Objective:To investigate the application value of antegrade splenic superior region dissection first in laparoscopic total gastrectomy of obesity gastric cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 obesity patients with gastric cancer who underwent laparoscopic total gastrectomy in Renji Hospital of Shanghai Jiaotong University School of Medicine from July 2018 to October 2023 were collected. There were 16 males and 5 females, aged (58±13)years. All 21 patients underwent laparoscopic total gastrec-tomy with antegrade splenic superior region dissection first. Observation indicators: operation time, volume of intraoperative blood loss, laparotomy conversion, intraoperative splenic hemorrhage or gastric hemorrhage, lymph node dissection, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay, postoperative complication. Measure-ment data with normal distribution were represented as Mean± SD, and count data were expressed as absolute numbers. Results:All 21 patients underwent laparoscopic total gastrectomy success-fully, with the operation time of (283±47)minutes, time for splenogastric ligament and vascular manage-ment of (34±12)minutes, volume of intraoperative blood loss of (143±86)mL, and no laparotomy conversion. There was no intraoperative splenic hemorrhage or gastric haemorrhage. The total number of lymph node dissected in 21 patients was 375, with the number of lymph node dissected as (21±9)per case. Time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay in 21 patients were (3.1±0.7)days, (4.0±0.8)days and (10.1±3.0)days, respectively. There were 2 patients with postoperative complications, including 1 case of incision infection and 1 case of lung infection. The 2 patients with postoperative com-plications were recovered and discharged after conservative treatment. There was no death during the postoperative 30 days.Conclusion:The application of antegrade splenic superior region dissec-tion first in laparoscopic total gastrectomy is safe and feasible, which can reduce surgical difficulty.

Objective:To identify the potential intracranial inflammation in neuromyelitis optica spectrum disorders(NMOSD) patients without supratentorial MRI lesions using quantitative susceptibility mapping (QSM).Methods:Seventy NMOSD patients and 35 age- and gender-matched healthy controls (NC) underwent QSM, 3D-T 1, diffusion MRI from Beijing Tiantan Hospital during June 2019 to June 2021. Susceptibility was compared among NMOSD patients with acute attack (ANMOSD), NMOSD patients in chronic phase (CNMOSD) and NC. The correlation between susceptibility in several brain regions and the cerebrospinal fluid levels of inflammatory makers were analyzed. Results:NMOSD patients showed different susceptibility in several brain regions including bilateral hippocampus, precuneus, right cuneus, putamen, superior parietal and inferior temporal ( P<0.001) and the posr-hoc showed it is higher than normal. Compared to CNMOSD patients, the ANMOSD patients showed increased susceptibility in the cuneus (0.009 ± 0.004 vs. 0.005 ± 0.004, P<0.05). There was significant positive correlations between susceptibility and CSF levels of sTREM2 which reflect the active of microglial cells ( r = 0.494, P<0.05). Conclusions:Despite the absence of supratentorial lesions on MRI, increased susceptibility suggests underlying inflammation in the cerebral cortex in both patients with ANMOSD and CNMOSD, and some of them are obviously related to inflammatory markers in CSF. QSM sequence can be used to explore the potential inflammation in NMOSD patients without obvious supratentorial lesions.

Objective:To evaluate the effect of different doses of compound sodium chloride injection combined with norepinephrine on prevention of hypotension after lumbar anesthesia in the patients undergoing caesarean section.Methods:A total of 150 patients with a singleton fetus, aged 18-45 yr, at ≥37 weeks of gestation, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with height ≥150 cm, weighing ≤100 kg, with body mass index < 40 kg/m 2, scheduled for elective caesarean section under lumbar anesthesia, were divided into 3 groups ( n=50 each) by the random number table method: compound sodium chloride injection 4, 8 and 12 ml·kg -1·h -1 groups (group A, group B, group C). Compound sodium chloride injection 4 ml/kg was intravenously injected for liquid preload before lumbar anesthesia, and 0.5% hyperbaric bupivacaine 12.5 mg was injected to the subarachnoid space for lumbar anesthesia. Norepinephrine was intravenously injected at a dose of 6 μg immediately after intrathecal injection, followed by an infusion of 0.05 μg·kg -1·min -1, and infusion was stopped at 5 min after delivery. Compound sodium chloride injection was intravenously infused simultaneously at a rate of 4, 8 and 12 ml·kg -1·h -1 in A, B and C groups, respectively. The maximum diameter of inferior vena cava (IVCmax) and the minimum diameter of inferior vena cava (IVCmin) were measured by ultrasound, and inferior vena cava collapse index (IVC-CI) was calculated at 1 min before fluid preload (T 1), immediately after fluid preload (T 2), at 5 min after anesthesia (T 3), at 5 min after fetal delivery (T 4) and immediately before leaving the operating room (T 5). The incidence of intraoperative adverse events (hypotension, severe hypotension, bradycardia, hypertension, nausea, and vomiting) and neonatal outcomes (umbilical artery blood gas index and Apgar score at 1 and 5 min after birth) were recorded. Results:Compared with group A, IVCmin was significantly increased and IVC-CI was decreased at T 5 in group B, and IVCmin and IVCmax were significantly increased and IVC-CI was decreased at T 5 in group C ( P<0.05). There was no significant difference in IVCmax, IVCmin and IVC-CI at each time point between group B and group C ( P>0.05). There was no significant difference in the incidence of hypotension, severe hypotension, bradycardia, hypertension, nausea and vomiting among the three groups ( P>0.05). There was no significant difference in the results of blood gas analysis of the umbilical artery and Apgar score at each time point after birth among the three groups ( P>0.05). Conclusions:Compound sodium chloride injection 4, 8 and 12 ml·kg -1·h -1 combined with norepinephrine can effectively prevent the occurrence of hypotension after lumbar anesthesia in the patients undergoing caesarean section without increasing maternal and infant adverse events, and the effect of 8 and 12 ml·kg -1·h -1 for volume supplementation is better than that of 4 ml·kg -1·h -1.

Objective:To analyze the implementation of early essential newborn care (EENC) in baby-friendly hospitals in China.Methods:This is an investigation carried out using convenience sampling method. People in charge of labor ward, obstetric wards or neonatology department of the selected hospitals, such as baby-friendly hospitals with birth facilities, primary or higher level of hospitals, or general hospitals or those specialized in obstetrics and gynecology or materal and child health care centers, were selected as the subjects of the survey. Information about EENC practices in these hospitals was collected using a self-designed questionnaire sent through WeChat from April 1 to 30, 2021. Chi-square test was used for statistical analysis. Results:A total of 126 questionnaires were distributed and 124 (124 baby-friendly hospitals) were withdrawn. There were 74 hospitals in the eastern, 18 in the central and 32 in the western region. Among the 124 hospitals, tertiary hospitals, general hospitals, and maternity and child care hospitals accounted for 72.6% ( n=90), 64.5% ( n=80) and 35.5% ( n=44), respectively. There were no significant differences in the hospital type, levels, EENC coverage and training, or implementation of mainly recommended EENC practices among the hospitals in the eastern, central and western regions (all P>0.05). The implementation rate of at least one mainly recommended EENC practice was 79.0% (98/124) and there was no significant difference in the implementation rates among eastern, central and western regions [86.4% (64/74), 13/18 and 65.6% (21/32), χ2=6.60, P=0.159]. A total of 80 (64.5%) hospitals implemented 10 or more recommended EENC practices, and the implementation rates in eastern, central and western regions were 71.6% (53/74), 10/18 and 53.1% (17/32), respectively ( χ2=4.08, P=0.130). Among the 17 mainly recommended measures of EENC, in eastern, central and western hospitals, the implementation rates were 10.8% (8/74), 2/18 and 18.8% (6/32) for mother-infant skin-to-skin contact for 90 min after birth; 66.2% (49/74), 11/18 and 68.8% (22/32) for delayed umbilical cord clamping; and 25.7% (19/74), 7/18 and 21.9% (7/32) for delayed routine care following skin-to-skin contact, respectively ( χ2=6.57, 0.34 and 4.53, all P>0.05). Conclusions:There is a big gap between the implementation of EENC in most baby-friendly hospitals in eastern, central and western China and the recommendation of the World Health Organization. It is necessary to further strengthen and standardize the implementation of EENC practices in baby-friendly hospitals in our country to continuously improve the health of newborns.

Objective:To analyze the detection strategy and basic detection situation of markers of infectious diseases transmitted by transfusion in blood testing laboratories of blood stations in China.Methods:Based on the data of practice comparison working party of Blood Stations in Mainland of China from 2017 to 2021, the data on the testing strategies and the basic detection information of the markers for the transmission of infectious diseases through transfusion in the member laboratories of the practice comparison working party of Blood Stations in Mainland of China from 2017 to 2021 were collected, and the situation of the selection for testing markers, testing strategy and the testing method and other relevant aspects were sorted out and analyzed by charts.Results:The selection of the testing markers was consistent, but HTLV testing item was added in some member laboratories. The detection strategy of using two ELISA reagents and one nucleic acid testing (NAT) reagent simultaneously was adopted in 47 member blood stations; 3) NAT method was dominated by mini pool-NAT in member laboratories. The number of members adopting mini-pools of 8 (MP8)-NAT decreased from 17 in 2017 to 14 in 2021, while the number of members adopting mini-pools of 6 (MP6)-NAT increased from 13 in 2017 to 22 in 2021; Roche NAT system accounted for the largest proportion.Conclusions:In order to ensure blood safety and avoid missing detection, the blood stations still adopt the detection strategy of using two ELISA reagents and one nucleic acid testing (NAT) reagent simultaneously; Meanwhile, in order to increase the NAT positive rate, the proportion of mini pool-NAT mainly decreased year by year despite its dominating role, while the proportion of individual donation-NAT increased year by year; NAT method is transiting from mini-pools of 8 (MP8) to mini-pools of 6 (MP6); The proportion of imported NAT system used in NAT laboratory is relatively large.

Gene expression labeling and conditional manipulation of gene function are important for elaborate dissection of gene function. However, contemporary generation of pairwise dual-function knockin alleles to achieve both conditional and geno-tagging effects with a single donor has not been reported. Here we first developed a strategy based on a flipping donor named FoRe to generate conditional knockout alleles coupled with fluorescent allele-labeling through NHEJ-mediated unidirectional targeted insertion in zebrafish facilitated by the CRISPR/Cas system. We demonstrated the feasibility of this strategy at sox10 and isl1 loci, and successfully achieved Cre-induced conditional knockout of target gene function and simultaneous switch of the fluorescent reporter, allowing generation of genetic mosaics for lineage tracing. We then improved the donor design enabling efficient one-step bidirectional knockin to generate paired positive and negative conditional alleles, both tagged with two different fluorescent reporters. By introducing Cre recombinase, these alleles could be used to achieve both conditional knockout and conditional gene restoration in parallel; furthermore, differential fluorescent labeling of the positive and negative alleles enables simple, early and efficient real-time discrimination of individual live embryos bearing different genotypes prior to the emergence of morphologically visible phenotypes. We named our improved donor as Bi-FoRe and demonstrated its feasibility at the sox10 locus. Furthermore, we eliminated the undesirable bacterial backbone in the donor using minicircle DNA technology. Our system could easily be expanded for other applications or to other organisms, and coupling fluorescent labeling of gene expression and conditional manipulation of gene function will provide unique opportunities to fully reveal the power of emerging single-cell sequencing technologies.
Alleles ; Animals ; CRISPR-Cas Systems ; DNA End-Joining Repair ; DNA, Circular/metabolism* ; Embryo, Nonmammalian ; Gene Editing/methods* ; Gene Knock-In Techniques ; Gene Knockout Techniques ; Genes, Reporter ; Genetic Loci ; Genotyping Techniques ; Green Fluorescent Proteins/metabolism* ; Integrases/metabolism* ; Luminescent Proteins/metabolism* ; Mutagenesis, Insertional ; Single-Cell Analysis ; Zebrafish/metabolism*

Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.

Objective To explore the short-term efficacy of green channel surgery for hip fractures in the elderly patients.Methods A retrospective study was conducted of the 128 elderly patients with hip fracture who had been operatively treated at Department of Orthopaedics,The First People's Hospital of Beijing Fangshan from January 2015 to September 2017.They were 44 men and 84 women,aged from 65 to 91 years (average,75.5 years).The interval from injury to surgery ranged from 24 to 48 hours for the green channel group of 63 cases but exceeded 48 hours for the non-green channel group of 65 cases.The 2 groups were compared in terms of complications during hospitalization,mortality 3 months after operation and good to excellent rate of hip function.Results The 2 groups were compatible due to insignificant differences in age,gender,internal disease upon admission or fracture type (P ＞ 0.05).All the patients were followed up for 0.5 to 3.0 months (average,2.7 months).The total incidence of complications during hospitalization,and incidences of hypostatic pneumonia,acute cardiac and cerebrovascular accidents and venous thromboembolism were all significantly lower in the green channel group than in the non-green channel group (P ＜0.05).There were no significant differences between the 2 groups in terms of in delirium,sudden death,pressure sore,postoperative urinary infection,or mortality 3 months after operation (P ＞ 0.05).No wound infection or pulmonary embolism was observed in either group.According to the scoring system for hip functions modified by Li Zirong,the good to excellent rate was 76.6％ in the green channel group (36/47) and 68.6％ (35/51) in the non-green channel group,showing no significant difference between the 2 groups (P ＞0.05).Conclusions Establishment of green channel surgery and multidisciplinary collaboration can significantly reduce incidence of postoperative complications.Its effect on the mid-and long-term mortality in these patients needs further observation.

Objective To investigate the correlation between the infiltration of tumor-associated macrophages (TAM) in breast cancer and the expressions of vascular endothelial growth factors (VEGF). Methods The expressions of CD163 (TAM marker) and VEGF in 45 postoperative tissue specimens of primary breast cancer in Affiliated Hospital of Guilin Medical University from January 2014 to January 2018 were examined by using immunohistochemistry EnVision method. Then TAM was counted under light microscope and the expression of VEGF was determined by using semi quantitative integration method. Correlation between the expression of TAM and VEGF and their relationships with clinicopathological parameters were also analyzed. Results TAM infiltration (the number of TAM under per high power field) in breast cancer patients (≤ 51 years old) was significantly more than that in breast cancer patients (> 51 years old) [(78.1±11.9)/HP vs. (69.7±14.0)/HP, t=2.167, P=0.036]. TAM infiltration in breast cancer patients with lymph node metastasis was more than that in breast cancer patients without lymph node metastasis [(79.2 ± 11.8)/HP vs. (70.2±13.6)/HP, t= 2.362, P= 0.023]. The positive rate of VEGF in breast cancer with lymph node metastasis was significantly higher than that in breast cancer without lymph node metastasis [100.00 ％(20/20) vs. 68.00％(17/25),χ2=5.749, P=0.017]. Pearson correlation analysis showed that the expression of VEGF was positively correlated with TAM infiltration (r 2 = 0.800, P< 0.05). Conclusion TAM infiltration and the expression of VEGF can be used to predict the malignant degree of breast cancer, and can be used as a potential intervention target for adjuvant therapy and clinical prognosis of breast cancer.

Objective To investigate the roles of phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway and its regulatory protein peroxisome proliferator-activated receptor γ (PPAR γ) and phosphatase and tension homologue deleted on chromosome 10 (PTEN) in regulating insulin sensitivity in rats with fetal growth restriction (FGR).Methods Sixteen pregnant rats were randomly divided into two groups including FGR and control groups on the 12th day of pregnancy (eight in each group).The FGR group was given low protein diet (8％ of casein) and restriction diet to establish the neonatal rat model of FGR.All maternal rats after delivery and newborn rats after weaning on 21 days after born were fed with normal diet.Each time blood samples were collected from eight newborn rats of each group to measure levels of fasting plasma glucose (FPG) and fasting insulin(FINS) at the time points of 21 days,two and four months after birth.Then insulin resistance index (IRI) and insulin sensitivity index (ISI) were calculated to evaluate insulin sensitivity.Expression of PI3K,AKT,PPAR γγ,PTEN and glucose transporters 4 (GLUT4) in skeletal muscle at mRNA and protein levels were measured at 21 days,two and four months after birth with real time fluorescence polymerase chain reaction and Western blot,respectively.Relationships between the expression of key molecules of PI3K/AKT signaling pathway and insulin sensitivity were analyzed.T-test,and Pearson's correlation analysis were used for statistical analysis.Results (1) The average birth weight of newborn rats in the FGR group was lower than that of the control group [(4.37± 0.69) vs (7.03±0.55) g,t=-20.75,P＜0.05].The incidence of FGR in the FGR group was 93.33％ (70/75).(2) Compared with normal offspring,those in the FGR group showed significantly increased FPG [two months after birth:(5.53± 0.58) vs (7.49 ± 0.38) mmol/L,t=8.08;four months afterbirth:(6.35±0.66) vs (8.94±0.90) mmol/L,t=6.58],FINS [two months afterbirth:(9.18±0.66) vs (14.67± 1.90) mU/L,t=7.71;four months after birth:(33.08±2.76) vs (56.33±2.81) mU/L,t=16.71] and IR1 (two months after birth:2.25±0.31 vs 4.90±0.81,t=8.63;four months after birth:9.30±0.90 vs 22.44±3.10,t=1 1.51),but decreased ISI (two months after birth:0.020 ± 0.002 vs 0.009± 0.001,t=-10.1 4;four months after birth:0.005±0.000 vs 0.002 ±0.000,t=-14.91) at two and four months after birth (all P＜0.05).(3) Compared with normal offspring,those in the FGR group showed decreased expression of PI3K (21 days after birth:0.082±0.028 vs 0.019±0.004,t=-6.29;two months after birth:0.020±0.003 vs 0.010±0.005,t=-4.78;four months after birth:0.014±0.004 vs 0.003±0.001,t=-7.87) and GLUT4 (21 days after birth:0.132±0.057 vs 0.041 ±0.019,t=-4.32;two months after birth:0.183±0.084 vs 0.069±0.017,t=-3.74;four months after birth:0.248±0.069 vs 0.113±0.040,t=-4.74) at mRNA level at 21 days,two and four months after birth (all P＜0.05).Compared with normal offspring,decreased expression of PPAR γ (two months after birth:0.028±0.002 vs 0.012±0.005,t=-3.70;four months after birth:0.030±0.008 vs 0.012±0.005,t=-3.80) and increased expression of PTEN (two months after birth:0.020±0.004 vs 0.045±0.014,t=5.09;four months after birth:0.023±0.007 vs 0.034±0.009,t=2.57) at mRNA level were observed in offspring of the FGR group at two and four months after birth (all P＜0.05).(4) Compared with normal offspring,expression of PI3K protein (21 days after birth:0.22±0.01 vs 0.17±0.02,t=-6.62;two months after birth:0.27±0.03 vs 0.16±0.02,t=-7.25;four months after birth:0.18±0.01 vs 0.09±0.02,t=-9.79) and GLUT4 protein (21 days after birth:0.21 ±0.01 vs 0.03±0.01,t=-27.29;two months after birth:0.10±0.01 vs 0.06t±0.01,t=-3.90;four months after birth:0.13 ±0.01 vs 0.08± 0.02,t=-8.10) decreased in offspring in the FGR group at 21 days,two and four months after birth (all P＜0.05).Compared with normal offspring,those in the FGR group showed decreased expression of PPAR γ protein (two months after birth:0.10 ± 0.01 vs 0.07± 0.01,t =-7.29;four months after birth:0.09±0.01 vs 0.08±0.01,t=-2.83),but increased expression of PTEN at protein level (two months after birth:0.10±0.01 vs 0.15±0.02,t=6.01;four months after birth:0.09±±0.01 vs 0.13±0.02,t=5.51) at two and four months after birth (all P＜0.05).(5) The IRI levels in offsprings in the FGR group were negatively correlated with the expression of PI3K,GLUT4 and PPAR γ at protein level (two months after birth:r=-0.90,-0.92 and-0.79;four months after birth:r=-0.92,-0.75 and-0.73,all P＜0.05),but positively correlated with the expression of PTEN at protein level (r=0.87 and 0.86,both P＜0.05) at two and four months after birth.Conclusions The abnormal expression of the key molecules of PI3K/AKT signaling pathway precedes the decrease of insulin sensitivity in newborn rats with FGR and the expression regulatory protein PPAR γ and PTEN are also changed,suggesting that these molecules may induce the impairment of insulin sensitivity in rats with FGR and be involved in the development of insulin resistance.