1 month after surgery, respectively, which returned to normal after the use of ophthalmic solution for lowing IOP.The incidence of haze severer than grade 1 was less than 1% (1 eye), and haze gradually disappeared after application of drugs. Conclusions:TransPRK assisted by SPT for high myopia shows good safety, effectiveness and predictability.It is an ideal corneal surface surgery to correct high myopia.